To evaluate the effect that discontinuing contact precautions for children with methicillin-resistant Staphylococcus aureus (MRSA) had on MRSA healthcare-associated infections (HAIs).

Retrospective, nonrandomized, observational, quasi-experimental study.

A large pediatric healthcare system including two tertiary children’s hospitals with level 4 neonatal intensive care units (NICUs).

Hospitalized children.

Contact precautions for children infected or colonized with MRSA was discontinued in October 2018. Prospective surveillance for MRSA HAIs was performed using standard definitions. Control charts monitored changes in annual MRSA HAI rates from 2014 to 2025. In March 2024, active surveillance cultures for MRSA were initiated in NICU A primarily for antibiotic stewardship purposes. MRSA nasal cultures were obtained upon admission and repeated every two weeks unless a patient was positive for MRSA. Healthcare-associated (HA) conversion was defined as a positive MRSA culture after one or more negative surveillance cultures.

Annual MRSA HAI rates/1000 patient days decreased for the System, Hospital A and Hospital B. Rates remained stable for NICU A and NICU B. Between March 2024 and December 2025, there were 1904 MRSA surveillance cultures from 682 patients in NICU A. Thirty-seven patients (5.4%) had a positive MRSA surveillance culture. HA conversion occurred in 21 patients (3.1%).

After seven years, discontinuing contact precautions for MRSA did not result in increased MRSA HAI rates in a large pediatric healthcare system. NICU MRSA HAI rates remained stable, and HA conversion of MRSA was low.

The Mediator complex is a 26 gene multi-subunit transcriptional regulator essential for RNA polymerase II-mediated gene expression in humans. Mediator complex mutations cause Lujan and Cornelia de Lange syndrome. More specifically, MED13L mutations cause neurodevelopmental disorders with structural brain abnormalities, intellectual disability and autism. Reports of psychosis in MED13L variants are not common while treatment strategies are unmapped.

A report is undertaken of the therapeutic potential of xanomeline to ameliorate psychotic symptoms in a treatment-resistant adolescent with a MED13L mutation.

Use of xanomeline is detailed in a 15-year-old male harboring a heterozygous de novo missense MED13L variant (c.3410 A>G, p.N1137S) and a 22q11.2 duplication copy number variant.

A 15 year-old male with a MED13L deleterious point mutation presented with worsening of psychotic symptoms, and a diagnosis of schizoaffective disorder, bipolar type. Past psychiatric history was notable for prior hospitalizations in May and April 2024 for aggression, in December 2024 for aggression and suicidal ideation and in July 2025 for aggression. Prior trials include citalopram 10 mg (worsened agitation), aripiprazole 5 mg (ineffective), haloperidol 7.5 mg (ineffective), olanzapine 10 mg (ineffective), valproate 750 mg (tremors, weight gain), sertraline (worsening manic symptoms) in 2024 and Ativan 1 mg TID (disinhibition) in 2023. Given the poor response overall to various mood-stabilizing and antipsychotic medications, xanomeline at 50 mg (+ 20 mg trospium) twice daily, titrated to 100/20 mg twice daily was cross-tapered with risperidone. Over the next 2 weeks, the patient’s behavior improved, he was more social and no more aggressive episodes were evident. No significant side effects were noted from use of xanomeline.

Xanomeline-trospium is an antipsychotic recently approved by FDA in September 2024 for use in adults with schizophrenia. Xanomeline, a muscarinic M1/M4 agonist, is given in combination with trospium to minimize GI side effects. In our patient, the drug was well tolerated and produced positive effects on psychosis and aggression in a span of 2 weeks. Unlike most antipsychotic agents, xanomeline does not exert any effect on dopamine or serotonin receptors. Most common adverse reactions include GI symptoms such as nausea, dyspepsia. Genetic variants presenting with psychotic symptoms include the 22q11 microdeletion syndrome, Prader-Willi syndrome among others. Due to the organic brain dysfunction that these syndromes entail, psychotic syndromes can follow a torpid course with limited response to current treatment options. This report considers the use of the novel low-side effect profile xanomeline-trospium for the treatment of psychosis in genetic syndromes which can be more susceptible to side effects.

None Declared

Vaccinations play a crucial role in public and personal health. Vaccines such as the Yellow Fever 17D vaccine are effective at preventing disease and provide lifelong immunity with few adverse events. Leveraging the increase in electronic medical records and the widespread use of machine learning algorithms in healthcare, this study aims to investigate and develop an algorithmic framework for analyzing clinical data on Yellow Fever 17D vaccinations in order to predict at-risk populations for adverse events following immunizations. This research incorporates parameters from the patient’s medical history and demographic information.

To build our analytic framework, we tested five machine learning algorithms: random forest, gradient boost, logistic regression, XGBoost, and Bernoulli naïve Bayes. We cleaned and managed the datasets through EHRchitect software. We assessed the performance of the algorithms using standard metrics, including precision, recall, F1-scores, accuracy, and the area under the receiver operating characteristic curve. Additionally, we implemented population sampling to mitigate potential biases common in clinical data and performed parameter ranking analysis to identify the most influential features in classifying patient reaction outcomes.

We found that logistic regression produced the highest performance, and through hyperparameter optimization, we developed a framework with precision, accuracy, and ROC scores of 87.7%, 99.0%, and 0.818, respectively.

In conclusion, this study examined five modeling algorithms to establish a framework for analyzing real-world data and to predict at-risk populations for adverse events following immunization. We incorporated a logistic regression algorithm to assess our clinical data to achieve a high-precision performance model for classifying patient predictions.

To support Antimicrobial Stewardship programs (ASPs) as well as the clinical care of patients with infections, we disseminated and implemented a Videoconference Antimicrobial Stewardship Team (VAST) to connect multidisciplinary teams from rural Veterans Affairs (VA) medical centers with geographically distant ID experts. Here, we describe the clinical syndromes discussed and the response to recommendations made during VAST sessions.

Between September 2021 to February 2024, eight ID consultants established VASTs with ten rural VAMCs, holding regularly scheduled videoconference sessions to discuss clinical cases and provide recommendations. Data were collected on patient demographics, clinical syndromes, and recommendations. Acceptance of recommendations within one week of each session was assessed via chart review. Six months after the intervention began, we conducted semi-structured interviews to assess participants’ perceptions of VASTs.

VASTs reviewed 626 cases involving 527 unique patients. Among 763 clinical syndromes discussed, the most common were infections of the respiratory (29%) or urinary tract (21%). Overall, VASTs made 973 recommendations, of which 71% were accepted. Of 570 recommendations related to antibiotics, 459 (80%) were accepted. Among 403 other recommendations, 235 (58%) were accepted. Interviews with participants indicated the importance of building trust and strong interpersonal relationships.

VASTs effectively supported Antimicrobial Stewardship in rural VA medical centers (VAMCs) without local ID expertise. High acceptance rates, particularly for antibiotic-related recommendations, suggest that telehealth-enabled provider-to-provider models enhance stewardship efforts.

An estimated 93,000 persons were potentially exposed to drinking water contaminated with petroleum jet propellant (JP)-5 fuel after a November 20, 2021, leak at the Red Hill Bulk Fuel Storage Facility on Oahu, Hawaii. Previous investigations identified the need to evaluate long-term mental health effects associated with JP-5 exposure.

We identified adults potentially exposed to jet fuel-contaminated water during November 20, 2021-March 18, 2022, who sought care within the military health system through February 24, 2023. We abstracted a sample of electronic medical records and categorized documented mental health conditions and symptoms as “worsening preexisting” or “persistent new.” We also assessed mental health-related medication use before and after November 20, 2021.

We abstracted medical charts for 411 adults potentially exposed to jet fuel-contaminated water. Of this cohort, 123 (29.9%) had documented worsening preexisting mental health conditions or symptoms, 86 (20.9%) had persistent new mental health conditions or symptoms, and 109 (26.5%) had at least one mental health-related medication prescribed after the exposure event.

These results highlight mental health needs during and after water contamination events. Continued access to mental health care services and monitoring for long-term mental health effects is recommended.

Severe mental disorders, characterized by their progressive course, early onset, and persistent symptoms, pose significant challenges to patients’ well-being and psychosocial functioning. Despite the growing recognition of the importance of comprehensive treatment, psychological therapies remain underutilized in this population in Vietnam. The Tree of Life therapy, a low-cost, evidence-based, and culturally adaptable intervention, offers a holistic perspective on mental health recovery through personal growth, enhanced coping skills, and social connectedness. This study aimed to explore the therapeutic potential of the Tree of Life group therapy for inpatients with severe mental disorders at Hanoi Mental Hospital.

1) To understand the experience of participating in the Tree of Life therapy group for inpatients with severe mental disorders; 2) To explore the perspectives of patients on the hospitalization, inpatient treatment process, their self-perception, life goals and resources before and after participating in the group

Using qualitative methods, we interviewed 30 inpatients about their experiences before and after participating in the therapy. The Tree of Life group was conducted through four 1-hour sessions guided by the original protocol (Ncube, 2006). The study design follows a qualitative approach. After collection, the data was transcribed, coded, and stored as online text. We chose thematic analysis using MAXQDA 24 software for data analysis.

Regarding the Tree of Life group therapy experience, prominent themes emerged, including positive group interactions, relevant content, enhanced health and well-being, therapeutic engagement promotion, and memorable session components. When examining patients’ perspectives on hospitalization, treatment, recovery, self-description, hopes and dreams, and resources, a strong emphasis on family stood out. The family theme was then analysed further to identify subthemes: Family members were perceived as gatekeepers to treatment, sources of love and support, motivations for recovery, active participants and decision-makers in future life plans.

The pilot qualitative study demonstrates the potential therapeutic efficacy of Tree of Life group therapy for patients with severe mental disorders. The findings also highlight the critical role of the family in supporting patients with severe mental disorders and underscore the importance of involving family members in the treatment process in the Vietnam context. However, further randomised controlled trials are required to establish the therapy’s effectiveness on a broader scale and provide robust evidence for clinical implementation.

None Declared

Suicide attempt is a person’s suicidal behavior that does not result in death and may or may not result in injury. Understanding the factors associated with suicide attempts in patients with major depressive disorder is important to predicting future suicide attempts.

To identify the associated factors with suicide attempts in patients with MDD at the University Medicine Center in Vietnam.

This cross-sectional analytical study was conducted in the psychiatry clinic of the University Medical Center of Ho Chi Minh City, Vietnam, from March to October 2023. Individuals aged 18 and more diagnosed with major depressive disorder as per DSM-5 TR were included. Exclusion criteria were current psychosis, severe intellectual disabilities, and acute medical illnesses.

Participants were interviewed using a questionnaire including sociodemographic criteria, clinical information, and the Hamilton Depression Rating Scale (HDRS).

We collected 151 participants. The average age of participants was 41.3±15.5 years, and they were predominantly female (78.8%) and living in urban areas (62.9%). Nearly four fifths (79.5%) of patients are currently in severe depression. The prevalence of suicide attempts in the lifetime and past 3-months were 7.9% and 5.3% respectively.

In univariate logistic regression analysis of sociodemographic factors and clinical features of depression associated with suicidal attempt among individuals with major depressive disorder, we found that young age (OR=0,91; p=0,004), single status (OR=0,09; p=0,002), early onset of illness (OR=0,91; 95% CI 0,85-0,97), and severe depression as measured by the total HDRS score (OR= 1,19; 95% CI 1,06-1,34). In particular, the risk of a suicide attempt was 72 times higher in patients with a history of self-harm (OR=72,22; 95% CI 13,71-380,49). There was no association between gender, area, education level, cohabitation status and employment status with lifetime prevalence of suicide attempts. After adjusting for covariates using a multivariable logistic regression model, only the severity of depressive episode and history of self-harm remained significantly associated with suicide attempts.

Suicide attempts were significantly high among patients of major depressive disorder in Vietnam. The severity of depression and previous self-harm was significantly associated with it. There is a need for more research and a better understanding of the associated factor with suicide attempts in this population which in turn could lead to the development and implementation of effective preventive interventions.

None Declared

On November 20, 2021, petroleum fuel contaminated the Red Hill well, which provides water to about 93 000 persons on Oahu, Hawaii. Initial investigations recommended further evaluations of long-term health effects of petroleum exposure in drinking water. We reviewed electronic health records of those potentially exposed to contaminated water to understand prevalence of conditions and symptoms.

A sample of persons potentially exposed during November 20, 2021-March 18, 2022 who sought care within the military health system through February 24, 2023 was identified. Abstracted records were categorized as worsening preexisting or persistent new for conditions and symptoms.

Of 653 medical charts reviewed, 357 (55%) had worsening preexisting or persistent new conditions or symptoms. Most-documented conditions included worsening preexisting migraine (8%; 50/653) and chronic pain (4%; 26/653), and persistent new migraine (2%; 14/653) and adjustment disorder (2%; 13/653). Most-documented symptoms included worsening preexisting headache (8%; 49/653) and anxiety (6%; 42/653), and persistent new rash (7%; 46/653) and headache (5%; 34/653).

Approximately half of the abstracted medical records demonstrated worsening preexisting or persistent new conditions or symptoms and might benefit from sustained access to physical, mental, and specialized health care support systems. Continued monitoring for long-term health outcomes is recommended.