Swallowing dysfunction (dysphagia) is increasingly recognised in chronic obstructive pulmonary disease (COPD) and has been associated with aspiration, exacerbations, and impaired health status. However, longitudinal data on dysphagia in COPD are limited.

To investigate the 2-year stability of self-perceived dysphagia in a COPD cohort and to identify factors associated with persistent dysphagia.

This prospective cohort study included 438 patients with spirometry-confirmed COPD from the Swedish Tools for Identifying Exacerbations (TIE) study. Self-reported swallowing symptoms were assessed at baseline and at 2-year follow-up using three questions. Dysphagia was defined as the presence of at least one symptom. Clinical assessments included lung function, dyspnoea (mMRC), health status (CAT), physical performance, body mass index (BMI), and exacerbation history. Dysphagia trajectories over time were analysed.

The prevalence of patient-reported dysphagia remained stable over the 2-year period (32% at baseline vs. 33% at follow-up). Four dysphagia trajectories were identified: no dysphagia (59%), incident dysphagia (8%), remission (8%), and persistent dysphagia (25%). Participants with dysphagia at follow-up had higher dyspnoea and CAT scores, poorer physical performance, higher BMI, and more frequent exacerbations. Persistent dysphagia was associated with a consistently higher symptom burden and poorer functional outcomes over time. In multivariate analysis, CAT ≥10 remained independently associated with dysphagia.

Self-perceived dysphagia affects approximately one-third of individuals with COPD and remains stable over two years. Persistent dysphagia may identifiy a more symptomatic COPD phenotype and warrants clinical attention. These findings support the inclusion of simple swallowing screening in routine COPD follow-up.

Elexacaftor/tezacaftor/ivacaftor (ETI) has significantly improved lung function and the clinical course of people with cystic fibrosis (PwCF) but also can cause elevations in liver function tests (LFTs). While the prescribing information (PI) provides some recommendations for holding ETI or hepatically adjusting doses based on certain criteria, clinicians are often faced with clinical scenarios that do not meet those criteria (e.g. PwCF with CF liver disease [CFLD, now termed CF hepatobiliary involvement (CFHBI)] that do not meet Child-Pugh Class B or C criteria). The purpose of this survey was to describe clinical practices regarding LFT monitoring and ETI dose adjustments in relation to hepatotoxicity and LFT abnormalities in PwCF with and without baseline CFLD or elevations in LFTs across adult and pediatric CF Foundation accredited care centers and affiliate programs (CFF-ACCAP) in the United States.

There were 53 unique respondents with representation from physicians, pharmacists, and advanced practitioners. When managing ETI in response to transaminase elevations that didn't meet PI recommendations for holding ETI in PwCF without CFLD or baseline LFT elevations, 51% of respondents would not change ETI therapy, and 41% would repeat LFTs, usually within a 2-4 week time frame. For those who met PI recommendations for pausing ETI, 49% of respondents would repeat LFTs in 1 month. In PwCF with baseline CFLD that doesn't meet Child-Pugh Class B or C criteria or baseline LFT elevations, 74% of respondents initiated ETI at full dose, and 79% of respondents checked LFTs earlier than the PI recommendations.

Despite ETI's remarkable impact on pulmonary and extrapulmonary CF manifestations, the CF care team faces clinical challenges related to hepatotoxicity as well as appropriate monitoring and dosing of ETI in clinically gray scenarios. The results of this survey demonstrate the need for a multidisciplinary guideline to navigate these complex situations.

The purpose of this study was to investigate cytological markers of cellular senescence-including senescence-associated β-galactosidase (SA-β-gal), senescence-associated heterochromatin foci (SAHF), and parameters of the cytokinesis-block micronucleus (CBMN) cytome assay-in peripheral blood samples from patients who had experienced an acute coronary syndrome accompanied by COVID-19 (Group 2), compared with similar patients without COVID-19 (Group 1). The relative proportion of SA-β-gal-positive leukocytes was approximately threefold higher in patients with a history of COVID-19 compared with Group 1. Group 2 also demonstrated a significantly higher frequency of SAHF-positive leukocytes. According to the CBMN assay, Group 2 showed a significantly higher relative content of binucleated leukocytes with micronuclei, as well as a higher frequency of apoptotic mononuclear cells. No significant differences were observed between the groups in the relative content of binucleated cells with nuclear buds or nucleoplasmic bridges, nor in the proportion of necrotic mononuclear cells. The cytokinesis-block proliferation index was comparable between the groups. The findings of this retrospective study may indicate a detrimental long-term effect of COVID-19 on the manifestation of cellular senescence at the organismal level, and the evaluated markers may be informative for developing new prognostic strategies for this patient population.

Coronavirus disease 2019 (COVID-19) causes severe complications in 15% of patients, many of whom are pregnant. Most infected women continue their pregnancies until term even though severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replicates in the decidua.

To assess the impact of SARS-CoV-2 infection remote from delivery on obstetric outcomes.

Women diagnosed with SARS-CoV-2 infection confirmed by polymerase chain reaction at least 14 days prior to delivery were enrolled prospectively and followed monthly until delivery. Their obstetric outcomes were compared to those of women who gave birth at our center during the year preceding the pandemic. The primary endpoint was a composite of hypertensive disorders of pregnancy, oligohydramnios, and fetal distress or meconium-stained amniotic fluid during labor. Other demographic and obstetric variables were also recorded.

The obstetric outcomes of 143 patients were compared to those of 3565 patients who gave birth during the year preceding the pandemic. The composite rate of placental complications was significantly higher in the study group (58 [41%] vs. 593 [17%], respectively), with an odds ratio of 3.4 (95% confidence interval 2.4-4.7). There was also an increased rate of labor induction or advancing the elective cesarean date in the study group (37 [26%] vs. 601 [17%]). No significant differences were found in the Apgar score, cord pH or gestational age at infection.

The risk of placental complications remains greater in pregnant women infected with SARS-CoV-2 after acute illness resolution. Those patients should be monitored closely until delivery.

National crises can significantly impact healthcare utilization patterns yet analyses of different types of crises are limited. While the effects of the coronavirus disease 2019 (COVID-19) pandemic on emergency department (ED) utilization have been well-documented, the healthcare impact of the Israel-Hamas war, which began 7 October 2023, remains unexplored.

To compare ED utilization patterns for non-traumatic low back pain (LBP) during two distinct national crises.

We conducted a retrospective observational study analyzing ED visits for non-traumatic LBP at our medical center. We compared ED utilization patterns, visual analog scale (VAS) pain scores, and surgical rates during 60 days before and after two distinct dates: 7 October 2023 and 19 March 2020 (the start of the COVID-19 lockdown). Statistical analysis included independent t-tests for continuous variables and chi-square tests for categorical variables.

Following 7 October, ED visits decreased by 28.6% (504 to 360). Mean VAS scores and surgery rates showed a non-significant increase from 5.5 ± 2.6 to 5.8 ± 2.4, and from 3.0% to 4.2%, respectively. During the COVID-19 lockdown, ED visits declined by 44.2%, with non-significant changes in pain scores (6.0 ± 3.0 to 5.5 ± 2.9) and surgical rates (3.5% to 2.5%).

Both events led to significant reductions in ED utilization for non-traumatic LBP, despite the heightened risk factors. Surgical rates remained stable, yet many symptomatic patients may have foregone adequate care. These findings underscore the need for resilient, crisis-specific emergency preparedness strategies to ensure continued access to care.

Amyloid A (AA) amyloidosis is a rare but life-threatening complication of cystic fibrosis (CF) driven by chronic inflammation. Despite advances in CF care, the clinical features and outcomes of CF-associated AA amyloidosis remain poorly defined. We aimed to characterize this complication through a case series and literature review. PubMed, Scopus, and Web of Science were searched through November 2025 for published cases of biopsy-proven AA amyloidosis in patients with CF. Reported cases were reviewed, and available clinical data were summarized; three additional cases from our center were included. A total of 70 patients were analyzed, including three cases from our center. The median age at CF diagnosis was 45 months, whereas the median age at AA amyloidosis was 21 years. Renal involvement occurred in 69 patients (98.6%), and 74% had nephrotic-range proteinuria. Among 24 patients with treatment data, 11 received RAAS blockade, nine colchicine, five corticosteroids, and three IL-1 or IL-6-targeting biologic therapies. Of the 55 patients with outcome data, 50 (91%) died, with a median survival of 13 months after diagnosis.

CF-associated AA amyloidosis is a devastating complication characterized by predominant renal involvement and poor survival. Regular urinary protein assessment may facilitate earlier diagnosis, while further studies are needed to establish effective disease-modifying therapies.

• AA amyloidosis is a rare complication of cystic fibrosis (CF) driven by chronic inflammation, with renal involvement as the predominant manifestation. • Reported outcomes have historically been poor, but the evidence has been limited to isolated case reports.

• In this largest review to date (70 patients), mortality was 91% with a median survival of 13 months after diagnosis. • We report the first cases of CF-associated AA amyloidosis treated with biologic therapies (anti-IL-1, anti-IL-6), with no meaningful clinical response.

Nirsevimab is a monoclonal antibody with demonstrated efficacy in preventing respiratory syncytial virus (RSV) infections in infants. Because acute respiratory tract infections (ARTIs), including viral infections, often lead to antibiotic prescribing, we aimed to determine the effectiveness of nirsevimab on antibiotic prescribing among infants with medically attended ARTIs.

A primary care attendee cohort was established using electronic health record data from 32 diverse practices across a healthcare network to emulate a target trial comparing nirsevimab to no treatment among infants <8 months. Eligible infants were seen at a primary care practice within 14 days of life. Primary outcomes included time to first antibiotic prescription for (1) outpatient ARTIs, (2) outpatient encounters for bronchiolitis, and (3) RSV-related hospitalizations. Nirsevimab effectiveness was calculated as 1 minus the risk ratio for each primary outcome.

Among 15 341 patients who met inclusion criteria, 7413 received nirsevimab. Compared with no treatment, nirsevimab administration led to a 14.4% (95% CI: 7.8%, 20.6%) reduction in antibiotic prescribing for outpatient ARTIs, a 40.3% (95% CI: 25.1%, 52.5%) reduction in antibiotic prescribing for outpatient bronchiolitis, and a 69.4% (95% CI: 4.8%, 90.1%) reduction in antibiotic prescribing for RSV-related hospitalizations.

Nirsevimab administration in primary care reduced antibiotic use for ARTIs in both ambulatory and inpatient settings.

Gut microbiota is associated with a variety of diseases, but its relationship with severe pneumonia remains to be explored. This study primarily analyzed the intestinal microbiota of patients with severe pneumonia and examined its association with clinical data. We collected clinical data from 96 patients with severe pneumonia for differential analysis and identified prognostic factors using logistic regression. Fecal samples from patients with severe pneumonia and healthy controls were collected and analyzed using 16S rRNA sequencing. We applied three machine learning algorithms (LASSO, Random Forest, and SVM) to identify microbial markers associated with severe pneumonia. The patients were grouped by "discharge status". Significant differences were observed in age (p = 0.025), total length of hospital stay (p < 0.001), and C-reactive protein (CRP) (p < 0.001). Logistic regression analysis identified age (p = 0.024) and total hospital stay (p < 0.001) as factors influencing the likelihood of improvement and discharge. Diversity analysis of collected stool samples revealed differences between the two groups. LDA Effect Size (LEfSe) analysis highlighted significant microbial differences at various taxonomic levels between the two populations. Three machine learning algorithms identified 9 microbial markers for severe pneumonia. A diagnostic prediction model was constructed, with an area under the Receiver Operating Characteristic (ROC) curve of 0.969 (95% CI: 0.946-0.992). Patients with severe pneumonia exhibit unique intestinal microbiota characteristics, which may be regulated by age and total length of hospital stay, thereby influencing the disease's prognosis.

Seasonal influenza causes substantial morbidity and hospitalisation each year. We estimated influenza vaccine effectiveness (VE) against laboratory-confirmed influenza-associated hospitalisation among patients in Northern Ireland (NI) during the 2024/25 influenza season.

We used a test-negative design to estimate VE against hospitalisation. Influenza-positive cases and test-negative controls were identified through the national laboratory surveillance system and linked to hospital admission and vaccination records. VE was estimated by influenza type/subtype, age group, sex, vaccine type and time since vaccination.

Among 15,133 hospitalised patients, 2024 (13.4%) tested positive for influenza. Among the 2024 patients admitted with laboratory-confirmed influenza, the vast majority tested positive for influenza A (n = 1803; 89.1%), whereas 221 cases (10.9%) were influenza B. Subtyping of influenza A identified 606 A(H1) infections and 93 A(H3) infections; the remaining 1104 influenza A samples were not subtyped. VE against laboratory-confirmed influenza infection was 46.0% (95% CI: 39.7% to 51.8%), with higher VE in children aged 2-17 years (60.8%; 95% CI: 48.3% to 70.5%) than in adults aged 18-64 years (40.5%; 95% CI: 24.9% to 53.2%) and ≥ 65 years (42.3%; 95% CI: 33.2% to 50.1%). VE against influenza A across all ages was 41.4% (95% CI: 34.2% to 47.9%). Vaccination reduced the odds of hospitalisation due to influenza A(H1) by 44.3% (95% CI: 33.2% to 53.7%) and A(H3) by 49.9% (95% CI: 20.3% to 69.3%). VE against influenza B was higher at 76.4% (95% CI: 64.9% to 84.7%). For influenza A, VE was highest 2-8 weeks after vaccination at 51.9% (95% CI: 42.1% to 60.1%) and declined with time since vaccination to 44.6% (95% CI: 35.6% to 52.5%) at 9-16 weeks and 41.4% (95% CI: 15.4% to 60.1%) at ≥ 16 weeks. VE against influenza B remained high throughout the season. No statistically significant differences in VE by vaccine type were found.

Influenza vaccination reduced the risk of hospitalisation with laboratory-confirmed influenza during the 2024/25 season, offering meaningful protection at individual and population levels, with the greatest benefit observed in children.

City-specific tools for assessing and warning about respiratory disease risks are underdeveloped, limiting effective public health response. This study aimed to develop and validate a novel city-specific prediction framework (WHA _air-LSTM) for forecasting daily respiratory outpatient visits by integrating a composite air pollution health index.

Based on over 223.7 million hospital visits across multiple megacities, we constructed and validated a five-level morbidity-driven composite air pollution index (WHA _air) for each city using city-specific exposure-response relationships. An LSTM model was built using WHA _air, temperature, humidity, and historical visit data to predict next-day visits. The proposed modeling framework was developed with city-level data, and it was externally validated using datasets from other cities.

Higher WHA _air levels were significantly associated with increased outpatient visits. The model demonstrated excellent predictive performance (Beijing: R ² = 0.963, RMSE = 53.5) and effectively captured visit surges. Excluding WHA _air degraded model accuracy (ΔRMSE = +44.1%). The framework maintained robust performance in external validation, confirming its transferability.

The WHA _air-LSTM framework provides a scalable and practical tool for city-level respiratory disease early warning by bridging environmental monitoring with clinical practice.