The outbreak and ongoing impact of coronavirus disease 2019 (COVID-19) have significantly affected people's physical and mental health, particularly among medical health workers. However, the effects of COVID-19 on the immunity of this population remain unclear.

This retrospective longitudinal study analyzed data from blood routine examinations of medical health workers conducted in 2019, 2020, 2022, and 2024. Data were collected from 1,818 participants, with subgroup analyses stratified by gender.

White blood cell (WBC), lymphocyte (LYM), and eosinophil (EOS) counts increased significantly in the post-COVID-19 year compared with the pre-COVID-19 year. Neutrophil (NEUT) counts decreased in COVID-19 year 1 and COVID-19 year 3 but returned to pre-COVID-19 year levels in the post-COVID-19 year. Monocyte (MONO) counts and monocyte-to-lymphocyte ratio (MLR) decreased in COVID-19 year 1, increased to pre-COVID-19 year levels in COVID-19 year 3, and reached their highest levels in the post-COVID-19 year. Basophil (BASO) counts and hemoglobin-to-red blood cell distribution width ratio (HRR) were significantly higher in COVID-19 year 1, COVID-19 year 3, and post-COVID-19 year than in pre-COVID-19 year. Platelet-to-lymphocyte ratio (PLR) in pre-COVID-19 year was significantly higher than in COVID-19 year 1 and post-COVID-19 year, but not significantly different from COVID-19 year 3. Neutrophil-to-lymphocyte ratio (NLR) significantly decreased in post-COVID-19 year when compared with pre-COVID-19 year. Aggregate index of systemic inflammation (AISI) in pre-COVID-19 year was significantly higher than in COVID-19 year 1 and COVID-19 year 3, but significantly lower than in post-COVID-19 year. Systemic inflammation response index (SIRI) decreased in COVID-19 year 1, but up to their pre-COVID-19 year levels in COVID-19 year 3 and post-COVID-19 year. Stratified analysis showed that the impacts of COVID-19 on immune cells and inflammation indicators were more pronounced in female.

Immune cells and inflammatory markers in medical health workers underwent changes between 2019 and 2024, particularly among female. Increased attention should be paid to the immune function and mental health of medical health workers.

Obstructive sleep apnea (OSA) is a significant risk factor for coronary heart disease (CHD), yet the precise pathophysiological mechanisms linking them remain incompletely understood. Remnant cholesterol (RC), as an atherogenic lipoprotein, is considered a key driver of residual cardiovascular risk. However, evidence regarding the role of RC in the association between OSA and CHD is still lacking.

In this single-center, cross-sectional study, we enrolled 368 consecutive patients with suspected coronary heart disease (CHD). All participants underwent overnight polysomnography (PSG) and were categorized into none/mild or moderate/severe obstructive sleep apnea (OSA) groups based on the apnea-hypopnea index (AHI). Coronary artery disease was assessed via angiography or computed tomography angiography (CTA), and its severity was quantified by the number of diseased vessels.

Compared to the none/mild OSA group, patients with moderate/severe OSA had a significantly higher prevalence of CHD (73.0% vs. 15.2%, p<0.001) and a greater proportion of multi-vessel disease (p<0.001). AHI was strongly positively correlated with the number of diseased vessels (overall population r=0.612, p<0.001). Multiple Linear Regression identified AHI as an independent determinant of the number of diseased vessels (β=0.804, p<0.001). Logistic regression confirmed that the number of diseased vessels was an independent risk factor for moderate/severe OSA (OR=3.575, p<0.001). While remnant cholesterol was not significantly correlated with AHI in the overall population (r=-0.051, p=0.327), it showed weak negative correlations with the number of diseased vessels in males (r=-0.120, p=0.036) and in the moderate/severe OSA subgroup (r=-0.130, p=0.035), which may be influenced by residual confounding factors.

This study demonstrates a strong and significant independent association between OSA severity and the presence and severity of CHD. Although remnant cholesterol showed no global association with OSA severity, its weak inverse correlation with coronary disease in males and severe OSA patients suggests a potential complex role, warranting further investigation into its mechanisms within specific populations.

To evaluate the prognostic value of disease distribution patterns and the baseline metabolic parameter, maximum standardized uptake value (SUVmax), on fluorine-18 fluorodeoxyglucose PET-computed tomography (¹⁸F-FDG PET-CT) in pediatric patients with Langerhans cell histiocytosis (LCH).

This retrospective study included 63 histopathologically confirmed LCH patients aged 1-18 years who underwent ¹⁸F-FDG PET-CT between August 2013 and 2025. Demographic, clinical, and imaging data were reviewed, including system involvement; risk and critical organ involvement; treatment regimens; survival time; and outcomes. Baseline SUVmax and disease distribution patterns were correlated with event-free survival (EFS) and overall survival (OS).

Of 63 patients, 40 (63.5%) were male and 23 (36.5%) females. Single-system involvement was observed in 32 (51%) patients, while 31 (49%) had multisystem disease. Risk-organ involvement (RO+) occurred in 12 (38.7%) multisystem patients, and critical organ involvement in 10 (32.2%). Diabetes insipidus was present in nine (14%) patients. Mean SUVmax was significantly higher in deceased patients than survivors (6.7 ± 1.8 vs. 4.7 ± 3.0; P = 0.01). Ten-year EFS was significantly better in single-system LCH than multisystem LCH (90.6 vs. 64.5%; P = 0.03) and worse in RO+ multisystem LCH than without risk-organ-involvement multisystem LCH (50 vs. 73.7%). Ten-year OS was higher in single-system LCH than multisystem LCH (93.8 vs. 74.2%; P = 0.04) and lower in RO+ multisystem LCH (50 vs. 89.5%; P = 0.01).

Single-system LCH demonstrates significantly better survival outcomes than multisystem LCH, particularly without risk-organ involvement. Baseline SUVmax appears to be a promising prognostic imaging biomarker for predicting outcomes in pediatric LCH.

BackgroundThe combined use of extracorporeal cardio-pulmonary resuscitation (ECPR) and large bore mechanical thrombectomy represents an emerging strategy for patients experiencing cardiac arrest secondary to catastrophic pulmonary embolism.MethodsThis retrospective, single-center study included patients treated between January 2023 and June 2025 who experienced cardiac arrest due to catastrophic pulmonary embolism and underwent ECPR followed by large bore mechanical thrombectomy. Primary outcomes were 90-days post-discharge survival and cerebral performance category (CPC) at discharge. Secondary outcomes included support duration, complications during support, and ICU and hospital length of stay.ResultsFifteen patients were included. Four (27%) sustained out-of-hospital cardiac arrest, and twelve (80%) presented with pulseless electrical activity. All patients underwent large bore mechanical thrombectomy using the Inari FlowTriever System (Inari Medical, Irvine, CA) within 6 hours of arrest in the cardiac catheterization laboratory. Eight patients (53%) survived to discharge with favorable neurological outcomes (CPC 1-2). Seven patients died following withdrawal of care due to cerebrovascular accident or anoxic brain injury (n = 4), intracranial hemorrhage (n = 2), or mesenteric ischemia (n = 1). Cerebrovascular or anoxic brain injury occurred more frequently among non-survivors (p = 0.02). No significant differences were observed in baseline characteristics, ECMO or ventilator duration, or length of stay between survivors and non-survivors.ConclusionECPR followed by large bore mechanical thrombectomy is a feasible resuscitative strategy for patients presenting with catastrophic pulmonary embolism. Larger, multicenter studies are warranted to better define outcomes and the overall impact of this combined approach.

 : Cystic fibrosis (CF) is likely underdiagnosed in Caribbean populations due to non-representative cystic fibrosis transmembrane conductance regulator (CFTR) variant screening panels, limited newborn screening programs, and structural healthcare barriers. Data from 2022 indicate substantial populations with European ancestry in Puerto Rico (1.4 M, 42.7%) and the Dominican Republic (1.4 M, 57.9%), yet the true burden of CF in the broader Caribbean remains largely undocumented.

Current diagnostic frameworks, largely based on European-derived CFTR variant distributions, fail to capture the true burden of CF in Caribbean populations, leading to underestimated prevalence and delayed or missed diagnoses.

To synthesize registry, clinical, and published data to identify barriers to accurately assessing CF prevalence in Caribbean populations.

This narrative literature review integrates CF registries, published data on CFTR variant distribution, population ancestry data, and clinical observations from CF centers in Puerto Rico and the Dominican Republic. Clinical insights were derived from pediatric patients evaluated at the Pediatric Rare Lung and Asthma Institute in Puerto Rico and the CF Clinic at Robert Reid Cabral Children's Hospital in the Dominican Republic.

CFTR variant patterns differ from those in the United States, with higher frequencies of rare variants such as p.Ala559Thr. Standard screening panels may miss these variants, contributing to underdiagnosis. Limited newborn screening, misdiagnosis, and restricted access to CFTR modulator therapies further exacerbate disparities.

Structural, diagnostic, and genetic factors hinder accurate CF prevalence estimates in the Caribbean, highlighting the need for region-specific research, improved screening, and expanded access to therapies.

Bronchiolitis represents a major cause of infant hospitalization, predominantly due to respiratory syncytial virus (RSV). Nirsevimab, a long-acting monoclonal antibody targeting the prefusion RSV F protein, has recently been introduced to provide season-long protection against RSV-related lower respiratory tract infection.

We conducted a multicenter, retrospective, population-based study across the Liguria Region (Northwest Italy) to assess the impact and effectiveness of the 2024-2025 nirsevimab immunization campaign. All infants under 2 years of age hospitalized with acute bronchiolitis between October 2023 and March 2025 were identified through the regional pediatric Hub-and-Spoke network. Data were compared between the pre-nirsevimab (2023-2024) and post-nirsevimab (2024-2025) seasons. Nirsevimab effectiveness (VE) against RSV-positive hospitalization was estimated using a test-negative design.

A total of 858 infants were hospitalized with bronchiolitis across the two seasons. Following the introduction of nirsevimab, bronchiolitis hospitalizations decreased from 41.7 to 17.3 per 1000 admissions (Incidence Rate Ratio 0.4; 95% CI: 0.4-0.5; p < 0.001), corresponding to a 60% reduction. Estimated nirsevimab effectiveness was 65.0% (95% CI: 39.2%-79.8%) against RSV-positive hospitalization. No high-risk infants-those previously eligible for palivizumab-developed severe RSV infection requiring PICU admission. Breakthrough infections occurred in a minority of immunized infants but showed a similar clinical course to non-immunized cases.

The introduction of universal nirsevimab immunization in Liguria was associated with a marked reduction in RSV-related hospitalizations, confirming its strong real-world epidemiological impact. These findings support nirsevimab as an effective and feasible public health intervention to substantially reduce the burden of RSV bronchiolitis in infants.

Achieving long-term behavioural change in chronic disease management, particularly in chronic obstructive pulmonary disease (COPD), remains a significant challenge. Although maintenance programmes have been developed to extend the benefits of pulmonary rehabilitation, patient adherence is often comperomised by persistent symptoms, low motivation, and fragmented care. Research highlights the importance of therapeutic alliance, social support, and personalised follow-up to encourage long-term healthy behaviour. Care managers (CMs) may help facilitate these key elements by providing individualised support and coordination. The aim of this study is to identify key elements that support the sustainable implementation of the CM role in chronic care pathways, by exploring the shared experiences of COPD patients and CM involved in an 18-month remote follow-up post-rehabilitation programme.

A qualitative descriptive study was conducted using semi-structured interviews with COPD patients and care managers who participated in the INSPIR'ACTION national experiment. This programme included an initial pulmonary rehabilitation phase followed by an 18-month remote follow-up. Interviews focused on the follow-up phase and were analysed using inductive thematic analysis.

Data saturation was reached with a final sample of 9 patients and 7 CMs. Patients described CMs as supportive professionals who helped sustain motivation, adherence to healthy behaviours, and continuity of care. The relationship was perceived as trustful and personalised, even in a remote format. CMs expressed pride in their role but also reported organisational challenges, including lack of recognition and insufficient time allocation. Both groups emphasised the importance of relational continuity and individualised support.

Patients and care managers described the CM as a key supportive figure offering personalised follow-up perceived as helping promote therapeutic engagement and behavioural change. Relational continuity throughout the remote follow-up was seen as fostering a trusting relationship that shaped participants' experience of the programme. By highlighting organisational elements that could influence implementation, our study may help inform future strategies to enhance the sustainable integration of care management in COPD care pathway.

COPD patients and CMs involved in the INSPIR'ACTION programme shared their experiences through interviews, helping to identify key factors for improving care manager support and long-term follow-up. Their input directly informed the study's findings and recommendations.

While COVID-19 had a devastating impact on mental health worldwide, little is known about its effects on adults with intellectual and developmental disabilities. We used a community-based participatory approach to study this population's mental health experiences.

Six focus groups were conducted: four with adults with intellectual and developmental disabilities (n = 21) and two with caregivers (n = 13). Conventional content analysis and thematic network analysis were utilised.

We identified cascading impacts of the pandemic on the mental health of this population. Sub-themes included: (1) environmental effects, (2) emotional effects and (3) physical and behavioural effects of COVID-19. Five modifying factors were identified.

The COVID-19 pandemic, while specific in its restrictions and timing, illustrated and exacerbated unmet mental health needs of adults with intellectual and developmental disabilities. These results suggest opportunities for empirical research and policy development, relevant for future emergencies and ongoing medical and non-medical support of this population.

The main aim of this study is to investigate the connection between a high workload and health-related quality of life among in-home care workers in northern Sweden during the COVID-19 pandemic. We also investigate whether social support and control at work can prevent poor health due to high workload.

A cross-sectional survey was conducted during the pandemic, with 629 (response rate 33 per cent) of an estimated 1,900 in-home care workers responding. Results were compared with a nearly identical survey conducted prior to the pandemic in which 1,154 (response rate 58 per cent) of an estimated 2000 in-home care workers responded. Psychosocial factors were measured using QPSNordic and health-related quality of life using EuroQol 5 Dimensions (EQ-5D). EQ-5D responses were translated into quality-adjusted life year (QALY) scores. Propensity scores were used with absolute risk differences.

During the pandemic, staff with high workload had a statistically significantly (6.2%) lower QALY score (confidence interval 2.2%-10.3%) compared to staff with a normal workload. This was also the case for the usual activities and the anxiety/depression dimensions of EQ-5D. These risk differences were greater, but not statistically significant, during the pandemic than before. The combination of a normal workload and a high degree of control over one's work appeared to protect against a low QALY score, while social support at work did not seem to be protective.

High workload is related to poorer health-related quality of life. This is mainly attributable to anxiety/depression. In-home care organisations need to manage workload better to prevent poor health among staff during strained situations such as a pandemic. The results of our study indicate that in-home care organisations should increase their readiness to promote opportunities for staff to maintain a high degree of control over their work, in order to counteract variations in workload that ultimately appear to have a negative impact on HRQoL.

Nirmatrelvir-ritonavir is an oral antiviral recommended for treating high-risk individuals with COVID-19 in the community. However, there remains uncertainty over its cost-effectiveness in largely vaccinated populations and subgroups defined by age and clinical risk.

To compare the cost-effectiveness of nirmatrelvir-ritonavir vs usual care based on the UK Platform Adaptative Trial of Novel Antivirals for Early Treatment of COVID-19 in the Community (PANORAMIC) trial.

This economic evaluation was a within-trial cost-utility analysis conducted using data from the PANORAMIC trial and linked routine health care data from December 8, 2021, to September 30, 2024, adopting a UK National Health Service (NHS) and personal social services perspective over 6 months. Eligible participants were community-dwelling adults aged 50 years and older or ages 18 to 49 years with comorbidities. Data were analyzed from April 20, 2022, to September 30, 2024, for the nirmatrelvir-ritonavir group and December 8, 2021, to September 30, 2026, for usual care.

Oral nirmatrelvir-ritonavir.

Cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) of nirmatrelvir-ritonavir vs usual care.

There were 1736 participants randomized to receive nirmatrelvir-ritonavir plus usual care (mean [SE] age, 54.7 [0.29] years), and 1768 to usual care alone (mean [SE] age, 54.8 [0.28] years); 2405 in the total cohort were female (69.2%]), and 3455 (98.6%) were vaccinated. Nirmatrelvir-ritonavir was cost-effective, on average, with lower total costs (£124; 95% CI, -£1207 to £1455) and higher QALYs (0.0110; 95% CI, 0.0062-0.0170) over 6 months compared with usual care (ICER, £10 897 per QALY). Nirmatrelvir-ritonavir had a 0.65 probability of being cost-effective at a £20 000 per QALY cost-effectiveness threshold, indicating decision uncertainty. The intervention remained cost-effective in most sensitivity analyses and prespecified subgroups, although several subgroup analyses were based on small sample sizes and should be interpreted as exploratory.

In this economic evaluation of nirmatrelvir-ritonavir for COVID-19, cost-effectiveness varied by age, comorbidity, and vaccination status. Subgroup findings should be interpreted with caution, but targeted prescribing for at-risk adults aged 18 to 64 years, those aged 65 to 69 years, and adults aged 75 years and above, particularly those with comorbidities and not recently vaccinated, was likely to provide the greatest health system value; cost-effectiveness was not observed in low-risk adults aged 50 to 64 years, those aged 70 to 74 years, or in unvaccinated or recently vaccinated individuals.