Monitoring Of Function Research Articles

Core outcome set of daily monitoring of gastrointestinal function in adult critically ill patients: a modified Delphi consensus process (COSMOGI)

PurposeGastrointestinal (GI) dysfunction is common in critically ill patients and associated with poor outcomes. There is a lack of standardised methods for daily monitoring of GI function. COSMOGI aimed to develop a Core Outcome Set (COS) for daily monitoring of GI function to improve consistency and comparability in future studies in critically ill patients.MethodsA modified Delphi consensus process engaging healthcare providers, clinical researchers, and patient representatives was performed. A systematic review identified existing parameters to monitor GI function, informing the development of potential outcomes. In Stage 1, participants rated outcomes (i.e., variables used for daily monitoring). In Stage 2, they refined and agreed on the definitions for the selected outcomes. The COS was ratified through consensus meetings.Results368 individuals registered for the Delphi process. 285 participants (77.4%) completed Stage 1, and 181 participants (63.5%) completed Stage 2. From 77 potential outcomes, 13 essential outcomes for daily monitoring of GI function in studies, each with an agreed-upon definition, were established: abdominal distension, bowel dilatation, intra-abdominal pressure, abdominal pain, stool passage, vomiting, GI bleeding (upper and lower), use of parenteral nutrition due to intolerance of enteral nutrition, prokinetics, postpyloric feeding due to gastroparesis, lower GI paralysis, gastroparesis, intolerance to enteral nutrition.ConclusionsUsing a modified Delphi consensus process, COSMOGI established a COS for monitoring GI function in critically ill patients in research. This COS and definitions provide a framework to guide future research, enabling comparability across studies and allowing for future definitions of GI dysfunction.Trial registration: This project was registered at (www.comet-initiative.org) on 27.03.2023 (number 2609) and was an ESICM-endorsed research project.

An integrated, multidisciplinary management team intervention to improve patient-centeredness, HIV, and maternal-child outcomes in Lesotho: formative research on participatory implementation strategies

BackgroundReducing perinatal HIV transmission and optimizing maternal and child health (MCH) outcomes in high HIV prevalence settings is an urgent, but complex, priority. Extant interventions over-emphasize individual-level provider and patient behaviors, and neglect critical health systems-level changes. The ‘Integrated Management Team to Improve Maternal-Child Outcomes (IMPROVE)’ study implemented a three-part, patient-centered, health-systems-level intervention to improve MCH and HIV outcomes in Lesotho. Ensuring intervention fit within the health systems context is important, but often overlooked. This manuscript describes implementation research conducted to tailor and adapt intervention implementation to optimize appropriateness, acceptability, and feasibility. It identifies resulting implementation variation across study sites and lessons learned.MethodsThe research team reviewed intervention implementation documentation and conducted structured reflections to: 1) assess implementation strategy adaptations, 2) identify facility-specific strategies employed to improve the MCH patient experience, and 3) synthesize lessons.ResultsFacility-based, integrated, multi-disciplinary management teams (MDT) were feasible and acceptable to establish through engagement with facility leadership and facilitation of a participatory training curriculum that established shared values between cadres supporting MCH, and identified facility-specific service delivery gaps and potential solutions. Ongoing MDT meetings provided coordination between facility and community-based MCH service providers to implement early ANC follow-up. Facility-specific improvement strategies included fee, staffing, and patient documentation-based changes. Piloting Positive Health, Dignity, and Prevention-focused counseling approaches resulted in tailored job aids pre-implementation. Leadership involvement was critical for improved coordination while staff turnover and competing donor priorities challenged MDT efforts.ConclusionsIMPROVE created facility-specific adaptation opportunities through participatory intervention implementation practices. The MDTs, benefitting from leadership support, built relationships between HCW cadres, led facility-specific quality improvements, and, importantly, offered HCWs sought-after positive feedback by recognizing HCW efforts. The coordination, monitoring and cross-cadre communication functions of the MDTs supported implementation of other interventions, and may serve as a valuable platform for improving patient-centered care practices in similar settings and for other health services. Trial registration number: NCT04598958, 05 October 2020, retrospectively registered.Trial registrationClinicalTrials.gov, NCT04598958. Registered 05 October 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT04598958

Chronic wound management: a liquid diode-based smart bandage with ultrasensitive pH sensing ability

Chronic wounds, which require prolonged healing periods, pose significant impacts on individuals with diabetes, vascular diseases, and high blood pressure. Simultaneous drainage and monitoring of wound exudate are vital for advanced wound management. However, recently reported smart dressings either lack integration of wound cleaning and monitoring functions or fail to achieve dynamic in situ monitoring of wound status, which hinders their ability to meet the demands of wound care. In this study, a smart bandage is introduced, which integrates a biocompatible liquid diode membrane with an ultrasensitive 3D polyaniline mesh (M-PANI)-based pH biosensor. The smart bandage allows for unidirectional drainage of wound exudate while dynamically sensing the wound pH environment. Specifically, the proposed smart bandage effectively cleans excessive wound exudate while providing real-time information on the wound status during the drainage process. The M-PANI-based pH biosensor demonstrates a high sensitivity of 61.5 mV/pH and a wide pH detection range from 4.0 to 10.0, encompassing the pH range of normal and infected wounds. Moreover, the sensing module exhibits excellent stability after 48 hours of dynamic testing and 28 days of storage, with only a 4.8% decline in the detected signal, and high repeatability with a device-to-device relative standard deviation (RSD) of 3.1%. To evaluate the practicality of this smart bandage, simulated skin and rats have been employed, and the results indicate the immense potential of this smart bandage for clinical applications. In conclusion, the present smart bandage demonstrates considerable promise for wound exudate cleaning and monitoring in advanced wound care and offers a promising method for home-based wound management.

Cardiac function monitoring during marathon training based on smart medical wearable sensor device

In recent years, intelligent wearable sensor devices have developed rapidly and can be seen everywhere in daily life. With the rapid development of electronic components and the continuous improvement of their performance, intelligent wearable intelligent products have gradually become possible and have shown explosive growth. In addition, intelligent wearable electronic devices have many advantages that traditional devices do not have. With the popularity of fitness wearable devices, intelligent wearable devices can also be used for real-time heart rate and dynamic electrocardiogram (ECG) monitoring during marathon sports. It can effectively prevent sudden death. During marathon training and other health services, it is very important to use intelligent wearable sensor devices to monitor heart function. This paper puts forward a heart function monitoring system for marathon training based on intelligent wearable sensor, expounds the origin of marathon sports and the importance of heart function monitoring for marathon athletes during training. This paper discusses the technology and construction method of heart rate monitoring system based on intelligent wearable sensor device. At the same time, relevant experiments are carried out to verify the relevant performance of the intelligent wearable sensor device in the algorithm. The results show that the R wave detection accuracy of wearable devices based on traditional algorithms is usually between 92% and 93%. The R wave detection accuracy of the intelligent wearable sensor device improved by the algorithm in this paper has been improved to more than 97%, and the R wave detection accuracy of the algorithm in this paper is much higher than that of the traditional algorithm. This also reflects the effectiveness of the intelligent wearable sensor device of the algorithm during the training of marathon athletes.

Effects of roxadustat on thyroid profiles in patients and animals with chronic kidney disease.

Background Roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor used in renal anemia treatment, has been associated with thyroid hormone suppression. This study investigated the patterns of thyroid profile changes following roxadustat administration and their clinical implications. Methods In this retrospective study (2019-2023) at Shenzhen Second People's Hospital, patients were categorized based on TSH reduction during follow-up (≥50% decrease vs<50% decrease). Thyroid profiles, clinical symptoms, and laboratory indicators were analyzed. Quality of life was assessed using EQ-5D-3L and ThyPRO questionnaires. Complementary animal experiments were conducted to verify the effects of roxadustat on thyroid function. Results A total of 118 patients were finally enrolled in our study. Among patients with initially normal thyroid function, 31 developed euthyroid sick syndrome post-roxadustat treatment. Treatment significantly decreased T3, FT3, FT4, and TSH levels, with TSH showing marked reduction within the first 10 weeks. Contrastingly, animal models exhibited decreased T3 but increased TSH levels, regardless of renal status. Blood lipid levels decreased in all patients, particularly in those with substantial TSH reduction. Despite thyroid alterations, quality of life scores remained unchanged between roxadustat-treated and untreated patients, with no overt clinical symptoms in either humans or animals. Conclusions While roxadustat induces significant thyroid hormone suppression in patients, these alterations rarely manifest as clinical symptoms. Euthyroid sick syndrome is the predominant thyroid dysfunction pattern observed. Regular thyroid function monitoring is recommended during roxadustat therapy, particularly during the initial treatment phase when TSH changes are most pronounced.

Machine‐Learning Enabled Biocompatible Capacitive‐Electromyographic Bimodal Flexible Sensor for Facial Expression Recognition

AbstractSingle‐mode sensors suffer from poor robustness and insufficient data features in facial expression recognition, so fusing multi‐sensor signals is the key to improving the accuracy of expression recognition systems. Here, a biocompatible capacitive‐electromyographic dual‐mode sensor (CEDS) is presented, consisting of a capacitive pressure sensing unit and dry electrodes for electrophysiological signal monitoring, assembled in a 3D stacking fashion. A double‐coupled microstructure is prepared and the electrical double‐layer effect is realized by doping ionic liquid, which significantly improves the capacitive performance of the sensor. The application of dry electrodes effectively solves the problems of hydrogel electrodes that are prone to water loss and skin irritation. Besides, the good biocompatibility and antimicrobial properties of CEDS are verified through cytotoxicity and bacteriostatic tests. Based on the sensing of a single signal, a fatigue driving monitoring system and a manipulator control system are constructed respectively. By further integrating the capacitive and electrophysiological signal monitoring functions of CEDS, a 1D convolutional neural network‐assisted facial expression recognition system is constructed, which effectively improves the accuracy of expression recognition and demonstrates the great potential of facial expression monitoring systems based on flexible sensor technology in practical applications.

The natural history of untreated X-linked nephrogenic diabetes insipidus with mutation in the vasopressin V2 receptor gene.

Nephrogenic diabetes insipidus (NDI) results from the kidneys' inability to concentrate urine. We describe a 6-month-old male with a history of poor weight gain who presented with an incidental finding of hypernatremia (155mEq/L) during an episode of acute gastroenteritis. The arginine vasopressin (AVP) test, along with molecular analysis revealing the M272R mutation in the AVP receptor 2 (AVPR2) gene, confirmed the diagnosis of congenital NDI. Interestingly, this mutation was also identified in the patient's maternal grandfather, who had never been diagnosed or treated for NDI despite a history of polydipsia, polyuria, and evidence of chronic kidney disease (CKD), severe bilateral hydronephrosis, hypertension, and severe bladder dysfunction. Early intervention with hydrochlorothiazide in the infant resulted in a significant reduction in urinary output and improved growth. The untreated grandfather's case highlights the potential severity of untreated NDI and the benefits of timely therapeutic intervention. This report contributes to the limited long-term data on congenital NDI, emphasizing the critical role of early detection and consistent management in preventing severe complications such as CKD, hydronephrosis, and bladder dysfunction. Regular follow-up, including renal ultrasound and monitoring of renal function, is essential for effectively managing NDI and improving patient outcomes.

Fatal Paraquat Poisoning: A Case Report

Abstract: Paraquat, a widely used herbicide, is notorious for its high toxicity and limited antidotal options. This case report details the clinical presentation, management strategies, and outcomes of a patient with paraquat poisoning. A 32-year-old male presented to the emergency department with a history of intentional ingestion of paraquat. The patient exhibited signs of acute toxicity, including gastrointestinal distress, respiratory distress, and multi-organ failure. Prompt recognition and initiation of treatment were crucial in navigating the complex clinical course. The treatment protocol involved aggressive decontamination, administration of activated charcoal, and utilization of specific antidotes such as cyclophosphamide and methylprednisolone. The patient received supportive care, including mechanical ventilation and hemodynamic support. Continuous monitoring of renal and hepatic functions was implemented to detect and manage complications promptly. Despite the aggressive therapeutic approach, the patient faced significant challenges, with progressive deterioration of respiratory and renal functions. The case highlights the limited efficacy of current treatment modalities in severe paraquat poisoning. The patient eventually succumbed to multi-organ failure, underscoring the need for further research to explore alternative interventions. Paraquat poisoning remains a significant clinical challenge with high mortality rates. This case report emphasizes the importance of early recognition, aggressive decontamination, and advanced supportive care in managing paraquat toxicity. Further research is imperative to explore novel treatment strategies and improve outcomes in cases of severe paraquat poisoning.

Effect of thyroid peroxidase antibody titers trajectories during pregnancy and postpartum on postpartum thyroid dysfunction.

To identify risk factors contributing to the development of postpartum hypothyroidism in women newly diagnosed with subclinical hypothyroidism (SCH) during the first trimester of pregnancy (T1). Additionally, this study aimed to explore the impact of thyroid peroxidase antibody (TPOAb) titers trajectories throughout pregnancy and postpartum. Thyroid hormone levels and thyroid autoantibody titers were collected from T1 to the 12th month postpartum. Logistic regression analysis was employed to identify independent risk factors for hypothyroidism at the 12th month postpartum and to develop a prediction model. Model performance was assessed through discrimination, calibration, and clinical applicability, with internal validation using the bootstrap resampling method. Growth Mixture Modeling was applied to delineate the trajectory of TPOAb titers during pregnancy and postpartum, and logistic regression analysis was conducted to investigate the influence of these trajectories on the occurrence of postpartum hypothyroidism. At the 12th month postpartum, hypothyroidism was either newly diagnosed or persisted in 76 of 209 cases (36.36%). Several significant risk factors for postpartum hypothyroidism were identified, including multiparity, positive TPOAb in T1, positive TPOAb and thyroglobulin antibody in T1, serum thyroid-stimulating hormone levels at SCH diagnosis in T1, and the final dose of levothyroxine in the third trimester. A prediction model was constructed and presented with a nomogram. Furthermore, a higher trajectory of serum TPOAb titer during pregnancy and postpartum emerged as a predictive factor for hypothyroidism at the 12th month postpartum. Women with elevated TPOAb titers during pregnancy and postpartum necessitate ongoing and vigilant monitoring of thyroid function, even after childbirth.

The impact of chronic kidney disease on prognosis in acute stroke: unraveling the pathophysiology and clinical complexity for optimal management.

Chronic kidney disease (CKD) significantly increases stroke risk and severity, posing challenges in both acute management and long-term outcomes. CKD contributes to cerebrovascular pathology through systemic inflammation, oxidative stress, endothelial dysfunction, vascular calcification, impaired cerebral autoregulation, and a prothrombotic state, all of which exacerbate stroke risk and outcomes. This review synthesizes evidence from peer-reviewed literature to elucidate the pathophysiological mechanisms linking CKD and stroke. It evaluates the efficacy and safety of acute reperfusion therapies-intravenous thrombolysis and endovascular thrombectomy-in CKD patients with acute ischemic stroke. Considerations, such as renal function, drug dosage adjustments, and the risk of contrast-induced nephropathy, are critically analyzed. Evidence-based recommendations and research priorities are drawn from an analysis of current practices and existing knowledge gaps. CKD influences stroke outcomes through systemic and local pathophysiological changes, necessitating tailored therapeutic approaches. Reperfusion therapies are effective in CKD patients but require careful monitoring of renal function to mitigate risks, such as contrast-induced nephropathy and thrombolytic complications. The bidirectional relationship between stroke and CKD highlights the need for integrated management strategies to address both conditions. Early detection and optimized management of CKD significantly reduce stroke-related morbidity and mortality. Optimizing stroke care in CKD patients requires a comprehensive understanding of their pathophysiology and clinical management challenges. This article provides evidence-based recommendations, emphasizing individualized treatment decisions and coordinated care. It underscores the importance of integrating renal considerations into stroke treatment protocols and highlights the need for future research to refine therapeutic strategies, address knowledge gaps, and consider tailored interventions to improve outcomes and quality of life for this high-risk population.

Exploring the dark side of diagnostic dyes with a focus on Indocyanine green’s adverse reactions

Indocyanine green (ICG) is a diagnostic dye commonly used in medical imaging and liver function monitoring. Given its widespread use, there is a need for detailed evaluations of its adverse drug reactions in real-world settings. As the comprehensive overview of its safety profile is very limited, this study aimed to analyze the adverse events (AEs) associated with ICG using data from the Food and Drug Administration Adverse Event Reporting System (FAERS). Data between 2004Q1 and 2023Q4 were extracted from the FAERS database. Signal detection was performed using various disproportionality analysis algorithms, including reporting odds ratio (ROR), proportional reporting ratio, Bayesian confidence propagation neural network, and multiitem gamma Poisson shrinker. During the study period, a total of 62 ICG-related AEs were reported in the FAERS database. Significant clinical adverse reactions included anaphylactic shock (ROR: 92.10, 95% confidence interval (CI): 37.71-224.96), procedural hypotension (ROR: 1397.27, 95% CI: 443.31-4404.08), and urticaria (ROR: 10.88, 95% CI: 4.02–29.42). This study provides valuable insights into the safety profile of ICG, highlighting the need for further monitoring to ensure its safe clinical use in clinical practice. Ongoing pharmacovigilance and large-scale studies are warranted to fully understand the potential risks associated with ICG.

Association Between Age-Related Macular Degeneration With Visual Disability and Risk of Dementia: A Nationwide Cohort Study

ObjectivesTo investigate the prospective association between the risk of dementia and age-related macular degeneration (AMD) in patients with related visual disability (VD). DesignA nationwide population-based cohort study used authorized data provided by the Korean National Health Insurance Service. Setting and ParticipantsA total of 1,788,457 individuals aged >50 years who participated in the Korean National Health Screening Program were enrolled. MethodsFrom January 2009 to December 2019, participants were tracked for a diagnosis of dementia using registered diagnostic codes from claims data. Participants with VD were defined as those registered in a national disability registration established by the Korean government. The prospective association of AMD and related VD with new-onset dementia was investigated using a multivariate-adjusted Cox proportional hazard model adjusted for age, sex, body mass index, income level, systemic comorbidities, psychiatric diseases, and behavioral factors. ResultsDuring the average follow-up period of 9.7 ± 2.16 years, 4260 of 21,384 participants in the AMD cohort and 137,166 of 1,662,319 participants in the control cohort were newly diagnosed with dementia, respectively. Participants diagnosed with AMD showed a higher risk of new-onset dementia than those in the control group in the fully adjusted model [hazard ratio (HR) 1.11, 95% CI 1.07–1.14]. The risk of dementia was higher in participants diagnosed with AMD and associated VD (HR 1.28, 95% CI 1.15–1.43) compared to those without VD (HR 1.09, 95% CI 1.06–1.13). Conclusions and ImplicationsA diagnosis of AMD was associated with an increased risk of all-cause dementia and its major subtypes. Close monitoring of cognitive function in AMD patients, especially those with VD, may help in early detection of all-cause dementia, which could reduce the socioeconomic burden and improve the quality of life of patients.

Integrating Remote Sensing and GIS for Precision Agriculture: Leveraging Google Earth Engine for Enhanced Agricultural Management

Abstract This study aims to develop a plant health monitoring platform using Google Earth Engine and Sentinel-2 satellite imagery. This platform enables real-time and accurate monitoring of plant conditions in Ponorogo Regency, supporting better decision-making in agricultural management. The platform utilizes high-resolution multispectral data such as the NDVI, Chlorophyll Vegetation Index, and Normalized Difference Built-up Index to generate vegetation indices, providing comprehensive information about plant structure and condition. The Google Earth Engine platform offers a robust platform for monitoring and analysis functions within the platform, providing valuable insights for precision agriculture applications

Lecanemab Planning: Blueprint for Safe and Effective Management of Complex Therapies.

Approximately 6.9 million American individuals have Alzheimer dementia and 50% have mild disease. Lecanemab, an approved antiamyloid antibody, is associated with modest reduction in functional decline in patients with mild dementia or mild cognitive impairment. In Clarity-AD, 239 (26.6%) of patients experienced amyloid-related imaging abnormalities (ARIAs) overall (i.e., ARIAs associated with hemorrhages or edema). The complexity of treatment and risks of adverse events necessitate a multidisciplinary collaborative approach. With limited treatment options, lecanemab approval generated significant interest among clinicians, patients, and families. Lecanemab treatment requires biweekly infusions along with ongoing imaging tests, laboratory monitoring, patient assessment, drug interaction screening, and cognitive function monitoring. Processes to support patient selection, access, and safety are important given the monitoring requirements and total cost of care. The planning process for lecanemab can serve as a blueprint to support safe and effective management of therapeutic innovation in neurology and other areas.

Thyroid Disorders in Patients with Polycystic Ovarian Syndrome in a Tertiary Care Center: An Observational study

Introduction: Polycystic ovarian syndrome is the most common endocrine and metabolic disorder in women of childbearing age, affecting 3–15% of women worldwide, leading to reproductive, metabolic, and psychological issues. Patients with polycystic ovarian syndrome require rigorous thyroid function detection, monitoring, and correction over time. In this study, we aimed to evaluate the clinical presentations and thyroid dysfunction in patients with polycystic ovarian syndrome.Methods: An observational study was done in patients with polycystic ovarian disease presenting to a tertiary care centre over six months, from December 2023 to May 2024 Total population sampling was done. All the women during the study period diagnosed with polycystic ovarian disease based on Rotterdam criteria were included in the study after getting ethical approval from the institutional review board. (Reference number: 20102023/03).Results: The mean age of women in the study was 24.74±5.01 years. A total of 28 (31.46%) patients of polycystic ovarian disease had hyperthyriodism, hypothyroidism was found in 13 (14.60%) and subclinical hypothyroidism was found in 6 (6.74%) patients. All the women had menstrual irregularities. Regarding androgenic characteristics, 53 (59.55%) of patients presented with hirsutism, 43 (48.51%) presented with acne, 13 (14.61%) women had alopecia, and 4 (4.49%) women had acanthosis.Conclusions: Hyperthyroidism, hypothyroidism and subclinical hypothyroidism were prevalent in polycystic ovarian disease patients, emphasizing the need for thorough thyroid evaluation in polycystic ovarian disease patients due to its impact on metabolic and reproductive health. High rates of menstrual irregularities, androgenic symptoms like hirsutism and acne, and fertility challenges were also prevalent, aligning with findings from similar studies.

Serum trypsin is a reliable biomarker of pancreas function.

Pancreatic diseases pose significant diagnostic and therapeutic challenges necessitating robust biomarkers for accurate diagnosis, management and monitoring of pancreas function. Pancreas function can be measured with direct (invasive) and indirect tests. However, both approaches do not allow continuous disease monitoring to identify disease progression or therapeutic response. We demonstrate literature evidence suggesting that trypsin, an important pancreatic digestive enzyme, holds promise as such a continuous biomarker. On one hand, assessment of trypsin concentration in the serum sensitively and specifically detects pancreas inflammation; whereas on the other hand, declining trypsin levels in serum showed good correlation with direct pancreatic function tests to identify exocrine pancreatic insufficiency. With this comprehensive review, we aimed to evaluate the existing evidence on the utility of trypsin as a continuous biomarker, spanning from acute to chronic pancreatitis and pancreas function, highlighting its potential in monitoring disease evolution on an individual patient level.

The Future of Smart Housekeeping in Multiple Scenarios

With the development of the social economy and the improvement of material living standards, multi-scenario intelligent housekeeper brings convenience and security to people's lives, improve the quality of the human living environment, and enable us to save more time and have higher efficiency. In this article, we introduce some background of smart home, there are also categories of smart homes on the market, but now in the market under the multi-scene intelligent butler is not very perfect, so in this work, we need to focus on the problems that have emerged, Including improper operation, execution of wrong commands, lack of compatibility, smart furniture privacy is not enough, expensive and other problems. We also studied the development trend of smart home products, including some functional development and future development of the research content. For example, voice recognition and voice response system, Bluetooth system, infrared temperature measurement module, monitoring, automatic sleep and other functions and some simple analysis of these functions are carried out. In my opinion, the future development of smart home in multiple scenarios is a process full of opportunities and challenges, and we need to continue to explore and innovate. Only in this way can we ensure the sustainable development and social acceptance of smart homes.

Chronic obstructive pulmonary disease as a risk factor for cognitive impairment: a systematic review and meta-analysis

BackgroundCognitive impairment is affecting plenty of patients with chronic obstructive pulmonary disease (COPD), and it is the main leading cause of quality of life to varying degrees. However, there are...

Hepatitis and Hepatitis B Virus Reactivation in Everolimus-Treated Solid Tumor Patients: A Focus on HBV-Endemic Areas.

Everolimus is approved for treating breast, renal, and pancreatic neuroendocrine cancers but carries the risk of hepatitis B virus (HBV) reactivation (HBVr) and hepatitis. However, data on HBVr in everolimus-treated patients are limited. This study evaluates the risk of hepatitis and HBVr in cancer patients with current or past HBV infection. This retrospective study analyzed patients prescribed everolimus between 1 January 2011 and 31 May 2022, using a private healthcare system database in Taiwan. Patients with HBsAg positivity or HBsAg negativity and anti-HBs or anti-HBc results were included. The cumulative incidence function and risk of hepatitis from a competing risk model, which estimates Fine-Gray subdistribution hazard (SDH), were analyzed across different HBV serological subgroups. The risk of hepatitis B reactivation was also calculated. Of 377 patients, 45% (36/80) of HBsAg-positive and 0.67% (2/297) of HBsAg-negative patients received nucleos(t)ide analogues (NUCs) prophylaxis. Hepatitis occurred in 28.75% of HBsAg-positive and 17.85% of HBsAg-negative patients. Baseline HBsAg positivity and exemestane use increased hepatitis risk. HBVr occurred in 11.36% (5/44) of HBsAg-positive patients without NUCs and 5.56% (2/36) with prophylaxis. Two HBsAg-negative, anti-HBc-positive patients developed severe HBVr-related hepatitis. Hepatitis occurred in 28.75% of HBsAg-positive and 17.85% of HBsAg-negative patients on everolimus. HBVr was common in HBsAg-positive patients but rare in HBsAg-negative individuals. HBV screening and liver function monitoring are critical for patients with past or current HBV infection receiving everolimus, especially in endemic areas.

Long-Term Pulmonary Sequelae and Immunological Markers in Patients Recovering from Severe and Critical COVID-19 Pneumonia: A Comprehensive Follow-Up Study

Background and Objectives: Severe and critical COVID-19 pneumonia can lead to long-term complications, especially affecting pulmonary function and immune health. However, the extent and progression of these complications over time are not well understood. This study aimed to assess lung function, radiological changes, and some immune parameters in survivors of severe and critical COVID-19 up to 12 months after hospital discharge. Materials and Methods: This prospective observational cohort study followed 85 adult patients who were hospitalized with severe or critical COVID-19 pneumonia at a tertiary care hospital in Vilnius, Lithuania, for 12 months post-discharge. Pulmonary function tests (PFTs), including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and diffusion capacity for carbon monoxide (DLCO), were conducted at 3, 6, and 12 months. High-resolution chest computed tomography (CT) scans assessed residual inflammatory and profibrotic/fibrotic abnormalities. Lymphocyte subpopulations were evaluated via flow cytometry during follow-up visits to monitor immune status. Results: The median age of the cohort was 59 years (IQR: 51–64). Fifty-three (62.4%) patients had critical COVID-19 disease. Pulmonary function improved significantly over time, with increases in FVC, FEV1, VC, TLC, and DLCO. Residual volume (RV) did not change significantly over time, suggesting that some aspects of lung function, such as air trapping, remained stable and may require attention in follow-up care. The percentage of patients with restrictive spirometry patterns decreased from 24.71% at 3 months to 14.8% at 12 months (p &lt; 0.05). Residual inflammatory changes on CT were present in 77.63% at 6 months, decreasing to 69.62% at 12 months (p &lt; 0.001). Profibrotic changes remained prevalent, affecting 82.89% of patients at 6 months and 73.08% at 12 months. Lymphocyte counts declined significantly from 3 to 12 months (2077 cells/µL vs. 1845 cells/µL, p = 0.034), with notable reductions in CD3+ (p = 0.040), CD8+ (p = 0.007), and activated CD3HLA-DR+ cells (p &lt; 0.001). This study found that higher CD4+ T cell counts were associated with worse lung function, particularly reduced total lung capacity (TLC), while higher CD8+ T cell levels were linked to improved pulmonary outcomes, such as increased forced vital capacity (FVC) and vital capacity (VC). Multivariable regression analyses revealed that increased levels of CD4+/CD28+/CD192+ T cells were associated with worsening lung function, while higher CD8+/CD28+/CD192+ T cell counts were linked to better pulmonary outcomes, indicating that immune dysregulation plays a critical role in long-term respiratory recovery. Conclusions: Survivors of severe and critical COVID-19 pneumonia continue to experience significant long-term impairments in lung function and immune system health. Regular monitoring of pulmonary function, radiological changes, and immune parameters is essential for guiding personalized post-COVID-19 care and improving long-term outcomes. Further research is needed to explore the mechanisms behind these complications and to develop targeted interventions for long COVID-19.