IntroductionDietary supplements (DS) and natural products were widely used in Malaysia before COVID-19, and post-pandemic demand remains high, raising safety concerns.MethodsThis study examined current usage practices during the endemic phase through an online cross-sectional survey among 464 predominantly young, educated Malaysian adults (2023-2024). A validated questionnaire assessed product use, reasons for consumption, frequency, and safety practices, with data analysed using descriptive statistics, Chi-square tests, Spearman's rank correlation and multivariate logistic regression.ResultsVitamin C (78.4%), honey (40.5%), lemon (31.0%), fish oil (30.6%), and green tea (26.5%) were the most commonly consumed products, primarily to boost immunity (89.2%). Although 90.7% of respondents reported no adverse effects, 41.4% engaged in suboptimal safety practices, specifically failing to consult healthcare providers or verify product registration. Usage frequency was significantly associated with the geographic state of residence and correlated with age, knowledge, and practice risk. Multivariate analysis identified age as the sole sociodemographic predictor of frequent use (p = 0.048), while high-risk practices were prevalent universally across all demographic groups.ConclusionDespite widespread use, unsafe practices persist, highlighting the need for public education, regulatory oversight, and evidence-based guidance to ensure safe and informed use of DS and natural products.

Biologic therapies for chronic rhinosinusitis with nasal polyps (CRSwNP) have been approved in Denmark since 2022. Chest X-ray (CXR) was implemented by the Global Airways Steering Group as pre-treatment screening to identify pulmonary conditions and monitor adverse effects. This study evaluates the utility of routine CXR screening before initiating biological therapy in patients with CRSwNP.

Baseline data, including chest X-ray, were collected prospectively in the nationwide Global Airways Registry (approved by the Danish Research Ethics Committee R. no.: H-21020685) and analysed in May 2025.

A total of 511 patients (335 males, 176 females; mean age 46.5 ± 14.6) years were identified and included in this study; 247 patients were initiated on biologic therapy. In the treatment group, 136 (55%) had normal CXRs, and 12 (5%) had abnormal findings. Among the 264 patients who did not receive biologic treatment, 143 (54%) had normal CXRs and ten (4%) demonstrated abnormal findings.

Routine baseline CXR screening before biologic therapy in patients with CRSwNP identified few abnormal findings. Accordingly, routine CXR is likely to offer limited clinical benefit.

The Global Airways database is funded by GlaxoSmithKline, Sanofi and Astra Zeneca. None of the pharmaceutical companies has access to data.

Not relevant.

ObjectivesTo determine the prevalence of insomnia in patients with chronic obstructive pulmonary disease (COPD) and evaluate its association with health status, pulmonary function, anxiety/depression, and exacerbations.MethodsA cross-sectional observational study was conducted including consecutive COPD outpatients. Data collected included sociodemographic and clinical variables, daytime sleepiness (Epworth Sleepiness Scale), quality of life (COPD Assessment Test, CAT), anxiety and depression (HADS), insomnia severity (Insomnia Severity Index, ISI), and exacerbations in the previous year. Multivariable logistic regression analysis was performed to identify independent predictors of insomnia.ResultsA total of 103 patients (77 males, 26 females) were included. Insomnia prevalence was 38.8% (32.5% mild, 55.0% moderate, 12.5% severe). No significant differences in pulmonary function were observed between patients with and without insomnia. However, patients with insomnia had poorer health status (CAT 19.13±8.63 vs. 11.32±8.13; p<0.001), greater daytime sleepiness (Epworth 5.23±3.10 vs. 3.84±2.31; p<0.011), higher anxiety prevalence (61.5% vs. 31.2%; OR=3.533), and more exacerbations (50% vs. 28.6%; OR=2.5; p<0.037). In multivariable analysis, the CAT score was the only independent predictor of insomnia (OR 1.083; 95% CI 1.011-1.160; p = 0.023).ConclusionsInsomnia is highly prevalent in COPD and is associated with poorer health status, greater daytime sleepiness, increased anxiety, and more frequent exacerbations. Poorer health status was the only independent predictor of insomnia.

This study aimed to evaluate the efficacy and safety of combining short-wave diathermy (SWD) with high-frequency chest wall oscillation (HFCWO) compared with HFCWO alone and routine treatment in patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

This single-center, parallel-group randomized controlled trial enrolled 89 patients with AECOPD admitted to Yongkang First People's Hospital between March 2024 and March 2025. Participants were randomly assigned (1:1:1) to receive routine treatment alone (control group), routine treatment plus HFCWO (HFCWO group), or routine treatment plus combined SWD and HFCWO (combined group) for 72 h. Primary and secondary outcomes were assessed at baseline and after 72 h of intervention, with both within-group and between-group comparisons performed. Primary outcomes included changes in the COPD Assessment Test (CAT) and Breathlessness, Cough, and Sputum Scale (BCSS) scores. Secondary outcomes included lung function parameters (FEV₁, FVC, and FEV₁/FVC), arterial blood gas parameters (PaO₂ and PaCO₂), inflammatory markers (interleukin-6, C-reactive protein, and white blood cell count), and quantitative sputum indices (24-h sputum volume, total cell count, and differential counts).

After the 72-h intervention, the combined therapy group demonstrated significantly greater reductions in CAT and BCSS scores compared with both the HFCWO group and the control group (p < 0.05). Combined therapy also achieved superior improvements in arterial blood gas parameters (PaO₂ and PaCO₂) and sputum clearance indices (24-h sputum volume and neutrophil and eosinophil percentages) compared with HFCWO alone or routine treatment. In contrast, no significant differences were observed in lung function parameters (FEV₁ and FVC) or inflammatory markers (IL-6, CRP, and WBC).

The combined intervention significantly improves respiratory symptoms, arterial oxygenation, and sputum clearance in patients with AECOPD compared with HFCWO alone or routine treatment. The addition of thermal therapy enhances the clinical efficacy of mechanical airway clearance, offering a feasible adjunctive strategy for acute-phase management of AECOPD.

American Indian and Alaska Native (AI/AN) communities experienced a disproportionate burden of COVID-19, including among the highest rates of infection, hospitalization, and mortality in the United States. The pandemic also introduced widespread stressors, and elevated perceived stress is itself a risk factor for adverse physical and mental health outcomes. Little is known about whether COVID-19 infection is associated with perceived stress among AI/AN peoples. We examined the association between self-reported COVID-19 infection and perceived stress among urban AI/AN adults.

Self-report surveys were initiated by N = 788 patients of 5 geographically dispersed health organizations that primarily served AI/AN peoples in urban settings between January and May of 2021. COVID-19 infection was assessed by participants' self-report of either a positive test result or having been informed they were infected by a health professional. Stress was measured using the Perceived Stress Scale-4 (PSS-4). The relationships between COVID-19 infection and mean stress were assessed using linear regressions; the relationships between COVID-19 infection and specified stress levels were assessed using modified Poisson regressions with results expressed as relative risk (RR).

COVID-19 infection was associated with an adjusted β = 0.9 (95% CI: 0.1, 1.8) points higher mean PSS-4 score and RR = 3.2 (95% CI: 1.2, 8.5) of high (≥13) PSS-4 score.

COVID-19 infection was associated with elevated perceived stress among urban AI/AN adults; this association was robust to adjustment for comorbid health conditions, social determinants of health, healthcare access, and pandemic-related stressors. Healthcare providers should be aware that AI/AN people who have been infected with COVID-19 are at higher risk of elevated stress, and further research on the downstream health consequences of stress among those infected with COVID-19 is warranted.

BACKGROUNDSevere acute respiratory infections (SARI) cause substantial disease burden in older adults and those with comorbidities.AIMTo inform Belgian vaccination policies, we aimed to compare risk profiles and outcomes of influenza, COVID-19 and RSV infections and examine age-related differences.METHODSAdults (≥ 18 years) hospitalised with SARI in nine Belgian sentinel hospitals during the 2023/24 and 2024/25 winter seasons were included. Patients with laboratory-confirmed RSV infection, influenza or COVID-19 were compared in terms of demographics, comorbidities, complications and outcomes. Adults 18-64 years were compared with those ≥ 65 years. Multivariate analyses were applied.RESULTSAmong 2,806 patients, 535 (19.1%) had RSV infection, 1,694 (60.4%) influenza and 577 (20.6%) COVID-19. Patients with influenza were significantly younger (mean age 68.9 years) and had significantly fewer comorbidities (89.7%) than patients with RSV (73.8 years; 95.8%) or COVID-19 (74.0 years; 93.6%). Patients with COVID-19 experienced significantly fewer complications (40.8%) than patients with RSV (48.9%) or influenza (45.2%). Patients with RSV had higher in-hospital mortality (11.9%) than patients with influenza (7.3%; p = 0.089) or COVID-19 (6.9%; p = 0.037). Across pathogens, younger adults had relatively more comorbidities after adjusting for differences in the general population. They had shorter hospital stays and lower mortality, but higher intensive care unit admission rates.CONCLUSIONPatients with RSV infection had a disease course comparable to patients with influenza or COVID-19 and a higher mortality rate, especially with increasing age. These findings highlight the importance of RSV vaccination in older adults and those with comorbidities, alongside established vaccination strategies for seasonal influenza and COVID-19.

This study aimed to assess the efficacy and safety of tofacitinib and tacrolimus (TAT) combination therapy for treating refractory interstitial lung disease (ILD) associated with anti-synthetase syndrome (ASyS-ILD).

Patients with refractory ASyS-ILD who were treated with TAT at Wuhan No. 1 Hospital were included in the study from January 2020 to May 2024. A retrospective analysis of the clinical data from these patients is presented.

A total of six patients, one male patient and five female patients, primarily presented with refractory ASyS-ILD. All patients experienced symptomatic relief following TAT therapy, which facilitated the successful tapering of glucocorticoids (GCs, 24.67 ± 17.42 vs. 8.34 ± 1.89, p = 0.004). After treatment, PGA, PGA-VAS, PhGA-VAS, and MMT-8 scores significantly improved, and diffusing capacity of carbon monoxide (DLCO) increased in all 6 patients. Moreover, the serum levels of creatine kinase (CK) and lactate dehydrogenase (LDH) were notably reduced, and inflammatory indices, including C-reactive protein (CRP), ferritin, and erythrocyte sedimentation rate (ESR), declined significantly in all patients after administration of TAT. Additionally, peripheral white blood cell and neutrophil counts were significantly reduced, while lymphocyte counts increased, with a markedly decreased neutrophil/lymphocyte ratio in patients with ASyS-ILD receiving treatment. However, during treatment, two patients developed herpes zoster, which resolved with antiviral treatment. Unfortunately, two fatalities occurred, one due to disease progression from severe Aspergillus fumigatus pneumonia and the other due to pancreatic cancer.

In this series of patients with refractory ASyS-ILD, TAT therapy showed some clinical effectiveness over the short term, with an observed steroid-sparing outcome, suggesting a possible benefit. Nevertheless, larger prospective controlled studies are necessary to further assess its efficacy and safety.

Acute respiratory infections are a major public health problem in children. The epidemiology of pediatric respiratory pathogens has shifted in recent years. This study aimed to compare the epidemiological patterns of six common respiratory pathogens among children with acute respiratory infections (ARI) in Xiamen and Linxia, China.

This retrospective study included 5,835 children with ARI from December 2024 to November 2025. Oropharyngeal swabs were tested for rhinovirus (RV), respiratory syncytial virus (RSV), influenza A virus (Flu A), influenza B virus (Flu B), adenovirus (ADV), and Mycoplasma pneumoniae (MP) using multiplex RT-PCR. Detection rates were compared by region, sex, age group and season.

Overall, 3,143 samples (53.9%) were positive; 290 (5.0%) had co-detections. RV (23.8%), RSV (20.2%) and Flu A (8.8%) were most frequently detected. Positivity was higher in Linxia than in Xiamen (65.4% vs. 49.0%; p < 0.001). After adjustment, Linxia remained associated with higher odds of detection (aOR 1.86, 95% CI 1.65-2.10). Detection was also associated with male sex, toddler/preschool age and autumn/winter seasons.

RV, RSV and Flu A were the most frequently detected pathogens in both regions. The findings indicate regional, age-related and seasonal heterogeneity, supporting locally tailored surveillance and prevention planning.

This study aimed to develop and externally validate a clinical risk identification model for prevalent rheumatoid arthritis-associated interstitial lung disease (RA-ILD) using multicenter Chinese patient cohorts. We also evaluated the discriminative value of MUC5B polymorphisms (rs35705950 and rs868903) in a combined clinical-genetic model for this purpose.

A multicenter, two-phase design was adopted. A total of 446 patients with rheumatoid arthritis (RA) from five medical centers were retrospectively enrolled in the discovery phase. Multivariate logistic regression was used to identify independent risk factors associated with RA-ILD and to construct a clinical risk identification model. A total of 238 patients with RA from three medical centers were then prospectively recruited for the validation phase and genotyped for MUC5B (rs35705950 and rs868903). External validation of the clinical model was performed first, followed by the construction of a combined clinical-genetic model. The model's discrimination was assessed using receiver operating characteristic (ROC) curve analysis, and calibration was evaluated using the Hosmer-Lemeshow test.

In the discovery phase, smoking history (odds ratio [OR] = 2.00, P = 0.045), elevated rheumatoid factor (RF) (OR = 1.10 per 10 IU/mL, P = 0.037), a higher 28-joint disease activity score (DAS28) (OR = 1.20, P = 0.023), elevated serum carbohydrate antigen 19-9 (CA19-9) (OR = 3.70, P = 0.002), elevated lactate dehydrogenase (LDH) (OR = 1.13 per 10 U L, P < 0.001), and disease duration of ≥ 24 months (OR = 1.73, P = 0.029) were identified as independent risk factors for RA-ILD. Our clinical risk identification model yielded an area under the ROC curve (AUC) of 0.785 (95% confidence interval [CI]: 0.74-0.83). In the prospective validation cohort, we identified a novel association between MUC5B rs868903 and RA-ILD (OR = 2.58, P = 0.001), with both rs868903 and rs35705950 distinguishing patients with RA-ILD from those without ILD (P < 0.05).The combined model incorporating MUC5B genotypes achieved an AUC of 0.786, which did not differ significantly from that of the clinical model alone (P = 0.507). Although the genetic variants significantly improved continuous risk stratification (integrated discrimination improvement [IDI] = 0.020, P = 0.040; continuous net reclassification improvement [NRI] = 0.466, P < 0.001), categorical NRI at clinically relevant thresholds was non-significant.

This multicenter study validated a clinical risk identification model for RA-ILD. We identified a novel association between MUC5B rs868903 and RA-ILD in a Chinese cohort. Although the incorporation of genetic information improved continuous risk estimation, it provided limited incremental value at standard clinical decision-making thresholds, indicating that clinical indicators play a dominant role in RA-ILD risk identification. The resultant clinical model may have broad potential for routine clinical use.

House dust mite allergen immunotherapy (HDM-AIT) trials in allergic rhinitis show substantial efficacy heterogeneity, traditionally evaluated by administration route. Whether clinical efficacy differs among HDM-AIT preparations with different allergen compositional breadth remains unclear.

To compare HDM-AIT efficacy using a component-resolved framework that stratifies preparations by allergen compositional breadth.

We searched PubMed, Embase, and CENTRAL for double-blind, placebo-controlled randomized trials of HDM-AIT lasting at least 12 months. Interventions were classified as comprehensive-component subcutaneous immunotherapy (CC-SCIT), major-component-dominant subcutaneous immunotherapy (MCD-SCIT), or major-component-dominant sublingual immunotherapy tablet (MCD-SLIT-tablet) using a prespecified component-resolved framework in which the breadth of treatment-induced component-specific IgG4 responses served as the primary node-defining criterion, with component-specific IgG and proteomic evidence used as supportive evidence. Frequentist pairwise and Bayesian network meta-analyses were performed. The primary outcome was symptom score; secondary outcomes were medication score and combined symptom and medication score.

Sixteen trials involving 7,329 participants were included. For symptom score, CC-SCIT showed the most favorable estimated treatment effect versus placebo (standardized mean difference [SMD], -0.40; 95% credible interval [CrI], -0.73 to -0.11; surface under the cumulative ranking curve [SUCRA], 82.6%), while MCD-SLIT-tablet showed a more precise estimate supported by a larger evidence base (SMD, -0.30; 95% CrI, -0.41 to -0.20; SUCRA, 60.7%). For medication score, CC-SCIT (SMD, -0.40; 95% CrI, -0.81 to 0.00; SUCRA, 79.8%) and MCD-SCIT (SMD, -0.38; 95% CrI, -0.72 to -0.05; SUCRA, 78.5%) showed similar estimated effects, whereas MCD-SLIT-tablet showed a smaller but more precise effect (SMD, -0.15; 95% CrI, -0.28 to 0.00; SUCRA, 39.9%). For combined symptom and medication score, CC-SCIT showed the largest estimated effect versus placebo (SMD, -0.84; 95% CrI, -1.53 to -0.37; SUCRA, 99.5%). The network was star-shaped, and comparisons among non-placebo treatment nodes were indirect. Posterior rank distributions also indicated uncertainty in the relative ordering of the treatment nodes, particularly those supported by fewer trials.

Reported immunologic and compositional profiles of HDM-AIT preparations were associated with variability in trial-level efficacy estimates. These findings support product-level molecular characterization and direct comparative studies as priorities for future precision AIT.

https://www.crd.york.ac.uk/PROSPERO/view/, CRD420261307571.