Multiple sclerosis (MS) is a long-term autoimmune disease characterized by inflammation and progressive degeneration of the central nervous system. Disease-modifying therapies (DMTs) have proved to be effective at ameliorating the course of MS. DMTs are immunomodulatory drugs affecting immune response to SARS-CoV-2 and its vaccine efficacy in MS patients (pwMS).

In this longitudinal study, we analyzed T and B cell subsets in peripheral blood and the antigen (spike)-specific T cell response in pwMS patients undergoing interferon β1-a (IFN) or ocrelizumab (OCRE), before and after BNT162b2 mRNA SARS-CoV-2 vaccination. Blood was collected from pwMS treated with IFN and OCRE before and after the two vaccine doses. Peripheral blood mononuclear cells were analyzed by flow cytometry to measure T and B cell frequency, the expression of activation/regulatory/memory T cell markers and their spike-specific T cell response.

CD20⁺ B-cells were decreased in OCRE- compared to IFN- treated pwMS before and after vaccination. CD8⁺ and CD4⁺ T cell responses and the immunological memory was comparable between the two groups. Th17 cells were increased after vaccination only in the OCRE-treated group. We detected a robust spike-specific T cell response, paralleled by a significant decrease of Treg frequency, in both pwMS groups.

Although IFN and OCRE induced distinct immunological profile, both DMTs allowed to mount a vaccine-induced cellular and humoral immune response. This study also represents a model that could be applied to dissect the vaccine-elicited immune response in individuals undergoing treatment with different biological drugs.

To determine tuberculosis prevalence among health-care facility patients and to assess the effectiveness of chest radiography in facility-based tuberculosis screening.

Our cross-sectional analysis used individual-level data collected during 2020-2023 from adults presenting at 796 health-care facilities participating in a public-private partnership in 15 provinces of Viet Nam. We constructed tuberculosis care cascades stratified by symptomatic presentation according to the World Health Organization (WHO) four-symptom screening and chest radiography. We reported diagnostic yield, number needed to screen and positivity.

Among 1 423 818 participants, 22 598 had bacteriologically confirmed tuberculosis. Diagnostic yields were 2.2% (19 289/892 894) among symptomatic individuals with cough, 1.0% (1869/191 677) among symptomatic individuals without cough and 0.4% (1440/339 247) among asymptomatic individuals. Tuberculosis-suggestive chest radiograph results compared with normal results increased bacteriologically confirmed positivity by 9.4 percentage points in symptomatic individuals with cough (17.3%; 18 746/108 650 versus 7.9%; 543/6851), by 4.6 percentage points in symptomatic individuals without cough (12.6%; 1748/13 831 versus 8.0%; 121/1515) and by 7.6 percentage points in asymptomatic individuals (15.0%; 1328/8862 versus 7.4%; 112/1511). Without chest radiography, the number of individuals requiring testing to detect tuberculosis among symptomatic individuals with cough and without a cough would have been 6.5 (1 084 571/165 679) and 5.4 (892 894/165 679) times higher, respectively.

Chest radiograph screening can reduce the number of expensive molecular tests used in symptomatic patients and enable tuberculosis diagnosis in asymptomatic patients. Future research should analyse cost and cost-effectiveness of using chest radiography in active and intensified case finding.

Urban environments may influence COVID-19 transmission.

To examine how urban form, population size, and density relate to COVID-19 spread in Saudi Arabian cities.

A cross-sectional study of 18 major cities categorized as centralized, linear, or grid-patterned. Data on confirmed cases, population, area, and density were analyzed using descriptive statistics and correlation analyses.

Total COVID-19 cases strongly correlated with city population size (r = 0.942, p < 0.001) and moderately with cases per density (r = 0.506, p = 0.032). Population density alone was not significant. Centralized cities exhibited higher infection rates than linear or grid-patterned cities.

Population size drives COVID-19 spread, while urban form and connectivity shape local transmission dynamics. Urban planning and targeted interventions in centralized areas can support pandemic mitigation.

Telehealth emerged as a vital tool for healthcare delivery during the COVID-19 pandemic. However, its utilization among middle-aged and older informal caregivers remains insufficiently explored in the U.S. This study examines the relationship between informal caregiving status and telehealth service utilization, including the modes of use, motivators, and barriers experienced during the pandemic in the U.S.

Data were derived from the Health Information National Trends Survey (HINTS6), a nationally representative, cross-sectional survey of U.S. adults (n = 3,354, ages ≥50 years). Multivariable multinomial logistic regression assessed the association between caregiving status and telehealth utilization, while Rao-Scott chi-square tests examined bivariate relationships.

Approximately 20% reported being informal caregivers. Compared to non-caregivers, caregivers were significantly more likely to have received (adjusted odds ratio [aOR] = 1.78; 95% CI: 1.31, 2.40) telehealth services during the pandemic. Caregivers more frequently cited convenience (66.4% vs. 56.2%; p = 0.036) and the ability to include family or other caregivers in appointments (30.8% vs. 19.0%; p = 0.037) as key motivators for telehealth use. Among those who were offered but who did not use telehealth, caregivers' preference for in-person care was nearly universal (98.0% vs. 89.7%; p = 0.043), but privacy concerns trended lower (7.9% vs. 17.3%; p = 0.06).

Informal caregivers exhibited higher rates of telehealth utilization and reported unique motivators and barriers. To enhance caregiver engagement and healthcare access, telehealth programs should optimize access and prioritize convenience, enable multi-participant visits, strengthen telehealth features that support care coordination. The findings may inform targeted telehealth policies and interventions for supporting this essential and vulnerable population.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is closely associated with coronary heart disease (CHD) and adverse cardiovascular outcomes, but the comparative value of the triglyceride-glucose (TyG) index and its body fat distribution composites for cardiovascular risk stratification in OSAHS remains unclear.

We assessed the associations of TyG, TyG-weight-adjusted waist index (TyG-WWI), TyG-Chinese visceral adiposity index (TyG-CVAI), and TyG-body roundness index (TyG-BRI) with prevalent CHD and incident major adverse cardiovascular events (MACE) in adults with OSAHS. This single-center retrospective observational study included 1,122 adults with OSAHS who underwent both polysomnography and coronary angiography, including 533 patients with CHD and 589 without CHD. TyG-related indices were standardized and analyzed per 1-standard deviation increase. Multivariable logistic regression, restricted cubic spline analysis, Cox proportional hazards models, time-dependent receiver operating characteristic analysis, and exploratory statistical decomposition were performed.

All TyG-related indices were independently associated with prevalent CHD after full adjustment. TyG-WWI showed the strongest association (odds ratio 3.21, 95% confidence interval 2.68-3.89 per 1-standard deviation increase). Adding TyG-WWI to conventional risk factors plus apnea-hypopnea index provided the greatest improvement in CHD discrimination (area under the curve 0.802; integrated discrimination improvement 0.150; continuous net reclassification improvement 0.706; all P<0.001). During a median follow-up of 17 months, 80 MACE occurred, and TyG-WWI showed the strongest association with incident MACE among the evaluated indices(hazard ratio 1.545, 95% confidence interval 1.217-1.961). Exploratory statistical decomposition suggested potential indirect pathway signals involving TyG-WWI and TyG-CVAI.

In this selected high-risk cohort of adults with OSAHS undergoing coronary evaluation, TyG and its adiposity-based composites were associated with prevalent CHD and showed supportive associations with follow-up MACE. TyG-WWI showed the most consistent cross-sectional, supportive longitudinal, and incremental discriminative value, suggesting its potential as a candidate marker for cardiovascular risk stratification. Given the limited MACE events and the exploratory nature of the statistical decomposition, these findings should be interpreted cautiously and validated prospectively.

Pulmonary tuberculosis is a major comorbidity of chronic obstructive pulmonary disease (COPD). However, the risk factors for tuberculosis development in patients with COPD have not been thoroughly studied. Thus, this study investigated the development of tuberculosis according to comorbidities and inhaler prescriptions for COPD.

A retrospective cohort study was conducted using data from the Korean Health Insurance Review and Assessment Service database from January 1, 2015 to December 31, 2020. This cohort included 139,589 COPD patients (≥ 40 years) with a new prescription of inhalers. Cox proportional hazards regression models were used to identify significant risk factors for predicting the development of tuberculosis.

Multivariate analysis demonstrated that a history of tuberculosis (hazard ratio [HR], 18.14; 95% confidence interval [CI], 16.44-20.02) and hospitalization during the screening period (HR for one hospitalization, 1.30; 95% CI, 1.17-1.44; HR for two or more hospitalizations, 1.54; 95% CI, 1.39-1.70), along with older age and male sex, were associated with the development of pulmonary tuberculosis.

Our data indicate that a history of tuberculosis and hospitalization during the screening period, along with old age and male sex, are independent risk factors for the development of pulmonary tuberculosis in patients with COPD.

Primary ciliary dyskinesia (PCD) is a rare genetic disorder that causes chronic lung disease. Patients with PCD often experience pulmonary exacerbations with worsening symptoms and lung function decline. This review provides an overview of the existing knowledge regarding the PEx in PCD and reveals understudied topics that should be addressed in the future. We describe the different PCD-specific PEx definitions that exist in the literature, and provide data on the frequency of PEx. Few studies targeted the pathophysiology of PEx, with a focus on the most common microorganisms in the airways and on inflammatory markers that are increased in the sputum (total cells, neutrophils, neutrophil elastase, interleukin-8). Several risk factors for PEx have been identified, among them female sex, age, and airway infection with Pseudomonas aeruginosa. Lung clearance index appears to be a good prognostic factor for future PEx. Current treatment and prevention strategies are described. Further research is needed to enhance our knowledge on PEx mechanisms, on appropriate treatment therapies, and on the long-term consequences of this condition.

Chronic Obstructive Pulmonary Disease (COPD) is associated with reduced physical activity, negatively affecting prognosis and quality of life. According to Self-Determination Theory (SDT), the quality of motivation plays a key role in sustaining active behavior, but evidence in COPD remains limited.

The objective of this study was to examine the associations between different types of exercise motivation and objectively measured physical activity and sedentary behavior in individuals with COPD.

This cross-sectional study included 50 community-dwelling individuals with COPD (GOLD stages 2-3; mean age 69.4 ± 7 years). Motivation was assessed using the Behavioral Regulation in Exercise Questionnaire (BREQ-3) and the Self-Determination Index (SDI). Physical activity was objectively measured with the ActiGraph GT3X accelerometer. Associations were examined using Spearman's correlations and hierarchical multiple linear regression models.

Integrated regulation was positively correlated with light physical activity (rho = 0.43, p < 0.05), total physical activity (rho = 0.40, p < 0.05), and daily step count (rho = 0.43, p < 0.05). Intrinsic motivation was positively correlated with light physical activity (rho = 0.37, p < 0.05), total physical activity (rho = 0.37, p < 0.05), and daily step count (rho = 0.35, p < 0.05). The Self-Determination Index was positively associated with light physical activity (rho = 0.28, p < 0.05) and daily step count (rho = 0.33, p < 0.05), but showed no significant association with sedentary time. In hierarchical regression analyses, higher levels of integrated regulation were independently associated with higher daily step count, with each one-unit increase associated with 687 additional steps per day. For total physical activity, integrated regulation showed a borderline independent association with the outcome after adjustment for clinical covariates (β = 0.279, p = 0.054), whereas FEV₁ (% predicted) remained independently associated with total physical activity (β = 0.304, p = 0.027). For sedentary behavior, higher self-determination was independently associated with lower sedentary time; specifically, each one-unit increase in the Self-Determination Index corresponded to approximately 13 fewer sedentary minutes per day (β = -0.327, p = 0.026).

Self-determined motivation was associated with more favorable physical activity profiles in individuals with COPD. Integrated regulation was independently associated with daily step count, while higher self-determination was associated with lower sedentary time. These findings suggest that autonomous forms of motivation may be important factors to consider when promoting active lifestyles in people with COPD.

Tuberculosis (TB) remains a major public health challenge in Thailand, a high-burden country undergoing both epidemiological transition and pandemic-related disruption. This study examined temporal and spatial patterns of age-standardized TB incidence from 2012 to 2023 across Thailand's 13 health regions and 77 provinces.

This nationwide ecological study used annual TB case notifications (2012-2023) for all 77 Thai provinces from Thailand's National Disease Surveillance System (Report 506), Bureau of Epidemiology, with mid-year and age-stratified provincial populations. Age-standardized incidence rates (ASR) were calculated using the WHO World Standard Population (2000-2025). Temporal trends were assessed by Joinpoint regression with Bayesian-Information-Criterion model selection (maximum 2 joinpoints) and validated by generalized additive models. Spatial clustering was evaluated by Global Moran's I and Local Indicators of Spatial Association (LISA) under queen contiguity, with sensitivity analyses across alternative weights and Benjamini-Hochberg false-discovery-rate correction. Provinces were classified into long-term trend categories combining effect size (AAPC) and significance, and COVID-19 impact was quantified by 2019-2023 ASR percent change.

National TB incidence declined substantially from 2012 to 2023, although marked regional heterogeneity persisted. Five health regions showed the strongest long-term reductions: region 3 [AAPC: - 20.51, 95% confidence interval (CI): - 33.00 to - 13.77], region 9 (- 19.42, 95% CI: - 28.98 to - 8.57), region 4 (- 17.53, 95% CI: - 23.64 to - 12.89), region 11 (- 11.79, 95% CI: - 22.16 to - 0.04), and region 13 (- 11.19, 95% CI: - 22.44 to - 3.74). Region 6 showed an early decline followed by stabilisation, and region 12 showed a mid-period increase before a post-2019 reduction.

Thailand has achieved substantial overall reductions in TB incidence over the past decade, but pronounced regional and provincial disparities persist. Localized hot-spots, biphasic regional trajectories that may reflect surveillance and programmatic transitions, and compound vulnerability during the COVID-19 period underscore the need for geographically targeted monitoring, equitable resource allocation, and pro-poor interventions to sustain progress toward TB elimination.

Determinants of telemedicine applications use by general practice patients with chronic respiratory diseases are not yet fully known. The aim of this study was twofold: (a) to assess facilitators and barriers for the use of digital home spirometers in primary care, and (b) to evaluate parameters for process quality in implementing guideline-recommended care in daily practice.

The study was evaluated using a mixed-methods design. Patients with bronchial asthma or chronic obstructive pulmonary disease were instructed to take daily measurements using a digital home-spirometry device. Primary care physicians regularly controlled spirometry data using a digital monitoring portal. Telephone interviews were conducted with patients and healthcare professionals. Qualitative analysis of the transcripts was based on content analysis. Quantitative data included the assessment of quality indicators in the beginning (t0) and at the end (t1) of each individual's participation in the study, the Patient Assessment of Chronic Illness Care Short-Version (t0) and reasons for use/non-use of the spirometer (t1). Logistic regression was performed to determine predictors of use according to instructions.

Altogether, 127 patients participated in the study; the average age was 59 years, 61% (n = 78) of participants were female. 21 telephone interviews with patients and healthcare professionals were conducted. Facilitators included: sense of obligation, habituation, visualization of progression, self-efficacy, physician contacts, remote treatment, and positive aspects of integration into daily practice. Barriers included: understanding of the disease, dyspnea, as well as project and technical requirements. Care providers considered time-consuming procedures and clinical assessability as barriers. At t0 and t1, approximately one third of respondents (33% resp. 36%) stated that they had received disease-specific training, and 57% stated in both cases that they had gotten the annual influenza vaccination. Logistic regression revealed that duration of disease (OR 0.96; CI 95% 0.93; 0.99), a daily measurement being too strenuous (OR 0.165; CI 95% 0.04; 0.076), and the fact that measurements could not be taken while away from home (OR 0.235; CI 95% 0.07; 0.75) to be negative predictors of use according to instructions.

For the patients in the study, digital applications improved self-efficacy and self-control. However, a better understanding of these applications and additional medical feedback could be helpful for the patients using such digital applications. The evaluation of process quality parameters showed potential for improving rates of disease-related education and influenza vaccination.