Search Results (9,713)

Background: Infants born small for gestational age (SGA) are at increased risk of altered postnatal growth and early metabolic vulnerability. Early feeding practices may modulate these outcomes, but evidence from Eastern Europe remains limited. Objective: To evaluate the influence of birth weight and early nutrition on anthropometric outcomes at 2–3 years of age in former SGA infants in Romania, and to examine associations with allergies, respiratory infections, and food intolerances. Methods: We conducted a retrospective comparative study including two cohorts of term SGA infants born in a Romanian tertiary hospital in 2010–2011 (n = 600) and 2020–2021 (n = 508). Perinatal data were extracted from medical records; anthropometrics and feeding practices at 2–3 years were obtained via parental telephone interviews. BMI z-scores were calculated using WHO standards. Logistic regression models were used to identify predictors of overweight/obesity and selected health outcomes. Results: Breastfeeding increased markedly over one decade (59.1% vs. 35.5%, p < 0.001), as did appropriate complementary feeding (74.2% vs. 66.3%, p = 0.005). Obesity prevalence decreased from 29.5% to 22.4% at 2 years and from 32.7% to 20.7% at 3 years (both p < 0.001), while overweight prevalence increased slightly. In the historical cohort, mixed feeding (vs. formula) predicted overweight/obesity at 2 years (aOR 2.55, 95% CI 1.52–4.43, p < 0.001); the association was directionally similar but not significant in the contemporary cohort (aOR 1.62, 95% CI 0.75–3.47, p = 0.215). Breastfeeding was protective in both cohorts. Appropriate complementary feeding was associated with lower allergy prevalence in the historical cohort (14.8% vs. 24.8%, p = 0.004). Food intolerances increased over time (16.3% to 27.6%, p < 0.001), while respiratory infections showed no significant differences. Conclusions: In this Romanian SGA population, early feeding practices improved substantially over one decade and were associated with more favorable weight outcomes, including a notable reduction in obesity. Mixed feeding emerged as a potential risk factor for early overweight, whereas breastfeeding remained protective. Despite these improvements, former SGA infants continue to exhibit elevated risk for early-onset overweight and obesity, underscoring the need for targeted nutritional counseling and longitudinal monitoring. Full article

H9N2 low-pathogenic avian influenza viruses (LPAIV) represent an ongoing zoonotic threat due to their enzootic circulation in poultry, reassortment capacity, and increasing human transmission events. This study characterized three H9N2 isolates recovered from apparently healthy poultry in a Changchun live poultry market (September–November 2022) that exhibited unprecedented genetic and phenotypic characteristics indicating enhanced zoonotic risk. Phylogenetic analysis showed a complex mosaic genome combining segments from four distinct lineages: HA from the BJ/94-like lineage (human-associated), PB1/NP/NS from the F98-like lineage, NA from the FJ/30-C-like branch, and PB2/M genes from the G1-like lineage. Bayesian molecular clock analysis estimated the most recent common ancestor at February 2022, with HL55 and HL56 diverging by May 2022, indicating rapid local viral evolution. All isolates retained hallmark LPAIV characteristics (monobasic HA cleavage site, zero intravenous pathogenicity index in chickens). However, receptor-binding assays demonstrated a critical divergence among the isolates: while HL45 exhibited exclusive avian α2-3 receptor preference, both HL55 and HL56 retained strong avian receptor binding while additionally showing measurable affinity for human α2-6 receptors-a dual-binding phenotype associated with enhanced zoonotic potential. Most significantly, the HL55 isolate successfully infected BALB/c mice without prior adaptation, causing transient upper respiratory tract replication, moderate weight loss (~9.2%), and mild disease without mortality or systemic dissemination. These findings demonstrate that the direct mammalian infectivity of this specific mosaic H9N2 lineage adds to the growing body of evidence regarding the zoonotic potential of contemporary H9N2 variants. The presence of known mammalian-adaptation markers (PB2 A588V, NA stalk deletion, HA position 226 leucine), combined with demonstrated dual receptor-binding capacity and inherent mammalian infectivity, underscores the accelerated evolutionary trajectory of H9N2 viruses toward increased zoonotic competence. These findings warrant intensified surveillance in live poultry markets, comprehensive antigenic characterization of emerging variants, and enhanced biosecurity measures to mitigate the risk of spillover events and potential pandemic emergence. Full article

Background: Intestinal parasitic infections are common in tropical settings and may influence immune regulation, allergic responses, and respiratory health. In children with sickle cell disease (SCD), respiratory morbidity is multifactorial, and the contribution of intestinal parasites remains uncertain. This study assessed whether documented intestinal parasitic infections, particularly helminth infections, were associated with asthma-like respiratory phenotypes and clinical morbidity in children with SCD in French Guiana. Methods: We conducted a multicenter cross-sectional analysis of children and adolescents younger than 18 years with confirmed SCD who were being followed by the pediatric SCD centers of Saint-Laurent-du-Maroni, Cayenne, and Kourou between January 2022 and December 2025. Clinical, respiratory, and parasitological data were extracted from routine-care medical records. Intestinal parasitic infection was defined as at least one documented stool parasitology result identifying Strongyloides stercoralis, hookworm, or Entamoeba histolytica, according to the variables consistently available in the database. Respiratory outcomes included physician-diagnosed asthma, bronchial obstruction, bronchodilator reversibility, and an asthma-like respiratory phenotype. Results: Among 233 included children, 105 (45.1%) had at least one documented intestinal parasitic infection and 82 (35.2%) had a helminth infection. Hookworm was the most common parasite (75/233, 32.2%), followed by Entamoeba histolytica (33/233, 14.2%) and Strongyloides stercoralis (24/233, 10.3%). An asthma-like respiratory phenotype was observed in 32/105 infected children (30.5%) versus 44/128 non-infected children (34.4%). Bronchial obstruction and bronchodilator reversibility were also similar between groups. After adjustment for age, sex, genotype, hydroxyurea treatment, rural residence, site of follow-up, and environmental tobacco smoke exposure, intestinal parasitic infection was not associated with asthma-like respiratory phenotype (adjusted OR: 0.94, 95% CI: 0.51–1.72; p = 0.844), recurrent hospitalization, or history of acute chest syndrome. Conclusions: In this routine-care multicenter pediatric SCD cohort from French Guiana, intestinal parasitic infections were common but were not associated with respiratory phenotype or selected morbidity outcomes. Because testing and respiratory assessment were not systematic, these findings should be interpreted as showing that routine parasitological status alone could not identify children with respiratory morbidity. Prospective studies with standardized repeated parasitological, immunological, environmental, and respiratory assessments are needed. Full article

Background/Objectives: Clostridioides difficile infection (CDI) is an increasingly recognised nosocomial complication in patients hospitalised with coronavirus disease 2019 (COVID-19), driven by broad-spectrum antibiotic exposure, corticosteroid use, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related intestinal dysbiosis. The contribution of underlying cardiovascular comorbidities, particularly heart failure, to CDI susceptibility in hospitalised COVID-19 patients remains insufficiently characterised. We aimed to evaluate the prevalence, risk factors, and clinical impact of CDI in hospitalised COVID-19 patients at a tertiary Romanian infectious diseases centre, with a specific focus on cardiovascular disease and modifiable antimicrobial-prescribing factors. Methods: This single-centre retrospective observational cohort study enrolled 395 consecutive adult patients hospitalised with SARS-CoV-2 infection confirmed by reverse transcription polymerase chain reaction (RT-PCR) at the “Victor Babeș” Clinical Hospital for Infectious Diseases and Pneumophthisiology, Timișoara, Romania, between 1 March 2020 and 31 December 2024. Patients were stratified into a CDI group (n = 24) and a non-CDI group (n = 371) on the basis of hospital-onset CDI. Demographic, clinical, laboratory, therapeutic, and outcome variables were extracted from electronic medical records. Continuous variables were compared using Student’s independent-samples t-test, categorical variables using Fisher’s exact test; odds ratios (ORs) with exact 95% confidence intervals (CIs) were computed for all binary comparisons, and a parsimonious multivariable logistic regression was used to adjust the antibiotic-exposure effect for age. Temporal relationships between CDI onset and sepsis documentation were also analysed. A two-sided p-value < 0.05 was considered statistically significant. Results: CDI was identified in 24 patients (prevalence 6.1%). The CDI and non-CDI groups were comparable in age (71.1 ± 10.2 vs. 71.7 ± 11.4 years; p = 0.817), sex distribution (50.0% vs. 45.8% female; p = 0.833), and vaccination status (p = 0.383). Heart failure prevalence did not differ between groups (29.2% vs. 26.7%; OR 1.13, 95% CI 0.46–2.81; p = 0.813). Any antibiotic therapy was strongly associated with CDI (95.8% vs. 70.6%; OR 9.57, 95% CI 1.28–71.74; p = 0.004), as was longer duration of antibiotic therapy (8.1 ± 2.2 vs. 5.2 ± 3.7 days; p < 0.001). In the multivariable model, each additional day of antibiotic therapy was independently associated with a 13.6% increase in the odds of CDI (adjusted OR 1.14 per day, 95% CI 1.03–1.26; p = 0.013) after adjustment for age. Piperacillin/tazobactam accounted for 65.2% (15/23) of the recorded pre-CDI broad-spectrum antibiotic regimens among antibiotic-exposed CDI patients. Documented sepsis was substantially more frequent in CDI patients (95.8% vs. 15.4%; p < 0.001) and length of hospitalisation was prolonged (15.6 ± 8.2 vs. 12.0 ± 8.1 days; p = 0.038). In-hospital mortality did not differ significantly (4.2% vs. 7.5%; p = 1.000). Conclusions: Hospital-onset CDI complicated 6.1% of hospitalised COVID-19 admissions and was independently associated with the cumulative duration of antibiotic therapy. Heart failure was not significantly associated with CDI in this cohort; however, given the limited number of CDI events, this should be interpreted as absence of evidence rather than evidence of absence. CDI was also associated with prolonged hospitalisation and high co-occurrence of documented sepsis, although causality cannot be inferred from the retrospective design. These findings support strengthened antibiotic stewardship and targeted CDI surveillance in COVID-19 inpatient wards. Full article

Background: Hip fractures are a major cause of morbidity and healthcare utilization among elderly patients. Early surgical intervention has been associated with improved postoperative outcomes; however, the effect of surgical timing on hospital length of stay (LOS) remains debated, especially in the Middle Eastern region. This study aimed to evaluate the impact of surgical timing on LOS and postoperative outcomes among elderly patients undergoing hip fracture surgery. Methods: A retrospective cohort study was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia. Patients aged ≥ 60 years who underwent surgical management for proximal femur fractures between May 2019 and May 2025 were included. Surgical timing was categorized as early (<48 h from admission) or delayed (≥48 h). The primary outcome was hospital LOS. Secondary outcomes included ICU admission, venous thromboembolism (VTE), respiratory infection, periprosthetic infection, and one-year mortality. Kaplan–Meier survival analysis and Cox proportional hazards modeling were used to assess time to hospital discharge. Relative risks (RR) with 95% confidence intervals (CI) were calculated for postoperative outcomes. Results: A total of 179 patients were included, of whom 100 (55.9%) underwent early surgery, and 79 (44.1%) underwent delayed surgery. The median LOS was significantly shorter in the early surgery group compared with the delayed surgery group (7 days [95% CI: 6–7] vs. 11.5 days [95% CI: 9–14]; log-rank p < 0.001). After adjustment for comorbidities, surgical factors, and pre-hospital delay, early surgery remained independently associated with earlier discharge (hazard ratio 2.17, 95% CI 1.55–3.04; p < 0.001). ICU admission occurred less frequently in the early surgery group (6.0%) compared with the delayed surgery group (17.7%) (RR 0.34, 95% CI 0.14–0.83; p = 0.013). No significant differences were observed in VTE, respiratory infection, periprosthetic infection, or one-year mortality between groups. Conclusions: Surgery performed within 48 h of admission was associated with significantly shorter hospital LOS and lower ICU admission rates among elderly patients undergoing hip fracture surgery. These findings highlight the importance of timely surgical intervention to improve perioperative efficiency and hospital resource utilization. Full article

Backgroud: Pathologies of the trachea and large bronchi are a heterogeneous group of rare structural disorders of the airway wall that are frequently underdiagnosed because their symptoms overlap with common respiratory diseases. Methods: We present three patients with chronic cough and dyspnea lasting approximately three years who had previously received multiple incorrect diagnoses, including COPD, asthma, gastroesophageal reflux, and acute bronchitis. Case Description: Following hospitalization for acute respiratory failure, comprehensive differential diagnostic workups revealed Mounier–Kuhn syndrome (tracheobronchomegaly) in Case 1, idiopathic tracheobronchomalacia in Case 2, and tracheobronchopathia osteochondroplastica in Case 3. Tracheobronchomegaly involves marked dilatation of the trachea and main bronchi; tracheobronchomalacia is characterized by expiratory airway collapse due to loss of cartilage stability; and tracheobronchopathia osteochondroplastica is a disease of unknown etiology featuring abnormal submucosal chondrification and ossification with luminal obstruction. All three impair mucociliary clearance and predispose to recurrent infections and progressive respiratory dysfunction. Conclusions: Through these cases we underscore the diagnostic challenges, characteristic radiological findings, and diverse management strategies of these conditions, emphasizing the critical need to consider tracheobronchial anomalies in patients with chronic respiratory symptoms and the key role of computed tomography in establishing an accurate diagnosis. Full article

Respiratory syncytial virus (RSV) and human metapneumovirus (hMPV), members of the family Pneumoviridae, represent a foremost global cause of acute lower respiratory tract infection in infants, young children, the elderly, and immunocompromised individuals. Despite the recent approval of preventive vaccines and monoclonal antibody prophylactics targeting the viral fusion protein, no widely adopted, RSV-specific direct-acting antiviral is currently approved for routine post-infection treatment. The large (L) protein of the viral RNA polymerase complex, which catalyzes genome replication and mRNA transcription in concert with its obligate cofactor, the phosphoprotein (P), constitutes an ideal drug target owing to its essential and multifunctional enzymatic activities and its absence from host cells. Over the past decade, Cryo-electron microscopy (Cryo-EM) has yielded a series of landmark structures of Pneumoviridae L–P complexes, including apo forms of RSV (at 3.2–3.67 Å) and hMPV (at 3.7 Å) polymerases, among the first promoter-bound non-segmented negative-sense (nsNSV) RNA virus polymerase structures (at 3.40–3.41 Å), and inhibitor-bound complexes that illuminate the molecular basis of non-nucleoside inhibitor (NNI) action at sub-nanomolar potency. This review synthesizes the structural biology of Pneumoviridae RNA polymerases from a chronological and mechanistic perspective, compares RSV and hMPV L protein active sites at near-atomic resolution, and critically evaluates how structural insights are being translated into next-generation antiviral drug candidates, including nucleoside analog inhibitors, allosteric non-nucleoside inhibitors, and emerging candidates at various stages of preclinical and clinical investigation. Full article

Object: Postoperative infection is a severe complication after pediatric cardiac surgery, which is closely associated with sepsis, multiple organ dysfunction, prolonged mechanical ventilation, extended ICU stay and increased mortality. Conventional microbiological tests (CMT) are limited by low sensitivity, long turnaround time, and poor capacity for detecting viruses and polymicrobial infections. This study aimed to compare the diagnostic efficacy of mNGS with that of CMT, and to explore the impact of polymicrobial infection on clinical outcomes in this high-risk pediatric population. Methods: A retrospective cohort study was conducted on 4889 pediatric patients admitted to the PICU after cardiac surgery from January 2025 to March 2026. A total of 510 patients were diagnosed with postoperative infections, including 879 CMT specimens and 86 mNGS specimens enrolled for analysis. Pathogen detection rates, pathogen spectrum and antimicrobial resistance profiles were compared between the two detection methods. Clinical prognostic indicators including mechanical ventilation duration, PICU length of stay and the requirement for continuous renal replacement therapy (CRRT) were further compared between patients with polymicrobial infection and monomicrobial infection. Results: Respiratory tract infection accounted for 87.8% of all postoperative infections, and Gram-negative bacteria were the predominant pathogens, accounting for 65.9%. The overall pathogen detection rate of mNGS was significantly higher than that of CMT (79.1% vs. 56.5%, p < 0.001). Notably, mNGS exhibited significantly better performance in detecting viruses (37.2% vs. 5.8%, p < 0.001), anaerobic pathogens and polymicrobial infections (38.2% vs. 5.4%, p < 0.001). Patients with polymicrobial infections had significantly longer mechanical ventilation time, longer PICU stay, and higher CRRT utilization rate (all p < 0.05), indicating a poorer clinical prognosis. Gram-negative bacteria showed high resistance to penicillins and early-generation cephalosporins, but remained susceptible to carbapenems and β-lactamase inhibitor combination agents. Gram-positive bacteria showed a high resistance rate to penicillin, while maintaining 100% susceptibility to vancomycin and linezolid. Conclusions: mNGS serves as a more sensitive and comprehensive tool for pathogen detection in children with post-cardiac surgery infections, especially for viral and polymicrobial infections. Polymicrobial infection is an independent risk factor for adverse clinical outcomes. Routine application of mNGS in critically ill children may help guide targeted antimicrobial therapy and improve prognosis. Full article

COVID-19, influenza, and respiratory syncytial virus are leading causes of severe acute respiratory infection (SARI). As viral dynamics shift post-pandemic, comparing their clinical profiles is essential for optimizing management and vaccination strategies. We conducted a retrospective observational study of adults hospitalized with PCR-confirmed COVID-19, influenza, or RSV over three consecutive seasons (2021–2024). We compared clinical features, comorbidities and outcomes, including mortality, intubation rates and respiratory deterioration. Multivariable analyses were performed where virus was the independent variable and respiratory deterioration, intubation rate and mortality, Charlson Comorbidity Index, smoking status and pneumonia were co-variates. 263 patients were analyzed. Key findings revealed distinct clinical profiles: influenza patients were significantly younger, while COVID-19 was the predominant cause of viral pneumonia. RSV patients presented with the most severe oxygenation deficit upon admission and experienced the highest rate of respiratory deterioration (28%). Logistic regression analyses demonstrated that pneumonia [OR 2.81, 95% Confidence Interval (CI): 1.23–6.43, p = 0.01] and RSV (OR 2.8, 95% CI: 1.16–6.63, p = 0.02) were independently associated with respiratory deterioration. Similarly, pneumonia (OR 4.86, 95%CI: 1.62–17.36, p < 0.01] and RSV (OR 4.67, 95%CI: 1.5–14.34, p < 0.01) were independently associated with high risk of intubation. Among patients hospitalized because of COVID-19, RSV and Influenza, pneumonia and RSV were linked with respiratory deterioration and increased risk of intubation but not with death. Full article

Background: Antibiotic-associated gut dysbiosis affects lung health and contributes to disease progression, but the individual response to antibiotics, which leads to host-specific reactions to the same respiratory insult, is not fully understood. Methods: Before infection with Aspergillus fumigatus, Albino Oxford (AO) and Dark Agouti (DA) rats received a mixture of antibiotics with poor systemic absorption to induce microbial perturbation only in the gut, and lung and gut tissue and colonic contents were analyzed. Results: Treatment with antibiotics induced gut inflammation in both rat strains, which was more pronounced in AO rats, and a disturbance in lung immunity was observed only in DA rats. Antibiotic-associated gut microbiota disturbance revealed rat strain-specific bacterial profiles (increased Gammaproteobacteria in DA and decreased Coriobacteriia in AO rats). Although gut dysbiosis increased the risk of lung A. fumigatus infection in both rat strains, a higher fungal burden was detected in the lungs of AO rats, whereas lymph node cell activation and lung tissue inflammation were observed in DA rats. Conclusions: Rat strain differences in response to antibiotic- and/or infection-induced gut dysbiosis suggest that basal gut microbiota may influence the lung immune response during A. fumigatus disease, highlighting the importance of the interplay of genotype-specific host gut microbial community with the environmental constraints in shaping individual immune makeup. Full article

Chikungunya virus (CHIKV), traditionally recognized as a mosquito-borne alphavirus that causes febrile illness and debilitating arthralgia, has increasingly been associated with atypical organ involvement, including respiratory manifestations. These observations raise important questions regarding whether respiratory symptoms reflect severe systemic disease or signal previously underappreciated respiratory exposure routes. This review aimed to synthesize current evidence on respiratory complications of CHIKV infection and to evaluate the plausibility of respiratory or aerosol-associated transmission. A systematic literature search of PubMed, EMBASE, and MEDLINE (Ovid) identified five eligible studies spanning clinical virology, outbreak surveillance, epidemiology, and experimental aerosol models. Across human studies conducted in India, Réunion Island, Puerto Rico, and Brazil, respiratory presentations—including pneumonia, dyspnea, and respiratory failure—were uncommon but consistently associated with increased hospitalization and mortality risk. Respiratory symptoms generally arose in the context of respiratory viral coinfections, systemic inflammation, or cardiopulmonary decompensation rather than primary viral tropism for the respiratory tract. Only one non-human primate study directly evaluated aerosol exposure, demonstrating that cynomolgus macaques could be infected via inhaled CHIKV, confirming biological plausibility but showing no evidence of enhanced respiratory pathology. Importantly, no epidemiologic data support human-to-human airborne or droplet transmission. Collectively, available evidence indicates that respiratory involvement serves as a marker of disease severity rather than a transmission route. Nonetheless, rare aerosol-acquisition events in laboratory settings underscore the need for continued vigilance, strengthened surveillance, and re-evaluation of respiratory risks as climate change and viral evolution expand CHIKV’s global footprint. Full article

Recombinase polymerase amplification (RPA) has become a central amplification strategy for decentralized molecular diagnostics because it operates rapidly at mild temperatures and requires far less thermal control than PCR. Its analytical value increases substantially when paired with microfluidic and paper-based platforms, where sample handling, reagent delivery, amplification, and signal readout can be organized within compact, low-power, and field-compatible formats. This review examines recent progress in microfluidic and paper-based RPA systems across biomedical diagnostics, food safety testing, environmental monitoring, and One Health biosurveillance. Particular attention is given to integrated device architectures, including centrifugal chips, capillary-driven platforms, microfluidic paper-based analysis devices (μPADs), electrochemical biosensors, CRISPR-assisted assays, digital microfluidic systems, and sample-to-answer cartridges. Biomedical applications now span respiratory viruses, reproductive and emerging infections, bacterial and parasitic diseases, pharmacogenomic markers, and cancer-related biomarkers. RPA-enabled platforms are moving steadily into food safety and environmental surveillance, covering pathogen detection, seafood and dairy monitoring, agricultural disease control, antimicrobial-resistance tracking, and airborne pathogen screening. At the same time, the field is shifting toward more intelligent diagnostic formats. Smartphone imaging, artificial intelligence (AI)-assisted interpretation, digital partitioning, cloud connectivity, and automated quality control are increasingly being built into rapid testing workflows, giving these systems greater portability, consistency, and decision-making value. Despite this progress, practical deployment still depends on robust sample preparation, multiplex stability, quantitative reliability, reagent storage, scalable fabrication, and regulatory validation. Continued convergence of RPA chemistry with microfluidics, paper devices, CRISPR recognition, electrochemical readout, and data-assisted interpretation is expected to support more robust and accessible molecular diagnostic workflows. Full article

Background/Objectives: Antimicrobial resistance (AMR) in companion animals is an increasing concern within the One Health framework, particularly regarding opportunistic pathogens such as Klebsiella spp. This retrospective study evaluated the epidemiology, antimicrobial susceptibility profiles, and temporal resistance trends of Klebsiella spp. infections in dogs and cats across the Iberian Peninsula. Methods: A total of 809 clinical isolates collected between 2016 and 2024 and submitted to a private diagnostic laboratory in Barcelona were analysed. Results: Klebsiella pneumoniae was the predominant species (70%), more frequently identified in cats (76%) than in dogs (68%). Dermatological and respiratory samples exhibited the highest prevalence of multidrug-resistant (MDR) isolates. Overall MDR prevalence was high, particularly in cats (51.1%; 95% CI 41.1–60.9%) compared with dogs (38.4%; 95% CI 34.1–42.8%) although it was not statistically significant. K. pneumoniae generally exhibited higher resistance rates than K. oxytoca, particularly to amoxicillin/clavulanic acid, first-/second-generation cephalosporins, third-/fourth-generation cephalosporins (3/4th GC), fluoroquinolones, and tetracyclines. In both bacterial species, resistance rates were consistently higher among feline isolates. In contrast, aminoglycosides and phenicols retained high activity against most isolates. Temporal analysis revealed a significant increasing resistance trend to amoxicillin/clavulanic acid, which is particularly concerning given the widespread use of this antimicrobial as a first-line treatment in small animal practice. However, resistance trend to aminoglycosides showed a significant decline. No significant temporal changes were detected for 3/4th GC and fluoroquinolones, suggesting the persistence of resistant populations within companion animals. Resistance to aminoglycosides and phenicols remained comparatively low in this study. Whereas critically important category B antimicrobials, such as 3/4th GC and fluoroquinolones, exhibited low to moderate effectiveness, raising concerns about their empirical use. Conclusions: These findings highlight the substantial AMR and MDR burden of K. pneumoniae in companion animals in the Iberian Peninsula and reinforce the need for prudent antimicrobial use, routine susceptibility testing, and integrated One Health surveillance strategies. Full article

Cardiac tamponade in pregnancy is an exceptional maternal–fetal emergency in which physiological tachycardia, hypervolaemia and dependent oedema mask the classical signs of tamponade. Corynebacterium amycolatum is a non-diphtherial, Gram-positive coryneform commensal of human skin and mucosa that is increasingly recognised as a true invasive pathogen, although pericardial infection has rarely, if ever, been reported. We aimed to describe the diagnostic and decompression strategy in such a case. We report a 29-year-old woman at 30 + 4 weeks of gestation with class III obesity (pre-pregnancy body mass index 36 kg/m²), pregnancy-induced hypertension and diet-controlled type 2 diabetes referred after a routine echocardiogram suggested tamponade despite preserved haemodynamic compensation. Transthoracic echocardiography demonstrated a large circumferential pericardial effusion with diastolic right-atrial and right-ventricular collapse, a plethoric inferior vena cava and respiratory mitral-inflow variation. Severe maternal obesity superimposed on advanced gestation degraded the acoustic windows, elevated the diaphragm, displaced the heart anteriorly and brought the gravid uterus into the subxiphoid corridor, rendering percutaneous pericardiocentesis prohibitively hazardous. After multidisciplinary heart-team review, a left anterior mini-thoracotomy with pleuro-pericardial window evacuated approximately 1000 mL of fluid. Aerobic culture yielded C. amycolatum (MALDI-TOF), with histological pericarditis and a consistent antibiogram; autoimmune, viral and neoplastic causes were excluded, although blood cultures and extended viral testing were not performed. Targeted intravenous cefazolin was given, and the patient delivered a healthy term neonate at 39 weeks, with a normal 7-month echocardiogram. To the best of our knowledge, this is among the first reported cases of C. amycolatum pericardial tamponade in pregnancy. Because blood cultures and molecular confirmation of pericardial involvement were not obtained, a contaminant or incidental role for the organism cannot be entirely excluded, and the causal attribution should be regarded as probable rather than definitive. The case highlights heart-team-based individualised decompression and the cautious microbiological interpretation of organisms traditionally regarded as commensals. Full article

Background/Objectives: Dry powder inhalation (DPI) is a promising strategy for the treatment of respiratory diseases such as cystic fibrosis (CF), where thick and viscous mucus limits drug penetration and contributes to persistent infection and inflammation. Although inhalation allows rapid drug action with reduced systemic exposure, its efficacy depends on the ability of inhaled drugs to achieve and maintain therapeutic concentrations in the lungs and to overcome airway barriers. This study aimed to develop and characterize effervescent dry powder formulations designed to enhance mucus permeabilization through mechanical disruption while delivering an antibiotic. Methods: Effervescent microparticles containing sodium bicarbonate, an organic acid (citric or tartaric acid), and levofloxacin were produced by spray drying using a triple-fluid nozzle to control component distribution and prevent premature effervescence. The influence of functional excipients, including L-leucine and mannitol, on particle formation, aerosol performance, and process yield was evaluated. Microparticles were characterized in terms of morphology, fine particle fraction (FPF), and effervescence-related properties. Results: Formulations containing L-leucine and citric acid reduced particle agglomeration and achieved a fine particle fraction of up to approximately 18%, although with a lower process yield. In contrast, formulations based on tartaric acid and mannitol improved both production yield and aerosol performance, with FPF values increasing up to 27.3% and more efficient CO₂ release. The resulting microparticles exhibited spherical, hollow, and partially fragmented morphology, consistent with premature CO₂ generation during spray drying. Conclusions: The effervescent approach, combined with controlled spray drying parameters, represents a promising formulation strategy to modulate particle behavior and drug release in mucus-relevant environments. These findings support further investigation of effervescent DPI systems for improved pulmonary drug delivery in CF. Full article