Mycoplasma pneumoniae accounts for a significant proportion of pathogens responsible for community-acquired pneumonia (CAP). Identifying Mycoplasma pneumoniae pneumonia (MPP) is challenging but essential for guiding early and appropriate antibiotic use.

We developed a predictive model using data from hospitalized CAP patients diagnosed with either MPP or bacterial pneumonia between January and December 2023. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to explore associations between clinical features (age, symptoms, laboratory findings) and the causative pathogens, and then a prediction model was developed based on the results. The model's clinical utility was assessed in an independent validation cohort comprising CAP patients who met the same inclusion/exclusion criteria in our hospital from 01/01/2024-30/06/2024.

A total of 244 patients were diagnosed with CAP, including 117 with MPP and 127 with bacterial pneumonia. Our analysis revealed that patients with MPP were younger (37.00 years vs. 61.00 years), had procalcitonin levels mostly within the normal range, exhibited higher serum albumin levels (40.68 g/L vs. 36.34g/L), and higher levels of complement C1q (209.30 mg/L vs. 169.55 mg/L) compared to patients with bacterial pneumonia. In contrast, thrombin time was relatively prolonged in patients with bacterial pneumonia (14.00 s vs. 13.10 s). Based on these findings, we developed a clinical prediction model with strong discriminatory performance for early differentiation between MPP and bacterial pneumonia with an area under the curve (AUC) of 0.879 (95% CI, 0.833-0.925). Temporal validation demonstrated the model's stability and good predictive performance (AUC: 0.922 vs. derivation 0.879).

Our study showed that age, serum albumin, complement C1q level, thrombin time, and normal-range procalcitonin levels were highly predictive of MPP. This study provides a predictive model for early differentiation between MPP and bacterial pneumonia to aid in timely clinical decision-making.

Peripheral neuropathy (PN) is a severe manifestation of eosinophilic granulomatosis with polyangiitis (EGPA). However, the aetiology of PN in EGPA remains unclear. This study aimed to elucidate the clinical characteristics and prognosis of patients with EGPA with PN using a multicentre database in Japan.

Newly diagnosed patients with EGPA between 2006 and 2024 were enrolled in this study. EGPA was diagnosed according to the ACR/EULAR 2022 classification criteria. Initial clinical characteristics were compared between patients with EGPA with and without PN based on BVAS ver. 3.0. The recurrence rate of PN in EGPA patients with neuropathy was also investigated, and risk factors for PN relapse were identified.

Of the 159 patients enrolled in the REVEAL cohort, 107 newly diagnosed and treatment-naïve patients with EGPA were included. MPO-ANCA was positive in 45 patients (42.1%) and 93 patients (86.9%) had PN. The levels of WBC, eosinophil granulocyte, serum immunoglobulin (Ig)G, and serum IgG4 were significantly higher in patients with EGPA with PN than in those without PN. Among them, IgG4 was the most useful clinical indicator for detecting PN in patients with EGPA. Kaplan-Meier estimator showed that 5-year relapse rate of PN among patients with EGPA with PN was 18.6%. The administration rate of intravenous cyclophosphamide (IVCY) was significantly lower in patients with relapse of PN than in those without relapse of PN.

Serum IgG4 might be a useful clinical indicator for detecting PN in EGPA and IVCY administration might be effective in preventing PN relapse.

Coblation intracapsular tonsillectomy (ICT) may offer a more favourable post-operative morbidity profile compared with extracapsular tonsillectomy for paediatric obstructive sleep-disordered breathing (oSDB). Data from the Singapore paediatric population remain limited. This study examines the outcomes of coblation ICT in children with oSDB at a tertiary centre in Singapore.

This was a single-centre prospective cohort study of 102 consecutive children aged 21 months to 15 years undergoing coblation ICT for oSDB (April-October 2023). Concurrent adenoidectomy was performed in 98.0% of patients. Primary outcomes included complications and disease-specific quality of life (QoL) via the Obstructive Sleep Apnea-18 Quality of Life (OSA-18) questionnaire (where higher scores indicate greater symptom burden and poorer quality of life), assessed pre-operatively and at 3 months. Secondary outcomes included pain, analgesia, diet, and snoring resolution.

No post-operative haemorrhage or major complications occurred. All 102 patients completed a 3-month review. The median OSA-18 score improved significantly from 74 (interquartile range [IQR] 54-89) to 29.5 (IQR 23-40) post-operatively (P<0.001), representing a shift from the moderate to the minimal impact band. The mean change of 39.3 points exceeded twice the published minimal clinically important difference (standardised response mean 2.17). Perceived QoL score improved from median 5 (IQR 4-6.6) to 8 (IQR 8-9) (P<0.001). At 3 months, 82.4% had no snoring. Postoperative pain was mild, with 75.5% requiring analgesia for 3 days or fewer.

In this uncontrolled single-arm cohort, coblation ICT with concurrent adenoidectomy was associated with low morbidity and clinically meaningful improvements in caregiver-reported outcomes. These hypothesis-generating findings warrant further investigation through multicentre comparative studies with longer follow-up.

To evaluate validity of the Caprini Risk Score (CRS) for predicting postoperative venous thromboembolism (VTE) in emergency surgery, as well as to investigate the impact of compliance with prophylactic protocols on the risk of postoperative thrombosis.

A single-center prospective study included 267 patients after urgent or emergency major surgery. CRS scores were calculated before the intervention and at discharge. Routine mechanical and pharmacological prophylaxis for VTE was used after surgery. The primary endpoint was combination of asymptomatic and symptomatic deep vein thrombosis (DVT), identified with obligatory Doppler ultrasound before discharge, and pulmonary embolism (PE) verified by imaging or autopsy.

The incidence of postoperative VTE was 15.7% (95% CI, 11.8-20.6%), including two cases of PE (1 death). The number of VTE significantly correlated with final CRS score and increased from 2.3% in low-risk group to 55.6% in extremely high-risk group (V=0.509, p<0.001). CRS demonstrated high predictive ability: AUC=0.82 (95% CI, 0.76-0.89, p<0.001). The threshold was 5.5 scores with 81% sensitivity and 72% specificity. Compliance with the recommended anticoagulant dose was observed in 66% of patients. About 10% of patients received complete pharmacological and mechanical prophylaxis that did not affect the risk of postoperative VTE. In selective assessment, all patients with DVT had missed doses of heparins.

The incidence of postoperative VTE in emergency surgery was 15.7% that correlated with CRS scores. Patients with CRS score ≥5 had a higher risk of complications.

Measurement properties of patient-reported outcome measures assessing functional performance and activity limitations in interstitial lung disease (ILD) are often unknown.

To evaluate the reliability and validity of the Canadian Occupational Performance Measure (COPM) and the Pulmonary Functional Status and Dyspnea Questionnaire-Modified version (PFSDQ-M) in European Portuguese among people with ILD, and to explore differences between fibrotic and non-fibrotic ILD.

Cross-sectional study. Internal consistency (Cronbach's α), test-retest/intra-rater and inter-rater reliability assessed using intraclass correlation coefficients [ICC_2,1[95%CI]], standard error of measurement (SEM), minimal detectable change at 95% confidence level (MDC₉₅) and Bland-Altman analysis, and floor/ceiling effects were evaluated. Construct validity was explored with correlations: convergent validity with the LCADL, CIS-8, 6MWT and 1-minSTS, only for PFSDQ-M; divergent validity with age and lung function for both instruments. Subgroup analyses compared fibrotic and non-fibrotic ILD.

A total of 334 participants were included. The COPM showed moderate test-retest/intra-rater and inter-rater reliability (ICC2,1 = 0.68[0.57-0.77]-0.72[0.63-0.80]), with SEM = 1.08-1.42 and MDC95 = 3.00-3.94, and no floor/ceiling effects. The PFSDQ-M demonstrated excellent internal consistency (α = 0.90-0.96) and good test-retest and inter-rater reliability (ICC2,1 = 0.80[0.74-0.85]-0.92[0.89-0.94]), with SEM = 15.80 and MDC₉₅ = 43.80 for total score. Bland-Altman analysis showed no systematic bias for the COPM and a small bias for the PFSDQ-M test-retest. Moderate-to-strong correlations with LCADL/CIS-8 and weak-to-moderate with 6MWT/1-minSTS supported convergent validity for PFSDQ-M. Negligible-to-weak correlations with age and lung function for COPM and PFSDQ-M supported divergent validity. Subgroup results were similar.

The European Portuguese COPM and PFSDQ-M demonstrated reliability. The COPM showed evidence of divergent validity, whereas the PFSDQ-M demonstrated both convergent and divergent validity. These findings support their use for assessing functional performance in people with ILD.

ObjectiveProton pump inhibitors (PPIs) are prescribed in the intensive care unit (ICU), but their association with outcomes in patients with pulmonary fibrosis remains unclear.MethodsWe conducted a retrospective cohort study using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database (v3.1). Propensity score matching (PSM) and multivariate regression models adjusted for baseline differences. Landmark, subgroup, dose-response, and exploratory drug-specific analyses were performed.ResultsAmong 551 patients, 286 (51.9%) received PPIs. After PSM, PPI use was associated with higher 30-day mortality (HR 1.59, 95% CI 1.08-2.34; p = 0.019), 90-day mortality (HR 1.62, 95% CI 1.15-2.30; p = 0.006), ICU mortality (OR 3.22, 95% CI 1.57-6.59; p = 0.001), and longer ICU stay (β 1.90, 95% CI 0.91-2.88; p < 0.001). Associations weakened in the 48-hour landmark analysis, with only 90-day mortality remaining significant (adjusted HR 1.40, 95% CI 1.02-1.90; p = 0.035). Exploratory drug-specific estimates varied across agents but were imprecise. In exploratory cumulative-dose analyses after PSM and adjustment, each 10-mg increase in omeprazole-equivalent exposure was associated with higher ICU mortality (OR 1.06, 95% CI 1.01-1.10; p = 0.012) and longer ICU stay (β 0.34 days, 95% CI 0.28-0.40; p < 0.001), but not 30-day or 90-day mortality. Initial timing was not associated with mortality after PSM and adjustment but was associated with longer ICU stays. Subgroup associations were consistent, with an interaction between PPI and H2RA use for ICU length of stay.ConclusionsPPI exposure was associated with higher short-term mortality and longer ICU stay, although the associations weakened in the 48-hour landmark analysis, with only 90-day mortality remaining significant. Higher cumulative PPI doses were associated with higher ICU mortality and longer ICU stay. These findings are hypothesis-generating and require prospective confirmation before informing changes in clinical practice.

Acute Respiratory Distress Syndrome (ARDS) is a life-threatening acute lung injury with great unmet medical needs. Lung edema resulting from increased vascular leak is a hallmark of the disease. Recently corticosteroids were recommended for ARDS patients by the American Thoracic Society. Here, we use the influenza infection mouse model to study vascular leak induced by viral lung injury and the effect of dexamethasone on vascular leak and mortality.

Near-infrared fluorescence (NIRF) imaging was used to quantitatively measure vascular leak in mice infected with influenza PR8, and the effect of dexamethasone was analyzed as a function of dose and time of the treatment.

NIRF imaging robustly detects vascular leak up to 14 days post-infection. Dexamethasone treatment reduces mortality and vascular leak when administered on day 9 post infection, corresponding to the time of influenza virus clearance. Early treatment of dexamethasone, either prophylactically or on day 5 post infection, has a negative impact on the host anti-viral response resulting in increase in viral titers and pro-inflammatory cytokines. Although the higher dexamethasone dose at 10 mg/kg shows a more potent pharmacodynamics effect in mice, 0.5 mg/kg dexamethasone is sufficient to reduce vascular leak.

This study provides a clear link between timing of dexamethasone treatment and viral burden, vascular leak, and mortality. 0.5 mg/kg dexamethasone affects clinically relevant parameters in the influenza model and has comparable exposure to human dexamethasone dosing; thus it is a more relevant dose to use in future mouse studies.

Hantavirus fevers (HF) are caused by pathogenic orthohantaviruses and are classified into two clinical forms: hemorrhagic fever with renal syndrome (HFRS), reported in Eurasia, and hantavirus pulmonary syndrome (HPS), reported in the Americas. HF are characterised by an acute course with predominant involvement of internal organs: HFRS is mainly associated with kidney damage, while HPS is characterised by severe lung injury. Both diseases may also affect the central nervous and endocrine systems. In addition, hantavirus fevers are marked by severe complications during the acute phase and a prolonged recovery period. Currently, there is neither a WHO-approved vaccine nor any effective etiotropic anti-hantavirus therapy. The development of antiviral treatment strategies focuses on preventing orthohantavirus entry into cells or suppressing their intracellular replication. One of the main directions in the search for effective anti-hantavirus therapy is the low-molecular-weight compounds development and testing, many of which have demonstrated pronounced antiviral activity against orthohantaviruses through direct or indirect effects on viral RNA polymerase function. The review shows that new antiviral nucleoside compounds development and study has promising potential, as well as their combined use for effective etiotropic, pathogenetic and symptomatic treatment of hantavirus fevers.

Background: Psychological morbidity is common following admission to adult intensive care units (ICUs), with many patients experiencing post-traumatic stress disorder (PTSD), anxiety, and depression as part of post-intensive care syndrome. Eye Movement Desensitisation and Reprocessing (EMDR) is an established trauma-focused psychological therapy; however, its evidence base within critical care populations remains emerging.Objectives: This scoping review aimed to map the extent, characteristics, and findings of the available literature on the use of EMDR for ICU-related psychological distress.Methods: A scoping review was conducted in accordance with Joanna Briggs Institute methodology and reported following the PRISMA-ScR guidelines. The review aimed to systematically identify and synthesise evidence relating to the application and reported outcomes of EMDR in ICU survivors.Results: Seven publications representing six independent study populations were included. Participants included adult ICU patients experiencing PTSD symptoms, delirium-related psychological disturbances, and COVID-19-related distress. EMDR was delivered using either standard protocols or the Recent Traumatic Episode Protocol (R-TEP). Across the evidence base, EMDR was associated with reductions in trauma-related distress, although evidence for improvements in anxiety and depression was less consistent. Where qualitative data were available, participants additionally reported improved integration and processing of ICU experiences. Overall, methodological heterogeneity, overlapping samples, small sample sizes, and limited controlled evidence restrict the strength of conclusions that can be drawn.Conclusions: This review highlights growing but preliminary evidence supporting the feasibility and potential utility of EMDR, including R-TEP, for ICU-related psychological distress. While findings are promising, the current evidence base remains insufficient to determine effectiveness. Future research should prioritise adequately powered controlled studies, standardised outcome measures, longer-term follow-up, and more diverse ICU populations to strengthen the evidence base and inform clinical implementation.

The COVID-19 pandemic created enormous challenges for families across the United States. Economic concerns related to job loss and unemployment, social isolation and school closures were just some of the stressors facing families and children. Because many of these factors are known correlates of child abuse and neglect, some were concerned that child abuse and neglect would significantly increase during the COVID-19 pandemic. A rigorous and comprehensive systematic review of scientific literature was conducted to triangulate hospital, child welfare, and self-report data on child maltreatment rates during COVID-19. Using PRISMA criteria for conducting systematic reviews, the current study reviewed scientific literature on changes in child maltreatment rates during COVID-19. Of the 4,193 unique studies identified, 73 studies met eligibility criteria. Data from child welfare sources suggested declining child maltreatment immediately after COVID-19 onset, while self-report studies document an increasing trend. Hospital data findings were largely mixed with more studies reporting decreased child maltreatment during COVID-19. Interpretation of child maltreatment surveillance data from COVID-19 must account for evidence from multiple data sources which could affect resulting conclusions.