To assess the cost-effectiveness, public health impact, and budget impact of receiving the LP.8.1-adapted Pfizer-BioNTech COVID-19 Vaccine among United States adults aged ≥ 18 years.

A previously published economic model was adapted to compare receiving the LP.8.1-adapted Pfizer-BioNTech COVID-19 Vaccine (2025/2026 formula) versus not in adults aged 18-64 years at high risk of severe COVID-19 and all adults aged ≥ 65 years. Age-specific epidemiological inputs were derived from public health surveillance data. Clinical, cost, and vaccine effectiveness parameters were informed by published literature. The budget impact analysis was based on a hypothetical 1-million-member plan and used a payer perspective.

Without vaccination, the model projected 41.5 million new symptomatic cases, 43,681 deaths, 338,252 hospitalizations, $80 billion in total costs, and 1.99 million QALYs lost among adults aged ≥18 years, with the greatest health burden observed among adults aged ≥65 years (73% of hospitalizations and 83% of deaths) and the greatest economic burden in adults aged 18 to 64 years at high risk of severe outcomes (62% of total costs). Compared to no vaccination, vaccination with the LP.8.1-adapted Pfizer-BioNTech COVID-19 vaccine (2025/2026 formula) in the populations aged 18 to 64 years and ≥18 years, respectively was projected to prevent 212,096 and 620,333 cases, 137 and 1,867 deaths, and 1,501 and 12,677 hospitalizations, resulting in incremental costs of $1.1 billion and $567 million, 2,411 and 15,430 LYs gained, 70,493 and 181,137 QALYs gained, ICERs of $16,238 and $3,137 from the societal perspective and $34,022 and $8,059 from the payer perspective. In the budget impact analysis from the payer perspective, vaccination was estimated to result in a modest budget increase.

Vaccinating adults at high risk of severe COVID-19 with the LP.8.1-adapted Pfizer BioNTech COVID-19 Vaccine is projected to be a cost-saving measure from the societal perspective that could reduce the public health and economic burden of COVID-19.

Tuberculosis remains a major global health challenge, particularly in resource-limited settings where access to expert radiological interpretation is constrained. Artificial intelligence offers a promising solution to enhance diagnostic accuracy and efficiency in TB screening.

This study aimed to evaluate the diagnostic performance of an AI-based system compared to a radiologist in screening for TB using chest X-rays from 1,010 patients.

Patients were adults ≥18 years with suspected TB in a high-burden setting. GeneXpert MTB/RIF served as reference to assess accuracy, sensitivity, specificity, PPV, NPV, and AUC for radiologist and AI TB predictions. Comparisons used McNemar's test and Cohen's kappa to evaluate agreement and significance of differences.

The AI system demonstrated superior performance with an accuracy of 91%, sensitivity of 86%, specificity of 93%, PPV of 85%, NPV of 94%, and AUC of 0.90. In contrast, the radiologist achieved an accuracy of 86%, sensitivity of 84%, specificity of 87%, PPV of 76%, NPV of 92%, and AUC of 0.86. McNemar's test revealed a statistically significant difference between the two modalities (p = 0.0021). Cohen's kappa indicated substantial agreement between AI and GeneXpert MTB/RIF result (κ = 0.79), moderate agreement for the radiologist and GeneXpert MTB/RIF result (κ = 0.69), and moderate agreement between radiologist and AI predictions (κ = 0.53).

The AI system outperformed the radiologist in TB screening, demonstrating higher diagnostic accuracy and agreement with GeneXpert MTB/RIF result. These findings support the integration of AI into TB screening workflows, particularly in settings with limited access to expert radiological interpretation.

Oral cavity procedures are essential for maintaining or improving oral health. In England and Wales, many factors affect these procedure trends. This study aimed to examine trends in oral cavity procedures in England and Wales from 2014 to 2023. This ecological study used main procedures and intervention data from the Patient Episode Database for Wales and the Hospital Episode Statistics database in England. The total annual number of procedures decreased by 30.1%, representing a 33.6% decrease in procedure rate from 633.67 (95% confidence interval: 631.63-635.72) in 2014 to 421.05 (95% confidence interval: 419.42-422.67) in 2023 per 100,000 person-years, trend test, P < .05. The most prevalent oral cavity procedures were "tooth and gingiva-related procedures" and "procedures related to tonsil and other parts of the mouth." Rates of all types of oral cavity procedures decreased from 2014 to 2023. Age and gender impacted the rate of oral cavity-related procedures; the 15- to 59-year age group accounted for 54.3% of the oral cavity procedures, and females contributed 53.6%. Oral cavity procedure trends were declining in England and Wales. Factors such as advancements in intervention and practical preventive approaches, the impact of the coronavirus disease 2019 pandemic, and demographic inequalities in access to these services have been associated with these declines.

Management of the patent ductus arteriosus (PDA) in the preterm infants has been highly controversial. Although the rate of surgical ligation has decreased, surgical ligation remains a necessary treatment option when the patient has a large hemodynamically significant PDA unresponsive with medical treatment or contraindicated of medical treatment. However, optimal timing of surgical ligation is still controversial and has no guideline. We compared clinical characteristics of early and late surgical ligation of PDA in preterm infants to understand the timing of surgical ligation. This retrospective study included preterm infants <36 weeks gestational age and with a PDA treated with surgical ligation in our hospital between January 2014 and December 2024. The infants were divided into early ligation group (at <2 weeks of life) and late ligation group (at >2 weeks of life) and compared both groups according to their clinical and echocardiographic data. The early ligation group and late ligation group included 64 and 35 patients, respectively. Baseline demographic characteristics, including gestational age and birth weight, were similar between the groups. Although PDA size and other echocardiographic parameters were comparable, the left atrial to aortic root ratio was significantly higher in the early group (1.97 vs 1.74, P = .018). The late ligation group had a significantly higher incidence of severe bronchopulmonary dysplasia (68.6% vs 35.9%, P = .003) and a trend toward longer mechanical ventilation duration. No significant differences were observed in rates of other complications, including intraventricular hemorrhage, necrotizing enterocolitis, or postoperative complications such as vocal cord palsy and post-ligation cardiac syndrome. Late PDA ligation in preterm infants is associated with a higher risk of severe bronchopulmonary dysplasia and prolonged ventilator support. These findings support considering earlier surgical ligation in selected preterm infants with hemodynamically significant PDA, particularly when medical therapy fails.

This study aimed to investigate the relationship between interstitial lung disease (ILD) severity and bone mineral density (BMD) and osteoporotic vertebral fractures (OVFs) in patients with rheumatoid arthritis (RA) and determine whether ILD independently affects skeletal health. This retrospective cross-sectional study included 150 RA patients treated between January 2021 and December 2024. Based on high-resolution chest computed tomography, patients were classified as RA-ILD (n = 62) or RA without ILD (n = 88). RA-ILD cases were further stratified by fibrosis extent into mild (<20%, n = 27), moderate (20%-50%, n = 24), and severe (>50%, n = 11). Demographic data, clinical features, inflammatory markers, vitamin D, bone turnover indices, and medication exposure, including cumulative glucocorticoid dose, were collected. BMD at the lumbar spine, total hip, and femoral neck was measured by dual-energy X-ray absorptiometry. OVF was assessed by thoracolumbar radiography or computed tomography using the Genant semiquantitative method. Group comparisons, trend analyses, correlation analyses, and multivariable logistic regression were performed to identify independent risk factors for OVF. ILD was present in 41.3% of RA patients. Compared with those without ILD, RA-ILD patients were older, had longer disease duration, higher disease activity, elevated C-reactive protein/erythrocyte sedimentation rate, lower 25-hydroxyvitamin D, higher bone alkaline phosphatase levels, and greater cumulative glucocorticoid exposure (all P < .05). Lumbar spine, total hip, and femoral neck BMD were significantly lower in the RA-ILD group, accompanied by a lower lumbar T-score. OVF prevalence was higher in RA-ILD patients (30.6% vs 14.8%), including more multiple fractures. Within the RA-ILD cohort, BMD declined progressively with increasing ILD severity, and pulmonary function indices (forced vital capacity [%] and diffusing capacity for carbon monoxide [%]) showed positive correlations with BMD. OVF frequency rose stepwise from mild to severe ILD (14.8%, 29.2%, and 54.5%). Multivariable analysis identified ILD severity as an independent predictor of OVF (odds ratios = 2.51, 95% confidence interval: 1.21-5.22), together with age and cumulative glucocorticoid exposure. RA patients with ILD exhibit significantly reduced BMD and an increased risk of OVFs, which worsen with ILD severity. ILD appears to be an independent risk factor for skeletal deterioration in RA, highlighting the importance of early bone health assessment and preventive management in this population.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with systemic inflammation and potentially influences the outcomes of critical illness. However, its impact on septic shock remains poorly defined. We aimed to evaluate the association between MASLD score and outcomes in patients with septic shock. We conducted a retrospective cohort study using the National Inpatient Sample (2016-2020) and included adults (aged ≥ 18 years) with septic shock. Patients were stratified according to the MASLD status, and those with acute liver diseases were excluded. A 1:1 propensity score matching was performed based on the demographics, comorbidities, and hospital characteristics. Outcomes included mortality, acute kidney injury (AKI), pulmonary embolism, cardiac arrest, acute respiratory distress syndrome, and transfusion requirements. Multivariable logistic regression was performed to assess the association between the MASLD score and outcomes. Among the 17,382 patients with septic shock, 8691 had MASLD. The incidence of AKI was higher in the MASLD compared than in the non-MASLD (69.9% vs 68.4%, P = .036). In contrast, MASLD was associated with lower mortality (27.8% vs 33.0%; P < .0001), cardiac arrest (5.3% vs 8.2%; P < .0001), acute respiratory distress syndrome (32.3% vs 36.4%; P < .0001), pulmonary embolism (2.2% vs 4.2%; P < .0001), and transfusion requirements (19.6% vs 21.3%, P = .005). MASLD had higher odds of AKI (adjusted odds ratio 1.071; 95% confidence interval, 1.005-1.143; P = .036), particularly in black patients (adjusted odds ratio 1.327; 95% confidence interval, 1.072-1.642; P = .0092). MASLD was associated with higher odds of AKI but paradoxically lower odds of other adverse outcomes. Further research is required to elucidate the mechanisms linking MASLD to septic shock outcomes.

Rheumatoid arthritis (RA) is a chronic autoimmune disease known for its systemic inflammatory effects and associated comorbidities. Chronic obstructive pulmonary disease (COPD) has been increasingly recognized as a significant comorbidity in RA patients. This meta-analysis aims to quantify the prevalence and relative risk of COPD in patients with RA compared to the general population.

A systematic search of PubMed, Embase, and Google Scholar was conducted until April 30th, 2024. Studies were selected based on predefined inclusion criteria, focusing on those reporting data on COPD in RA patients. Random-effects models were used to estimate pooled prevalence rate and risk ratios, along with 95% confidence intervals (CIs), to report the overall effect size. Statistical significance was set at P < .05. Statistical analyses were conducted using Review Manager and MedCalc software, with results pooled using the Mantel-Haenszel random-effects model. Heterogeneity was assessed using I2 statistics, and publication bias was evaluated using funnel plots, Egger regression, and Begg rank correlation tests.

Twenty-four studies with a combined population of 1,710,600 individuals were included. The pooled prevalence of COPD in RA patients was 7.06% (95% CI 4.56-10.13). Subgroup analysis showed a prevalence of 6.36% in Asia and 7.1% in the studies from the rest of the world. RA patients had a significantly higher risk of developing COPD compared to the general population, with an risk ratios of 1.58 (95% CI 1.37-1.82, P < .0001). The relative risk in Asian populations was 1.61 (95% CI, 1.19-2.18, P < .0001) compared to 1.56 (95% CI, 1.24-1.97, P < .0001) in studies from the rest of the world. According to Newcastle-Ottawa Scale, most studies were of high or moderate quality. According to Egger regression and Begg rank correlation tests, all analyses were free of publication bias.

This meta-analysis offers strong evidence that individuals with RA are at a significantly higher risk of developing COPD. These findings emphasize the need for regular screening for COPD in RA patients and the implementation of proactive management strategies to reduce this risk. Further research is required to fully understand this relationship.

The COVID-19 pandemic has challenged everyone's adaptive resources. However, a limited number of studies have examined its effects on mental health workers, a population at increased risk for vicarious traumatization.

A mediation model was tested using longitudinal self-report data (N=1597). The association among occupation, severity of trauma-related and stressor-related (TSR) symptoms during the first wave of the COVID-19 pandemic, and self-efficacy was explored.

Mental health workers reported greater self-efficacy than other survey participants (health care workers, general population) (unstandardized β=1.53, P<0.001), and greater self-efficacy was associated with lower TSR symptoms (-0.09, P<0.001). Hence, mental health workers reported lower TSR symptoms through both direct (-0.80, P=0.005) and indirect associations (-0.94, P<0.001), with higher self-efficacy compared with other survey participants.

Despite being at greater risk for vicarious traumatization, mental health workers fared well during the first wave of COVID-19. Increasing self-efficacy in high-risk populations in the context of stressful/traumatic events may have some value, an avenue requiring further investigation.

Psychological distress is a common comorbidity in chronic obstructive pulmonary disease (COPD), yet its relationship with disease severity remains incompletely understood. This study aimed to assess depression, anxiety, and stress using the Depression Anxiety Stress Scales-21 (DASS-21) and to examine their distribution across COPD severity stages.

This multicenter, cross-sectional observational study included 285 clinically stable COPD patients enrolled between 2023 and 2025. COPD severity was classified according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Multinomial and binary logistic regression models were constructed to identify independent predictors of COPD severity and clinically significant psychological distress, adjusting for demographic and clinical covariates. Bayesian independent sample analyses and ANOVA effect size estimates were additionally performed.

Smoking exposure was independently associated with advanced COPD stages (GOLD 4 vs. GOLD 1-3: aOR 1.05, p < 0.001), as was dyspnea severity (mMRC: aOR 14.66, p < 0.001). In multivariable models examining psychological outcomes, COPD severity was not independently associated with clinically significant depression (p = 0.899), anxiety (p = 0.460), or stress (p = 0.843). In contrast, symptom burden measured using the COPD Assessment Test (CAT) score was consistently associated with depression (aOR 1.133, p < 0.001), anxiety (aOR 1.179, p < 0.001), and stress (aOR 1.144, p < 0.001). ANOVA effect sizes across GOLD stages were small (η² ≤ 0.047), and Bayesian analyses provided moderate to strong evidence supporting minimal differences in DASS-21-R scores between severity groups.

Psychological distress is prevalent across all COPD severity stages and is not independently determined by airflow limitation. Symptom burden rather than spirometric severity appears to be more closely associated with emotional outcomes.

Introduction: Recombinant human deoxyribonuclease I (rhDNase) cleaves DNA in mucus, facilitating increased mucociliary clearance of purulent sputum. In cystic fibrosis (CF), rhDNase improves pulmonary function and decreases exacerbations. Conversely, rhDNase use in non-CF bronchiectasis (NCFB) patients has not yielded similarly effective results. We explored the safety and feasibility of rhDNase in patients with bronchiectasis due to primary ciliary dyskinesia (PCD). Methods: In this real-life pilot study, patients with PCD received rhDNase to treat viscous mucus. We compared pulmonary function tests and pulmonary exacerbations for these patients over six months of use of rhDNase. Results: Eight PCD patients with symptomatic bronchiectasis commenced use of rhDNase at variable dosing (ranging from at least twice weekly to a full 2.5 mg dose daily). Over a six-month period, pulmonary function tests, as measured by mean FVC and FEV₁, remained relatively stable compared to prior to commencing rhDNase. Mean pulmonary exacerbations decreased from 3.1 to 2.3 in the six-month period after commencing rhDNase, as compared to the six-month period prior to rhDNase. Conclusions: Use of rhDNase in PCD patients was safe and did not adversely impact lung function or increase pulmonary exacerbations, in contrast to earlier trial results in NCFB patients with heterogeneous etiologies. Further clinical data is required to identify the population of PCD patients who can benefit from rhDNase, as well as the appropriate dosing and timing.