Introduction: Probiotics are live microorganisms that, when administered in appropriate colonies, can delay the destruction of the immune system and contribute to the maintenance of immunity in HIV patients. Probiotics play an important role in stimulating natural killer T cells, strengthening the functional gut barrier, and reducing systemic inflammation.Methods: This study was a randomized double‐blind clinical trial involving 30 patients treated with antiretroviral therapy who had experienced immunological failure despite HIV viral suppression. Patients were divided into two equal groups of 15, group (B) received two probiotic capsules daily with a colony count of 10⁹ CFU per capsule containing seven strains, after 3 months they were examined for CD4⁺ counts by flow cytometry, and after a 1‐month washout period the participants who had received probiotics were switched to placebo, and the participants who had received placebo were given probiotics for 3 months, and they were examined for CD4⁺ counts 7 months after the start of the study.Results: In the first group (A), administration of the placebo resulted in a decrease in CD4 count in the first 3 months (from 202.21 to 181.79, p value < .001), which may be due to the natural history of the disease. After probiotics administration, CD4 count increased significantly (from 181.79 to 243.86, p value < .001). Overall, after 7 months of study, there was a significant increase in the mean CD count from 202.21 to 243.86 (p value < .001). In the second group (B), the administration of probiotics in the first 3 months of the study resulted in a significant increase in the mean CD4 count (from 126.45 to 175.73, p value < .001). Termination of treatment with probiotics resulted in a significant decrease (from 175.73 to 138.9, p value < .001) but overall the CD4 count at the end of the study was significantly higher than at baseline (p value < .001).

Background: Acute kidney injury (AKI) in critically ill patients is clinically complex and heterogeneous, limiting the development of structured simulation models. Digital twin approaches require clearly defined causal relationships grounded in expert consensus. We aimed to establish an international Delphi consensus to inform the development of an interpretable, AI-driven digital twin framework for AKI in critical care. Methods: We conducted a modified Delphi study involving up to three survey rounds. Experts in nephrology and critical care were invited to evaluate statements addressing AKI etiology, biomarker integration, biopsy indications, contrast use, and ICU management. Consensus was predefined as ≥75% agreement. Results: Fifty-six experts were invited, and 49 completed the first round. Consensus was achieved after two rounds. Hemodynamic instability and nephrotoxicity were identified as leading contributors to AKI. Experts supported integrating biomarkers beyond serum creatinine and urine output, although agreement varied for specific assays. Daily biomarker assessment reached consensus, whereas contrast use in advanced AKI stages did not. Desmopressin use prior to kidney biopsy in patients with markedly elevated blood urea nitrogen achieved consensus. A structured Directed Acyclic Graph was developed to represent the expert-derived causal framework. Conclusions: This Delphi study established a clinically grounded framework for AKI in critical care while highlighting areas of practice variability. The resulting causal structure provides a transparent foundation for future AI-driven digital twin development and prospective validation.

Background: Pregnancy-related acute kidney injury (PrAKI) is an uncommon but serious complication associated with adverse maternal and neonatal outcomes, with limited data in high-resource settings. Methods: We conducted a retrospective cohort study of 29 586 deliveries at Mayo Clinic hospitals between 2017 and 2022. PrAKI was defined using Kidney Disease Improving Global Outcomes (KDIGO) creatinine criteria. Maternal characteristics, nephrotoxin exposure, clinical interventions, and neonatal outcomes were compared between patients with and without PrAKI. Results: PrAKI occurred in 341 patients (1.15%). Compared with controls, PrAKI was associated with higher rates of chronic hypertension (28.7% vs 5.2%), cesarean delivery (68.5% vs 35.1%), intensive care unit (ICU) admission (59.1% vs 6.2%), and nephrotoxin exposure (58.7% vs 31.6%) (all P < .0001). Dialysis was required in 7.1% of patients with PrAKI, with 1.17% remaining dependent at discharge and 0.88% at 30 and 90 days; no control patients required dialysis. Neonates of mothers with PrAKI had higher rates of prematurity and neonatal ICU (NICU) admission (48.7% vs 9.8%; P < .0001). Maternal mortality was rare. Conclusions: PrAKI is a marker of severe maternal illness and is associated with adverse maternal and neonatal outcomes. Although most patients recover kidney function, a subset develop persistent dysfunction. Early identification, cautious use of nephrotoxic medications, and structured postpartum follow-up are essential.

Purpose: Electrolyte disturbances, including hyponatremia, are common in cirrhosis, with hyponatremia already incorporated into the MELD-Na score as a prognostic marker. However, the prognostic role of serum chloride, the main extracellular anion, remains underexplored. Emerging evidence suggests hypochloremia is independently associated with increased mortality and acute kidney injury (AKI) in cirrhotic patients. Proposed mechanisms include dysregulated activation of the renin-angiotensin, vasopressin, and sympathetic nervous systems, leading to renal vasoconstriction and impaired function. This systematic review evaluates the association between serum chloride levels and outcomes, including mortality and KDIGO-defined AKI rates, aiming to enhance understanding and inform management strategies. Methods: This review followed PRISMA guidelines and a PROSPERO-registered protocol (CRD42024550945). Comprehensive searches of MEDLINE, EMBASE, Cochrane, Scopus, and Web of Science were conducted through June 6, 2024, without language restrictions. Controlled vocabulary and keywords were used to identify relevant studies. Two independent reviewers performed title, abstract, and full-text screening, with disagreements resolved through consensus or third-party arbitration. Inter-rater reliability was assessed using Cohen’s kappa. Data extraction and risk of bias evaluations were performed using the PROBAST tool. Findings were summarized using a PRISMA flowchart. Results: Five studies (n = 3,150) were included, primarily retrospective cohorts, with one prospective study. Hypochloremia was defined as serum chloride < 99 mEq/L in most studies, except one, which used < 107.35 mmol/L. Cirrhosis etiologies included alcohol-related liver disease (40–64%), hepatitis B (7.9–59.9%), hepatitis C (7–8.9%), and non-alcoholic fatty liver disease (7–11.7%), with fewer cases of autoimmune and cryptogenic causes. Comorbidities included diabetes mellitus (21.3%), hypertension (13.4%), and varices (72–87%), with 62–99% having a history of decompensation. Extrahepatic organ failures were prevalent, affecting 79.4% of patients, with 31.6% and 13.4% experiencing two and three organ failures, respectively.Meta-analysis showed hypochloremia was significantly associated with increased mortality (pooled OR: 2.52; 95% CI: 1.88–3.39, p < 0.0001). Individual ORs ranged from 2.08 to 17.42, with low to moderate heterogeneity (I² = 36%). Hypochloremia also correlated with elevated creatinine levels and increased AKI prevalence. Conclusion: Hypochloremia is a strong predictor of mortality and renal dysfunction in cirrhotic patients. Early recognition and management of hypochloremia are critical to improving outcomes in this high-risk population. Clinical trial number: Not applicable.

Introduction: Probiotics are live microorganisms that, when administered in appropriate colonies, can delay the destruction of the immune system and contribute to the maintenance of immunity in HIV patients. Probiotics play an important role in stimulating natural killer T cells, strengthening the functional gut barrier, and reducing systemic inflammation. Methods: This study was a randomized double blind clinical trial involving 30 patients treated with ART who had experienced immunological failure despite HIV viral suppression. Patients were divided into two equal groups of 15, the first group received 2 probiotic capsules daily with a colony count of 10⁹CFU per capsule containing seven strains ,after three months they were examined for CD4+ counts by flow cytometry, after a one month washout period the participants who had received probiotics were switched to placebo, and the participants who had received placebo were given probiotics for three months, and they were examined for CD4+ counts seven months after the start of the study. Results: In the first group, administration of the placebo resulted in a decrease in CD4 count in the first three months (from 202.21 to 181.79, p-value < 0.001),which may be due to the natural history of the disease. After probiotics administration, CD4 count increased significantly (from 181.79 to 243.86, p-value < 0.001). Overall, after 7 months of study, there was a significant increase in the mean CD count from 202.21 to 243.86 (p-value < 0.001). In the second group, administration of probiotics in the first three months of the study resulted in a significant increase in the mean CD4 count (from 126.45 to 175.73, p-value < 0.001).Termination of treatment with probiotics resulted in a significant decrease (from 175.73 to 138.9, p-value < 0.001)but overall the CD4 count at the end of the study was significantly higher than at baseline (p-value < 0.001).