Human metapneumovirus (hMPV) causes mild and self-limiting disease in adults. However, the risk factors for serious adverse outcomes following hMPV infection in adult patients without preexisting chronic airway diseases remain poorly understood. We conducted a territory-wide retrospective study on adult patients (aged ≥ 18 years) without chronic airway diseases hospitalized for hMPV infections between January 1, 2016 and June 30, 2023 in Hong Kong. We assessed the incidence and risk factors for in-patient mortality, severe respiratory failure (SRF), secondary bacterial pneumonia and acute kidney injury (AKI) were assessed. A total of 1552 eligible adult patients without chronic airway diseases hospitalized for hMPV infections were analyzed. Within the index admission, 92 (5.9%) patients died. Ischemic heart disease (IHD) was associated with increased risks of SRF [adjusted odds ratio (aOR) 2.00 (95% CI 1.48-2.71), p < 0.001]. IHD, heart failure (HF), and history of ischemic stroke were significant predictors for AKI [aOR 1.51 (95% CI 1.12-2.04), 2.87 (95% CI 2.14-3.85), and 1.47 (95% CI = 1.12-1.93), p = 0.007, < 0.001, and 0.005, respectively). Patients with end-stage kidney disease (ESKD) requiring renal replacement therapy (RRT) were at increased risk of in-patient mortality [aOR 6.36 (95% CI 2.34-17.26), p < 0.001] and SRF [aOR 8.80 (95% CI 3.84-20.16), p < 0.001]. The presence of cardiovascular diseases and ESKD requiring RRT is a strong predictor of severe in-hospital outcomes among adult patients without chronic airway diseases who are hospitalized for hMPV infections.

The COVID-19 pandemic disproportionately affected Indigenous populations, yet Métis-specific data remain limited. We described COVID-19-related experiences, physical and mental health, health behaviours, and socio-economic wellbeing among Métis people in Alberta (Canada) during the early pandemic.

Misi Yehewin was a cross-sectional survey series conducted with the Otipemisiwak Métis Government of the Métis Nation within Alberta. Self-identified Métis aged ≥16 years completed surveys in three phases: December 2020-January 2021 (Wave 1), March-April 2021 (Wave 2), and November-December 2021 (Wave 3). Each wave included an independent sample of participants. We calculated weighted proportions for 28 key items and compared estimates across waves.

Overall, 2,439 participants completed the surveys. Confirmed COVID-19 cases were reported by 5% of participants in Wave 1 and 15% in Wave 3. Reports of worsening physical and mental health were less frequent in later phases; yet, across waves, 41% screened positive for depressive symptoms, 47% for anxiety, and 68% for high perceived stress. Food insecurity was reported by 39.4% of participants in Wave 1 and 52.9% in Wave 3. Reduced family time and cultural activities were common, particularly in earlier waves. Reports of financial strain (~56%), racism (~25%), and strong Métis identity (~89%) was similar across waves.

Findings highlight ongoing structural inequities influencing Métis health during COVID-19. Despite fewer reports of worsening overall health in later phases, symptom-based measures showed persistently high perceived stress and widespread food insecurity. Métis-led, culturally grounded strategies are needed to address both immediate and long-term determinants of health.

Tuberculosis (TB) primarily manifests as pulmonary TB (PTB), but extrapulmonary TB (EPTB) remains a major clinical challenge. Distinct diagnostic and therapeutic difficulties arise from differences in immune responses, pathogen behaviour and host susceptibility. However, the factors driving disease localisation are still incompletely understood. We conducted a comprehensive narrative review of studies examining differences between PTB and EPTB in terms of epidemiology, mycobacterial factors, genetic and epigenetic determinants, host immune responses, transcriptomic profiles, cytokine and chemokine patterns, and immunophenotypes. EPTB is more common among females, children, older adults and immunocompromised individuals with deficient granuloma formation. This review is intended to provide deeper insight for clinicians and researchers and provides an accessible synthesis of current basic science findings together with their relevance for clinical practice. Certain Mycobacterium tuberculosis lineages, notably lineage 1, and specific virulence factors are associated with extrapulmonary dissemination. While genetic polymorphisms influence TB localisation, no studies specifically addressing epigenetic predisposition to EPTB were identified. PTB typically is characterised by T-helper 1-driven immunity, high bacillary loads and robust macrophage activation, whereas EPTB involves compartmentalised immune responses, reduced cytotoxicity and broader cytokine variability. Transcriptomic analyses reveal site-specific gene expression differences and emerging diagnostic blood-based biomarkers show promise but require further validation. Cytokine profiles and immunophenotyping suggest greater immune exhaustion and regulatory T-cell activity in EPTB. We outline practical implications for diagnosis and management and highlight constraints in resource-limited settings and emphasise access and implementation considerations. Integrating these clinical and mechanistic insights can guide more timely recognition and tailored care.

The Non-Specific Pattern (NSP) is characterized by a reduced Forced Expiratory Volume in 1 s (FEV₁) and/or Forced Vital Capacity (FVC), a preserved FEV₁/FVC ratio, and a normal Total Lung Capacity (TLC). Although recognized in recent American Thoracic Society/European Respiratory Society (ATS/ERS) recommendations, this pattern remains poorly understood.

To systematically review the literature addressing the NSP in adult patients, with a focus on its physiological definition, clinical correlates, underlying mechanisms, and longitudinal outcomes.

A systematic search was conducted in PubMed and Embase from inception to 16 June 2025, following PRISMA guidelines. Eligible studies included adults presenting a physiologically defined NSP. Seven retrospective studies were included and appraised using the Joanna Briggs Institute checklist.

Across included studies, NSP was consistently defined using core physiological criteria, though specific thresholds and diagnostic strategies varied. Etiologies included asthma, obesity, obstructive sleep apnoea, interstitial lung disease, and neuromuscular disorders. Several functional markers, such as increased Residual Volume (RV)/TLC ratios, Slow Vital Capacity (SVC)-FVC differences >100 mL, and reduced FEV₁/SVC ratios, suggested early small airway involvement or masked restriction. Two longitudinal studies revealed that NSP may evolve toward obstruction or restriction, with baseline bronchodilator responsiveness and elevated airway resistance as predictors of obstruction. Despite the clinical implications, therapeutic management remains unexplored.

NSP is not a benign or incidental respiratory functional profile. It may represent an early or intermediate functional state between classic obstructive and restrictive defects. Complementary functional markers and structured follow-up may aid in clinical interpretation and risk stratification.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary objective To assess the benefits and harms of tenecteplase compared to alteplase in people suffering from large vessel occlusion or non-large vessel occlusion acute ischemic stroke. Secondary objective To explore the effects of the interventions (tenecteplase and alteplase) in different groups based on age, sex, ethnicity, and place of residence (high-, middle-, low-income country), to inform health equity considerations.

This article describes the case of a 68-year-old woman presenting with acute dizziness and double vision, diagnosed with wall-eyed bilateral internuclear ophthalmoplegia (WEBINO). She experienced unprovoked, nonpositional dizziness, and binocular double vision that improved with eye closure. Neurological examination showed right eye exotropia, left eye hypertropia, mild right eyelid ptosis, and impaired extraocular movements, especially in elevation and adduction. Diagnostic tests including blood work and cerebrospinal fluid analysis were largely normal, but brain magnetic resonance imagingindicated symmetric diffusion-weighted imaging brightening in the bilateral midbrain, suggesting an acute infarction. WEBINO, a rare neuro-ophthalmological disorder often linked to brainstem strokes or demyelinating diseases, is characterized by bilateral medial rectus weakness due to lesions in the medial longitudinal fasciculus. The case underscores the importance of thorough clinical and radiological evaluation in diagnosing atypical presentations of neuro-ophthalmological disorders, with management focused on treating the underlying cause and providing symptomatic relief for diplopia.

Takotsubo cardiomyopathy (TCM), also known as stress cardiomyopathy, affects 0.02% of hospitalized patients and is primarily triggered by emotional stressors, although unusual medical situations have also been documented. We report the case of a 36-year-old female patient who presented with symptoms of infection (oropharyngeal pain and diarrhea) 10 days before admission. Upon arrival at the emergency department, she exhibited progressive weakness, lower cranial nerve involvement, and areflexia, necessitating invasive mechanical ventilation support. Diagnostic evaluation revealed sinus tachycardia and atrial fibrillation, leading to a diagnosis of Guillain-Barré syndrome (GBS) with associated cardiovascular dysautonomia. Echocardiography demonstrated apical hypokinesia of the left ventricle, consistent with TCM. Furthermore, her thyroid profile indicated hyperthyroidism, fulfilling the criteria for a thyroid storm. Treatment comprised intravenous human immunoglobulin, methimazole, and propranolol. We present the first documented case of TCM attributed to dysautonomia resulting from GBS and thyroid storm.

Physical activity (PA) is a widely accepted non-pharmacological therapy for patients with Alzheimer's disease (AD). Existing studies have demonstrated that PA can improve cognitive function in AD patients. However, few of the meta-analyses conducted to date have included participants with a confirmed AD diagnosis that meets standardized diagnostic criteria, nor have they systematically evaluated the interactions between different intervention parameters. The aim of this study was therefore to investigate the effects of PA on cognitive function improvement in AD patients, and how different intervention parameters may influence the effect sizes.

Two investigators independently conducted systematic searches in four international databases (PubMed, Web of Science, Embase, and Cochrane Library) and two Chinese databases (China National Knowledge Infrastructure [CNKI] and VIP Database [VIP]) while adhering to PRISMA guidelines. The search was limited to randomized clinical trials (RCTs) and covered each database from its inception to March 31, 2025. The methodological quality of included studies was assessed using criteria from the Cochrane Handbook 5.1.0. All analyses were performed using Stata 15.0.

The meta-analysis included 13 RCTs with a total of 813 AD patients. PA significantly improved Mini-Mental State Examination (MMSE) scores in AD patients (Weighted Mean Difference [WMD] = 1.79, 95% CI: 1.03 to 2.55, p < 0.001). Subgroup analyses showed that interventions with moderate intensity (WMD = 2.12), a single session duration of 30 min (WMD = 2.15), a frequency of >3 times per week (WMD = 3.03), a total weekly intervention time of >120 min (WMD = 2.10), and a total intervention duration of >12 weeks (WMD = 1.95) significantly improved MMSE scores. Meta-regression analysis revealed that intervention frequency (p < 0.001) and total intervention duration (p = 0.002) were significantly correlated with improved cognitive function, while the intervention intensity (p < 0.001) and single session duration (p = 0.002) showed negative correlations.

Our findings suggest that PA interventions can improve MMSE scores and enhance cognitive function in AD patients. We recommend that PA interventions for AD patients consist of moderate-intensity, a single session duration of 30 min, a frequency of >3 times per week, a total weekly intervention time of >120 min, and a total intervention duration of >12 weeks. The PROSPERO Registration: CRD420250631766. https://www.crd.york.ac.uk/PROSPERO/view/CRD420250631766.

Background and Objective: Previous studies have shown that experience of racial discrimination is associated with increased mental health problems, especially stress. Using a cluster analytical procedure, the current study aimed to examine stress characteristics related to racial discrimination in individuals from diverse racial identities.Method: In total, 4220 participants completed the questionnaires assessing stress, resilience, everyday racial discrimination, and experience of major racial discrimination. K-means cluster analysis was performed to cluster participants' features regarding stress, resilience, everyday racial discrimination, and major racial discrimination. To determine the optimal number of clusters, the gap statistic was employed. Extracted clusters were then compared across racial groups using chi-square tests.Results: Cluster analysis revealed a three-cluster solution, including 'low stress', 'stress cluster with high racial discrimination', and 'stress cluster with low racial discrimination' clusters. Concerning the race-differences, Black (32.57%) and Indigenous (33.63%) participants had higher membership in the stress cluster with high racial discrimination compared to other racialized groups. Regarding the stress cluster with low racial discrimination, a higher membership was observed among Arab participants (30.82%) and those with other racial identities (30.40%) compared to other racialized groups.Conclusions: The findings demonstrate a type of stress characterized by high levels of racial discrimination and accompanying psychosocial burdens. Implications for intervention, prevention, and future research are discussed in the paper.

Body weight misperception is increasingly prevalent among adolescents, yet the association between weight misperception and academic performances is unclear. This study aims to examine the association among weight misperception and academic performances among Chinese adolescents and estimate the mediating effect of loneliness on this association.

This repeated cross-sectional study uses data of adolescents aged 13-19 years, collected from the Ningbo Youth Risk Behavior Surveys from 2007 to 2022. Data of anthropometric, demographic, weight perception, mood, and academic performance information were collected via self-reported questionnaires. Multivariate logit regression is used to investigate the association between weight misperception and academic performance. A generalized structural equation model is used to assess the mediating effect of loneliness on this association.

The sample sizes for each wave were 921, 909, 1,555, and 2,690. Adolescents with overestimation of body weight were significantly associated with higher odds of having poor academic performances for both girls (OR: 1.23, 95% CI: 1.03-1.46) and boys (OR: 1.45, 95% CI: 1.18-1.77). Specifically, body weight overestimation was significantly associated with higher odds of loneliness for girls (OR: 1.28, 95% CI: 1.05-1.56) and boys (OR: 1.40, 95% CI: 1.11-1.75), while loneliness was significantly associated with poorer academic performances for girls (OR: 1.34, 95% CI: 1.05-1.71) and boys (OR: 1.31, 95% CI: 1.09-1.59). Loneliness played a mediating role in the association between overestimation of body weight and poor academic performances, with indirect effects of 58.19 and 55.85% for girls (OR: 1.69, 95% CI: 1.14-2.24) and boys (OR: 1.81, 95% CI: 1.28-2.34), respectively.

Overestimation of body weight is associated with poorer academic performances in Chinese adolescents, mediated by loneliness. This finding suggests that family and school-based health education and psychological interventions, such as education on body image, targeted mental health consulting, mutual aid networks, fostering inclusive classroom, and family-school collaboration, should be encouraged to the well-being of adolescents.