Search Results (73)

Background/Objectives: Infant feeding is critical for health and development, yet the influence of maternal psychosocial factors on its timing is not fully understood. While maternal adverse childhood experiences (ACEs) are known to affect perinatal outcomes, their impact on the specific timing of initiating formula and complementary foods remains under-investigated. We hypothesized that maternal ACEs are associated with delayed initiation of infant formula and complementary foods and that this association is mediated by postpartum depression (PPD). This study aimed to examine the link between maternal ACEs and delayed infant feeding, and to assess the mediating role of PPD using data from a large nationwide Japanese database. Methods: This cross-sectional study utilized data from the Japan COVID-19 and Society Internet Survey (JACSIS), conducted between July and August 2021. The analysis included 3446 postpartum mothers. Maternal ACEs were assessed using a 9-item questionnaire, and a cumulative score was categorized as high (≥4 ACEs) versus low (0–3 ACEs). The primary outcomes were infant feeding behavior including breastfeeding, formula feeding and complementary foods. We used logistic regression analysis with inverse probability of treatment weighting (IPTW) to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). A mediation analysis was conducted to evaluate the role of smoking, alcohol and PPD. Results: High ACE exposure (≥4) was present in 221 mothers (6.4%). A high maternal ACE score was significantly associated with delayed initiation of formula feeding (≥7 days) (Adjusted OR: 2.12, 95% CI: 1.12–4.01, p = 0.02) and late initiation of complementary foods (≥7 months) (Adjusted OR: 2.27, 95% CI: 1.38–5.01, p = 0.03); no significant associations were observed for ever/late/continued breastfeeding or ever/continued formula feeding. These associations attenuated to non-significance after adjusting for PPD. Conclusions: Maternal ACEs are associated with delayed initiation of complementary foods and formula, largely through PPD. Perinatal services should combine ACE/PPD screening with trauma-informed mental health and nutrition support to promote timely infant feeding. Full article

Objectives: This study aims to evaluate the association between antibiotic prophylaxis (particularly cephalosporins) and clinical outcomes in elderly hip fracture patients. Methods: We analyzed 4044 elderly hip fracture patients (2008–2022) from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database using inverse probability treatment weighting (IPTW). Cox proportional hazards models assessed mortality risk, while logistic regression evaluated infection and Intensive Care Unit (ICU) admission risks. Dose–response and subgroup analyses were performed for significant findings. Results: In total, 166 patients received no antibiotics, 2589 received Cephalosporin monotherapy, 403 received non-cephalosporin therapy, and 886 received Cephalosporin combination therapy. After IPTW adjustment, monotherapy showed significantly lower mortality risk versus combination therapy at all timepoints (hazard ratio (HR) for 28-day mortality: 0.46, 95% confidence interval (95% CI): 0.28–0.75; HR for 90-day mortality: 0.60, 95% CI: 0.44–0.82; HR for 180-day mortality: 0.67, 95% CI: 0.51–0.87; HR for 1-year mortality: 0.71, 95% CI: 0.57–0.89). The SII cut-off values were 1310.1 for 28-day mortality, 2077.5 for both 90-day and 180-day mortality, 1742.2 for 1-year mortality, 2199.7 for ICU admission, and 1930.7 for infection. Subgroup analyses showed that males and internal fixation patients derived more benefits after cephalosporin monotherapy treatment at all time nodes. Patients with multiple injuries had a lower risk of 28-day mortality, while high-comorbidity patients (CCI ≥ 5) and those with osteoporosis exhibited particular advantages with cephalosporin monotherapy. Conclusions: Cephalosporin monotherapy appears non-inferior to combination therapy for elderly hip fracture patients, potentially reducing long-term mortality risk, especially in males, internal fixation cases, and patients with CCI ≥ 5 and osteoporosis. Full article

Background/Objectives: Sodium-glucose cotransporter-2 inhibitors (SGLT2is), by elevating urinary glucose levels, may predispose patients to urinary tract infections (UTI). However, limited evidence is available regarding the association between SGLT2is and postoperative outcomes after transurethral resection of bladder tumors (TURBT). We evaluated the impact of SGLT2is on post-TURBT pyuria and febrile UTI (fUTI), as well as oncological outcomes. Methods: We retrospectively reviewed the data of 812 patients with and without diabetes mellitus (DM) who underwent TURBT between January 2019 and May 2024. The patients were categorized into three groups: non-DM (Nara Medical University cohort, n = 344), DM non-SGLT2i (multi-institutional cohort, n = 363), and DM SGLT2i (multi-institutional cohort, n = 105). We compared fUTI-free survival, fUTI-related hospitalization-free survival, and persistent pyuria duration as well as oncological outcomes using the inverse probability of treatment weighting (IPTW)-adjusted Kaplan–Meier method and Cox regression analysis. Results: No significant differences in fUTI-free or hospitalization-free survival were observed between the non-DM and DM groups, whereas the DM group had prolonged pyuria compared to the non-DM group (1-year pyuria rate: 36.6% vs. 18.2%; p < 0.001). In contrast, the DM SGLT2i group had significantly shorter fUTI-free survival (1-year fUTI-free survival: 83.0% vs. 90.0%; p = 0.013) and longer pyuria persistence (1-year pyuria rate: 70.6% vs. 28.9%; p < 0.001) than the DM non-SGLT2i group. Additionally, the DM SGLT2i group was significantly associated with shorter UTUC-free survival than the DM non-SGLT2i group (p = 0.0072). SGLT2i was an independent prognostic factor for fUTI and prolonged pyuria in IPTW-adjusted Cox regression analysis. No significant differences were observed in fUTI-free survival, hospitalization-free survival, or persistent pyuria duration among the different SGLT2i types. Conclusions: Temporal discontinuation of SGLT2i in the peri-TURBT period may prevent persistent postoperative pyuria and the risk of fUTI. Full article

Shadow education refers to supplementary educational activities outside of the formal school system, typically provided by private institutions to enhance students’ academic performance. This phenomenon has become increasingly prominent worldwide, drawing significant attention from both scholars and the public. While shadow education is often associated with improved academic outcomes, its potential mental health implications for adolescents remain underexplored. Based on four large-scale surveys conducted in China from 2016 to 2022, this study examines the association between the duration of shadow education and adolescent depressive symptoms, with particular attention being paid to differences across family backgrounds and policy environments. Utilizing multilevel regression models that incorporate individual, family, and community factors, as well as inverse probability weighting regression adjustment and sensitivity analyses, this study yields three main findings. First, the relationship between shadow education duration and adolescent depressive symptoms demonstrates a U-shaped pattern: moderate engagement is associated with lower depressive symptoms, while both limited and excessive participation are linked to higher symptom levels. Second, adolescents from higher-income families are more likely to maintain shadow education participation within an optimal range and report fewer depressive symptoms. Third, following the implementation of regulatory policies on shadow education in China after 2021, the duration of shadow education among adolescents has generally shifted toward a more balanced level, accompanied by a decrease in depressive symptoms. These results underscore the need to consider the nonlinear mental health effects of shadow education in both research and policymaking. In particular, contextual factors, such as socioeconomic background and policy interventions, should be taken into account when formulating and regulating supplementary educational activities. By addressing these dimensions, policymakers can better balance the academic benefits of shadow education with its potential risks for adolescent mental health. Full article

Background and Objectives: Behçet’s syndrome (BS) is a systemic inflammatory disorder characterized by recurrent oral and genital ulcers, uveitis, and vascular involvement. Serum uric acid (SUA) has been implicated in various inflammatory conditions, due to its antioxidant properties and role in oxidative stress. Abnormal SUA levels, particularly hypouricemia, may influence inflammatory processes, but their significance in BS pathophysiology remains unexplored. This study aimed to determine the prevalence of abnormal SUA levels among BS patients and investigate their associations with its clinical manifestations and laboratory parameters. Materials and Methods: A retrospective analysis was conducted on 436 patients with complete data who met the international criteria for Behçet’s syndrome, including 420 patients classified as hypouricemic or normouricemic, for detailed evaluation. Patients were classified as hypouricemic (<3 mg/dL), hyperuricemic (>7 mg/dL), or normouricemic (3–7 mg/dL). Data on sociodemographics, laboratory findings, and clinical characteristics were collected. Mortality and malignancy associations were analyzed using logistic regression. Inverse probability weighting (IPW) was employed to adjust for confounding factors. Results: Initial unadjusted analysis showed that hypouricemic BS patients had significantly lower rates of acneiform lesions (7.3% vs. 14.4%, p = 0.020) and vascular involvement (3.8% vs. 11.6%, p = 0.038) compared to normouricemic patients. However, after adjustment for confounding variables using the IPW methodology, these associations lost statistical significance (p = 0.592 and p = 0.519, respectively). Both before and after adjustment, no significant differences were observed between groups regarding major organ involvement, disease severity, or activity markers. Conclusions: After controlling for confounding factors, hypouricemia in BS patients did not demonstrate significant associations with specific clinical manifestations or disease outcomes. While the unadjusted data initially suggested potential relationships with acneiform lesions and vascular involvement, these associations were not supported by comprehensive statistical analysis. Further prospective studies are warranted to elucidate the complex relationship between uric acid metabolism and BS pathophysiology. Full article

Background/Objective: High-risk subsets of patients with acute coronary syndrome (ACS) experience decreased access to optimal care and have poor clinical outcomes, reflecting an inertia to the delivery of guideline-directed and evidence-based therapy and implementation of critical care pathways. We aim to investigate the clinical effectiveness of a simplified implementation checklist to counter treatment inertia in patients with high comorbidity burden. Methods: An ACS critical care pathway was simplified and reduced to a minimalistic checklist including only items on GDMT and invasive strategy. A total of 2005 consecutive patients with ACS were evaluated including 1499 patients receiving standard care and 506 patients managed with the checklist. Patients with STEMI undergoing primary percutaneous coronary interventions and patients receiving upfront cardiovascular intensive care were excluded. Multivariate regression spline models were used to study the relationship between comorbidity, expressed as the Charlson Comorbidity Index (CCI) and a management strategy including guideline-directed medical therapy (GDMT) and an early invasive approach. Inverse probability of treatment weighting (IPTW) was used to address confounding factors. The use of GDMT and early invasive therapy were compared in patients receiving standard care and checklists. The 90-day composite outcome of all-cause mortality, recurrent ACS and stroke were compared between patients receiving standard care and those receiving checklists. Results: High CCI was associated with decreased GDMT, invasive strategy and the utilization of critical care pathway. Checklist utilization was unaffected by high CCI and led to sustained and higher use of GDMT and invasive approach in patients despite high CCI. Checklist managed patients have >10% higher rates of prescription of each class of GDMT (p < 0.0001) and more than twice the rate of early invasive approach (51.0% vs. 20.7%, (p < 0.0001) compared to patients receiving standard care. The 90-day composite outcome was lower in checklist management patients compared to patients receiving standard care, adjusted hazard ratio 0.61 (95% CI 0.46–0.81), log-rank p = 0.0006, especially in patients with high CCI, adjusted hazard ratio 0.60 (95% CI 0.38–0.97), log-rank p = 0.035 for CCI 5–6; adjusted hazard ratio 0.53 (95% CI 0.35–0.84), log-rank p = 0.0057 for CCI 7 or more. Conclusions: The use of a simplified checklist is associated with better implementation of GDMT and invasive strategy as well as better 90-day clinical outcomes in ACS patients with high comorbidity burden Full article

Objective: To determine the impact of trans-arterial embolization (TAE) on overall survival (OS) in patients with liver metastases from gastroenteropancreatic neuroendocrine tumors (LM-GEP-NETs) and to identify factors that may influence tumor response to TAE treatment. Methods: This study included patients with histologically and radiologically confirmed LM-GEP-NETs who received TAE treatment at The First Affiliated Hospital, Sun Yat-sen University, between November 2016 and January 2023. Imaging responses were assessed using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and modified RECIST (mRECIST) criteria. Tumor response was defined as complete or partial remission. Results: In total, 267 patients with LM-GEP-NETs were included. Patients with liver tumor burdens <25%, 25–50%, and ≥50% had progressively worse OS (p < 0.005). According to the RECIST criteria, 65.9% of patients exhibited tumor responses. Using the mRECIST criteria, 77.5% of patients showed tumor responses. Survival analyses with log-rank tests indicated that patients with tumor responses assessed using either the RECIST or mRECIST criteria had significantly better OS (p = 0.015 and p = 0.023, respectively). Further logistic regression analyses showed that early TAE (within 4 months after diagnosis of liver metastases) was associated with tumor responses assessed using RECIST or mRECIST. These results were further verified using propensity score matching and inverse probability treatment weighting adjusted datasets. Conclusions: A higher liver tumor burden was associated with poorer OS in patients with LM-GEP-NETs. Tumor response after TAE indicates survival benefits. Early TAE (within 4 months of diagnosis) was associated with better treatment responses. Full article

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) has the potential to improve neurological outcomes in patients with refractory out-of-hospital cardiac arrest (OHCA), offering an alternative to conventional cardiopulmonary resuscitation (CCPR). However, its effectiveness in OHCA remains controversial despite advancements in resuscitation techniques. Methods: This retrospective single-center study compared neurological outcomes and 30-day survival between ECPR and CCPR patients from January 2014 to January 2022. Patients aged 18–75 with witnessed OHCA, minimal no flow and low flow times, and cardiac arrests occurring at home or in public places were included. All patients were transported directly to our institution, a tertiary medical center serving the southeastern region of Seoul, where extracorporeal membrane oxygenation implantation was consistently performed in the emergency department. Neurological outcomes were assessed using Cerebral Performance Category scores, with good outcomes defined as scores of 1–2. Statistical analyses included logistic regression models and Kaplan–Meier survival curves, adjusted for confounders using inverse probability of treatment weighting. Results: ECPR was associated with significantly better neurological outcomes than CCPR (p < 0.001). Factors predicting poor outcomes included older age and longer low flow times, while male sex and shockable rhythms were protective. No significant difference was found in 30-day survival between the ECPR and CCPR groups, although a trend toward better survival was noted with ECPR. Conclusions: ECPR may improve neurological outcomes in patients with refractory OHCA compared to CCPR, although it does not significantly affect 30-day survival. Further studies are necessary to validate these findings and explore the long-term impacts of ECPR. Full article

Background: Olecranon bursitis (OB) involves fluid accumulation in the bursa, with common causes being trauma and preexisting conditions. Its incidence is difficult to quantify, and risk factors such as diabetes, obesity, and male gender are frequently noted. Hyperlipidemia has been linked to musculoskeletal disorders, but its role as a risk factor for OB remains unexplored. This study aimed to investigate the association between OB and hyperlipidemia, diabetes, obesity, cardiovascular disease, and statin use. Methods: A retrospective cohort study analyzed a large-scale database (2005–2020), ultimately including 10,301 patients with olecranon bursitis and 44,608 controls after applying exclusion criteria. Participants were aged 18–90 years, with BMI between 10 and 55. Key variables such as smoking, diabetes, hyperlipidemia, statin use, cardiovascular diseases (CVDs), and cerebrovascular accidents (CVAs) were analyzed. Logistic regression models were applied with stabilized inverse probability of treatment weighting (IPTW) to estimate odds ratios (ORs) for risk factors, and p-values were adjusted using the Benjamini–Hochberg method. Results: OB was significantly associated with male gender (OR: 1.406; p < 0.0001), hyperlipidemia (OR: 1.239; p < 0.0001), statin use (OR: 1.117; p = 0.0035), and smoking (OR: 1.068; p = 0.0094). Age and BMI were significant continuous variables influencing OB risk, particularly in older patients and those with elevated BMI. CVDs and diabetes were not significantly linked to OB. Hyperlipidemia increased OB risk, especially in males and individuals with higher BMI. Conclusions: Male gender, hyperlipidemia, and smoking are key risk factors for OB, with hyperlipidemia posing a notable risk in older individuals and those with higher BMI. Statin use did not significantly alter OB risk in hyperlipidemic patients. Further studies are needed to clarify the mechanisms behind these associations. Full article

With the market-driven approach to agricultural technical services and the application of digital technology, digital agro-technical services have gradually emerged as a novel service model. However, there is a lack of empirical research on the effectiveness of this service in the academic literature. To address this research gap, this study measured the impact of this service on the technical efficiency and income levels of mango farmers, using data collected from 131 mango farmers in Hainan Province, China, from 2022 to 2024. This study employed the endogenous switching regression model (ESRM) and the inverse probability-weighted regression adjustment model (IPWRA) to analyze the data, addressing endogeneity through the instrumental variable method by replacing core explanatory variables and conducting sub-regional regression for robustness testing. The main research conclusions are as follows: Under the counterfactual assumption of ESRM, farmers who adopt this service would have experienced a decrease in technical efficiency by 0.025 (a decline of 3.6%) if they had not adopted the service. Conversely, farmers who did not adopt it would have seen an increase in technical efficiency by 0.047 (an increase of 7.3%) if they had chosen to do so. Additionally, under the post-treatment income effect estimation using IPWRA, compared to farmers who did not receive the service, those who did so saw an income increase of 15.6%. The analysis results from methods such as K-nearest neighbors matching also confirm this conclusion. Therefore, it is evident that digital agro-technology services play a significant role in improving the technical efficiency and income levels of small-scale farmers. Full article

Background/Objectives: This retrospective cohort study evaluated the relative vaccine effectiveness (rVE) of two bivalent (original/Omicron BA.4/BA.5) vaccines mRNA-1273.222 versus the BNT162b2 Bivalent in preventing COVID-19-related outcomes in adults with underlying medical conditions associated with increased risk for severe COVID-19. Methods: In a linked electronic health record/claims dataset, US adults (≥18 years) with ≥1 underlying medical condition of interest who received either the bivalent vaccine between 31 August 2022 and 28 February 2023 were identified. The inverse probability of treatment weighting was used to adjust for cohort differences. Cohorts were followed up for COVID-19-related hospitalizations and outpatient encounters until 31 May 2023. Hazard ratios and rVEs were estimated using Cox regression. Subgroup analyses were performed on individuals with pre-specified comorbid conditions. Results: 757,572 mRNA-1273.222 and 1,204,975 BNT162b2 Bivalent recipients were identified. The adjusted rVE over a median follow-up of 198 days was 10.9% (6.2%–15.2%) against COVID-19-related hospitalization and 3.2% (1.7%–4.7%) against COVID-19-related outpatient encounters. rVE estimates for COVID-19 hospitalizations among subgroups with comorbid conditions were as follows: diabetes 15.1% (8.7%–21.0%), cerebro- and cardiovascular disease 14.7% (9.0%–20.1%), chronic lung disease 11.9% (5.1%–18.2%), immunocompromised 15.0% (7.2%–22.2%), chronic kidney disease 8.4% (0.5%–15.7%). Conclusions: Overall, among adults with underlying medical conditions, mRNA-1273.222 was more effective than BNT162b2 Bivalent, especially in preventing COVID-19-related hospitalizations. Full article

Background: Amiodarone is an anti-arrhythmic drug that has extensive tissue distribution and substantial storage in the fat tissue. Different studies have described some implications of body fat composition in its pharmacokinetics and pharmacodynamics. However, no clinical studies have described its implications for clinical efficacy. Methods: We studied 878 patients with persistent atrial fibrillation (AF) treated with a regimen of amiodarone and referred to electrical cardioversion (ECV), included prospectively in two Spanish registries. We analyzed the influence of body mass index (BMI), as well as overweight and obesity, in the efficacy of amiodarone for achieving pharmacologic cardioversion to sinus rhythm (SR) before ECV. Results: A total of 185 patients (21.1%) reverted to SR before ECV. Patients who reverted to SR had a lower BMI than those who did not revert (27.45 ± 4.36 kg/m² vs. 29.11 ± 4.09 kg/m²; p < 0.001). We observed a progressively lower probability of reverting to SR in overweight and obese patients (normal weight 28.3%, overweight 21.3%, obesity 13.1%; p < 0.001). In the logistic regression, BMI (kg/m²) adjusted for other related variables remained as the main factor inversely related to reversion to SR (OR = 0.904 × kg/m²); CI 75% 0.864–0.946). Conclusions: We observed a negative relationship between an increased BMI and the efficacy of amiodarone for reversion to SR, suggesting a negative clinical impact of excess body fat in its efficacy. Full article

Introduction: Health technology assessment (HTA) agencies express a clear preference for randomized controlled trials when assessing the comparative efficacy of two or more treatments. However, an indirect treatment comparison (ITC) is often necessary where a direct comparison is unavailable or, in some cases, not possible. Numerous ITC techniques are described in the literature. A systematic literature review (SLR) was conducted to identify all the relevant literature on existing ITC techniques, provide a comprehensive description of each technique and evaluate their strengths and limitations from an HTA perspective in order to develop guidance on the most appropriate method to use in different scenarios. Methods: Electronic database searches of Embase and PubMed, as well as grey literature searches, were conducted on 15 November 2021. Eligible articles were peer-reviewed papers that specifically described the methods used for different ITC techniques and were written in English. The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: A total of 73 articles were included in the SLR, reporting on seven different ITC techniques. All reported techniques were forms of adjusted ITC. Network meta-analysis (NMA) was the most frequently described technique (in 79.5% of the included articles), followed by matching-adjusted indirect comparison (MAIC) (30.1%), network meta-regression (24.7%), the Bucher method (23.3%), simulated treatment comparison (STC) (21.9%), propensity score matching (4.1%) and inverse probability of treatment weighting (4.1%). The appropriate choice of ITC technique is critical and should be based on the feasibility of a connected network, the evidence of heterogeneity between and within studies, the overall number of relevant studies and the availability of individual patient-level data (IPD). MAIC and STC were found to be common techniques in the case of single-arm studies, which are increasingly being conducted in oncology and rare diseases, whilst the Bucher method and NMA provide suitable options where no IPD is available. Conclusion: ITCs can provide alternative evidence where direct comparative evidence may be missing. ITCs are currently considered by HTA agencies on a case-by-case basis; however, their acceptability remains low. Clearer international consensus and guidance on the methods to use for different ITC techniques is needed to improve the quality of ITCs submitted to HTA agencies. ITC techniques continue to evolve quickly, and more efficient techniques may become available in the future. Full article

Background: A universal infant free school meals (UIFSM) policy was introduced in 2014/15 in England and Scotland for schoolchildren aged 4–7 years; as a result, school meal uptake rose sharply. School food in the UK is known overall to be healthier and less processed than food brought from home (packed lunches), but it is unknown as to how UIFSM impacted the level and type of ultra-processed food (UPF) consumed. Therefore, this study aimed to evaluate the impact of the UIFSM policy on the processing levels of food consumed during the school lunchtime period among schoolchildren in England and Scotland. Methods: Data from the National Diet and Nutrition Study (NDNS), a nationally representative repeated cross-sectional survey, were used to conduct a difference-in-difference study. The average intake of UPF (% of total lunch grams and % total lunch Kcal) using the NOVA classification was calculated for each school lunch. The lunchtime intakes in the intervention group (4–7 years, n = 866) were compared to the control (8–11 years, n = 808) pre- (2008–2014) and post-intervention (2014–2019) using linear regression, adjusting for sociodemographic variables and total lunchtime intake (grams). Inverse probability weights were used to balance the characteristics across the intervention groups. Results: Before UIFSM, the consumption of UPFs as a proportion of total lunch energy (UPF % Kcal) was similar in the intervention and control groups (67% Kcal vs. 69% Kcal). After adjustment for covariates, UPF consumption decreased by 6.3 pp (95% CI −11.3, −1.3) after UIFSM. The findings were similar for UPF as the percentage of total lunch grams. These effects were driven by increases in minimally processed dairy and eggs and starchy foods and decreases in salty snacks and ultra-processed bread and drinks consumption. The greatest reduction in UPF consumption was in low-income children (−17.2% Kcal; 95% CI −26.5, −7.8), compared to mid- (0.5% Kcal; 95% CI −4.0, 1.0) or high-income children (−5.3% Kcal; 95% CI −13.6, 2.9). Conclusions: This study builds on previous evidence and shows that UIFSM improved children’s dietary intake at school by minimising exposure to UPFs. These results indicate that universal free school meal policies could be an important policy for long-term equitable improvements in children’s diet and subsequent health. Full article

Carbapenem-resistant Acinetobacter baumannii (CRAB) infections pose a serious threat, with high morbidity and mortality rates. This retrospective cohort study, conducted at Nakornping Hospital between January 2015 and October 2022, aimed to evaluate the efficacy and safety of a high loading dose (LD) of colistin combined with nebulized colistin in critically ill patients with CRAB pneumonia. Of the 261 patients included, 95 received LD colistin, and 166 received LD colistin with nebulized colistin. Multivariate Cox regression analysis, adjusted for baseline covariates using inverse probability weighting, showed no significant difference in 30-day survival between patients who received LD colistin and those who received LD colistin with nebulized colistin (adjusted hazard ratio [aHR]: 1.17, 95% confidence interval [CI]: 0.80–1.72, p = 0.418). Likewise, there were no significant differences in clinical response (aHR: 0.93, 95% CI: 0.66–1.31, p = 0.688), microbiological response (aHR: 1.21, 95% CI: 0.85–1.73, p = 0.279), or nephrotoxicity (aHR: 1.14, 95% CI: 0.79–1.64, p = 0.492) between the two treatment groups. No significant adverse events related to nebulized colistin were reported. These findings suggest that the addition of nebulized colistin may not offer additional benefits in terms of 30-day survival, clinical or microbiological response, or nephrotoxicity in these patients. Full article