Respiratory Disease Research Articles

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

Background 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. Methodology 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. Results 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. Conclusion 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.

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

Background 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. Materials and methods 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). Results 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. Conclusions 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.

Use of Disinfectants and Cleaning Products Associated with Respiratory Disease: A Scoping Review

Introduction: there is extensive evidence on the harmful respiratory effects of exposure to disinfectants and cleaning products. Methodology: an exploratory systematic review was carried out in five databases: LILACS, PubMed, MEDLINE and BIREME. Twenty articles from 2013 to 2024 were selected for the present review. Results: chemical compounds present in some disinfectants and cleaning products such as Polyhexamethylene guanidine (PHMG) and Chloromethylisothiazolinone/Methylisothiazolinone (CMIT/MIT) influence the development of Humidifier Respiratory Distress Syndrome (HDRS) and increased incidence of asthma and Chronic Obstructive Pulmonary Disease (COPD) in adults. Conclusions: There is a relationship between exposure to chemical compounds in certain disinfectants and lung health impairment. It is imperative to increase the general population’s awareness of the effects of these substances will lead to improved self-care in those who are in daily contact with these elements.

PECULIARITIES OF THE EXOCRINE SECRETORY FUNCTION OF THE PANCREAS IN NEONATES WITH PERINATAL PATHOLOGY

Introduction. Post-asphyxia syndrome in newborn infants due to experienced intrauterine hypoxia and asphyxia at birth remains a relevant issue in neonatology. The intestines and glands of internal and external secretion are target organs of pathologic hypoxic influence. Their ischemic damage can be a cause of digestive disorders against the background of multiple organ damage of a newborn child. Objective of this study is to determine peculiarities of the exocrine secretory functions of the pancreas in full-term neonates with perinatal pathology. Material and methods. One hundred fifty five Full-term neonates with the signs of perinatal pathology were examined. I group included 82 neonates with severe perinatal pathology, II group – 73 moderate pathology, 50 healthy infants constitute III control group. Inclusion criteria were gestational age more than 37 full weeks, clinical-paraclinical signs of maladjustment syndrome at birth and/or during the early neonatal period, parents’ written consent to participate in the study. Exclusion criteria were gestational age less than 37 full weeks; congenital defects; low body weight (size) at birth; signs of infectious processes. Clinical examination of patients and biochemical blood tests were carried out on the base of the clinical laboratory of the Municipal Non-Profit Institution «Municipal Clinical Maternity Home №2» of Chernivtsi Municipal Council, and German-Ukrainian laboratory «Bukintermed» (Chernivtsi). The study was conducted in accordance with the 'Rules of Ethical Principles of Conducting Scientific Medical Research with Human Participation,' approved by the Declaration of Helsinki (1964-2013), ICH GCP (1996), EU Directive No. 609 (24.11.1986), the Order of the Ministry of Health of Ukraine No. 690 (23.09.2009), and the approval of the Biomedical Ethics Board of Bukovinian State Medical University. For statistical analysis, licensed software programs were used, including Statistica (StatSoft Inc., Version 7), Microsoft Excel (AtteStat, Version 12.5), and MedCalc Software Ltd (Version 22.021). Results and discussion. The examination groups were representative according to their gestational age and anthropometric parameters at birth, and gender characteristics. A comprehensive clinical-paraclinical examination of infants showed that severe disorders of infants in I group were caused by the signs of severe (13.4 %) and moderate (13.4 %) asphyxia at birth, meconium aspiration syndrome (20.7 %), severe respiratory disorders (53.6 %), hypoxic-ischemic damage of the central nervous system (39.0 %), convulsive syndrome (13.4 %), birth trauma (7.3 %) etc. Moderate maladjustment in infants from II group were associated with the signs of perinatal damage of the central nervous system (65.8 %), hemolytic diseases of the newborns (27.4 %), neonatal jaundice (28.8 %), respiratory disorders (35.6 %) etc. The condition of neonates from ІІІ group was satisfactory during the period of early postnatal adaptation. The results of additional examination methods found certain peculiarities of the exocrine secretory function of the pancreas in full-term neonates with perinatal pathology. Thus, blood amylase activity in the first day of life in the infants from І group was 0.39 ± 0.03 Un/L, ІІ group – 0.29±0.02 Un/L, ІІІ group – 0.14±0,01 Un/L (рІ-ІІ = 0.016, рІ-ІІІ < 0.0001, рІІ-ІІІ < 0.0001). According to the examination group, activity of the enzyme in the blood of infants at the end of their first week of life was 17.8 ± 0.81, 15.28 ± 0.22 and 14.81±0.06 Un/L respectively (рІ-ІІ = 0.006, рІ-ІІІ = 0.009, рІІ-ІІІ = 0.0435). The study found similar tendencies in changes of lipase activity in the blood of full-term infants. During the first day of life it was 0.35±0.01 Un/L in I group, ІІ group – 0.31±0.01 Un/L, ІІІ group – 0.32 ± 0.01 Un/L (рІ-ІІ = 0.003, рІ-ІІІ = 0.01, рІІ-ІІІ > 0.05). Activity of the enzyme in the blood of infants at the end of their first week of life was 19.7±0.22, 19.1±0.13 and 18.9±0.37 Un/L respectively (рІ-ІІ = 0.021, рІ-ІІІ > 0.05, рІІ-ІІІ > 0.05). Conclusion. The results obtained were indicative of a reliable increase of amylase and lipase activity in the blood of full-term neonates in all the examination groups in the dynamics of observation. It is associated with physiological stimulation of the exocrine secretory function of the pancreas in the early neonatal period. Attention should be paid to a direct correlation between an increased activity of the enzymes and severity of perinatal pathology both in the first day of life and at the end of the first week. It can be indicative of an excessive activation of pancreatic function due to pathologic hypoxic damage.

Evaluation of pitolisant, sodium oxybate, solriamfetol, and modafinil for the management of narcolepsy: a retrospective analysis of the FAERS database

ObjectiveNarcolepsy, a rare neurological disorder believed to have an autoimmune etiology, necessitates lifelong management. This study aimed to provide evidence supporting the safety of pharmacological treatment for narcolepsy.MethodsFive-year data on pitolisant, sodium oxybate, solriamfetol, and modafinil were extracted from the FDA Adverse Event Reporting System (FAERS) self-reporting database for the period spanning from 2019 to 2023. Various statistical methods, including the reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian confidence propagation neural network analysis (BCPNN), and multi-item gamma Poisson shrinker (MGPS), were employed to quantify the signals. Finally, a comparative analysis was conducted between demographic data, outcomes, and inherent associations among the medications and the signals.ResultsAfter data analysis, we obtained 50 signals (a cumulative count of 762 cases) for pitolisant, 640 signals (corresponding to 46,962 cases) for sodium oxybate, 40 signals (equivalent to 1,228 cases) for solriamfetol, and finally, 72 signals (representing 632 cases) for modafinil. The majority of these patients were female. Psychiatric and nervous system disorders were identified as the predominant adverse drug events (ADEs). For sodium oxybate, it is crucial to consider psychiatric disorders (such as suicidal ideation), respiratory disorders (including sleep apnea syndrome and respiratory depression), and signs of pregnancy and congenital familial diseases. For solriamfetol, noteworthy new ADEs include drug inefficacy, suicidal ideation, restless legs syndrome, and somnambulism. Furthermore, a relationship has been observed between modafinil use and restricted fetal growth, spontaneous abortion, cognitive disorders, and drug inefficacy and abuse.ConclusionThe majority of observed adverse reactions in this study were consistent with those listed in the product instructions. However, potential novel or notable ADE signals were identified through real-world pharmacovigilance analysis. It is anticipated that this paper will offer additional information regarding safe and rational medication for narcolepsy.

Local and systemic humoral immune responses to Histophilus somni recombinant antigens administered intranasally and subcutaneously to dairy calves

AbstractBovine respiratory disease (BRD) causes significant economic losses in dairy calves. Induction of an early immune response via parenteral vaccination is complicated by the interference of colostral immunity. In this study, we investigated early immunization against selected conserved bacterial antigens. Calves were vaccinated twice intranasally and then subcutaneously with Histophilus somni recombinant proteins (rOMP40 or rHsp60) mixed with one of two adjuvants: CpG ODN2007 or MPLA. The control group (Con) was treated with PBS. The first immunization was done between 24 and 48 h of life and then twice in two weeks intervals. Blood, nasal, and saliva secretion samples were collected directly before vaccination (S1–S3) and then on 42–44 (S4) and 59–61 (S5) day of life. Antibodies (IgG1/IgG2/IgM/IgA in serum; IgG1/IgA in secretions) against both vaccine antigens were quantified in all samples. Intranasal and subcutaneous vaccinations using the described formulas did not increase antibody reactivity against the tested proteins. The reactivity of serum IgG1, IgM, and IgA anti-rOMP40 antibodies was significantly higher in S1 in all groups than that in the other samplings (p˂0.01). Significant differences in the reactivity of serum anti-rOMP40 antibodies between groups were identified in S1 (IgA reactivity was higher in the CpG vs. MPLA group; p < 0.05), S4 (IgM reactivity was higher in Con vs. CpG group; p < 0.05), and S5 (IgG1 reactivity was higher in MPLA vs. Con group; p < 0.05). The lack of consistent changes in antibodies after immunization (S4 and S5) hinders the drawing of conclusions regarding the effect of immunization on antibody reactivity. In the future, establishing a proper immunization window and adjuvants for nasal vaccines against bacterial pathogens causing BRD in calves remains to be determined.

Improving diets and multimorbidity prevention

In 2023, the UK government announced a Major Conditions Strategy, publishing ‘The case for change and our strategic framework’, which set out the focus on cancers, diabetes, dementia, mental ill health, musculoskeletal disorders, CVD and chronic respiratory diseases. Together, these conditions account for 60% of total disability-adjusted life years lost to early death or ill health in England, and one in four adults has at least two (multimorbidity). This review considers some of the key dietary risks for these major conditions and population policies that may improve diets and reduce risks. UK Government dietary recommendations, based on independent risk assessment and advice from the Scientific Advisory Committee on Nutrition, are encapsulated in the national food model, the Eatwell Guide. Based on key sources of dietary data – chiefly consumption data from the National Diet and Nutrition Survey and consumer purchase data from Kantar – most people do not meet dietary recommendations. This review considers how science and evidence inform health improvement policy. This includes policies that encourage healthier food choices, such as labelling and public procurement standards to those that minimise the impact of the less healthy choice such as sugar and salt reduction and reformulation. The review also considers nutritional approaches to managing some non-communicable diseases. Given the role nutrition and excess weight play in the onset, prognosis and quality of life for those living with one or more of the major conditions, there are huge potential gains from even small dietary improvements across population groups.

Asthma and Memory Function in Children

ImportanceAsthma is a chronic respiratory disease affecting approximately 5 million children in the US. Rodent models of asthma indicate memory deficits, but little is known about whether asthma alters children’s memory development.ObjectiveTo assess whether childhood asthma is associated with lower memory abilities in children.Design, Setting, and ParticipantsThis cohort study used observational data from the Adolescent Brain Cognitive Development (ABCD) Study, a multisite longitudinal investigation that began enrollment in 2015. Approximately 11 800 children aged 9 to 10 years were enrolled at baseline with follow-up at 1 and 2 years. Participants were selected based on exposures described subsequently to determine longitudinal and cross-sectional associations between asthma and memory. Data were analyzed from Month year to Month year.ExposuresAsthma was determined from parent reports. For the longitudinal analysis, children were selected if they had asthma at baseline and at the 2-year follow-up (earlier childhood onset), at the 2-year follow-up only (later childhood onset), or no history of asthma. For the cross-sectional analysis, children were selected if they had asthma at any time point, or no history of asthma. The comparison group of children with asthma history was matched on demographic and health covariates for each analysis.Main Outcomes and MeasuresThe primary outcome was episodic memory. Secondary outcomes included processing speed, inhibition and attention.ResultsFour hundred seventy-four children were included in the longitudinal analysis (earlier childhood onset: 135 children; mean [SD] age, 9.90 [0.63] years; 76 [56%] male; 53 [28%] Black, 29 [21%] Hispanic or Latino, and 91 [48%] White; later childhood onset: 102 children; mean [SD] age 9.88 [0.59] years; 54 [53%] female; 22 [17%] Black, 19 [19%] Hispanic or Latino, and 83 [63%] White; comparison: 237 children; mean [SD] age, 9.89 [0.59] years; 121 [51%] male; 47 [15%] Black, 48 [20%] Hispanic or Latino, and 194 [62%] White). Children with earlier onset of asthma exhibited lower rates of longitudinal memory improvements relative to the comparison group (β = −0.17; 95% CI, −0.28 to −0.05; P = .01). Two thousand sixty-two children were selected for the cross-sectional analysis (with asthma: 1031 children; mean [SD] age, 11.99 [0.66] years; 588 [57%] male; 360 [27%] Black, 186 [18%] Hispanic or Latino, and 719 [54%] White; without asthma: 1031 children; mean [SD] age 12.00 [0.66] years; 477 [54%] female; 273 [21%] Black, 242 [23%] Hispanic or Latino, and 782 [59%] White). Children with asthma (1031 children) showed lower scores on episodic memory (β = −0.09; 95% CI, −0.18 to −0.01; P = .04), processing speed (β = −0.13; 95% CI, −0.22 to −0.03; P = .01), and inhibition and attention (β = −0.11; 95% CI, −0.21 to −0.02; P = .02).Conclusions and RelevanceIn this cohort study, asthma was associated with memory difficulties in children, which may be more severe if asthma onset is earlier in childhood and may extend to executive function abilities.

Serological and Molecular Investigation of Infectious Laryngotracheitis Virus in Chickens from Robe Town, Southeastern Ethiopia

Infectious laryngotracheitis virus (ILTV) is responsible for avian infectious laryngotracheitis (ILT), a highly contagious acute respiratory disease affecting chickens. However, there is limited information on ILTV and its distribution in Ethiopia, particularly in the southeastern region. The aim of this study was to establish the serological prevalence and molecular evidence in commercial and backyard chickens from Robe town, Southeastern Ethiopia. A cross-sectional study was conducted between December 2021 and June 2022, collecting 240 serum samples from randomly selected chickens belonging to eight kebeles (farms) using systematic random sampling. ILTV-specific antibodies were detected using a commercial indirect enzyme-linked immunosorbent assay (ELISA). From 240 serum samples, 26.7% were positive for ILTV antibodies. Logistic regression analysis identified the type of poultry farm (backyard) and the introduction of chickens from other farms as potential risk factors associated with ILTV exposure. Tracheal tissue and oropharyngeal and tracheal swabs were collected from suspected chickens for isolation and molecular detection. A total of six samples were successfully isolated in embryonated eggs (40%), with four of them verified with a specific PCR. These findings documented the presence of ILTV in the study area, which needs further insight to fully understand the actual spread of ILTV and quantify the damage caused to the poultry sector.

Delayed immune-related adverse events profile associated with immune checkpoint inhibitors: a real-world analysis

BackgroundImmune-related adverse events (irAEs) typically occur within 3 months of initiating immune-checkpoint inhibitors (ICIs), which has been extensively documented. But the clinical profiles of late-onset irAEs remain inadequately characterized. Therefore, this study aims to quantify the correlation between delayed irAEs and ICIs, and to delineate the profiles of delayed toxicities associated with ICIs using data from the Food and Drug Administration Adverse Event Reporting System (FAERS).MethodsData from the January 2011 to December 2023 in FAERS database were extracted. Four signal detection indices, reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian confidence propagation neural network (BCPNN) and multi-item gamma Poisson shrinker (MGPS), were employed to evaluate the associations between ICIs and delayed irAEs.ResultsA total of 147,854 cases were included in this study, of which 3,738 cases related to delayed irAEs were identified. Generally, 8 signals at System Organ Class (SOC) level were found to be associated with ICIs. Males had a slightly higher reporting frequencies for respiratory disorders (ROR975 = 0.95) and blood and lymphatic system disorders (ROR025 = 1.22), but lower reporting frequencies for immune system disorders (ROR025 = 1.16). Three monotherapy (anti-PD-1, anti-PD-L1 and anti-CTLA-4) were all associated with significant increasing gastrointestinal disorders (ROR025 = 1.66, 1.16, 1.99) and metabolism disorders (ROR025 = 2.26, 1.74, 3.13). Anti-PD-1 therapy exhibited higher rates of respiratory toxicities (ROR025 = 1.46 versus 0.82) and skin toxicities (ROR025 = 1.27 versus 0.94) compared with anti-CTLA-4 therapy. At PT levels, pneumonitis (ROR025: from 11.85 to 29.27) and colitis (ROR025: from 2.11 to 24.84) were the most notable PT signals associated with all three ICI regimens. For outcomes of delayed irAEs, gastrointestinal disorders showed the highest proportion (51.06%) of death.ConclusionOur pharmacovigilance analysis indicates that a small percentage of patients receiving ICIs therapy experience delayed irAEs, which are challenging to manage and may result in severe consequences. Prompt identification and intervention of these delayed irAEs are crucial in clinical practice.

INCIDÊNCIA E MORTALIDADE POR CÂNCER DE TIREOIDE NO BRASIL: UM ESTUDO EPIDEMIOLÓGICO

Thyroid cancer is the most common endocrine malignancy, being twice as prevalent in women, although men have a poorer prognosis. In Brazil, thyroid cancer is one of the main cancers among women, occupying the 5th position with 5.4% of the total. For each year of the 2020-2022 triennium, 11,950 new cases of thyroid cancer are estimated in the country in women, representing an estimated risk of 11.15/100,000 inhabitants. Signs and symptoms include a lump in the neck, swelling, pain, hoarseness, difficulty swallowing, respiratory problems and cough. Studies attribute the increase in the incidence of this thyroid carcinoma to the increase in iodine intake in the diet, as well as to genetic factors, since 20% of cases are related to the autosomal dominant gene. This study aims to identify the incidence and mortality rate of thyroid cancer in Brazil between 2012 and 2022. It also aims to verify the mortality rate by sex and age group and identify the region of the country with the highest mortality rate. This is an epidemiological, quantitative, and descriptive study. The research was carried out by collecting data related to Brazil from the INCA, SIM, and DATASUS databases. Throughout the period investigated, we observed a total of 8,679 deaths from thyroid cancer, of which 2,948 were in men, equivalent to 33.97%, and 5,731 were in women, with a percentage of 66.03%. Comparing the occurrence of deaths from thyroid cancer between men and women, it is observed that the mortality rate among women is approximately three times higher than that of the male population, throughout the period analyzed. The results found reinforce that mortality from thyroid cancer has been high in the last decade, affecting women more women than men. These results suggest that more investment is needed to minimize and, if possible, reverse the situation.

IMPAIRED RESPIRATORY FUNCTIONS IN CHILDREN WITH CAT SENSITIZATION IN THE EARLY AGES OF CHILDHOOD

ABSTRACT Background To evaluate the respiratory functions in children with cat sensitization accompanying allergic respiratory diseases and to compare these with those of healthy controls, as well as within themselves by classifying according to their diseases, domestic cat exposure, age groups’ Methods This prospective case-control study included 130 children aged 3-17 years with cat sensitization (CS group) accompanying respiratory allergic diseases and 70 age- and sex-matched healthy controls (HC group). The cases’ demographic parameters were recorded, and respiratory functions were analyzed using IOS and spirometry. Results At IOS evaluation, zR5, R5-20, Fres, and AX values ​​were higher in children in the CS group compared to the HC group (p = 0.029, p = 0.008, p = 0.001, and p < 0.001, respectively), while zX5 and zX20 values ​​were lower (p = 0.001 and p < 0.001). R5-20 and AX were higher in asthma compared to allergic rhinitis (p = 0.008, p = 0.015), but were insignificant compared to asthma and allergic rhinitis coexistent group (p > 0.05). R5-20, Fres, and AX were higher, and zX20 was lower in the pre-school age group (p < 0.001). No correlation was found between zFEV1, zFVC, zFEV1/FVC, zFEF25-75 and zR5 values in the CS group (p > 0.05). Conclusions Pulmonary resistance was higher and reactance was lower in the entire and peripheral airways in children with cat sensitization accompanying respiratory allergic diseases compared to the healthy controls. Peripheral airway resistance and reactance were more impaired in asthma group compared to allergic rhinitis. However, peripheral airway resistance and main airway reactance were more impaired in the pre-school age group than the older ones.

Moving beyond species: fungal function in house dust provides novel targets for potential indicators of mold growth in homes

BackgroundIncreased risk of asthma and other respiratory diseases is associated with exposures to microbial communities growing in damp and moldy indoor environments. The exact causal mechanisms remain unknown, and occupant health effects have not been consistently associated with any species-based mold measurement methods. We need new quantitative methods to identify homes with potentially harmful fungal growth that are not dependent upon species. The goal of this study was to identify genes consistently associated with fungal growth and associated function under damp conditions for use as potential indicators of mold in homes regardless of fungal species present. A de novo metatranscriptomic analysis was performed using house dust from across the US, incubated at 50%, 85%, or 100% equilibrium relative humidity (ERH) for 1 week.ResultsGene expression was a function of moisture (adonis2 p < 0.001), with fungal metabolic activity increasing with an increase in moisture condition (Kruskal–Wallis p = 0.003). Genes associated with fungal growth such as sporulation (n = 264), hyphal growth (n = 62), and secondary metabolism (n = 124) were significantly upregulated at elevated ERH conditions when compared to the low 50% ERH (FDR-adjusted p ≤ 0.001, log2FC ≥ 2), indicating that fungal function is influenced by damp conditions. A total of 67 genes were identified as consistently associated with the elevated 85% or 100% ERH conditions and included fungal developmental regulators and secondary metabolite genes such as brlA (log2FC = 7.39, upregulated at 100% compared to 85%) and stcC (log2FC = 8.78, upregulated at 85% compared to 50%).ConclusionsOur results demonstrate that moisture conditions more strongly influence gene expression of indoor fungal communities compared to species presence. Identifying genes indicative of microbial growth under damp conditions will help develop robust monitoring techniques for indoor microbial exposures and improve understanding of how dampness and mold are linked to disease.-X5AkW-U2mftBzktcaxDSrVideo

A cross-sectional study of point-of-care lactate testing in integrated community care management (ICCM) for children with acute respiratory illness in rural uganda

Abstract Background Integrated community case management (iCCM) programs leverage lay village health workers (VHWs) to carry out the initial evaluation of children with common conditions including malaria, pneumonia and diarrhea. Therefore, it is imperative that VHWs are able to identify children who are critically ill and require referral to a health facility. Elevated venous lactate levels have been associated with severe illness and adverse health outcomes, including death. However, lactic acidosis may not be recognized in rural settings because it is not routinely measured outside of hospitals and research studies. Point-of-care lactate tests may help identify patients in need of a higher level of care and improve VHWs’ ability to make timely and appropriate referrals. Methods The study was a cross-sectional evaluation of children aged &amp;lt;5 y presenting to VHWs in rural southwestern Uganda with complaints of fever and cough. Demographics, clinical presentation, evaluation, management and disposition were recorded. VHWs were trained and instructed to perform lactate testing using a point-of-care assay in eligible participants. Results During the study period, 238 children were enrolled and completed an initial assessment. Of the 204 participants included in the analysis, 113 (55.4%) were female, and the median (IQR) age was 23 (9–36) months. Most participants, 139/200 (69.5%), had negative results on the malaria rapid diagnostic test. The median lactate level was 2.1 mmol/L; 12% (24/204) had a lactate ≥3.5 mmol/L and only nine participants (4.4%) had a lactate ≥5 mmol/L. Having a lactate level above either cut-off was not associated with the presence of danger signs at presentation. Conclusions Few children presenting with fever and cough to VHWs in western Uganda had elevated lactate levels. However, most of the children with elevated lactate levels did not otherwise satisfy established iCCM criteria based on physical examination findings for referral to a health facility. Therefore, while elevated lactate was not associated with danger signs in this small study, it is possible that there is under-recognition of severe illness using current iCCM guidelines.

Nepal Family Cohort study: a study protocol

IntroductionThe Nepal Family Cohort study uses a life course epidemiological approach to collect comprehensive data on children’s and their parents’ environmental, behavioural and metabolic risk factors. These factors can affect...

Comparative evaluation of the effectiveness of sanatorium treatment programs on the severity of respiratory disorders in patients with postcovid syndrome

The purpose of the study. To conduct a comparative assessment of the effectiveness of various sanatorium treatment programs for patients with respiratory disorders in postcovid syndrome.Material and methods. The study involved 112 people with impaired respiratory system functions who were referred for sanatorium treatment 2–3 months after suffering a new coronavirus infection COVID-19. Of these, 74 are women and 38 are men. The programs used: physical therapy, halotherapy, inhalation of nitric oxide, electrostatic massage.Results. The use of an extended program of sanatorium treatment with the inclusion of inhalations of nitric oxide and electrostatic massage in patients with respiratory disorders with postcovid syndrome contributes to a significant reduction in the number and severity of complaints in this category of patients.Conclusion. The inclusion of nitric oxide inhalations and electrostatic massage in the programs of sanatorium treatment in patients with respiratory disorders with postcovid syndrome increases the effectiveness of rehabilitation treatment after acute infectious disease.

Knowledge Aware Automated Health Claims Processing with Medical Ontologies and Large Language Models

One of the major challenges in automating health insurance claims processing lies in the complexity involved in validating an incoming claim's medical diagnoses against its policy Underwriting (UW) exclusions. Termed UW Exclusion Detection, this process ensures claims are only paid out if their diagnoses are not medically associated with conditions excluded under the policy. Medical diagnoses in health insurance claims are typically represented by the International Classification of Disease (ICD) codes, established by the World Health Organization. For example, given a policy that excludes "all respiratory illness". A claim with the ICD code J45 (Asthma) will be subject to rejection as J45 is a respiratory-related diagnosis that falls within the scope of the policy's UW exclusion. The key challenge in automating this process lies in the wide range of available ICD codes. The ICD-10-CM coding scheme consists of over 40,000 codes, which often results in scenarios where codes encountered during inference are absent from the training data. These unseen ICD codes limit the effectiveness of data-driven approaches, which depend on the training data to discern medically relevant associations between UW exclusions and ICD codes. This underscores the need to supplement data-driven approaches with additional domain knowledge. We hypothesize that integrating implicit medical domain knowledge inherent in Large Language Models (LLMs) with explicit domain knowledge from medical ontologies, will enhance data-driven approaches for UW Exclusion Detection. Thoroughly validated on real-world health insurance claims data, our proposed approach proved effective in accurately establishing medically relevant associations between UW exclusions and ICD codes.

A higher mortality in men compared to women with heart failure in primary care and ejection fraction equal to or more than 40%

ABSTRACT The aim of this study was to describe gender-related differences in characteristics and mortality in heart failure (HF) patients managed in primary care (PC). We included 1802 hF patients aged 77.5 ± 8.8 years (47% women) with ejection fraction (EF) ≥ 40% from the Swedish Heart Failure (SwedeHF) registry. The patients were divided by gender, and by heart failure with mildly reduced ejection fraction (HFmrEF; EF 40–49%) or heart failure with preserved ejection fraction (HFpEF; EF ≥ 50%). Men included in the study were younger (mean-age 76.4 vs 78.7 years, p < 0.0001) and showed a higher age-adjusted mortality (p < 0.0001). Men more often showed ischemic heart disease, 49% vs. 38% (p < 0.0001), atrial fibrillation, 56% vs. 50%, and diabetes, 25% vs. 17% (both p < 0.01). Women had higher blood pressure compared to men (p < 0.01), more commonly had kidney dysfunction (p < 0.01), and a worse functional capacity (p < 0.01). Cardiovascular diseases were the dominating causes of death in men and women (60% and 56%) but were less dominating in individuals with EF ≥ 50%, especially among women (56% in men vs. 46% in women). Among women with EF ≥ 50%, the mortality was dominated of mixed and unspecified diseases. Other important causes of death were cancer (15%) and chronic obstructive pulmonary disease (13%). Men managed in PC with HF and EF ≥ 40% have a higher age-adjusted mortality than women. Cardiovascular disease is the dominating cause of death in both genders. Other frequent causes of death were malignant tumors and respiratory diseases, illustrating the need to carefully diagnose and treat all associated comorbidities.

Does Every Strain of Pseudomonas aeruginosa Attack the Same? Results of a Study of the Prevalence of Virulence Factors of Strains Obtained from Different Animal Species in Northeastern Poland

Background: Pseudomonas aeruginosa is a pathogen that causes infections in animals and humans, with veterinary implications including ear infections in dogs, respiratory diseases in cats, and mastitis in ruminants. In humans, it causes severe hospital-acquired infections, particularly in immunosuppressed patients. This study aimed to identify and assess the prevalence of specific virulence factors in Pseudomonas aeruginosa isolates. Methods: We analyzed 98 Pseudomonas aeruginosa isolates from various animal samples (dogs, cats, ruminants, fowl) from northeastern Poland in 2019–2022 for virulence-related genes (toxA, exoU, exoT, exoS, lasB, plcN, plcH, pldA, aprA, gacA, algD, pelA, endA, and oprF) by PCR and assessed biofilm formation at 48 and 72 h. Genomic diversity was assessed by ERIC-PCR. Results: The obtained results showed that all strains harbored the pelA gene (100%), while the lowest prevalence was found for pldA (24%) and exoU (36%). Regardless of the animal species, strong biofilm forming ability was prevalent among the strains after both 48 h (75%) and 72 h (74%). We obtained as many as 87 different genotyping profiles, where the dominant one was profile ERIC-48, observed in four strains. Conclusions: No correlation was found between presence or absence of determined genes and the nature of infection. Similarly, no correlation was found between biofilm-forming genes and biofilm strength. The high genetic diversity indicates challenges for effective prevention, emphasizing the need for ongoing monitoring and research.

Long-Term Ozone Exposure, COPD, and Asthma Mortality: A Retrospective Cohort Study in the Republic of Korea

Ozone concentrations have increased in recent decades, and several studies have reported that long-term exposure to ozone increases the mortality risk induced by respiratory conditions. However, research on cause-specific mortality related to ozone exposure and respiratory diseases remains scarce. We constructed a retrospective cohort of 5,360,032 adults aged ≥ 65 years from the National Health Insurance Service of Republic of Korea, and death certificates were obtained from Statistics Republic of Korea to determine the cause of death between 2010 and 2019. The daily maximum 8 h average levels of ozone during the warm season annually (May–September) and other air pollutants were determined for the residential district. We analyzed the data using a time-varying Cox proportional hazards model with individual- and district-level covariates, incorporating a competing risk framework to address deaths from causes other than chronic obstructive pulmonary disease (COPD) and asthma. In our single-pollutant model with a 3-year moving average, a 1 ppb increase in ozone exposure was associated with a hazard ratio (HR) of 1.011 (95% confidence interval [CI]: 1.008–1.013) for COPD mortality and an HR of 1.016 (95% CI: 1.011–1.022) for asthma mortality. In our model adjusted for the presence of underlying diseases and district-level variables, the HRs were 1.009 (95% CI: 1.008–1.014) for COPD and 1.017 (95% CI: 1.011–1.023) for asthma, respectively. These associations remained robust in our two-pollutant model, except for NO2 and COPD. A linear concentration–response relationship was identified between ozone concentration, COPD, and asthma mortality. In this large nationwide cohort study, long-term exposure to ozone was associated with an increased risk of death from COPD and asthma in older Korean adults.