Improved survival from critical illness has produced a growing population of intensive care unit (ICU) survivors with new or worsened physical, cognitive, and mental-health impairment, defined as post-intensive care syndrome (PICS), and frequent distress among families/caregivers (PICS-family, PICS-F). This narrative review synthesises the evidence in adults treated in high-resource settings. Rather than a formal guideline process, we used a structured descriptive approach: for each recommendation, we identified the predominant study design, assessed the consistency of findings, summarised uncertainties, and assigned an evidence-strength label (high, moderate, low, or insufficient). We summarise the definition of PICS and its overlap with related constructs (post-sepsis morbidity, chronic critical illness, post-COVID conditions, and frailty); the mechanisms linking acute injury to persistent disability, including skeletal-muscle pathobiology, neuroinflammation, mitochondrial and neuroendocrine dysfunction, and epigenetic change; and the instruments assessing the three PICS core domains (recommending a two-step assessment approach), as well as quality of life, across the care continuum. We describe preventive and rehabilitative interventions from the ICU (e.g., the ABCDEF bundle that includes light/no sedation, delirium prevention, early mobilisation and family participation) through the ward to the post-hospital phase, the heterogeneous organisation of post-ICU recovery services, PICS-F, the educational and cultural change needed, and the health-system and policy context. PICS-F affects 20-60
Background: Diagnosis and treatment of systemic lupus erythematosus (SLE) are often delayed in Latin America due to barriers at the patient, provider, and health care system levels. Methods: This qualitative study, conducted in 16 countries, explored the experiences and recommendations of persons with SLE and rheumatologists to identify key needs and strategies to improve care. Semistructured interviews and focus groups were analyzed thematically. Results: Six main themes emerged: (1) education and training, (2) access to specialized care, (3) health care system organization, (4) awareness, (5) patient organizations, and (6) research. Participants underscored the need to strengthen professional competencies, decentralize care, reduce administrative barriers, and raise awareness among decision-makers and society. Conclusions: The perspectives of persons with SLE and rheumatologists converge on the urgent need for coordinated, equitable, and patient- and caregiver-centered approaches to SLE care. Implementing these recommendations—through improved education, health care system reform, advocacy, and research—could substantially reduce diagnostic and treatment delays and improve outcomes for people living with SLE in Latin America.
As survival from critical illness improves, the global burden of post-intensive care syndrome (PICS) and PICS-family continues to grow, reshaping the goals of modern intensive care. Despite growing awareness, prevention, follow-up and rehabilitation remain fragmented, and important gaps persist in the organisation of recovery-oriented care. We propose BEYOND PICS, a conceptual framework for ICU survivorship built around six complementary pillars: Begin before ICU discharge, Early follow-up and equitable access, Your journey, Ongoing multidomain assessment and rehabilitation, Networked care, and Driving improvement. Rather than describing clinical interventions to be implemented in practice, the framework promotes a coordinated recovery pathway integrating prevention, patient partnership, education, rehabilitation, multidisciplinary collaboration and continuous quality improvement across the peri-ICU continuum. BEYOND PICS is not a clinical bundle or guideline, it provides a mental model to guide the organization of care, integrating the key components of ICU survivorship into a coherent continuum of care while highlighting priorities for future research.
Radiofrequency catheter ablation (RFCA) of ventricular arrhythmias (VA) originating from the right ventricular outflow tract (RVOT) is a well-established therapy. Traditionally, RFCA is guided using electroanatomical 3D mapping systems, which involve manual catheter navigation within cardiac chambers. This approach, while effective, may be time-consuming and may be associated with some risk of cardiac wall perforation. Thus, alternative mapping methods are welcomed to reduce procedural time and increase overall performance of RVOT-VA ablation. To evaluate the safety, feasibility and efficacy of implementing a universal RVOT 3D model for ablation of idiopathic RVOT-VA. Consecutive patients undergoing VA ablation with a universal RVOT 3D model (3D-MODEL group) were included in the study. Patients who underwent classic electroanatomical mapping served as controls (EAM group). A total number of 228 patients were included in the study (143 women, age 50±16 years): 149 in the 3D-MODEL group and 79 in EAM group. Procedural time in the 3D-MODEL group was significantly shorter compared to the EAM group (38±14 min vs 81±40 min, p<0.001). Significant differences were also observed in ablation parameters between 3D-MODEL and EAM groups regarding power (40±8W vs 36±8W p<0.001) and radiofrequency time (248±172s vs 435±421 s, p<0.001). No significant difference in fluoroscopy time was observed between the 3D-MODEL and EAM groups (284±166 s vs 271±331 s, p=0.72). Acute, complete elimination of clinical VA was achieved in 132 (89%) of patients in the 3D-MODEL group vs 62 (78%) in the EAM group, while partial VA suppression was achieved in 17 (11%) patients in the 3D-MODEL group vs 15 (19%) in EAM group. In the remaining 2 (3%) patients from the EAM group no effect of ablation was observed during the procedure. Two cases of cardiac tamponade occurred, both in patients from the EAM group. During follow-up lasting 14±10 months, 82% of patients remained arrhythmia free (86% in 3D-MODEL group vs 76% in EAM group, p=0.66). The use of a universal RVOT 3D modelling is feasible, safe and effective alternative to conventional electroanatomical mapping for ablation of idiopathic RVOT-VA .
Pelizaeus-Merzbacher disease (PMD) is an X-linked leukodystrophy of the central nervous system characterized by a developmental arrest in myelin formation. It is classified into five phenotypes, with different severity. The most common clinical features are nystagmus, spasticity, tremor, ataxia, and hypotonia. A 11-month-old child was referred to the Neuropediatric Unit due to nystagmus, hypotonia, and developmental delay. Brain magnetic resonance imaging showed signs of diffuse hypomyelination (absence of the T2 low signal in the supratentorial white matter). Molecular analysis revealed a duplication in the PLP1 gene, confirming the diagnosis of PMD. PMD should be considered in infants with nystagmus, hypotonia, and cognitive impairment. Neuroimaging supports the diagnosis, and it should be confirmed by genetic testing. Since no definitive treatment is available, management of this disorder is mainly symptomatic and a multidisciplinary approach for these patients is essential for an improvement in their quality of life.
