Search Results (1,785)

Background/Objectives: Providing an appropriate diet to older adults with dysphagia can prevent aspiration, choking, and nutritional deficiencies and help preserve their quality of life. Therefore, assessments for determining the appropriateness of food types are required. This multicenter study aimed to determine the reliability and validity of the Meal Rounds Observation Form (MROF), which was developed to identify food forms that can be safely consumed by older adults with dysphagia. Methods: We analyzed 532 food–texture observations obtained from 155 participants (114 men and 41 women). The reliability and validity of the MROF were compared with those of videofluoroscopic (VF) or videoendoscopic (VE) examinations of swallowing. Results: The food-form categories were water (108 pairs), 0j (54 pairs), 0t (118 pairs), 1j (20 pairs), 2-1 (28 pairs), 2-2 (37 pairs), 3 (68 pairs), 4 (67 pairs), and normal food (32 pairs) based on JDD 2021 codes. The AUC was lowest for the water (0.568) category and highest for food forms requiring chewing, such as those of the 4 and normal food (0.678) categories. The sensitivity and specificity of the Gugging Swallowing Screen were 60.1% and 69.1%, respectively (p < 0.001). The agreement between the Gugging Swallowing Screen and the MROF evaluation for food types requiring mastication was 73.2%. Logistic regression analysis revealed asymmetric movement of the corners of the mouth and coughing as important indicators when evaluating food types requiring mastication. Conclusions: The MROF is useful for determining food intake safety when VF or VE tests cannot be performed in medical and nursing care settings and can guide clinical decision-making. However, caution is required in applying it clinically because of its relatively low specificity. Full article

Artificial intelligence (AI) is increasingly used to support tuberculosis (TB) screening and diagnosis, particularly through computer-aided detection (CAD) applied to chest radiography (CXR). However, the programmatic value of AI depends not only on diagnostic accuracy but also on implementation context, threshold calibration, and integration into diagnostic pathways. We conducted a narrative, state-of-the-art review of AI applications across the TB diagnosis pathway. Evidence was synthesized from World Health Organization policy documents, independent validation initiatives, and peer-reviewed studies published between 2010 and 2026, with a structured selection process aligned with PRISMA principles. CAD for CXR is the most mature AI application and is recommended by WHO for TB screening and triage among individuals aged ≥15 years in specific contexts. Across studies, CAD-CXR demonstrates sensitivity comparable to human readers, although performance varies by product, population, and imaging conditions, necessitating local threshold calibration. Evidence from implementation studies suggests improvements in screening efficiency and potential cost-effectiveness in high-burden settings. Other AI modalities, including computed tomography (CT)-based imaging analysis, point-of-care ultrasound interpretation, cough or stethoscope sound analysis, clinical risk models, and genomic resistance prediction show promising but heterogeneous results, with most requiring further independent validation and prospective evaluation. AI has the potential to strengthen TB screening and diagnostic pathways, but its impact depends on integration into health systems and evaluated using patient- and program-level outcomes rather than accuracy alone. A differentiated approach is needed, with responsible scale-up of policy-endorsed tools alongside rigorous evaluation of emerging technologies to support effective and equitable TB care. Full article

Background: CD8A-related CD8α deficiency (Immunodeficiency 116) is a rare autosomal recessive primary immunodeficiency disease characterized by absent CD8⁺ T cells and variable sinopulmonary disease. Case Presentation: A seven-year-old boy from a consanguineous family was referred for chronic wet cough and “uncontrolled asthma” despite being prescribed high-dose inhaled corticosteroids and montelukast. He was hospitalized seven times over a two-year period for presumed asthma exacerbations complicated by pneumonia. An examination revealed bilateral crackles without wheezing. Throat culture tested positive for Haemophilus influenzae. CT imaging showed signs of chronic rhinosinusitis (maxillary mucosal thickening) and chronic airway disease with bronchiectatic changes. The patient’s immunoglobulin levels were within normal ranges for his age group. Flow cytometry revealed profound CD8⁺ T-cell lymphopenia (CD8⁺ 0.21%; 11 cells/µL; near-absent after excluding dual-positive cells) with expansion of CD3⁺CD4⁻CD8⁻ T cells (29.5%). CD8A gene sequencing identified a novel homozygous nonsense variant NM_001768.7:c.319C>T (p.Arg107Ter; GRCh38: chr2:86790412G>A), consistent with loss of CD8α and secondary loss of CD8β surface expression. A literature review identified three previously reported symptomatic patients (and two asymptomatic sisters in the first family), all with recurrent respiratory infections and variable structural lung disease. Conclusions: This case highlights CD8A deficiency as a rare mimic of pediatric asthma and expands the genotype spectrum with a truncating CD8A variant. Early lymphocyte immunophenotyping in children with recurrent sinopulmonary infections may prevent delayed diagnosis and progressive airway damage. Full article

Gnaphalium affine D. Don (G. affine), a genus within the genus Gnaphalium of the Asteraceae family, is recognized as a significant medicinal resource. Phytochemical investigations identified various bioactive compounds in G. affine, including flavonoids, terpenoids, phenolic acids, alkaloids, and amino acids. These compounds exhibit a range of pharmacological activities such as antimicrobial, cough expectorant, antioxidant, and anti-inflammatory properties, as well as the regulation of lipid and glucose metabolism, reduction of uric acid levels, hepatoprotective effects, and anti-tumor activities. However, research concerning the chemical composition, biological activities, and potential applications of synthesized G. affine remains limited. In light of the growing interest in this species, the present paper aims to provide a comprehensive overview of the current research advancements related to the traditional applications, chemical constituents, and biological effects of G. affine. Additionally, this study will discuss future prospects for the development and application of G. affine to enhance its utilization in various fields. Full article

Whooping cough has re-emerged as a significant global public health concern. Hence, an SEIRS model for whooping cough transmission in Japan is proposed to capture the disease dynamics because of a strong resurgence of the epidemic. The model is analyzed mathematically, establishing the non-negativity and boundedness of its solutions and investigating both the disease-free and endemic equilibria with their local and global stability. The model is fitted to actual infection data by estimating the time-varying transmission rates using a Long Short-Term Memory (LSTM) network and calibrating vaccination and treatment rates via Latin Hypercube Sampling (LHS). Sensitivity analysis identifies the key parameters for optimal control, and results indicate that simultaneously enhancing the vaccination rate most effectively mitigates the epidemic, as supported by cost-effectiveness analysis. Full article

Background: Peripheral venous cannulation is one of the most common clinical procedures, yet it often causes significant pain, anxiety, and discomfort for patients. While pharmacological methods exist, non-pharmacological interventions offer a low-cost, low-risk alternative that eliminates waiting times for anesthetic onset. The aim of this review is to synthesize the various nonpharmacological interventions for procedural pain reduction during PIVC in adults, covering interventions ranging from psychological distraction to advanced procedural support technologies. Methods: A systematic review was conducted following PRISMA 2020 guidelines and the Joanna Briggs Institute (JBI) framework. Databases including PubMed, CINAHL, Web of Science, and Scopus were searched for studies published between 2015 and 2025. Inclusion criteria focused on randomized controlled trials (RCTs) and quasi-experimental studies involving adult patients undergoing PIVC. Results: Thirty studies (29 randomized controlled trials and one experimental study) were included in the final analysis. The interventions were categorized into three primary groups: distraction techniques, physical methods, and behavioral techniques. The application of virtual reality (VR), optical illusion cards, and music therapy significantly reduced pain scores and enhanced patient satisfaction. Similarly, physical methods, such as thermomechanical stimulation (e.g., the Buzzy^® device), local heat application, and vibration, were found to be effective in lowering pain intensity compared to standard care. Behavioral techniques, including the “cough trick,” diaphragmatic breathing, and the Valsalva maneuver, consistently demonstrated efficacy in reducing both procedural pain and anxiety. Notably, while most interventions successfully reduced pain, certain methods—such as near-infrared (NIR) vein visualization—improved procedural success rates without significantly altering the subjective perception of pain. Conclusions: Findings from this review suggest that non-pharmacological interventions may serve as effective, safe, and feasible adjuncts for pain management during peripheral venous cannulation. Techniques such as the cough trick and vibration-based devices are particularly recommended due to their ease of integration into routine nursing practice, potentially improving patient comfort and clinical outcomes. Full article

Kalanchoe daigremontiana, a succulent herbaceous plant in the Crassulaceae family from Madagascar, has gained global popularity as an ornamental and medicinal species. This review examines the traditional uses, phytochemical composition, biological properties, toxicological aspects, and regulatory challenges of K. daigremontiana. The traditional medicinal uses of its leaves and roots include treating burns, rheumatic disorders, hypertension, diabetes, kidney pain, diarrhea, cough, fever, gastric issues, anxiety, inflammation, and cancer. Chemical compounds identified include phenolic acids, flavonoids, tannins, alkaloids, glycosides, saponins, sterols, terpenes, and fatty acids, with phenolic compounds and bufadienolides being predominant. In vitro studies of the crude extracts, bufadienolide-rich fractions, and isolated compounds have shown antioxidant, antibacterial, antifungal, antiviral, antiparasitic, anthelmintic, anti-inflammatory, anticoagulant, anti-aging, cytotoxic, antitumoral, and antiproliferative properties. In vivo studies have demonstrated hepatoprotective, skincare, and cardiac-glycoside-like effects. While crude extracts and bufadienolide-rich fractions have shown toxic effects in 2-week-old chicks, guinea pigs, and Artemia salina, no toxicity has been reported in goats, broiler chickens, laying hens, or human erythrocytes. Although K. daigremontiana-based products are commercially available as dietary supplements with various health claims, these lack scientific validation. Despite the potential pharmaceutical applications of K. daigremontiana, further research is needed to determine its effects, dosage, mechanisms, long-term safety, and side effects, with clinical studies essential to validate its therapeutic potential. Full article

Background/Objectives: This aim of this study was to describe the demographic, clinical, and laboratory characteristics of hospitalized children with benign acute childhood myositis (BACM) and to evaluate seasonal patterns, including changes observed during the COVID-19 pandemic. Methods: We conducted a retrospective single-center review of pediatric patients hospitalized with a diagnosis of BACM between January 2016 and December 2024. Clinical, laboratory, and epidemiological data were analyzed, including seasonal distribution before and after the COVID-19 pandemic. Results: We identified 47 cases of BACM, with a male predominance (66%) and a median age of 7 years. Most cases (72%) occurred during autumn and spring. The most common prodromal symptoms were fever, cough and rhinorrhea. Bilateral calf pain was the most frequent presenting symptom. The median creatine phosphokinase (CPK) level was 4986 U/L, with higher values in boys (p = 0.040). Higher CPK levels were associated with longer hospital stays in our cohort (p = 0.030). Influenza B was the most frequently identified pathogen (63%). No BACM cases were recorded during the COVID-19 pandemic period (2020–2022), followed by an increase in 2024. All patients fully recovered, with a median hospital stay of 3.2 days. Conclusions: BACM is a self-limiting condition with a characteristic clinical and laboratory profile. The absence of cases during the COVID-19 pandemic suggests a possible association between reduced viral circulation and BACM incidence. Awareness of its typical presentation may support early diagnosis, reduce unnecessary investigations, and facilitate appropriate clinical management. Full article

Background/Objectives: Peak cough flow (PCF) is an objective measure of cough effectiveness after stroke, but biomarkers reflecting physiological vulnerability related to reduced PCF are not well established. We investigated whether bone turnover markers (BTMs)—C-terminal telopeptide of type I collagen (CTX) and procollagen type 1 N-terminal propeptide (P1NP)—were associated with PCF in subacute ischemic stroke. Methods: In this retrospective study, 112 patients admitted within 21 days of stroke onset had fasting morning CTX and P1NP measured by electrochemiluminescence immunoassay, and PCF measured within 72 h of admission. Associations were assessed using Spearman correlation and multivariable linear regression with BTMs standardized (per 1 standard deviation increase), adjusting for age, sex, body mass index, onset-to-admission days, National Institutes of Health Stroke Scale score, Korean version of the Modified Barthel Index, estimated glomerular filtration rate, smoking status, and brainstem lesion. Results: CTX showed an inverse correlation with PCF (rho = −0.469; p < 0.001) and remained independently associated with lower PCF after multivariable adjustment (β = −42.32 L/min; 95% confidence interval, −56.12 to −28.52; p < 0.001), whereas P1NP showed weaker associations. In secondary outcome analyses, higher CTX was associated with low PCF (PCF < 160 L/min), aspiration pneumonia, and longer length of stay. Conclusions: Higher CTX levels were independently associated with lower peak cough flow and selected respiratory-related outcomes in this retrospective cohort. These findings are hypothesis-generating, do not imply prognostic validation, and warrant confirmation in prospective multicenter studies assessing incremental predictive value. Full article

Background and Objectives: The close anatomical relationship between pelvic support structures and the lower urinary tract contributes to high rates of urinary dysfunction among patients with pelvic organ prolapse (POP). POP reduction alone has been shown to alter urinary tract functioning. The aim of this study was to assess urinary functioning outcomes following a novel reconstructive surgical technique for POP. Materials and Methods: This randomized controlled trial was conducted between September 2024 and December 2025. The trial was registered in the German Clinical Trials Register (identifier: DRKS00038206), on 27 October 2025. Participants were randomly assigned to undergo either conventional laparoscopic sacrocervicopexy or the modified technique. Urinary outcomes were assessed using the International Consultation on Incontinence Questionnaire—Urinary Incontinence Short Form (ICIQ-UI), the Urogenital Distress Inventory Short Form (UDI-6), the cough test, and urodynamic testing. Assessments were performed prior to surgery and at a 6-month follow-up. Results: Both the classical and modified techniques resulted in significant improvements in ICIQ-UI and UDI-6 scores. However, no statistically significant differences were observed between groups. De novo SUI occurred in 14.3% of patients in the classical technique group and in no patients in the modified technique group. Conclusions: Urinary symptoms improved in both groups, with no statistically significant between-group differences. De novo SUI occurred only in the classical technique group, but this finding should be interpreted cautiously given the limited sample size. These results are exploratory and hypothesis-generating, and larger studies with longer follow-up are needed to clarify whether true between-group differences in postoperative continence outcomes exist. Full article

A 10-year-old castrated male Chihuahua weighing 3.06 kg was presented with a chronic, progressively worsening cough of five months’ duration. Diagnostic imaging, including thoracic radiography and computed tomography, identified a well-defined cranial mediastinal mass consistent with a thymic tumor. Surgical excision was performed via median sternotomy with complete thymectomy. Following tumor removal, sternal closure was achieved using a non-absorbable ultra-high-molecular-weight polyethylene (UHMWPE) suture material (FiberWire^®, Arthrex, Naples, FL, USA). Histopathological examination confirmed the diagnosis of an epithelial-predominant thymoma with narrow but complete surgical margins. Postoperative recovery was uneventful, and the dog was discharged three days after surgery. Clinical signs, including coughing, progressively improved during follow-up. Radiographic evaluation performed up to postoperative day 57 demonstrated stable sternal alignment without evidence of dehiscence, implant-related complications, or disease recurrence. This report describes the first clinical case of FiberWire use for median sternotomy closure following thymectomy in a dog. The favorable clinical and radiographic outcomes observed during postoperative follow-up suggest that FiberWire may represent a viable alternative to traditional stainless-steel wire for sternal fixation in canine thoracic surgery. Full article

The development of AI-driven computational methods has enabled rapid and non-invasive analysis of respiratory sounds using acoustic data, particularly cough recordings. Although the COVID-19 pandemic accelerated research on cough-based acoustic analysis, many early studies were limited by insufficient data quality, lack of standardized protocols, and limited reproducibility due to data scarcity. In this study, we propose an audio analysis framework for cough-based respiratory disease screening research using COVID-19 as a clinically validated case dataset. All analyses were conducted on a single clinically acquired multicentric dataset collected under standardized conditions in certified laboratories in Mexico and Spain, comprising cough recordings from 1105 individuals. Model training and testing were performed exclusively within this dataset. The framework incorporates signal preprocessing and a comparative evaluation of segmentation strategies, showing that segmented cough analysis significantly outperforms full-signal analysis. Class imbalance was addressed using the Synthetic Minority Over-sampling Technique (SMOTE) for CNN2D models and the supervised Resample filter implemented in WEKA for classical machine learning models, both applied exclusively to the training subset to generate balanced training sets and prevent data leakage. Feature extraction and classification were carried out using Random Forest, Support Vector Machine (SVM), XGBoost, and a 2D Convolutional Neural Network (CNN2D), with hyperparameter optimization via AutoML. The proposed framework achieved a best balanced screening performance of 85.58% sensitivity and 86.65% specificity (Random Forest with GeMAPSvB01), while the highest-specificity configuration reached 93.90% specificity with 18.14% sensitivity (CNN2D with SMOTE and AutoML). These results demonstrate the methodological feasibility of the proposed framework under the evaluated conditions. Full article

Background: Respiratory tract infections (RTIs) are common in children and represent one of the main reasons for pediatric consultations. Although generally benign, pediatric RTIs can lead to medical complications and significant socioeconomic burden. The objective of this trial was to evaluate the efficacy of a food supplement intended to support the immune system in reducing the rate and severity of pediatric RTIs. Methods: A randomized, double-blind, placebo-controlled, parallel-group clinical trial was conducted to assess the efficacy and safety of a food supplement based on vitamins, minerals, herbal extracts, and Lactobacillus rhamnosus CRL1505 (Pegaso^® Immuno Junior). A daily dose was administered for approximately 60 days within a three-month period to children aged 3–10 years with at least four RTI episodes in the previous year. RTI frequency, illness days, days with fever, cough, and rhinitis, and antipyretic and antibiotic use per episode were recorded over four months. Results: A total of 110 children completed the study. Compared with the placebo, the active supplement significantly reduced the mean number of RTI episodes per child (2.41 ± 0.84 vs. 4.13 ± 1.66; RR = 0.745, 95% CI 0.583–0.953) as well as the number of illness days, days with fever, cough, and rhinitis, and days with antipyretic or antibiotic use. The supplement was well-tolerated. Conclusions: The patented supplementation based on vitamins, minerals, herbal extracts, and Lactobacillus rhamnosus CRL1505 (Pegaso^® Immuno Junior), taken over a three-month period, may reduce the frequency and severity of RTIs in children aged 3–10 years. Full article

Background and Objectives: Peak Cough Flow (PCF) is an objective measure of cough effectiveness, traditionally used in patients with neuromuscular disorders. Sarcopenia may also impair respiratory muscles, but its relationship with cough efficacy in hospitalized patients with respiratory diseases is not well established. This study investigated the correlation between PCF and sarcopenia indicators and evaluated the influence of comorbidities, anthropometric variables, and body position on PCF. Methods: A cross-sectional observational study was performed. PCF was measured using a portable peak flow meter in seated and supine positions. Sarcopenia was assessed through handgrip strength and validated questionnaires. Comorbidity burden was quantified using the Charlson Comorbidity Index (CCI). Nutritional status and sleep apnea risk were evaluated with the Mini Nutritional Assessment–Short Form (MNA-SF) and STOP-BANG questionnaire. Correlation analyses and linear regression were performed. Results: 53 patients were enrolled (mean age 72.6 ± 15.2 years; 64% male). Men showed significantly higher PCF values than women in both seated (p < 0.001) and supine positions (p < 0.001). Sarcopenic patients exhibited reduced PCF compared to non-sarcopenic subjects (p = 0.037). Handgrip strength was strongly correlated with PCF in seated and supine positions (p < 0.0001). CCI was negatively correlated with PCF (seated r² = 0.17, p = 0.0021; supine r² = 0.16, p = 0.0027). No significant associations were observed with BMI, MNA-SF, or STOP-BANG. Postural change resulted in comparable PCF reduction in men and women (ΔPCF: 20 ± 37.9 vs. 17 ± 37.9 L/min). Conclusions: Sarcopenia and comorbidity burden are significantly associated with reduced cough efficacy. Handgrip strength is a strong predictor of PCF, supporting routine PCF assessment beyond neuromuscular populations. Full article

Hemorrhagic fever with renal syndrome (HFRS) is the most common zoonotic disease in Russia, with about a 98% abundance of Puumala virus in all HFRS cases. We report clinical manifestations and genomic characteristics of the Puumala virus strain that caused an unconventional course of HFRS with sudden death. The patient was admitted to the hospital on the third day from fever onset with hyperthermia, cough, shortness of breath, and severe weakness, and died 28 h after hospitalization despite intensive care. Further analyses of autopsy samples led to Puumala virus detection. The viral genome was sequenced, followed by phylogenetic and similarity plot analyses. The genomic sequences of three viral segments were identified as endemic for the Moscow region strain. Phylogenetic and similarity plot analysis revealed the reassortant origin of the strain via M segment exchange. This finding increases the explored molecular diversity of Puumala virus in the Central Federal District and underscores the need for heightened awareness of HFRS manifestations that deviate from regular clinical presentation. Full article