Background: Chronic obstructive pulmonary disease (COPD) and acute myocardial infarction (AMI) frequently coexist and share several biological pathways and risk factors. Although COPD is associated with worse outcomes after AMI, the prognostic value of objective pulmonary function has not been well characterized. The aim of this study was to evaluate the association between airflow-obstruction severity and five-year all-cause mortality after AMI among patients with COPD. Methods: This single-center retrospective cohort study was restricted to adult post-AMI patients (2002-2017) with a background diagnosis of COPD and documented spirometry; therefore, the final cohort represents a selected subgroup of the source COPD-AMI population. Airflow obstruction was categorized according to forced expiratory volume in one second (FEV1) as Mild, Moderate, Severe, or Very Severe (according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD)). The outcome was all-cause mortality during up to five years of follow-up. Results: Among 1594 patients hospitalized with AMI and a COPD diagnosis, 169 patients with available spirometry were included in this selected analytical cohort (mean age 66.76 ± 9.86 years, 76.9% male). During follow-up, 65 patients died, corresponding to an overall five-year mortality rate of 38.5%. Mortality increased progressively across obstruction categories: 19.0%, 33.3%, 40.0%, and 70.8% in Mild, Moderate, Severe, and Very Severe, respectively (p for trend <0.001). In multivariable analysis, adjusted hazard ratios for mortality were: 2.49 (95% CI 0.86-7.24), 3.38 (95% CI 1.09-10.46), and 5.23 (95% CI 1.62-16.89) for Moderate, Severe, and Very Severe, compared with Mild obstruction. Conclusions: Among patients with COPD who survived hospitalization for AMI, more severe airflow obstruction was associated with substantially higher five-year all-cause mortality. These findings support the potential role of spirometry-based risk stratification and highlight the need for integrated cardiopulmonary follow-up after AMI.

Background/Objectives: This study aimed to compare structural and functional parameters between chronic obstructive pulmonary disease (COPD) patients and healthy controls, assess associations with pulmonary function, and identify factors independently associated with COPD status. Methods: A cross-sectional study was conducted in 89 participants (COPD: n = 45; controls: n = 44). Structural parameters included forward shoulder posture (FSP), scapular rotation, scapular distance (SD), and pectoralis minor index, measured bilaterally. Functional parameters included maximum inspiratory and expiratory pressures (MIP/MEP), chest expansion at three thoracic levels, spinal angles, and spirometry (%FVC, %FEV1, FEV1/FVC, FEF_25-75%, PEFR). Univariate and stepwise multivariate logistic regression identified variables independently associated with COPD. Results: COPD patients were older and exhibited lower anthropometric measures. Scapular rotation was greater in COPD (p < 0.05 bilaterally), while SD was significantly reduced (p < 0.001 bilaterally). MIP, MEP, and chest expansion at all three levels were significantly impaired in COPD (p < 0.05). All spirometric parameters were markedly lower in COPD (all p < 0.001). SD was positively associated with spirometric indices on both sides (p < 0.01). FSP was inversely associated with MIP, MEP, and chest expansion (p < 0.05). In multivariate logistic regression, age (OR 1.280, p = 0.018), %FVC (OR 0.875, p = 0.029), and FEF_25-75% (OR 0.909, p < 0.001) were independently associated with COPD status. Conclusions: Patients with COPD demonstrated reduced SD and increased scapular rotation. SD was significantly associated with pulmonary function, whereas FEF_25-75% and %FVC emerged as independently associated variables of COPD status. Collectively, these findings underscore the clinical relevance of integrating targeted scapulothoracic and respiratory rehabilitation strategies to optimize functional outcomes and support overall respiratory health and well-being.

Background/Objectives: Pleural effusions are frequently encountered on pre-procedural computed tomography (CT) scans in patients undergoing transcatheter aortic valve implantation (TAVI). While often regarded as a marker of congestion and advanced cardiovascular disease, their clinical and prognostic significance in contemporary TAVI populations remains poorly understood. This study investigated the relationship between AI-derived pleural effusion volume, cardiovascular dysfunction, and long-term mortality after TAVI. Methods: Consecutive patients undergoing transfemoral TAVI between 2016 and 2022 who had available pre-procedural CT imaging were retrospectively included. Pleural effusion volume was quantified using an artificial intelligence-based segmentation workflow and analyzed as categorical, continuous, log-transformed, and threshold-based variables. Associations with clinical and echocardiographic characteristics were evaluated using Spearman correlation analyses. Long-term mortality was assessed using Kaplan-Meier analysis, Cox proportional hazards regression, and restricted cubic spline models. Results: A total of 470 patients were included (median age 82 years, 50.9% male). Pleural effusion was present in 124 patients (26.38%), including 73 (15.53%) with small, 26 (5.53%) with moderate, and 25 (5.32%) with larger effusions. Increasing pleural effusion volume was associated with atrial fibrillation (AF) (rho = 0.189, p < 0.001), higher systolic pulmonary artery pressure (rho = 0.224, p < 0.001), lower tricuspid annular plane systolic excursion (rho = -0.236, p < 0.001), impaired right ventricular-pulmonary arterial coupling (rho = -0.267, p < 0.001), lower stroke volume index (rho = -0.229, p < 0.001), and reduced left ventricular ejection fraction (rho = -0.221, p < 0.001). Despite these associations, pleural effusion volume was not associated with long-term mortality in univariable analyses, multivariable Cox regression models, or restricted cubic spline analyses. In the fully adjusted model, log-transformed pleural effusion volume was not independently associated with mortality (HR 1.00, 95% CI 0.93-1.08; p = 0.976). Conclusions: AI-derived pleural effusion volume is associated with markers of cardiovascular congestion and adverse hemodynamic remodeling in patients undergoing TAVI. However, pleural effusion burden does not independently predict long-term mortality, suggesting that its value lies primarily in phenotyping cardiovascular disease severity rather than risk stratification.

Background: Although diagnosis of pulmonary nontuberculous mycobacterial (NTM) disease typically relies on bronchoscopic sampling, microbiologic testing, and histopathologic evaluation, definitive diagnosis is often difficult. This study investigated whether cytokine profiling of bronchoalveolar lavage (BAL) fluid can help differentiate NTM pulmonary disease (NTM-PD) from other diffuse lung disorders. Methods: From January 2023 to July 2025, we prospectively evaluated 50 patients presenting with undiagnosed micronodular or diffuse pulmonary opacities. BAL fluid was collected during bronchoscopy and analyzed for cytokines and related biomarkers. Eleven patients were clinically diagnosed with NTM-PD based on American Thoracic Society/Infectious Diseases Society of America criteria. Cytokine and cellular profiles were compared between patients with NTM-PD and those with other diffuse lung disorders. A secondary analysis compared infectious granulomatous disease (NTM-PD; n = 11) with noninfectious granulomatous disease (e.g., sarcoidosis; n = 8). Results: BAL fluid from patients with NTM-PD showed significantly higher levels of interleukin-8 (IL-8), interleukin-13 (IL-13), YKL-40, and neutrophils compared to those with other diffuse lung disorders. In subgroup analysis, IL-8, IL-13, and neutrophil proportions remained significantly elevated in infectious granulomatous NTM-PD compared with noninfectious granulomatous disorders. Conclusions: NTM-PD is associated with a distinct BAL cytokine profile characterized by elevated IL-8, IL-13, YKL-40, and neutrophil proportions.

Positive end-expiratory pressure (PEEP) increases end-expiratory lung volume through the addition of PEEP-induced lung volume (PEEPVol), potentially affecting respiratory mechanics and energy load. However, its physiological impact in patients without lung injury remains poorly characterized. We hypothesized that PEEPVol would be closely associated with respiratory system loading beyond conventional respiratory mechanics variables.

We conducted a secondary analysis of a prospective physiological study including 16 deeply sedated, mechanically ventilated adults without lung disease. A standardized incremental PEEP titration (0-16 cmH₂O, steps of 4 cmH₂O) was performed under volume-controlled ventilation. At each step, respiratory mechanics were assessed, including static compliance (Cstat), driving pressure, plateau pressure, and mechanical power. PEEPVol was estimated as PEEP × Cstat, and strain indices were derived relative to predicted functional residual capacity. Linear mixed-effects models evaluated changes across PEEP levels, and associations were initially explored using Spearman correlation and linear regression. To account for repeated measurements within subjects, confirmatory linear mixed-effects regression models were subsequently performed using patients as a random intercept.

Incremental PEEP significantly increased PEEPVol, plateau pressure, mechanical power, and both static and global strain (all p < 0.001), while changes in compliance and driving pressure were minimal and not clinically meaningful. PEEPVol showed moderate-to-strong correlations with plateau pressure (ρ = 0.68) and mechanical power (ρ = 0.76) and explained 43% and 56% of their variance, respectively (all p < 0.001);these associations remained significant in additional linear mixed-effects regression analyses accounting for within-subject correlation. PEEPVol also correlated strongly with static strain (ρ = 0.93) and global strain (ρ = 0.83); however, because static strain is calculated as PEEPVol/FRCt, this association is mathematically expected rather than an independent physiological finding and is reported here only for completeness. Notably, 11.1% of measurements exceeded Pplat > 30 cmH₂O and 61.9% exceeded MP ≥ 17 J/min, even at moderate PEEP levels.

In patients without lung injury, PEEP-induced increases in lung volume are strongly associated with higher mechanical load and strain, despite minimal changes in compliance or driving pressure. PEEPVol may represent a promising physiological surrogate of static lung deformation and energy transfer, whose potential to improve bedside detection of occult overdistension warrants validation against direct imaging or physiological measurements in larger prospective studies.

Post-COVID-19 syndrome represents a global health problem, manifesting with persistent multiple organ symptoms, including respiratory ones. This review aimed to evaluate the efficacy of different pulmonary rehabilitation interventions in the management of the disease, including its particularities.

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) statement and prospectively registered in the PROSPERO database (CRD420261292824). PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from January 2021 to January 2026. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Cochrane Risk of Bias 2 (RoB 2) tool. Twenty randomized controlled trials involving 2101 adult patients with post-COVID-19 syndrome met the eligibility criteria and were included in the qualitative synthesis.

Pulmonary rehabilitation (PR) demonstrated significant improvements in exercise capacity, with notable increases in 6MWT and VO₂max. Respiratory and peripheral muscle strength significantly increased. The quality of life, dyspnea and fatigue consistently improved. The results for intrinsic pulmonary function, anxiety, and depression were heterogeneous, suggesting benefits more related to reconditioning.

Pulmonary rehabilitation is an essential and efficient component in post-COVID-19 syndrome, improving physical function, respiratory and peripheral muscle strength, the quality of life, fatigue and dyspnea. Telerehabilitation is a viable alternative. Adapting protocols is crucial, recognizing that most benefits derive from physical reconditioning and muscle training, not necessarily from major structural pulmonary changes.

To investigate associations between air pollutants and hospitalization of patients with chronic obstructive pulmonary disease (COPD) in Kashi, and to identify susceptible populations.

We conducted a retrospective study of COPD patients in Kashi between 2012 and 2022. Daily pollutant concentrations were matched to residential addresses for individual exposure assessment. A time-stratified case-crossover design with conditional logistic regression was used to evaluate associations between pollutants and COPD hospitalization. Stratified analyses were performed by age, gender, smoking history and hospitalization season. Sensitivity analysis was conducted by excluding hospitalizations during the COVID-19 pandemic to test result robustness.

A total of 68,482 patients were included. The strongest significant association between particulate matter (PM₁₀) and COPD hospitalization was identified at lag day 4, particulate matter (PM_2.5), PM₁₀, nitrogen dioxide (NO2) and carbon monoxide (CO) exposures generally had relationships of COPD hospitalization [OR (95% CI): 1.015 (1.002-1.032), 1.008 (1.002-1.016), 1.034 (1.008-1.067), and 1.034 (1.005-1.065), respectively]. Individuals who are young, patients with a history of severe acute exacerbations, farmers, smokers, and individuals admitted in cooler seasons may be particularly susceptible. Sensitivity analyses omitting COVID-19 cases showed barely significant associations for PM_2.5, PM₁₀ and NO₂, with CO displaying only a faint, non-significant relationship.

PM_2.5, PM₁₀, NO₂, and CO exposures were associated with COPD hospitalization in Kashi, precautionary measures should be taken with a focus on vulnerable subgroups, to control hospitalization for COPD associated with air pollutants.

Sarcopenia and osteoporosis are common but underrecognized extrapulmonary manifestations of chronic obstructive pulmonary disease (COPD). When they coexist, functional limitation, falls, fractures, hospitalization, and mortality may be amplified. This structured narrative review synthesizes evidence available through April 1, 2026, focusing on shared mechanisms, clinical identification, diagnostic interpretation, and management. Coexisting muscle-bone impairment is plausibly driven by systemic inflammation, hypoxia and oxidative stress, physical inactivity, malnutrition, exacerbation-related catabolism, and systemic glucocorticoid exposure, with additional but incompletely validated myokine-osteokine signaling. Integrated assessment is most relevant for patients with systemic wasting, recurrent exacerbations or substantial systemic glucocorticoid exposure, marked activity limitation, falls or fragility fractures, or planned pulmonary rehabilitation. A stepwise pathway links low-burden functional screening with consensus-based muscle assessment and formal bone evaluation; opportunistic computed tomography (CT) and musculoskeletal ultrasound may add complementary information but lack universal COPD-specific thresholds. Management should combine individualized endurance, resistance, and balance training with nutritional support, fracture-risk management, and serial reassessment. Prospective multicenter studies are needed to determine whether this approach reduces fractures, rehospitalization, or mortality.

Acute respiratory tract infections place substantial strain on healthcare systems, particularly during seasonal respiratory surges and mass-gathering events. Delayed confirmation of respiratory pathogens contributes to diagnostic uncertainty, unnecessary antimicrobial use, delayed infection prevention decisions, and inefficient patient flow. Rapid molecular point-of-care testing (mPOCT) offers near-PCR-level diagnostic accuracy with turnaround times compatible with real-time clinical decision-making; however, implementation and integration into routine clinical pathways remain variable across healthcare systems.

We conducted an implementation-focused mixed-methods descriptive study integrating a synthesis of published evidence with structured stakeholder engagement in Saudi Arabia. Primary data were collected through three multidisciplinary scientific meetings and a stakeholder survey (N = 35) involving physicians, point-of-care experts, and laboratory professionals from Ministry of Health (MOH), institutional, and private healthcare settings. Quantitative survey data were analyzed descriptively using R version 4.3.3, including exploratory descriptive subgroup summaries by workplace sector and stakeholder role. Qualitative findings from expert discussions were synthesized thematically and integrated with survey findings and published evidence through methodological triangulation.

Physicians represented 48.6% of respondents, with most participants working in MOH facilities (60.0%). Rapid mPOCT was reported to be routinely used during respiratory seasons, with 68.6% indicating daily use. Immediate treatment decision-making (74.3%) and patient management activities, including bed designation (57.1%), were the most frequently reported indications for testing. Nearly half of respondents preferred results within 15 min (45.7%), while most preferred turnaround times of 30 min or less (85.7%). Participants reported generally moderate-to-high implementation of rapid mPOCT (mean implementation score 7.69/10; range 2-10), although variability remained in guideline integration, standard operating procedures, and institutional implementation. Frequently reported implementation barriers included limited education or guidance (31.4%), perceived availability of alternative diagnostic approaches (28.6%), and financial or reimbursement constraints (28.6%).

Saudi healthcare stakeholders perceived rapid mPOCT as a valuable diagnostic tool for respiratory infections, particularly in emergency and acute care settings where timely results may support clinical decision-making. Wider implementation will require standardized diagnostic pathways, workforce education, supportive governance, and sustainable reimbursement strategies to facilitate consistent integration into routine clinical practice.

Influenza is a contagious viral infection and a significant seasonal threat to public health. Vaccinating healthcare workers (HCWs) is a critical strategy for protecting vulnerable patients and the healthcare workforce. In the Gulf Cooperation Council (GCC) countries, vaccine uptake is <75%, despite the healthcare promotion initiatives and free vaccination campaigns. To guide future initiatives, this review aims to evaluate the evidence regarding influenza vaccine uptake among HCWs in the GCC, as well as the perceived enablers and barriers.

A comprehensive search was conducted across PubMed, Scopus, Google Scholar, and ScienceDirect for relevant studies published between 2010 and 2025. This review includes studies addressing influenza vaccine utilization and its determinants among HCWs in GCC countries.

Vaccine uptake rates across the GCC vary widely, from 36.9% in a study from Bahrain to 88.3% in Saudi Arabia during the Hajj season. Although higher than the global average, vaccine uptake in the GCC countries (about 51%), is still below the WHO target.

The desire for self-protection and protection of patients and family members were the commonly cited vaccination enablers. Institutional factors, including mandatory policies, employer recommendations, free on-site access, and targeted awareness campaigns, were strongly associated with higher uptake. Conversely, barriers such as fear of side effects, doubts about vaccine efficacy, misconceptions about the necessity of vaccination, and logistical constraints such as lack of time was commonly cited. Influenza vaccine coverage among HCWs in the GCC is suboptimal and highly variable. Mandatory institutional policies and accessible campaigns have proven to be effective enablers. To achieve WHO targets, future strategies focusing on mitigation of specific barriers such as educational efforts to counter misinformation, increase the convenience of vaccination and improve access for all HCWs across healthcare cadres.