Respiratory Disease Research Articles

Myocarditis in children. Modern aspects of diagnostics

Introduction. A review of the current literature on the features of the diagnosis of myocarditis in children is presented. Myocarditis is an acute or chronic inflammatory myocardial disease characterized by a variety of clinical manifestations, nonspecific symptoms and physical data. With insufficient number of informative diagnostic tests, there is a challenge for practitioners at all stages of medical care. Aim of the review is to comprehensively present the features of the clinical diagnosis of myocarditis in children. The presence of myocarditis should be assumed in situations where children, regardless of the age, first developed symptoms of heart failure (HF), as well as in the presence of a clinic of viral infections accompanied by respiratory or abdominal symptoms, combined with the development of tachycardia, hypotension or cardiac arrhythmias, even in the absence of cardiomegaly. Myocarditis should be clinically suspected at the stage when the necessary decisions should be made about the patient’s routing, the formation of a complex of diagnostic examinations and the start of therapy. Magnetic resonance imaging (MRI) of the heart is today the non-invasive gold standard for the diagnosis of myocarditis that allows detecting myocarditis within 2–3 weeks after the first symptoms appear. Endomyocardial biopsy can be used for accurate morphological diagnosis of myocarditis in children. Molecular biological and genetic studies that determine the severity and outcome of the disease are important for the diagnosis of myocarditis in children. Conclusion. Based on the literature data and own experience in diagnosing myocarditis, the authors have developed an original diagnostic algorithm to make the right medical decision in case of suspected acute myocarditis in children.

Abstract 4124313: An unusual case of pericardial mass

A 30-year-old male electrician presented with two days of fever and positional left shoulder pain and was found to have elevated inflammatory markers and a large pericardial effusion with echocardiographic evidence of tamponade for which he underwent pericardiocentesis. He was discharged on a course of anti-inflammatory therapy with presumed diagnosis of idiopathic pericarditis based on negative cytology. He returned 6 months later with several weeks of upper respiratory infection symptoms as well as new abdominal discomfort and emesis. On presentation, his vital signs were notable for tachycardia to 113 and cardiac exam was notable for tachycardia, regular rhythm, no rubs or murmurs, nondisplaced precordial impulse, normal jugular venous pressure with Kussmaul sign, and pulsus paradoxus of 6. An electrocardiogram showed sinus tachycardia with diffuse ST segment changes (Figure A). His cardiac biomarkers were unremarkable (troponin 21). His labs revealed normocytic anemia with hemoglobin of 11 and erythrocyte sediment rate above assay. Echocardiogram demonstrated a circumferential complex pericardial effusion with echocardiographic evidence of early tamponade (Figure B, C). A pericardiocentesis was attempted with inability to advance wire within pericardial space. A malignancy workup was initiated. CT demonstrated multi-station thoracic and lower cervical lymphadenopathy, moderate left pleural effusion, and an intrapericardial mass with associated pericardial effusion (Figure D). Cardiac magnetic resonance imaging demonstrated a circumferential intrapericardial non-mobile mass measuring up to 22 mm in thickness posteriorly and the mass was isointense to myocardium indicating low-fat content (Figure E). A supraclavicular lymph node biopsy was obtained with immunohistochemical staining positive for WT1 and calretinin, consistent with metastatic epithelioid mesothelioma of pericardial versus pleural etiology (Figure F). A PET-CT subsequently showed a FDG-avid circumferential anterior pericardial mass and multiple pleural-based lesions concerning for metastatic mesothelioma. He was initiated on pemetrexed/carboplatin systemic chemotherapy. With systemic therapy, his disease has been stable for 6 months. Pericardial mesothelioma is a rare malignancy. This case underscores the diagnostic challenges associated with pericardial mesothelioma and the importance of cancer workup as part of the pericardial effusion workup.

Abstract 4123849: Respiratory Syncytial Virus (RSV) Cases Involving Hospitalization Are Associated with an Increased Risk of Myocardial Infarction and All−Cause Mortality Among Adults Aged 50 Years and Older

Background: Older adults and adults with comorbidities are at increased risk for severe respiratory syncytial virus (RSV) disease and related complications. Aims: To estimate the risk of myocardial infarction (MI) and all−cause mortality among adults aged ≥50 years hospitalized with RSV compared to those with no recent acute respiratory illness (ARI) and those hospitalized with influenza. Methods: Data from Optum’s de−identified Clinformatics® Data Mart Database were analyzed (October 2015–June 2023) in this retrospective cohort study. Adults aged ≥50 years with ≥12 months of continuous enrollment were assigned to cohorts based on RSV or influenza hospitalization (from ICD−10 codes; RSV and flu cohorts) or no recent ARI (control cohort). Index dates for RSV and flu cohorts were the start of an ARI that included hospitalization. Baseline characteristics were measured in the 12 months pre−index. MI (from ICD−10 codes) and all−cause mortality were measured during follow−up and compared between cohorts using time−varying coefficient multivariable adjusted Cox models (MI results accounted for the competing risk of death). Results: In the RSV cohort (n=14,759), mean age (76.5 years) and mean Charlson comorbidity index (CCI; 3.3) were higher than the flu (n=77,468; 75.4 years, CCI=2.9) and control (n=73,795; 69.5 years, CCI=1.0) cohorts. Adjusted HRs (95% CI) for MI and all−cause mortality risk were significantly higher in the RSV vs control cohort across follow−up, ranging from 30.96 (26.22–36.54) within 30 days post−index to 2.26 (2.04–2.51) >365 days post−index for MI and 10.77 (9.19–12.63) within 30 days post−index to 2.29 (2.18–2.42) >365 days post−index for mortality. Compared to the flu cohort, adjusted MI and mortality risk in the RSV cohort were lower during the 30 days post−index (MI: 0.87 [0.82–0.92]; mortality: 0.84 [0.78–0.90]) but higher >365 days post−index (MI: 1.11 [1.01–1.22]; mortality: 1.05 [1.01–1.10]). Conclusion: MI and all−cause mortality risk were higher for hospitalized RSV cases compared to controls. Smaller differences in outcomes were observed when comparing hospitalized RSV cases with hospitalized influenza cases, with varying direction over time. With existing evidence of increased MI and mortality risk after influenza and these findings on MI and mortality risk after RSV, future research should aim to further understand the impact of RSV on cardiovascular outcomes and assess the role of RSV prevention in lowering the risk of MI and mortality.

The Use of Artificial Intelligence to Analyze the Exposome in the Development of Chronic Diseases: A Review of the Current Literature

The “Exposome” is a concept that indicates the set of exposures to which a human is subjected during their lifetime. These factors influence the health state of individuals and can drive the development of Noncommunicable Diseases (NCDs). Artificial Intelligence (AI) allows one to analyze large amounts of data in a short time. As such, several authors have used AI to study the relationship between exposome and chronic diseases. Under such premises, this study reviews the use of AI in analyzing the exposome to understand its role in the development of chronic diseases, focusing on how AI can identify patterns in exposure-related data and support prevention strategies. To achieve this, we carried out a search on multiple databases, including PubMed, ScienceDirect, and SCOPUS, from 1 January 2019 to 31 May 2023, using the MeSH terms (exposome) and (‘Artificial Intelligence’ OR ‘Machine Learning’ OR ‘Deep Learning’) to identify relevant studies on this topic. After completing the identification, screening, and eligibility assessment, a total of 18 studies were included in this literature review. According to the search, most authors used supervised or unsupervised machine learning models to study multiple exposure factors’ role in the risk of developing cardiovascular, metabolic, and chronic respiratory diseases. In some more recent studies, authors also used deep learning. Furthermore, the exposome analysis is useful to study the risk of developing neuropsychiatric disorders or evaluating pregnancy outcomes and child growth. Understanding the role of the exposome is pivotal to overcome the classic concept of a single exposure/disease. The application of AI allows one to analyze multiple environmental risks and their combined effects on health conditions. In the future, AI could be helpful in the prevention of chronic diseases, providing new diagnostic, therapeutic, and follow-up strategies.

The Impact of NO2 on Epithelial Barrier Integrity of a Primary Cell-Based Air-Liquid Interface Model of the Nasal Respiratory Epithelium.

Nitrogen dioxide (NO2) is a pervasive gaseous air pollutant with well-documented hazardous effects on health, necessitating precise toxicological characterization. While prior research has primarily focused on lower airway structures, the upper airways, serving as the first line of defense against airborne substances, remain understudied. This study aimed to investigate the functional effects of NO2 exposure alone or in combination with hypoxia as a secondary stimulus on nasal epithelium and elucidate its molecular mechanisms because hypoxia is considered a pathophysiological factor in the onset and persistence of chronic rhinosinusitis, a disease of the upper airways. Air-liquid interface cell cultures derived from primary nasal mucosa cells were utilized as an invitro model, offering a high invitro-in vivo correlation. Our findings demonstrate that NO2 exposure induces malfunction of the epithelial barrier, as evidenced by decreased transepithelial electrical resistance and increased fluorescein isothiocyanate (FITC)-dextran permeability. mRNA expression analysis revealed a significant increase in IL-6 and IL-8 expressions following NO2. Reduced mRNA expression of the tight junction component occludin was identified as a structural correlate of the damaged epithelial barrier. Notably, hypoxic conditions alone did not alter epithelial barrier integrity. These findings provide information on the harmful effects of NO2 exposure on the human nasal epithelium, including compromised barrier integrity and induction of inflammatory responses. Overall, this study contributes to our understanding of pathophysiological mechanisms underlying also upper airway respiratory diseases associated with air pollution exposure and emphasizes the importance of mitigating NO2 emissions to safeguard respiratory health.

Late side effects of testicular cancer and treatment: a comprehensive review.

Testicular cancer is a rare solid organ tumour associated with high cure rates and young age at diagnosis, hence it has a sizeable cohort of survivors worldwide. As it is one of the earliest tumours to be cured, a lot of studies have highlighted the late side effects of cancer and its different treatment modalities including surgery, radiotherapy and chemotherapy. While we are trying to identify the population at higher risk of platinum based chemotherapy and reduce its exposure, cisplatin based regimes remain an important tool to cure testicular cancer. The list of late side effects include a number of fatal and morbid conditions including but not limited to the second malignant neoplasms, cardiovascular disease, hypogonadism, infertility, metabolic syndrome, chronic respiratory disease, renal insufficiency, hearing loss, peripheral neuropathy, infertility and psychological illnesses like stress and anxiety. These complications eventually result in compromised social and economic health as well as lower life expectancy compared to the normal population. This article provides a comprehensive review of the latest data regarding the late side effects in testicular cancer survivors. A review of these conditions can help us develop recommendations and guidelines to improve the morbidity and mortality in survivors of testicular cancer.

Enhanced pathogenicity and synergistic effects of co-infection with bovine viral diarrhea virus 1 and HoBi-like virus in cattle and guinea pigs

IntroductionThe Bovine Viral Diarrhea Virus 1 (BVDV1) and HoBi-like virus (BVDV3), both within the same genus, share genomic homology and exhibit low antigenic cross-reactivity despite presenting similar clinical manifestations. In 2021, a bovine respiratory disease complex (BRDC) outbreak on two cattle farms in the Inner Mongolia Autonomous Region of China resulted in ten fatalities.MethodsMetagenomic and metatranscriptomic analyses were used to identify viral agents, including a co-infection case. A genetic evolution analysis assessed the relationships with related strains. Experimental infections in guinea pigs and calves evaluated the pathogenicity of the virusesResultsPhylogenetic analysis of the BVDV3 isolate IM2201 revealed close relatedness to Brazilian strains, with 97.06% nucleotide homology to the highly virulent strain SV478/07. Experimental co-infection in guinea pigs resulted in more severe clinical signs, including fever, cough, diarrhea, and significant pathological changes, and led to a higher mortality rate (40%) compared to no mortality from single-virus infections with BVDV1 or BVDV3. Similarly, co-infected cattle exhibited more severe clinical signs, including bloody diarrhea and rectal temperatures exceeding 40°C, along with persistent viremia and nasal viral shedding from 7 to 21 days post-infection. Blood analysis revealed significant reductions in white blood cell counts, particularly in co-infected cattle.DiscussionThis study highlights the enhanced pathogenicity and synergistic effects of BVDV1 and BVDV3 co-infection, exacerbating disease severity.

Abstract 4123480: Navigating Aspirin Allergy With Rapid Desensitization In A Patient Requiring Urgent Coronary Intervention

Introduction: Aspirin (ASA) hypersensitivity is a challenge in determining the appropriate, cost-effective therapy in patients after percutaneous coronary intervention (PCI). Various ASA desensitization protocols were studied and showed favorable outcomes. In this case, we highlight the use of rapid ASA desensitization protocols for patients requiring dual antiplatelet therapy (DAPT) post urgent PCI. Case: A 52-year-old male presented with severe left-sided chest pain associated with diaphoresis. He had a history of allergic reaction to ASA at the age of 18 years with swelling of the face and throat without shortness of breath or hypotension. Physical examination was unremarkable except for tachycardia. Workup showed no ECG abnormalities but significantly elevated, uptrending high sensitivity troponin. Medical management included clopidogrel load, heparin drip, and nitropaste for persistent pain. Urgent coronary angiography showed a severe bifurcating lesion in the LCx and OM1 arteries, successfully treated with the T stent technique using a drug-eluting stent. He received cilostazol and prasugrel, overlapped with a tirofiban drip post PCI. ASA desensitization was performed with oral ASA every 90 minutes for four doses (Figure). Vital signs were monitored every 30, 60, and 90 minutes after each dose. He was discharged home with no reported symptoms on follow up. Discussion: DAPT with ASA and oral P2Y12 inhibitors is recommended for patients with PCI. ASA desensitization could be considered for patients who are intolerant to ASA. Major clinical ASA desensitization protocols, like in ADAPTED and SCRIPPS studies, showed good outcomes in major adverse cardiovascular events. However, one limitation of these widely used protocols is the prolonged time required to achieve desensitization. The rapid protocol used in our patient who did not have ASA exacerbated respiratory disease showed effectiveness with shorter hospital stay. Conclusion: ASA desensitization is an appropriate option for patients with a history of ASA allergy requiring DAPT. Rapid desensitization protocols are associated with shorter hospitalization courses, and future efforts should evaluate their effectiveness in randomized controlled trials.

Influence of Secondary Metabolites According to Maturation of Perilla (Perilla frutescens) on Respiratory Protective Effect in Fine Particulate Matter (PM2.5)-Induced Human Nasal Cell

Fine particulate matter (PM2.5) exposure worsens chronic respiratory diseases through oxidative stress and inflammation. Perilla frutescens (L.) has potential respiratory protective properties, but the impact of growth stages on its beneficial metabolites is unclear. We aimed to evaluate how different growth stages affect phenolic acids, flavonoids, and polycosanols in perilla seeds and flowers and their efficacy in countering PM2.5-induced damage. Perilla seeds and flowers from five varieties at 10, 20, 30, and 40 days post-flowering were analyzed for metabolite content. Their antioxidant, anti-inflammatory, and respiratory protective effects were tested in RPMI 2650 cells. Our findings indicated that perilla flowers contained higher levels of functional components than seeds and exhibited significant variation with maturation. Phenolic acids of perilla flowers were highest at the early stages of maturation after flowering. However, individual flavones of perilla flowers were the highest at the late maturation stages after flowering. Extracts from perilla flowers harvested 20 days after flowering exhibited significant respiratory protection, effectively inhibiting inflammatory cytokines, mucus secretion, and oxidative stress markers. In conclusion, the flower parts of perilla, particularly those harvested 20 days after flowering, are useful materials for obtaining phenolic compounds, including rosmarinic acid, with high antioxidant and respiratory enhancement effects.

A novel chronic obstructive pulmonary disease mouse model induced by intubation-mediated intratracheal co-administration of porcine pancreatic elastase and lipopolysaccharide.

Chronic obstructive pulmonary disease (COPD) is a significant respiratory disorder in humans characterized by persistent airway constriction or obstruction due to chronic bronchitis and pulmonary emphysema. Various methods of inducing COPD in mouse models are frequently used in COPD research; however, these cannot completely reproduce histopathologic lesions. This study aimed to establish a new COPD mouse model that reproduces histopathological lesions closely resembling clinical COPD within a shorter induction time. The new strategy involved the co-administration of porcine pancreatic elastase (PPE) and lipopolysaccharide (LPS), with PPE intended to induce pulmonary emphysema and LPS intended to induce chronic bronchitis. Male C57BL/6J mice were administered PPE (8 U/kg) on days 0 and 3 and LPS (400µg/kg) on days 6, 9, 12, and 15. Each administration was performed using a noninvasive intubation-mediated intratracheal instillation method with a laryngoscope. Postmortem examination on day 22 revealed that pulmonary emphysema and chronic bronchitis were simultaneously induced in 90.91% of the lung lobes. Molecular studies revealed higher messenger ribonucleic acid (mRNA) expression levels of interleukin-6(IL-6) and matrix metalloproteinase-12(MMP-12) associated with the pathogenesis of COPD. A new method was developed to establish a COPD mouse model that displays a more severe representation of the histopathological findings of clinical COPD than previous COPD models. It also reduces the time required for model induction. This newly developed COPD mouse model is expected to be a valuable tool for the pathogenesis and therapeutic research on human COPD.

Correlation Between Feeding Pattern and Duration of Hospital Stay in Pneumonia of Infants Below 6 Months of Age

<i>Introduction</i>: Pneumonia is the most common respiratory disorder among infants and one of the leading causes of hospital admission. Various feeding patterns have multiple impacts on pneumonia and recovery from it. Breast milk provides some protective properties against respiratory tract and gastrointestinal illness to protect infants during the first year of life. This study aimed to find an association between feeding patterns and duration of hospital stay due to pneumonia in infants below 6 months of age. <i>Methodology</i>: This cross-sectional study was conducted in the Department of Paediatrics, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh from February, 2019 to August, 2020. In our study, 200 infants below 6 months of age admitted with pneumonia in the Department of Paediatrics in Shaheed Suhrawardy Medical College Hospital, Dhaka were enrolled according to selection criteria. <i>Result</i>: Maximum incidence was seen in the 3 to 4 months of age, e.g.40.0% & 36.30% in girls and boys respectively, mean age of the pneumonia patient was 2.9±1.5 months. Out of 200 cases, 55.0% cases were male and 45.0% were female. Among all infants 93.75% of exclusively breastfed infants needed ≤10 days, and 27.88% of non-exclusive breastfed infants needed>10 days in the hospital for recovery from pneumonia. In both cases, the p-value was 0.001. <i>Conclusion</i>: Exclusive breastfed infants have shorter and non-exclusive breastfed infants have longer hospital stays due to pneumonia below 6 months of age.

Parental stress and nurse-parent support in the neonatal intensive care unit: a cross-sectional study.

Admission of a preterm infant to the Neonatal Intensive Care Unit (NICU) is highly stressful for parents. NICU nurses play a crucial role in providing support, positively impacting health and aiding effective stress management during this challenging period. This study assesses stress and nurse-parent support for parents with preterm infants in the NICU, exploring connections between stress, support, and various parental and infant variables. This descriptive cross-sectional study was conducted between January and July 2019 on a total of 150 parents (75 mothers and 75 fathers) with preterm infants in a private hospital's NICU in Ankara, Turkey. Data were collected using the Parent and Infant Information Form, Parental Stressor Scale: NICU (PSS: NICU), and Nurse-Parent Support Tool (NPST). There was no significant correlation between PSS: NICU and NPST scores (p > 0.05). However, a significant difference was observed in the overall NPST score (p = 0.036) and its emotional support subscale (p = 0.013). Mothers' PSS: NICU was influenced by infant information (p = 0.027) and marital duration ((p = 0.002), while fathers' was influenced by number of children (p = 0.040) and infant care participation (p = 0.001). NPST was affected by number of children (p = 0.004) and infant respiratory status (p = 0.011) for mothers and number of children for fathers (p = 0.038). Since parents require informational, emotional, and care-related support, nurses should continuously enhance their professional and communication skills to establish effective communication with parents and provide targeted support. This study found mothers received greater nurse support than fathers. Mothers with one child had higher nurse support, while mechanical ventilation for mothers and having more than one child for fathers were linked to reduced support. Lower stress levels were noted in mothers married for 6-10 years, those informed about the infant, and fathers actively participating in infant care with more than one child.

Assessment of PM2.5 pollution features and health advantages in Northwest China.

The elevated concentration of suspended particulate matter in the atmosphere is closely associated with the morbidity and mortality of human diseases. In northwest China, fine particulate matter pollution has persistently affected local health, production, and daily life due to climatic factors and economic development. This paper first examines the distribution and variation of PM2.5 concentrations in northwest China from 2013 to 2022 to understand changes in PM2.5 exposure levels, as well as their associated health and economic benefits since the implementation of the "Air Pollution Prevention and Control Action Plan." Second, we estimated the number of premature deaths in the research region under various control scenarios based on PM2.5 concentrations recorded in 2013 and 2021, utilizing existing epidemiological studies for reference. Finally, we calculated the financial benefits resulting from variations in PM2.5 concentrations within this region. Results indicated that (1) from 2013 to 2022, the Tarim Basin exhibited the highest PM2.5 concentration among all studied areas, while northern Xinjiang and Qinghai Province had notably lower levels. Additionally, wintertime concentrations were consistently higher than those observed during summer months; however, there has been a general trend toward reduced PM2.5 content over the past decade. (2) A significant inverse relationship was found between premature mortality rates and PM2.5 concentrations; specifically, fluctuations in PM2.5 levels exerted a more pronounced impact on premature deaths attributable to cardiovascular diseases compared to respiratory conditions within this northwest region. (3) Males were disproportionately affected by increases in PM2.5 concentration relative to females-experiencing two to three times more early fatalities than their female counterparts did. (4) Over a 9-year period within this research area, fiscal benefits derived from interventions targeting PM2.5 treatment increased by approximately 891 million yuan.

Oral Health and Systemic Disease: A Systematic Review of the Impact of Dental Care on Overall Health

Oral health is increasingly recognized as a critical component of overall health, with research highlighting its potential impact on various systemic diseases. This systematic review examines the current evidence on the association between oral health, particularly dental care, and systemic conditions such as cardiovascular disease, diabetes, respiratory illnesses, and adverse pregnancy outcomes. A comprehensive literature search was conducted across multiple databases, focusing on studies published from 2016 onward. Studies indicate that periodontal disease and other oral health issues may contribute to systemic inflammation, a common factor in many chronic conditions. Specifically, findings suggest that managing oral health can have beneficial effects on cardiovascular health, glycemic control in diabetic patients, and respiratory function, as well as reduce risks for adverse pregnancy outcomes. However, while associations are evident, causality remains difficult to establish, and further longitudinal research is needed to clarify these relationships. This review underscores the importance of incorporating dental care into holistic health approaches, advocating for greater collaboration between dental and medical professionals. Public health initiatives promoting regular dental check-ups and preventive care may play a crucial role in improving overall health outcomes.

The impact of vaping on the health of children and adolescents

The article discusses the issue of the use of vape pens and electronic cigarettes, particularly among children and teenagers. The authors analyzed 58 scientific articles that discuss the damage to the lungs caused by smoking electronic devices, in order to identify symptoms and pathological changes. The study highlights the various clinical manifestations of lung damage associated with vaping and using electronic cigarettes (EVALI, e-cigarettes or vaping-associated lung injuries), and the need for a differential diagnosis with other respiratory illnesses, including COVID-19. It is essential to conduct educational and awareness campaigns in society to spread information about the risks of using electronic devices. Further research is needed to understand the long-term effects of vape pens and e-cigarettes on human health.

Smokeless tobacco use and its associated factors among secondary school students of Rangeli Municipality of Morang district, Nepal.

The tobacco epidemic is one of the biggest public health threats and the world's leading cause of preventable death which is responsible for killing 8 million people every year. Adolescents are the vulnerable age group and are at greater risk of any tobacco use including smokeless tobacco (SLT) and nicotine addiction. Tobacco use at a young age increases the risk of various non-communicable diseases (NCDs) such as respiratory illness, asthma, chronic obstructive respiratory disease (COPD), reduced pulmonary function, and cancers. This study aimed to determine the prevalence of smokeless tobacco and its associated factors among secondary school students of grades 11 and 12 in Rangeli Municipality, Nepal. A cross-sectional study was conducted among 355 students from the selected secondary schools. A self-administered questionnaire was used to collect the data. Data was cleaned and then exported to IBM SPSS Statistics 20 for analysis. Participants' characteristics were described using frequencies, percentages, mean, and standard deviation. Multivariate logistic regression was conducted to determine the association between individual characteristics and prevalence of smokeless tobacco. All the tests were performed at a 95% Confidence Interval (CI) and a p-value less than 0.05. The mean (±SD) age of the participants was 18.0±1.3 years. Most participants were female (61.1%). The majority of the participants were from grade 11 (58.3%), government schools (60%), and nuclear families (64.8%). This study found that 38.4% and 61.6% of the participants were SLT ever users and never users respectively. Among the ever users, 29.5% were current users and most tried (47.7%) at the age of 10-14 years. Most participants revealed that homes and public places were common sites for SLT use. Paan Masala and Gutkha were the most commonly preferrable SLTs. This study found that age (AOR = 1.5, CI: 1.2-2.2), sex (AOR = 2.6, CI:1.6-4.4), and school type (AOR = 1.8, CI:1.1-3.0) were significantly associated with the prevalence of SLT. This study found that the prevalence of current SLT users is higher than the national survey. This study concludes that males, young adolescents, and students from private schools are at greater risk of SLT use and are unaware of the consequences on their health. Concerned stakeholders must expand awareness and promote educational programs on the harmful use of tobacco targeting secondary school students. The government organizations, educational institutions, and private organizations jointly work to strengthen the implementation of tobacco cessation programs and tobacco control strategies.

Establishment and application of a duplex fluorescent quantitative PCR assay for H9N2 subtype avian influenza virus and infectious bronchitis virus.

The H9N2 subtype of avian influenza virus (AIV) and infectious bronchitis virus (IBV) are important avian viruses that cause respiratory symptoms in poultry, and can form mixed infections. In this study, primers and probes were designed based on the HA gene of H9N2 and the 5' noncoding region of IBV, respectively, and a fluorescent quantitative RT-PCR assay was established for simultaneous detection of these two pathogens. The reaction system and conditions were optimized. The method only detected AIV subtype H9N2 and IBV and no other viruses, confirming its high specificity. The assay detected 13.5 copies/μL and 1.66 copies/μL of H9N2 and IBV in clinical samples, respectively. The coefficients of variation for intra- and interassay repeatability were < 3%. The established method was used to analyze 254 clinical samples (oropharyngeal and cloacal swabs) from Hubei Province, China; 98.82% were positive for both pathogens. In summary, a duplex fluorescent quantitative RT-PCR method capable of simultaneously detecting AIV subtype H9N2 and IBV was established. It is specific, sensitive, and reproducible, and can be used for diagnosis of a variety of clinical samples. It provides a technological means for the rapid and simultaneous detection of both pathogens, and thus can facilitate clinical diagnosis and epidemiological investigations.

Cardiovascular Profile of Patients With COVID-19 Infection Admitted in a Tertiary Care Hospital in Manila, Philippines: A 2-Year Single-Center Retrospective Study

INTRODUCTION: Respiratory symptoms are the most commonly observed clinical manifestations in patients with COVID-19 infection; however, some patients may present with cardiovascular complications. Patients with underlying cardiovascular diseases are associated with increased mortality risk. This study aimed to provide local data on the clinical profile and cardiovascular outcomes and to determine predictors of in-hospital mortality among COVID-19 patients admitted to a tertiary care hospital in the Philippines. METHODS: This single-center retrospective study included hospitalized patients diagnosed with COVID-19 between March 2020 and May 2022. Clinical parameters were subjected to univariate and multivariate regression analyses, with in-hospital mortality as the dependent variable. RESULTS: A total of 1341 patients were admitted with a mean age of 50 years, half of whom were males. Hypertension is the most common comorbidity (728 [54.3%]), followed by diabetes mellitus (393 [29.3%]) and heart disease (136 [10.1%]). Patients admitted to the intensive care unit had significantly higher systolic blood pressure than non–intensive care unit patients (127 ± 19 vs 139 ± 26 mm Hg; P &lt; 0.001), as well as higher plasma erythrocyte sedimentation rate, C-reactive protein, D-dimer, troponin, ferritin, and lactate dehydrogenase. The most common cardiac complications observed were heart failure (39%), acute cardiac injury (30%), and arrhythmia (30%). During hospitalization, 100 patients (7.4%) died; almost half were admitted to the critical care unit, and 84 had cardiac complications, with heart failure (21%) being the most common. Sinus tachycardia was the most common electrocardiographic abnormality (436 [32%]). Univariate analysis showed diabetes (odds ratio [OR], 2.7; P = 0.029) and hypertension (OR, 3.4; P = 0.11). Multivariate analysis revealed that age (OR, 1.095; P &lt; 0.05) and admission duration (OR, 0.906; P &lt; 0.05) were significantly associated with mortality. CONCLUSION: This study highlights the clinical characteristics of patients contracted with COVID-19 who may experience several cardiac conditions. Therefore, particular attention should be given to the role of preexisting cardiovascular diseases and cardiac complications that may contribute to long-term outcomes. KEYWORDS: cardiac complications, COVID-19, cardiovascular outcomes

Diverse antifungal potency of terbinafine as a therapeutic agent against Exophiala dermatitidis in vitro.

Exophiala dermatitidis (E. dermatitidis), which causes skin or respiratory disease, is occasionally fatal in immunocompromised patients. Here, we report the unique antifungal potency of terbinafine (TRB), which targets squalene epoxidase, against E. dermatitidis (SQLEED) using various in vitro approaches. The versatile antifungal activities, including fungicidal activity, biofilm formation inhibition, biofilm eradication activity, and the combination effect of TRB, posaconazole (PSC), and amphotericin B (AmB) with great antifungal potency against E. dermatitidis were evaluated using crystal violet and cell viability assay. TRB formed an H-bond through Y102 in SQLEED in the binding model. E. dermatitidis hyphae elongated and attached to a cell scaffold, forming a membrane-like biofilm. TRB and PSC showed more potent antibiofilm activities than AmB, and exhibited post-antifungal effects without incubation against E. dermatitidis conidia, reducing growth at lower concentrations. In contrast, AmB exhibited strong dose- and time-dependent killing and biofilm-eradication activities. The combination of TRB and PSC was more effective than that of TRB and AmB or PSC and AmB. Although the tissue migration of TRB must be considered, these data suggest that TRB and PSC may be useful agents and a potent combination in severely immunocompromised patients with refractory and systemic E. dermatitidis infection.

Gastroesophageal reflux disease and risk of incident lung cancer: A large prospective cohort study in UK Biobank.

Some pathogenic mechanisms suggest a potential relationship between gastroesophageal reflux disease (GERD) and respiratory diseases. However, evidence regarding the association between GERD and lung cancer is mixed. We aim to explore this relationship based on data from the large-scale UK Biobank study. We performed a cross-sectional and prospective cohort study in 501,569 (45.58% male) individuals included in the UK Biobank at baseline (2006-2010). The Cox proportional hazards model and logistic regression models were used to assess the relationship between GERD and lung cancer, small cell lung cancer (SCLC), lung squamous cell carcinoma (LUSC), and lung adenocarcinoma (LUAD). During a mean follow-up of 11.54 years, 3,863 (0.84%) incident lung cancer cases were identified. In the cross-sectional analysis using logistic models, significant associations were found between GERD and prevalent lung cancer cases (odds ratio [OR] = 1.87, 95% confidence interval [95% CI]: 1.45-2.38) and subtypes of lung cancer, with an OR (95% CI) of 3.19 (1.47-6.79) for SCLC, 2.08 (1.33-3.21) for LUSC, 1.85 (1.15-2.91) for LUAD. In the follow-up analysis using Cox models, GERD was associated with an increased risk of lung cancer (hazard ratio [HR] = 1.24, 95%CI: 1.14-1.34). Similar associations were also observed between GERD and SCLC (HR = 1.39, 95% CI: 1.09-1.78), LUSC (HR = 1.40, 95% CI: 1.18-1.65), and LUAD (HR = 1.17, 95% CI: 1.02-1.33). The risk of lung cancer resulting from GERD was mainly elevated in former smokers (HR = 1.38, 95% CI: 1.23-1.54) and current smokers (HR = 1.18, 95% CI: 1.04-1.34), but not in never-smokers (HR = 0.89, 95% CI: 0.70-1.14). No significant association was observed in former smokers who had quit smoking for at least 25 years. We found that GERD was positively associated with an increased risk of lung cancer, especially among smokers. Awareness of this association may be beneficial for prevention and treatment strategies of both diseases.