Diagnosis of Pneumocystis jirovecii pneumonia (PCP) relies on lower respiratory tract sampling, often requiring bronchoscopy. Given its invasive nature, non-invasive diagnostic methods are desirable. In this retrospective case-control study, we evaluated the diagnostic performance of serum P. jirovecii PCR and β-D-glucan for PCP diagnosis. Adult patients with hematologic malignancies and positive P. jirovecii PCR in lower respiratory tract samples were included as cases and classified as PCP or colonization. Controls had negative BAL PCR. Stored serum samples were analyzed by P. jirovecii PCR and β-D-glucan. Forty-one cases (29 PCP, 12 colonization) and 36 controls were included. Serum P. jirovecii PCR was positive in 20/41 cases (49%) and in 15/29 patients with PCP (52%), while no controls were serum PCR-positive. For PCP diagnosis, serum PCR had a sensitivity of 52% and a specificity of 89%. For detection of P. jirovecii in the lower respiratory tract, sensitivity was 49% and specificity 100%. Detectable serum P. jirovecii DNA was associated with higher P. jirovecii load in respiratory tract samples and higher β-D-glucan levels, but not with the presence or severity of pneumonia. Serum P. jirovecii PCR is a highly specific marker of P. jirovecii in the lower respiratory tract and may serve as a useful initial non-invasive test in patients with suspected PCP, prior to invasive respiratory sampling.

Background: Bronchiectasis is a chronic respiratory condition characterised by irreversible airway dilation and recurrent infections, resulting in significant symptom burden and frequent healthcare utilisation. Although nurses are central to chronic respiratory disease management, their specific roles and responsibilities in outpatient bronchiectasis care remain poorly defined. Understanding these roles is imperative to support workforce planning, optimise multi-disciplinary collaboration, and improve patient outcomes. Aim: This scoping review aimed to map and synthesise existing evidence on the roles and responsibilities of nurses involved in the outpatient management of adults with non-cystic fibrosis bronchiectasis. Methods: A scoping review was conducted. Six databases were systematically searched (MEDLINE, CINAHL Complete, Central, Web of Science, and ProQuest Dissertations and Theses Citation Index). Records describing nursing roles, responsibilities, or models of care within outpatient bronchiectasis settings were included (any design). Data was analysed descriptively and thematically. Results: Five studies and two international clinical practice guidelines published between 2002 and 2025 were included. Nurses were shown to play roles across five key domains: 1. clinical assessment and monitoring, 2. self-management support and patient education, 3. care co-ordination and multi-disciplinary collaboration, 4. patient advocacy and communication, and 5. leadership and service development. Evidence on measurable outcomes and standardised role definitions remains limited. Conclusions: This review mapped five domains within which nurses may contribute to outpatient bronchiectasis care; however, most identified roles and responsibilities were derived from multi-disciplinary recommendations rather than explicit descriptions of nursing practice. Further research is required to better define nursing roles and responsibilities and evaluate nurse-led models of care in bronchiectasis outpatient care settings.

Severe treatment-resistant asthma (STRA) in children is often sustained by type 2 inflammation and eosinophil-dependent airway disease that persists despite optimized inhaled therapy and the mitigation of modifiable factors. This review summarizes the clinical and translational evidence on monoclonal antibodies targeting the interleukin-5 (IL-5) axis (anti-IL-5 and anti-IL-5Rα) available in pediatric severe asthma. PubMed/MEDLINE was searched up to January 2026 for English-language studies in patients aged 0-18 years addressing mepolizumab and benralizumab, including randomized trials, high-quality observational studies, meta-analyses, and international guidance. Mepolizumab has the most robust pediatric data, showing consistent reductions in exacerbations and blood eosinophils, and improvements in symptom control and quality of life, with safety broadly comparable to adults. The pediatric evidence for benralizumab is more limited but shows rapid eosinophil depletion, improved outcomes in selected children, and acceptable safety; further trials are ongoing. Overall, IL-5-directed biologics represent a key add-on option for carefully selected children with severe eosinophilic asthma, while pediatric-specific predictors of response, comparative effectiveness, and standardized long-term monitoring and stopping criteria remain priorities.

Paraquat (PQ) poisoning causes high mortality via acute lung injury (ALI) driven by excessive reactive oxygen species (ROS) in pulmonary microvascular endothelial cells. We developed BR@Lipo-CerTP, a lung-targeted nanotherapeutic using C16-ceramide-binding peptide-modified bilirubin liposomes, to enhance endothelial delivery and treat PQ-induced ALI.

BR@Lipo-CerTP was characterized for physicochemical properties and cellular uptake in pulmonary microvascular endothelial cells (PMVECs). In vitro efficacy was assessed via cytotoxicity, apoptosis, ROS, antioxidant capacity, and mitochondrial function assays in PQ-exposed PMVECs. Multi-omics analysis elucidated therapeutic mechanisms. In vivo efficacy and biosafety were evaluated in a PQ-induced ALI mouse model through survival, histopathology, edema, and toxicity assessments.

BR@Lipo-CerTP exhibited uniform ~120 nm spherical morphology, narrow size distribution, excellent stability, and enhanced PMVEC uptake versus non-targeted liposomes. In vitro, it significantly attenuated PQ-induced cytotoxicity, apoptosis, and ROS accumulation while restoring antioxidant capacity and mitochondrial function. Multi-omics revealed it disrupts a vicious cycle of glutathione depletion, ferroptosis, and NF-κB/NLRP3-driven inflammation, resetting pathological crosstalk between redox homeostasis, regulated cell death, and immune activation. In vivo, BR@Lipo-CerTP markedly improved survival, alleviated pulmonary damage and edema, suppressed oxidative stress and inflammation, with no systemic toxicity.

Pulmonary endothelial-targeted bilirubin delivery effectively mitigates PQ-induced ALI by coordinately regulating redox balance, cell death, and inflammation. This strategy offers a promising nanotherapeutic for PQ poisoning and other ROS-driven pulmonary diseases, highlighting targeted nanomedicine's potential in toxicological emergencies.

This study examined changes in anti-Spike (anti-S) antibodies (Abs) and type I interferon (IFN-I) following the BNT162b2 vaccine in people living with HIV (PLWH) and analyzed the impact of demographic and immunological factors. In total, 75 PLWH and 28 healthy donors were followed at baseline (T0), at the second dose (T1), after the second dose (T2), and more than 1 year later (T3). Anti-S Abs were assessed by chemiluminescence and vesicular stomatitis virus (VSV)-based pseudo virus-neutralization assay, while IFN-α2, IFN-β, and IFN-ω mRNA levels were measured by RT-Real Time PCR. PLWH showed an increase in anti-S Immunoglobulin G (IgG) levels comparable to healthy donors (p < 0.001) and an induction of anti-S neutralizing Abs (p < 0.014 for T2 vs. T3). Age, gender, CD4⁺ T cell count, exposure to combined antiretroviral therapy (cART) and IFN-I levels at T0 did not affect the anti-S IgG production. IFN-I gene expression showed temporal changes, with a decrease at T2 (p < 0.01) and a subsequent increase at T3 (p < 0.001, for IFN-α2 and IFN-ω). A multivariable model revealed no overall change in the IFN-I response over time, except for IFN-β, which was lower at T3 than at T1 (p = 0.032). CD4⁺ T cell count was positively correlated with the IFN-I response (p < 0.05). These results suggest that mRNA vaccination can elicit an effective anti-S response and modulate the IFN-β gene expression in PLWH, with CD4⁺ T cell count being a key determinant of vaccine-induced changes in IFN.

In total, 1 147 respiratory specimens were collected from severe acute respiratory infection (SARI) cases at three sentinel hospitals in Huangpu District, Shanghai Ctiy, between 2015 and 2024. Multiplex polymerase chain reaction (PCR) assays were performed to detect eight major respiratory viruses: influenza A virus (Flu A), influenza B virus (Flu B), human parainfluenza virus (HPIV), respiratory syncytial virus (RSV), human adenovirus (HAdV), enterovirus/human rhinovirus (EV/HRV), human coronavirus (HCoV), and human metapneumovirus (HMPV). The results showed that the overall positive rate of the eight respiratory viruses was 11.60% (133/1147). The viruses with the highest detection rates were EV/HRV (32/1147, 2.79%), HPIV (31/1147, 2.70%), and Flu A (29/1147, 2.53%). The overall positive rates in male and female cases were 10.63% (68/640) and 12.82% (65/507), respectively, with no statistically significant difference (P>0.05). The positive rate of HAdV in the 14-64-year age group was 1.44% (5/347), which was higher than that in the≥65-year age group (0.13%, 1/800), and the difference was statistically significant (P=0.011). A total of 12 cases (1.05%) with mixed detection were identified, all of which were dual-positive.

The evolving understanding of the regulation of allergic airway inflammation has offered new approaches for asthma therapy. For example, our understanding of the role of alarmins, Th2 cytokines and eosinophils has allowed the development of biologics that have revolutionized therapy for severe asthma. However, many questions remain and several of our patients are still not controlled with the current available therapies. Many immune cells have been implicated in asthma pathophysiology, but one cell that is missing from these studies is the monocyte. Monocytes (Mos) are bone marrow-derived cells that circulate in the blood and develop into macrophages and/or dendritic cells following migration to peripheral tissues. Macrophages (Møs) and dendritic cells have been implicated in the development and progression, of allergic airway inflammation, but also in tissue repair after inflammation. Recent studies in animal models suggest a major role for Mos in allergic airway inflammation, primarily through their ability to mediate recruitment of eosinophils and/or neutrophils to the airways. However, there is little information regarding the role of monocytes in human asthma. Here we review the literature regarding the presence and functions of peripheral blood and airway Mos in human asthma and suggest further work that needs to be done to consolidate the information on Mo functions. Studies show changes in Mo numbers and activation status in the peripheral blood of patients with asthma, changes that in many cases correlate with disease severity and/or activity. Studies also show altered phenotype of Mos present in the airways of patients with asthma. Detailed human studies need to be performed, if possible, studies that include therapeutic interventions, to allow for a full understanding of the role of Mos in asthma.

The decision to transfuse a patient with myocardial infarction (MI) and anemia at a higher vs lower hemoglobin threshold must consider the potential benefit of reduced risk of 30-day death or MI and the potential risk of heart failure.

To estimate bayesian posterior risk differences and posterior probabilities that a liberal vs restrictive transfusion strategy is associated with reduced risk of 30-day death or MI and whether the probabilities exceed predefined thresholds.

The Myocardial Ischemia and Transfusion (MINT) trial recruited adults from April 26, 2017, to April 14, 2023, who were hospitalized with MI and anemia at 144 sites in 6 countries. Statistical analysis was performed from July 31, 2024, to February 18, 2026.

The MINT trial randomized participants to a restrictive (transfuse if hemoglobin is <7 to 8 g/dL) or liberal (maintain hemoglobin at >10 g/dL) transfusion strategy.

Bayesian posterior risk differences were estimated for 30-day death or MI and for heart failure using 3 prior beliefs regarding the treatment strategies: noninformative, liberal strategy superiority, or restrictive strategy superiority.

The mean (SD) age of the 3504 participants was 72.1 (11.6) years and 1911 (54.5%) were men. Compared with the restrictive strategy, the risk of 30-day death or MI with the liberal strategy was 1.4% (95% credible interval, -0.8% to 3.5%) to 2.4% (95% credible interval, 0.3%-4.6%) lower, depending on prior beliefs. The probability that the liberal strategy was associated with a lower risk of 30-day death or MI ranged from 89.1% to 98.8%, and the probability that a liberal strategy was associated with at least 1 less death or MI per 100 treated was between 62.7% and 90.4%. Conversely, the risk of heart failure with the liberal strategy was 0.2% (95% credible interval, -1.6% to 1.2%) to 0.6% (95% credible interval, -2.0% to 0.8%) higher compared with the restrictive strategy, depending on prior beliefs. The probability that the liberal strategy was associated with a higher risk of heart failure ranged from 60.6% to 80.0%, and the probability that a liberal strategy was associated with at least 1 more heart failure event per 100 treated was between 13.3% and 29.3%.

This post hoc analysis of a randomized clinical trial of patients with MI and anemia suggests that a liberal transfusion strategy was associated with a lower risk of 30-day death or MI, outweighing the increased risk of heart failure. Consistent with guideline recommendations and according to patients' values and clinician risk assessment, a liberal transfusion strategy may be reasonable.

ClinicalTrials.gov Identifier: NCT02981407.

A robust chain of survival is important for achieving positive outcomes following out-of-hospital cardiac arrest, which continues to pose a substantial public health challenge in Singapore. Although improvements have been made in prehospital resuscitation and survival to hospital admission, further progress is required for survival to hospital discharge and neurological recovery. This underscores the urgent need to strengthen post-cardiac arrest care-the sixth link in the chain of survival-to optimise outcomes for patients admitted to the intensive care unit after return of spontaneous circulation. This review builds on earlier recommendations of the National Targeted Temperature Management Workgroup (2017) and the National Post-Cardiac Arrest and Survivorship Workgroup (2021), providing an updated summary of post-cardiac arrest management and practical guidance for clinicians treating resuscitated cardiac arrest patients in the intensive care unit.

Advanced cardiovascular life support (ACLS) provides a structured approach to the management of cardiac arrest and life-threatening arrhythmias, building on early recognition, high-quality cardiopulmonary resuscitation (CPR), and timely defibrillation. The 2026 Singapore ACLS guidelines present updated, evidence-based recommendations informed by the latest guidance from the American Heart Association and the European Resuscitation Council. Key updates include optimisation of CPR quality, integration of point-of-care ultrasonography, and refined use of pharmacological and electrical therapies during resuscitation. The role of extracorporeal CPR as a rescue strategy in selected patients and the importance of organised post-resuscitation care in improving neurological outcomes are emphasised. Management of tachyarrhythmias and bradyarrhythmias is also addressed. Special circumstances, including pulmonary embolism, drowning and cardiac arrest during pregnancy, are discussed. These guidelines aim to standardise practice and improve survival and functional outcomes following cardiac arrest in Singapore.