This study aimed to investigate the clinical characteristics of patients infected with coronavirus disease 2019 (COVID-19) and to identify risk factors associated with severe infection among Chinese patients.

We collected demographic data, clinical characteristics, and laboratory test results at admission for COVID-19 patients hospitalized in one of two designated tertiary hospitals in Yili Prefecture, Xinjiang Province, between July 2022 and October 2022. Patients were categorized into Group A (asymptomatic, mild, and moderate cases) and Group B (severe and critical cases) based on disease severity. Multivariate regression analysis was conducted to identify risk factors for severe disease, and a nomogram prediction model was developed using these factors. Additionally, stratified analyses were performed by comorbidity status.

Multivariate analysis indicated that older age, male sex, elevated urea nitrogen, higher D-dimer levels, and combined laboratory parameters at admission were positively associated with disease severity. The predictive performance of these factors, measured by area under the curve, was 0.872 (95% CI: 0.819-0.925), 0.613 (95% CI: 0.514-0.712), 0.813 (95% CI: 0.724-0.902), 0.790 (95% CI: 0.717-0.862), and 0.931 (95% CI: 0.891-0.971), respectively. Conversely, vaccination appeared to mitigate progression to severe disease to some extent.

Patient age, sex, urea nitrogen, D-dimer, and serum creatinine levels at admission, as well as vaccination status and comorbidities, significantly influence disease progression in COVID-19 patients. Clinical management can be optimized by tailoring early warning systems and intervention strategies based on these patient-specific risk factors, thereby supporting informed decisions for diagnosis, treatment, prevention, and control.

Pseudomonas aeruginosa is a major cause of ventilator-associated pneumonia (VAP) and is increasingly associated with extensive antimicrobial resistance, limiting therapeutic options and contributing to poor clinical outcomes. The emergence of high-risk clones that combine multidrug resistance and virulence-associated traits represents a growing public health concern.In this study, 100 clinical P. aeruginosa isolates recovered from VAP patients were screened using culture-based identification and antimicrobial susceptibility testing. Two isolates exhibiting the most extensive resistance profiles, consistent with pandrug-resistant (PDR) phenotypes, and associated with fatal clinical outcomes were selected for whole-genome sequencing using Oxford Nanopore technology.Comprehensive genomic analyses were performed to characterize antimicrobial resistance determinants, chromosomal resistance mutations, virulence-associated genes, mobile genetic elements, genomic islands, and phylogenomic relationships. Both isolates were assigned to sequence type ST308 and serogroup O11, a globally disseminated high-risk lineage. Core-genome phylogenomic analysis of 52 genomes identified 144,617 informative SNPs across 5,085 shared core genes and showed that the two Egyptian isolates differed by only 74 core-genome SNPs while clustering within the international ST308 lineage.The isolates harbored an extensive resistome including blaNDM-1, blaOXA-10, blaOXA-488, qnrVC1, rmtF, sul1, sul2, floR, and msrE. High-confidence chromosomal resistance mutations were detected in gyrA (T83I), parC (S87L), oprD (Q402HfsTer99), nalC, nalD, and pmrB, supporting resistance to fluoroquinolones, carbapenems, and polymyxins. Two complete class 1 integrons and one In0 structure, all carrying the class 1 integrase IntI1, were identified, comprising integron-associated multidrug resistance modules containing qnrVC1, aadA11, aac(6')-II, dfrB5, sul1, qacEΔ1, rmtF, blaOXA-10, and blaPAC-1. In contrast, blaNDM-1 was located within a distinct ISVsa3-associated resistance island together with ble and msrE. Genomic island analysis further demonstrated the co-localization of key resistance determinants and the exoU virulence factor within predicted genomic islands.Both isolates carried a highly conserved virulome, including exoU, exoT, type VI secretion system components, iron-acquisition systems, and biofilm-associated genes. Collectively, these findings indicate the convergence of resistance islands, integron-associated multidrug resistance modules, chromosomal resistance mechanisms, and virulence-associated determinants within a globally disseminated ST308/O11 high-risk clone associated with fatal VAP cases in Egypt.To our knowledge, this study provides the first comprehensive genomic characterization of ST308/O11 P. aeruginosa exhibiting a pandrug-resistant phenotype based on the antimicrobial panel tested and associated with fatal ventilator-associated pneumonia in Egypt. Furthermore, by integrating cohort-level screening of 100 clinical isolates with comparative whole-genome analysis, this work provides additional insight into the genomic diversity of globally disseminated high-risk lineages through the accumulation of resistance and virulence determinants.

This study aims to investigate the association between hourly nitrogen dioxide (NO₂) concentrations and emergency hospital admissions for adult patients with asthma in the Birmingham-Solihull metropolitan area, West Midlands, UK.

A time-series study.

The study was conducted in the Birmingham-Solihull metropolitan area, West Midlands, UK.

Adult patients with asthma (aged ≥16 years at the time of admission) from 1 June 2016 to 31 May 2022 residing in Birmingham and Solihull, West Midlands.

We analysed the hourly rate of emergency hospital admissions for acute asthma. A Poisson generalised additive model combined with the distributed lag non-linear model was applied to assess the association between hourly NO₂ concentrations and hourly counts of hospital admissions for acute asthma. Furthermore, the effect modification of the NO₂-asthma association in specific participant groups, such as sex, deprivation index and ethnicity, was explored in stratified analyses.

The study included 18 943 adults with asthma exacerbations who attended the four acute hospitals in the study area during the study period. The study observed a significant positive association between hospital admissions for acute asthma and hourly NO₂ concentrations. The mean NO₂ exposure (18 µg/m³) over a lag of 0-24 hours was associated with a 13% (RR=1.13, 95% CI 1.01 to 1.26) increase in the risk of daytime emergency hospital admissions for acute asthma in comparison with no exposure. The results show a significant association between NO₂ exposure and hospital admissions for a lag of 3-6 hours. Furthermore, subgroup-specific analysis indicated a higher positive risk associated with hourly NO₂ among patients living in the most deprived areas.

This study strengthens the evidence for the importance of using high-temporal resolution air pollution data to examine impacts on health, particularly where there are marked temporal patterns in exposure. Understanding these exposure-response relationships will improve healthcare preparedness and resource allocation in relation to air pollution levels.

This chapter presents a comprehensive overview of central sleep apnea (CSA) and central hypoventilation disorders in the pediatric population. It places particular emphasis on children with complex medical conditions and genetic syndromes, including congenital central hypoventilation syndrome (CCHS) and rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) syndrome.In addition, the chapter examines related conditions such as Prader-Willi syndrome and other hypoventilation disorders arising from structural or functional abnormalities, including Chiari malformations and Leigh syndrome. It reviews current knowledge of the pathogenesis, epidemiology, clinical presentation, and diagnostic evaluation of these disorders in children, and concludes with evidence-based guidance for their management and treatment.

At elevations above roughly 2500 m, susceptible individuals manifest central sleep apnea due to high-altitude periodic breathing (high-altitude central sleep apnea [HA-CSA]) characterized by a typical periodic breathing pattern. Mechanistically, HA-CSA develops when sleep-related decreases in respiratory drive, triggered by hypocapnia, resulting from hypoxia-induced hyperventilation, interact with increased loop gain during non-rapid eye movement sleep. Clinically, severity is mitigated by descent or supplemental oxygen. Pharmacologic strategies such as acetazolamide are effective, and sleep quality may improve with judicious hypnotic use independent of CSA severity. This article integrates the description of HA-CSA mechanisms, clinical expression, ethnic and chronic-exposure perspectives, and management strategies.

This article provides an overview of central sleep apnea (CSA) in the context of cardiovascular diseases (CVDs), highlighting its common association with conditions such as heart failure, atrial fibrillation, and cerebrovascular accidents. While the detailed pathophysiology is addressed elsewhere, the article notes that central apneas generally arise during sleep when arterial carbon dioxide levels drop below the apnea threshold, despite variability in underlying mechanisms. It also emphasizes that affected patients are typically normocapnic or hypocapnic rather than hypercapnic. The article focuses on key clinical aspects of CSA in CVD, including its epidemiology, clinical presentation, prognostic significance, and available treatment approaches.

This study aimed to determine public interest in intra-articular injection treatments for knee osteoarthritis (KOA) using Google Trends data. Relative search volumes (RSVs) for platelet-rich plasma (PRP), hyaluronic acid (HA), and stem cell treatments used in KOA treatment were analyzed using Google Trends data collected over the past decade (2015-2025). The annual search volume changes for each treatment were assessed using polynomial regression analysis. A subgroup analysis was performed based on the changes caused by COVID-19. The seasonal search trends were evaluated using the autoregressive integrated moving average model. Over the last 10 years, interest in the use of intra-articular injections for the treatment of KOA has increased. This increase was most pronounced in PRP. Although HA had a lower RSV than the other treatments, its trend toward a moderate increase was observed. Finally, although stem cells were the most common treatment between 2015 and 2020, their use has decreased in recent years. An increasing RSV trend was observed for PRP and HA over the past decade (R2 = 0.869, β = 7.364, P < .001; R2 = 0.880, β = 2.670, P < .001, respectively). Stem cells were the most common treatment between 2015 and 2020. They exhibited a decreasing trend in 2020 and beyond (R2 = 0.103, β = -1.002, P = .355). Seasonal analyses revealed no statistically significant differences in the number of searches across seasons. A dramatic decrease in the number of searches occurred during the COVID-19 pandemic. This decline is expected to revert to an increasing trend by 2022.

Leptospiral pulmonary hemorrhage syndrome is a rare but life-threatening manifestation of leptospirosis and is frequently complicated by acute respiratory distress syndrome, with persistently high mortality. Using veno-venous extracorporeal membrane oxygenation (VV-ECMO) in this setting remains challenging because systemic anticoagulation may exacerbate pulmonary bleeding.

A 58-year-old male farmer presented with high fever, myalgia, and rapidly progressive dyspnea following possible environmental exposure. He developed severe hypoxemia accompanied by diffuse pulmonary hemorrhage and multi-organ dysfunction.

According to clinical presentations, radiologic findings, and next-generation sequencing of peripheral blood, the diagnosis of severe leptospirosis complicated by pulmonary hemorrhage and refractory acute respiratory distress syndrome was established.

Despite lung-protective mechanical ventilation and adjunctive prone positioning, hypoxemia persisted. VV-ECMO was initiated as rescue therapy using an individualized anticoagulation strategy. Continuous renal replacement therapy with regional citrate anticoagulation was employed to minimize systemic anticoagulant exposure. Pathogen-directed antimicrobial therapy was promptly instituted following microbiological confirmation.

The patient exhibited progressive improvement in oxygenation and organ function. VV-ECMO was successfully weaned after 6 days, followed by extubation and transfer out of the intensive care unit with stable respiratory status.

VV-ECMO may be considered a viable therapy for life-threatening hypoxemia in leptospiral pulmonary hemorrhage when the underlying disease is potentially reversible. Individualized anticoagulation strategies and continued application of lung-protective measures, including prone positioning when feasible, are critical to optimizing outcomes.

E-cigarette or vaping product use-associated lung injury (EVALI) is a rare pulmonary condition linked to the use of e-cigarettes or vaping products. The primary symptoms of EVALI are respiratory, including shortness of breath and cough. It is rare for cases to present without pulmonary symptoms. The absence of typical symptoms often leads to clinical misdiagnosis or oversight.

We present a 33-year-old male with a history of e-cigarette use and allergic rhinitis. He initially sought care for recurrent nasal congestion in the absence of pulmonary symptoms; however, chest imaging unexpectedly revealed extensive lung shadows.

Laboratory results ruled out bacterial, fungal, and viral infections. These findings, along with his history of e-cigarette use, imaging features, and lung pathology, led to the final diagnosis of EVALI.

The patient then received glucocorticoid therapy: oral prednisone acetate tablets 20 mg once daily for 14 days followed by a standardized tapering regimen.

His condition showed clinical improvement with glucocorticoid therapy, and lung shadows were reduced on imaging. A 2-year follow-up revealed no signs of recurrence.

We emphasize that although EVALI without pulmonary symptoms is rare, it should be included in the differential diagnosis for individuals with a history of e-cigarette use who present with atypical or extrapulmonary manifestations.

Longitudinal nasopharyngeal swabs sample and reveal upper airway humoral memory generated after intranasal FluMist vaccination.