Chronic obstructive pulmonary disease (COPD) is one of the most widespread diseases. Previous research has found that immune cells and telomeres may affect COPD's pathogenesis, but their combined mechanism in COPD remains unclear. This study aims to investigate the diagnostic value of telomere-associated genes and immune cells in COPD, as well as their synergistic mechanisms, thereby providing novel insights for the clinical management of COPD.

Data comprising 19 COPD cases, 24 control samples, and 2086 telomere-related genes (TRGs) were obtained from public databases. The differentially expressed genes (DEGs) between COPD and control were obtained by differential expression analysis. The key module genes related to different immune cells (DICs) were obtained via weighted gene co-expression network analysis (WGCNA). Subsequently, biomarkers were further identified by intersecting all genes, utilizing machine learning algorithm, and verifying the expression level.Furthermore, the nomogram was constructed, and gene set enrichment analysis (GSEA) of biomarkers was adopted. The transcription factors (TFs), microRNAs (miRNAs) and drugs linked to biomarkers were obtained from the databases. The expression of biomarkers in 10 clinical samples was validated via reverse transcription quantitative polymerase chain reaction (RT-qPCR).

In this study, ALDH2 and HNMT were identified as biomarkers. The nomogram results demonstrated that the model had an outstanding predictive ability for COPD (area under curve (AUC) = 0.88). Besides, ALDH2 and HNMT were enriched in junction, starch, and sucrose metabolism. In addition, a total of 6 TFs such as ELF3, and 2 miRNAs, such as miR-206, were linked to ALDH2 and HNMT, and clozapine was the drug that had been found to be associated with both ALDH2 and HNMT. Finally, the RT-qPCR results were consistent with bioinformatics analysis.

This study identified 2 biomarkers (ALDH2 and HNMT), which might serve as potential targets for COPD. A nomogram model constructed based on biomarkers was employed for the clinical auxiliary diagnosis of COPD. This study provided new scientific evidence for improving the diagnostic process and individualized treatment strategies for COPD.

Respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD), lung cancer, tuberculosis, and acute respiratory distress syndrome (ARDS) remain major global health challenges, causing significant morbidity and mortality worldwide.^1,2 Despite the availability of pharmacological treatments such as bronchodilators, corticosteroids, antibiotics, and chemotherapeutics, most conventional drug administration routes (oral or intravenous) are often associated with critical limitations. These systemic delivery methods lead to the widespread distribution of drugs throughout the body rather than targeted accumulation at the site of infection or inflammation. This lack of specificity reduces the drug concentration at the affected region while increasing off-target toxicity in healthy tissues.³ Furthermore, many orally administered drugs suffer degradation in the gastrointestinal tract or undergo first-pass metabolism in the liver, which significantly decreases the amount of active drug reaching the systemic circulation and ultimately the target lung tissues.⁴ Many therapeutic drugs also have short half-lives, necessitating frequent dosing to maintain therapeutic levels, reducing patient compliance in chronic or long-term treatments.⁵ Therefore, there is an urgent need for advanced drug delivery systems capable of improving pulmonary targeting, enhancing therapeutic efficacy, and minimizing systemic side effects. Nanotechnology offers a promising and innovative alternative platform for addressing these challenges. Nanoparticles, ranging from 1-100 nm and employed as drug delivery systems, display unique physical, chemical, and biological properties compared to their macro-scale counterparts. As a transformative field in biomedical science, nanotechnology enables the design of novel nanoformulations to overcome the major limitations of conventional treatments. Nano-based drug delivery systems can enhance solubility, extend drug half-life, and achieve localized accumulation in the lungs by penetrating mucosal barriers.⁶ Different nanoparticle types, such as polymeric, lipid-based, and metallic nanoparticles, have been developed to optimize therapeutic efficiency and minimize side effects.⁷ Considering liposomes, polymeric nanoparticles, solid lipid nanoparticles, and inorganic nanoparticles as representative platforms for pulmonary applications a comparison of conventional and nanotechnology-based drug delivery systems is important (Figure 1). Recent studies highlight the great potential of nanoparticle-based systems for respiratory diseases For example, inhalable reactive oxygen species (ROS)-responsive nanoparticles were designed to release anti-inflammatory drugs only in regions with high oxidative stress, reducing inflammation and tissue damage in COPD and ARDS models.⁸ Similarly, glutathione (GSH)-triggered nanoparticles utilize redox-sensitive linkers to release antibiotics selectively in infection sites, improving bacterial clearance in pulmonary infections.⁹ Nanoliposomal formulations of salbutamol sulfate provide controlled bronchodilator release and prolonged lung retention in asthma therapy.¹⁰ Biodegradable poly(lactic acid) (PLA) nanoparticles enhance the stability and controlled release of anti-inflammatory agents, offering improved safety profiles.¹¹ Meanwhile, mannose-conjugated chitosan nanoparticles effectively target alveolar macrophages for the treatment of tuberculosis, improving drug accumulation and antimicrobial efficacy.¹² Collectively, these examples underscore that nanotechnology-based systems hold great promise for overcoming the intrinsic barriers of conventional therapies by achieving site-specific, sustained, and safer drug delivery in respiratory diseases.

Nanoparticle-based drug delivery systems provide a significant advancement in the treatment of respiratory diseases by overcoming the fundamental limitations of conventional therapies. Through their small size, tunable physicochemical properties, and ability to target specific lung regions, nanoparticles ensure improved bioavailability, controlled release, and reduced systemic toxicity. Studies on various nanocarriers -such as ROS-responsive and GSH-triggered nanoparticles, nanoliposomal salbutamol sulfate, PLA nanoparticles, and mannose-conjugated chitosan nanoparticles- have demonstrated promising outcomes in enhancing drug retention, reducing inflammation, and improving therapeutic efficacy in respiratory disorders. Despite these achievements, challenges such as mucus barrier penetration, long-term pulmonary toxicity, and large-scale reproducibility still remain. However, ongoing interdisciplinary research combining materials science, pharmacology, and pulmonary biology continues to improve the design, safety, and performance of nanoparticle systems. Collectively, these advancements indicate that nanotechnology can transform the current therapeutic landscape of respiratory medicine, making treatments more effective, safer, and more patient-centered.

The future of nanoparticle-based pulmonary therapies lies in the development of next-generation smart and personalized nanomedicines. Stimuli-responsive nanoparticles capable of detecting disease-specific microenvironments, such as pH shifts, oxidative stress, or enzymatic activity, will enable localized and on-demand drug release, minimizing off-target effects. Personalized nanomedicine approaches will allow the design of patient-specific formulations that combine multiple therapeutic agents, offering synergistic efficacy for complex respiratory disorders. Hybrid nanoplatforms that integrate metallic nanoparticles (e.g., silver, gold) with natural bioactive compounds such as phycocyanin are expected to exhibit both therapeutic and diagnostic potential, enhancing the scope of precision medicine. Furthermore, advancements in inhalation device technology, aerosol engineering, and biocompatible excipient development will further support the translation of nanoparticle-based formulations from laboratory research to clinical application. As large-scale production, regulatory harmonization, and long-term safety validation advance, nanoparticle-based systems are expected to become a cornerstone of future respiratory therapies, offering precision, safety, and efficacy beyond the limitations of current treatments.

Self-medication among healthcare workers poses serious risks to both personal health and patient safety. Operating room (OR) personnel, exposed to high-acuity care, irregular shifts, and systemic pressures, may be particularly vulnerable, yet comprehensive studies in this population remain limited.

This explanatory sequential mixed-methods study investigated self-medication among OR personnel during the COVID-19 pandemic. In the quantitative phase, 400 participants completed a validated 15-item questionnaire on self-medication behaviors, individual factors, and organizational/environmental determinants. In the qualitative phase, 20 semi-structured interviews were thematically analyzed. Integration was achieved through narrative weaving and a joint display.

Self-medication prevalence was 65%. Quantitative analysis identified psychological stress (β = 0.35, p < 0.001) and workplace pressures (β = 0.30, p < 0.001) as the strongest predictors, with poor healthcare access and prior experience also contributing. Surgical technologists reported higher rates than nursing aides (p < 0.05). Qualitative analysis revealed four themes: psychological strain, self-medication as coping, workplace pressures, and emotional consequences. Integration showed a reinforcing cycle in which stress and systemic barriers promoted self-medication, which in turn generated further emotional burden.

Self-medication among OR personnel during crises is prevalent and shaped by intertwined psychological and systemic factors. Interventions should address immediate stressors at the hospital level while implementing health-system policies that reduce structural barriers, to safeguard both healthcare providers and patient safety.

Not applicable.

The COVID-19 pandemic has introduced major disruptions in clinical practices, including infection management strategies and antibiotic prescribing habits. This study aimed to investigate changes in the distribution of respiratory pathogens and their antimicrobial resistance (AMR) patterns in intensive care units (ICUs) before and after the onset of COVID-19 pandemic.

In this retrospective cross-sectional study, 1,662 respiratory tract samples (bronchoalveolar lavage, deep tracheal aspirate, and sputum) collected from ICU patients at a tertiary hospital in Turkey between January 1, 2016 and December 31, 2024 were analyzed. The study compared bacterial isolates and resistance profiles between the pre-pandemic (January 2016-Feb 2020) and post-pandemic (Mar 2020-December 2024) periods.

Acinetobacter baumannii and Klebsiella pneumoniae remained the most frequently isolated pathogens throughout the study. Post-pandemic, resistance rates increased significantly for several antibiotics, particularly against Acinetobacter baumannii (gentamicin: 70.9% to 91.3%, p < 0.001; colistin: 3.2% to 12.3%, p < 0.001) and Klebsiella pneumoniae (carbapenems: p < 0.001; colistin: 23% to 62.7%, p < 0.001). For Pseudomonas aeruginosa, meropenem, piperacillin-tazobactam, and ceftazidime resistance rates increased significantly after the post-pandemic period (33.9% to 52.0%, p = 0.003; 50.4% to 65.1%, p = 0.011; 27.9% to 56.4%, p < 0.001, respectively). The changes in resistance rates of Escherichia coli were not statistically significant and also showed a reduced isolation rate post-pandemic (11.4% to 7.0%, p < 0.05). Among Gram-positive isolates, only Enterococcus faecium showed a significant increase in vancomycin resistance (50.0% vs. 0%, p = 0.046). In contrast, no significant findings were observed for methicillin resistance in Staphylococcus aureus (MRSA) and vancomycin resistance in Enterococcus faecalis (31.3% vs. 28.0%, p = 0.823; and 25% vs. 0%, p = 0.285, respectively). Mortality also increased significantly during the post-pandemic period (70.5% to 74.9%, p = 0.048), alongside a higher prevalence of comorbidities such as hypertension and coronary artery disease.

The findings highlight a marked escalation in AMR following the COVID-19 pandemic, likely driven by increased empirical antibiotic use, prolonged ICU stays, expanded use of invasive procedures, and broader steroid administration. This study underscores the deepening AMR crisis in ICUs and provides critical data from Turkey that may support global antimicrobial stewardship efforts.

Past studies show a mixed relationship between the Global Health Security (GHS) Index and COVID-19 pandemic health outcomes. Some recent work that suggested higher GHS Index scores are associated with better mortality outcomes has been criticised on methodological grounds. There remains scope for improved analyses of these relationships, including of island nations and macroeconomic pandemic outcomes. We aimed to determine the relationship between GHS Index scores and COVID-19 pandemic excess mortality 2020-2021 and macroeconomic pandemic outcomes.

Cross-sectional, multivariable regression design (controlling for per capita gross domestic product (GDP) and political corruption), comparing island and non-island jurisdictions.

194 jurisdictions with 2019 GHS Index scores.

Age-standardised cumulative excess mortality 2020-2021, GDP per capita growth 2019-2020 and 2020-2021.

The GHS Index predicted better health outcomes in terms of age-standardised excess mortality through 2020-2021 in non-island jurisdictions (β=-0.046, p=0.00068, adj R²=0.48), but not in island jurisdictions (β=0.012, p=0.734). For a starting age-standardised excess mortality of 100 per 100 000, a +10-point rise in overall GHS Index score predicts a 26.7 per 100 000 reduction in age-standardised mortality. We found no robust evidence that a higher GHS Index predicted higher year-on-year GDP per capita growth through 2019-2020 or 2020-2021.

The GHS Index demonstrated clear associations with favourable health outcomes of non-island jurisdictions through the COVID-19 pandemic, supporting its use to guide pandemic preparedness investments. Contrasting findings for islands suggest the need to enhance how the Index measures border biosecurity capacities and capabilities, including the ability to support the exclusion/elimination strategies that successfully protected islands during the COVID-19 pandemic.

To examine the epidemiological patterns and trends of sexual violence against adults and children before and during the COVID-19 pandemic in the Buffalo City and Amathole districts of the Eastern Cape Province, South Africa.

Observational, retrospective, cross-sectional study based on a review of medical records of survivors of sexual violence who reported for healthcare between January-December 2019 and January-December 2020.

The study was conducted in two healthcare facilities in the Buffalo City and Amathole districts of the Eastern Cape Province, South Africa.

A total of 1957 survivors of sexual violence presented for healthcare at the two healthcare facilities during the study period. Inclusion criteria were survivors of all ages with confirmed cases of sexual violence; records with no evidence of sexual violence were excluded.

Primary outcome measures were prevalence and distribution of sexual violence before and during the COVID-19 pandemic. The secondary outcome measures were demographic characteristics of survivors (age, sex and ethnicity), perpetrator identity and location of incidents.

The majority of survivors were female (93.6%), and 49% were under 18 years of age. Most were Black (96.3%) and resided in rural (45.6%) or semiurban (45.6%) areas. Perpetrator identity was unknown in 42.5% of cases. Among known perpetrators, non-partners such as neighbours (22.5%) and family members (13.6%) were most common. More cases were reported pre-pandemic (n=930; 60.5%) compared with during the pandemic (n=608; 39.5%). During the pandemic, 45.0% of cases occurred in the perpetrator's home, and 53.7% occurred in rural settings. Most pandemic-period cases (63.1%) were reported during alert level 1, when most social and economic activities had resumed.

Overall, there was a high rate of sexual violence, with trends correlating with the extent of COVID-19 restrictions; the highest rates were reported pre-pandemic and during alert level 1. These findings highlight the importance of prioritising the safety of women and children and informing protective strategies in both rural and urban areas during future emergency responses.

Evidence is growing for interventions beyond inhaled therapies in chronic obstructive pulmonary disease (COPD). Clinician attitudes and access to these therapies are crucial to informing COPD care pathways.

We sought to explore current attitudes, practices, future directions and challenges in the management of moderate to severe COPD among respiratory consultants in the Republic of Ireland (ROI).

A custom online survey was disseminated by email and text messaging to respiratory consultants in the ROI through the Irish Thoracic Society contact list.

37 responses were received (24.5% response rate), of which 36 were eligible for inclusion. Completion rate was 97.2% (n=35). Only 9 of 30 respondents (30%) reported sufficient access to pulmonary rehabilitation (PR), and 9 of 29 (31%) to a dedicated COPD multidisciplinary team (MDT). 10 of 29 respondents (34%) infrequently or never consider long-term non-invasive ventilation (LTNIV), despite 21 of 27 (78%) rating the quality of evidence for its benefit in reducing hospitalisations as moderate or high. 16 of 27 respondents (59%) infrequently or never consider lung volume reduction (LVR), despite 22 of 25 (88%) perceiving it to be moderately or highly beneficial towards improving quality of life. There was variable uncertainty regarding the evidence for biologics in COPD, with up to 11 of 24 respondents (46%) uncertain about Tezepelumab. Perceived challenges to integrating biologics into COPD care in the ROI included the absence of national drug reimbursement agreements, lack of dedicated COPD MDTs and administrative burden.

Our study highlights insufficient access to PR and COPD MDTs, variable attitudes towards LTNIV and LVR, and uncertainty around the role of biologics in COPD care. While the modest response rate may limit generalisability, our findings underscore the need to address infrastructural and systemic barriers to optimise care pathways for moderate to severe COPD in the ROI.

The prognostic value of respiratory symptom profiles for predicting exacerbation risk and lung function decline remains unclear in mild-to-moderate chronic obstructive pulmonary disease (COPD).

Are respiratory symptom profiles associated with both exacerbation risk and lung function decline in mild-to-moderate COPD?

This was a posthoc analysis of data from participants with mild-to-moderate COPD from the SubPopulations and InteRmediate Outcome Measures in COPD Study. Respiratory symptom profiles were identified through latent class analysis. Outcomes included exacerbation rates evaluated by zero-inflated negative binomial regressions, time-to-first exacerbation evaluated by Cox regression and longitudinal forced expiratory volume in 1 second (FEV₁) decline evaluated by linear mixed-effects models.

Among the 954 participants with mild-to-moderate COPD, five distinct respiratory symptom profiles were identified. Compared with the 'minimal respiratory' profile, the 'productive cough' profile was associated with a higher rate of any respiratory exacerbations (relative ratio [RR] 1.84; 95% confidence interval [CI] 1.29 to 2.64) and severe respiratory exacerbations (RR 2.05; 95% CI 1.12 to 3.74). Similarly, the 'Wheeze' profile was associated with higher rates of any (RR 1.55; 95% CI 1.12 to 2.15) and severe exacerbations (RR 1.73; 95% CI 1.00 to 2.98). The 'nearly all respiratory symptoms' profile was associated with a higher rate of exacerbations (any exacerbation: RR 2.12; 95% CI 1.56 to 2.89; severe exacerbations: RR 2.07; 1.23 to 3.47) and an accelerated annual FEV₁ decline (-15.41 mL/year; 95% CI -30.33 to -0.51 mL/year). The 'dry cough' profile exhibited the lowest FEV₁ trajectory despite a non-significant annual decline.

Respiratory symptom profiles identifies distinct prognostic outcomes in mild-to-moderate COPD. The productive cough is associated with increased exacerbation risk, while the dry cough is associated with a lower lung function trajectory.

NCT0196934.

to assess burnout syndrome in nursing technicians working in an Intensive Care Unit exclusively for COVID-19 patients.

a quantitative and qualitative study was carried out at a university hospital in Rio de Janeiro, Brazil. The quantitative stage included a sample of 51 professionals, using Maslach Burnout Inventory. The qualitative stage involved interviews with 12 professionals, and data were analyzed using the Statistical Package of the Social Sciences and the R Interface for Multidimensional Analysis of Texts and Questionnaires.

most participants, mainly women (74.5%), did not present criteria for burnout. Quantitatively, protection against COVID-19, satisfaction and adequate resources reduced exhaustion and depersonalization. Qualitatively, factors for the development of burnout and protective aspects emerged.

the association between emotional exhaustion, high work demands and lack of appropriate equipment suggests a greater predisposition to mental health problems. However, workers developed strategies that allowed them to measure their job satisfaction.

To analyze the association between the presence of post-COVID-19 syndrome after six months and health-related quality of life 6 and 12 months after hospital discharge.

An ambidirectional cohort study was conducted with individuals discharged from three of the main hospitals in Cuiabá (in the state of Mato Grosso) between October 2021 and March 2022. After collecting data from medical records, individuals were interviewed via telephone 6 months (n = 189) and 12 months (n = 159) after hospital discharge, evaluating the presence of at least one persistent post-COVID-19 symptom at 6 months (post-COVID-19 syndrome) and health-related quality of life (EQ-5D-3L) at 6 and 12 months, as well as specific dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). The association was assessed via Poisson regression with robust variance, adjusted for sociodemographic, health, and hospitalization characteristics.

Of the individuals assessed, 88.4% answered that they had COVID-19 symptoms in the interview after 6 months. At 6 and 12 months after hospital discharge, 55.0% and 74.2% of individuals, respectively, had some impairment in quality of life. In the multiple model, post-COVID-19 syndrome remained associated with having any quality of life issue (RR = 2.43; 95%CI: 1.06-5.57) and specifically with the anxiety/depression domain (RR = 2.74; 95%CI: 1.08-7.01) at 6 months after discharge. The association was no longer significant after 12 months.

These results show the long-term negative repercussions of post-COVID-19 syndrome on cognitive, emotional, and physical functions, exposing the negative impact on the quality of life of those affected.