Tuberculosis (TB) in Indonesia causes a high burden, with pulmonary tuberculoma representing a mass-like manifestation that poses diagnostic and therapeutic challenges due to poor drug penetration. Data regarding the treatment duration and outcomes of pulmonary tuberculoma remain limited. This study aims to evaluate characteristics and outcomes of pulmonary tuberculoma following standard anti-TB therapy in Indonesia.

This retrospective study evaluated pulmonary tuberculoma confirmed with histopathological findings of granulomatous inflammation at the National Respiratory Center in Indonesia, between 2022 and 2025. Enrolled subjects had completed anti-TB therapy. Clinical and radiological outcomes were evaluated upon treatment completion. Tuberculoma size was measured as the longest diameter on a computed tomography scan. Radiological response was categorized as complete resolution, decreased (≥30% reduction), increased (≥20% increase), or stable (the remainder).

A total of 38 subjects were analyzed. The most common radiological characteristic was multiple, irregular lesions, with a median size of 4.4 cm (range: 1.4-10.1 cm). The median treatment duration was 12 months (range: 6-18 months). All subjects achieved clinical improvement, while sequelae were reported in 5 (13.2%) subjects. Radiological evaluation showed complete resolution in 9 (23.7%) subjects, decreased in 15 (39.5%), and stable in 14 (36.8%). Bivariate analysis revealed that positive microbiological status was significantly associated with lower odds of complete resolution (odds ratio = 0.17, 95% confidence interval: 0.03-0.85, P = 0.036). A single tuberculoma was also associated with complete resolution, while none of the patients with multiple tuberculomas achieved complete resolution ( P = 0.014). Multivariate analysis was not performed due to the limited number of events.

The treatment duration for pulmonary tuberculoma varies from 6 to 18 months, with nearly two-thirds of patients achieving radiological improvement. Positive microbiological status and multiple lesions are significant factors associated with incomplete radiological resolution.

In the aftermath of the COVID-19 pandemic, telemedicine has evolved from a contingency-based alternative into a structural pillar of healthcare delivery, increasingly being integrated with artificial intelligence. Algorithms for triage, clinical decision support, remote monitoring, and generative language models now actively participate in medical care. This integration is more than just functional; it reorganizes the foundational aspects of medicine-ontological, ethical, and epistemological-by redefining what qualifies as valid knowledge, who has legitimate authority, and how care is organized when an algorithmic agent facilitates the clinical interaction. This article critically examines the emergence of the patient-clinician-algorithm triad in telemedicine, and analyzes its implications for autonomy, informed consent, epistemic trust, privacy, justice, responsibility, and the phenomenology of care. It argues that the future of medicine will not be human or algorithmic but human-algorithmic, provided clinical judgment, explainability, and moral responsibility remain central.

Button battery (BB) ingestion has emerged as a global health concern, particularly among children.

To investigate the clinical outcomes and complications related to BB ingestion among pediatric patients managed at a referral center.

A case series study was conducted between March 2016 and December 2023, including patients under 14 years old diagnosed with BB ingestion. Clinical and radiological evaluations were performed, followed by endoscopic assessment and treatment when required. Data collected included clinical presentation, endoscopic findings, complications, and outcomes.

A total of 568 cases of foreign body ingestion were initially reviewed, from which only 16 pediatric patients with confirmed BB ingestion were identified between 2016 and 2023. No cases were documented between 2016 and 2018; however, a substantial increase was observed from 2019 through 2022, with a pronounced surge during 2020-2021 that coincided with the COVID-19 pandemic (P=0.011). Patient ages ranged from 3 months to 5 years, with a median of 3.22 years (1.62-4.55). Endoscopic retrieval was required in seven children (n=7, 43.7%), whereas nine did not undergo endoscopic intervention owing to the extraesophageal location of the BB. Complications were documented in seven patients, including ulceration (n=6; 37.5%), fistulas (n=3, 18.7%), and stenosis (n=3, 18.7%).

This study highlights the significant risks of severe complications associated with BB ingestion, even in very young children. A significant increase in severe cases referred to our center during the COVID-19 pandemic underscores the importance of awareness, prevention, and timely medical intervention.

The onset of the COVID-19 pandemic in 2020 led to a major reorganization of the health care system, including the suspension of elective surgical procedures. This reduction in operative activity may have affected general surgery training. The aim of this study was to assess the impact of the pandemic on the volume and profile of surgical procedures performed at a university hospital.

This retrospective, observational, comparative study examined records of procedures performed by the General Surgery Department of a university hospital between March 2018 and February 2021. Demographic variables (age and sex) and procedural characteristics (type and complexity) were analyzed. Statistical significance was set at p < 0.05.

Medical records from 1,619 patients were analyzed. The study periods were categorized into three intervals: two pre-pandemic (2018-2019 and 2019-2020) and one pandemic (2020-2021). The mean patient age was 49.5 ± 14.8 years, with a female patient majority of 61.3%. During the pandemic period, the mean patient age was significantly lower (p = 0.003) and there were no sex-related differences. Cholecystectomies accounted for 46.0% of procedures, with intermediate-complexity operations predominating (69.2%). A marked reduction in total surgical volume was observed during the pandemic period (344 procedures), compared to the previous 2 years (569 and 706 procedures). Significant increases were observed in appendectomies (p = 0.031), debridement procedures (p = 0.030), and tracheostomies (p < 0.001), whereas excisional procedures decreased significantly (p < 0.001), particularly lipoma (p < 0.001) and skin tumor (p = 0.028) excisions.

The COVID-19 pandemic resulted in a substantial reduction in elective surgical procedures and an increase in critical care-related interventions, such as tracheostomies. These findings demonstrate a quantitative shift in procedural exposure during surgical residency training.

BackgroundPeople with HIV (PWH) may be vulnerable to worsening mental health during disease outbreaks. The African Cohort Study enrolls PWH in Kenya, Uganda, Tanzania, and Nigeria.MethodsEvery six months, participants completed physical evaluations, medical record abstraction, and questionnaires including the Center for Epidemiologic Studies Depression Scale. Multivariable logistic regression models with generalized estimating equations estimated adjusted odds ratios for factors associated with a positive depression screen.ResultsAmong 2,067 participants, a positive depression screen was observed at 3.0% of visits pre-COVID-19 and peaked at 5.1% during the Delta surge. Participants who screened for depression were more likely to be aged ≥50 years and female. After adjustment, only the Delta surge was associated with a near-two-fold increased odds of a positive depression screen compared with the pre-COVID-19 period. Conclusions: Depressive symptoms among PWH increased early in the pandemic. Mental health support for PWH should be prioritized during disease outbreaks.

Nonstructural protein 1 (NS1) is the key virulence factor of influenza A virus (IAV) that affects the replication and pathogenicity of IAV, which can be used as a promising anti-IAV target. Herein, we identify a marine derived NS1 inhibitor HDN2398 with broad-spectrum anti-IAV effects in different cell lines and female mice, superior to oseltamivir and baloxavir. HDN2398 attenuates the interferon antagonist function of NS1 by blocking NS1 dimerization and its binding to dsRNA. HDN2398 can block NS1 nucleolar localization, viral mRNA splicing and nuclear export through destroying the interaction between NS1 and nucleolin or NXF1. Phe9 and Trp187 may be required for the interaction between HDN2398 and NS1. In summary, our findings support the development of HDN2398 as a promising anti-IAV agent targeting NS1-host interaction.

Unannounced drills using professional patient actors (mystery patients) have been used to evaluate health care facility management of patients with infectious diseases of public health concern. Ongoing outbreaks and the expanding role of urgent care centers highlight the need to evaluate the ability of health care facilities to rapidly identify, isolate, and safely manage patients with transmissible diseases. During January-June 2026, 73 drills were conducted in three jurisdictions within U.S. Department of Health and Human Services Region 2 (New Jersey, New York, and the U.S. Virgin Islands) using a simulated avian influenza A(H5) scenario. During these drills, facilities conducted symptom screening in 68 (93%) drills and obtained travel history upon patient arrival in 58 (80%) drills. Among 60 (82%) drills during which the patient was appropriately masked, the median interval from arrival at the facility to masking was 2 minutes (IQR = 1.0-6.0 minutes) (target = 1 minute), and among 52 (71%) drills during which the patient was isolated, the median interval from arrival to isolation was 11 minutes (IQR = 8.0-19.2 minutes) (target = 10 minutes). Both masking and isolation occurred in 44 (60%) drills. The clinical team planned to notify infection prevention and control teams in 40 (54%) drills. The clinician wore all recommended personal protective equipment in 17 (25%) drills. These drills provided an opportunity for facilities to examine implementation of the principles of identification, isolation, and informing. Findings from these drills will help guide future public health interventions to improve readiness among regional health care facilities for emerging and reemerging infectious disease threats.

The leadership challenges in the Canadian healthcare system became more complex during the global pandemic. Major disruptions in nursing education programs occurred simultaneously, creating an acute adaptive crisis. Academic nursing leaders were required to respond to rapidly changing public health directives and institutional policies while ensuring the safety and continuity of their nursing program.

The purpose of this qualitative study was to explore higher education nursing leadership experiences, including leader styles, interactions, risk management, decision-making, changes to education programs, daily operations, and team dynamics.

The study used an interpretative phenomenologically informed design, which was informed by complexity leadership theory. Semistructured, in-depth interviews were conducted with 20 academic nursing leaders across Canada. Recruitment and data collection occurred from spring 2023 to fall 2024 during the final phases of the COVID pandemic. Interviews were recorded, transcribed, and analyzed following the principles of content analysis.

Content analysis of the 20 interviews revealed three main themes: maintaining quality nursing education programs; administrative decision challenges; and communication during a crisis.

Study findings provide insights into the often invisible work of academic nursing leaders navigating the intersection of educational continuity, regulatory requirements, student progression, faculty workload, clinical placement disruption, institutional policy, and public health directives. Ensuring effective organizational adaptation was the major focus of complexity nursing leadership. In preparation for potential future crises, succession planning and preparation of future leaders are a priority.

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrotic interstitial pneumonia of unknown etiology, in which macrophages serve as central orchestrators of the pathological microenvironment. During IPF progression, the alveolar macrophage pool undergoes a critical compositional shift: tissue-resident alveolar macrophages (TR-AMs) are progressively depleted and replaced by monocyte-derived alveolar macrophages (Mo-AMs) harboring a distinct pro-fibrotic transcriptional and metabolic identity. These populations differ fundamentally in their baseline metabolic programs, and both undergo further reprogramming within the fibrotic niche that sustains myofibroblast activation and extracellular matrix (ECM) deposition. This review systematically examines how metabolic reprogramming across three principal axes (glucose metabolism, lipid metabolism, and amino acid metabolism) drives pro-fibrotic macrophage polarization in IPF. Within each axis, alterations in metabolic flux and intermediate accumulation converge to reinforce the pro-fibrotic phenotype, promote fibroblast activation, and perpetuate ECM deposition. Importantly, these metabolic alterations differ between TR-AM and Mo-AM subpopulations in ways that reflect their distinct ontogenetic origins and predispose Mo-AMs to preferential pro-fibrotic polarization within the fibrotic microenvironment. Building on this mechanistic framework, we systematically categorize pharmacological modulators targeting these metabolic checkpoints and evaluate the integration of advanced drug delivery systems for precision intervention within the alveolar macrophage niche. This review ultimately proposes a therapeutic strategy that co-targets macrophage ontogenetic origin, polarization state, and metabolic reprogramming as an interconnected axis, offering new perspectives for re-educating macrophages to attenuate fibrotic progression in IPF.

Pneumonia remains a leading cause of global morbidity and mortality, with diagnostic uncertainty frequently complicating clinical management, particularly in patients with chronic lung disease, immunocompromise, or healthcare-associated infections. Conventional imaging modalities and microbiologic testing lack specificity for distinguishing bacterial pneumonia from viral infection, sterile inflammation, or noninfectious lung disease, often resulting in empiric antibiotic overuse and delayed alternative therapies. In this study, we evaluated [¹⁸F]-fluoromannitol, a pathogen-specific Positron Emission Tomography (PET) tracer, in well-established murine models of pulmonary infection caused by Streptococcus pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa. Compared with controls, including heat-killed bacterial pneumonitis, influenza A virus-induced pneumonia, and noninfectious Poly-(I:C) induced pneumonia. [¹⁸F]-fluoromannitol PET enabled robust, rapid, and anatomically localized detection of active bacterial pneumonia, with tracer uptake correlating with bacterial burden and disease progression. These findings demonstrate that [¹⁸F]-fluoromannitol PET can noninvasively distinguish bacterial lung infection from viral and noninfectious etiologies. By directly targeting bacterial metabolism rather than host inflammation, this approach offers a promising strategy to improve etiologic classification of lower respiratory tract infections and support antimicrobial stewardship.