Antimicrobial resistance (AMR) continues to threaten our healthcare system. Unnecessary antibiotic use contributes to the development of AMR infections in hospitalized pneumonia patients. This study was conducted to determine the prevalence of AMR and its associated factors in pneumonia among adult patients treated in-patient in a hospital.

A cross-sectional study was conducted using data extracted from the hospital's electronic medical records. Patients aged 18 years or older admitted to the hospital from 1st January 2018 to 31st December 31 2023, discharged with a diagnosis of pneumonia were included in the study population.

A total of 300 eligible samples were selected using universal sampling. The analysis revealed a prevalence of AMR of 15.7% (95% CI: 11.5, 19.8). Multivariable analysis using multiple logistic regression showed that patients' age (OR = 1.03; 95% CI: 1.01, 1.05), Indian and other ethnicities (OR = 2.24; 95% CI: 1.05, 4.77), length of stay (OR = 1.05; 95% CI: 1.01, 1.08) and invasive procedures (OR = 3.65; 95% CI: 1.71, 7.82) were significantly associated with AMR.

The findings from our study highlighted a considerable burden of AMR among pneumonia patients in a Malaysian tertiary hospital. Thus, there is a need for targeted infection control strategies and antimicrobial stewardship, especially among high-risk groups. Strengthening surveillance and justified antibiotic use is crucial to fight the rising threat of AMR in Malaysia.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a prevalent inflammatory disease that significantly impairs quality of life (QOL) and imposes a substantial economic burden. Socioeconomic and demographic factors influence access to care, treatment adherence, and outcomes, yet their impact on response to biologic therapy remains poorly defined.

To examine the impact of socioeconomic and demographic determinants on symptom severity and QOL before and after monoclonal antibody therapy for CRSwNP.

Exploratory retrospective cohort study with prospective socioeconomic and demographic data curation.

Tertiary medical center.

Adults with recalcitrant CRSwNP from January 2020 to January 2024 who had undergone endoscopic sinus surgery and completed a 16-week regimen of monoclonal antibody therapy.Intervention or Exposures:The primary exposures evaluated were socioeconomic status (SES; including household income) and demographic determinants.

Baseline and post-treatment (16 weeks) follow-up of 22-item Sino-Nasal Outcome Test (SNOT-22) and Meltzer grading evaluation.

Forty patients (21 males and 19 females; mean age 50.4 ± 12.1) were included. The mean baseline SNOT-22 score was 69.0 ± 15.8, and the median Meltzer score was 3 (interquartile range [IQR]: 2-3.75). At 16-week follow-up, these scores improved to 33.8 ± 20.5 and 1 (IQR: 0-2), respectively. Low-income patients (<40 000 United States Dollar [USD] yearly) had worse baseline SNOT-22 scores compared to medium (40 001-80 000 USD yearly) and high-income patients (>80 000 USD yearly; 79.4 vs 68.6 vs 57.1, respectively, P < .01) but showed the largest absolute point reduction (ΔSNOT-22, 47.8 vs 34.7 vs 20.8, respectively, P = .01). Low-income patients showed the largest absolute improvement after biologic treatment (P = .01); however, covariate adjustment for baseline scores showed similar proportional effects across all income tiers.

Patients with lower incomes exhibited higher baseline disease severity. However, biologic treatment yielded meaningful absolute improvement in QOL across all SES tiers.

Recognizing socioeconomic factors may help optimize biologic therapy in CRS. Future multi-center research is needed to validate these disparities and optimize intervention strategies.

Although mechanical ventilation (MV)-associated excessive stretch directly damages airway epithelial cells (AECs) and contributes to ventilator-induced lung injury (VILI), the contribution of paracrine factors from airway cells, particularly airway smooth muscle cells (ASMCs) and AECs, remains poorly understood. As stretch-sensitive cells, ASMCs and AECs may respond to excessive stretch by secreting paracrine factors such as transforming growth factor β1 (TGF-β1), thereby disrupting airway epithelial integrity. This study compared the sensitivity of cultured ASMCs and AECs to MV-associated excessive stretch and their ability to induce paracrine factors, particularly TGF-β1, that inhibit AEC proliferation in vitro.

Human ASMCs and AECs (16HBE14o-) were cultured under static, physiological stretch (5% strain), or pathological excessive stretch (13% strain) conditions for 72 h. Conditioned media were collected and used to culture 16HBE14o- cells for 48 hours. Active and total TGF-β1 levels in the conditioned media were measured using an enzyme-linked immunosorbent assay. Cell viability, proliferation, migration, stress fiber formation, cell cycle distribution, and Smad2 signaling were assessed using the Cell Counting Kit-8 assay, cell counting, wound healing assay, immunofluorescence, flow cytometry, quantitative reverse transcription polymerase chain reaction, and Western blotting, respectively.

Conditioned media derived from ASMCs, but not 16HBE14o- cells, cultured under 13% excessive stretch inhibited 16HBE14o- cell proliferation. In addition, excessive stretch enhanced TGF-β1 activation in ASMCs in an integrin αV-dependent manner. Experiments using a TGF-β1-neutralizing antibody and transforming growth factor β receptor I inhibitors demonstrated that inhibition of 16HBE14o- cell proliferation by conditioned media derived from excessively stretched ASMCs was dependent on TGF-β1 activation and Smad2 signaling.

Conditioned media derived from ASMCs, but not AECs, exposed to MV-associated excessive stretch induced G1 cell cycle arrest in AECs via TGF-β1/Smad2 signaling. These findings suggest that ASMCs are more sensitive than AECs to excessive stretch-induced TGF-β1 activation and may thereby contribute to disruption of airway epithelial integrity. Targeting this paracrine pathway may warrant further investigation as a potential strategy for preventing or treating VILI.

Endoscopic laser cordotomy, also known as Kashima operation, is used for the treatment of bilateral vocal cord palsy where the glottis chink is made posteriorly, sufficient enough for patient to breathe comfortably without any stridor. The objective of the study was to assess outcome of unilateral transverse cordotomy (Kashima operation) for bilateral vocal cord immobility. This prospective observational study was conducted in the Department of Otolaryngology-Head & Neck Surgery, Bangladesh Medical University, Dhaka, Bangladesh from January 2020 to June 2021 with 12 patients having bilateral vocal cord immobility with shortness of breath (SOB) or tracheostomized for SOB due to bilateral vocal cord immobility. The diagnosis was confirmed by fiberoptic laryngoscopy. Endoscopic assessment of subglottis and trachea was also done for assessment of any co-incidental pathology which may affect the outcome. Outcome of the surgery was evaluated by Flow volume loop Spirogram, Medical Research Council Dyspnoea Scale (MRCDS) 2007 and Voice Handicap Index (VHI) scores. All the information were recorded in a pretested questionnaire. The mean ±SD preoperative MRCDS was 4.33±0.49 and mean postoperative MRCDS was 1.75±1.06, 1.50±0.80 and 1.33±0.6 at 1st, 2nd and 3rd months of follow-up respectively. Mean ±SD preoperative total VHI score was 24.50±2.11 and postoperative score was 75.50±25.57, 44.17±31.50 and 37.33±22.86 at 1st, 2nd and 3rd months of follow-up respectively. MRCDS was significantly improved after Kashima operation (p<0.001). But no significant difference was observed in pre and at 3 months postoperative VHI score (p>0.05). In this study, preoperative mean of FVC, PEFR, PIFR, FEF50% and FIF50% were found 1.7±0.09 L, 2.5±0.12 L/S, 1.75±0.11 L/S, 0.84±0.06 and 2.08±0.38 respectively. Postoperative means of FVC, PEFR, PIFR, FEF 50% and FIF 50% were found 2.5±0.12 L, 4.5±0.12 L/S, 3.54±0.54 L/S, 1.84±0.40 and 3.54±0.69 at follow-up period of 2 months respectively. Statistically significant differences were observed in between pre and postoperative all the parameters of spirometry (p<0.001). In this study, only 2(16.67%) cases were developed complications after surgery. Vocal cord oedema in 1(8.33%) case and Fibrosis with granuloma in 1(8.33%) case. Kashima procedure is an effective surgery to reduce the severity of dyspnoea in bilateral vocal cord immobility without significant change of voice.

The COVID-19 pandemic disrupted healthcare access globally through restrictions aimed at limiting virus transmission. Using a cross-sectional design, this project explored perceived barriers to and facilitators of healthcare access during the pandemic in remote Indigenous communities in Northwest Territories (NWT), Canada. Convenience sampling was utilised to recruit self-identifying Indigenous adults (≥18 years) within 10 NWT communities. Information was collected through an interviewer-administered questionnaire exploring experiences with, barriers to, and facilitators of healthcare access during the COVID-19 pandemic. Among the 287 participants (mean age 41.63 years; 66.55% women), 17.42% reported having avoided healthcare service utilisation during COVID-19 due to the risk of exposure. Of participants with a current prescription, 15.73% reported difficulty accessing prescription medications. Some partcipants (7.69%) reported difficulty accessing traditional medicines and healers. The participants reported that many services were disrupted by shortages of healthcare providers, service delays and cancellations, public health measures, and medical travel disruptions. A total of 35.89% of participants utilised virtual care, and while many found it was convenient for certain needs, some reported that it was inadequate. The findings highlight the perceived challenges to healthcare access in NWT during the pandemic. These challenges are closely tied to the healthcare context in the region, which depends heavily on medical travel and visiting specialist clinics.

The objective of this analysis was to assess reactogenicity profile differences between a protein- and mRNA-based COVID-19 vaccine in participants who had previously received ≥2 doses of an mRNA-based vaccine in a real-world, double-blinded, randomized, controlled trial. In the BEEHIVE/NCT06065176 trial (ClinicalTrials.gov: NCT06065176), participants randomized 1:1 received one dose of the Novavax (NVX) or Pfizer-BioNTech (PFZ) COVID-19 vaccine 2023-2024 formulation (XBB.1.5); a comparator group did not receive a dose. Electronic surveys collected solicited systemic (fatigue, fever, headache, joint pain, malaise/feeling sick, muscle pain, and nausea/vomiting) and local (injection-site pain, tenderness, and swelling) events on days 1, 2, and 6 after study vaccination. Significantly lower proportions of participants in the NVX (n = 448) vs. PFZ (n = 453) group reported a systemic (62.1% vs. 75.7%; risk difference -13.7%, 95% CI: -19.6% to -7.7%) or local (81.0% vs. 92.7%; risk difference -11.7%, 95% CI: -16.0% to -7.3%) event in the day-1 survey (both Cochran-Mantel-Haenszel P < .0001). Most events were mild. Reactogenicity rates decreased throughout the week; >80% and >94% of participants in either group reported no systemic or local reactogenicity, respectively, in the day-6 survey. Mean number of events/person were significantly lower for the NVX vs. PFZ group in the day-1 (systemic and local) and day-2 (local) surveys (each P < .0001). There were significant differences in reactogenicity profiles for the 2023-2024 formulations of the NVX and PFZ COVID-19 vaccines, with NVX consistently associated with lower reactogenicity rates than PFZ.

Vaccines not only directly protect vaccinated individuals but also contribute to protecting the entire population via indirect herd-immunity benefits. However, researchers have long struggled to quantify these indirect effects at the population level, hindering the assessment of vaccination programme effectiveness. We developed a new method to estimate these effects, thereby markedly improving measures of the number of infections, hospitalizations and deaths averted by vaccination. Our population-based analysis of 6 440 000 residents of Victoria, Australia, reveals strong indirect effects during the Delta outbreak (September-November 2021). By modelling a non-vaccination counterfactual, we conservatively estimate 315 000 infections were averted (95% Bayesian credible interval (BCI): 231k-406k), as well as 33 400 hospitalizations (95% BCI: 22k-46k), and 4900 deaths (95% BCI: 2.8k-7.2k). These are 4.0, 7.5 and 8.0 times higher, respectively, than observed. Half of the averted infections and around one-quarter of hospitalizations and deaths were attributable to indirect protection. Homogeneous vaccination across local government areas could have reduced outcomes by approximately 25%.

Interstitial lung disease (ILD) comprises a highly heterogeneous group of pulmonary disorders, whose diagnosis often requires the integration of clinical, radiologic, and pathologic evidence. Lung biopsy is a key method for obtaining a histopathologic diagnosis, but unified standards are lacking for determining indications, selecting biopsy techniques, managing patients perioperatively, and integrating pathologic and clinical information. To address these gaps, the Respiratory Physicians Branch of the Chinese Medical Doctor Association and the ILD Group of the Chinese Thoracic Society spearheaded this initiative, collaborating with national experts in respiratory medicine, radiology, pathology, thoracic surgery, and rheumatology to formulate this consensus. Developed in strict adherence to evidence-based medicine principles, this consensus is founded on systematic literature reviews and evidence grading, utilizing the Delphi method for anonymous voting. It culminates in 15 recommendations, each explicitly annotated with the level of evidence and strength of recommendation. This consensus systematically delineates the multidisciplinary discussion (MDD)-centered full-process management of lung biopsy. The main contents encompass: assessment of the necessity and feasibility of lung biopsy; indication stratification strategies based on HRCT patterns; applicability scenarios and selection pathways for the four major lung biopsy techniques; shared decision-making; perioperative comprehensive management; management strategies for acute exacerbation of ILD (AE-ILD); standardization of tissue processing and pathological reporting; the post-biopsy MDD process for integrated diagnosis; and biopsy decision-making in special clinical contexts, such as ILD complicated by lung cancer or connective tissue disease-associated ILD (CTD-ILD). This consensus aims to provide clinicians with clear, safe, and practical guidance on lung biopsy, promote standardized and precise decision-making, and improve patient outcomes.Summary of RecommendationsRecommendation 1: For patients with suspected ILD, a comprehensive multidisciplinary discussion (MDD) is mandatory prior to lung biopsy. This evaluation should establish the diagnostic certainty of the preliminary clinical assessment, evaluate the clinical utility of the biopsy, and facilitate shared decision-making (SDM) that incorporates patient preferences (Level of evidence: 3, Recommendation: strong).Recommendation 2: For ILD patients in whom the diagnosis remains uncertain following a comprehensive non-invasive evaluation, or when precise histopathologic subtyping is required, a lung biopsy is recommended to establish a definitive diagnosis and guide the therapeutic management (Level of evidence: 4, Recommendation: strong).Recommendation 3: For patients with an interstitial pattern, a lung biopsy is strongly discouraged if HRCT demonstrates a definite UIP pattern and secondary etiologies have been excluded. A conditional recommendation for a lung biopsy applies to patients with a probable UIP patterns in whom NSIP or fibrotic HP cannot be ruled out. A lung biopsy is strongly recommended to achieve a definitive diagnosis in patients with an indeterminate or non-UIP patterns and insufficient clinical evidence (Level of evidence: 4, Recommendation: conditional).Recommendation 4: For patients with an alveolar filling pattern, a lung biopsy is recommended to clarify the etiology once infection, alveolar hemorrhage, and pulmonary edema have been systematically excluded, and there is either a lack of response to empirical therapy or a clinical necessity to differentiate the lesion from malignancy (Level of evidence: 2, Recommendation: strong).Recommendation 5: For suspected rare ILDs, including PAP, iEP, LAM, and LIP, non-invasive or minimally invasive diagnostic modalities should be prioritized; a lung biopsy is conditionally recommended if these approaches are non-diagnositic. Conversely, a lung biopsy is strongly recommended for patients with clinically suspected AFOP or PLCH (Level of evidence: 2, Recommendation: conditional).Recommendation 6: Lung biopsy is not recommended for patients with acute respiratory failure, severe pulmonary functional impairment, recent cardiovascular events, hemodynamic instability, significant pulmonary hypertension, severe coagulopathy, or end-stage systemic debilitation (Level of evidence: 1, Recommendation: strong).Recommendation 7: Site selection for lung biopsy should target active lesions identified on HRCT (e.g., ground-glass opacities or fine reticulation). Specimens must include the interface between diseased and normal parenchyma to facilitate pattern assessment. High-risk areas, such as major vessels and severe bullae, must be strictly avoided. Multi-lobar sampling from at least two sites of varying severity is recommended to adequately capture disease heterogeneity (Level of evidence: 4, Recommendation: strong).Recommendation 8: A TBLB is recommended as the first-line diagnostic approach for suspected granulomatous diseases (e.g., sarcoidosis) and specific alveolar filling patterns. If a TBLB is non-diagnostic, escalation to TBLC or SLB is advised. A TBLB is not recommended for the evaluation of predominantly fibrotic ILDs (e.g., UIP or NSIP) (Level of evidence: 4, Recommendation: strong).Recommendation 9: TBLC is recommended as the preferred modality in expert centers, particularly for patients who are poor candidates for or are averse to SLB. The procedure should be standardized under general anesthesia with prophylactic balloon placement for hemorrhage control and integrated with imaging or navigational guidance to optimize diagnostic yield while minimizing procedural complications (Level of evidence: 2, Recommendation: strong).Recommendation 10: SLB is recommended for patients in whom TBLC yields a non-diagnostic result, provided their cardiopulmonary physiological reserve permits surgical intervention. Video-assisted thoracoscopic surgery (VATS) is the preferred approach, requiring sampling from at least two distinct lobes. Biopsies should prioritize the dependent segments of the upper lobes or the superior segments of the lower lobes; sampling from the lingula or the right middle lobe should only be considered if these sites harbor the most representative lesions and no superior alternatives exist (Level of evidence: 2, Recommendation: strong).Recommendation 11: PTNB is recommended for the diagnosis and differential diagnosis in ILD patients presenting with solitary nodules, masses, or focal consolidations, particularly to rule out malignancy. However, it is not recommended for the histopathological evaluation of diffuse fibrosing ILDs (Level of evidence: 2, Recommendation: strong).Recommendation 12: A shared decision-making model is recommended throughout the biopsy selection process. Clinicians should thoroughly counsel patients regarding the benefits, risks, and alternatives of the procedure, ultimately formulating a clinical plan that aligns medical evidence with patient values (Level of evidence: 4, Recommendation: strong).Recommendation 13: Histological or imaging patterns of usual interstitial pneumonia (UIP), active disease phase, and reduced diffusing capacity for carbon monoxide (DLCO) are the main risk factors for acute exacerbation of interstitial lung disease (AE-ILD). Routine prophylactic use of glucocorticoids or antifibrotic therapy is not recommended for all patients; instead, meticulous perioperative management is recommended to prevent acute exacerbations. Once AE occurs, the underlying cause should be promptly investigated, and high-dose glucocorticoids along with supportive therapy may be considered (Level of evidence: 2, Recommendation: strong).Recommendation 14: Histopathological reports must adhere to current international standardized nomenclature, prioritizing the description of the predominant histological patterns and their salient features, while specifically noting any findings indicative of a specific etiology. Diagnostic limitations secondary to suboptimal specimen quality must be explicitly stated. Pathologists are required to provide a systematic and standardized microscopic description of the tissue pathology, formulate a histopathological classification, and offer etiological insights whenever feasible (Level of evidence: 4, Recommendation: strong).Recommendation 15: Post-biopsy MDD is central to formulating an integrated diagnosis and should be conducted by the same cohort of clinicians, radiologists, and pathologists involved in the initial evaluation. A systematic correlation between the histopathology and the clinical andradiologic data is required; any discordances must be thoroughly analyzed to achieve a consensus integrated diagnosis and guide therapeutic planning. If an integrated diagnosis cannot be established, a subsequent MDD or referral to an expert center for a repeat biopsy is warranted (Level of evidence: 2, Recommendation: strong).

Acute respiratory distress syndrome (ARDS) is characterized by rapid progression and a high mortality rate. Current therapeutic strategies focus primarily on pathogen clearance, which may not adequately regulate the host's dysregulated immune response. The homeostasis of the local pulmonary immune microenvironment is a significant factor determining the severity of tissue injury and the efficacy of subsequent repair. Taking the evolution of ARDS from physiological defense to pathological injury as its main thread, this review examines the spatiotemporal transition mechanisms involved in this pathological process. It outlines the molecular basis of early-stage inflammatory dysregulation, identifying macrophage M1/M2 polarization imbalance, metabolic reprogramming, and the formation of neutrophil extracellular traps as key drivers of pulmonary inflammation. It further describes how a persistent inflammatory microenvironment can induce senescence of type Ⅱ alveolar epithelial cells and pathological remodeling of the extracellular matrix, which serve as primary barriers to alveolar regeneration and contribute to pulmonary fibrosis. Based on these mechanisms, this article summarizes recent advances in stage-specific interventions, focusing on mesenchymal stem cell therapy, immunometabolic reprogramming, and environment-responsive nanomedicines.

Objective: To investigate the associations between snoring phenotypes recorded during preoperative drug-induced sleep endoscopy (DISE) and polysomnographic (PSG) metrics in children with obstructive sleep apnea (OSA). Methods: We retrospectively enrolled 175 children who underwent structured preoperative DISE between November 1, 2024 and January 1, 2026 because of confirmed/suspected obstructive sleep apnea (OSA) or adenoid-related upper airway assessment before orthodontic treatment. Among them, 108 were boys and 67 were girls, with a mean age of (6.9±1.9) years and a median age of 7.0 years (interquartile range, 5.6-8.0 years). All 175 children were included in the DISE descriptive analysis set to summarize structured DISE findings, snoring intensity, and snoring-source plane distribution. Of these, 136 children with DISE-documented snoring were included in the snoring-source plane analysis set to evaluate snoring-source planes and their combinations. Children were grouped according to DISE-recorded snoring intensity grades 0, 1, and 2, the number of five key snoring-source planes, and the presence or absence of each key plane. The five key snoring-source planes included the adenoid, soft palate, tonsil/lateral pharyngeal wall, tongue, and epiglottis. Among the 175 children, 108 with complete PSG outcomes and covariates including age, sex, and body mass index (BMI) were included in group comparisons and multivariable regression analyses. The primary outcome was obstructive apnea-hypopnea index (OAHI), and the secondary outcome was minimum peripheral oxygen saturation (SpO₂ nadir). Group comparisons were performed using the Kruskal-Wallis test or Mann-Whitney U test. Multivariable linear regression was used to analyze the association between DISE snoring phenotypes and PSG metrics. Results: Among 175 children, 108 were boys (61.7%), the mean age was (6.9±1.9) years, and DISE documented snoring in 136(77.7%). In the PSG subgroup, median OAHI [interquartile range] across snoring grades 0, 1, and 2 was 3.6(2.2, 6.4), 5.8(3.0, 10.5), and 19.1(9.4, 45.6) events/h, respectively (H=14.43, P<0.001); corresponding SpO₂ nadirs were 91.5%(89.0%, 94.0%), 93.0%(89.0%, 94.5%), and 84.0%(80.0%, 92.0%) (H=9.90, P=0.007). After adjustment for age, sex, and body mass index (BMI), snoring intensity remained independently associated with OAHI (β=0.45, P=0.010); each one-grade increase corresponded to a 56.8% increase in (OAHI+1) (95%CI 11.3%-120.9%). Conclusions: Snoring intensity during preoperative DISE was independently associated with PSG-derived obstructive burden in children with OSA. Tonsillar/lateral pharyngeal wall involvement predominated, while epiglottic and tongue-related planes were also common.