Search Results (996)

Background/Objectives: Next to malaria, respiratory viruses, particularly respiratory syncytial virus (RSV), are responsible for the hospitalization and death of thousands of young children each year in sub-Saharan Africa. During peak seasons, conducting separate tests is time-consuming and distressing. This underscores the need for efficient, rapid multiplexed diagnostic tools. This study aimed to evaluate the clinical performance of a lateral flow assay (LFA) based antigen combo rapid diagnostic test (ML Ag Combo RDT, manufactured by MobiLab) that detects RSV, influenza viruses A and B (Flu A/B), and SARS-CoV-2. Methods: The Allplex panel 1 rRT-qPCR assay was used as a reference assay to evaluate the clinical performance of the LFA Ag Combo RDT in pediatric hospital settings. It was performed using 470 nasopharyngeal swab (NPS) specimens from hospitalized children under two years of age with respiratory symptoms. Results: Based on the comparative analysis of the testing results for 470 NPS, the ML Ag Combo RDT demonstrated high sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 90.06%, 98.38%, 93.67, and 97.39% for RSV, and 30%, 100%, 100%, and 95.43 for Flu A/B, respectively. Agreement with the Allplex panle1 1 rRT-qPCR was strong (κ = 0.90 for RSV) and moderate (κ = 0.45 for Flu A/B), with overall accuracies of 96.63% for RSV and 95.5 for Flu A/B. This was further supported by ROC analysis for aggregated data (RSV and, Flu A/B) with an AUC value of 0.925. As expected, in samples with high viral loads (Ct < 20), the Ag Combo RDT achieved 100% sensitivity for RSV and Flu A/B. Sensitivity declined slightly at lower viral loads (Ct > 35). Conclusions: The ML Ag Combo RDT demonstrates high specificity and diagnostic accuracy for the detection of RSV and Flu A/B in pediatric hospital settings where timely diagnosis is critical. Full article

Objectives: Diuretics are frequently used in bronchopulmonary dysplasia (BPD), yet evidence describing their short-term physiological effects remains limited. This study aimed to describe early changes in respiratory support parameters and safety outcomes following combined oral spironolactone and hydrochlorothiazide (SP/HCTZ) therapy in preterm infants with BPD. Methods: A retrospective, single-center before–after observational study was conducted. Preterm infants diagnosed with BPD who initiated SP/HCTZ therapy were included. Respiratory parameters (FiO₂, PEEP, and flow rate) and serum electrolytes were compared between Day 1 (initiation) and Day 3 of treatment. A predefined clinical response was defined as either a ≥10% reduction in FiO₂ or a step-down in respiratory support modality. Results: Fifty-six infants (mean gestational age 27.7 ± 2.3 weeks) were analyzed. After 72 h of SP/HCTZ therapy, mean FiO₂ decreased from 26.2 ± 6.3% to 22.4 ± 3.4% (p < 0.001). Significant reductions were also observed in PEEP and cannula flow rates (p = 0.004 and p = 0.003, respectively). Overall, 39 infants (69.6%) met the predefined clinical response criteria. The prevalence of hyponatremia (Na < 133 mmol/L) increased from 7.1% at baseline to 25.0% on Day 3 (p = 0.039). Conclusions: Initiation of SP/HCTZ was temporally associated with short-term reductions in respiratory support parameters; however, these findings should be interpreted as associations rather than treatment effects. Given the increased frequency of hyponatremia by Day 3, close electrolyte monitoring appears warranted during the early phase of therapy. Full article

We present a case of a patient in their 80s initially presenting with myelodysplastic syndromes (MDS). Chromosomal analysis showed an abnormal female karyotype with a complex karyotype. Metaphase FISH confirmed four copies of KMT2A (MLL) in 24.5% [49/200] and amplification of KMT2A (MLL) with more than four copies in 22% [44/200]. FISH also revealed the presence of MYC (8q24) on the long arm of chromosome 2 at 2q33 locus, two copies of BCR on each homolog 22, and two additional copies of BCR on a derivative chromosome 22. Flow cytometric analysis revealed a population of aberrant myeloid blasts (15–17%). Bone marrow analysis showed hypercellular marrow with a significant increase in myeloid blasts (~50%) and trilineage dysplasia. Eventually, these findings were consistent with a final diagnosis of acute myeloid leukemia non-M3 and a complex karyotype, correlating with cytogenetics, flow cytometry, molecular, and clinical findings. The patient’s clinical course was marked by a rapid deterioration, including recurrent arrhythmias, hypoxic respiratory failure, and septic shock. Given their poor clinical status and adverse-risk molecular profile, care was transported to hospice. The presence of KMT2A amplification is a rare event in AML and is present in ~1% of AML and MDS cases. MYC translocation, KMT2A (MLL) amplification, and 5q/20q losses suggest secondary therapy-related AML and categorize this case in the adverse risk prognosis under the ELN 2022 guidelines. Full article

Introduction: Severe traumatic brain injury (sTBI) frequently coexists with polytrauma and often necessitates damage control neurosurgery (DCNS), where rapid decompression and temporary stabilization take precedence over definitive reconstruction. Within this context, anesthetic management must balance cerebral protection with ongoing resuscitation, yet high-quality DCNS-specific evidence remains limited. Materials and Methods: A comprehensive search of PubMed, Scopus, and Google Scholar (2015–2025) was conducted using MeSH terms and keywords related to neurotrauma, anesthesia, intracranial pressure, and perioperative management. Studies were included if they examined anesthetic or hemodynamic strategies in severe TBI or DCNS and reported relevant clinical or physiologic outcomes. Results: Nineteen articles addressing perioperative strategies for optimizing DCNS outcomes were analyzed. Discussion: Preoperative care emphasizes hemodynamic stabilization and permissive hypertension, damage control resuscitation including massive transfusion protocols, optimization of cerebral perfusion pressure (CPP) and neuromonitoring, and the use of hyperosmolar therapy. Transexamic acid can be used in sTBI safely but with unclear improvement in outcomes. Intraoperatively, propofol-based total intravenous anesthesia is generally preferred over volatile agents due to favorable effects on intracranial pressure (ICP), cerebral blood flow (CBF), autoregulation, and emergence. While historically contraindicated, ketamine and etomidate are now increasingly used as hemodynamically protective induction agents. Analgesic and sedative strategies prioritize dexmedetomidine and carefully titrated opioids to minimize respiratory depression and reduce postoperative complications. CPP and ICP-directed management relies on individualized blood pressure targets, vasopressor selection, lung-protective ventilation, and strict temperature control. Conclusions: Emerging evidence has suggested the benefit of DCNS for patient survival. Overall, perioperative care is guided largely by physiology and extrapolation, highlighting the need for standardized protocols. Full article

Objectives: This study investigated the effects of trunk extension-based inspiratory muscle strengthening on respiratory function, balance, and gait in patients with stroke. Methods: Thirty stroke patients were randomly assigned to the study group (n = 15) or control group (n = 15). The study group performed inspiratory muscle strengthening exercises in a trunk extension posture, while the control group received conventional inspiratory muscle training. Both groups trained five times per week for six weeks. Outcome measures included maximal inspiratory pressure (MIP), maximal inspiratory flow rate (MIFR), maximal inspiratory volume (MIV), peak expiratory flow (PEF), forced expiratory volume in 1 s (FEV₁), Berg Balance Scale (BBS), weight distribution ratio (WDR), limits of stability (LOSs), Timed Up and Go (TUG), gait velocity, cadence, and stride length. Results: The study group showed significantly greater improvements in respiratory parameters (MIP, MIFR, MIV, PEF, FEV₁) and functional outcomes (WDR, LOS, BBS, TUG, gait velocity, cadence, stride length) compared to the control group. Conclusions: Trunk extension-based inspiratory muscle strengthening effectively improves respiratory function, balance, and gait in stroke patients, and may serve as a valuable addition to stroke rehabilitation programs. Full article

Background: The use of HFNC (High Flow Nasal Cannula) in the management of acute respiratory failure has been fully established in clinical practice. Conversely, less data is available supporting its use in chronic hypoxemic–hypercapnic respiratory failure. The aim of the present study is to evaluate the efficacy of HFNC in chronic hypercapnic respiratory failure associated with stable COPD. Methods: In this retrospective single-center longitudinal observational study, 40 patients treated with HFNC at home followed at the COPD Clinic of Respiratory Diseases (University of Campania L. Vanvitelli Monaldi Hospital, Naples) were included. All patients are re-assessed at our clinic at T0, T3, T6 and T12 months through functional respiratory tests and blood gas analysis. Results: After 12 months, significant reductions in pCO₂ (arterial partial pressure of carbon dioxide) (from 58.5 to 48.0 mmHg) and lactates (from 1.60 to 0.90 mmol/L) were observed, and MIP and MEP improved significantly. Patients receiving HFNC flows ≥50 L/min experienced greater reductions in pCO₂ and fewer exacerbations. Multivariate analysis identified HFNC flow rate (p = 0.0046), hours of use/day (p = 0.0157), lactate levels (p = 0.0301), and FEV₁ (forced expiratory volume in 1 s) (p = 0.0491) as independent predictors of reduction in PaCO₂. Higher BMI and greater airway obstruction were associated with a reduced response. Conclusions: Treatment with HFNC represents a reasonable therapeutic choice to reduce AEs-COPD and reduce PaCO₂ and lactates in stable COPD patients. Full article

Background: Prenatal exposure to air pollutants may increase the risk of adverse respiratory outcomes, particularly in offspring of asthmatic mothers. Evidence on wildfire-related PM_2.5 exposure during pregnancy remains limited. This study investigated associations between early gestational wildfire-related PM_2.5 exposure, infant lung function, and respiratory outcomes at 6 years. Methods: Gestational wildfire-related PM_2.5 exposure patterns were characterised using group-based trajectory modelling and linked to infant lung function outcomes. Infant respiratory measurements were obtained at six weeks of age during behaviourally defined quiet sleep using tidal-breathing flow–volume loops (TBFVL). Airway mechanics at six years were assessed by impulse oscillometry (IOS) following international guideline standards. Trajectory modelling of PM_2.5 during gestation was conducted in SAS (PROC TRAJ); all additional statistical analyses were performed in Stata IC 16.1. Results: Increased mean tidal inspiratory flow (MTIF, beta coefficient [β]: 10.51 mL/s, 95% CI: 3.66 to 17.36, p = 0.003) and peak tidal inspiratory flow (PTIF, β: 12.49 mL/s, 95% CI: 2.48 to 22.51, p = 0.014) were observed in infants born to mothers with higher wildfire-related PM_2.5 exposure during early gestation (n = 420; n = 411 not exposed, n = 9 exposed). β-coefficients from infant mixed models were then used as proxy indicators and applied in linear regression models and associated with higher reactance at 5 Hz frequency (n = 73) at 6 years of age (PTIF: β: 9.88 mL/s, 95% CI: 0.10 to 19.67, p = 0.048 and MTIF: β: 13.43 mL/s, 95% CI: 1.43 to 25.44, p = 0.029). PTIF was further associated with asthma diagnoses at 6 years (aOR: 1.36, 95% CI: 1.07 to 1.73, p = 0.012; n = 259; n = 116 asthma). Conclusion: Early gestational exposure to wildfire-related PM_2.5 may be linked with altered respiratory patterns in infancy and differences in airway reactance during childhood. Findings also suggest a relationship with asthma risk, although mechanisms remain uncertain. Full article

Background: The factors driving Coronavirus disease 2019 (COVID-19) severity and its long-term respiratory sequelae remain poorly understood. This study evaluates whether baseline lung function (LF) influences COVID-related clinical outcomes, mortality, and post-infection LF decline. Methods: Data from 602 participants in the Prospective Urban Rural Epidemiology (PURE)-Colombia study were analyzed. Among these, 200 with confirmed SARS-CoV-2 infection and 402 controls (65% women; 68% aged ≥60 years). All underwent baseline spirometry prior to 2010 and follow-up testing 1–40 months post-recovery. Among infected individuals, 51 (26%) died. Spirometric parameters Forced Expiratory Volume in 1 Second (FEV₁), Forced Vital Capacity (FVC), and Peak Expiratory Flow (PEF) were compared using paired t-tests and Cohen’s d. Non-parametric data were compared using Wilcoxon s (z statistic). Results: Compared to baseline LF, hospitalized COVID-19 patients showed significant declines in follow-up LF: FEV₁ (2.84 vs. 2.34 L; p = 0.002), FVC (3.01 vs. 2.53 L; p = 0.006), and PEF (399 vs. 328 L; p = 0.001). Non-hospitalized COVID-19 cases showed a non-significant downward trend, while controls maintained stable LF. Risk factors for post-COVID FEV₁ < 80% predicted included hospitalization, elevated waist-to-hip ratio, and incomplete or absent COVID-19 vaccination. Moderate-to-high physical activity was protective. Post-COVID PEF < 80% predicted was associated with female sex, diabetes mellitus, and subsidized healthcare enrollment. Mortality risk was elevated among individuals with low baseline LF, age > 65, male sex, hypertension, obesity, low physical activity, and reduced handgrip strength. Conclusions: Significant LF decline was observed in hospitalized COVID-19 patients, with minimal changes in outpatients and controls. Identifying clinical and demographic predictors of post-COVID LF impairment may inform targeted interventions to mitigate long-term pulmonary complications. Full article

Four-dimensional (4D) flow MRI enables the comprehensive assessment of cardiovascular hemodynamics. To compensate for respiratory motion, self-gating strategies are typically used and perform reliably at clinical field strengths. With the recent push towards field strengths below 1 Tesla, these strategies need to be re-evaluated given the reduced signal-to-noise ratio (SNR). Camera-based, contactless respiratory monitoring offers an attractive alternative to self-gating, as it is unaffected by imaging. This study compared respiratory self-gating (SG) and camera-based (VE) binning for phase-contrast gradient-echo (PC-GRE) 4D flow MRI at 0.6 T. Data were acquired from twenty healthy subjects (age: 32.8 ± 12.6 years) using a pseudo-spiral undersampled Cartesian four-point velocity encoding scheme. Reconstructions were performed with FlowMRI-Net for the end-expiratory state using either SG or VE binning. SG and VE showed strong agreement, with cross-correlation coefficients of ~0.87, accuracies of ~0.87, and F1-scores of ~0.9. Velocity analysis revealed high concordance (R² = 0.99; RMSE = 3.9 cm/s), with mean differences in peak velocity of 1.25 ± 2.36 cm/s. In this feasibility study, respiratory self-gating and camera-based binning yielded similar hemodynamic parameters from PC-GRE 4D flow MRI at 0.6 T, with the camera-based approach being independent of MR image SNR. Full article

Accurate, non-contact vital-sign monitoring promises a scalable alternative to conventional sensors, yet low signal quality and long recording times have limited real-life adoption. We present a dual-modality system that combines Eulerian video magnified remote photoplethysmography (rPPG) from facial videos with optical flow-based shoulder tracking to estimate heart rate (HR) and respiratory rate (RR) from ultra-short 15 s recordings. With 200 participants, each providing 2 videos, 387 videos passed strict usability criteria, excluding flicker, blur, occlusion, and low illumination. For 15 s recordings, the HR estimates reached 98.5% accuracy within a ±10 beats per minute tolerance (MAE = 3.25, RMSE = 4.88, r = 0.93; p < 0.05) and the RR estimates achieved 98.4% accuracy within a ±5 respirations per minute tolerance (MAE = 0.69, RMSE = 0.87, r = 0.90; p < 0.05), exceeding prior studies that required 30 to 60 s recording lengths. Computational analysis on a standard home computer confirmed feasibility, with near real-time performance achievable on optimized hardware. By integrating complementary modalities and rigorous video quality control, the system overcomes low-SNR challenges, delivering high-fidelity, clinically validated vital signs monitoring. These results establish a robust, scalable, and precise framework for clinical and home care, demonstrating that accurate, contact-free HR and RR monitoring can now be achieved in seconds, making rapid, real-life vital signs assessment practical and accessible. Full article

Constrictive pericarditis (CP) results from persistent or insufficiently controlled pericardial inflammation arising from diverse etiologies. It remains a challenging clinical condition, typically presenting with non-specific symptoms that demand a high degree of clinical suspicion and meticulous imaging assessment. As CP progressively impairs both left- and right-sided cardiac function, it can lead to overt heart failure and a marked decline in quality of life, making early recognition crucial. Multimodality imaging plays an essential role in the diagnostic and prognostic evaluation of CP, enabling distinction from restrictive cardiomyopathy (RCM), detection of active pericardial inflammation, and guidance of therapeutic decision-making. Echocardiography provides key hemodynamic insights, including ventricular interdependence and respiratory variation in flow patterns. Cardiac Computed Tomography (CT) offers high-resolution delineation of pericardial thickening and calcification, while Cardiac magnetic resonance (CMR) allows comprehensive characterization of pericardial anatomy, myocardial–pericardial coupling, and inflammatory burden through late gadolinium enhancement (LGE) and parametric mapping. Additionally, positron emission tomography (PET) imaging can identify metabolically active inflammation, aiding in determining the suitability of medical therapy versus pericardiectomy. By integrating these complementary modalities, clinicians can achieve greater diagnostic precision, refine risk stratification, and tailor management strategies, ultimately improving outcomes for patients with constrictive pericarditis. Full article

Gastroesophageal reflux disease (GERD) is a common chronic condition mainly caused by the dysfunction of the antireflux mechanism at the gastroesophageal junction. This is composed of the lower esophageal sphincter and the crural diaphragm. Increasing evidence suggests that diaphragmatic dysfunction and reduced inspiratory muscle strength may contribute to the persistence of GERD symptoms. Although respiratory physiotherapy has shown beneficial effects, the role of a structured inspiratory muscle training (IMT) program has not been sufficiently examined. This study aims to investigate the effects of an inspiratory muscle training program on inspiratory muscle strength and secondary clinical outcomes in individuals with GERD. A total of thirty adults with a confirmed GERD diagnosis will be enrolled in a two-arm randomized controlled trial. These volunteers will be randomly assigned either to the experimental group, which will undergo a 3-month inspiratory muscle training (IMT) using tapered flow resistive loading at 40% of maximal inspiratory pressure (MIP), or to the control group, which will receive sham IMT with a consistent low resistance. Primary outcomes will include maximal inspiratory pressure (MIP) and maximal dynamic inspiratory pressure (S-index). Secondary outcomes will assess GERD symptoms, disease-related quality of life, and pulmonary function. Measurements will be performed at baseline, at three months of intervention, and at six months from recruitment (follow-up). IMT is expected to lead to significant improvements in inspiratory muscle strength, symptom burden, and quality of life compared with sham training. This trial will provide novel evidence regarding the role of inspiratory muscle training as a non-pharmacological intervention in the management of GERD. Trial registration: ClinicalTrials.gov Identifier: NCT07131397. Full article

Thicklipped grey mullet (Chelon labrosus) shows potential as an appealing species for aquaculture in the EU. Knowledge of its metabolic requirements is essential for species management and control of environmental conditions. We examined routine and postprandial oxygen consumption (OC) in juveniles as a function of body weight (Bw: 2–85 mg) and temperature (T: 14–26 °C), as well as OC and ventilatory frequency (VF) under gradual hypoxia as a function of T (14–22 °C). Multiple regression analyses determined the effects of Bw and T on mean daily (OC_mean), postprandial (OC_SDA), routine (OC_routine), and maximum (OC_max) levels, as well as on OC_max/OC_routine ratio (MSF), postprandial OC duration (D_SDA) and time to reach maximum activity (D_peak). The effects of dissolved oxygen (DO) and T on OC and of T on initial VF (VF_ini), maximum VF (VF_max), critical DO threshold (%DO_crit), and VF change threshold (%VF_ch) were also analysed. All OC levels increased with T and Bw, except MSF, D_SDA, and D_peak, uninfluenced by Bw. Under gradual hypoxia, OC decreased with falling DO, more sharply at higher T, consistent with oxyconformer behaviour. VF remained stable until 50% DO, then rose progressively, reaching higher VF_max at higher T. Simulations using derived equations estimate C. labrosus respiratory response and water flow requirements under aquaculture conditions. Full article

Acute respiratory distress syndrome (ARDS) is a heterogeneous inflammatory lung injury marked by increased alveolar–capillary permeability, reduced respiratory system compliance, and impaired gas exchange. Despite advances in supportive care, ARDS remains associated with high mortality. Lung-protective ventilation with low tidal volumes and prone positioning is the cornerstone of treatment. However, these strategies do not fully account for patient-specific physiological variability. Recent guidelines emphasize a more individualized approach to respiratory support. Key elements include limitation of driving pressure, optimized use of high-flow nasal oxygen, and application of bedside tools such as the SpO₂/FiO₂ ratio and lung ultrasound. These measures improve diagnosis, monitoring, and physiological assessment at the bedside. This narrative review summarizes current evidence supporting contemporary ventilatory and non-invasive strategies in ARDS. It also examines emerging diagnostic and therapeutic approaches that integrate respiratory physiology into clinical decision-making. Finally, we discuss future directions focused on personalized, physiology-guided management to improve outcomes in patients with ARDS. Full article

Coverage expansions and affordability reforms often presume that improved access to care yields better population health. We examine this premise in a capacity-constrained healthcare system, where congestion and throughput determine whether potential access translates into realized care. Using U.S. state-year panel data from 2006 to 2023, we study (i) how healthcare workforce density relates to multiple access margins and (ii) whether the mortality effects of access improvements depend on local delivery capacity. Reduced-form estimates show that higher workforce density is associated with higher insurance coverage and fewer cost-related barriers to care, while associations with having a usual source of care are weaker. With full controls these relationships attenuate, and Medicaid expansion and poverty explain much of the remaining variation. Instrumental variable models suggest that policy-driven improvements in effective access are associated with lower mortality, although the first-stage strength varies across specifications. Interaction-IV estimates indicate capacity dependence: for all-cause and external-cause mortality, implied benefits are larger in lower-capacity settings and diminish as workforce density increases; for endocrine mortality, benefits are concentrated in higher-capacity settings, while respiratory effects are not detectable. Overall, the results support a systems perspective in which the health returns to access expansions depend on local delivery capacity, underscoring the importance of aligning access reforms with constraints in healthcare production and flow. Full article