Abstract: Fragrance use is deeply embedded in personal identity, culture, and wellbeing, and many healthcare workers use perfumes and body sprays to feel fresh and confident during long duty hours. In hospitals, however—especially in oncology units, intensive care units, transplant wards, post-operative areas, and respiratory isolation rooms—strong fragrances can provoke patient distress and contribute to avoidable clinical complications, including nausea, headache, bronchospasm, cough, and sensory intolerance in physiologically vulnerable individuals. Several hospitals and health systems have implemented fragrance-free or fragrance-restricted policies, but many existing policies remain binary (“allowed” versus “not allowed”) and rarely provide quantified, clinically reasoned guidance on safe dosing, application sites, or self-assessment methods. This paper proposes a balanced, patient-centred framework that permits respectful fragrance use while prioritising patient safety and infection control. It introduces two practical concepts—hospital-appropriate dosing and micro-dosing zones—translating perfumery fundamentals (concentration categories, projection, sillage, longevity, top/heart/base notes, and fragrance families) into measurable clinical behaviours. The framework includes quantified spray guidance, application-site recommendations relevant to bedside practice, strategies for “taming” heavier perfumes through layering, and detailed self-assessment methods that healthcare workers can use for real-time safety checks. Finally, the paper outlines implementation strategies for hospitals, including staff education, patient-facing communication, and visitor guidance, without advocating blanket bans.

Abstract: Introduction: The African Union and regional initiatives, such as the African Food Safety Agency and the Southern African Development Community's (SADC) food safety guidelines, introduced interventions to reduce the burden of foodborne disease. However, progress in strengthening food safety regulations for small food businesses (SFBs) across SADC remains limited. Objective: to investigate the existing food safety regulations for SFBs and their compliance levels to achieve a sustainable local food system across SADC. Methodology: The PRISMA Protocol was used to review thirty-one articles collected from online databases between 2018 and 2025. Screened with inclusion and exclusion criteria. Result: Ten national health-related food laws, acts, and regulations were identified across the 16 member states of the region; all the countries have public health law except for Comoros, 87% have animal health law, and 69% have the Standard Quality Act, Consumer Protection Law, livestock and meat law, and plant-related law. South Africa and four other countries have the highest number of food-related laws, which also include the most explicit law for SFBs, known as the Foodstuffs, Cosmetics and Disinfectants Act, 1972, revised in 2018. Conditions like poor hygienic practices, inadequate cooling and storage methods, cultural beliefs, a lack of potable water, limited consumer awareness, low technology adoption, and outdated laws for SFBs, potable water, limited consumer awareness, low technology adoption, technical know-how, and old and fragmented laws affected their compliance level. The review identified better coordination, capacity building for vendors and regulators, collaborative efforts, and digital technology adoption as best practices. Conclusion: An autonomous Food Safety Agency situated under the member state's Ministry of Health with a multisectoral board for coordination. The Food Act should be aligned with SFBs' complexities, integrating innovations and a risk-based assessment.

Abstract: Economic crises characterized by financial instability, rising unemployment, and austerity measures are known to have profound social and public health consequences. While their economic impacts are widely studied, their effects on mental health across diverse populations and geographic regions remain fragmented and require synthesis. This scoping review aims to consolidate existing evidence on the relationship between economic crises and a broad range of mental health outcomes, including suicide, depression, anxiety, psychological distress, and health service utilization. Multiple databases (PubMed, EMBASE, Web of Science, Scopus, PsycINFO, EconLit) were explored for reports published between January 2000 and December 2025, following PRISMA-ScR guidelines. Totally, 122 studies met the inclusion criteria. Economic crises are consistently associated with adverse mental health outcomes. Key findings include increased suicide mortality, particularly among working-age men, with pronounced spikes during and after major crises such as the 2008 global financial crisis and the 1997 Asian financial crisis. Non-fatal suicidal behaviors (ideation, attempts, self-harm), depression, anxiety, and psychological distress also rise significantly, driven by unemployment, income loss, debt, and housing insecurity. Vulnerable groups, including the unemployed, low-income populations, youth, and those with pre-existing mental health conditions are disproportionately affected. The evidence also indicates mixed patterns in mental health service utilization, often constrained by austerity and access barriers. Social protection systems and supportive policies appear to mitigate negative mental health impacts. Economic crises exert a significant and multifaceted toll on population mental health, exacerbating inequalities and increasing the burden of mental disorders and suicidal behavior. The findings underscore the need for integrated policy responses that strengthen social safety nets, ensure accessible mental healthcare, and address the psychosocial and economic determinants of health during periods of financial instability. Research gaps remain, particularly in low- and middle-income countries and regarding long-term mental health trajectories post-crisis.

Abstract: The H5N1 subtype of highly pathogenic avian influenza (HPAI) poses a major zoonotic threat due to its high fatality rate and capacity for cross species transmission. In early 2025, Argentina detected a novel triple reassortant A(H5N1) virus in Chaco Province, combining Eurasian, North American, and South American lineage segments. Genomic analyses of subsequent outbreaks in Buenos Aires and Entre Ríos confirmed persistence of this reassortant and additional HA substitutions (T204K, P251S) potentially linked to increased mammalian receptor affinity. Although PB2 sequences lacked canonical mammalian-adaptive markers (E627K, Q591K, D701N), all contained I292M, a mutation associated with human adaptation. Phylogenetic analyses revealed distinct genotypes and increasing divergence. These findings indicate ongoing viral evolution and adaptation within Argentina, emphasizing the urgent need for sustained genomic surveillance, timely data sharing, and integrated One Health strategies to mitigate zoonotic and socioeconomic risks associated with H5N1 spread in South America.

Abstract: This study analyzed environmental noise in neonatal hospital units, including low- and high-risk nurseries and neonatal intensive care units (NICUs). Continuous 24-hour measurements over ten days showed that average sound levels significantly exceeded international recommendations, with peaks up to 92.7 dB (p < 0.05). Hourly LAeq values often reached or surpassed 65 dB, with more than 20% of daily recordings above this limit and, in some cases, over 50%. Heatmaps revealed recurrent patterns: high-risk nurseries showed peaks during late morning and afternoon, low-risk nurseries at night, and NICUs maintained elevated levels throughout the day. Main noise sources were alarms, medical equipment, and staff or visitor activity. The Premature Infant Pain Profile (PIPP) suggested associations between noise and neonatal discomfort. Overall, up to 60% of noise could be reduced through architectural, technological, and organizational measures, underscoring the need for hospital policies that protect neonatal neurosensory health. These findings provide evidence-based guidance for designing quieter neonatal care environments.

Abstract: Infection Prevention and Control (IPC) forms the backbone of effective healthcare delivery and disease prevention. This study aimed to explore healthcare workers' perspectives on factors influencing compliance with infection prevention and control practices in Katavi Regional Referral Hospital, Tanzania. With a qualitative approach, we aimed to enable a broader narrative, to gain a more detailed understanding of IPC practices, and to identify experiences that may be overlooked in a forced-choice questionnaire. A phenomenological study design was employed, using an interview guide to collect data from 19 professionals (five doctors, four nurses, four laboratory practitioners, and six from other subspecialties) between July 24, 2025, and August 23, 2025. Among participants, nine were the key informants, and 10 were involved in in-depth interviews. Thematic analysis revealed that the availability of IPC supplies, awareness of IPC protocols, supportive supervision, institutional support, and desire for personal and patient safety were factors influencing compliance, while HCWs' negative attitudes towards IPC and the high volume of patients were factors hindering compliance. To enhance compliance, the health system should strengthen supervision, ensure a constant supply of IPC materials, and promote positive attitudes among healthcare workers.

Abstract: Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection in young children, especially during infancy, resulting in substantial morbidity and mortality. Acknowledging the real-world evidence on RSV immunisation, the College of Paediatrics, Academy Medicine of Malaysia has appointed an expert panel to develop a position paper on recommendations for infant and/or maternal vaccination against childhood RSV specifically in the Malaysian context with year-round RSV activity. Recognising the potential constraints and limitations in the implementation process, the expert panel recommends targeted immunisation with long-acting RSV monoclonal antibody (mAb) for high-risk infants as a pragmatic first step, with subsequent scale-up to universal immunisation of infants when resources permit. Year-round maternal vaccination between 28- and 36-weeks’ gestation combined with immunisation at six months for all infants may potentially circumvent the unclear seasonality.

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Background: Obesity has emerged as a significant public health issue in Saudi Arabia, showing regional variations in its prevalence and associated risk factors. This study assessed the prevalence of obesity and explored its associated risk factors among adults in Hawtat Bani Tamim. Methods: A cross-sectional study was conducted with 394 adults living in Hawtat Bani Tamim. Sociodemographic, lifestyle, and clinical data were collected through standardized questionnaires and anthropometric measurements. Multivariate logistic regression was used to identify factors independently associated with obesity. Results: The prevalence of obesity in the study population was 28.9%. Increased odds of obesity were observed in individuals aged 41–50 years (OR=1.45, P=0.001) and 51–60 years (OR=2.40, P<0.001), males (OR=1.20, P=0.007), those with lower education levels (secondary school or less, OR=4.18, P=0.008), short sleep duration (OR=1.25, P=0.021), smokers (OR=1.30, P=0.008), physically inactive individuals (OR=1.60, P=0.005), and those with hypertension. Moderate activity was protective (OR=0.75, P=0.028). There is no significant association between obesity and place of residence, marital status, occupation, or most dietary factors. Conclusion: Obesity is prevalent among adults in Hawtat Bani Tamim and is closely linked to age, gender, education level, sleep hours, smoking, physical inactivity, and hypertension. These results underscore the importance of targeted public health efforts and policies to reduce obesity rates and prevent related health issues in this area.

Abstract: Background : Antimicrobial resistance (AMR) refers to the ability of microbes to withstand the effects of antimicrobial drugs that are intended to eliminate them. Studies estimate the global disease burden caused by AMR to be approximately 4.95 million. Organisms such as Carbapenem Resistant Enterobacterales (CRE) and Carbapenem Resistant Acinetobacter baumannii (CRAB) are significant contributors to rising mortality rates due to the limited treatment options available. Methods: This scoping review o analyze the clinical challenges posed by AMR from an internal medicine viewpoint. Results: AMR significantly affects the incidence of urinary tract infections (UTIs) [95% UI: 19.79–36.30] and hospital-acquired infections (95% CI 12.39–17.15%; 16,793/164,717). It also increases multisystem infections and reduces the efficacy of drugs like colistin and penicillin. Conclusion :Antimicrobial stewardship has become a crucial responsibility for every physician. The quadripartite collaboration plays a vital role in establishing policies on judicious antibiotic use. The WHO and CDC's Global AMR Action Plans say that education, diagnostic vigilance, and responsible prescribing are all important parts of fighting AMR. These strategies are in line with those plans.

Abstract: Sudden unexplained cardiac death (SUCD) is unpredictable causing major emotional, economic, and productivity loss. In young, apparently healthy individuals remains one of the most challenging causes of mortality to predict or to prevent, and yet no molecular screening test exists. Conventional screening tools such as electrocardiography, echocardiography, and genetic testing often fail to detect early molecular disturbances that precede electrical or structural cardiac abnormalities. Recent evidence suggests that oxidative stress and redox imbalance play a crucial mechanistic role in cardiac electrical instability, modulating ion channel function, calcium handling, mitochondrial signaling, and intercellular coupling. In this literature review we are trying to explore the emerging role of salivary redox biomarkers as non-invasive indicators of early cardiac vulnerability, introducing the concept of a “Salivary Redoxome”—an integrated oxidative–antioxidative profile measurable in saliva that could reflect systemic redox homeostasis and arrhythmogenic risk. Key antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), together with oxidative damage indices such as malondialdehyde (MDA) and total antioxidant capacity (TAC), are revised for their potential diagnostic and prognostic significance. Also, the study is trying to cover methodological considerations, biomarker validation, and translational perspectives for integrating salivary redox profiling into early SUCD risk screening frameworks. Establishing the clinical utility of the salivary redoxome could become a revolution in preventive cardiology by enabling population-level, real-time monitoring of redox homeostasis in young individuals at risk of sudden cardiac events.

Abstract: Supporting children with Autism Spectrum Disorder (ASD) requires highly individualized knowledge, but crucial information is often scattered across documents such as Individualized Education Plans (IEPs), diagnostic assessments, and caregiver notes. We propose SHARE (Synthesis of Heterogeneous Autism-support Records into Evidence-based Recommendations), a framework that transforms diverse autism-related documents into a concise, actionable set of recommendations directed towards caregivers of children with autism. Recommendations are generated with OpenAI’s large language model API, grounded in user-provided evidence with optional web-based augmentation for missing details, and each recommendation is citation-linked to ensure traceability. When caregivers rate attempted recommendations, SHARE applies a lightweight Bayesian bandit with Upper Confidence Bound (UCB) re-ranking to refine and personalize future outputs. This adaptive feedback loop sets SHARE apart from prior systems that have focused on static goal drafting or summaries by combining LLM-based generation, caregiver input, and interpretable ranking in a pipeline that evolves over time.

Abstract: Poor diet is the leading preventable risk factor for death worldwide, associated with over 10 million premature deaths and $8 trillion related costs every year. Artificial intelligence or AI is rapidly emerging as the most historically disruptive, innovatively dynamic, rapidly scaled, cost efficient, and economically productive technology (that is increasingly providing transformative countermeasures to these negative health trends, especially in low- and middle-income countries (LMICs) and underserved communities which bear the greatest burden from them). Yet widespread confusion persists among healthcare systems and policymakers on how to best identify, integrate, and evolve the safe, trusted, effective, affordable, and equitable AI solutions right for their communities, especially in public health nutrition. We therefore provide here the first known global, comprehensive, and actionable narrative review of the state-of-the-art of AI-accelerated nutrition assessment and healthy eating for healthcare systems, generated by the first automated end-to-end empirical index for responsible health AI readiness and maturity: the Responsible Health AI readiness and Maturity Index (RHAMI). The index, analysis, and review are built by a multi-national team spanning the Global North and South, consisting of front-line clinicians, ethicists, engineers, executives, administrators, public health practitioners, and policymakers. RHAMI analysis identified top performing healthcare systems and their nutrition AI, along with leading use cases including multimodal edge AI nutrition assessments as ambient intelligence, strategic scaling of practical embedded precision nutrition platforms, and sovereign swarm agentic AI social networks for sustainable healthy diets. This index-based review is meant to facilitate standardized, continuous, automated, and real-time multi-disciplinary and multi-dimensional strategic planning, implementation, and optimization of AI capabilities and functionalities worldwide, aligned with healthcare systems’ strategic objectives, practical constraints, and local cultural values. The ultimate strategic objectives of RHAMI starting in AI-accelerated public health nutrition are to improve population health, financial efficiency, and societal equity through a global cooperation of the public and private sectors stretching across the Global North and South.

Abstract: Vaccines save lives, but only if they are available at health facilities for administration. Stockouts occur for various reasons, including inaccurate forecasting and resupply calculations. Population-based forecasts are typically used for immunization programs, yet are often based on inaccurate population estimates. This retrospective study analyzed available routine facility-level data from two districts in Mozambique to provide insights for improved supply chain management, including resupply decisions, at the facility level. Data from August to October 2023 were collected and analyzed for wastage rate, session cohort, and forecast accuracy. Results show that district-level wastage rates are nominally different from World Health Organization standards, while significantly different at the facility level. Analysis also showed divergence of vaccination doses provided to a session cohort during the month-long time period. Using population-based forecast for resupply methodology consistently undersupplied facilities, while using the number of doses of administered BCG as a proxy for the population provided a more accurate forecast with some chance of oversupply for a few vaccines. The results suggest an opportunity to shift from a one-size-fits-all approach to forecasting and resupply decisions, leveraging existing data systems, applying tailored wastage rates, and adjusting inventory management policies to ensure vaccine availability.

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Background: Maryland's all-payment model (APM) replaces fee-for-service hospital payments with regulated global budgets to stabilize finances and restrain costs. Evidence of how this model affects hospital margins and prices relative to similar fee-for-service states remains limited. Objective: To compare trends in hospital financial margins and inpatient prices in Maryland and Massachusetts from 2017 to 2024. We hypothesized that Maryland hospitals would exhibit more stable margins and lower overall price levels than Massachusetts hospitals, under regulated global budgets. Methods: We used hospital-level panel data from the RAND Hospital Cost Report Information System for fiscal years 2017–2024, restricted to acute-care hospitals in Maryland and Massachusetts. The outcomes were total margin and log inpatient revenue per discharge (proxy for price per discharge). A difference-in-differences fixed-effects model with hospital and year fixed effects and standard errors clustered at the hospital level compared changes before and after 2019, when Maryland's Total Cost of Care phase began (md×post2019). Results: At baseline, Maryland hospitals had slightly higher margins and lower prices than Massachusetts hospitals (mean total margin 0.019 vs –0.073; mean log price per discharge 9.27 vs 9.49). After 2019, there was no statistically significant difference in the total margins between Maryland and Massachusetts (β = –0.001, SE = 0.003, p = 0.76). In contrast, log inpatient revenue per discharge grew modestly faster in Maryland, from a lower starting level (β = 0.072, SE = 0.025, p = 0.004), although Maryland prices remained below Massachusetts levels by 2024. Conclusions: Maryland's all-payer global budget system appears compatible with stable hospital margins and a loweroverall price level relative to a benchmark fee-for-service state, but it was not associated with slower post-2019 price growth. Global budgets may support financial stability and moderate price levels, yet they should not be assumed to produce stronger price restraints than well-regulated fee-for-service benchmarks.

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Background: Women’s empowerment has been significantly associated with improved child health outcomes. Cambodia, amid rapid socioeconomic transition, offers a critical setting to examine how women’s empowerment influences child immunization. This study evaluated changes in women’s empowerment from 2010 to 2022 and examined its association with the completion of child vaccinations within the first two years of life. Methods: Data from the Cambodia Demographic and Health Surveys conducted in 2010, 2014, and 2021–22, encompassing 9,222 women with recent births, were analyzed. Empowerment was measured across literacy and information access, employment, and decision-making domains. Multinomial logistic regression assessed associations between empowerment factors and completion of oral polio (OPV), diphtheria–tetanus–pertussis (DTP), pneumococcal conjugate (PCV), and measles–rubella (MR) vaccines, adjusting for demographic and socioeconomic variables. Results: Between 2010 and 2022, women’s empowerment in Cambodia improved across literacy, employment, and decision-making. The proportion of women with no schooling declined to 12%, and nearly half completed primary education. Digital access expanded rapidly, with 82.4% owning a mobile phone and about half using the internet daily. Although the share of non-working women slightly increased, agricultural employment fell by one-fifth, and cash earnings rose from 48.7% to 82.5%. Most women, independently or jointly, made decisions about major household matters. Completion rates for OPV, DTP, and PCV ranged from 79% to 83%, while just over half of children were fully vaccinated against measles. Higher maternal education and cash earnings were positively associated with OPV, DTP, and PCV completion but negatively associated with measles vaccination. Joint decision-making on respondents’ income use increased measles non-completion (OR = 2.26, 95% CI: 1.13–4.51), whereas joint decision-making on respondents’ health care was linked to higher completion (OR = 0.42, 95% CI: 0.21–0.83). Conclusions: Women's empowerment remains a key determinant of vaccination outcomes in Cambodia. The distinct pattern of measles underscores structural and behavioral barriers that require integrated approaches to enhance both women's autonomy and service accessibility.

Abstract: Nepal’s health policy landscape has evolved significantly over the past decades, transitioning from curative-focused and centralized approaches toward preventive, equitable, and decentralized health governance. Beginning with the first National Health Policy of 1991, successive reforms in 1997, 2014, and 2019 have progressively aimed to expand access, strengthen institutional capacity, and align with global health commitments such as the Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC).This review critically examines the National Health Policy 2019 (NHP 2019) through document analysis, comparative policy review, and evaluation using the World Health Organization’s (WHO) health system building blocks framework. The findings reveal that NHP 2019 marks a major policy advancement by integrating federal governance structures, promoting health insurance and digital health systems, and recognizing emerging challenges such as non-communicable diseases, mental health, and environmental health risks.However, critical gaps persist in implementation, including weak coordination among federal, provincial, and local governments; inequitable financing and workforce distribution; insufficient data systems; and limited inclusion of marginalized populations and traditional health practices.The review concludes that while NHP 2019 is ambitious and forward-looking, its success depends on effective implementation, sustained financing, and evidence-driven governance. Strengthening intergovernmental coordination, promoting equitable resource allocation, enhancing workforce capacity, and integrating traditional medicine and community health systems are key to realizing the policy’s vision of “healthy, alert, and conscious citizens oriented to a happy life.”

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Background: The "weekend effect" describes the possibility that patients treated on weekends experience worse outcomes because of differences in staffing, resource availability, and workflow. Evidence for a weekend effect in elective orthopedic surgery is limited, and most prior work does not isolate cases in which admission and surgery truly occur on the weekend. Methods: We performed a retrospective cohort study using the Nationwide Readmissions Database from 2020 to 2022. Adult patients undergoing elective primary total knee arthroplasty (TKA) with surgery on hospital day 0 were identified, yielding 437,121 admissions. Weekend admissions (Saturday to Sunday) were compared with weekday admissions (Monday to Friday). Baseline characteristics, in-hospital outcomes (length of stay, total hospital charges, mortality, and major postoperative complications) and 90 day outcomes (all cause readmission, time to readmission, readmission length of stay, and procedures during readmission) were compared using t tests and chi square tests. Results: Of all eligible cases, 435,822 (99.7 percent) occurred on weekdays and 1,299 (0.3 percent) on weekends. Baseline demographics, comorbidities, and hospital characteristics were highly similar between groups. In-hospital outcomes, including thromboembolic, renal, infectious, respiratory, and surgical complications, did not differ in a clinically meaningful way between weekday and weekend cases. Ninety day readmission rates, timing of readmission, readmission length of stay, and the need for procedures during readmission were also comparable. Conclusion: In this large contemporary national cohort of elective primary TKA with surgery on hospital day 0, weekend admission was not associated with worse in-hospital outcomes or higher 90 day readmission rates. These findings suggest that, within standardized perioperative pathways, elective TKA can be safely performed on weekends without a detectable weekend effect.

Abstract: Background: Interventions are considered complex when a number of factors associated with their use contribute to their health system impact (i.e., costs and effectiveness). An emerging complex intervention is the use of T-cell redirecting therapy. These therapies change the behaviour of a patient’s T-cells to modify (usually amplify) an immune response. Feasible approaches to care delivery, or initiatives that may support the safe delivery of these therapies given their real potential for expansion were identified. In doing so, the purpose of this report is to identify alternative feasible approaches to care delivery, or initiatives that may support the safe delivery and access to care of complex therapies in the Canadian and other health systems; Methods: readiness for complex therapies was explored using a mixed-methods approach. Information was sought using a conventional content approach and based on semi-structured interviews (30–60 min) and deliberation across key informants including patient representatives (n=2), healthcare system leaders/ administrators (n=2), and healthcare providers (n=11). (3); Results: This discussion revealed several insights for the future of complex therapies that will require attention including the need for: organizational change leadership and a change management function; specialized programs of care and implementation of navigational tools and educational strategies directed to providers and patients; trans-parent processes of evaluation that adhere to good practices in health technology assessment and implementation science; improving data collection to measure the cost and impact of new complex interventions; novel approaches to financing.

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Orthopedic and lower limb fracture surgeries are among the most frequent emergency procedures and are commonly performed under general anesthesia (GA); Background and clinical significance: Epidemiologically, postoperative coma after GA is rare (0.005–0.08%), but delayed awakening (2–4%) and postoperative delirium or postoperative cognitive dysfunction (POCD) (15–40%) remain significant. These neurological complications increase markedly in vulnerable brain patients with psychiatric, cerebrovascular, or neurodegenerative disorders; Methods: This mechanistic narrative review synthesizes evidence from clinical and experimental studies (1990–2025) comparing the effects of general versus Regional (RA)/local (LA) or spinal anesthesia in vulnerable neuropsychiatric populations “with pre-existing brain illness” undergoing orthopedic surgery. Domains analyzed include: Neuropsychiatric medications effects and interactions with GA process and with general anesthetic agents, alongside alterations in neurotransmitter modulation, cerebrovascular autoregulation, mitochondrial dysfunction, oxidative stress, redox imbalance and neuroinflammatory activation. The review summarizes evidence on how the choice of anesthesia type influences postoperative brain outcomes in patients with known brain neurological conditions; Results: From previous studies, patients with psychiatric and/or chronic brain illness have 3-5-fold increased risk of delayed emergence and up to 60% incidence of postoperative delirium. Pathophysiological mechanisms involve GABAergic over inhibition, impaired perfusion, mitochondrial energy failure, and inflammatory amplification. Regional/local and spinal anesthesia preserve cerebral perfusion and are associated with significantly lower neurological complication rates; Conclusion: General anesthesia may exacerbate pre-existing brain vulnerability, converting reversible neural suppression into irreversible dysfunction. Therefore, whenever possible, regional/local or spinal anesthesia with or without sedation should be prioritized to reduce the length of hospital stay (LOS) and to lower postoperative neurological complications and risks in psychiatric and neurologically unstable patients.

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Extremely low birth weight (ELBW) neonates (< 1000 g) contribute significantly to global neonatal and under-five mortality, with heightened vulnerability in resource-limited settings. The overall aim of this manuscript is to evaluate the survival outcomes and associated factors among ELBW infants in a resource-limited tertiary care setting in South Africa. This retrospective cohort study examined survival outcomes, causes of death, and associated morbidities among 192 ELBW infants admitted to Frere Hospital, South Africa (SA), between January 2020 and February 2025. Kaplan-Meier survival analysis and multivariable Poisson regression were used to identify predictors of mortality. Overall, 42% of neonates survived discharge. Common morbidities included respiratory distress syndrome (78%) and extreme prematurity (30%). Extreme prematurity (< 28 weeks) was associated with a markedly increased risk of mortality (adjusted IRR = 0.20; 95% CI: 0.08–0.53; p < 0.001), while caesarean section conferred a protective effect compared to vaginal delivery (adjusted IRR = 0.38; 95% CI: 0.23–0.64; p < 0.001). These findings support strengthening antenatal interventions, timely respiratory support, equitable access to neonatal intensive care, and protocols tailored to reduce neonatal mortality in resource-limited settings.