Autonomic symptoms and orthostatic syndromes have been reported in Long COVID, but few studies have characterized findings using head up tilt table testing.

To characterize autonomic responses to positional changes among individuals with Long COVID.

We assessed autonomic symptoms using the Composite Autonomic Symptom Scale 31 (COMPASS 31) instrument and performed head up tilt table testing for 30 minutes at 70 degrees among individuals with Long COVID and recovered comparators.

We included 26 participants (median age 56 years, 50% female median 25 months after first COVID): 16 with Long COVID and 10 recovered comparators. COMPASS 31 scores (0-100, higher is worse) were higher among those with Long COVID (median 30.5 vs 8, p = 0.003). Heart rate was 8 beats per minutes higher throughout tilt among those with Long COVID (95% CI 1.1 to 14.4; p = 0.02); there were no differences in blood pressure. Ten (63%) with Long COVID had symptoms during tilt compared to none among recovered participants (p = 0.003). Three (19%) with Long COVID had clinically abnormal findings: one each with orthostatic hypotension, and delayed orthostatic hypotension, and cardioinhibitory/vasovagal presyncope.

Among those with chronic autonomic symptoms in the setting of Long COVID, symptoms were common during tilt testing, and heart rate was increased, but most did not meet diagnostic criteria for a clinically abnormal hemodynamic response. Further research into mechanisms of autonomic symptoms in Long COVID is urgently needed.

Pulmonary embolism (PE) is a life-threatening condition requiring prompt diagnosis and treatment. Visual assessment of computed tomographic pulmonary angiography (CTPA) is the first-choice diagnostic tool. New imaging biomarkers could provide additional prognostic information for improved risk stratification. We hypothesized in this exploratory study, that contrast enhancement patterns in the aorta may contain such information.

CTPA scans of 93 acute PE patients were analyzed retrospectively. Firstly, the aorta was segmented automatically by TotalSegmentator and its centerline was extracted. Subsequently, lines were fitted on intensities within a region of interest perpendicularly to the aorta centerline, from which three parameters were extracted: mean intensity, proximal intensity and contrast gradient. After confounder analysis, logistic regression with forward selection evaluated the predictive value of these parameters for 12 adverse outcomes (six short-term and six long-term).

Lung volume, aorta dimension and contrast delay were considered as possible confounders but were not selected by forward selection. Logistic regression (n = 93) showed that a less steep contrast gradient (decreasing by 10 Hounsfield unit/%) was associated with a reduction in odds of the following short-term adverse outcomes: 48.1% for intensive care unit admission (odds ratio [OR] = 0.519, 95% confidence interval [CI]: 0.306-0.804), 29.3% for oxygen therapy >24 hours (OR = 0.707, 95% CI: 0.496-0.976), 60.6% for reperfusion therapy (OR = 0.394, 95% CI: 0.178-0.682), 57.5% for vasopressor therapy (OR = 0.425, 95% CI: 0.194-0.741), and 50.2% for PE-related death (OR = 0.498, 95% CI: 0.246-0.915). No significant associations were found with long-term outcomes.

The aorta contrast gradient, automatically quantified from CTPA, is a relevant adjunctive predictor for short-term outcomes in PE patients. Long-term outcomes, however, could not be predicted by aorta measurement. This pilot study provides initial insights into predictive value of aorta enhancement, stimulating further exploration with external data.

For many people living with long COVID (PWLC), self-tracking has emerged as a valuable practice to monitor their illness. An examination of self-tracking practices can, therefore, shed light on the ways in which individuals navigate their care, make sense of their experiences and advocate for their needs. This study investigates how PWLC engage in self-tracking practices and how they utilise and negotiate the data generated. Based on 33 semi-structured interviews with PWLC in the Netherlands, Austria and Switzerland, we found that PWLC use self-tracking to recognise patterns and identify limits, triggers and effective interventions. The insights drawn from this are used to make informed decisions about health management strategies. Yet, self-tracking may also reify symptoms and negatively influence the subjective illness experience, exacerbating stress and anxiety. Although PWLC themselves negotiate and question their tracking data, they find a variety of responses from healthcare providers in clinical interactions. Using the concept of 'trading zone' (Kjærulff and Langstrup), we argue that although self-tracking cannot replace treatment and good care, its integration into the healthcare experience as a valuable form of patient knowledge may improve the patient-provider relationship.

Accurate forecasts of disease outbreaks are critical for effective public health responses, management of healthcare surge capacity, and communication of public risk. There are a growing number of powerful forecasting methods that fall into two broad categories-empirical models that extrapolate from historical data, and mechanistic models based on fixed epidemiological assumptions. However, these methods often underperform precisely when reliable predictions are most urgently needed-during periods of rapid epidemic escalation. Here, we introduce epimodulation, a hybrid approach that integrates fundamental epidemiological principles into existing predictive models to enhance forecasting accuracy, especially around epidemic peaks. When applied to empirical and machine learning forecasting methods (Autoregressive Integrated Moving Average, Holt-Winters, gradient-boosting machines, Prophet, and spline models), epimodulation improved overall prediction accuracy by an average of 12.3% (range: 8.5 to 18.7%) for COVID-19 hospital admissions and by 32.9% (range: 24.2 to 43.7%) for influenza hospital admissions; accuracy during epidemic peaks improved even further, by an average of 27.9% and 43.8%, respectively. Epimodulation also substantially enhanced the performance of complex forecasting methods, including the COVID-19 Forecast Hub ensemble model, demonstrating its broad utility in improving forecast reliability at critical moments in disease outbreaks.

Aims/Background The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted global health and the economy. Vaccination is crucial for controlling its spread, and healthcare workers (HCWs) in Saudi Arabia prioritize vaccination. This systematic review aimed to: (1) evaluate the reported side effects of COVID-19 vaccines among HCWs in Saudi, (2) assess vaccine acceptance rates and their temporal changes, and (3) identify the factors influencing vaccine uptake and hesitancy. Methods We conducted a systematic review following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The protocol included: (1) systematic searching of five major databases (MEDLINE, Embase, PubMed, Scopus, and Web of Science) up to 25 November 2024; (2) independent screening and selection by three reviewers using predefined inclusion criteria; (3) quality assessment using the Joanna Briggs Institute (JBI) critical appraisal tool; and (4) standardized data extraction and synthesis focusing on vaccine side effects, acceptance rates, and influencing factors among healthcare workers in Saudi Arabia. Results Of the 220 citations, 30 met the inclusion criteria. Studies have revealed predominantly mild to moderate side effects, with severity patterns varying by professional role and demographic factors. Vaccine acceptance showed significant improvement over time, which was attributed to public health campaigns, peer influence, and improved accessibility. Higher acceptance was correlated with professional experience and education levels, while hesitancy stemmed from safety concerns and efficacy doubts. Conclusion Understanding these patterns supports the development of targeted interventions, suggesting a need for evidence-based communication and peer-led education programs. Healthcare institutions should focus on transparent safety communication and address specific misconceptions to enhance vaccine confidence among HCWs.

Background: Trelegy Ellipta is a widely prescribed triple inhaler therapy for chronic obstructive pulmonary disease (COPD). Although its clinical efficacy is well established, evidence on sex-specific differences in adverse event (AE) profiles from real-world pharmacovigilance data remains limited. In addition, some AEs may reflect underlying disease characteristics rather than drug exposure, which complicates interpretation of safety signals. Objective: To explore sex-related differences in AEs associated with Trelegy Ellipta using the FDA Adverse Event Reporting System (FAERS). The study aimed to identify potential safety signals while accounting for alternative explanations, including comorbidity burden and disease-related variation. Methods: We retrospectively analyzed FAERS reports from January 2018 to April 2025, identifying 4555 AEs attributed to Trelegy Ellipta. Events were coded by System Organ Class (SOC) and stratified by patient sex. Frequencies were compared between male (n = 1621) and female (n = 2934) patients using chi-square tests, and associations were expressed as reporting odds ratios (RORs) with 95% confidence intervals (CIs). Results: Male patients more frequently reported hypertension (63.4% vs. 47.0%; p = 0.01), pneumonia (87.8% vs. 76.8%; p < 0.001), anxiety (91.0% vs. 66.9%; p < 0.001), sleep disorders (20.1% vs. 6.8%; p < 0.001), and hyperglycemia (92.7% vs. 52.1%; p < 0.001). Female patients more often reported headache (56.7% vs. 32.6%; p < 0.001), depression (33.1% vs. 9.0%; p < 0.001), and osteoporosis (41.7% vs. 2.4%; p < 0.001). Further variation was observed across neurological, musculoskeletal, and respiratory categories, suggesting a multidimensional pattern of sex differences. Conclusions: This FAERS-based analysis indicates distinct sex-specific safety signals for Trelegy Ellipta, particularly in cardiovascular, neuropsychiatric, and steroid-related domains. These findings are hypothesis-generating and highlight the importance of incorporating sex-disaggregated analyses into future pharmacovigilance and clinical studies.

First-line treatment for obstructive sleep apnoea (OSA) is continuous positive airway pressure (CPAP). However, adherence to CPAP is poor. Non-adherent patients may benefit from other treatment modalities. Drug-induced sedation endoscopy (DISE) is a validated tool to suggest individualised treatment options. This study aimed to investigate the outcome of DISE in patients with OSA or severe snoring.

Patients with OSA and/or snoring who had poor compliance with CPAP were included in a database from May 2020 to October 2022. The inclusion criteria were BMI less-than 35 kg/m2, age 18-65 years and no contraindications to propofol infusion. DISE was performed, and anatomic collapse during DISE was evaluated using the velum-oropharynx-tongue-base-epiglottis classification. Treatment suggestions were registered.

The database included 190 referred patients, and 109 patients underwent DISE. Among these, 34 had mild OSA or snoring (Apnea-Hypopnea Index (AHI) less-than 15 events/hour)) and 75 had moderate-severe OSA (AHI ≥ 15 events/hour). A total of 51% of patients were recommended sleep surgery, the most frequent being tonsillectomy. Surgery was recommended more among patients with AHI ≥ 15 events/hour.

DISE suggests a personalised treatment for eligible patients with OSA or severe snoring. When the DISE findings were considered, half of the patients were recommended for sleep surgery. The value of DISE in planning such surgery in this cohort needs to be determined.

None.

The study was approved by the Institutional Review Board and the Scientific Ethical Committee of the Central Denmark Region (no: 1-10-72-228-17).

Research on pneumonia in patients undergoing treatment for alcohol withdrawal symptoms (AWS) is sparse. This study describes the microbiological aetiology in this patient group within an intensive care unit (ICU).

We conducted a retrospective, observational study at Copenhagen University Hospital, Bispebjerg, Denmark. Patients admitted to the ICU between 1 June 2017 and 31 December 2020 who had received at least 200 mg of chlordiazepoxide for AWS within the preceding days were identified through electronic health records. Admissions presenting with clinical symptoms of pneumonia were included in the study.

A total of 76 patients with 88 admissions met the inclusion criteria. We identified 58 bacterial species, with the most common being Staphylococcus aureus (n = 14; 24%), Haemophilus influenzae (n = 12; 21%) and Streptococcus pneumoniae (n = 11; 19%). In the overall ICU population, excluding our cohort study, 516 bacterial samples from the lower airways were identified. The prevalence rate in the study period for S. aureus was 25.6% (n = 132), for H. influenzae 8.3% (n = 43) and for S. pneumoniae 8.5% (n = 44).

Pneumonia was prevalent in patients with AWS in the ICU, and it had a predominantly bacterial aetiology. The most frequently isolated bacteria were S. aureus, H. influenzae and S. pneumoniae. Notably, the prevalence of S. aureus in our study cohort was similar to that in the overall ICU population at the study site.

None.

The study was approved by the Hospital Board of Directors as a quality study.

Although well-documented asthma treatments are available, many patients with asthma remain symptomatic, even when managed by respiratory specialists. We aimed to describe barriers to optimal asthma management in Danish respiratory specialist practice.

This was a qualitative study of 20 patients (mean age 37.6 years, six 40+ years; 17 women) with asthma from two specialist practices, with interviews conducted by phone.

Many patients were unaware of the timeline for their course of treatment or what it entailed to be a patient in a pulmonary clinic, including being uncertain about how many consultations they were entitled to, the agenda of the next appointment and what the exact goals of the treatment were. Patients expressed doubts regarding the dosage and effectiveness of their medication. Some questioned whether they were taking their medication correctly and whether it was acceptable to take additional doses. Patients reported that they occasionally forgot to take their medication because they had not established a consistent routine for it.

Barriers were often quite practical and simple, and can most likely be broken down by focusing on simple behavioural aspects rather than by providing more information.

This study was funded by Fonden for Faglig Udvikling i Speciallægepraksis, Danske Regioner.

Not relevant.

Atrial fibrillation (AF) prevalence is projected to double in the coming decades, necessitating innovative management strategies. This study evaluated the feasibility of a decentralised clinical trial for home-based sleep apnoea (SA) screening, activity tracking and heart rhythm monitoring in patients with AF.

This prospective cohort study enrolled patients with AF without known SA. Participants underwent a 12-week study using three home-monitoring systems: NightOwl for SA evaluation, FibriCheck for heart rhythm monitoring and SENS Motion for activity tracking. Patients completed questionnaires assessing AF-related quality of life, symptom severity, sleep quality and eHealth literacy at baseline and 12 weeks.

The study included 18 patients with AF with a median age of 68.0 (interquartile range: 60.0-71.5) years, 11 (61%) women and 15 (83%) with paroxysmal AF. The study demonstrated high feasibility of remote monitoring, with data completeness rates of 83.3% for SA home evaluations, 97.6% for questionnaires, 91.7% for activity tracking and 88.8% for heart rhythm measurements. A drop-out rate of only 5.6% was recorded.

The study reports the feasibility of a decentralised digital platform for comprehensive AF patient monitoring. High patient engagement and data completeness suggest that digital health technologies can effectively integrate into clinical trials for patients with AF.

The Danish Heart Foundation (2023-12410) and Helsefonden (20-B-0269).

NCT06188247.