To characterize the profile of people with post-COVID-19 conditions and factors associated with treatment outcome at a rehabilitation center in Campina Grande, Paraíba state, Brazil.

This was a cross-sectional study, based on the analysis of 398 medical records of public health service users treated at a post-COVID rehabilitation center. Sociodemographic, clinical and care variables were assessed using prevalence ratios (PR) with 95% confidence intervals (95%CI) and a 5% significance level. The outcome of interest was the treatment result, categorized as hospital discharge or dropout.

The analysis of the 398 medical records revealed a predominance of females (62.6%) and adults in the 18-59 age group (63.3%). Treatment dropout was more frequent among females than among males (PR 1.68; 95%CI 1.11; 2.53; p-value 0.012). Hospitalized patients had lower risk of treatment dropout (PR 0.48; 95%CI 0.31; 0.74; p-value 0.001), and those who received oxygen therapy also had lower risk of treatment dropout (PR 0.50; 95%CI 0.31; 0.82; p-value 0.004). Of the 398 users analyzed, 282 (78.1%) were discharged from the rehabilitation center and 79 (21.9%) dropped out of treatment.

Being female was associated with higher dropout rates, while hospitalization and oxygen therapy acted as protective factors for adherence. These findings emphasize the need for targeted follow-up strategies capable of reducing losses to follow-up and promoting greater effectiveness in post-COVID-19 rehabilitation within the Brazilian Unified Health System (Sistema Único de Saúde, SUS).

To describe and analyze the temporal trend of non-COVID-19 respiratory tract infection deaths among children under 5 years of age in Brazil from 2002 to 2022.

This is a descriptive study of respiratory tract infection deaths and time series analysis of mortality rates using data from the Mortality Information System. Trend analysis used the Trigonometric seasonality, Box-Cox transformation, ARMA errors, Trend and Seasonal components model for interrupted time series, examining monthly mortality rates. Annual percentage change (APC) for the period was estimated in order to present the time series trend and its 95% confidence interval (95%CI).

A total of 52,015 respiratory tract infection deaths were recorded among children under 5 years old during the period, with a higher incidence among males (54.2%), Black children (46.0%), and those under 1 year of age (66.9%). The respiratory tract infection mortality rate among children under 5 years old in Brazil in 2002 was 1.22 deaths/1,000 live births, and in 2022 it was 0.87 deaths/1,000 live births. The proportional mortality rate in children aged 28 days to 5 years varied around 13.0%. There was a decreasing mortality rate trend from 2002 to 2019 (APC -0.37%; 95%CI -0.43; -0.31). In the post-pandemic period, there was no significant variation in the mortality rate analyzed (APC -1.41%; 95%CI -8.74; 6.52).

Despite the reduction in respiratory infection mortality rates along the time series, there was no reduction in proportional mortality. New strategies are needed to prevent and reduce respiratory tract infection deaths in the Brazilian health system.

To analyze the temporal trend and spatial distribution of deaths from respiratory tract infections in the Indigenous population residing in Minas Gerais, Brazil, between 2000 and 2023.

Time-series and multiple-group analysis of deaths recorded in the Brazilian Mortality Information System (Sistema de Informação sobre Mortalidade, SIM), coded according to the underlying cause of death as respiratory tract infections based on the International Classification of Diseases (ICD). The number of deaths was calculated according to demographic and clinical characteristics. In the trend analysis, the Joinpoint regression model was used to estimate the annual percent change (APC), and for spatial analysis, the global and local Moran's I indices were applied.

A total of 271 deaths were recorded, predominantly affecting females (51.7%), widowed individuals (30.3%), those with low educational level (49.1%), and older adults (62.7%). In 65.3% of cases, the infection affected the lower respiratory tract, and in 53.5% of cases, the etiologic agent was unspecified. Health macroregions exhibited a downward trend in deaths between 2020 and 2023, namely Central (APC -6.1), East (APC -38.3), and North (APC -25.0). Spatial analysis using Moran's quadrants identified significant clusters of deaths in São João das Missões, Belo Horizonte, and Bertópolis.

The results demonstrated a high number of deaths among older adults, with marked temporal and territorial inequalities. Specific and sustained public policies are needed to prevent health inequities and ensure equitable access to health services for Indigenous Peoples, alongside improvements to health information systems.

This study aimed to identify, analyse and compare adults with and without respiratory symptoms over time after COVID-19 and identify predictors of persistent respiratory symptoms, in hospitalised and non-hospitalised patients.

Participants were recruited at the Post COVID-19 clinic at Karolinska University hospital, Sweden, between May 2020 until December 2022, with longitudinal data collected until February 2025. Data from medical records and two clinical follow-up visits were analysed. Participants were categorised based on presence or absence of self-reported respiratory symptoms. Clinical outcomes included physical function, patient-reported outcomes, lung function and other clinically relevant parameters.

A total of 963 out of 1976 participants were included, of whom 760 (79%) were identified with respiratory symptoms and 203 (21%) were not at first follow-up visit. The respiratory symptom group showed poorer physical function and worse patient-reported outcomes at the first follow-up (adjusted p < 0.05). Lung function was generally preserved, although diffusing lung capacity for carbon monoxide (DLCO) was lower in the respiratory symptom group (79% vs 84%, adjusted p < 0.05). Both groups improved over time, and the magnitude of change did not differ significantly between groups. However, participants in the respiratory symptom group remained more impaired across several outcomes at follow-up. Presence of respiratory symptoms at the first follow-up visit was the strongest independent predictor of belonging to the respiratory symptom group at second follow-up visit (OR 5.31, 95% CI 2.74-10.89).

Respiratory symptoms after acute COVID-19 were highly prevalent and were associated with poorer clinical outcomes, despite similar recovery over time. Further research is needed to better clarify underlying mechanisms and to guide targeted rehabilitation strategies.

Exposure to tobacco smoke remain major public health concerns due to its' association with multiple morbidities and increased health-services use. This cross-sectional study aimed to, (i) assess the prevalence of exposure to tobacco smoke (first-hand and second-hand) among students at a public university; (ii) assess the prevalence of tobacco smoke-related concurrent morbidities; (iii) assess the prevalence of health-services use (≥ 1 vs. none) during the past one-year; and (iv) evaluate the association between demographics, tobacco smoking, concurrent morbidities, and health-services use during the past year.

A cross-sectional study was conducted in October 2022 among undergraduate students at Kuwait University using a structured electronic questionnaire. Participants were recruited as a sample of convenience. The prevalences (%) of exposure to tobacco smoke (1st hand and 2nd hand at home) were estimated. Self-reported respiratory symptoms, physician-diagnosed morbidities, and health-services use (≥ 1 visit vs. none) during the past year were assessed. Multivariable logistic regression analysis was conducted to examine the association between sociodemographics, lifestyle factors, concurrent morbidities, and health-services use during the past year. The adjusted odds ratios (OR) and 95% confidence intervals (CI) were used to interpret the final model.

Of 1,323 participants, the majority were Kuwaiti (87.5%) and female (75.8%). The prevalence of exposure to first-hand tobacco smoke was 13.4% (177/1,323), while 50.8% (672/1,323) reported exposure to second-hand tobacco smoke at home. Overall, the prevalence of exposure to tobacco smoke was 55.9% (740/1323). The reported respiratory symptoms were shortness of breath (59.1%), cough (46.3%), chest pain (26.9%), and difficulty during exercise (21.6%). Physician-diagnosed conditions included asthma (16.8%), eczema (11.2%), and chronic obstructive pulmonary disease (1.4%). Of the participants, 44.6% (590/1323) used the health-services at least once during the past year. In the multivariable model, after adjusting for effects of age and sex, participants were significantly more likely to report at least one instance of health-services use during the past year if they reported cough (adjusted OR = 2.10; 95% CI: 1.66-2.64; p < 0.001), shortness of breath (adjusted OR = 1.30; 95% CI: 1.01-1.67; p = 0.044), nausea/vomiting (adjusted OR = 2.52; 95% CI: 1.79-3.54; p < 0.001), or asthma (adjusted OR = 1.95; 95% CI: 1.43-2.65; p < 0.001). However, tobacco smoking (active and/ or secondhand) was not significantly associated with health services use at least once during the past year in this evaluation.

This study reports high prevalence of second-hand tobacco smoke exposure at home among young adults, along with high levels of respiratory and allergic morbidities. Although tobacco exposure (first and/ or secondhand) itself was not directly associated with health-services use at least once in the past year, smoking-related symptoms and ill-health conditions were significantly associated with health-care use at least once during the past year. Public health interventions aimed at reducing exposure to tobacco smoke may help decrease related morbidities and subsequent health-services use among young adults.

Obstructive sleep apnea (OSA) remains substantially underdiagnosed, and recurrent intermittent hypoxia (IH) is a key pathophysiological feature of OSA and may affect thalamic function. We aimed to develop a neuroscience-guided MRI-based deep learning model for auxiliary OSA diagnosis.

Male C57BL/6J mice were exposed to IH, and thalamic activation was assessed using immunofluorescence staining and in vivo calcium imaging. Clinical brain MRI and polysomnography (PSG) data were retrospectively collected from 760 adults across two centers. Center 1 was divided into training and validation cohorts, and center 2 served as an independent external test set. Based on the experimental findings, bilateral thalamic regions were segmented, and a dual-branch 3D CNN with Transformer-based feature fusion was developed.

IH induced prominent thalamic activation in mice, and central lateral thalamic nucleus (CL) showed the strongest relative response among the examined thalamic subregions. Compared with the control group, the IH group showed a marked increase in c-Fos-positive cells in the CL (62.50 ± 11.67 vs. 9.67 ± 4.89, n = 6, P < 0.0001). Further calcium signal recordings showed that calcium activity in the CL was significantly increased within the 1-minute time window after stimulation. In the human MRI cohort, the bilateral thalamic deep learning model achieved AUCs of 0.944 (95% CI, 0.926-0.960), 0.928 (95% CI, 0.893-0.957), and 0.911 (95% CI, 0.856-0.957) in the training, validation, and external test sets, respectively, outperforming the unilateral models (P < 0.001).

IH-induced thalamic activation, with CL serving as a representative highly responsive thalamic subregion, provided experimental support for thalamic ROI selection. The bilateral thalamic MRI model provides a biologically grounded and externally validated imaging-based approach that may assist OSA identification.

Parasitic eosinophilic lung disease is characterized by eosinophil infiltration and dysregulated immune responses, posing significant challenges due to its complex immunoregulatory mechanisms which remain incompletely understood. This review explores the emerging role of IgE immune complexes (IgE ICs) in modulating eosinophilic immune responses, proposing a hypothetical signaling axis involving the NLRC4 inflammasome that may influence disease progression. We synthesize preliminary evidence from cellular models and discuss the potential implications of this pathway for parasitic eosinophilic lung disease. Integrating recent findings, we explore how IgE ICs interact with Toll-like receptor 2 (TLR2) and Fc epsilon receptor II (FcϵRII) to regulate eosinophil inflammatory responses, degranulation, and the expression of associated proteins. These interactions reveal a dual regulatory function of immune complexes in parasitic infections and related pulmonary disorders. By critically examining the available evidence for crosstalk between IgE ICs and the NLRC4 inflammasome, this review aims to provide a conceptual framework and hypothesis-generating perspectives for developing targeted immunotherapeutic strategies for parasitic eosinophilic lung disease. Importantly, we acknowledge that the mechanistic evidence for this axis is primarily derived from in vitro studies and requires validation in physiologically relevant systems.

High-altitude hypoxia can trigger maladaptive cardiopulmonary responses, with hypoxia-induced pulmonary hypertension (HPH) representing a major clinical challenge with limited therapeutic options. Shengxian Decoction (SXT), a classical traditional Chinese medicine formula for treating "qi deficiency and sinking", has shown clinical benefits, but the molecular pathways associated with its effects remain incompletely understood.

Male Sprague-Dawley rats were exposed to simulated high altitude (5000 m; 404 mmHg, 10.8% O₂) for 28 days and treated with SXT at three doses (1.8, 3.6, or 7.2 g/kg/day; n = 6/group). Integrated serum metabolomics (UHPLC-Q-TOF-MS) and lung transcriptomics (RNA-seq) were applied. Multivariate analysis, pathway enrichment, weighted gene co-expression network analysis, and cross-omics correlation were used for data integration. After randomization, allocation concealment and blinding were strictly implemented throughout all experimental procedures, with all interventions and outcome assessments performed by personnel blinded to group assignment until completion of data analysis.

Chronic hypoxia induced HPH with elevated mPAP, RVHI, RVWI and pulmonary vascular remodeling (increased WT% and WA%), while SXT dose-dependently ameliorated these abnormalities and restored hypoxia-disrupted metabolomic and transcriptomic profiles, with the high-dose group showing the most pronounced effect. Chronic hypoxia induced pronounced metabolic and transcriptional remodeling, with model animals clearly separated from controls in principal component analysis. Most differentially expressed genes exhibited downregulated expression, indicating global transcriptional suppression. SXT treatment dose-dependently restored both metabolomic and transcriptomic profiles, with the high-dose group most closely resembling controls. These pyruvate-proximal nodes may represent potential points of convergence through which SXT-associated metabolic and transcriptional alterations are coordinated. The relationships reported here are based on cross-omics associations, and causal inference will require further functional validation.

These findings suggest that SXT may ameliorate HPH partly through coordinated regulation of metabolic pathways and gene networks, particularly those related to energy metabolism, rather than fully explaining disease pathogenesis. The study provides multi-omics evidence supporting the traditional concept of "replenishing qi and elevating sunken qi" and identifies candidate metabolic biomarkers for further investigation. However, the results should be interpreted cautiously because of the relatively small sample size, the lack of functional validation experiments, and the exploratory nature of the biomarker findings. Further mechanistic and clinical studies are required to confirm these observations.

Lower respiratory tract infections (LRTIs) represent a significant global public health issue and impose a substantial disease burden. However, regional epidemiological surveillance data on bacterial LRTIs in central China remain insufficient. This study aimed to systematically analyze the epidemiological characteristics of patients with bacterial LRTIs in Jingzhou, Hubei Province, China.

This study included 5,442 hospitalized patients diagnosed with LRTIs between January 2020 and December 2024. Detection of respiratory pathogens was performed both using a chip-based loop-mediated isothermal amplification (LAMP) assay and the standard culture method (SCM). The LAMP assay kit simultaneously detects ten predefined bacterial respiratory pathogens, including Streptococcus pneumoniae (S. pneumoniae), Staphylococcus aureus (S. aureus), Klebsiella pneumoniae (K. pneumoniae), Pseudomonas aeruginosa (P. aeruginosa), Acinetobacter baumannii (A. baumannii), Stenotrophomonas maltophilia (S. maltophilia), Haemophilus influenzae (H. influenzae), Legionella pneumophila (L. pneumophila), Mycoplasma pneumoniae (M. pneumoniae), and Mycobacterium tuberculosis (M. tuberculosis).

Among 5,442 samples, the overall positive rate of LAMP was 31.86%, with single-pathogen infections accounting for 26.17%. H. influenzae (8.18%) and S. pneumoniae (7.75%) were the most commonly detected pathogens. Dual-pathogen co-infections predominated among polymicrobial infections, with S. pneumoniae and H. influenzae representing the most frequent pathogen combination. The LAMP assay demonstrated a higher overall positive rate than SCM, with moderate agreement observed between the two methods for most pathogens. The overall pathogen positive rate exhibited seasonal variation, peaking from April to June. S. pneumoniae showed a bimodal distribution, with higher positive rate in May-June and November-December annually. During the COVID-19 pandemic era, S. pneumoniae and H. influenzae were predominant, while the positive rates of M. pneumoniae and M. tuberculosis notably increased in the post-pandemic era. School-aged children exhibited the highest positive rate, with M. pneumoniae as the predominant pathogen. Pathogen composition was more diverse among adults and older adults.

These findings demonstrate significant age-related and temporal variations in the pathogen spectrum of bacterial LRTIs and provide epidemiological evidence to support empirical antibacterial decision-making and population-targeted prevention strategies. In addition, LAMP may serve as a practical molecular diagnostic tool for rapid bacterial pathogen detection, although its clinical utility in primary healthcare settings warrants further investigation.

X-linked hyper-immunoglobulin M (XHIGM) syndrome is a rare primary immunodeficiency caused by mutations in the CD40 ligand gene (CD40LG), characterized by defective T-cell-dependent B-cell class-switch recombination. Patients typically present with recurrent infections in early childhood, but diagnosis is often delayed due to heterogeneous clinical manifestations and the fact that serum IgM levels may remain within the normal range in a significant proportion of patients. Here we report a case of XHIGM in an infant whose diagnostic journey began with recurrent lymphadenitis and culminated in life-threatening Pneumocystis jirovecii pneumonia (PJP).

A 6-month-old male infant was admitted with severe respiratory distress and hypoxemia. He had recurrent axillary lymphadenitis at 1 and 2 months of age and significant failure to thrive. Chest CT showed bilateral consolidative and interstitial opacities. Immunological evaluation revealed markedly decreased IgA, normal IgM and IgG, and profound T-cell lymphopenia. Sputum metagenomic sequencing identified Pneumocystis jirovecii. Whole-genome sequencing identified a hemizygous likely pathogenic CD40LG mutation (NM_000074.3:c.520C>T, p.Q174*); his mother was a carrier. He was treated with mechanical ventilation, trimethoprim-sulfamethoxazole (TMP-SMX), micafungin, corticosteroids, and intravenous immunoglobulin (IVIG), and was discharged after 36 days.

In infants with recurrent or opportunistic infections, persistently low IgA and declining T-cell counts-even when initial screening appears normal-should raise suspicion for underlying immunodeficiency and prompt genetic evaluation. Early aggressive management and evaluation for hematopoietic stem cell transplantation are essential to improve outcomes.Serial immunological evaluation is essential in infants with recurrent or opportunistic infections, as persistently low IgA and declining T-cell counts-even when initial screening appears normal-should prompt genetic evaluation for underlying immunodeficiency. Early aggressive management and evaluation for hematopoietic stem cell transplantation are essential to improve outcomes.