Severe Pneumonia Research Articles

Development of Artificial Intelligence-Based Programs for the Diagnosis of Myocarditis in COVID-19 Using Chest Computed Tomography Data»

It has been established that 7.2% of patients hospitalized with coronavirus disease (COVID-19) exhibit signs of heart disease, with 23% of these patients experiencing heart failure. Currently, there is a lack of data on chest computed tomography (CT) for diagnosing myocarditis associated with COVID-19. The aim. To justify the feasibility and develop classification models for diagnosing myocarditis in COVID-19 patients based on chest CT data processing. Materials and methods. A retrospective analysis of data from 140 COVID-19 patients was conducted. Chest CT scans were analyzed using DRAGONFLY software, with permission from Object Research Systems. The COVID-CT-MD database, which includes CT data from 169 confirmed cases of SARS-CoV-2 infection, was used to build classification models. The regions of interest were fragments of heart CT images. Texture analysis methods were employed to create diagnostic models. Results. It was shown that the average density of the myocardium of a patient with a confirmed diagnosis of SARS-CoV-2 infection according to the Hounsfield scale does not essentially differ from the densitometric indicators of a healthy person. Therefore, the research was focused on finding structural changes in CT images for their use in constructing diagnostic models. The use of different classification algorithms had little effect on classification accuracy, probably due to the informational content of the input data. However, the obtained accuracy of the diagnostic models is acceptable and allows them to be used to support medical decision-making regarding diagnosis and treatment. Conclusions. Using classic methods, myocarditis was diagnosed in 7.1% of patients with severe pneumonia caused by the coronavirus. The global data closely aligns with the results of our clinical studies. The obtained results allowed for assessing structural changes in the myocardium characteristic of the acute form of SARS-CoV-2 infection. The constructed classification models indicate that specific changes in the myocardium during the acute form of SARS-CoV-2 infection can be identified using CT. The highest diagnostic accuracy on test samples reached 74%. The implementation of the developed diagnostic programs based on texture analysis of CT data and artificial intelligence technologies enables the diagnosis of myocarditis and the assessment of long-term treatment efficiency. Creation of these diagnostic programs using artificial intelligence technologies significantly simplifies the work of radiologists and improves the efficiency of myocarditis diagnosis in patients with SARS-CoV-2 infection.

The Prognosis in Children With Pneumonia of Respiratory Syncytial Virus Co-detection With Airway Dominant Flora.

Airway bacterial microbiota influences the prognosis in children with respiratory syncytial virus infection. The study aimed to investigate the effect of the airway-dominant bacterial microbiota on disease severity in children with pneumonia of respiratory syncytial virus infection. A retrospective study was conducted in the Children's Hospital of Chongqing Medical University, which involved a cohort of patients with respiratory syncytial virus (RSV)-infected pneumonia from January 2012 to December 2021. Patients were assigned to a normal flora group or to a dominant flora group (with the top 5 individual bacteria) based on the nasopharyngeal aspirates culture and matched using propensity-score matching. Univariate analysis and multivariate analysis were performed to estimate the risk factors of poor prognosis in dominant flora. Five thousand five hundred and twelve patients in the normal flora and 4556 in the dominant flora were included ( Escherichia coli 514, Streptococcus pneumoniae 1516, Staphylococcus aureus 506, Moraxella catarrhalis 509 and Haemophilus influenzae 1516, respectively). The dominant flora had more patients developing severe pneumonia, needing mechanical ventilation/tracheal intubation (up to 15.8% in the S. aureus ) and admission to the intensive care unit (up to 4.5% in the E. coli ) than in the normal flora (28.5% vs. 25.9%; P = 0.001; 9.8% vs. 5.4%; P < 0.001; 2.0% vs. 1.2%; P <0.001). And the hospitalization was longer in the dominant flora than in the normal flora [8 (6-9) vs. 8 (7-9) days; P < 0.001], the E. coli and S. aureus had the longest hospitalization [8 (7-10) days]. Several factors were associated with critical illness in Dominant flora according to multivariate analysis ( P < 0.001), including age (OR: 0.965; CI: 0.954-0.976; P < 0.001), anhelation (OR: 0.530; CI: 0.446-0.631; P < 0.001), disorders of consciousness (OR: 0.055; CI: 0.016-0.185; P < 0.001) as well as assisted respiration (OR: 0.115; CI: 0.097-0.138; P < 0.001), C-reactive protein >10 mg/L (OR: 0.686; CI: 0.560-0.839; P < 0.001), SpO 2 <90% (OR: 0.366; CI: 0.214-0.628; P < 0.001), pulmonary consolidation (OR: 0.511; CI: 0.364-0.717; P < 0.001) and pulmonary atelectasis (OR: 0.362; CI: 0.236-0.555; P < 0.001). The airway-dominant bacterial microbiota influenced disease severity and comorbidities in children with RSV-infected pneumonia. Clinicians should pay attention to the nasopharyngeal aspirate culture, especially after detecting S. aureus and E. coli in RSV-infected children with pneumonia, closely observe the disease progression and take timely measures to avoid adverse outcomes.

Artificial intelligence-powered chest computed tomography analysis unveils prognostic insights for COVID-19 mortality among prevalent hemodialysis patients.

Coronavirus disease 2019 (COVID-19) has led to severe pneumonia and mortality worldwide, however, clinical outcomes in end-stage renal disease patients remain unclear. This study evaluates the prognostic value of chest computed tomography (CT) findings in predicting COVID-19-related outcomes in prevalent hemodialysis patients. We retrospectively analyzed 326 prevalent hemodialysis patients diagnosed with COVID-19 who underwent chest CT scans. Characteristics assessed included pleural effusion, lung involvement volume, nodular consolidation, patchy infiltration, and ground-glass opacity. Artificial intelligence (AI)-assisted CT analysis quantified lung involvement. The primary endpoint was in-hospital mortality. Clinical data were collected, and logistic regression analysis assessed the association between CT findings and mortality. The mean age of the patients was 66.7 ± 12.6 years, 61.0% were male, and 58.6% were diabetic. Chest CT showed that 18.1% had lung involvement >10%, 32.5% had pleural effusion, 68.7% had nodular consolidation, 57.1% had patchy infiltration, and 58.0% had ground-glass opacity. Seventy patients (21.5%) died. Multivariate logistic regression analysis identified lung involvement >2.7% (odds ratio [OR], 16.70; 95% confidence interval [CI], 4.35-65.63), pleural effusion (OR, 3.28; 95% CI, 1.15-9.35), nodular consolidation (OR, 4.08; 95% CI, 1.12-14.82), and patchy infiltration (OR, 3.75; 95% CI, 1.17-12.03) as significant mortality risk factors. Chest CT findings, including lung involvement >2.7% and the presence of pleural effusion, nodular consolidation, and patchy infiltrates, significantly indicated mortality in COVID-19 pneumonia among prevalent hemodialysis patients. AI-assisted CT analysis proved useful in assessing lung involvement extent, showing that even minimal lung involvement can be associated with increased mortality.

Characterization of a mammalian orthoreovirus isolated from the large flying fox, Pteropus vampyrus, in Indonesia.

Fruit bats serve as an important reservoir for many zoonotic pathogens, including Nipah virus, Hendra virus, Marburg virus and Lyssavirus. To gain a deeper insight into the virological characteristics, pathogenicity and zoonotic potential of bat-borne viruses, recovery of infectious viruses from field samples is important. Here, we report the isolation and characterization of a mammalian orthoreovirus (MRV) from a large flying fox (Pteropus vampyrus) in Indonesia, which is the first detection of MRV in Southeast Asia. MRV was recovered from faecal samples of three different P. vampyrus in Central Java. Nucleotide sequence analysis revealed that the genome of the three MRV isolates shared more than 99% nucleotide sequence identity. We tentatively named one isolated strain as MRV12-52 for further analysis and characterization. Among 10 genome segments, MRV12-52 S1 and S4, which encode the cell-attachment protein and outer capsid protein, had 93.6 and 95.1% nucleotide sequence identities with known MRV strains, respectively. Meanwhile, the remaining genome segments of MRV12-52 were divergent with 72.9-80.7 % nucleotide sequence identities. Based on the nucleotide sequence of the S1 segment, MRV12-52 was grouped into serotype 2, and phylogenetic analysis demonstrated evidence of past reassortment events. In vitro characterization of MRV12-52 showed that the virus efficiently replicated in BHK-21, HEK293T and A549 cells. In addition, experimental infection of laboratory mice with MRV12-52 caused severe pneumonia with 75% mortality. This study highlights the presence of pathogenic MRV in Indonesia, which could serve as a potential animal and public health concern.

Transitions in lung microbiota landscape associate with distinct patterns of pneumonia progression.

The precise microbial determinants driving clinical outcomes in severe pneumonia are unknown. Competing ecological forces produce dynamic microbiota states in health; infection and treatment effects on microbiota state must be defined to improve pneumonia therapy. Here, we leverage our unique clinical setting, which includes systematic and serial bronchoscopic sampling in patients with suspected pneumonia, to determine lung microbial ecosystem dynamics throughout pneumonia therapy. We combine 16S rRNA gene amplicon, metagenomic, and transcriptomic sequencing with bacterial load quantification to reveal clinically-relevant pneumonia progression drivers. Microbiota states are predictive of pneumonia category and exhibit differential stability and pneumonia therapy response. Disruptive forces, like aspiration, associate with cohesive changes in gene expression and microbial community structure. In summary, we show that host and microbiota landscapes change in unison with clinical phenotypes and that microbiota state dynamics reflect pneumonia progression. We suggest that distinct pathways of lung microbial community succession mediate pneumonia progression.

Challenges in Diagnosis of COVID-19 Pneumonia under Ocrelizumab and De-Risking Strategies in Multiple Sclerosis—The Elephant Is (Still) in the Room

Severe SARS-CoV-2 infections may still be observed in people bearing risk factors, such as the use of anti-CD20 monoclonal antibodies (mAbs), which are adopted in several autoimmune disorders including multiple sclerosis (MS). COVID-19 diagnosis is routinely based on nasopharyngeal swab testing, but suboptimal sensitivity for SARS-CoV-2 detection compared to bronchoalveolar lavage (BAL) may lead to misdiagnosis in some cases. Such diagnostic issues were described in a few MS patients receiving anti-CD20 mAbs, including middle-aged people and lacking information on subsequent MS therapeutic management, a debated topic as no evidence-based guidance on de-risking strategies is currently available. Here, we report the case of a young MS patient who developed severe COVID-19 pneumonia under treatment with the anti-CD20 mAb ocrelizumab, and who was finally diagnosed with SARS-CoV-2 by BAL despite repeatedly negative nasopharyngeal swabs. Ocrelizumab was then discontinued, and treatment with a sphingosine-1 phosphate receptor modulator was started, followed by maintenance of clinical and radiological MS stability. Challenges in diagnosing COVID-19 pneumonia in people without risk factors other than immunomodulatory treatment are hence discussed, as well as potential strategies for de-risking MS therapies. The latter topic is increasingly debated based on raising concerns for potential long-term safety issues of high-efficacy treatments, including anti-CD20 mAbs.

The role of coronavirus infection in lung injury, which contributes to the occurrence of complicated course of community-acquired pneumonia

Annotation. The review article focuses on the role of coronavirus infection in lung damage, which contributes to the complicated course of community-acquired pneumonia. Based on the scientometric databases Web of science, Scopus, PubMed, a retrospective analysis of the literature on this topic for 2013-2023 was conducted. 32 sources were selected after reviewing the abstracts of the articles and reading their full text. The results of the search indicate that most people infected with SARS-CoV-2 do not develop severe illness, and the infection is likely to be limited to the upper respiratory tract. However, in some people, infection with the virus leads to severe pneumonia dominated by immunopathology, probably caused by lower respiratory tract infection. Alveolar damage can be a direct consequence of cell infection or an indirect consequence caused by local inflammatory reactions. People with severe COVID-19 often have a tendency to have a delayed immune response. Inflammation and coagulation further exacerbate pro-inflammatory and/or profibrotic reactions, which contributes to the development of complications. Uncontrolled inflammation ultimately leads to severe immunopathology characteristic of COVID-19. In this regard, understanding the pathogenesis of SARS-CoV-2 infection and how it contributes to critical illness and its complications may help to improve risk allocation and develop targeted therapies to reduce the acute and long-term consequences of this disease.

Disruption of immune responses by type 1 diabetes exacerbates SARS-CoV-2 mediated lung injury.

COVID-19 commonly presents as pneumonia, with those most severely affected progressing to respiratory failure. Patient responses to SARS-CoV-2 infection are varied, with comorbidities acting as major contributors to varied outcomes. Focusing on one such major comorbidity, we assessed whether pharmacological induction of type 1 diabetes mellitus (T1DM) would increase the severity of lung injury in a murine model of COVID-19 pneumonia utilizing wild-type mice infected with mouse-adapted SARS-CoV-2. Hyperglycemic mice exhibited increased weight loss and reduced blood oxygen saturation in comparison with their euglycemic counterparts, suggesting that these animals indeed experienced more severe lung injury. Transcriptomic analysis revealed a significant impairment of the adaptive immune response in the lungs of diabetic mice compared with those of control. To expand the limited options available for tissue analysis due to biosafety restrictions, we also employed a new technique to digest highly fixed tissue into a single-cell suspension, originally designed for scRNA-Seq, which we then adapted for flow cytometric analysis. Flow immunophenotyping and scRNA-Seq confirmed impaired recruitment of T-cells into the lungs of T1DM animals. In addition, scRNA-Seq revealed a distinct, highly inflammatory macrophage profile in the diabetic cohort that correlates with the more severe infection these mice experienced clinically, allowing insight into a possible mechanism for this phenomenon. Recognizing the near certainty that respiratory viruses will continue to present significant public health concerns for the foreseeable future, our study provides key insights into how T1DM results in a much more severe infection and identifies possible targets to ameliorate comorbidity-associated severe disease.NEW & NOTEWORTHY We define the exacerbating effects of type 1 diabetes mellitus (T1DM) on COVID-19 pneumonia severity in mice. Hyperglycemic mice experienced increased weight loss and reduced oxygen saturation. Transcriptomic analysis revealed impaired immune responses in diabetic mice, while flow cytometry and single-cell RNA sequencing confirmed reduced T-cell recruitment and an inflammatory macrophage profile. In addition, we introduced a novel technique for tissue analysis, enabling flow cytometric analysis on highly fixed tissue samples.

Severe Bacterial Superinfection of Influenza Pneumonia in Immunocompetent Young Patients: Case Reports

Influenza can lead to or coexist with severe bacterial pneumonia, with the potential to permanently damage lung tissue, refractory to conservative treatment in the post-COVID-19 period. It can lead to serious complications; therefore, annual vaccinations are recommended. This case series with a literature review pertains to two young female patients with an insignificant past medical history, who required emergency lobectomy due to bacterial complications after influenza infection. Urgent lobectomy proves to be a feasible therapeutic option for selected patients with pleural complications.

The Impact of Antidepressants on COVID-19 and Post-Acute COVID-19 Syndrome: A Scoping-Review Update

On May 20, 2024, this systematic scoping review in PUBMED identified 1016 articles related to AD and COVID-19, Long COVID and SARS-COV-2. These included 10 retrospective "large scale" studies (> 20000 chart reviews), 8 prospective clinical trials (plus 4 regarding Long COVID), 11 placebo-controlled randomized (RCT) (plus 2 regarding Long COVID) and 15 meta-analyses. COVID-19: Retrospective studies with cohorts taking AD primarily for psychiatric comorbidities or chronic pain conditions directly prior to SARS-COV-2 infection described that this substance class (most studied: Selective Serotonin Re-Uptake Inhibitors (SSRI) and Selective Serotonin Noradrenaline Re-Uptake Inhibitors (SSNRI)) were associated with (i) significantly fewer SARS-COV-2 infections and (ii) a milder course of COVID-19 ("COVID-19 protection"). Ten of the 11 RCTs found regarding COVID-19 tested fluvoxamine, as this old AD appeared suitable as a prophylactic agent against severe COVID-19, taking into account its in vitro potency against the progression of intracellular sepsis cascades. Therefore, most (12 out of 15) meta-analyses also referred to fluvoxamine. They found (iii) a significant (40-70% reduction) in mortality, intubation and hospitalization rates when fluvoxamine was used as an add-on to standard therapy for mild to moderate COVID-19. When this AD was used in the early stages of the disease, it was more successful than when it was given later in advanced, severe COVID-19 (e.g. severe pneumonia, final sepsis stages). A dose dependency was observed: 2x50 mg fluvoxamine over 15 days was less effective than 2x100 or even 3x100 mg with an adverse event profile still at the placebo level. Direct comparisons with drugs approved for COVID-19 do not yet exist. A first indirect meta-analytical comparison showed an advantage of paxlovid or molnupiravir versus fluvoxamine against the development of severe COVID-19: risk reduction of 95% (I2 = N/A, but only one study) or 78% (I2=0) versus 5+-5% (I2=48). However, an add-on of fluvoxamine was still significantly more efficacious than symptom-oriented standard therapy alone. Long COVID: A common Long COVID phenotype with dominant anxiety and depression symptoms, which responds to AD, relaxation therapy and/or psychotherapy, has now been identified. Casuistics report positive effects of AD on fatigue, cognitive and autonomic dysfunctions. A first large prospective open-label RCT has just shown significantly more favourable courses, less viral load and less pro-inflammatory cytokines in the treatment of mild to moderate COVID-19 with fluvoxamine versus standard treatment, also with regard to the subsequent development of neuropsychiatric and pulmonary Long COVID or fatigue. Overall, there is promising evidence of a preventive effect of AD (especially fluvoxamine) against progression to severe COVID-19 and against the development of Long COVID. It is likely, that the entire AD substance class could be effective here. This assumption is based on the results of retrospective large scale studies, but awaits verification by better controlled studies. The potential effectiveness/efficacy (currently low and moderate confidence of the evidence for the entire substance class and specifically fluvoxamine, respectively) of fluvoxamine as an add-on against COVID-19 and possibly also directly against Long COVID could stimulate similar projects in other infectious diseases that also have the potential to pose a lasting threat to the health of those affected. We consider the evidence to date to be sufficient to be able to emphasize a possible positive effect of these substances in the psychoeducation of patients with COVID-19 or Long COVID who are already receiving AD for other conditions - especially also against the symptoms associated with the viral disease or its consequences. In regions where neither vaccines nor antiviral agents currently approved for the prevention or treatment of COVID-19 are available, AD and in particular fluvoxamine would be a cost-effective alternative to protect against a severe course, even if this AD appears to have a smaller effect against COVID-19 than the currently approved antiviral agents, but with presumably better tolerability. A direct comparative clinical trial with approved antiviral agents is still pending and should be positive to further open the door for a guideline-based recommendation of fluvoxamine (or perhaps even AD) for COVID-19 or its aftermath.

An Update on Highly Pathogenic Avian Influenza A(H5N1) Virus, Clade 2.3.4.4b.

Since the resurgence of highly pathogenic avian influenza (HPAI) A(H5N1) virus, clade 2.3.4.4b, during 2021, these viruses have spread widely among birds worldwide, causing poultry outbreaks and infections of a wide range of terrestrial and marine mammal species. During 2024, HPAI A(H5N1) virus, clade 2.3.4.4b, was detected in dairy cattle for the first time and caused an ongoing multistate outbreak, with high levels of virus documented in raw cow milk. Human infections with clade 2.3.4.4b viruses from exposures to infected poultry or dairy cattle have resulted in a wide spectrum of illness severity, from conjunctivitis or mild respiratory illness to severe and fatal pneumonia in different countries. Vigilance, and stronger global virologic surveillance among birds, poultry, terrestrial and marine mammals, and humans, with virus characterization and rapid data sharing, is needed to inform the threat of clade 2.3.4.4b viruses, as they continue to evolve, to public health.

A case of mortality in a re-introduced European bison associated with severe pneumonia caused by Dictyocaulus viviparus

BackgroundDictyocaulosis is a parasitic disease caused by pulmonary nematodes from genus Dictyocaulus affecting various ungulate hosts. It can cause verminous bronchopneumonia and for heavily infected individuals, fatal outcomes can occur.Case presentationThe study describes the case of a male European bison which died three months after relocation from Slovakia to one of the reintroduction areas in Nucșoara village, Făgăraș Mountains, Romania. Necropsy revealed the presence of pulmonary nematodes in the respiratory tract. Morphology and molecular diagnosis was performed and Dictyocaulus viviparus was identified.ConclusionRigorous health monitoring is essential to assure the success of reintroduction programs, understanding and preventing infectious diseases and limiting their impact on population health.

Integrative description and histopathological lesions of Cyathostoma americana (Nematoda, Syngamidae) parasitizing a barn owl (Tyto alba) in Chile.

Syngamid worms (Nematoda: Syngamidae) parasitizing birds of prey are considered cosmopolitan, but the efforts to understand their biology and systematics are restricted to the Holarctic region. However, in the Neotropical region there is only one recent record with no data about its molecular characterization or its significance to the health of its hosts. Thus, this study aimed to identify through an integrative approach the Syngamid worms parasitizing a native owl, and to describe its pathological consequences. A total of 14 barn owls (Tyto alba) were dissected between 2015 and 2021, from which one bird was found to be parasitized by a high parasitic burden (i.e. 185 worms). Considering light microscopy and SEM, these nematodes were morphologically identified as Cyathostoma americana, and then supported through molecular analyses of nuclear loci ITS and LSU. The pathological changes were described as severe airsacculitis and pneumonia, which probably were the cause of death of the bird. This study represents the first effort to characterize the parasitism by this nematode in a nocturnal bird of prey from the Neotropics, with a lethal outcome. Additional studies are required from other geographical areas and Neotropical countries to better understand the dynamics of this parasite and their hosts, considering both diurnal and nocturnal birds of prey.

Surgical treatment of graft infection combined with aortoesophageal fistula after TEVAR: a retrospective single-center, single-arm study

ObjectiveAortoesophageal fistula (AEF) secondary to thoracic aortic endovascular repair (TEVAR) is rare and fatal. The author reports the treatment methods and outcomes of 10 patients with a TEVAR graft infection and an aortoesophageal fistula.MethodA retrospective analysis was conducted on the clinical data of 10 patients who developed a secondary AEF and a graft infection after TEVAR from March 2018 to March 2024.ResultThe perioperative mortality rate was 70%. Two patients had TEVAR only and all died of bleeding and infection. Eight patients underwent open surgery, five died within 30 days, four of them died due to massive bleeding, the one patient died of a serious infection after surgery. Three patients recovered well and were discharged. One patient died of severe pneumonia 3 months after discharge, and two patients survived for 6 years and 3 months, respectively.ConclusionExtra-anatomical bypass reconstruction is feasible for treating graft infection combined with aortoesophageal fistula after TEVAR but related to bad outcomes in most of the patients. It is reserved for highly select patients and is performed at centers with experience with this procedure.

Identifying severe community-acquired pneumonia using radiomics and clinical data: a machine learning approach

Evaluating Community-Acquired Pneumonia (CAP) is crucial for determining appropriate treatment methods. In this study, we established a machine learning model using radiomics and clinical features to rapidly and accurately identify Severe Community-Acquired Pneumonia (SCAP). A total of 174 CAP patients were included in the study, with 64 cases classified as SCAP. Radiomic features were extracted from chest CT scans using radiomics techniques, and screened to remove irrelevant features. Additionally, clinical indicators of patients were similarly screened and constituted the clinical feature set. Subsequently, eight common machine learning models were employed to complete the SCAP identification task. Specifically, interpretability analysis was conducted on the models. In the end, we screened out 15 radiomic features (such as LeastAxisLength, Maximum2DDiameterColumn and ZonePercentage) and two clinical features: Lymphocyte (p = 0.041) and Albumin (p = 0.044). Using radiomic features as inputs in model predictions yielded the highest AUC of 0.85 on the test set. When using the clinical feature set as model inputs, the AUC was 0.82. Combining the two sets of features as model inputs, Ada Boost achieved the best performance with an AUC of 0.89. Our study demonstrates that combining radiomics and clinical data using machine learning methods can more accurately identify SCAP patients.

Fei-yan-qing-hua decoction exerts an anti-inflammatory role during influenza by inhibiting the infiltration of macrophages and neutrophils through NF-κB and p38 MAPK pathways

Ethnopharmacological relevanceFei-Yan-Qing-Hua decoction (FYQHD) is an empirical formula that has shown clinical success in treating community-acquired pneumonia (CAP) for two decades. Influenza viral infection is a significant trigger for severe pneumonia, yet the role of FYQHD in treating influenza remains unclear. Aim of the studyThis study aimed to assess the potential efficacy of FYQHD in treating influenza viral infection and to elucidate its underlying mechanisms. Materials and methodsThe protective effects of FYQHD against influenza were evaluated through survival assessments and pathological analyses. Transcriptomic analysis was performed to identify the genes and pathways influenced by FYQHD in influenza. The anti-inflammatory effects and molecular mechanisms of FYQHD were studied in macrophages stimulated by Toll-like receptor (TLR) 7 ligation in vitro. The key constituents of FYQHD absorbed in mouse sera were identified using untargeted metabolomics, and the anti-inflammatory activity of some of these compounds in macrophages was evaluated using ELISA. ResultsOur findings demonstrate that FYQHD enhances survival and reduces lung damage in PR8-infected mice, primarily through its anti-inflammatory properties. Lung indexes and organ damage were significantly lower in the PR8 + OSV + FYQHD group compared to the PR8 + OSV group, indicating a potential complementary therapeutic effect of FYQHD and OSV in treating influenza. FYQHD effectively reduced chemokine expression, thereby decreasing the chemotaxis and infiltration of inflammatory monocytes/macrophages and neutrophils in the lungs. The anti-inflammatory effects of FYQHD in macrophages were achieved through the inhibition of NF-κB activation and p38 phosphorylation. The key constituents of FYQHD absorbed in mouse sera were identified, with some, such as wogonin, luteolin, kaempferol, and isorhamnetin, showing anti-inflammatory effects in primary macrophages. ConclusionFYQHD demonstrates protective efficacy against influenza and shows promise as an adjuvant therapeutic agent, particularly when used in combination with antiviral drugs like OSV. The potent anti-inflammatory components within FYQHD provide a basis for further exploration in drug research and development aimed at combating influenza.

Patients with influenza admitted to a tertiary-care hospital in Riyadh between 2018 and 2022: characteristics, outcomes and factors associated with ICU admission and mortality

BackgroundInfluenza is a common cause of hospital admissions globally with regional variations in epidemiology and clinical profile. We evaluated the characteristics and outcomes of patients with influenza admitted to a tertiary-care center in Riyadh, Saudi Arabia.MethodsThis was a retrospective cohort of adult patients admitted with polymerase chain reaction-confirmed influenza to King Abdulaziz Medical City-Riyadh between January 1, 2018, and May 31, 2022. We compared patients who required intensive care unit (ICU) admission to those who did not and performed multivariable logistic regression to assess the predictors of ICU admission and hospital mortality.ResultsDuring the study period, 675 adult patients were hospitalized with influenza (median age 68.0 years, females 53.8%, hypertension 59.9%, diabetes 55.1%, and chronic respiratory disease 31.1%). Most admissions (83.0%) were in the colder months (October to March) in Riyadh with inter-seasonal cases even in the summertime (June to August). Influenza A was responsible for 79.0% of cases, with H3N2 and H1N1 subtypes commonly circulating in the study period. Respiratory viral coinfection occurred in 12 patients (1.8%) and bacterial coinfection in 42 patients (17.4%). 151 patients (22.4%) required ICU admission, of which 62.3% received vasopressors and 48.0% mechanical ventilation. Risk factors for ICU admission were younger age, hypertension, bilateral lung infiltrates on chest X-ray, and Pneumonia Severity Index. The overall hospital mortality was 7.4% (22.5% for ICU patients, p < 0.0001). Mortality was 45.0% in patients with bacterial coinfection, 30.9% in those requiring vasopressors, and 29.2% in those who received mechanical ventilation. Female sex (odds ratio [OR], 2.096; 95% confidence interval [CI] 1.070, 4.104), ischemic heart disease (OR, 3.053; 95% CI 1.457, 6.394), immunosuppressed state (OR, 7.102; 95% CI 1.803, 27.975), Pneumonia Severity Index (OR, 1.029; 95% CI, 1.017, 1.041), leukocyte count and serum lactate level (OR, 1.394; 95% CI, 1.163, 1.671) were independently associated with hospital mortality.ConclusionsInfluenza followed a seasonal pattern in Saudi Arabia, with H3N2 and H1N1 being the predominant circulating strains during the study period. ICU admission was required for > 20%. Female sex, high Pneumonia Severity Index, ischemic heart disease, and immunosuppressed state were associated with increased mortality.

A comparative study of linear type multiple instance learning techniques for detecting COVID-19 by chest X-ray images

AbstractAt the end of 2019, the World Health Organization (WHO) referred that the Public Health Commission of Hubei Province, China, reported cases of severe and unknown pneumonia. A new coronavirus, SARS-CoV-2, was identified as responsible for the lung infection, called COVID-19 (COronaVIrus Disease 2019). Although the definitive COVID-19 diagnosis is made through specific molecular tests, an early diagnosis by imaging became crucial to contain the spread, morbidity and mortality of the pandemic. In such context, chest X-ray radiography, as an element that assists the diagnosis allowing also the follow-up of the disease, plays a very important role since it is the most easily available and least expensive alternative. This work focuses on applying different linear type instance-level Multiple Instance Learning techniques to discriminate between COVID-19 and common viral pneumonia chest X-ray images, which is a difficult task due to the strong similarity characterizing the two classes. A relevant advantage of such approaches is that they are also suitable in terms of interpretability, as they easily allow clinicians to identify abnormal subregions in a positive radiographic image. Numerical experiments have been performed on a set of 200 images, obtaining the following results: accuracy = 95%, sensitivity = 99.29%, specificity = 91.24% and MCC = 0.9. The used algorithms appear promising in practical applications, taking into account their high speed and considering that no particular pre-processing techniques have been employed.

Measles-Clinical and Biological Manifestations in Adult Patients, Including a Focus on the Hepatic Involvement: Results from a Single-Center Observational Cohort Study from Romania.

Background: Hepatic involvement in measles, particularly among adolescents and adults, has been recognized since 1960. This involvement typically manifests during the eruptive phase of the disease and is primarily characterized by hepatocellular dysfunction, with jaundice being a less common occurrence. Studies have reported hepatic involvement in 80-86% of measles cases among young adults associated with severe forms of the disease with intra-infectious hepatitis. Recent data from Romania indicated 20,035 confirmed measles cases between January and June 2024, including 17 fatalities and significant hepatic alterations. These findings underscore the need for the further investigation of the hepatic manifestations of measles. The primary objective of our study was to evaluate the clinical and baseline characteristics of the enrolled patients with a brief assessment of liver impairment. Methods: In light of these observations, we conducted a retrospective analysis between 1 November 2023 and 15 June 2024 in patients aged >16 years who were confirmed, by the detection of measles IgM in serum samples, to have acute measles infection and hospitalization. Results: During the study period, 71 hospitalized patients were diagnosed with measles, of whom 37 were female (52.1%), with ages ranging from 16 to 64 years (mean age 34.21 years). Most cases (77.5%) exhibited moderate clinical forms of measles, while 22.5% had severe forms. Respiratory failure requiring oxygen therapy was uncommon (25.4% of severe pneumonia cases). Although a Pearson chi-square test indicated no significant association between the presence of pneumonia and clinical form (p = 0.066), the likelihood ratio test suggested a potential link (p = 0.018). Hepatic involvement was common with elevated AST (87.3%) and ALT (76%) levels. Jaundice was observed in 12.7% of patients. GGT changes were noted in 35.2% of cases, with significant correlations between GGT levels and disease severity (p = 0.001). Analysis of various symptoms revealed significant associations between nausea, dyspnea, and severe clinical forms. Anorexia, diarrhea, and nausea were the most frequently reported symptoms. Thrombocytopenia was observed in 11 patients, with no significant correlation with disease severity. Comorbidities, such as COPD, were significantly associated with disease severity (p = 0.010). Conclusions: Our findings highlight that, while cytolytic hepatic damage is a typical response to measles infection, cholestatic involvement may serve as an indicator of more severe disease progression.

Strategy of Severe Pneumonia and Management of Related Complications After Autogenous Cartilage Microtia Reconstruction.

Since the pioneering use of autologous costal cartilage for microtia reconstruction, significant progress has been made in treating microtia, effectively improving patients' quality of life and reducing their psychological burden. Cartilage auricle reconstruction is the primary treatment, but many postoperative complications can occur. Common postoperative complications include infection and hematoma at the recipient site, pleural tears at the donor site, and thoracic scoliosis. Among these, severe postoperative pneumonia is a rare but potentially fatal complication. This study presents a case of severe pneumonia after auricular reconstruction with autologous cartilage. It details the complications associated with autologous cartilage microtia reconstruction, especially pulmonary complications, and suggests a possible relationship between pulmonary complications and auricular reconstruction using cartilage.