Hemoptysis is a life-threatening condition requiring urgent treatment. Bronchial artery embolization (BAE), established as the primary intervention, is an effective treatment for hemoptysis. Common etiologies include bronchiectasis, tumors, tuberculosis, aspergilloma, and cystic fibrosis. Approximately 20% of hemoptysis cases are categorized as cryptogenic. We conducted a retrospective observational study to understand the clinical characteristics of patients with cryptogenic hemoptysis (CH).

The clinical characteristics, angiographic findings, and immediate and long-term efficacies of BAE were retrospectively analyzed in 36 consecutive patients between January 2010 and December 2022. Superselective BAE was successfully performed in all patients by using a gelatin sponge (GS).

The median age was 68 years, and 21 patients (58.3%) were male. Among them, 15 patients (41.7%) presented with massive hemoptysis, and 7 (19.4%) required intubation. Angiographic evaluation revealed the treatment of total 57 vessels, comprising 51 (89.5%) bronchial arteries, 5 (8.8%) intercostal arteries, and 1 (1.8%) inferior transverse artery. The recurrence-free rates were 100% at 1 month, 94.4% at 3 months, 94.4% at 12 months, and 86.1% at more than 12 months. Only one patient required a second BAE for hemoptysis, while others were managed for recurrences with oral hemostatic agents. No serious complications, such as spinal cord infarction, were observed during the study period.

BAE treatment with GS for CH proved to be a suitable therapeutic modality, demonstrating high efficacy in halting bleeding in both the short and long terms, with the absence of severe complications, including spinal cord infarction.

This study was retrospectively registered for the UMIN Clinical Trial Registry (UMIN000042050) on October 8th, 2020.

Aging is a complex, multifactorial process in which nutritional alterations, sedentary lifestyle, and chronic diseases can increase the risk of functional limitations, dependence, and disability in older adults. Identifying the degree of frailty is essential for designing programs to enhance their quality of life. The objective of the study was to determine the prevalence of frailty and its association with nutritional status, functionality, physical activity, and socioeconomic level in older adults in Azuay, a province in Ecuador, during post-pandemic period of 2023.

A cross-sectional study was conducted with 294 older adults from Azuay Anthropometric measurements were taken, and validated questionnaires were administered to collect demographic data. Frailty was assessed using criteria validated by Fried and Watson. The Katz Index was employed to determine the level of dependency, physical activity was assessed using the short version of IPAQ, and socioeconomic level was determined according to the Ecuadorian Institute of Statistics and Censuses (INEC). Data were analyzed using SPSS version 26.0, employing frequency distribution, measures of central tendency (mean) and dispersion (standard deviation). Odds Ratio (OR) with a 95% confidence interval to explore associations.

The mean age was 74.1 years (± 7.1), with a higher prevalence between 65 and 74 years (52.4%). Women represented 72.1% of the sample, nearly half were married, 67.7% had completed primary education, and over a quarter were engaged in household work. According to BMI, women showed a higher prevalence of overweight and obesity, along with greater abdominal obesity. Both sexes reported moderate levels of physical activity. The prevalence of frailty in women was higher than in men (10.4% vs. 4.9%) and was significantly associated with physical inactivity (OR = 1.634, 95% CI 1.458-1.817; p < 0.001) and low socioeconomic level (OR = 2.176, 95% CI 1.027-4.608; p < 0.039).

Frailty prevalence was high among older adults and was significantly associated with low physical activity and low socioeconomic status. These findings highlight critical challenges for Ecuador's public and private healthcare systems in implementing proactive measures to delay the onset of frailty and improve quality of life in this population.

Ventilator-associated infectious complications are the most prevalent healthcare-acquired infection in intensive care units. The surveillance of ventilator-associated events (VAE) has now supplanted traditional ventilator-associated pneumonia (VAP) monitoring. However, its use is not common and limited reports have been published. We aimed to describe the epidemiology, etiology and the prognosis of VAE.

This multicenter observational-descriptive study was conducted at 15 centers with active prospective surveillance of VAE. Their daily basis follow-up was for 90 days. The Centers for Disease Control and Prevention guideline 2015 update was used for the definition of VAE. VAE subdiagnosis was defined as ventilator-associated condition (VAC), infection-related ventilator-associated complication plus (IVAC-plus), infection-related ventilator-associated complications (IVAC), and possible ventilator-associated pneumonia (PVAP) RESULTS: A total of 185 VAE episodes developed in 174 of the 1018 patients included in the study. The VAE incidences per 1000 mechanical ventilation day were; VAC 2.33, IVAC-plus 6.0, IVAC 1.3 and PVAP 4.7. Additionally 158 VAP episodes (14.8%, 7.09/1000 MV days) were observed, 85 (45.9%, 4.99/1000 MV days) of them fit the definition of a concurrent VAE criteria. Risk factors for VAE included a Sequential Organ Failure Assessment (SOFA) score greater than 7 on admission (odds ratio [OR]: 1.75; 95% confidence interval [CI]: 1.23-2.47), the presence of a tracheostomy (OR:1.78; CI:1.19-2.65), and antibiotic use within the previous 90 days (OR:2.41; CI:1.09-4.20) were risk factors for VAE. The mortality rate was 59.6% in ventilated patients. Multivariate analysis identified several risk factors for mortality, as follows: age greater than 63 years (OR: 1.75; CI: 1.26-2.42), a SOFA score greater than 5 on admission (OR: 2.00; CI: 1.47-1.46), a higher mean Charlson Comorbidity Index (OR: 1.08; CI: 1.02-1.13), being a medical-type patient (OR: 1.54; CI: 1.06-2.21), healthcare-associated infections (OR: 2.01; CI: 1.39-2.88), and the occurrence of VAE (OR: 2.21; CI: 1.04-4.70).

VAE is a common complication in intubated patients and is 2.21 times more likely to occur in intubated patients who die. Patients with a high SOFA score, tracheostomy and antibiotic use in the last 90 days are at increased risk. prevention of VAE in intubated patients is important for patient survival.

Despite recognised benefits against vaccine-type pneumococcal infections, limited and inconsistent evidence exists on the effectiveness of pneumococcal vaccination in preventing pneumococcal and all-cause pneumonia in adults. This study investigated clinical effectiveness of the 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine (PPsV23) against hospitalised pneumococcal pneumonia (PP) and/or all-cause pneumonia (ACP) among middle-aged and older adults before COVID-19 pandemic started.

Population-based cohort study involving 2,234,003 persons ≥ 50 years old in Catalonia, Spain, followed between 01/01/2019-31/12/2019. An Institutional Research database (SIDIAP-DB) was used to establish baseline characteristics of cohort members (demographics, underlying-risk conditions, vaccinations' history) and hospitalisations from PP/ACP were captured by hospital discharge codes (ICD10: J12-J18) in 68 referral Catalonian hospitals. Cox regression was used to evaluate the association between receipt of PCV13/PPsV23 and risk of PP/ACP.

Cohort members were followed for 2,194,200 person-years (23,494 PCV13-vaccinated and 783,465 PPsV23-vaccinated), observing 2319 hospitalised PP cases (110 in PCV13-vaccinated, 1558 in PPsV23-vaccinated) and 12,848 hospitalised-ACP cases (542 in PCV13-vaccinated, 9097 in PPsV23-vaccinated). Receipt PCV13 was associated with a greater risk of PP (multivariable-hazard ratio [MHR]: 1.83; 95%CI: 1.49-2.24) and ACP (MHR: 1.55; 95%CI: 1.42-1.70). Receipt PPsV23was also associated with increased risk of PP (MHR: 1.21; 95%CI: 1.10-1.36) and ACP (MHR: 1.24; 95%CI: 1.18-1.31) in the overall study cohort. Vaccination did not significantly alter the risk of death from PP/ACP. In sensitive analyses restricted to elderly (≥ 65 years old) and at-risk persons (immunocompromised, chronic respiratory/cardiac disease), PCV13 and/or PPsV23 did not emerge effective either.

This study did not find evidence of the clinical effectiveness of PPsV23/PCV13 vaccination in preventing the outcomes measured at population-based level. At present, new extended-valency, PCVs (PCV15/PCV20/PCV21) have been marketed for using in adults and, logically, vaccines' effectiveness must be re-evaluated in the coming years.

Nontuberculous mycobacteria (NTM), particularly the Mycobacterium avium complex (MAC), is becoming a global health burden with increasing incidence worldwide. Previous studies have linked pulmonary function impairment with increased mortality in NTM lung disease, suggesting that lung volume may be a critical predictor of mortality. The objective of this study was to assess the prognostic value of lung field area (LFA) in predicting all-cause mortality among patients with MAC lung disease.

We conducted a longitudinal cohort study of 232 patients diagnosed with MAC lung disease at NHO Fukuoka National Hospital from April 1996 to December 2021. Quantitative CT image analysis was performed to measure LFA. Statistical analysis included Kaplan-Meier curves and Cox proportional hazards models to estimate mortality risk, adjusting for demographic and clinical variables.

Patients with lower LFAs had significantly higher mortality rates (P < 0.01 for a trend), with a multivariable-adjusted hazard ratio of 5.90 (95% CI, 1.85-18.76) for the lowest tertile as compared to the highest. The predicting ability of mean LFA for all-cause death was superior to that of cavitary lesions assessed by low-attenuation areas (LAA), with area under the curve values of 0.77 for LFA versus 0.53 for LAA (P < 0.01).

Decreased LFA is an independent risk factor for mortality in patients with MAC lung disease, offering better prognostic utility than traditional markers of disease severity such as cavity lesions. These findings highlight the potential for LFA to guide clinical management and risk stratification in MAC lung disease.

Psychological distress has been identified as a risk factor for long COVID in individuals infected with COVID-19. Little is known about the differences in long COVID symptom profiles between older adults with pre-existing depression and those without.

A population-based longitudinal prospective study was performed using the Survey of Health, Ageing and Retirement in Europe (SHARE) with participants aged 50 years and older. Depression was assessed by the EURO-D scale at the baseline. Long COVID symptoms were self-reported by participants during the 12-month follow-up. A hurdle negative binomial model was employed to assess the impact of pre-existing depression on the burden of long COVID. We compared the differences in symptoms between participants with pre-existing depression and those without with the Chi-squared test.

Participants with pre-existing depression had an approximately 16% increased risk of experiencing additional persistent symptoms after COVID-19 infection. During the 12-month follow-up following COVID-19 infection, the prevalence of headaches (32.2% vs. 25.9%; P = 0.027), body aches or joint pain (38.5% vs. 29.4%; P < 0.001), and confusion (10.6% vs. 7.6%; P < 0.01) were significantly higher among participants with pre-existing depression than among those without.

Older adults with pre-existing depression had a higher burden of long COVID following COVID-19 infection and they were more likely to suffer from persistent physical pain and confusion compared to those without a history of depression.

Since the onset of the pandemic, COVID-19 mortality has disproportionately impacted populations impacted by health inequities. This study aimed to identify the barriers and facilitators to COVID-19 vaccination uptake in Appalachian Kentucky as a first step to developing vaccination interventions.

Key informant interviews were conducted with 36 community leaders in 14 Appalachian Kentucky counties from January-June 2023. Interviews focused on leaders' perspectives about their community's COVID-19 experiences, community impacts of the pandemic, and vaccine facilitators and barriers in their communities. Iterative inductive-deductive coding was used to characterize responses.

There were barriers and facilitators at multiple levels of the socioecological model. For example, individual barriers included distrust of federal government and diminished perceived risk, and interpersonal barriers included anti-vaccination norms. Community barriers included logistical challenges, as well anti-vaccination messages from healthcare providers. Perceived politicization of the vaccine and frequent changes to recommendations during the pandemic presented policy-level barriers. Facilitating factors included pro-vaccine messages from trusted community leaders, beliefs about reducing risk for others, and cues to action such as community events.

The challenges to and opportunities for improving COVID-19 vaccination uptake identified here can inform vaccination education, distribution, and policy efforts in both Appalachian Kentucky and other communities with similar characteristics.

Flash pulmonary edema is a medical emergency in which immediate recognition can be life-saving, especially when patients do not have typical clinical manifestations.

Herein, we report the case of a 56-year-old man who was admitted to the hospital due to paroxysmal palpitations for one week. His pro-B-type natriuretic peptide (BNP) level and left ventricular ejection fraction (LVEF) were normal, and he had no obvious symptoms of dyspnea. However, a CT scan of the chest indicated flash pulmonary edema. Through anti-heart failure treatment, the lung lesions improved.

The patient was diagnosed with HFpEF caused by paroxysmal supraventricular tachycardia. The abnormal imaging manifestations in the lung were due to flash pulmonary edema, which was caused by acute heart failure.

Flash pulmonary edema is a medical emergency in which immediate recognition can be life-saving, especially when patients do not have typical clinical manifestations.

This study aimed to evaluate aerobic capacity in children and adolescents following a diagnosis of Multisystem Inflammatory Syndrome in Children (MIS-C) compared to healthy matched controls.

Prospective cohort study.

Quaternary Pediatric intensive care unit and Pediatric cardiology unit.

14 children diagnosed with MIS-C.

None.

Cardiopulmonary fitness parameters at the time of post-Pediatric intensive care unit follow-up (mean 3.6 months) such as maximum oxygen uptake (VO_2max) and the first ventilatory anaerobic threshold (VAT), as a marker of muscular deconditioning.

A total of 14 patients (12 boys) with a confirmed diagnosis of MIS-C and 70 healthy children were included. The median age was 13.2 years (range 10.7-13.6 years). All participants had a normal echocardiogram and normal lung function at the time of cardiopulmonary exercise test. As measured by VO_2max Z-score, exercise capacity was significantly lower in the MIS-C group compared to healthy controls (median-0.91 vs 0.13, p < 0.01), and a significantly higher proportion of children in the MIS-C group had impaired aerobic capacity (VO_2max Z-score<-1.64) compared to controls (29% vs. 3%, p < 0.01). The VAT was also significantly lower in the MIS-C group with a higher proportion of children with an impaired VAT (VAT Z-score<-1.64) compared to controls (43% vs. 3%, p = 0.03). Impaired aerobic capacity in the MIS-C group was associated with higher BMI, higher PELOD 2 score and lower platelet count at the PICU admission, and lower hemoglobin level at the cardiopulmonary exercise test time.

This study suggests that children with MIS-C experience significant reductions in aerobic capacity compared to healthy controls, primarily due to muscular deconditioning. These findings highlight the importance of considering post-ICU consultations and implementing strategies to address physical deconditioning in this population.

Pathogens have been one of the primary sources of natural selection affecting modern humans. The footprints of historical selection events - "selective sweeps"- can be detected in the genomes of present-day individuals. Previous analyses of 629 samples from the 1000 Genomes Project suggested that an ancient coronavirus epidemic ~ 20,000 years ago drove multiple selective sweeps in the ancestors of present-day East Asians, but not in other worldwide populations.

Using a much larger genetic dataset of 76,719 unrelated individuals from each of the China Kadoorie Biobank (CKB) and UK Biobank (UKB) to identify regions of long-range linkage disequilibrium, we further investigated signatures of past selective sweeps and how they reflect previous viral epidemics. Using independently-curated lists of human host proteins which interact physically or functionally with viruses (virus-interacting proteins; VIPs), we found enrichment in CKB for regions of long-range linkage disequilibrium at genes encoding VIPs for coronaviruses, but not DNA viruses. By contrast, we found no clear evidence for any VIP enrichment in UKB. These findings were supported by additional analyses using saltiLASSI, a selection-scan method robust to false positives caused by demographic events. By contrast, for GWAS signals for SARS-CoV-2 susceptibility (critical illness, hospitalization, and reported infection), there was no difference between UKB and CKB in the number located at or near signals of selection, as expected for a novel virus which has had no opportunity to impact the CKB/UKB study populations.

Together, these results provide evidence of selection events consistent with historical coronavirus epidemic(s) originating in East Asia. These results show how biobank-scale datasets and evolutionary genomics theory can provide insight into the study of past epidemics. The results also highlight how historic infectious disease epidemics can shape the genetic architecture of present-day human populations.