To map the existing evidence on the impact of transverse craniofacial alterations on mandibular advancement device treatment outcomes in adults with obstructive sleep apnea, with the objective of identifying knowledge gaps and informing future research and clinical decision-making.

A systematic literature search was conducted in six databases. Additionally, gray literature sources were searched, and clinical trial registries, including ClinicalTrials.gov, were screened for RCT protocols. The reference lists of all included sources of evidence were also screened, and experts in the field were consulted.

The literature search yielded a total of 1,508 references after duplicate removal. Nine studies and one conference report were found eligible for inclusion. The literature demonstrated heterogeneous associations between transverse craniofacial characteristics and mandibular advancement device treatment outcomes. Most studies (n = 7) did not identify significant associations between isolated transverse craniofacial measurements and treatment response. Greater mandibular transverse dimensions were associated with better therapeutic outcomes in two studies, whereas one study reported better treatment response in individuals with smaller mandibular transverse dimensions. Reduced maxillary width and unfavorable anatomical balance were more frequently associated with greater obstructive sleep apnea severity or poorer treatment outcomes.

While some studies suggest that the response to mandibular advancement devices in obstructive sleep apnea is associated with transverse mandibular dimensions, most investigations have not identified this relationship. Future standardized and well-designed studies are needed to clarify the influence of this anatomical characteristic on the outcomes of this common treatment for obstructive sleep apnea.

In a household cohort enrolled during the COVID-19 pandemic in Lima, Peru, detections of human rhinovirus, endemic coronaviruses, and parainfluenza viruses were significantly lower compared to these viral detections in a similar household cohort followed during the same seven epidemiological weeks in a period immediately preceding the COVID-19 pandemic.

The aim of the present study is to evaluate the 2023/24 and 2024/25 influenza vaccination campaigns in Liguria (Italy), specifically analyzing how the transition toward a proximity-based model impacted vaccine appropriateness across different age groups (60-64 y, ≥65 y) and providers. Data regarding seasonal influenza vaccine administrations were extracted from the official Local Health Units (LHUs) immunization registries, which aggregate immunization records from different providers [LHUs, General Practitioners (GPs), pediatricians and community pharmacies]. To evaluate prescriptive appropriklateness, administered vaccines were cross-referenced with national guidelines based on the patient's age. A 6% overall decrease in coverage rates between the two seasons was recorded while the provider landscape shifted significantly. Unfortunately, while enhancing proximity (General Practitioners and pharmacies), this evolution introduced wide variability in prescriptive appropriateness. Our analysis reveals a persistent mismatch between national recommendations and real-world clinical practice and only 65% (2023/24 season) and 73% (2024/25 season) among ≥65 y individuals received enhanced vaccines. Strengthening clinical governance and targeted professional training for pharmacists and GPs is essential to ensure that the convenience of proximity-based vaccination does not compromise clinical efficacy through the use of sub-optimal vaccine platforms for high-risk cohorts.

Whether supranormal lung function is associated with incident atrial fibrillation (AF), and whether obstructive sleep apnoea (OSA) modifies this association, remain to be determined.

We analysed 2,408 participants from the Sleep Heart Health Study who were free of AF at baseline and had no spirometric airflow obstruction. The primary analysis classified forced expiratory volume in 1 second (FEV₁) as below normal, normal, or supranormal using race-neutral Global Lung Function Initiative (GLI) Global (2022) reference equations. Categories defined by forced vital capacity (FVC) were examined in a secondary analysis. Associations with incident AF were evaluated using multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Firth penalised logistic regression and sensitivity analyses were used to assess the robustness of the findings. Interaction with OSA was explored.

Among 2,408 participants, 282 developed AF. Compared with normal FEV₁, supranormal FEV₁ was associated with lower odds of incident AF in the primary adjusted model (OR, 0.420; 95% CI, 0.198-0.888). The corresponding Firth estimate was 0.443 (95% CI, 0.199-0.869). Supranormal FVC showed a similar association in standard logistic regression (OR, 0.351; 95% CI, 0.167-0.736) and Firth penalised logistic regression (OR, 0.371; 95% CI, 0.168-0.721). The direction of the associations was generally consistent across sensitivity analyses. There was no statistically significant evidence of effect modification by OSA.

Supranormal lung function was associated with lower odds of incident AF. These findings support supranormal spirometry as a potential marker of favourable systemic and cardiopulmonary physiology.

Adenotonsillectomy is one of the most frequently performed surgical procedures in children with obstructive sleep apnoea due to chronic upper airway obstruction. There is paucity of data about the impact of adenotonsillectomy on children's quality of life in Nigeria.

This study evaluated the quality of life of children pre and post adenotonsillectomy.

Caregivers of children who had adenotonsillectomy completed the obstructive sleep apnoea OSA-18 quality of life (QOL) validated questionnaire before, and 6 months after adenotonsillectomy. The OSA-18 contains 18 questions and assessed the QOL in 5 domains.

A total of 80 (out of 105) caregivers completed and returned the questionnaires concerning 80 children (M = 38, F = 42). The age of the children ranged from 1 - 9 years with a mean ± SD of 3.67 ± 1.92 years. Caretaker preoccupation and sleep disorders were the domains with the greatest changes in their mean scores having 17.51 and 17.11 respectively. The mean ± SD of the total OSA-18 score was 89.89 ± 13.16 preoperatively, and 22.43 ± 4.31 post operatively. The changes in the scores for each domain, for each item of the OSA-18 survey, and the total score were highly significant (p ˂ 0.001). The mean of the caretaker-perceived quality of life for the children showed improvement from 3.50 to 8.50 (p ˂ 0.001).

Adenotonsillectomy produced markedly significant improvements in the affected children's quality of life.

To determine the incidence, severity, and factors associated with bronchopulmonary dysplasia (BPD) using the Jensen definition in a high-risk preterm infant cohort from a middle-income country.

A retrospective observational cohort study was conducted, including babies born at <32 weeks of gestational age between 2021 and 2023 at a tertiary neonatal intensive care unit in Colombia. BPD was defined as the need for supplemental oxygen or respiratory support at 36 weeks' postmenstrual age (PMA) or at discharge. Demographic, perinatal, and clinical variables were obtained from medical records. Factors associated with BPD were evaluated using bivariate analyses and multivariable Poisson regression with robust variance.

Of 395 eligible neonates, 338 were included; 299 (88.4%) survived to 36 weeks PMA or hospital discharge and were evaluable for BPD. The overall incidence of BPD was 76.3%. Most BPD cases were classified as grade 1 (92.1%). Potentially fatal BPD (positive-pressure support or pulmonary vasodilators at 38 weeks PMA) was identified in 4.8% of patients. Overall mortality in the cohort was 13.0%. In the multivariable analysis, BPD was independently associated with extreme prematurity, requirement for invasive mechanical ventilation during hospitalization, diuretic use for fluid overload, documented infection requiring antimicrobial therapy, maternal thyroid disease, and exposure to antenatal corticosteroids, all of which were statistically significant (p<0.05).

BPD incidence was high in this neonatal cohort. Although mild disease predominated, a relevant proportion of severe and potentially fatal cases was observed. The identification of modifiable postnatal factors highlights opportunities to optimize respiratory management, infection prevention, and fluid strategies in similar middle-income settings.

Respiratory syncytial virus, a major cause of respiratory infections and hospitalizations in young children, especially bronchiolitis, is an important burden to the health system in Brazil. This study evaluated the trends, seasonality, and economic impact of hospitalizations associated with respiratory syncytial virus in Brazilian children.

This study analyzed hospitalizations for acute bronchitis and bronchiolitis (International Code of Diseases-10 J20-J21) in Brazilian children <5 years of age from January 2014 and March 2025 using data from the Brazil's Unified Health System. Annual trends were assessed with linear regression, while time series decomposition evaluated seasonality. Direct medical costs were adjusted for inflation and converted to international dollars (Int$). Pearson's correlation coefficient was employed to analyze associations between length of stay and hospitalization cost.

A total of 727,808 hospitalizations were recorded, with 86.8% occurring in children under 5 years old. Hospitalizations increased by 307.8%, with marked declines in 2020 during the coronavirus disease-2019 pandemic and consistent seasonal peaks between March-June. Direct medical costs totaled Int$ 166.8 million, with 55.5% of expenditures after 2020. The mean cost per hospitalization increased by Int$ 21.48 between 2014-2024 (Int$ 118.16-139.64). Length of stay correlated moderately with cost (r = 0.55), particularly strongly in southeastern and southern Brazil.

Our findings revealed distinct seasonal and regional patterns in hospitalizations and a post-pandemic increase in costs. The association between prolonged hospitalization and higher expenditures underscores the need for targeted, region-specific preventive strategies and timely clinical interventions, to reduce the growing economic burden on the system.

to verify the salivary excretion of Torque Teno Virus (TTV) in children and adolescents who underwent kidney transplantation and to correlate the number of viral copies with the polymerase chain reaction test for SARS-CoV-2.

a cross-sectional observational study conducted at the post-kidney transplant outpatient clinic of Hospital do Rim e Hipertensão.

thirty-one patients were included, with a predominance of males (54.8%) and ages between 13 and 15 years (38.7%). Salivary excretion of TTV was detected in 96.7% of participants, of whom 36.7% also tested positive for SARS-CoV-2. However, no significant association was found between the two viruses. A moderate negative correlation (-0.463) was observed between TTV levels and serum tacrolimus concentration.

salivary excretion of TTV was identified in children and adolescents who underwent kidney transplantation. Although no correlation was observed between TTV and SARS-CoV-2, an association was found between TTV and serum tacrolimus levels.

Risk stratification in acute pulmonary embolism (PE) is based primarily on findings obtained at hospital admission. However, whether serial assessment of right ventricular (RV) dysfunction and hemodynamic changes provides incremental prognostic value beyond the initial risk stratification remains uncertain.

To evaluate longitudinal clinical and imaging variables associated with adverse in-hospital outcomes in patients with intermediate-high- and high-risk acute PE.

This prospective registry included patients with intermediate-high- and high-risk acute PE. The primary composite endpoint comprised in-hospital mortality, invasive mechanical ventilation, persistent shock or hypotension, and extracorporeal membrane oxygenation. Longitudinal variables were assessed 24-72 hours after admission. All statistical tests were two-tailed, and a p-value < 0.05 was considered statistically significant. Multivariable logistic regression models were constructed, and discriminative performance was evaluated using the area under the receiver operating characteristic curve (AUC-ROC). A prespecified missing-data analysis was performed to assess the availability of follow-up computed tomography pulmonary angiography (CTPA).

The primary composite endpoint occurred in 21.2% of the 151 patients, with an in-hospital mortality rate of 9.3%. Persistent RV dysfunction on follow-up CTPA (χ2 = 15.48; p < 0.001) and follow-up systolic blood pressure (SBP; p < 0.001) were the strongest individual predictors of adverse outcomes. In the longitudinal multivariable model (n = 60), persistent RV dysfunction on follow-up CTPA (OR 9.70; 95%CI, 1.96-47.89; p = 0.005) and follow-up SBP (OR 0.90; 95%CI, 0.83-0.96; p = 0.003) remained independent predictors. The model demonstrated excellent discrimination (AUC-ROC = 0.874) and adequate calibration. The missing-data analysis showed that patients without follow-up CTPA were more severely ill at baseline, consistent with a missing not at random mechanism.

Reassessment of established risk markers during hospitalization may improve identification of patients who remain at high risk despite initial risk classification and treatment. Persistent RV dysfunction and lower follow-up SBP were independently associated with adverse in-hospital outcomes, which supports the use of dynamic risk stratification in acute PE.

to perform cross-cultural adaptation and psychometric analysis of Teachers' Self-Efficacy in Asthma Management for Brazil.

a psychometric study encompassing the stages of translation, translation synthesis, back-translation, expert committee submission, pre-final version testing, and adapted version testing. Confirmatory factor analysis and Cronbach's alpha coefficient were performed to analyze construct validity and reliability.

the Content Validity Index of the translated version was higher than 0.80, after modifications proposed by experts. Pre-final version testing indicated good comprehension and ease of response. The adapted version was tested on 143 teachers. Confirmatory factor analysis demonstrated a good fit to the model, with factor loadings between 0.555 and 0.911. Cronbach's alpha coefficient was 0.922.

the Brazilian version of the scale presented reliable and valid psychometric measures, confirming its unidimensionality.