Search Results (340)

Background/Objectives: Acute kidney injury (AKI) worsens outcomes in COPD exacerbation (COPDe), yet limited data compare the demographics and mortality risk factors of COPDe admissions with and without AKI. Understanding this association may enhance risk stratification and management strategies. The aim of this study was to identify demographic differences and mortality risk factors in COPDe admissions with and without AKI. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (NIS) from 1 January 2016 to 1 January 2021. Patients aged ≥ 35 years with a history of smoking and a diagnosis of COPDe were included. Patients with CKD stage 5, end-stage kidney disease (ESKD), heart failure decompensation, urinary tract infections, myocardial infarction, alpha-1 antitrypsin deficiency, or active COVID-19 infection were excluded. Baseline demographics were analyzed using descriptive statistics. Multivariate logistic regression analysis was used to measure the odds ratio (OR) of mortality. Statistical analyses were conducted using IBM SPSS Statistics V.30, with statistical significance at p < 0.05. Results: Among 405,845 hospitalized COPDe patients, 13.6% had AKI. These patients were older, had longer hospital stays, and included fewer females and White patients. AKI was associated with significantly higher mortality (OR: 2.417), more frequent acute respiratory failure (OR: 4.559), intubation (OR: 10.262), and vasopressor use (OR: 2.736). CVA, pneumonia, and pulmonary hypertension were significant mortality predictors. Hypertension, CAD, and diabetes were associated with lower mortality. Conclusions: AKI in COPDe admissions is associated with worse outcomes. Protective effects from certain comorbidities may relate to renoprotective medications. Study limitations include coding errors and retrospective design. Full article

Introduction: This study aimed to assess the accuracy of real-time polymerase chain reaction (PCR) as a diagnostic tool for Pneumocystis jirovecii pneumonia (PCP) in immunocompromised patients and evaluate the applicability of quantification cycle (Cq) data for PCP diagnosis. Methods: Clinical and laboratory data were collected from medical records of 96 immunocompromised patients hospitalized at the Hadassah hospital from 2018 to 2022, for lower respiratory tract infection. PCP diagnosis was independently categorized by two infectious disease specialists, blinded to PCR results, as either “definite” (confirmed by microscopic identification of P. jirovecii) or “probable” (compatible clinical data and negative microscopy). Clinical characteristics, PCR test performance, and Cq values were then compared between these PCP diagnostic groups and a control group of 85 patients who underwent bronchoscopy for indications unrelated to P. jirovecii infection. Results: The PCR test was found to be highly reliable for diagnosing PCP, with high sensitivity and specificity (93.1%, 98.7%, respectively), a positive predictive value (PPV) of 96.4%, a negative predictive value (NPV) of 97.1%, a negative likelihood ratio of 0.71, and a positive likelihood ratio of 46.5. A Cq cutoff value of 21.89 was found to discriminate between probable PCP and definite PCP. In addition, patients with probable PCP had lower in-hospital mortality than those with definite PCP or no PCP. Conclusions: PCR offers a promising approach for diagnosing PCP in immunocompromised patients with negative respiratory microscopy results. While further research may be warranted, its use may allow for more timely treatment and potentially improved outcomes. Full article

Introduction: Respiratory Syncytial Virus (RSV) is the leading cause of lower respiratory tract infections in infants and children, as well as hospitalizations for respiratory infections in the pediatric population, representing a significant public health concern. Nirsevimab, a long-acting anti-RSV monoclonal antibody, has recently been approved by the European Medicines Agency (EMA). The aim of this study is to assess the utility of certain parameters, such as the Number Needed to Immunize (NNI), in supporting decision-makers regarding the introduction of nirsevimab as a universal prophylactic measure. Methods: A literature review was conducted to identify the definition and application of the NNI in the context of infectious disease prevention. The following online databases were consulted: Scopus, MEDLINE, Google Scholar, Web of Science, and Cochrane Library. The search was restricted to English-language texts published between 1 January 2000 and 30 January 2025. Results: The NNI represents the number of individuals who need to be immunized to prevent clinical outcomes such as medical visits and hospitalizations caused by infectious diseases. Six studies were identified that utilized this parameter to outline the benefits of immunization and describe the advantages of using monoclonal antibodies for RSV disease. Finelli and colleagues report that to prevent one RSV-related hospitalization, 37–85 infants aged 0–5 months and 107–280 infants aged 6–11 months would need to be immunized with long-acting anti-RSV antibodies. A recent study by Mallah et al. on the efficacy of nirsevimab estimates that the NNI required to prevent one RSV-related hospitalization is 25 infants. Studies by Francisco and O’Leary report NNI values of 82 and 128 infants, respectively, to prevent one RSV-related hospitalization with nirsevimab. Mallah et al. describe NNI as a metric useful to quantify the immunization effort needed to prevent a single RSV hospitalization. A recent Italian study reports that 35 infants need to be immunized to prevent one hospitalization due to RSV-LRTI and 3 infants need to be immunized to prevent one primary care visit due to RSV-LRTI. The studies indicate that the NNI for anti-RSV monoclonal antibodies is lower than the corresponding Number Needed to Vaccinate (NNV) for vaccines already included in national immunization programs. The main limitations of using this parameter include the absence of a shared threshold for interpreting results and the lack of consideration for the indirect effects of immunization on the population. Conclusions: The NNI is an easily understandable tool that can be used to convey the value of an immunization intervention to a variety of stakeholders, thereby supporting public health decision-making processes when considered in association with the uptake of the preventative strategy. At the current status, the estimated NNI of monoclonal antibodies against RSV results favourable and confirms the use in the first year of life for the prevention of RSV disease. Full article

Respiratory diseases represent a persistent global health challenge, underscoring the need for intelligent, accurate, and personalized diagnostic and therapeutic systems. Existing methods frequently suffer from limitations in diagnostic precision, lack of individualized treatment, and constrained adaptability to complex clinical scenarios. To address these challenges, our study introduces a modular AI-powered framework that integrates an audio-based disease classification model with simulated molecular biomarker profiles to evaluate the feasibility of future multimodal diagnostic extensions, alongside a synthetic-data-driven prescription recommendation engine. The disease classification model analyzes respiratory sound recordings and accurately distinguishes among eight clinical classes: bronchiectasis, pneumonia, upper respiratory tract infection (URTI), lower respiratory tract infection (LRTI), asthma, chronic obstructive pulmonary disease (COPD), bronchiolitis, and healthy respiratory state. The proposed model achieved a classification accuracy of 99.99% on a holdout test set, including 94.2% accuracy on pediatric samples. In parallel, the prescription module provides individualized treatment recommendations comprising drug, dosage, and frequency trained on a carefully constructed synthetic dataset designed to emulate real-world prescribing logic.The model achieved over 99% accuracy in medication prediction tasks, outperforming baseline models such as those discussed in research. Minimal misclassification in the confusion matrix and strong clinician agreement on 200 prescriptions (Cohen’s $\kappa$ = 0.91 [0.87–0.94] for drug selection, 0.78 [0.74–0.81] for dosage, 0.96 [0.93–0.98] for frequency) further affirm the system’s reliability. Adjusted clinician disagreement rates were 2.7% (drug), 6.4% (dosage), and 1.5% (frequency). SHAP analysis identified age and smoking as key predictors, enhancing model explainability. Dosage accuracy was 91.3%, and most disagreements occurred in renal-impaired and pediatric cases. However, our study is presented strictly as a proof-of-concept. The use of synthetic data and the absence of access to real patient records constitute key limitations. A trialed clinical deployment was conducted under a controlled environment with a positive rate of satisfaction from experts and users, but the proposed system must undergo extensive validation with de-identified electronic medical records (EMRs) and regulatory scrutiny before it can be considered for practical application. Nonetheless, the findings offer a promising foundation for the future development of clinically viable AI-assisted respiratory care tools. Full article

Adenovirus is an important respiratory virus that causes severe diseases in immunocompromised patients. Data on its impact in immunocompetent patients are relatively limited. We conducted a territory-wide retrospective study on adult patients hospitalized for respiratory tract infections caused by adenovirus or influenza viruses in Hong Kong between 1 January 2016 and 30 June 2023. Inpatient mortality, severe respiratory failure (SRF), secondary bacterial pneumonia and acute kidney injury (AKI) were compared. The risk factors for these outcomes in patients hospitalized for adenovirus respiratory tract infections were assessed. Overall, 41,206 and 528 patients were hospitalized for influenza and adenovirus respiratory tract infections, respectively. Patients with respiratory tract infections due to adenoviruses showed significantly higher risk of inpatient mortality, SRF, secondary bacterial pneumonia and AKI compared to seasonal influenza. Medical comorbidities including cardio-pulmonary diseases, end-stage kidney disease requiring dialysis, and a lower estimated glomerular filtration rate were robust independent risk factors for inpatient mortality and serious respiratory outcomes in adenovirus respiratory tract infections. Adults hospitalized for adenoviruses respiratory tract infections had a significantly higher risk of inpatient mortality and adverse outcomes than adults infected with seasonal influenza. Medical comorbidities are important risk factors for severe adenovirus infections in adult patients. Full article

Background: Respiratory syncytial virus (RSV) remains a leading cause of lower respiratory tract infections and hospitalizations in infants and young children globally. Recently, RSV prevention has advanced with the introduction of nirsevimab, a long-acting monoclonal antibody, and the RSV preF vaccine for maternal immunization. While these interventions have improved early protection, several limitations hinder their broader impact and long-term effectiveness. Methods: This narrative review synthesizes evidence from clinical trials, observational studies, and regulatory reports to evaluate the main limitations of nirsevimab and maternal RSV vaccination. Literature searches were conducted in major databases, focusing on efficacy, safety, immunogenicity, implementation, and population-specific challenges. Results: Both nirsevimab and maternal vaccination provide strong protection during the first six months of life, but their effectiveness wanes thereafter. This is concerning as nearly half of RSV-related deaths occur in children over six months old. Maternal vaccine efficacy is uncertain in very-preterm infants, and safety concerns persist, including potential associations with preterm birth, Guillain–Barré syndrome, and hypertensive disorders. Real-world data from low-income countries are lacking, limiting generalizability. Additionally, the risk of vaccine-associated enhanced disease (VAED), although unconfirmed, has delayed pediatric vaccine development. Emerging monoclonal antibodies and live-attenuated vaccines are under investigation to extend protection beyond infancy. Conclusions: Despite substantial progress, current RSV prevention strategies leave critical gaps, particularly for older infants and underserved populations. There is a pressing need for next-generation vaccines, enhanced pharmacovigilance, and equitable global implementation to ensure sustained and inclusive RSV protection. Full article

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the 2019 coronavirus disease pandemic. The virus primarily spreads through person-to-person contact via aerosols and droplets, contributing to high case numbers and related morbidities. SARS-CoV-2 targets the respiratory tract, causing acute respiratory distress syndrome, particularly in immunocompromised individuals such as those with cystic fibrosis (CF). CF is a life-threatening genetic disorder caused by mutations in the CF transmembrane conductance regulator (CFTR) gene, leading to impaired respiratory function and recurrent severe respiratory symptoms. Despite their potential vulnerability, CF patients have shown a lower incidence of severe COVID-19, suggesting protective factors against SARS-CoV-2. Differential expression of the ACE2 receptor, crucial for viral entry, and other host factors, such as TMPRSS2, may play a role in this resistance to SARS-CoV-2. Analyzing the genomics and transcriptomics profiles of CF patients could provide insights into potential resistance mechanisms. The potential resistance mechanisms include blood and extracellular ATP levels, a deleted/dysfunctional CFTR gene, ACE and ACE2 regulation and expression, ACE and ACE2 polymorphism effects, host proteins and SARS-CoV-2 interactions, and SMN1 and ACE/ACE2 interactions. This review discusses the underlying factors and potential resistance mechanisms contributing to CF patients’ responses to SARS-CoV-2 infection. The review provides an opportunity to further investigate future therapy and research through understanding the underlying potential resistance mechanisms exhibited by CF patients against SARS-CoV-2, including ACE and ACE2 polymorphisms. Full article

Acute lower respiratory tract infections are a leading cause of death in individuals under the age of 5 years, mostly in low- and middle-income countries (LMICs). The lack of respiratory support systems contributes to the poor outcomes. Bubble CPAP is widely used for non-invasive respiratory support, but sicker children often require support over what CPAP provides in the form of BiPAP. We developed and tested a simple bubble-based bilevel ventilator (Bubble bi-vent) and compared it with a standard care BiPAP device. The bubble bilevel device consisted of a single tube submerged in a water-sealed column to maintain end-expiratory positive airway pressure. It moves vertically via an electric motor to also provide inspiratory positive airway pressure for augmentation of lung volumes, with the duration and frequency of breaths controlled by a microprocessor. We tested this novel device in passively breathing mechanical lung models for infants and small children. We compared pressure and tidal volume delivery between the novel device and a Trilogy BiPAP ventilator. The results showed that the Bubble bi-vent could deliver set pressures in a mechanical lung and was comparable to a standard Trilogy ventilator. While two different bubble-based bilevel pressure devices have been piloted for neonates and adults, our results demonstrate the feasibility of bubble bilevel ventilation for infants and small children with moderate to severe lung disease for whom this was previously not described. Full article

Air pollution and health effects in communities near industrial areas are matters of concern in Thailand. Elevated air pollution concentrations are associated with morbidity and mortality arising from lower respiratory tract illness. In this study, we aimed to assess whether living in a community near a new industrial estate in Central Thailand was associated with an elevated incidence of lower respiratory tract illness (LRTI) among the elderly. We used data on hospital admissions from a primary hospital and sub-district-level health-promoting hospitals in six sub-districts located within a radius of 5 km from the industrial estate, between 1 November 2023 and 31 March 2024, using a cross-sectional study design. There were 1311 elderly individuals living within a radius of 3 km and 1488 between 3 and 5 km. We found a statistically significant increased risk of hospitalization for LRTI in the elderly living within a radius of less than 3 km (odds ratio: 3.43 [95% CI: 1.61–7.36] compared to those living in a radius between 3 and 5 km. Our results provide strong support for an association between hospitalization for LRTI and living distance from a new industrial estate. Full article

Respiratory syncytial virus (RSV) continues as the major cause of acute lower respiratory tract infections in children around the world, and its substantial morbidity, particularly among infants and high-risk children, poses a significant burden on healthcare systems worldwide. RSV infections occur as a spectrum, ranging from mild upper respiratory symptoms to severe bronchiolitis and pneumonia, and the number of infections shows seasonal variations in different latitudes, as well as lasting impacts, reflecting the COVID-19 pandemic. The pathogenesis of the virus involves epithelial cell invasion and/or fusion to form syncytia, along with exaggerated immune-mediated responses. Disease severity is known to depend on viral load, strain variation, and host immune immaturity. Severe RSV infection during infancy is notably linked with long-term respiratory sequelae such as recurrent wheezing and asthma. Diagnosis is based on clinical suspicion and laboratory confirmation using rapid antigen testing or nucleic acid amplification tests, namely PCR. Non-pharmaceutical interventions, maternal vaccination, and prophylaxis with monoclonal antibodies, e.g., palivizumab and nirsevimab, a newly introduced long-acting agent, are efficient protective and preventive measures. Treatment is still, for the most part, supportive in nature and focuses on oxygen supplementation, hydration, and respiratory support for patients with more severe disease courses; however, the development of immunoprophylaxis and vaccine candidates shows promise for reducing the global burden of RSV. Full article

Influenza is a highly transmissible seasonal disease that significantly impacts public health worldwide, causing lower respiratory tract infections, numerous hospitalizations, and prolonged stays. However, data on its clinical burden in children in Latin America remain limited. This retrospective cohort study analyzed the demographic and clinical characteristics of children hospitalized with influenza in Latin America, stratified by age, and identified factors associated with mechanical ventilation. Medical records of children with severe acute respiratory infection associated with influenza were reviewed. Statistical analyses included chi square and Wilcoxon tests to compare groups, and Cox regression to identify predictors of mechanical ventilation. Among 212 cases, 46% of admissions were in school-age children; 93.4% had comorbidities. Influenza AH1N1 was more frequent in children <5 years and influenza H3N2 in children >5 years of age. The mechanical ventilation rate per age group was 24.1% among those <1 year, 29.8% in 1–4 years of age, 4.9% in 5–9 years of age, and 26.3% in children 10–18 years of age. Hypotension, paradoxical breathing, and nosocomial infection were identified as predictors for mechanical ventilation. These findings enhance the understanding of influenza’s clinical impact on pediatric populations, particularly in predicting severe outcomes requiring intensive care, and aid in developing strategies to mitigate its effects. Full article

Background: Respiratory diseases are among the main causes of morbidity and mortality in captive reptiles. In Romania, pneumonia is a frequently observed illness affecting pet reptiles. Key factors contributing to the high incidence of pneumonia include inadequate animal husbandry, poor nutrition, and insufficient hygiene practices. Bacteria may act as primary pathogens or as facilitators of disease severity. Methods: This study investigates bacterial strains from multiple genera and species (Chryseobacterium (C.) indologenes, Staphylococcus (S.) epidermidis, Escherichia (E.) coli, and Pseudomonas (P.) aeruginoasa) from six ball pythons regarding their antibiotic susceptibility and the effect of essential oils. Bacteria were isolated from the lower respiratory tract, displaying clinical signs of pneumonia. All isolates were tested with essential oils (lemongrass, oregano, rosemary, and sage) and a grapefruit seed extract (GSE) at different dilutions. Results: The incidence of Chryseobacterium indologenes was highest (3 isolates/12 samples, 25%), followed by E. coli and Staphylococcus epidermidis (2/12 each, 16.6%), and Pseudomonas aeruginoasa (1/12, 8.3%). Resistance profiling to different antibiotic classes revealed that all isolates (eight) were resistant to multiple antibiotics tested by us. All isolates were resistant to β-lactams and fluoroquinolones. One strain of E. coli exhibited intermediate resistance to quinolone and penicillin. All strains were categorized as multidrug-resistant. GSE showed antibacterial activity against all isolates. Conclusions: Wanting to deepen our understanding of the microorganisms that can infect ball pythons and recognizing that all isolated bacteria have zoonotic potential, this paper highlights some common issues faced by exotic animal owners and suggests that treatments should also include the use of essential oils. Full article

Cases of new COVID-19 infection, which manifested in 2019 and caused a global socioeconomic crisis, still continue to be registered worldwide. The high mutational activity of SARS-CoV-2 leads to the emergence of new antigenic variants of the virus, which significantly reduces the effectiveness of COVID-19 vaccines, as well as the sensitivity of diagnostic test systems based on variable viral antigens. These problems may be solved by focusing on highly conserved coronavirus antigens, for example nucleocapsid (N) protein, which is actively expressed by coronavirus-infected cells and serves as a target for the production of virus-specific antibodies and T cell responses. It is known that anti-N antibodies are non-neutralizing, but their protective potential and functional activity are not sufficiently studied. Here, the protective effect of anti-N antibodies was studied in Syrian hamsters passively immunized with polyclonal sera raised to N(B.1) recombinant protein. The animals were infected with 10⁵ or 10⁴ TCID₅₀ of SARS-CoV-2 (B.1, Wuhan or BA.2.86.1.1.18, Omicron) 6 h after serum passive transfer, and protection was assessed by weight loss, clinical manifestation of disease, viral titers in the respiratory tract, as well as by the histopathological evaluation of lung tissues. The functional activity of anti-N(B.1) antibodies was evaluated by complement-dependent cytotoxicity (CDC) and antibody-dependent cytotoxicity (ADCC) assays. The protection of anti-N antibodies was evident only against a lower dose of SARS-CoV-2 (B.1) challenge, whereas almost no protection was revealed against BA.2.86.1.1.18 variant. Anti-N(B.1) monoclonal antibodies were able to stimulate both CDC and ADCC. Thus, anti-N(B.1) antibodies possess protective activity against homologous challenge infection, which is possibly mediated by innate Fc-mediated immune reactions. These data may be informative for the development of N-based broadly protective COVID-19 vaccines. Full article

Background: Although upper and lower respiratory tract diseases coexist, studies discussing the relationship between chronic rhinitis (CR) and chronic obstructive pulmonary disease (COPD) are limited. Fluticasone nasal sprays are common treatment options for patients with rhinitis. Therefore, we aimed to investigate the effects of fluticasone nasal spray on patients with both CR and COPD. Methods: A retrospective review was performed using data from former smokers with CR and COPD at China Medical University Hospital (CMUH). Based on their medication history, patients were allocated into Group A, who had received treatment with fluticasone nasal spray, and Group B, who had never received this treatment. Pulmonary function test results, including forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC), were collected for both groups before treatment and one year after treatment. Statistical analysis was performed to evaluate the impact of fluticasone nasal spray treatment on pulmonary function. Results: A total of 123 former smokers were included, with 62 patients in Group A and 61 patients in Group B. At baseline, there was no significant difference in age, sex, and pulmonary function between the two groups. After one year of treatment, Group A showed an upward trend in pulmonary function, with the FEV1 increasing from 1.613 ± 0.554 to 1.708 ± 0.675 (p < 0.05) and the FVC increasing from 2.540 ± 0.694 to 2.670 ± 0.839 (p < 0.05). On the other hand, Group B exhibited a downward trend in pulmonary function after one year, with the FEV1 decreasing from 1.609 ± 0.554 to 1.544 ± 0.517 (p < 0.05) and the FVC decreasing from 2.586 ± 0.665 to 2.495 ± 0.679 (p < 0.05). Conclusions: This retrospective study suggests that the combined use of fluticasone nasal spray may be associated with improved pulmonary function in former smokers with both CR and COPD. This finding supports the concept of “united airway disease”. Full article

Vaccination plays a pivotal role in the control and prevention of animal infectious diseases. However, no efficient and safe universal vaccines are currently registered for major pathogens such as influenza A virus, foot-and-mouth disease virus (FMDV), simian immunodeficiency virus (SIV), and small ruminant lentiviruses (SRLV). Here, we review the development of Sendai virus (SeV) vectors as a promising vaccine platform for animal diseases. Recombinant SeV vectors (rSeVv) possess several key features that make them highly suitable for developing vaccination strategies: (1) SeV has exclusively cytoplasmic replication cycle, therefore incapable of transforming host cells by integrating into the cellular genome, (2) rSeVv can accommodate large foreign gene/s inserts (~5 kb) with strong but adjustable transgene expression, (3) can be propagated to high titers in both embryonated chicken eggs and mammalian cell lines, (4) exhibits potent infectivity across a broad range of mammalian cells from different animals species, (5) undergo transient replication in the upper and lower respiratory tracts of non-natural hosts, (6) has not been associated with disease in pigs, non-humans primates, and small ruminants, ensuring a favorable safety profile, and (7) induce a robust innate and cellular immune responses. Preclinical and clinical studies using rSeVv-based vaccines against influenza A virus, FMDV, SIV, and SRLV have yielded promising results. Therefore, this review highlights the potential of rSeVv-based vaccine platforms as a valuable strategy for combating animal viruses. Full article