The nocturnal breathing alterations among patients with obstructive sleep apnea (OSA) impact their daytime breathing mechanics. However, dysfunctional breathing remains under-recognized with limited evidence in these patients. The study aimed to examine the relationship between dysfunctional breathing (DB) and apnea hypopnea index (AHI) among patients with moderate and severe OSA. The secondary objective was to compare DB between patients with moderate and severe OSA.

A cross sectional study was performed at Manipal Hospital, Bangalore with 120 participants. The biomechanical component, biochemical component and patient reported symptoms of DB were assessed using manual assessment of respiratory motion (MARM), breath holding test (BHT) and self evaluation of breathing questionnaire (SEBQ), respectively. Correlation and regression analysis were used to determine the relationship between DB and AHI. Comparison of outcomes among individuals with moderate OSA and severe OSA was done.

MARM volume showed non-significant negative correlation with AHI with ρ = -0.085. MARM Balance and ribcage motion showed significant correlation (p < 0.05) with ρ = 0.187 and ρ = 0.205, respectively. The BHT showed non-significant correlation (p > 0.05) with ρ = -0.105 and patient reported symptoms showed significantly positive correlation with ρ = 0.458. The regression model showed significant findings on adjusting for the potential confounders. Also, significantly deteriorated dysfunctional breathing outcomes were reported in patients with severe OSA.

The DB outcomes showed marked relationship with the severity of OSA. Additionally, all the aspects of DB were substantially affected in individuals with severe OSA as compared to those with moderate OSA.

Guidelines from the Oncology Nursing Society (ONS) and Infusion Nurses Society (INS) were reviewed to establish a flushing protocol. No consensus on implanted vascular access port (IVAP) flush frequency was recommended. Guidelines suggest extending up to 12 weeks may be safe based on functionality. However, limited research on the risks associated with stagnant reservoir contents leaves this practice under debate.

An oncology clinic studied IVAP flush practices during the COVID-19 pandemic when routine care was delayed. Concerns arose about biofilm, clots, or other harmful substances being flushed into patients. A new approach was developed to observe IVAP reservoir contents, allowing abnormal substances to be aspirated and discarded before flushing.

In 150 patients observed from 5 to 17+ weeks, visible clots and altered reservoir contents were found in 52% of cases.

Findings suggest that prolonged intervals between flushes may increase risks associated with stagnant IVAP contents. This research highlights the need for further studies to establish safe and evidence-based flush frequencies. The new observational method offers a proactive approach to identify and remove harmful substances, helping to mitigate risks when routine IVAP maintenance is delayed. Ensuring patient safety requires further investigation into the physiological impacts of extended flush intervals.

We performed a single-center observational cohort study on patients with COVID-19. We retrospectively analyzed 54 patients with confirmed SARS-CoV-2 infection, diagnosed as critically ill. Severely ill patients have a poor prognosis and it is a matter of great interest to identify these cases for an adequate management. Current findings revealed that altered levels of some blood markers might be linked with the degree of severity and mortality of patients with COVID-19. Our study aimed to assess the relationship between inflammation and coagulation in SARS-CoV-2 infection and to find out if pro-inflammatory markers are correlated with coagulation parameters in COVID-19. Pro-inflammatory markers included leptin and classical biomarkers. This paper highlights the results obtained. We found statistically significant associations between blood levels of various biomarkers including leptin, IL-6, ferritin, neutrophil-lymphocyte ratio, C-reactive protein, fibrinogen, erythrocyte sedimentation rate and lactate dehydrogenase and the presence of coagulopathy, as indicated by the Pearson Chi-Square and Likelihood Ratio tests. The relationships are not linear, as indicated by the nonsignificant Linear-by-Linear Association test. The correlations between some biomarkers such as leptin, IL-6, ferritin, neutrophil-lymphocyte ratio, C-reactive protein, fibrinogen, erythrocyte sedimentation rate and lactate dehydrogenase and coagulopathy are weak and not statistically significant and the correlation between IL-6 levels and coagulopathy is very weak and negative and not statistically significant. Different crosstabulations between serum leptin levels and D-dimers, Prothrombin time, Prothrombin activity, International-normalized-ratio and activated partial thromboplastin time have been performed including the analysis of a potentional correlation. There are statistically significant associations between serum leptin levels and coagulation parameters, including D-dimers, prothrombin time, prothrombin activity and activated partial thromboplastin time, as indicated by the Pearson Chi-Square test. There is also a statistically significant association between serum leptin levels and international-normalized ratio (INR) as indicated by the Pearson Chi-Square test. The Linear-by-Linear Association test indicates a significant linear relationship between Leptin levels and international-normalized ratio. Pearson R shows a moderate positive correlation, which is statistically significant.

Allergic asthma (AA) is a heterogeneous chronic inflammatory airway disorder. In this study, we performed a retrospective bioinformatics analysis based on public transcriptome datasets to identify critical genes associated with immune cell infiltration in AA and to establish a novel predictive model.

Two transcriptome datasets (GSE73482 and GSE40889) were analyzed to explore key genes implicated in AA. Functional enrichment analyses, including Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses, were performed using Metascape. Least absolute shrinkage and selection operator regression was applied to screen feature genes and construct a diagnostic prediction model. Weighted gene co-expression network analysis (WGCNA) was conducted to identify AA-related gene modules. The fractions of infiltrating immune cells were estimated using single-sample gene set enrichment analysis (ssGSEA). Gene set variation analysis and gene set enrichment analysis (GSEA) were performed to explore the biological functions and related signaling pathways of the key genes. The Cistrome Data Browser database was used to predict transcription factors that potentially regulate these key genes.

We identified 4 highly significant genes in the brown module: membrane associated O acetyltransferase 1 (MBOAT1), leucine rich repeats and immunoglobulin-like domains 1 (LRIG1), LOC401357, and G protein regulated inducer of neurite outgrowth 3 (GPRIN3). GSEA results revealed that these key genes were significantly enriched in multiple immune-related signaling pathways. To further explore the regulatory network of these genes, transcription factors were predicted using the Cistrome Data Browser database, and the regulatory network was visualized using Cytoscape software.

MBOAT1, LRIG1, LOC401357, and GPRIN3 are candidate AA-associated genes identified through retrospective modeling. The identification of these genes offers potential opportunities to utilize them as biomarkers and targets for immunotherapy in AA.

This study aimed to comprehensively assess the prognostic value of routinely obtained blood-based systemic inflammatory indices in predicting all-cause mortality among individuals with chronic obstructive pulmonary disease (COPD). This retrospective cohort study analyzed data from the National Health and Nutrition Examination Survey (NHANES) cycles 2007-2010. A total of 1109 eligible adults with COPD were included, with 333 deaths recorded during the follow-up period. Eleven systemic inflammatory indices were derived from baseline hematological parameters. The associations between these indices and all-cause mortality were initially evaluated using multivariate Cox proportional hazards models. To manage high-dimensional data and identify complex patterns not captured by conventional statistical methods, machine learning (ML) algorithms were applied for feature selection, model development, and performance evaluation. Model discrimination and clinical utility were assessed using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis. Among the 1109 participants (mean age 57.9 ± 15.5 years, 52.2% male), non-survivors (n = 333) were significantly older and had a higher baseline burden of comorbidities. After full adjustment for covariates, several inflammatory indices showed statistically significant associations with all-cause mortality. The neutrophil percentage-to-albumin ratio (NPAR) and neutrophil-to-lymphocyte ratio exhibited the strongest associations, with HRs of 2.46 (95% CI: 1.64-3.69) and 2.14 (95% CI: 1.42-3.22), respectively, in the highest quartile (Q4) compared to the lowest (Q1). The neutrophil-to- high-density lipoprotein ratio also demonstrated a significant positive association (HR for Q4 vs Q1: 1.79, 95% CI: 1.18-2.70). In contrast, higher levels of the C-reactive protein-albumin-lymphocyte index index were associated with reduced risk, indicating a protective effect (HR for Q4 vs Q1: 0.49, 95% CI: 0.33-0.72). The ML-derived NPARTEST model, based on the NPAR index, achieved an AUC of 0.828 for predicting all-cause mortality, demonstrating good discriminative performance and clinical utility. Systemic inflammatory indices, particularly the NPAR and neutrophil-to- high-density lipoprotein ratio, are independently associated with all-cause mortality in patients with COPD, often exhibiting nonlinear relationships. The ML-based NPARTEST model demonstrates promising predictive performance. These findings underscore the potential of cost-effective, routinely measured blood-based biomarkers to enhance risk stratification in COPD management. External validation in diverse populations is warranted to confirm the generalizability of these results.

Elevated serum vitamin B12 levels have emerged as a paradoxical prognostic marker associated with increased mortality across various clinical settings, yet their significance in hospitalized dementia patients remains unexplored. Given the high vulnerability of this population, we aimed to investigate the association between elevated serum vitamin B12 levels and all-cause mortality. This retrospective cohort study evaluated 90-day outcomes in hospitalized adults with dementia who had serum vitamin B12 levels measured within 7 days of admission (2010-2024). Patients were categorized into exposure (vitamin B12 ≥ 900 pg/mL) and control (300-900 pg/mL) groups. Propensity score matching balanced baseline characteristics, including demographics, comorbidities, and laboratory parameters. The primary endpoint was all-cause mortality within 90 days. Secondary endpoints comprised sepsis, pneumonia, urinary tract infection, and admission to the intensive care unit (ICU). Sensitivity analyses restricted the cohort to patients with unspecified dementia and to patients with a dementia diagnosis established at least 1 year before the index admission. After propensity score matching, 16,513 patients were included in each cohort. Elevated vitamin B12 was significantly associated with increased 90-day mortality (10.9% vs 8.3%; odds ratio [OR] 1.36, 95% confidence interval [CI] 1.26-1.46, P < .001), sepsis (4.2% vs 3.0%; OR 1.43, 95% CI 1.27-1.61, P < .001), pneumonia (8.3% vs 6.6%; OR 1.28, 95% CI 1.18-1.39, P < .001), and ICU admission (3.9% vs 3.0%; OR 1.31, 95% CI 1.16-1.47, P < .001). No association was observed with urinary tract infection (OR 0.97, 95% CI 0.90-1.04, P = .377). The findings remained robust across sensitivity and subgroup analyses. Elevated vitamin B12 levels are associated with increased short-term mortality, infectious complications, and ICU admission in hospitalized patients with dementia. This readily available biomarker may serve as a potential indicator for risk stratification in this vulnerable population. However, given the observational nature of this study, future prospective studies are warranted to confirm these findings and elucidate the underlying mechanisms.

To explore the risk factors and predictive value of Mycoplasma pneumoniae (MP) infection in children. A total of 2042 children with suspected Mycoplasma pneumoniae infection who were treated for the first time at Civil Aviation General Hospital from October 2023 to December 2023 were selected as the study subjects. Among them, 1637 cases were confirmed as Mycoplasma pneumonia-infected and were included in the pneumonia group, while the remaining 405 cases were non-Mycoplasma pneumonia-infected and were included in the non-Mycoplasma pneumonia group. The clinical data of the 2 groups of children (including gender, age, initial symptoms, laboratory indicators, etc) and the risk factors of MP infection in children were compared, and the receiver operating characteristic curve was analyzed. This study showed that the percentage of neutrophils in the non-MP infection group was significantly lower than that in the MP infection group, and the difference was statistically significant (P < .001). When comparing the percentages of lymphocyte percentage (LY) and hemoglobin in the 2 groups of children, the Mycoplasma pneumonia-infected group was lower than the non-Mycoplasma pneumonia-infected group, and the differences were both statistically significant (P < .05). Logistic regression analysis revealed that white blood cell and neutrophil-to-lymphocyte ratio (NLR) might be valuable markers for predicting MP infection. The Spearman correlation indicated that LY was collinear with the occurrence of MP infection, and Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis demonstrated that both LY and NLR might be valuable markers for predicting MP infection (P < .05). Receiver operating characteristic curve analysis revealed that the area under the curve of the NLR for diagnosing MP infection was 0.624, with a cutoff value of 1.36 (sensitivity of 0.798 and specificity of 0.558). In the diagnosis of MP infection, the consistency between the RNA method and the immunogold colloidal method was poor (Kappa = 0.108, P < .05). The consistency between the RNA method and the immunogold colloidal method in the diagnosis of MP infection is poor. Both the white blood cell and NLR are valuable markers for MP infection.

This study aimed to investigate the association between social isolation and mortality risk in U.S. adults with chronic obstructive pulmonary disease (COPD) and to explore the potential mediating role of systemic inflammation. We conducted a retrospective cohort study of adults with COPD from the 1999 to 2018 National Health and Nutrition Examination Survey. The associations between social isolation and mortality risks from all-cause, cardiovascular disease (CVD), and chronic lower respiratory disease (CLRD) were assessed using Cox proportional hazards models by reporting hazard ratios and 95% confidence intervals. Mediation analyses were performed to assess the contributions of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio. Among 1726 participants (mean age 65.29 years; 50.97% women) included, the prevalence of social isolation was 15.47%. Over a median follow-up of 83 months, 709 deaths occurred. Socially isolated participants demonstrated significantly increased mortality risks, with fully adjusted hazard ratios (95% confidence intervals) of 1.59 (1.22-2.08) for all-cause, 2.66 (1.64-4.32) for CVD, and 1.86 (1.13-3.05) for CLRD mortality, compared to nonisolated participants. Population-attributable fraction analyses indicated that social isolation was associated with 13.2% of all-cause, 24.2% of CVD, and 16.5% of CLRD deaths. Mediation analysis revealed that neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio explained 6.32% to 13.15% and 4.78% to 7.75% of these associations, respectively. Social isolation is independently associated with a significantly elevated mortality risk in U.S. adults with COPD, partially mediated by systemic inflammation. These findings highlight the potential clinical and public health importance of addressing social isolation to improve survival in COPD patients.

This study aims to examine the impact of the COVID-19 public health emergency on state-level dental service utilization, focusing on endodontic care; and to understand how benefit design and coverage influence healthcare disparities in oral health.

The data comes from the 2019-2021 Centers for Medicare & Medicaid Services (CMS) unredacted Transformed Medicaid Statistical Information System (T-MSIS). State-level coverage was collected from state Medicaid program provider manuals. We analyzed service utilization rates overall and by demographic factors such as age, sex, and race/ethnicity. Chi-square tests were used to test for significant differences in the rates across the years and within each group. Clustered-robust standard error models were used to predict the odds of receiving an endodontic service.

The COVID-19 pandemic significantly disrupted dental service utilization across the United States, with a marked decrease in preventive and routine dental care. Utilization of endodontic services experienced less of a decline during the pandemic and a significant increase post-pandemic, compared to other dental services. States with more comprehensive Medicaid dental benefits design had significantly higher rates of endodontic service utilization for children and adults. Among children, increased age, female gender, and non-Hispanic Black race/ ethnicity were significantly associated with lower levels of endodontic service utilization. Among adults, rural residence designation was significantly associated with lower levels of endodontic service utilization.

The study highlights the critical role of benefit design in ensuring dental service utilization, particularly during public health emergencies. Oral health stakeholders must recognize the potential long-term consequences of delayed dental care and remain innovative in providing care under limited circumstances.

Telehealth has increasingly been integrated into neurological practice worldwide, particularly following the COVID-19 pandemic. Despite national efforts to expand telehealth services in Saudi Arabia, evidence on neurologists' telehealth use, attitudes, and intentions to adopt telehealth in routine practice remains limited.

A national cross-sectional survey was conducted among neurologists practicing in Saudi Arabia to assess attitudes and intentions toward telehealth use. Participants were recruited via snowball sampling to complete a structured, self-administered questionnaire. The required sample size was calculated for a finite population and estimated at 281; a total of 300 neurologists were recruited to account for non-responses. Survey validity was established through expert content review and face validity testing, while reliability was confirmed using Cronbach's alpha (0.73) and test-retest correlation (r = 0.82). Descriptive statistics summarized responses, and inferential analyses-including chi-square tests, Mann-Whitney U tests, and multivariate logistic regression, were performed to identify factors associated with intention to use telehealth, with p < 0.05 set as the criterion for statistical significance.

Overall, 78.7% (n = 236) intended to use telehealth. Intention was significantly higher among neurologists working in the Central region (39.8% vs. 20.3%, p = 0.017), governmental institutions (89.8% vs. 73.4%, p = 0.001), and tertiary care centers (51.3% vs. 32.8%, p = 0.030), and among consultants compared with specialists (36.0% vs. 21.9%, p = 0.006). Confidence in telehealth was higher for follow-up care than for new patients (82.7% vs. 24.0%, p < 0.001). The attitude toward telehealth was moderately positive (median 1.47, IQR = 0.47) and significantly higher among those intending to use telehealth (median 1.53 vs. 1.00, p < 0.001). Multivariate analysis showed that familiarity with telehealth (OR = 32.0, 95% CI: 8-126), positive attitudes toward follow-up care (OR = 21.0, 95% CI: 7-63), and institutional provision of audio services (OR = 4.84, 95% CI: 1.48-15) were strongly associated with the intention to use telehealth.

Most surveyed neurologists reported a high intention to use telehealth. Confidence in telehealth was higher for follow-up care than for new-patient consultations. Overall attitudes toward telehealth were moderately positive and were significantly associated with the intention to use the service. Familiarity with telehealth, positive attitudes toward follow-up care, and institutional provision of audio services were identified as significant independent factors associated with telehealth adoption. These findings underscore the importance of individual and organizational factors in shaping neurologists' willingness to adopt telehealth, suggesting that targeted strategies to enhance adoption should focus on increasing familiarity, promoting positive attitudes, and ensuring institutional support.