Search Results (3,347)

Acid sphingomyelinase deficiency (ASMD) is an autosomal recessive lysosomal storage disorder caused by mutations in the SMPD1 gene, resulting in sphingomyelin accumulation. With a birth prevalence of 0.25–0.6 per 100,000, it is more prevalent in Ashkenazi Jewish and Middle Eastern populations. The disease features a clinical spectrum ranging from severe, early-onset neurodegeneration (infantile neurovisceral ASMD) to chronic, non-neurological visceral involvement (chronic visceral ASMD) and intermediate forms (chronic neurovisceral ASMD). The chronic visceral form is characterized by liver dysfunction, respiratory symptoms, and hepatosplenomegaly, which can lead to secondary thrombocytopenia. The majority of patients exhibit thrombocytopenia and/or mild bleeding manifestations, most commonly easy bruising and epistaxis, whereas clinically significant bleeding events, including gastrointestinal or variceal hemorrhage, occur less frequently. Systematic platelet-function studies in patients with ASMD are currently lacking. Evidence retrieved from biological models indicates that ASMD contributes to platelet dysfunction, including impaired secretion and thrombin generation, mediated by complex pathological mechanisms. These findings underscore the importance of hematological monitoring and further research in patients with this condition and could potentially offer new therapeutic possibilities. Full article

Caused by the SARS-CoV-2 virus, the COVID-19 pandemic is still considered a complex challenge, with manifestations not only of respiratory issues, but also conditions related to chronic cerebrovascular damage. Endothelial biomarkers, neuropathological and neuroimaging findings indicate endothelial dysfunction, microthrombosis, and disruption of the blood–brain barrier (BBB) are central mechanisms for acute and chronic ischemic and hemorrhagic cerebral events. Understanding these mechanisms is vital to reducing their impact on population health, whether through treatment or prevention of adverse outcomes. The objective of this study is to perform a review of the scientific literature on the post-infection effects of SARS-CoV-2 affecting the cerebral endothelium and the BBB, correlating them with potential clinical outcomes. Material and Methods: Analysis of studies extracted from the PubMed database using the following terms: Long-COVID “AND” SARS-CoV-2 “AND” blood–brain barrier. Inclusion criteria: keywords, publications related to the topic, and primary studies published after peer review. Exclusion criteria: preprint studies, publication outside of the timeframe 2020–2025, study design not compatible with this research, and full text not available. Results: An initial 121 studies were identified, of which 105 were excluded due to not meeting all inclusion criteria and 6 studies were inaccessible due to not being in the English language and full-text access limitations. Fifteen articles were included in the analysis, for topics as expression of viral receptors in the endothelium, markers of their activation, cerebral microvascular injury and coagulopathies. To clarify the pathogenic cascade, the evidence was stratified by biological model where in vitro evidence demonstrates that the Spike protein induces direct endothelial toxicity and platelet aggregation, establishing the primary molecular insult. Animal models confirm the translation of this insult into structural degradation of the BBB and pericyte loss. Clinically, infection-phase findings, characterized by multifocal microthrombosis and permeability spikes, act as the determining event that predisposes to the persistent neuroinflammatory environment. Biomarkers of BBB disruption and neuronal damage were consistently reported, with persistence of BBB dysfunction modifying risk stratification and rehabilitation efforts. Reported cases of Long-COVID demonstrated normalization of BBB markers without correlation with long-term symptoms, suggesting that other mechanisms are involved in Long-COVID. Conclusion: Cerebral endotheliopathies and BBB dysfunction in patients with COVID-19 continue to impact the health of the population. The scientific literature indicates that SARS-CoV-2 induces cerebral endothelial injury, BBB disruption, and an increased risk of vascular events related to endotheliopathy, inflammation, and hypercoagulability. Understanding the impact of COVID-19 pathology on the population and developing prospective studies is essential to quantify the prevalence and mechanisms of brain injury. The identification of molecular targets and infection pathways are promising toward defining both preventive and therapeutic strategies to improve outcomes in the Long-COVID population. Full article

Background: Atopic dermatitis (AD) and asthma are common type 2 inflammatory diseases linked by the atopic march. In adults with AD, the prevalence of comorbid asthma and the strength of the AD–asthma association remain uncertain, with marked heterogeneity across studies. Moreover, the role of modern systemic therapies in this comorbidity is increasingly debated. Objective: To estimate the global pooled prevalence of asthma in adults with AD, quantify the AD–asthma association, and discuss the potential impact of targeted therapies (dupilumab, abrocitinib, omalizumab) on asthma comorbidity. Methods: Systematic review and random-effects meta-analysis (ID CRD420261304804) of observational studies from PubMed, EMBASE, and Cochrane Library (inception to 19 January 2026). Pooled prevalence and odds ratios (ORs) were calculated, with subgroup analyses by region, ethnicity, and disease definition. Results: Seventy-five studies were included. The global pooled prevalence of asthma in adults with AD was 25.9% (95% CI 22.1–30.0%; I² = 99.9%). AD was significantly associated with asthma (OR 3.64, 95% CI 2.89–4.57; I² = 98.6%). Prevalence varied from 9.3% in Asia to 63.2% in South America. Although dupilumab and other targeted agents are effective in both diseases, isolated reports of new-onset asthma after treatment were identified; these cases more likely reflect the natural progression of AD or unmasking of pre-existing asthma than a direct adverse drug reaction. Conclusions: Asthma is highly prevalent in adults with AD and is strongly associated with AD. Geographic and ethnic disparities call for stratified screening. Clinicians should be aware that new-onset respiratory symptoms during targeted therapy may represent AD-related comorbidity rather than drug-induced asthma. Full article

Background: Post-acute sequelae of COVID-19 (PASC), commonly known as long COVID, affects an estimated 10–30% of SARS-CoV-2 non-hospitalised and 50–70% of hospitalised survivors. This condition remains clinically heterogeneous, and the specific mechanisms driving the transition from acute infection to chronic sequelae remain poorly understood. We assessed independent risk factors, tracked the evolution of clinical features, defined distinct symptom-based phenotypes, and assessed the impact of different pandemic waves on the likelihood of developing long COVID in hospitalised survivors. Methods: We conducted a single-centre, retrospective cohort study at a university hospital in London. The population comprised 627 adults hospitalised with acute COVID-19 between February 2020 and December 2022. Baseline characteristics and outcomes were compared between long COVID and resolved cases using appropriate statistical tests for continuous and categorical variables. Multivariable logistic regression identified risk factors. McNemar’s test quantified the phenotypic shift from admission to follow-up. Latent Class Analysis (LCA) identified clinical subtypes based on symptom clusters. Results: Of 627 patients, 252 (40.2%) met long COVID criteria. Comorbidity burden was the strongest predictor; patients with a single condition had a 4-fold increase in odds (aOR 4.62, 95% CI 2.36–9.04). The ORs were also significantly elevated among patients with 2 (aOR 3.26), 3 (aOR 2.68), or 4 or more (aOR 3.24) comorbidities. Older age (aOR 1.04), acute disease severity (measured by length of hospital stay) (aOR 1.27 per log-day) and elevated admission fibrinogen (aOR 1.21 per g/L) were significant predictors. Temporal analysis revealed a precipitous decline in risk from Wild-type/Alpha (>50%) to Delta/Omicron (<21%). We observed a distinct phenotypic shift: while acute respiratory inflammation resolved, systemic fatigue increased fourfold (7.0% to 32.4%), and memory difficulties emerged in the post-acute phase. LCA identified two phenotypes: fatigue-dominant and multisystem phenotypes. Conclusions: Long COVID is a multifactorial syndrome driven by host susceptibility, acute severity, and persistent coagulopathy. Clinical management should move beyond a monolithic approach and favour phenotype-specific strategies. Full article

Background and Clinical Significance: Foreign body aspiration is an important cause of morbidity and mortality in children younger than three years of age. Although laryngeal foreign bodies are uncommon, they may be life-threatening and are frequently misdiagnosed because of their variable clinical presentation. Eggshell aspiration is exceptionally rare, with only a few cases reported in the literature. We report a case of delayed diagnosis of a glottic eggshell foreign body in a toddler presenting with persistent upper airway symptoms. Case Presentation: A 16-month-old previously healthy girl was referred to our hospital for evaluation of persistent hoarseness and barking cough following a witnessed choking episode while eating boiled egg. The choking episode had occurred 15 days before presentation during an episode of viral upper respiratory tract infection. Initial symptoms were attributed to laryngitis and persisted despite medical treatment. Flexible laryngoscopy revealed a foreign body impacted at the glottic level, while neck radiography demonstrated a radiopaque calcified lesion corresponding to the foreign body. Microlaryngoscopy under deep sedation was performed, and an approximately 10-mm eggshell fragment was successfully removed. A small amount of granulation tissue was observed at the posterior commissure, corresponding to the site of foreign body impaction. The postoperative course was uneventful, and repeat endoscopic examination on postoperative day three demonstrated satisfactory laryngeal healing with regression of the granulation tissue. Conclusions: This case highlights the importance of considering a retained laryngeal foreign body in young children with persistent hoarseness or barking cough following a choking episode, even in the presence of concomitant respiratory infection. Early endoscopic evaluation is essential to avoid diagnostic delay and facilitate prompt treatment. In addition, this report emphasizes the importance of food choking prevention and caregiver education in children younger than three years of age. Full article

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is an idiopathic, multisystem disorder marked by debilitating fatigue, post-exertional malaise, cognitive dysfunction and neuroinflammation. Its etiology remains unclear, yet emerging evidence implicates a complex interplay between immune dysregulation, metabolic impairment, mitochondrial bioenergetics, and environmental stressors such as viral infection or low-dose ionizing radiation (LDIR). To develop treatments for ME/CFS, it is essential to identify suitable targets for therapy. In this narrative review, we discuss recent findings on the overlap of ME/CFS with LDIR effects and examine potential mechanistic links that may arise from LDIR-induced bystander effects (RIBEs). We highlight potential candidate biomarkers that bridge these domains: mitochondrial respiratory dysfunction, altered ornithine transport via SLC25A15 (ORNT1), possible roles of CD38 in the context of immunity and NAD+ depletion, cyclin D1–dependent metabolic reprogramming and modulation of gene expression, and α-synuclein as a potential neuroinflammatory damage-associated molecular pattern (DAMP). While the involvement of these biomarkers in ME/CFS is yet to be confirmed experimentally, evidence from in vitro studies of irradiated cells, exosome profiling, and patient samples suggests that RIBEs can, in theory, produce prominent cellular ME/CFS phenotypes through associated mechanisms, including those exhibiting oxidative stress, impaired ATP production, and immune modulation. We propose a hypothetical, exploratory model wherein LDIR initiates or contributes to adaptive metabolic shifts (including CD38 upregulation and cyclin D1 stabilization) that, coupled with persistent bystander signaling, could potentially culminate in chronic fatigue and neurocognitive symptoms in some reported ME/CFS cases. Finally, we outline a research agenda encompassing the establishment of standardized diagnostic criteria, multi-omics profiling of patient cohorts, exosome analysis, functional mitochondrial assays, and targeted therapeutic trials focusing on possible anti-CD38 antibodies and NAD+ precursor therapy. By integrating recent findings in low-dose radiation biology with ME/CFS pathophysiology, this review aims to promote interdisciplinary investigations that may uncover mechanistic insights and novel biomarkers for diagnosis and treatment of ME/CFS. We further review steps in a proposed model taking us from low-dose radiation exposure to a number of possible targets. Full article

Tuberculosis (TB) remains a major global health challenge, compounded by rising drug resistance. Traditional medicinal plants used for TB-related symptoms represent a valuable yet underexplored source of potential antimycobacterial agents. In this study, the phytochemical content and biological activities of Dombeya rotundifolia and Lippia javanica were evaluated, and antimycobacterial compounds were isolated through bioassay-guided fractionation. Plant leaves were collected, extracted with solvents of varying polarity, and screened for phenolics and flavonoids. Antioxidant activity was assessed using DPPH and ferric reducing power assays, antimycobacterial activity was tested against Mycobacterium smegmatis, anti-inflammatory activity was determined by the egg albumin denaturation method, and cytotoxicity was evaluated in THP-1 cells using the MTT assay. Extraction yields varied, with water extracts of L. javanica showing the highest yield and hexane extracts of D. rotundifolia the lowest. Both plants contained bioactive phytochemicals with measurable antioxidant activity, while acetone and dichloromethane extracts of D. rotundifolia displayed the strongest antimycobacterial activity with MIC values of 0.16 mg/mL. Cytotoxicity assays indicated moderate toxicity at higher extract concentrations. Bioassay-guided isolation led to the identification of two fatty acid fractions with tentative characterization, which showed notable antimycobacterial activity (MIC 0.25 mg/mL). These findings provide preliminary support for the ethnomedicinal use of D. rotundifolia in respiratory conditions traditionally associated with tuberculosis and suggest a potential contribution of its fatty acids to its observed antimycobacterial activity. Full article

Background: Despite normal lung imaging and preserved pulmonary and cardiac function, many patients with long COVID continue to experience persistent respiratory symptoms. This study aimed to quantify the pulmonary blood and airway volumes in patients with long COVID compared with healthy controls and to evaluate the associations of COVID-19 vaccination with these imaging parameters. Methods: Patients with long COVID presenting with persistent respiratory symptoms despite normal laboratory findings, pulmonary function tests, chest radiography, and chest computed tomography (CT) were prospectively enrolled. CT datasets were analyzed using functional respiratory imaging (FRI), incorporating the three-dimensional reconstruction and automated segmentation of the lungs, airways, and pulmonary vasculature. Quantitative imaging parameters were compared with those of historical healthy controls from the COPDGene study, matched for age, sex, body mass index, comorbidities, and pulmonary function test parameters. Results: Thirty patients with long COVID (mean 221 ± 128 days after confirmed SARS-CoV-2 infection) and 30 matched healthy controls were included. Compared with controls, patients with long COVID demonstrated significantly lower pulmonary blood volumes in small and large pulmonary vessels, together with significantly reduced intrapulmonary airway volumes. Within the long COVID cohort, full COVID-19 vaccination was associated with a significantly greater small-vessel pulmonary blood volume and lobar airway volume compared with non-vaccinated individuals. Conclusions: These findings indicate that patients with long COVID exhibit persistent reductions in pulmonary blood and airway volumes despite normal conventional imaging and pulmonary function tests, suggesting the presence of subtle microvascular and small-airway abnormalities that may contribute to ongoing respiratory symptoms. The association between full COVID-19 vaccination and higher small-vessel pulmonary blood and lobar airway volumes suggests a potential protective effect on pulmonary structure and function; however, these findings require confirmation in larger, prospective controlled studies. Full article

Background/Objectives: Respiratory infections are a major cause of morbidity and mortality among older adults. However, vaccination coverage against respiratory pathogens remains suboptimal, particularly in rural and vulnerable populations. This study aimed to identify factors associated with respiratory vaccination uptake among older adults living in rural Amazonian communities in Peru. Methods: We conducted an observational, analytical, cross-sectional study using secondary data from the Amazon Frail Project. A total of 429 adults aged ≥60 years from rural and suburban communities in San Martín, Loreto, and Ucayali were included. Vaccination coverage for influenza, pneumococcal disease, pertussis, and COVID-19, as well as vaccine combinations, was assessed. Multiple linear and Poisson regression models with robust variance were used to identify associated factors. Results: Complete vaccination coverage was 42.89% for influenza, 23.08% for pneumococcal disease, 4.43% for pertussis, and 70.16% for COVID-19. Only 3.50% of participants had received all four respiratory vaccines. Higher educational attainment, multimorbidity, social frailty, greater muscle mass, better physical performance, and healthcare center attendance were associated with higher vaccination uptake. Depressive symptoms, cognitive impairment, functional dependency, physical frailty, dynapenia, and higher body mass index were associated with lower vaccination uptake. Conclusions: Respiratory vaccination coverage was suboptimal among older adults living in rural Amazonian communities. Educational, functional, physical, social, and healthcare access factors significantly influenced vaccine uptake, highlighting the need for targeted immunization strategies in vulnerable rural populations. Full article

Coronaviruses (family Coronaviridae) are enveloped, positive-sense, single-stranded RNA viruses with broad host adaptability. They transmit across species among humans, livestock, companion animals, and wildlife, eliciting a disease spectrum ranging from mild respiratory and gastrointestinal symptoms to fatal multi-organ failure, thereby posing significant challenges to global health. In this context, drug repurposing has emerged as a practical strategy for rapidly identifying broad-spectrum antivirals against emerging and re-emerging coronaviruses. Using coronaviruses as a paradigm, this review systematically summarizes research advances and mechanistic insights into the repurposing of existing drugs against coronaviruses. Simultaneously, we dissect core challenges including species-specific pharmacokinetic disparities, insufficient inter-genera conservation of viral targets, and systemic barriers between human and veterinary drug regulatory frameworks and propose innovative solutions encompassing AI-driven cross-species drug prediction, next-generation cross-species infection models, and a “human-veterinary dual-track” collaborative research and development system. Collectively, this review highlights the promise of drug repurposing as a broad-spectrum antiviral strategy and provides a translational perspective for the development of cross-species anti-coronavirus therapeutics. Full article

Background: Migrant agricultural workers in Italy often experience social and health vulnerabilities, including unstable housing and limited access to primary care. In Southern Italy, many live in informal settlements and seek care through outreach services. This study describes patterns of pharmacological treatment in this population and examines how they relate to the clinical conditions managed in mobile clinics. Methods: We analyzed routinely collected data from 2928 unique patients (8547 clinical encounters; 8965 treatment occurrences) managed by Doctors with Africa CUAMM mobile clinics in 12 informal settlements in Apulia, Italy, between 2017 and 2026. Diagnoses were grouped into clinical categories, and pharmacological treatments were classified by therapeutic class. We conducted a descriptive analysis of the distribution of diagnostic categories and associated treatments. Results: The population was predominantly male (96.5%), young (81% <45 years), and largely excluded from regular primary care (93.5% without a General Practitioner). Musculoskeletal disorders and fatigue were the leading diagnostic category (34.0%), followed by gastrointestinal (13.5%) and respiratory conditions (13.0%). Non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics were the most frequently recorded treatments (32.6% of treatment occurrences). Among musculoskeletal presentations, NSAIDs were used in 76% of cases. Gastroprotective agents were documented in 52% of encounters with gastrointestinal symptoms. Among cardiovascular presentations, 87.7% of treatment occurrences involved chronic management with antihypertensives or beta-blockers. Conclusions: In this outreach setting, medication use provides a descriptive picture of common health problems and treatment responses among migrant agricultural workers living in informal settlements. The prominent use of symptomatic pharmacological relief, particularly NSAIDs in musculoskeletal conditions, suggests that care is often focused on managing pain and acute complaints in a population facing barriers to continuous primary care. These findings support the need for stronger inclusion of migrant workers in the National Health Service and for policies that address underlying social and structural determinants of health. Full article

Thoracic morphology is increasingly recognized as an important determinant of cardiopulmonary phenotype, influencing cardiovascular mechanics, respiratory physiology, and the interpretation of diagnostic imaging findings. Although the radiological Haller Index (HI) remains the reference standard for quantifying pectus excavatum severity, its dependence on computed tomography and ionizing radiation limits widespread clinical implementation, particularly in settings requiring serial evaluations. To overcome these limitations, the Modified Haller Index (MHI) was developed as a simple, non-invasive, radiation-free alternative that combines external thoracic anthropometry with echocardiographic assessment. Since its introduction, the MHI has undergone clinical validation and has progressively expanded beyond the assessment of chest wall deformities, demonstrating that thoracic conformation is not merely an anatomical characteristic but a clinically relevant determinant of cardiovascular and respiratory physiology. Growing evidence indicates that thoracic morphology influences cardiac chamber geometry, ventricular filling, stroke volume, myocardial deformation, ventricular–arterial coupling, exercise stress echocardiography findings, pulmonary function, and symptom perception across a broad spectrum of cardiovascular and respiratory diseases. Elevated MHI values identify individuals with a reduced antero-posterior thoracic diameter and a distinctive cardiopulmonary phenotype characterized by external cardiac compression, smaller cardiac chambers, restrictive ventilatory physiology, and apparent alterations in myocardial mechanics despite the absence of intrinsic myocardial disease. Building upon the clinical validation of the MHI, a novel patented anatomical measurement device was engineered to standardize thoracic morphometric assessment by enabling direct acquisition of both latero-lateral and antero-posterior thoracic diameters within a single measurement procedure. The device integrates dedicated anatomical reference elements, an innovative adjustable sternal pointer, movable measurement components, and a standardized acquisition workflow into a portable, low-cost, and radiation-free platform, thereby improving measurement reproducibility while simplifying bedside MHI determination. This narrative review summarizes the historical evolution of thoracic morphometry, the development and clinical validation of the MHI, the engineering rationale, structural architecture, and measurement workflow of the patented device, and the growing evidence supporting the clinical significance of thoracic conformation across cardiovascular and respiratory medicine. Together, the MHI and the proposed anatomical measurement device establish a practical platform for standardized, radiation-free thoracic morphometry that may facilitate routine bedside phenotyping. Future integration with digital technologies, artificial intelligence, and advanced imaging systems may further enable next-generation digital thoracic phenotyping for personalized cardiovascular and respiratory characterization, risk stratification, and precision medicine. Full article

Respiratory medicine is transitioning from symptom-driven, standardized care to a more precise, patient-specific approach guided by molecular profiling. This evolution is being enabled by advances in liquid biopsy, multiomics, and artificial intelligence (AI) analytics. Fractional exhaled nitric oxide (FeNO) and blood eosinophils, the two commonly used markers in asthma, are now being joined by more precise airway markers such as galectin-10, which could aid clinicians in making more informed decisions for biological treatments. In chronic obstructive pulmonary disease (COPD) similar progress is underway, with treatment now emphasizing inflammation endotypes, especially eosinophilic patterns, to direct therapeutic choices. Alongside these developments, routine blood-based ratios (e.g., platelet-to-lymphocyte and neutrophil-to-lymphocyte) are being explored as predictors of exacerbation risk, and forced oscillation testing (FOT) is proving useful for picking up early disease shifts. In more severe conditions, biomarkers are linked to an early and better prognosis, enabling timely intervention. Markers like Matrix metalloproteinase-7 (MMP-7) and CC chemokine ligand 18 (CCL18) have proven to be reliable indicators of mortality and disease progression in idiopathic pulmonary fibrosis. Meanwhile, in lung cancer, liquid biopsies, especially those measuring circulating tumor DNA and micro-RNA (miRNA) panels, are enhancing screening accuracy while helping to cut down on the high false-positive rates seen with low-dose computerised tomography (CT). Other respiratory conditions such as bronchiectasis, pulmonary embolism, pneumonia, and acute respiratory distress syndrome (ARDS) are also benefiting from biomarker advances. At the same time there is a growing push to standardize how these biomarkers are measured. AI-based clinical decision support systems are also playing an increasingly important role in the translation of all these complicated data into actionable clinical insights. Together these developments pave the way for improved respiratory care that is precise and responsive to individual patient needs. Full article

Background and Clinical Significance: Necrotizing fasciitis (NF) is a fulminant, life-threatening polymicrobial infection of the soft tissues, characterized by the progressive and widespread necrosis of the subcutaneous tissues and fascial planes. Although the cervical region is an infrequent site of involvement, cervical necrotizing fasciitis (CNF) is distinguished by its rapid anatomical spread, severe systemic complications, and significant mortality rates. Case Presentation: This report details the fatal clinical course of a 37-year-old immunocompetent male with no relevant active comorbidities. The patient initially presented with insidious, non-specific symptoms clinically interpreted as an uncomplicated upper respiratory tract infection/acute pharyngitis, including pharyngodynia, hoarseness, fever, lateral cervical lymphadenopathy, and catarrhal secretion. Within a brief period, his clinical status underwent rapid deterioration, with progressive cervical swelling, dysphonia, swallowing impairment, dyspnoea, shock, and subsequent multi-organ dysfunction syndrome. A total-body computed tomography scan revealed lateral cervical subcutaneous emphysema, a small pneumomediastinum, bilateral pleural effusion and bilateral pulmonary parenchymal consolidations. Conclusions: A comprehensive forensic examination revealed swelling and brownish-green discoloration of the right cervical region, palpable crepitus, and extensive necrosis of the cervical soft tissues, with involvement of the deep fascial layers and regional musculature. Histological examination confirmed massive cervical soft tissue necrosis associated with inflammatory infiltration and air bubbles. Multifocal acute pneumonia was also documented. This case underscores the importance of a meticulous examination of the cervical region during autopsy in suspected infection-related fatalities. Clinically, it highlights the diagnostic challenges posed by the deceptive and paucisymptomatic onset of CNF. Full article

The COVID-19 pandemic accelerated the use of telemedicine and revealed persistent barriers in rural primary healthcare, especially among older adults and caregivers. This study proposes an LLM-mediated smart tele-primary-care framework to support respiratory infection monitoring in underserved communities of Córdoba, Colombia. The framework is based on caregiver-centered teleconsultation, remote monitoring, preventive education, structured symptom reporting, risk-based teletriage, and clinician-supervised digital support. The LLM functions as a controlled conversational interface to collect symptoms, organize patient information, reinforce health education, generate follow-up reminders, and identify predefined warning signs, without replacing clinical judgment or making autonomous diagnostic or treatment decisions. A preliminary scenario-based assessment examined whether the proposed workflow supports coherent triage and appropriate escalation of high-risk cases. Importantly, the described architecture—a telematic system for intelligent-engine access in assisted medicine support (ATIMAMS)—has been implemented and is currently operational at the Systems Engineering Program, Universidad del Sinú (Montería, Colombia), providing intelligent decision support for telemedicine consultations and remote assistance appointments in the study region. Overall, the study presents a context-sensitive, low-barrier, and safety-aware model for strengthening rural primary care, improving continuity of care, and supporting caregiver-mediated respiratory infection monitoring. Full article