This study aimed to evaluate influenza vaccine hesitancy among healthcare workers (HCWs) at Istanbul Okan University Hospital and also explore the factors influencing their decision to get the influenza vaccine.

A cross-sectional questionnaire was conducted with 428 HCWs, and a 94% response rate was achieved. The questionnaire included demographic data, knowledge assessments about influenza, and vaccination history.

Only 22% of participants reported receiving the influenza vaccine in 2024, while 78% did not. The main reasons for hesitancy were distrust in vaccine efficacy (32%), fear of side effects (32%), and distrust of vaccine manufacturers (31%). Among those who were vaccinated, the key motivations included self-protection (19%) and being part of a risk group (15%). Interestingly, 91% of respondents had received the coronavirus disease 2019 (COVID-19) vaccine, citing similar reasons for acceptance or refusal.

Despite well-documented evidence of the influenza vaccine's role in reducing morbidity and mortality, hesitancy remains prevalent, reflecting certain trends also observed in the literature. Educational and health promotion campaigns, on-site vaccination programs, and awareness initiatives emerged as potential strategies that would improve the vaccine uptake. This study highlights the critical need for targeted interventions to address vaccine hesitancy among HCWs. Building trust, providing accurate information, and ensuring easy access to vaccines are essential steps to boost influenza vaccination rates and enhance public health outcomes.

Coronavirus disease-2019 (COVID-19) has been declared a global pandemic. Along with multi-organ failure, increased fibrinogen occurs in severe disease and is converted to fibrin, which can trigger pulmonary fibrosis. This study aimed to analyse the correlation between serum fibrinogen levels and the occurrence of lung fibrosis in COVID-19 patients using the core biopsy technique.

This was a prospective observational study in patients who died during severe COVID-19 treatment in the intensive care unit of a tertiary hospital. Serum fibrinogen levels were measured using a Sysmex Coagulometer based on the Clauss method, which is an automated coagulometric technique. The core biopsy procedure was performed in fibrotic areas identified by radiological imaging. The degree of lung fibrosis according to the Ashcroft scale. Results of fibrinogen levels, fibrosis incidence, and the degree of fibrosis were compared.

There was an increase in fibrinogen with a mean level of 616.14 mg/dL, and 35 of 37 samples were positive for fibrosis. The Ashcroft scale score of 5 was the most common fibrosis degree (37.8%). Fibrosis was found among COVID-19 lung biopsies, and fibrinogen also tends to increase in lung fibrosis based on the Ashcroft score, despite no significant correlation between the serum fibrinogen levels and lung fibrosis degree (p = 0.716).

Pulmonary fibrosis was frequently observed in lung biopsy specimens from patients with fatal COVID-19. Serum fibrinogen levels tended to be higher in patients with fibrosis, they were not significantly associated with fibrosis severity as assessed by the Ashcroft scale.

The Covid-19 pandemic imposed strict lockdown measures, -significantly reducing social interactions among residents in nursing homes (NH). The lack of social support has been independently associated with the progression of cognitive symptoms and the worsening of behavioral and psychological symptoms of dementia (BPSD) in residents with major neurocognitive disorders (MND). However, few studies have examined the evolution of these symptoms in relation to movement restrictions and isolation, independent of Covid-19 infection. This study aims to assess the impact of lockdown measures on the severity of BPSD in NH residents with MND. A retrospective, descriptive, and analytical multicentric study was conducted in 15 NH in the Indre-et-Loire region, France. A total of 251 residents diagnosed with MND by their primary care physician or a specialist were included. The severity of BPSD was assessed using the Neuropsychiatric Inventory (NPI), and scores were compared before and after the lockdown in March 2020. Of the 251 residents included, a total of 240 NPI measurements were performed before the lockdown, involving 222 residents, and 95 NPI measurements were conducted after the lockdown, involving 84 residents. The average NPI score after the lockdown (39.3) was higher than the average score before the lockdown (37.7), although this difference was not statistically significant (p = 0.3). The observed increase in NPI scores following the lockdown suggests a trend towards worsening BPSD related to the lockdown, although this trend did not reach statistical significance. Further studies with a more robust methodology and larger sample size are needed to confirm these findings and to better understand the impact of isolation measures on this vulnerable population.

The effect of non-smoking factors on Chronic Obstructive Pulmonary Disease (COPD) is gaining attention. Long-term contributions of pulmonary tuberculosis (PTB) during the developmental period to COPD development in later adulthood remain poorly understood.

To investigate the impact of PTB during the developmental period of COPD and pre-COPD.

Retrospective cohort studyMethods:This retrospective cohort study analyzed 496,534 participants using the UK Biobank cohort. PTB during the developmental period was defined as a diagnosis at age ⩽25 years. Outcomes were COPD and pre-COPD stages, including preserved ratio impaired spirometry (PRISm) and impaired spirometry (below Lower Limit of Normal (LLN) thresholds). Associations were evaluated using the multivariable logistic regression, adjusting for age, sex, body mass index, smoking, asthma, bronchiectasia, and air pollution.

Among 10,178 patients (62 (9) years old) diagnosed with COPD, PTB during the developmental period was statistically associated with increased COPD risk across four models, showing a fully adjusted odds ratio (aOR) of 1.82 (95% CI: 1.45-2.26), and remained significant regardless of sex or smoking status. Critically, PTB was also independently associated with both PRISm and airflow obstruction (aOR = 1.52, 95% CI: 1.35-1.71) and impaired spirometry below LLN (aOR = 1.32, 95% CI: 1.14-1.52). Sensitivity analyses further reinforced the robustness of these findings.

PTB during the developmental period is an independent risk factor for COPD and pre-COPD status in mid-to-late adulthood, necessitating long-term respiratory monitoring in PTB during the developmental period survivors and the implementation of targeted public health strategies.

This study aimed to explore clinical characteristics and outcomes among patients with biomass smoke-related chronic obstructive pulmonary disease (BS-COPD), those with cigarette smoke-related COPD (CS-COPD), and those exposed to both (CS+BS-COPD). The outcomes of patients receiving different inhaled drugs was also explored.

This was a real-world, combined cross-sectional and prospective observational study conducted within the RealDTC cohort. The participants were divided into BS-COPD, CS-COPD, and CS+BS-COPD groups. Study outcomes included symptom improvement, moderate-to-severe exacerbations during 1-year follow-up, and all-cause mortality during the total follow-up period.

Among the 4436 eligible patients, compared with the CS-COPD group, the BS-COPD group had more females, higher CAT scores, fewer low attenuation areas (LAA%>5%), but more airway mucus plugs, higher WA%, and higher dPA/A. The CS+BS-COPD group had a higher proportion of LAA%>5% than BS-COPD group and more patients with mucus plugs than CS-COPD group. In the adjusted model, BS-COPD had a lower risk of moderate-to-severe exacerbations than CS-COPD, with similar mortality. The CS+BS-COPD group had a higher incidence of moderate-to-severe exacerbations than the other two groups. Moreover, BS-COPD group experienced greater symptom improvement than the others. Across all groups, LABA+LAMA or ICS+LABA+LAMA were associated with lower exacerbation risk than LAMA alone.

In this real-world study, BS-COPD patients had less emphysema but greater airway wall thickness and more mucus plugs, along with lower exacerbation risk and greater symptom improvement than CS-COPD patients. Combined exposure to both biofuels and cigarette smoke was associated with an aggravated exacerbation risk.

Poststroke pneumonia (PSP) is a common complication in bedridden patients with speech dysfunction, often leading to poor outcomes. This retrospective cohort study explores the clinical efficacy of electroacupuncture (EA) by stimulating the phrenic nerve to improve diaphragmatic activity and treat PSP.

In this study, 88 hospitalized poststroke patients with pneumonia were divided into two groups. The nonexposure group received standard treatment, including respiratory rehabilitation, whereas the exposure group received additional EA therapy targeting the phrenic nerve. Propensity score matching (PSM) was applied, resulting in 22 patients in the exposure group and 29 in the nonexposure group. Both groups were treated for 2 weeks, during which Clinical Pulmonary Infection Score (CPIS) scores, white blood cell (WBC) count, C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) levels were measured. In the exposure group, diaphragmatic activity and thickness were also assessed before, during, and after EA.

The exposure group showed significantly greater improvements compared with the nonexposure group in reducing CPIS scores (mean difference: -1.087; 95% confidence intervals (CIs): -1.68 to -0.494; p < 0.05) and improving inflammatory markers (WBC, CRP, IL-6, and PCT) (p < 0.05 for all comparisons). After PSM, CPIS scores demonstrated a larger absolute reduction in the exposure group compared with controls (-2.32 vs. -1.00), indicating a greater magnitude of clinical improvement. Within the exposure group, diaphragmatic activity improved significantly after 10 days of EA compared with baseline, with significant between-group differences (p < 0.05 for all comparisons). Quantitative assessment further showed that diaphragmatic excursion increased by approximately 0.32 cm following intervention (95% CIs: 0.18-0.46), suggesting enhanced diaphragmatic functional mobility.

EA may enhance diaphragmatic activity through phrenic nerve stimulation, improving ventilation, sputum clearance, and regulating neuroimmune responses, contributing to the effective management of PSP.

International Traditional Medicine Clinical Trial Registry: ITMCTR2024000729.

Mycoplasma pneumoniae pneumonia (MPP) can cause plastic bronchitis (PB), a rare, life-threatening condition. However, current diagnostic methods often fail to identify early-stage PB in children.The aim of our study was to develop machine learning algorithms to identify early-stage PB in pediatric patients with MPP.

This retrospective cohort study involved 307 pediatric patients with MPP who underwent bronchoscopy intervention from April 2023, to June 2025.Patients were randomly split into training and test sets (7:3). After feature selection using LASSO and Boruta algorithms, four algorithms, namely, extreme gradient boosting (XGBoost), logistic regression, random forest, and support vector machine, were employed to construct machine learning (ML) models through 5-fold cross-validation. Model performance was evaluated using the area under the curve (AUC), calibration curves, and decision curve analysis (DCA). The best-performing ML was selected using AUC, and feature importance in the model was ranked using SHapley Additive exPlanations (SHAP). Finally, a web-based risk predictor was constructed to facilitate user operability.

MPP children with PB demonstrated more significant abnormalities in inflammation- and nutrition-related indices compared to those without PB. The XGBoost algorithm exhibited the best predictive performance, surpassing other models (logistic regression, random forest, and support vector machine) with an AUC of 0.948 (95% CI: 0.919-0.973), a sensitivity of 0.904, and a specificity of 0.858 on the training set, and an AUC of 0.905 (95% CI: 0.843-0.957), a sensitivity of 0.812, and a specificity of 0.852 on the test set. This algorithm also presented good calibration and net clinical benefit. SHAP analysis identified the retinol-binding protein 4 level, M. pneumoniae cycle-threshold value, D-dimer level, fever duration before admission, C-reactive protein-to-albumin ratio, and presence of pleural effusion as key predictors. To facilitate the clinical adoption, a freely accessible online calculator has been developed (https://plasticbronchitis.shinyapps.io/plastic_bronchitis_risk_calculator/).

The developed interpretable ML models deployed in the network application can help clinicians identify children at high risk of developing PB earlier and tailor timely bronchoscopy intervention and nutritional support as well as anti-inflammatory therapy.

The COVID-19 pandemic imposed a major global health and economic burden. Although the pandemic was no longer declared a public health emergency of international concern in May 2023, SARS-CoV-2 variants continue to emerge, and millions remain affected by long COVID. This raises the question whether continued vaccination provides lasting benefits in preventing viral transmission and severe illness.

This longitudinal study assessed the effects of the third BNT162b2 mRNA vaccine dose on the circulating proteome for 6 months.

Plasma levels of 354 unique proteins were quantified before, and at 3- and 6-months post-booster using Olink technology in 70 healthy individuals; 35 infection-naïve and 35 previously infected individuals (18 infected before, 17 after completing the two-dose regimen).

Infection-naïve individuals showed altered levels of eleven and eight proteins at 3- and 6-months post-booster, respectively, including a significant sustained increase in PARP-1 (FC = 1.53, p=8.59x10^-5, pFDR=0.01) and significant decrease in MMP-7 (FC = 0.68, p=4.58x10^-5, pFDR=0.01), in addition to elevated levels of MMP-1 (FC = 1.46, p=0.04, pFDR>0.05) and decrease in 4E-BP1 (FC = 0.58, p=0.01, pFDR>0.05) at 6 months post-booster. Similarly, previously infected individuals, in particular those with earlier infections before receiving the second dose exhibited a significant sustained upregulation of PARP-1 (FC = 2.10, p=1.19x10^-5, pFDR=0.003) and downregulation of MMP-7 (FC = 0.58, p=2.19x10^-5, pFDR=0.003) at 6-months post-booster. Notably, PARP-1 and MMP-7 were consistently affected across all individuals. Longitudinal proteome profiling revealed dysregulation of key inflammatory proteins for up to 6 months post-booster, including PARP-1 and MMP-7 (pFDR=1.58x10^-8 and pFDR=1.59x10^-5, respectively).

These findings provide insights into the temporal dynamics of circulating proteomic responses following booster vaccination, highlighting molecular features that may be relevant to immune readiness and post-vaccination inflammatory processes.

Urinary tract infections (UTIs) in male patients represent a distinct and underexplored clinical entity. The COVID-19 pandemic has further influenced infection patterns and antimicrobial use, potentially accelerating resistance trends. This study aimed to evaluate the prevalence of uropathogens and their resistance patterns in a large cohort of Romanian men during the full pandemic. A retrospective descriptive study was conducted at a tertiary academic urology center in Bucharest, Romania, including male patients evaluated during the COVID-19 pandemic (September 2021-February 2022). Male patients with positive urine cultures (≥10⁵ CFU/mL) and a single identified pathogen were included, while duplicate and polymicrobial samples were excluded. 733 male patients were included, with Gram-negative predominating (78.99%) over Gram-positive (21.01%). E. coli (32,74%) and Klebsiella (27.15%) were the most frequent isolates. UTIs were markedly more prevalent in patients >55 years. Gram-negative uropathogens showed high resistance to commonly used antibiotics, particularly Amoxicillin-Clavulanic acid (43.98%) and Levofloxacin (39.16%). E. coli demonstrated elevated resistance to Levofloxacin (36.52%) and Amoxicillin-Clavulanic acid (35.78%), while Klebsiella exhibited the most concerning profile, exceeding 50% resistance to Amoxicillin-Clavulanic acid (57.29%) and Nitrofurantoin (56.96%), with additional carbapenem resistance (Imipenem 13.59%, Meropenem 12.9%). Gram-positive isolates displayed relatively stable resistance patterns, with Enterococcus showing high resistance to Levofloxacin (56.7%) and lower resistance to Penicillin (19.67%). The male population showed higher resistance rates to several antibiotics, possibly due to the more complicated nature of their infections. These data highlight the need for tailored therapeutic approaches based on gender-specific resistance patterns.

Connective tissue disease-associated interstitial lung disease (CTD-ILD) is triggered by pulmonary vascular injury. However, early subclinical lung changes in polymyositis/dermatomyositis (PM/DM) patients without ILD (PM/DM-non-ILD) remain undetectable by conventional imaging.

To evaluate microvascular integrity and parenchymal features in PM/DM-non-ILD patients using quantitative computed tomography (QCT). Additionally, this study aims to identify associations between QCT parameters and laboratory markers of inflammation and autoimmunity, and evaluate the performance of QCT metrics in detecting subclinical lung pathology.

This retrospective study included 71 PM/DM-non-ILD patients and 71 age- and sex-matched healthy controls were enrolled. Chest high-resolution CT (HRCT) images, laboratory data, and clinical records were collected. All HRCT scans were analyzed using the "Digital Lung" platform to obtain QCT parameters, including lung volume, density, and intrapulmonary vascular volumes (IPVV) for the whole lung and individual lobes. Standardized IPVV was calculated by dividing the vascular volume by the corresponding lobe volume to account for lung volume differences. QCT parameters and laboratory results were compared, their correlation analyzed, and diagnostic performance evaluated using receiver operating characteristic (ROC) analysis.

In PM/DM-non-ILD patients, standardized IPVV was notably lower in the entire lung and each lobe compared to healthy controls (P < 0.05). Hematological analysis of PM/DM-non-ILD patients showed a pattern consistent with immune dysregulation, characterized by significantly reduced levels of hemoglobin, lymphocytes, eosinophils, and basophils (including their percentages), alongside elevated monocytes, monocyte percentage, neutrophil percentage, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio compared to controls (all P < 0.05). QCT parameters showed significant correlations with key hematologic inflammatory indicators (P < 0.05).

The decreased standardized intrapulmonary vascular volume (IPVV), across all lung lobes (whole lung, right lung, left lung, right upper lobe, right middle lobe, right lower lobe, left upper lobe, left lower lobe) indicates its potential as a sensitive marker for early pulmonary involvement in patients with polymyositis/dermatomyositis without interstitial lung disease. The distinct vascular changes in the right middle lung lobe may serve as a discriminative indicator for subclinical lung pathology in this population, potentially reflecting underlying immune dysregulation.