Search Results (4,562)

Background: The impact of Long-Term Non-Invasive Ventilation (LT-NIV) on patient-relevant outcomes has yet to be clearly established in types 2 and 3 Spinal Muscular Atrophy (SMA). Objectives: The current study aimed to assess LT-NIV effect(s) on tracheostomy-free survival and the need for hospitalization. Its secondary aim was to identify patient characteristics that can be considered risk factors for an unsatisfactory response to treatment. Design: This study is a retrospective analysis of long-term outcomes in types 2 and 3 SMA patients receiving home LT-NIV. Methods:Patients and interventions: Eighteen types 2 and 3 SMA patients who were receiving home LT-NIV between 1 January 1990 and 31 March 2025 were included. Primary study endpoint: The endpoint comprised a composite of tracheostomy-free survival time and hospitalization rate. Results: Twelve patients (66.7%) had a positive response to LT-NIV (group A); the response was unsatisfactory in the remaining 6 (33.3%) (group B). Tracheostomy-free survival time was significantly reduced in the latter compared to the former [66 (range: 2–172) vs. 280 (range: 67–407) months; p = 0.010] and the hospitalization rate was significantly higher [0.35 (range: 0.06–1.44) vs. 0.07 (range: 0.00–0.18) episodes/yr; p = 0.007]. A correlation was found between an unsatisfactory response to LT-NIV and treatment initiation following an episode of acute respiratory failure (OR: 7.90; 95% CI, 0.99–123.2; p = 0.051). Conclusions: LT-NIV has a positive impact on tracheostomy-free survival and hospitalizations in types 2 and 3 SMA patients. The risk of an unsatisfactory response appears to be higher when the treatment is initiated in clinically unstable patients. Full article

Background: Community-acquired pneumonia (CAP) remains a leading cause of emergency department (ED) visits, hospitalizations, and mortality worldwide. The choice between oral (PO) and intravenous (IV) antibiotic administration in the ED varies based on patient presentation and provider preference, yet the impact of this choice on clinical outcomes, including revisit rates and ED length of stay (LOS), remains unclear. This study aimed to compare PO versus IV antibiotic therapy in CAP patients discharged from the ED in terms of baseline characteristics, treatment outcomes, and healthcare utilization. Method: This retrospective cohort study was conducted at a tertiary care ED at the Ministry of National Guard Health Affairs in Saudi Arabia. Adult patients diagnosed treated with antibiotic for CAP and discharged from the ED between 2020–2024 were included. Patients were categorized into two groups based on antibiotic administration: POIV. The primary results were ED LOS and 30-day revisit rates. Secondary outcomes included time to first antibiotic administration, fluid administration patterns, and baseline risk factors. Data was extracted from the electronic health record and analyzed using descriptive and inferential statistics. Results: A total of 430 patients were included, with 162 (37.7%) receiving PO antibiotics and 268 (62.3%) receiving IV antibiotics. Baseline characteristics showed higher heart rate, respiratory rate, and temperature in the IV group, suggesting more severe presentations. The mean ED LOS was similar between groups (oral: 6.5 ± 4.9 h vs. IV: 6.4 ± 4.5 h; p = 0.5559). However, the 30-day ED revisit rate was significantly lower in the IV group (23.1%) compared to oral group (34.0%) (p = 0.0146). IV fluids were administered more frequently in the IV group (60.4% vs. 22.2%). Conclusions: While both PO and IV antibiotic strategies resulted in similar ED LOS, IV antibiotic use was associated with a significantly lower 30-day revisit rate. These findings support the need for risk-based treatment decisions in the ED and highlight opportunities for antibiotic stewardship to improve patient outcomes. Full article

Introduction/Goal: Stress and negative emotions have been shown to exert a substantial impact on cancer patients, affecting their ability to adapt to therapy and the overall effectiveness. Elevated cortisol levels, a stress-induced hormone, have been shown to suppress immune system function, potentially reducing the body’s capacity to combat cancer cells. On the contrary, prolactin, a hormone that stimulates the immune system, has shown potential in this context but requires further study. The objective of this study was to investigate the acute physiological changes that occur during a single Conscious Connected Breathing (CCB) session, as part of a larger investigation on Integrative Breathwork Psychotherapy (IBP), a novel integrative psychosomatic intervention designed to improve psychosomatic and immune status in cancer patients. Methods: The project involved 93 breast cancer patients hospitalized for postoperative radiotherapy who participated in a ten-session IBP program. Fifty-six patients agreed to participate (response rate: 60%). During the experiment, 8 patients were excluded from the analysis. IBP consisted of small group sessions (up to six participants) conducted three times weekly. Each session included 45 min of CCB—defined as rhythmic circular nasal breathing at a depth exceeding resting tidal volume, without breath-holding, performed in a state of mindful acceptance—followed by 15 min of free emotional expression (verbal articulation of emerging feelings and sensations). This was a within-subject pre-post design: physiological measurements were obtained immediately before and 30 min into the tenth session (when participants had achieved technical proficiency) in all participants, who served as their own controls. Outcome measures included: arterialized capillary blood gas parameters (pH, pCO₂, pO₂, ctO₂, COHb, HHb, cH⁺), serum cortisol and prolactin concentrations, and immunoglobulin A (IgA). Results: During the CCB session, blood gas analysis revealed significant changes consistent with mild respiratory alkalosis: decreases in pCO₂ (p = 0.003), pO₂ (p < 0.001), cH⁺ (p < 0.001), ctO₂ (p < 0.001), COHb (p = 0.03), and HHb (p = 0.004), alongside an increase in pH (p < 0.001). Concurrently, prolactin levels increased significantly (p < 0.001), while cortisol (p < 0.001) and IgA (p < 0.001) decreased. Conclusions: This study is the first to analyze acute changes in capillary blood gas parameters and neuroendocrine balance during Conscious Connected Breathing sessions in cancer patients, revealing measurable immunostimulatory and stress-modulatory effects. The observed shift toward respiratory alkalosis, combined with increased prolactin and decreased cortisol, suggests that CCB may facilitate favorable neuroendocrine-immune interactions. These findings support the potential of breathwork as a complementary therapy for cancer patients. Further research is needed to explore underlying mechanisms and assess long-term psychological and immunological impacts. Full article

Background: Coronary artery disease remains the leading cause of morbidity and mortality in developed countries. Despite advances in treatment and standard rehabilitation, conventional programs may be monotonous and insufficiently engaging. Normobaric hypoxia, simulating high-altitude conditions, has emerged as a potential method to enhance cardiovascular adaptations in post-myocardial infarction (MI) patients. Objective: This study aimed to compare the efficacy and safety of exercise-based cardiac rehabilitation performed under normobaric hypoxia corresponding to altitudes of 2000 m and 3000 m above sea level in patients after MI treated with percutaneous coronary intervention (PCI). Methods: A total of 61 male post-MI patients (mean age 60.4 ± 8.9 years) were randomized into two groups: training under simulated altitudes of 2000 m (n = 35) or 3000 m (n = 26). The 22-day program consisted of interval ergometer sessions. Pre- and post-intervention assessments included cardiopulmonary exercise testing (CPET), echocardiography, and tissue Doppler imaging (TDI). Results: Both groups demonstrated significant improvements in exercise tolerance. Training at 2000 m significantly increased test duration (r = 0.735) and peak heart rate (r = 0.467). At 3000 m, additional benefits were observed, including improvements in metabolic equivalent (r = 0.861), peak oxygen consumption (d = 0.81), and reduction in respiratory exchange ratio (r = 0.682). Intergroup analysis revealed moderate differences favoring the 3000 m group in MET, breathing frequency, and RER. Echocardiography showed beneficial remodeling in both groups, with improvements in LV dimensions, ejection fraction, and MAPSE. Notably, training at 2000 m resulted in more consistent echocardiographic benefits compared to 3000 m. Conclusions: Cardiac rehabilitation under normobaric hypoxia is effective and safe in stable post-MI patients. Training at 3000 m provides greater improvements in exercise tolerance, while 2000 m confers more favorable effects on cardiac structure and function. These findings suggest that moderate hypoxic exposure (2000 m) may represent an optimal balance between efficacy and safety in post-MI rehabilitation. Full article

Swine respiratory disease (SRD) is a complex interaction whereby viral infection predisposes the host to secondary bacterial pulmonary invasion, which may be fatal. Antimicrobial agents remain an important therapy and serve to reduce morbidity and mortality in treated animals. Pradofloxacin is the newest of the veterinary antibiotics to be approved to treat SRD. It is a dual-targeting fluoroquinolone with in vitro and clinical activity against Gram-negative and -positive bacteria, along with atypical agents including anaerobes. In this study, we compared the killing of Actinobacillus pleuropneumoniae, Pasteurella multocida, and Streptococcus suis by pradofloxacin and comparator antibiotics in a 3 h kill assay, using four clinically relevant drug concentrations. Pradofloxacin was bactericidal against the three pathogens, with kill rates ranging from 94.4 to 99.9% (A. pleuropneumoniae) following 15–20 min of exposure to the maximum serum and maximum tissue drug concentration. For P. multocida, the kill rates were 68.7–96.9% following 5–30 min of drug exposure at the maximum serum drug concentration, and 91.7% following 5 min of drug exposure at the maximum tissue drug concentration. For S. suis, pradofloxacin killed 92.4–99.4% and 71.6–97.1% of cells following 60–180 min of drug exposure at the maximum serum and maximum tissue drug concentration, respectively. Pradofloxacin appears to be an important addition to the drugs currently available for treating SRD. Full article

Objectives: This study aimed to evaluate how non-invasive ventilation (NIV) and high-flow nasal cannula therapy (HFT) versus conventional oxygen therapy (COT) affect neural ventilatory drive during exercise in patients with severe chronic obstructive pulmonary disease (COPD). Methods: We conducted an experimental, controlled study with one arm and three different conditions for the same cohort. After initial testing on conventional oxygen therapy (COT), patients exercised under NIV and HFT in sequential days and a random order. Participants: Twenty patients (mean age 60 years old (SD 3.9), 6 female) with severe COPD (30% women) on home NIV as a bridge to lung transplantation were enrolled in this study, with a mean FEV₁ of 19.78% predicted and marked hyperinflation. Protocol: Participants performed constant-load cycling exercises at 75% maximum tolerated workload under three conditions: COT, NIV, and HFT. Neuro-respiratory drive (NRD) was measured using surface parasternal and sternocleidomastoid electromyography, and mixed ANOVA was performed to analyze repeated measures across conditions. Results: In total, 20 patients were included in this study. NIV demonstrated superior performance, with 60% lower NRD compared to COT (488.81 µV vs. 1180.63 µV, p < 0.05). HFT showed intermediate effects (807.8 µV). NIV also achieved greater reduction in respiratory rate (4.2 breaths/min), lower perceived exertion (Borg score decrease: 1.8 points), and more pronounced CO₂ reduction (5.3 mmHg) compared to both COT and HFT. Conclusions: NIV significantly reduces NRD during exercise in severe COPD patients compared to HFT and COT. This supports its use as a valuable adjunct to pulmonary rehabilitation in severe COPD. Full article

Background/Objectives: Myopathies are acquired or genetic muscle diseases causing weakness and wasting, leading to poor posture, impaired coordination, reduced daily function, and scoliosis. The objective of this ambispective study was to compare clinical, radiological, and functional outcomes of patients with myopathic scoliosis treated surgically or non-surgically. Methods: We identified 118 patients (55% male) with myopathy and scoliosis from ALYN Rehabilitation Hospital’s database (1990–2022). Mean age at first visit was 5.45 ± 5.27 years. Seventeen (14%) underwent scoliosis surgery; others were managed non-surgically. Due to unbalanced group sizes, comparative group analyses used propensity score matching (15 surgical, 30 non-surgical patients). Retrospective data included demographics, medical history, respiratory and mobility status, Cobb angle (CA), pelvic obliquity (PO), and surgical details when applicable. Prospective telephone interviews were conducted including SRS-22r Quality of Life (QoL), WHO-QoL, and Functional Independence Measure for Children (WeeFIM). Results: Longitudinal analysis showed significant or near-significant worsening over time in CA (p = 0.03) and PO (p = 0.08), regardless of treatment type but no significant difference between surgical and non-surgical groups in progression rates. Interview data, for 7 surgical and 6 non-surgical patients, revealed that surgical patients reported higher overall QoL, FIM, and SRS-22r self-image scores, but lower scores for SRS-22r pain, general function, and activity levels. Conclusions: Existing research and this study suggest that despite surgical risks, scoliosis correction in neuromuscular conditions generally leads to improved QoL. Findings highlight the complexity of surgical decision-making for myopathic scoliosis, where medical risks must be weighed against potential long-term functional and QoL outcomes. Full article

Background/Objectives: Individuals experiencing long COVID (LC) frequently report orthostatic intolerance symptoms, which may be linked to autonomic and cardiovascular dysfunction. The active standing test provides a simple, clinically relevant means to assess these impairments. This systematic review aims to determine the use of the active standing orthostatic stress test in evaluating cardiovascular, autonomic, and respiratory responses in people experiencing LC. Methods: A systematic search, according to PRISMA guidelines, was conducted in PubMed, MEDLINE, EMBASE, CINAHL, and Scopus for articles published between 2020 and 2025. This study was registered in PROSPERO CRD-42024615872. Studies were included if they used the active standing test, enrolled adults (≥18 years), included both long COVID and healthy control groups, used continuous beat-to-beat measurements, and reported physiological outcomes. Risk of bias was assessed using the nine-point Newcastle–Ottawa Scale. Results: Three studies (216 participants experiencing LC and 186 controls) met the inclusion criteria. Across studies, LC individuals consistently exhibited elevated heart rate in both supine and standing positions. However, blood pressure findings were more variable: only one study reported 13% of participants met orthostatic hypotension criteria, while another found significant increases in diastolic blood pressure during standing. Long COVID groups also showed reduced heart rate variability compared to controls. Conclusions: Individuals experiencing LC show elevated heart rate and impaired autonomic function during active standing, with subgroup-specific blood pressure changes. These alterations may contribute to dizziness, fatigue, and reduced activity tolerance. Incorporating active standing into clinical assessment could aid early identification of autonomic dysfunction and inform rehabilitation strategies, though more research is urgently needed. Full article

Background/Objectives: Children with neurological impairments, especially those who are non-ambulatory, may require additional care services beyond what is available for the general pediatric population, and tracheostomy may be necessary for addressing respiratory problems, but no established consensus or clear guidelines have been established on the optimal timing of this procedure in the pediatric intensive care unit (PICU). Methods: We conducted a study involving 38 patients with neurological impairments who underwent tracheostomy in the PICU from January 2017 to December 2022. We collected demographic, tracheostomy, and outcome data and compared the data between two groups based on the duration of mechanical ventilation before tracheostomy. Results: The patients had heterogeneous neurological conditions, with refractory epilepsy being the most common. Almost all patients received tracheostomy for prolonged mechanical ventilation, with a median duration of 14.5 days of mechanical ventilation before the procedure. A majority of the patients (60.5%) experienced complications related to tracheostomy. The overall mortality rate was 36.8%, with 7.9% directly related to tracheostomy. When the patients were divided into two groups based on the median duration of mechanical ventilation before tracheostomy, the group that received tracheostomy earlier had significantly shorter total PICU stays and hospitalization stays compared to the group that received it later. Conclusions: Children with neurological impairments who undergo tracheostomy have substantial comorbidities and a high rate of complications and mortality. Earlier tracheostomy, based on shorter mechanical ventilation duration, was associated with significantly reduced PICU and hospital stay without increasing adverse outcomes. These findings suggest that timely tracheostomy may improve resource utilization in this medically fragile population. Full article

Anesthetic protocols for non-invasive immobilization of Black Vultures (Coragyps atratus) and Turkey Vultures (Cathartes aura) for procedures lasting up to two hours are lacking. This study directly evaluated the safety and efficacy of a multimodal anesthetic protocol in 11 Black Vultures and 4 Turkey Vultures undergoing electroretinography (ERG). Vultures were anesthetized with intramuscular dexmedetomidine (5 μg/kg), midazolam (0.2 mg/kg), butorphanol (0.2 mg/kg), and ketamine (5 mg/kg) (DMBK), followed by isoflurane induction and maintenance. All vultures were mechanically ventilated to maintain consistent end-tidal CO₂. Monitored parameters included sedation and recovery quality, heart and respiratory rates, hemoglobin oxygen saturation, non-invasive blood pressure, body temperature, and end-tidal concentrations of CO₂, isoflurane, and oxygen. All vultures achieved profound sedation with smooth induction and a median isoflurane maintenance concentration of 1.4% for approximately two hours. Recovery was rapid and uneventful. Heart rates ranged from 60 to 119 beats/min. Mean arterial blood pressure averaged 149 mmHg in Black Vultures and 158 mmHg in Turkey Vultures, with Turkey Vultures showing significantly higher diastolic pressure. A second-degree heart block was detected in one Black Vulture but required no treatment. All ERG procedures were completed successfully. The DMBK protocol provided profound sedation in both species, maintained key cardiorespiratory parameters, including heart rate and arterial blood pressure, within a clinically acceptable range throughout isoflurane maintenance, and enabled uneventful rapid recovery. These findings support DMBK with the cardiorespiratory monitoring system as a safe and effective regimen for anesthetizing vultures and likely other similarly sized raptors requiring non-invasive immobilization. Full article

Dexmedetomidine improves pulmonary function in dogs and humans, but evidence in horses is scarce. This study evaluated dexmedetomidine infusion on oxygenation and respiratory mechanics in anesthetized horses. Twenty horses undergoing elective surgery were included in a prospective, non-randomized, observational study. Horses received either lidocaine alone (1.3 mg/kg over 15 min, then 3 mg/kg/hour; LIDO) or combined with dexmedetomidine (1.75 μg/kg over 15 min, then 1.75 μg/kg/hour; DL). Respiratory mechanics, gas exchange, and cardiovascular variables were recorded at baseline, post-loading, and after 30, 60, and 90 min. Data were analyzed using mixed-effects linear models with horse as a random effect and time and treatment and their interaction as fixed effects (p ≤ 0.05). Peak inspiratory pressure increased over time with both treatments but was lower with DL at 90 min (−1.26 mmHg, p = 0.046). There was no evidence that arterial oxygen pressure or oxygenation ratio improved over time with DL (p > 0.75). Shunt fraction did not significantly change over time or between treatments (Wald χ² = 4.77, p = 0.85). Heart rate with DL decreased from baseline (p ≤ 0.001) but remained higher than LIDO overall (p = 0.001). Dexmedetomidine infusion showed no benefit on oxygenation or respiratory mechanics in anesthetized horses. Full article

Implementation of novel antiviral coatings and textiles, which can be utilised in the production of personal protective equipment, has the potential to enhance public health security against future pandemic outbreaks. Respiratory viruses, particularly SARS-CoV-2, responsible for COVID-19, have emerged as a major global concern due to their rapid transmission and high mortality rates, leading to nearly seven million deaths worldwide between 2020 and 2025. This statistic underscores the necessity for the development and implementation of advanced antiviral materials to prevent viral infections. This research focused on the in vitro evaluation of the antiviral properties of three antibacterial compounds containing silver (Ag) that were functionalized with coatings. We assessed onsite synthesised Ag powder in comparison to commercially available antibacterial additives, which included nanosilver on colloidal silica (AgSiO₂) and silver sodium hydrogen zirconium phosphate (AgNaOPZr), as potential antiviral agents in coatings against human coronavirus (HCoV). Antiviral assessments revealed that coatings containing Ag at higher concentrations (2.5 and 5%) exhibited limited antiviral effectiveness, with a titer reduction in log < 2. In contrast, the functionalization of AgSiO₂ on coatings significantly suppressed viral replication resulting in a notable reduction in virus titer of log ≥ 2 for all tested concentrations. Full article

Acinetobacter baumanni (A. baumannii) is a well-known pathogen associated with antimicrobial-resistant infections. It is a major cause of nosocomial infections and is frequently associated with polymicrobial and antibiotic-resistant infections. This study investigates the frequency of A. baumannii infections, its antimicrobial resistance profile and the main co-pathogens isolated in respiratory samples at the San Giovanni di Dio e Ruggi d’Aragona Hospital in 2015–2019 (pre-COVID-19 pandemic) and 2020–2023 (during/post-COVID-19 pandemic). Bacterial identification and antibiotic susceptibility testing were performed using the VITEK^® 2 system (2015–2019), while identification was carried out with MALDI-TOF MS starting from 2020. A total of 1679 strains were isolated between 2015 and 2019, and 1186 between 2020 and 2023, with significantly higher frequencies in males 61–80 and females 71–80. A. baumannii was isolated predominantly from respiratory specimens, derived predominantly in intensive care units (ICUs). The antimicrobial resistance rates of A. baumannii were above 90% for gentamicin, trimethoprim/sulfamethoxazole, imipenem and ciprofloxacin, while colistin resistance was less than 1% (0.95%) in pre-pandemic and alarmingly increased during/post pandemic period (6.1%). A. baumannii was most frequently associated with Klebsiella pneumoniae, Staphylococcus aureus and Pseudomonas aeruginosa in respiratory tract infections. A. baumannii represents a serious global health threat due to its extensive antimicrobial resistance, highlighting the need for continuous surveillance, detailed strain characterization, and development of new antimicrobial agents. Full article

Oxidative stress impairs the productivity and welfare of heat-stressed hair sheep; however, the key factors contributing to its occurrence remain unclear. Twenty-two Dorper × Katahdin ewe lambs weighing 23.5 ± 2.8 kg and experiencing outdoor heat stress in a desert region were used to establish the contribution of climatic variables, physiological responses, metabolism, and feedlot performance to the oxidant-antioxidant imbalance. Pearson’s correlation, principal component analysis, and multiple linear regression were applied to the datasets. Oxidative stress biomarkers showed positive relationships with average and minimum climatic variables, morning rectal temperature, serum triglycerides and insulin, and feed efficiency. Still, these biomarkers were negatively correlated with maximum ambient temperature (Te) and temperature-humidity index (THI), morning and afternoon respiratory rate (RR), total protein, and feed intake. While total oxidant capacity and fat oxidation were mainly associated with decreased maximum Te, protein oxidation was primarily associated with increased morning RR. Total antioxidant capacity was favored by a reduction in maximum THI and oxidative stress index (OSI) by an increase in maximum relative humidity. With minimal contribution (≤6%), protein and fat oxidation were also explained by increased serum insulin and feed intake, respectively, whereas OSI was explained by increased weight gain. Overall, the presence of oxidative stress in feedlot hair sheep experiencing outdoor heat stress was regulated by a combination of climatic conditions, morning RR, and, to a lesser extent, productive performance. Full article

This study investigated the long-term trends in human parainfluenza virus (HPIV) types 1, 2, and 3 in Korea by year, age group, and season. A total of 23,284 nasopharyngeal swabs collected from patients with respiratory symptoms at a tertiary hospital in Korea between 2007 and 2024 were tested for HPIV using real-time reverse-transcription polymerase chain reaction. Of the 23,284 specimens tested, 481 were positive for HPIV-1, 164 for HPIV-2, and 1102 for HPIV-3. HPIV-3 showed the highest incidence between 2010 and 2016, a decline after 2018, a sharp decline during the 2020 COVID-19 pandemic, and a resurgence in 2021. HPIV-1 and HPIV-2 incidence fluctuated between 2007 and 2019, followed by a sharp decline in 2020. HPIV-3 activity peaked in spring and summer, whereas HPIV-1 and HPIV-2 peaked in autumn. For all three types, infection rates were generally highest among children aged 1–12 years, followed by those in infants, but infection rates varied significantly by type, year, season, and age group. These findings emphasize targeted pediatric prevention, predictive modeling of seasonal peaks, and continued molecular surveillance to clarify the genetic and antigenic diversity of HPIV types after the pandemic, supporting the Sustainable Development Goals (SDG 3 for Good Health and Well-Being). Full article