Background: During pregnancy, mothers and their infants are at increased risk for complications due to COVID-19 infection, influenza, and pertussis. At the time of writing, the previous advisory committee on immunization practices (ACIP) recommended that pregnant women receive the COVID-19 vaccine, influenza, tetanus-toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine, as well as respiratory syncytial virus vaccinations during pregnancy. The COVID-19 pandemic greatly impacted routine vaccinations especially among medically underserved women in the South. The barriers to recommended vaccinations during pregnancy for medically underserved women in the South are unclear and require further investigation. The purpose of this study is to examine the attitudes, opinions, and beliefs of a multiracial pregnant cohort from diverse backgrounds in Central Tennessee about their experiences with the vaccines that are recommended during pregnancy. The vaccines included in the study are COVID-19, flu, and Tdap because RSV was not yet FDA-approved for pregnant women at the launch of this study. Methods: In this study, we focus on medically underserved women in Nashville, Tennessee, and the surrounding rural counties regarding vaccine acceptance and initiation of the COVID-19, influenza, and the Tdap vaccines. This study involved 208 pregnant people (100%) aged 18-49 years. All respondents were pregnant at the time of the study. The study consisted of a 26 question Redcap survey about participants' beliefs, attitudes, opinions, and experiences with the COVID-19, flu, and Tdap vaccines during their pregnancy. Results: The randomly selected participants in the cohort were 40.4% White, 31.7% Black, 21.6% Hispanic, and 6.3% other race/ethnicity. The mothers in the cohort were young, with an average age of 27 years, most were married, and 52.8% had an annual household income before taxes of less than USD 35,000. Only 19.2% of the mothers in this study were very confident of the safety of the COVID-19 vaccine, compared to 32.7% for both the flu and Tdap vaccines. Overall, primary care providers were identified as the most trusted messengers for both disease and vaccine information for COVID-19, flu, and Tdap. However, only 11 participants out of 208 received all three of the ACIP recommended vaccines during their pregnancies in the study, barring the time-dependent vaccination for Tdap. The most common reasons for not receiving these vaccines involved concerns for the safety of themselves and their babies and a fear of needles. Conclusions: Education and awareness of ACIP-recommended vaccines during pregnancy needs improvement, and the support of primary care providers as the main driver of pregnancy vaccine initiation is essential.

Community-acquired pneumonia (CAP) remains a leading cause of morbidity and mortality worldwide, underscoring the need for accessible and cost-effective biomarkers to support early risk assessment. This retrospective study investigated the prognostic performance of two systemic inflammatory indices-the Systemic Immune-Inflammation Index (SII) and the Systemic Inflammation Response Index (SIRI)-in 240 adults hospitalized with CAP between January and December 2024. The primary outcome was 30-day all-cause mortality. Logistic regression and receiver operating characteristic (ROC) analyses were applied to compare these indices with established severity scores, CURB-65 and the Pneumonia Severity Index (PSI). Thirty-day mortality occurred in 15.4% of patients. Non-survivors exhibited significantly higher SII values (p = 0.043) and a trend toward increased SIRI levels (p = 0.072). Both indices showed weak but statistically significant positive correlations with conventional inflammatory markers such as C-reactive protein and procalcitonin. While CURB-65 and PSI retained superior discriminative ability, SII and SIRI provided only modest prognostic information and did not significantly improve mortality prediction beyond these scores. These findings indicate that simple, hematology-based indices reflecting systemic inflammation may offer limited but potentially clinically relevant adjunctive information when integrated with traditional clinical scoring systems.

Understanding the clinical implications of minimum inhibitory concentration (MIC) may facilitate optimal drug selection in Mycobacterium avium complex pulmonary disease (MAC-PD) treatment. This study aimed to investigate the association of individual MICs with treatment response of MAC-PD. A retrospective cohort study was conducted in China, including eligible patients diagnosed with MAC-PD between 2018 and 2021. Treatment success rates were calculated across different MIC levels in a subgroup of patients receiving relatively uniform regimens. Associations between MICs and treatment outcomes were investigated by logistic regression analysis. In total, 209 patients with confirmed MAC-PD and initiated treatment were included. The median age was 60.0 years. Among 155 patients who completed treatment, 67.1% achieved treatment success. The treatment success rate was low in patients with clarithromycin MIC ≥ 64 mg/L (25.0%, 1/4) or ethambutol MIC > 16 mg/L (42.9%, 3/7), while remaining relatively stable (75-100%) at other MIC levels. Univariate analyses showed that clarithromycin and ethambutol MICs above these thresholds were associated with increased risk of treatment failure. Our findings suggest an association between clarithromycin MICs and treatment outcomes in patients with MAC-PD receiving standard guideline-recommended regimens. Meanwhile, elevated ethambutol MICs exhibited potential clinical relevance, warranting further investigation.

Background and Objectives: Post-COVID-19 condition (PCC, long COVID) is associated with persistent symptoms and marked reductions in health-related quality of life (HRQoL), but real-world data on rehabilitation and everyday functioning remain limited. Materials and Methods: In a cross-sectional online survey conducted between 15 April and 15 May 2024, we analysed 406 adults (308 women; mean age 36.0 ± 12.1 years) with ongoing post-COVID symptoms recruited from two moderator-supervised support communities. The questionnaire included sociodemographic and clinical items, the 36-Item Short Form Health Survey (SF-36) and the Post-COVID-19 Functional Status (PCFS) scale. Participants indicated whether they had completed any form of rehabilitation targeting post-COVID problems (yes/no). Group differences were examined using Welch's t-test, Mann-Whitney U and χ² tests, as appropriate. Multiple linear regression models with Bonferroni correction were used to explore associations between rehabilitation status, age, sex, symptom duration and outcomes. Results: Overall, 182 respondents (44.8%) reported rehabilitation and 224 (55.2%) did not. The groups did not differ significantly in age, sex distribution, BMI, number of infections, symptom duration or hospitalisation history. Most SF-36 domains, component summaries and PCFS differed significantly between groups, with small-to-large effects favouring respondents who reported rehabilitation. The largest effect sizes were observed for Vitality and Mental Health, whereas Physical Functioning showed no clear difference. In multivariable models, older age and longer symptom duration were consistently associated with poorer HRQoL, while rehabilitation status remained a robust correlate of better scores in several SF-36 domains, both component summaries, perceived health, and lower PCFS grades after correction for multiple testing. Conclusions: Although the cross-sectional design, self-reported data and non-standardised rehabilitation exposure preclude causal inference, the findings highlight the substantial HRQoL and functional burden of long COVID and suggest that, within a symptomatic population, reported completion of rehabilitation is positively associated with multiple aspects of everyday health and functioning.

Background and Objectives: This study investigated and compared the efficacy of therapeutic plasma exchange (PEX) between antineutrophil cytoplasmic antibody (ANCA)-positive and ANCA-negative patients with microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA) presenting with diffuse alveolar haemorrhage (DAH) and rapidly progressive glomerulonephritis (RPGN). Materials and Methods: A total of 336 patients with ANCA-associated vasculitis were screened, and 34 patients with MPA/GPA receiving PEX for DAH or RPGN were included. PEX was performed a total of 5-6 times consecutively (three times a week × 2 weeks) in all 34 patients. All-cause mortality (ACM) and end-stage kidney disease (ESKD) were evaluated as poor outcomes of MPA/GPA. Clinical data and poor outcomes were compared between ANCA-positive and ANCA-negative MPA/GPA patients receiving PEX. Results: The median age of the 34 MPA/GPA patients was 67 years (15 men and 19 women), of whom two were diagnosed with ANCA-negative vasculitis. Among the 34 patients, 28 (82.4%) received PEX owing to RPGN, and 6 (17.6%) due to DAH. During follow-up, 13 patients (38.2%) died, and 15 (44.1%) progressed to ESKD. Serum protein and C-reactive protein levels at AAV diagnosis were higher in ANCA-positive MPA/GPA patients than in ANCA-negative patients, although the difference was not statistically significant. Similarly, there were no differences in ACM or ESKD between the two groups during follow-up. Survival analysis showed that ANCA-positive MPA/GPA patients did not have significantly different cumulative patient or ESKD-free survival rates compared to ANCA-negative patients. Conclusions: This pilot study is the first to demonstrate the clinical feasibility of PEX in managing severe and refractory ANCA-negative MPA and GPA.

Venous access selection represents a pivotal aspect of permanent pacemaker implantation, directly influencing both procedural safety and long-term device performance. Although the subclavian vein has been traditionally favored, its use is associated with notable risks, including pneumothorax, hemothorax, and crush syndrome. In contrast, axillary access has gained prominence, supported by observational studies and a small number of randomized trials demonstrating reduced pneumothorax rates, fewer arterial punctures, and potentially fewer long-term mechanical lead failures, particularly when ultrasound guidance is used. However, these findings are derived from heterogeneous studies with variable definitions, imaging protocols and operator experience, highlighting that evidence quality remains moderate. Contemporary advances-such as routine ultrasound guidance, micropuncture techniques, and structured training-have improved procedural consistency and safety, a trend reflected in recent guidelines. This review provides a focused appraisal of complication patterns, anatomical differences and patient-specific considerations to support individualized and evidence-aligned venous access selection in modern clinical practice.

Background and Objectives: Aspiration pneumonia is a well-described complication of upper digestive endoscopy. However, limited data are available on incidence, risk factors and clinical consequences of post-endoscopic retrograde cholangiopancreatography (ERCP) aspiration pneumonia (pEP). Materials and Methods: All consecutive ERCPs performed under anesthesiologist-administered sedation at the Endoscopy Unit of the University of Verona between 1 April 2022 and 31 August 2024 were retrospectively evaluated. Demographic, clinical and endoscopic data were collected. Results: One thousand one hundred forty consecutive ERCPs were included. The main indication was malignant biliary stricture, and the patient's mean age was 68 ± 13.9 years. Overall incidence of pEP was 2.7%. The American Society of Anesthesiologists (ASA) score, presence of active cholangitis before ERCP and performance of endoscopic ultrasound (EUS) and ERCP in the same sedation session were significantly associated with a higher risk of pEP at both univariable and multivariable analysis. pEP was an independent risk factor for post-ERCP 30-day mortality and for prolonged hospital stay. Conclusions: pEP is a relatively frequent adverse event after ERCP. In patients with a high ASA-score, active cholangitis and scheduled EUS and ERCP in the same sedation session, preventive medical and/or anesthesiological strategies might be considered. Additional prospective studies are needed to confirm these data.

Background and Objectives: The aim of this study was to identify clinical features and laboratory findings that correlate with and predict pathological echocardiographic findings in children diagnosed with Multisystem Inflammatory Syndrome. Materials and Methods: Retrospective study included all patients aged 0-18 diagnosed with Multisystem Inflammatory Syndrome and hospitalized at our clinic from July 2020 to December 2022. The clinical and laboratory data of 61 patients were studied and compared between two subgroups (normal/abnormal echocardiography). Results: Elevated values of high-sensitivity troponin I were observed in 65.57% patients with MIS-C. The mean high-sensitivity troponin I value in the whole sample was 400.89 ± 1989.31 pg/mL. In patients with pathological echocardiographic findings, the mean value was 1240.24 ± 3609 pg/mL, while in patients with normal echocardiographic findings, it was 52.87 ± 71.86 pg/mL. Even though mean value was higher in the group of patients with abnormal echocardiography, no statistically significant difference was observed between high-sensitivity troponin I values in patients with and without pathological echocardiographic findings. Troponin levels were not in good correlation with pathological echocardiographic findings (point-biserial correlation; rpb = 0.25, p = 0.054) and were not good predictors of pathological echocardiographic findings (logistic regression; Chi² = 3.77, p = 0.052). Logistic regression showed significant positive correlation of blood urea nitrogen levels and the degree of fever with abnormal echocardiographic findings (Chi² = 10.04, p 0.002/Chi² = 6.10, p = 0.013, respectively). Conclusions: Only blood urea nitrogen levels and high fever showed statistically significant correlation and predictive value for abnormal echocardiographic findings in children with Multisystem Inflammatory Syndrome. High sensitive troponin I had no significant power to discriminate between normal and abnormal echocardiographic findings.

Background and Objectives: Obstructive sleep apnea (OSA) is a clinically relevant comorbidity in both alcoholic fatty liver disease (AFLD) and non-alcoholic fatty liver disease (NAFLD). However, whether its impact differs between these etiologies remains unclear. This study directly compared OSA risk in patients with AFLD and NAFLD to elucidate its role in disease progression. Materials and Methods: We conducted a retrospective cohort study using the TriNetX research network. Adults aged ≥ 20 years with newly diagnosed AFLD or NAFLD between 2006 and 2020 were included. Propensity score matching was applied to balance demographic and clinical covariates. The primary endpoint was incident OSA, assessed at 1-, 2-, 3-, and 5-year intervals, and cumulatively through 28 September 2025. Effect estimates were expressed as relative risk, odds ratio and hazard ratio (HR). Results: Before matching, 896,302 NAFLD and 12,694 AFLD patients were identified; after 1:1 PSM, 11,583 patients remained in each group with balanced baseline characteristics. NAFLD patients consistently demonstrated higher OSA risk. Post-matching, OSA incidence became significantly elevated from year 2 onward (HR at 2 years = 1.764) and persisted at 3 years (HR = 2.078), 5 years (HR = 1.950), and cumulative follow-up (HR = 1.940). Conclusions: NAFLD confers nearly double the long-term OSA risk compared with AFLD. These findings support longitudinal OSA screening and targeted risk reduction strategies in NAFLD populations.

Background and Objectives: This study aimed to evaluate postoperative changes in voice quality and glottic function following early injection laryngoplasty with hyaluronic acid performed using a modified general anesthesia approach without airway instrumentation in patients with unilateral vocal fold paralysis. Materials and Methods: Thirty-two patients (19 females, 13 males; mean age 51.8 years, range 21-70) who underwent injection laryngoplasty within the first three months after the onset of paralysis were included in this retrospective study. All procedures were performed under general anesthesia without endotracheal intubation, using endoscopic visualization. Objective acoustic and aerodynamic analyses and videostroboscopic examinations were performed preoperatively and postoperatively. Data were analyzed using the Wilcoxon signed-rank test, with p < 0.05 considered statistically significant. Results: Significant postoperative improvement was observed in acoustic and aerodynamic parameters. Shimmer, jitter, and noise-to-harmonic ratio (NHR) values significantly decreased (p < 0.001, p < 0.001, and p = 0.001, respectively), while maximum phonation time (MFT) increased markedly (p < 0.001) and the S/Z ratio decreased (p = 0.006). The mean fundamental frequency (F0) decreased slightly but not significantly (p = 0.085). Videostroboscopic findings demonstrated improved glottic closure and vocal fold vibration. No major complications occurred. Conclusions: Early injection laryngoplasty with hyaluronic acid performed under general anesthesia and endoscopic guidance provides significant improvement in objective voice parameters and glottic efficiency in unilateral vocal fold paralysis. Early intervention appears to enhance phonatory stability and may prevent maladaptive laryngeal changes.