Rickets in infants attributable to inadequate vitamin D intake and decreased exposure to sunlight continues to be reported in the United States. It is recommended that all infants, including those who are exclusively breastfed, have a minimum intake of 200 IU of vitamin D per day beginning during the first 2 months of life. In addition, it is recommended that an intake of 200 IU of vitamin D per day be continued throughout childhood and adolescence, because adequate sunlight exposure is not easily determined for a given individual. These new vitamin D intake guidelines for healthy infants and children are based on the recommendations of the National Academy of Sciences.

Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake.

Pediatrics

Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease which, if untreated, often leads to cirrhosis, liver failure and death. The last British Society of Gastroenterology (BSG) guideline for the management of AIH was published in 2011. Since then, our understanding of AIH has advanced in many areas. This update to the previous guideline was commissioned by the BSG and developed by a multidisciplinary group. The aim of this guideline is to review and summarise the current evidence, in order to inform and guide diagnosis and management of patients with AIH and its variant syndromes. The main focus is on AIH in adults, but the guidelines should also be relevant to older children and adolescents.

British Society of Gastroenterology guidelines for diagnosis and management of autoimmune hepatitis.

How we use critical care ultrasound in the management of ventilatory settings in ARDS patients.

Intensive Care Medicine

Acute HIV-1 infection (AHI) is a transient period where the virus causes evident damage to the immune system, including an extensive apoptosis of CD4+ T cells associated with a high level of activation and a major cytokine storm to fight the invading virus. HIV infection establishes persistence by integrating the viral genome into host cell DNA in both replicating and non-replicating forms, effectively hiding from immune surveillance within infected lymphocytes as cellular reservoirs. The measurement of total HIV-1 DNA in peripheral blood mononuclear cells (PBMCs) is a reliable reflection of this reservoir. Initiating treatments during AHI with nucleoside reverse transcriptase inhibitors (NRTIs) and/or integrase strand transfer inhibitors (INSTIs) is essential to alter the dynamics of the global reservoir expansion, and to reduce the establishment of long-lived cellular and tissue reservoirs, while preserving and enhancing specific and non-specific immune responses. Furthermore, some of the patients treated at the AHI stage may become post-treatment controllers and should be informative regarding the mechanism of viral control, so patients treated during AHI are undoubtedly the best candidates to test innovative remission strategies toward a functional cure that could play a pivotal role in long-term HIV control. AHI is characterized by high levels of viral replication, with a significant increase in the risk of HIV transmission. Detecting AHI and initiating early treatment following diagnosis provides a window of opportunity to control the epidemic, particularly in high-risk populations.

Acute HIV-1 Infection: Paradigm and Singularity.

Viruses

Surgical site infection (SSI) and incisional hernia (IH) are common complications following midline laparotomy. The small-bites technique for closing a midline laparotomy has been suggested to improve SSI and IH rates compared with the classic mass closure. The aim of this work was to perform a systematic review, meta-analysis and fragility assessment of existing evidence comparing small-bites and conventional closure.

The study was registered with PROSPERO. A systematic search of PubMed and EMBASE databases was performed for all comparative studies examining small-bites versus conventional closure for midline laparotomy. The fragility index for randomized controlled trials (RCTs) was assessed and the number of outcomes required to render results insignificant using the Fisher exact test was calculated.

Seven studies were included, with a total of 3807 patients. Small bites was performed in 1768 and large bites in 2039. Follow-up ranged from 12 to 52&#x2009;months. On meta-analysis of all studies, small bites is associated with a lower risk of IH (p&#x2009;&lt;&#x2009;0.00001), SSI (p&#x2009;=&#x2009;0.0002) and wound dehiscence (p&#x2009;=&#x2009;0.02). On meta-analysis of RCTs there is a lower risk of IH (p&#x2009;=&#x2009;0.01) but no difference in SSI (p&#x2009;=&#x2009;0.06) or wound dehiscence (p&#x2009;=&#x2009;0.73). Fragility is evident among RCTs reporting differences in IH rates.

There is evidence to suggest that small-bites closure provides a decreased likelihood of IH over varying follow-up in RCTs but significant fragility exists among studies.

Small-bites versus large-bites closure of midline laparotomies: A systematic review and meta-analysis.

Colorectal Disease

Cardiac arrest is the loss of functional cardiac activity; emergency clinicians are integral in the management of this condition.

This paper evaluates key evidence-based updates concerning cardiopulmonary resuscitation (CPR).

Cardiac arrest includes shockable rhythms (i.e., pulseless ventricular tachycardia and ventricular fibrillation) and non-shockable rhythms (i.e., asystole and pulseless electrical activity). The goal of cardiac arrest management is to achieve survival with a good neurologic outcome, in part by restoring systemic perfusion and obtaining return of spontaneous circulation (ROSC), while seeking to diagnose and treat the underlying etiology of the arrest. CPR includes high-quality chest compressions to optimize coronary and cerebral perfusion pressure. Chest compressions should be centered over the mid-sternum, with the compressor's body weight over the middle of the chest. A compression depth of 5-6&#xa0;cm is recommended at a rate of 100-120 compressions per minute, while allowing the chest to fully recoil between each compression. Clinicians should seek to minimize any interruptions in compressions. When performed by bystanders, compression-only CPR may be associated with improved survival to hospital discharge when compared to conventional CPR with ventilations. However, in trained personnel, there is likely no difference with compression-only versus conventional CPR. Mechanical approaches for CPR are not associated with improved patient outcomes, including ROSC or survival with good neurologic function, but mechanical compression devices may be beneficial in select circumstances (e.g., few rescuers available, prolonged arrest/transport). Monitoring of chest compressions is not associated with improved ROSC, survival, or neurologic outcomes, but it can improve guideline adherence. Types of monitoring include real-time feedback, a CPR coach, end tidal CO2 , arterial line monitoring, regional cerebral tissue oxygenation, and point-of-care ultrasound.

An understanding of CPR literature updates can improve the ED care of patients in cardiac arrest.

Emergency medicine updates: Cardiopulmonary resuscitation.

American Journal of Emergency Medicine

The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" incorporates new evidence since the "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction" and the corresponding "2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes" and the "2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction." The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" and the "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization" retire and replace, respectively, the "2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease."

A comprehensive literature search was conducted from July 2023 to April 2024. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.

Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.

2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.

Journal of the American College of Cardiology

Despite the widespread adoption of lung-protective ventilation strategies, mortality among patients on invasive mechanical ventilation (IMV) remains high. Mechanical power (MP) integrates various variables responsible for ventilator-induced lung injury and has been associated with mortality in patients with acute respiratory distress syndrome (ARDS). However, the impact of MP on intensive care unit (ICU) mortality in the larger group of patients with acute hypoxemic respiratory failure (AHRF) has not been well established, and previous studies have reported inconsistent thresholds for predicting outcomes.

Is high MP (&gt; 17 J/min) within the first 24 hours of IMV, calculated using dynamic driving pressure, associated with ICU mortality in patients with AHRF? Additionally, does a threshold exist below which IMV is considered "safe"?

In this multicenter cohort study, we included adult patients with AHRF who received IMV. Patients were excluded if they received IMV for &gt; 24 hours before inclusion or were on extracorporeal life support. We applied multivariable logistic regression models with inverse probability of treatment weighting and used change-point regression models with restricted cubic splines.

Of the 21,714 patients in our registry, 9,031 (42%) met the inclusion criteria. After adjusting for baseline characteristics, high MP was associated with increased ICU mortality (odds ratio 1.58 [95% CI: 1.44, 1.72]), with a non-linear dose-response relationship. No consistent "safe" MP threshold was identified. High MP was also associated with lower extubation rates and fewer ventilator-free days.

Exposure to high MP within the first 24 hours of IMV was associated with increased ICU mortality in patients with AHRF. The absence of a consistent "safe" threshold suggests that reducing MP at IMV initiation may be a potential strategy to improve outcomes, warranting exploration in clinical trials.

The association between mechanical power within the first 24 hours and ICU mortality in mechanically ventilated adult patients with acute hypoxemic respiratory failure: A registry-based cohort study.

Chest

Whether the choice of ventilator mode affects outcomes for critically ill patients is unknown.

What are the effects of three common ventilator modes (volume control vs pressure control vs adaptive pressure control) on death and duration of mechanical ventilation among critically ill adults?

We conducted a pragmatic, cluster-randomized, crossover pilot trial among adults receiving invasive mechanical ventilation in a medical intensive care unit between November 1, 2022 and July 31, 2023. Each month, patients in the participating unit were assigned to receive volume control, pressure control, or adaptive pressure control during continuous mandatory ventilation. The primary outcome was ventilator-free days through 28 days.

Among 566 patients included in the primary analysis, the median proportion of ventilator mode assessments in the assigned mode during the first 72 hours was 100% in each group. The median number of ventilator-free days was 23 [IQR, 0-26] in the volume control group, 22 [0-26] in the pressure control group, and 24 [0-26] in the adaptive pressure control group (P=0.60). The median tidal volume was similar in the three groups, but the percentage of breaths larger than 8mL/kg of predicted body weight differed between volume control (median, 4.0%; IQR, 0.0-14.1), pressure control (10.6%; 0.0-31.5), and adaptive pressure control (4.7%; 0.0-19.2).

This pilot trial establishes the feasibility of conducting a cluster-randomized, crossover trial of ventilator mode among critically ill adults receiving invasive mechanical ventilation and demonstrates differences in intermediate outcomes that warrant further investigation in a larger trial.

Effect of Ventilator Mode on Ventilator-Free Days in Critically Ill Adults: A Randomized Clinical Trial.

To review the key updates in the 2024 KDIGO clinical practice guideline for the evaluation and management of chronic kidney disease (CKD) and highlight the essential role of pharmacists in implementing these recommendations.

The updated guideline introduces significant changes in CKD management, including the use of validated equations for estimating glomerular filtration rate (GFR) for drug dosing, with incorporation of serum cystatin C into GFR estimates for specific patient populations, and an emphasis on a comprehensive approach to delay disease progression. The guideline recommends sodium-glucose cotransporter 2 inhibitor (SGLT2i) therapy for kidney disease with proteinuria, with or without diabetes, renin-angiotensin-aldosterone system inhibitors (RAASi) blood pressure control and proteinuria management, and statins to reduce the risk of atherosclerotic cardiovascular disease. New evidence supports the use of finerenone in patients with type 2 diabetes and CKD, and GLP-1 receptor agonists for their kidney-protective effects. The guidelines also emphasize the importance of nephrotoxin stewardship and prevention of acute kidney injury through patient education on sick day medication management.

Pharmacists play a crucial role in implementing these updated guidelines through comprehensive medication management, nephrotoxin stewardship, drug dosing adjustments, and patient education. Their involvement in interprofessional care teams is essential for optimizing health outcomes in patients with CKD.

Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake.

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