This systematic review aims to summarise the impact of exercise training on peripheral muscle fatigability in people with COPD, addressing different assessment methods and exercise interventions (i.e. endurance, resistance and combined training).PubMed, CENTRAL, CINAHL and PEDro databases and trial registers were searched from inception to September 2024. We identified randomised and nonrandomised trials assessing pre-to-post-training changes in muscle fatigue resistance, assessed as a reduction in volitional or non-volitional measures of muscle strength or muscle total work output during standardised fatiguing protocols. The Cochrane Risk of Bias 2 (RoB 2) and Risk of Bias in Non-randomized Studies - of Interventions (ROBIN-I) tools were used for assessing risk of bias in randomised controlled trials and nonrandomised studies of interventions, respectively, and meta-analyses were performed.A total of 20 studies (574 participants from 14 randomised controlled trials and 217 from six nonrandomised studies of interventions) were included. Overall, combined endurance and resistance training appeared to improve muscle fatigue resistance. While results varied by study design, type of training and fatiguing protocols, similar improvements were observed in quadriceps fatigue resistance regardless of the assessment method. In contrast, no significant improvements were observed in the fatigue resistance of the arm muscles. However, the presence of moderate to high risk of bias in several included studies may have influenced the results.The findings of this systematic review suggest a positive effect of exercise training in improving muscle fatigue resistance, particularly in the leg muscles, in people with COPD. Future research should establish standardised protocols for assessing muscle fatigability and explore alternative tools to facilitate the clinical implementation of muscle fatigability outcomes into COPD rehabilitation.

Alpha-1 antitrypsin deficiency (AATD) is a genetic disorder characterised by low circulating levels of alpha-1 antitrypsin (AAT) protein, a key inhibitor of neutrophil elastase and proteinase 3 (PR3) which is also the main autoantigen in granulomatosis with polyangiitis (GPA). This systematic review examines the association between AATD and GPA.

A systematic search of PubMed, Embase, Cochrane, EBSCO Medline and Scopus (December 2024) identified studies on AATD and GPA. Data extraction and quality assessment followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A random-effects meta-analysis was conducted to calculate pooled odds ratios and assess heterogeneity.

23 studies (9634 individuals) met inclusion criteria. The Z-allele prevalence was 11.65% in GPA compared to 3.29% in controls and the S-allele prevalence was 10.8% in GPA compared to 5.26% in controls. Among 1755 individuals with GPA across 10 studies that provided specific genotype data, 22 (1.25%) were homozygous for the Z-allele. Meta-analysis showed that Z-allele carriers had 3.11 times higher odds of developing GPA (eight studies; 95% CI 2.43-3.9; I²: 0%).

This meta-analysis reinforces the link between AATD and GPA, particularly in carriers of the Z-allele, supporting the role of PR3 dysregulation in GPA pathogenesis.

Breathlessness is a debilitating symptom affecting many adults, yet its prevalence and correlates are not well summarised. This review synthesised evidence on breathlessness prevalence, correlates and assessment methods across general and clinical populations.

We undertook an umbrella review and updated systematic review using a comprehensive search of three databases up to January 2025. The umbrella review incorporated existing systematic reviews and meta-analyses, while the updated systematic review and meta-analysis included original studies published after the most recent eligible review.

The umbrella review encompassed 10 reviews conducted between 2010 and 2025, incorporating 315 studies. The primary tool for assessing self-reported breathlessness was the Medical Research Council questionnaire and its modified version (mMRC). The prevalence of breathlessness ranged from 0.9% to 61.6% in general populations and from 20.4% to 87% in clinical populations. Six categories of breathlessness correlates were identified: sociodemographic, physiological, clinical, psychological, environmental and radiological/pathological factors. An updated systematic review and meta-analysis found 15 studies published between 2021 and 2024 reporting prevalence of breathlessness. Using the most common criterion of an mMRC score ≥2, the pooled prevalence was 12.5% (range 3.7-29.5%) in general populations and 37.5% (range 27.5-48.6%) in clinical populations. These studies reported diverse correlates of breathlessness, including psychological and clinical factors.

Substantial variability exists in the prevalence and correlates of breathlessness, emphasising its complexity and multifaceted nature. This review highlights the need for standardised assessment of breathlessness to assess prevalence and comprehensive approaches to address its diverse factors.

The case fatality of tuberculosis (TB) has progressively decreased since the use of antibiotics in anti-TB treatment, leaving 155 million TB survivors alive in 2020. Of the 122 million disability-adjusted life years (DALYs) due to TB in 2019, 58 million DALYs were attributed to the post-TB phase. TB causes massive lung structure damage, declined lung function and excessive inflammation, which persist even after microbiological cure and predispose to multiple lung diseases (e.g. COPD, chronic pulmonary aspergillosis, bronchiectasis and COVID-19). TB survivors also face a higher risk of cancers and cardiovascular diseases. These post-TB morbidities together with worse psychological and socioeconomic status lead to poor quality of life and a three- to four-fold higher mortality rate than the general population. Understanding the epidemiology of post-TB morbidities can help to set intervention and research priorities to lower public health burdens associated with post-TB morbidities. In this narrative review, we summarise what we know and do not know about the prevalence, risk factors and management of post-TB morbidities and their associated mortality. We identify the major post-TB morbidities based on current evidence. Delayed or incomplete TB treatment, residual lung structure damage and prolonged inflammation after TB treatment are important risk factors. Developing host-directed therapies to reduce lung structure damage, smoking cessation, implementing pulmonary rehabilitation to improve lung function and adopting well-tailored preventive strategies and screening protocols may improve the management of these post-TB morbidities and mortality and warrant future research.

Transthoracic echocardiograms (TTEs) have limited value in guiding management of normotensive patients with acute pulmonary embolism (PE). Nevertheless, TTEs are frequently ordered inappropriately. This quality improvement project aimed to decrease inappropriate TTE orders by 30% over 6 months in patients with PE admitted to general internal medicine at a community hospital. Two interventions were implemented using successive plan-do-study-act (PDSA) cycles: educational sessions for physicians and the distribution of TTE-ordering algorithms for triaging of TTE appropriateness. Four audits on TTE orders for inpatients with PE were conducted throughout the project: a pre-intervention audit (pre-audit; March to August 2020), a post-intervention 1 audit (post-I1; August to September 2022), a post-intervention 2 audit (post-I2; December 2022 to February 2023) and a post-intervention audit (post-audit; March to August 2023). The primary outcome measure was the proportion of inappropriate to appropriate TTE orders during the pre-intervention and post-intervention periods. During the pre-audit, post-I1, post-I2 and post-audit periods, 89, 23, 20 and 158 patients, respectively, were admitted with PEs. 37, 10, 3 and 14 patients in each of these periods, respectively, received a TTE for PE-related reasons and were therefore included in the audits. 42%, 43%, 15% and 24% of patients, respectively, received a TTE for PE-related reasons. 89%, 50%, 67% and 79% of those TTEs, respectively, were inappropriate. There was a transient decrease in inappropriate to appropriate TTE orders ratio after the first intervention (p<0.005). Inappropriate investigations lead to additional healthcare costs and delays in patient care. This quality improvement project highlights an ongoing need to increase awareness surrounding TTE indications to improve appropriate utilisation. Next steps include further PDSA cycles with additional interventions to continue to try and decrease inappropriate TTE orders in the community hospital setting.

To determine the association between rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection following home, community and work-related exposures, to assess real-world relative vaccine effectiveness, and to determine whether anti-receptor-binding domain (RBD) IgG levels were associated with the rates of subsequent infection.

Prospective cohort of 34 months' duration (February 2021 to December 2023).

Teachers and education workers working ≥8 hours per week in the Canadian province of Ontario.

3155 education workers were eligible for the risk factor analysis; 2977 for the serological analysis.

Rate of SARS-CoV-2 infection.

1909 SARS-CoV-2 infections were reported (0.93 per 1000 participant-days); the highest incidence occurred during the period dominated by the Omicron BA.2 variant (2.01 per 1000 participant-days). Rates of infection were significantly higher following the repeal of the mask mandate. Compared with participants without known contact with an infected person, those in close contact with infected adult or child household members (adjusted HR (aHR) 1.43; 95% CI 1.24 to 1.65 and 1.39; 95% CI 1.17 to 1.65, respectively), coworkers (aHR 1.28; 95% CI 1.10 to 1.50), or individuals from more than one setting (aHR 1.44; 95% CI 1.27 to 1.64) had higher rates of infection. Participants with three or more doses of vaccine were 79%-87% less likely to develop SARS-CoV-2 than participants who had two or fewer vaccine doses. Blood samples with anti-RBD antibody levels in the highest quintile (≥5850 binding antibody unit/mL) were associated with a lower rate of subsequent infection (aHR 0.40; 95% CI 0.23 to 0.72) compared with samples with RBD levels below the threshold of detection.

Risk of SARS-CoV-2 infection in education workers occurred at home as well as the workplace, indicating the need to practise multiple intervention strategies whenever the potential for transmission of respiratory diseases is high. COVID-19 vaccines provided protection through December 2023.

The highest childhood mortality rates are observed from external causes of death. Our study aims to investigate the trends in deaths from external causes among children aged 0-14 years between 2000 and 2022, comparing the pre-pandemic (2000-2019) and the COVID-19 pandemic (2020-2022) periods.

This is a population-based retrospective cohort study.

From the 'Dissemination Database' of the Hungarian Central Statistical Office, we collected the monthly and annual mortality of all external causes (International Classification of Diseases, 10th Revision: V01-Y89) and the two most common external causes (traffic accidents and drownings) for the period 2000-2022.

Children aged under 15 years, and the relevant population, were available from this database by gender, 5-year age group and region.

The trends were characterised by the incidence rate ratio (IRR) and its 95% CI.

During the study period, 1813 deaths (1142 boys and 671 girls) occurred. There was a significant decreasing trend in all external-cause mortality (IRR=0.94; 95% CI 0.93 to 0.95; p<0.001). A similar trend was detected for mortality in traffic accidents and drownings. For external-cause mortality, significant seasonality was found in the pre-pandemic (July; p<0.001) and pandemic (May; p=0.041) periods. Similar seasonality (July-August) characterised mortality from traffic accidents and drownings. The highest mortality in the pre-pandemic period was observed in Northern Hungary and Southern Transdanubia regions. In contrast, these regions had the lowest external-cause mortality rates during the pandemic period, while the regions of the Northern Great Plains and the Southern Great Plains (HU33) had the highest external-cause mortality rates. The highest mortality rate from traffic accidents was found in the HU33 in both periods.

There is a significant decreasing annual trend in childhood external-cause mortality in Hungary. Mortality from drowning was significantly higher around our larger natural water bodies in the summer months, while mortality from traffic accidents was the highest in the HU33.

Questionnaire-based symptom assessment may introduce recall bias and lacks bidirectional exploration. This is particularly relevant, given the unclear direction of the associations between physical activity (PA), sedentary time (ST), and symptoms in patients with chronic obstructive pulmonary disease (COPD). Understanding these associations could inform symptom management strategies and improve patient quality of life.

This study aimed to investigate the direction of the association between PA, ST, and symptoms in patients with COPD using accelerometry and ecological momentary assessment (EMA).

A subsample from the FAntasTIGUE study answered 8 randomly timed EMA questionnaires daily for 5 days. Ten symptoms were rated on a 7-point Likert scale: "I feel relaxed, short of breath, energetic, cheerful, insecure, irritated, satisfied, anxious, tired, and mentally fit." Concurrently, step count and ST were measured using the ActiGraph GT9X Link placed on the right hip. Step count and ST 15 and 30 minutes pre- and post-EMA were used in multilevel models, controlled for pre-EMA steps and ST, and the previous EMA score. Significant confounders were used as covariates, and patient ID was used as random intercept.

Thirty-four patients (19/34, 56% men, mean age 66, SD 7 years; forced expiratory volume in 1 second 52±20% predicted; 1035 EMA responses) were included. Feeling more relaxed was associated with a higher step count 15 minutes post-EMA (β=5.1; 95% CI 0.9 to 10.1; P=.046). Conversely, higher step count 15 and 30 minutes pre-EMA was associated with feeling less relaxed (β=-5.2×10-4; 95% CI -9.7×10-4 to -7.0×10-5; P=.02; and β=-3.2×10-4; 95% CI -5.6×10-4 to -7.9×10-5; P=.009), more short of breath (β=8.5×10-4; 95% CI 4.7×10-4 to 1.2×10-3; P<.001; and β=4.6×10-4; 95% CI 2.6×10-4 to 6.6×10-4; P<.001), and tired (β=5.1×10-4; 95% CI 7.2×10-5 to 9.4×10-4; P=.02; and β=2.9×10-4; 95% CI 5.3×10-5 to 5.2×10-4; P=.02). Higher ST 15 and 30 minutes pre-EMA was associated with feeling more anxious (β=1.7×10-4; 95% CI 1.7×10-5 to 3.2×10-4; P=.03; and β=8.5×10-5; 95% CI 2.5×10-6 to 1.7×10-4; P=.04).

A bidirectional association of feeling relaxed with PA was found in patients with COPD. Higher step count was related to feeling more short of breath and tired, whereas higher ST was associated with heightened anxiety.

To compare self-assessment of voice handicap, sleep quality, and quality of life related to coughing and swallowing before and after using a heat and moisture exchange filter in total laryngectomized patients.

This was a prospective longitudinal study whose participants completed the Voice Handicap Index (VHI), Pittsburgh Sleep Quality Index (PSQI), Leicester Cough Questionnaire (LCQ), and MD Anderson Dysphagia Inventory (MDADI) at three times: (T1) before starting to use the heat and moisture exchange filter, (T2) 2 weeks after using it, and (T3) 4 weeks after using it.

14 participants (12 men) with a mean age of 66.4 ± 5.8 years. The medians of the total VHI score at T1, T2, and T3 were, respectively, 65.5 (47.5-86.3), 55.5 (39.5-71.3), and 44.5 (39-72), p=0.085. The medians of the PSQI score at T1, T2, and T3 were, respectively, 6.5 (4.25-11.8), 4.5 (2.25-10.8), and 3.0 (2.0-5.75), p=0.010. The medians of the total MDADI score at T1, T2, and T3 were, respectively, 78.6 (69.1-92.7), 76.3 (73.3-92.6), and 85.7 (72.7-94), p=0.571. The medians of the total LCQ score at T1, T2, and T3 were, respectively, 16.7 (13.1-18.5), 19.1 (17.4-19.4), and 19.0 (17.3-19.9), p=0.002.

The total laryngectomized patients participating in this study self-assessed an improvement in the emotional domain of voice handicap, sleep quality, and cough-related quality of life after 2 weeks of using a heat and moisture exchange filter. They also maintained the perception of improvement after 4 weeks of using the device.

To analyze tuberculosis cases in the international border region between the state of Santa Catarina, Brazil, and the province of Misiones, Argentina, from 2009 to 2021.

This was a time series study with geocoding of the average tuberculosis incidence rates of reported tuberculosis cases. Choropleth maps were plotted to identify the spatial distribution pattern and verify changes between the pre-COVID-19 pandemic period (2009 to 2019) and the full study period (2009 to 2021). Global and local Moran indices were used for spatial analyses, and segmented linear regression using the joinpoint regression method was employed for temporal analysis.

We identified a heterogenous tuberculosis spatial distribution pattern, positive spatial autocorrelation in both periods (Moran's index 0.177 and 0.178; p-value 0.020), presence of spatial clusters and non-significant changes in temporal trends, were not significant, average annual percentage change was 4.0 and the 95% confidence intervals ranged from -1.7 to 10.0. There was no change in case recording during the COVID-19 pandemic. Being adult and of the male sex were predominant characteristics of the patients.

No significant changes in the temporal trend of incidence were detected, but spatial clusters of the high-high type (municipality and neighboring areas with high incidence) were located in Argentina and low-low clusters (municipalities and neighboring areas with low incidence) in Brazil.