Comparison of lower and upper respiratory tract specimens for the detection of respiratory viruses and atypical pneumonia pathogens by multiplex real-time polymerase chain reaction.

Preoperative assessment is a central but increasingly complex component of pediatric anesthetic care. While perioperative safety in children has improved substantially, preventable complications remain prevalent. This review examines current concepts of pediatric preoperative evaluation, highlights emerging trends and controversies, and proposes the concept of anesthesia as a perioperative "navigator", whose guiding function begins with preoperative assessment. Contemporary practice of preoperative assessment increasingly includes structured risk stratification, procedure-specific planning, optimization of modifiable risk factors, and family centered communication. Advances highlight shorter fasting regimens, growing implementation of methods to optimize preexisting or chronic conditions such as pediatric patient blood management, refined strategies to manage upper respiratory tract infections and individualized approaches to manage preoperative anxiety. At the same time, digitalization, remote preassessment models, and delegation of assessment tasks are shaping clinical workflows. Shared decision-making and proactive communication have emerged as key determinants of cooperation for children and their families. Modern pediatric preoperative evaluation should be viewed less as a static medical checkpoint and more as starting for the dynamic process of perioperative "navigation". Integrating medical risk assessment with structured planning and effective communication remains essential to reduce complications and improve both safety and experience in pediatric anesthesia.

Yinhuang decoction alleviates RSV-induced viral pneumonia via TLR4/NF-κB/NLRP3 pathway with colloidal phase as dominant active fractions.

Public Insurance Is Associated With Increased Emergency Visits After Craniosynostosis Surgery.

Glaesserella parasuis serotype 5 disrupts the swine respiratory epithelial barrier via NBR1-mediated selective autophagic degradation of Claudin-1.

Chronic pancreatitis (CP) is driven by smoking, excessive alcohol use, and chronic inflammation - all known contributors to carcinogenesis. However, its association with malignancies beyond the pancreas remains underexplored. This study aimed to assess the frequency and spectrum of cancers in patients with CP. A retrospective cohort study was conducted at Nottingham University Hospitals of patients diagnosed with CP between 1 January 2006 and 31 December 2014, identified through a multisource case ascertainment strategy. Cancer frequencies were assessed in patients residing within Greater Nottingham. Age-adjusted standardised incidence ratios (SIRs) were calculated using national cancer incidence data from England as the reference population. Statistical analyses were performed using R (version 4.3.3). Of the 1003 CP patients identified, 678 resided in Greater Nottingham (median age at diagnosis 68 years (IQR 53-79); 66% male; 92% Caucasians. The median follow-up period was 7.3 years (IQR 2.8-11.6). Compared to the general population, patients with CP demonstrated significantly higher SIRs for upper respiratory tract (12.4; 95%CI 6.6-21.1; p < 0.0001), pancreatic (10.8; 95%CI 6.2-17.6; p < 0.0001), liver (8.8; 95%CI 2.4-22.6; p < 0.0001), lung (5.6; 95%CI 4.0-7.7; p < 0.0001), renal tract (4.8; 95%CI 2.7-7.9; p < 0.0001) oesophageal (4.8; 95%CI 1.8-10.4; p = 0.0001) and colorectal (2.5; 95%CI 1.4-4.2; p = 0.0009) cancers. CP confers a markedly elevated risk of both pancreatic and extra-pancreatic cancers. These findings hypothesise that CP might be a high-risk state for malignancy that could warrant proactive, risk-based cancer surveillance in this vulnerable population.

Antimicrobial resistance (AMR) is a growing global health threat that extends beyond biomedical dimensions, as it is profoundly shaped by social and structural determinants such as gender, socioeconomic status, and access to care. However, research exploring these factors remains limited. This study adapts and applies a gender and equity matrix to examine how these factors intersect to affect AMR risks in rural Pakistan. We synthesized literature on antibiotic prescription and use in Pakistan and similar sociocultural and economic context settings, focusing on upper respiratory tract and diarrhoeal infections. We then integrated these findings with insights from a structured consultation with gender and public health experts. The gender and equity matrix mapped inequities across three topic-specific domains-susceptibility/vulnerability to infection, care provision (during facility visits), and care uptake (before and after facility visits)-cross-referenced with biological and social stratifiers along with gender analysis domains. Findings were synthesized into cross-cutting themes to identify actionable drivers of AMR. The context analysis highlighted persistent gender- and equity-related barriers in access to care, including women's limited mobility, lower health literacy, and restricted decision-making autonomy. We also identified structural constraints, including limited household financial resources that result in women being deprioritized for care, alongside gender-insensitive health care service delivery. In rural low- and middle-income countries' settings, addressing these barriers requires gender-responsive health system design, equitable provider-patient communication, and interventions that reduce economic and physical barriers to care uptake. The gender and equity matrix offers a structured approach to reveal how social and structural determinants interact to drive AMR risks, providing a practical tool for systematically integrating gender and equity considerations into AMR policy and programming.

Lung injury after hematopoietic stem cell transplantation (HCT) occurs due to infection, chemotherapy toxicity, and alloreactive inflammation. Analyses of bronchoalveolar lavage (BAL) fluid have revealed dominant pathobiologic signatures, but minimally-invasive diagnostics are needed. To determine whether microbiome and gene expression perturbations are shared along the respiratory tract or isolated to the alveoli in pediatric HCT patients with lung injury. We performed bulk RNA sequencing on 206 paired nasal and BAL samples from 160 HCT patients and 17 healthy controls enrolled at 28 children's hospitals (2016-2025). Microbial and human transcripts were compared using multivariable models accounting for age, sex, and paired sampling. HCT BAL and nasal transcriptomes differed across 13,698 genes, 48 cellular components, and network interactions linking inflammation, reactive oxygen species, and immunometabolism. Minimal BAL-nasal correlation was observed in gene expression levels (median ρ = 0.03, IQR -0.03 to 0.08) or fractional abundance of key cells such as neutrophils and CD8 + T-cells. BAL microbiomes harbored fewer commensal bacteria and more fungi and DNA viruses. BAL bacterial RNA was associated with diminished immune signaling whereas nasal bacterial RNA aligned with inflammatory gene expression. Further, only BAL microbial RNA was linked to transcriptional shifts in epithelial injury response, keratinization, and collagen deposition. Finally, BAL commensal microbiome depletion, epithelial injury, and immune dysregulation signatures were associated with death or prolonged mechanical ventilation, whereas nasal samples provided minimal prognostic information. These data support alveolar compartmentalization in pediatric HCT and emphasize the ongoing need for minimally-invasive but informative diagnostics.

Ferreira, ABdM, Halson, S, Galvão-Coelho, NL, Almeida, RNd, Nakamura, FY, and Mortatti, AL. Impact of sleep restriction and intensified training on mucosal immunity and psychological responses in young soccer players. J Strength Cond Res XX(X): 000-000, 2026-This study analyzed the effects of training intensification during a period of sleep restriction (SR) on mucosal immunity (salivary IgA), upper respiratory tract health, mood states, and stress tolerance in young soccer players. Sixteen male youth soccer players completed 7 weeks of training with varied workloads. Weeks 3 and 5 involved a 75% increase in internal training load (ITL); however, although sleep was unrestricted in week 3, allowing for an increase in total sleep time (TST) (+53 minutes vs. baseline), week 5 included a ∼10% reduction in TST (-44 minutes vs. baseline). Internal training load was assessed using session-rating of perceived exertion, and sleep was monitored via actigraphy. Salivary IgA, upper respiratory tract infection (URTI) severity (Wisconsin Upper Respiratory Symptom Survey), perceived recovery status (PRS), stress tolerance (Daily Analysis of Life Demands of Athletes), and mood states (Brunel Mood Scale) were evaluated weekly. Salivary IgA concentrations significantly decreased in both intensified training weeks (week 3: β = -87.41, p = 0.007; week 5: β = -114.04, p < 0.001). However, only in week 5, this reduction was accompanied by a significant increase in URTI severity (p = 0.001), heightened fatigue (χ2 (6) = 42.499, p < 0.001), reduced vigor (χ2 (6) = 49.422, p < 0.001), impaired PRS (p < 0.001), and lower stress tolerance (p = 0.001). In contrast, during week 3, despite the intensified training, PRS, mood states, and stress tolerance remained stable. These findings emphasize the protective role of adequate sleep during intensified training, as greater sleep availability in week 3 may have mitigated the negative effects observed in week 5. Ensuring sufficient sleep during periods of high training loads is essential to maintain physical and psychological health.

Ornithobacterium hominis is a recently described Gram-negative bacterium that colonizes the human nasopharynx and may be associated with poor upper respiratory tract health. Here, we describe the isolation of O. hominis from samples collected from a South African birth cohort, creating the first archive of cultured strains of the species from Africa. Sequenced genomes from this archive reveal that South African O. hominis is more similar to Australian strains than those from Southeast Asia and that it may share genes with other members of the microbiome that are relevant for virulence, colonization and antibiotic resistance. Leveraging existing microbiome data from the cohort, O. hominis was found to be closely associated with bacterial co-colonizers that are rare in non-carrier individuals, including Suttonella, Rappaport, Helcococcus, Lwoffella, Moraxella and Gracilibacteria. Their collective acquisition has a significant impact on the diversity of nasopharyngeal communities that contain O. hominis. Individuals who have not yet acquired O. hominis have a higher abundance of Lwoffella lincolnii than individuals who never acquire O. hominis, suggesting that this could be a precursor state for successful colonization.

ABSTRACT Background Respiratory syncytial virus (RSV) is a common virus affecting the respiratory system in all ages. The study’s objective was to obtain RSV-related health utility values for older adults and their caregivers from the Japanese population. Research design and methods A cross-sectional, observational study was conducted among Japanese adults (≥18 years) between April–June 2023 to quantify the burden of RSV. Participants completed an online survey with six vignettes describing RSV-related health states for patients and caregivers: severe lower respiratory tract infection (sLRTI), lower respiratory tract infection (LRTI), and upper respiratory tract infection (URTI). Using a time trade-off (TTO) approach, respondents indicated the number of days they would trade to avoid these health states. Quality-adjusted life-year (QALY) losses were then estimated. Results Of 1,770 participants, 1,529 were excluded, leaving 241 for analysis (45 with caregiving experience). Median discounted TTO values were 73, 22, and 7 days for sLRTI, LRTI, and URTI, respectively, and 31, 16, and 3 days to avoid caregiving burden. QALY losses were 0.200, 0.060, and 0.018 for patients and 0.086, 0.043, and 0.008 for caregivers. Conclusions Japanese individuals are willing to trade a significant number of days from the end of their life to avoid an RSV episode or its caregiver burden.

Ritlecitinib, an oral covalent Janus kinase 3 (JAK3)/TEC inhibitor, is now used for alopecia areata (AA), but pragmatic early-on-treatment markers to guide continuation decisions are needed. We evaluated whether the Week-12 (W12) change in Severity of Alopecia Tool (ΔSALT) predicts Week-24 (W24) response in real-world care. We conducted a single-center observational cohort of consecutive patients with moderate-to-severe AA treated with ritlecitinib 50 mg once daily. Assessments occurred at baseline (V0, n = 77) and W12 (n = 55), W24 (n = 32), W36 (n = 20), W48 (n = 11), W60 (n = 7). The primary endpoint was the proportion achieving SALT ≤ 20 at W24. Secondary endpoints included SALT trajectory, clinician-reported outcomes (ClinRO) for eyebrows/eyelashes, patient-reported outcomes (HADS, Skindex-16), and safety/laboratories. Exploratorily, we tested ΔSALT V0 to W12 as a predictor of W24 response using receiver operating characteristic/area under the curve (ROC/AUC). Median SALT declined from 90.0 (V0) to 70.0 (W12) and 30.0 (W24); intra-individual median ΔSALT vs. baseline was -10.0 at W12 and -45.0 at W24. Responders (SALT ≤ 20) were 18.2% at W12 (10/55) and 43.8% at W24 (14/32). Periocular ClinRO improved by W24 in 54.5% (eyebrows) and 36.4% (eyelashes). Patient-reported outcomes improved from W12 to W24. Safety was favorable: No serious adverse events or dose modifications were reported; adverse events were mostly mild to moderate (e.g., headache, acne, upper respiratory tract infection [URTI]/nasopharyngitis), and laboratory panels remained stable with modest lipid increases. Early ΔSALT robustly discriminated W24 outcomes: Median -41.0 in future responders vs. +3.0 in non-responders with an AUC = 0.875. ΔSALT at W12 also predicted sustained response at W48 (AUC 0.83). In multivariable analysis, ΔSALT remained independently associated with W24 response (odds ratio [OR] 1.52 per 10-point decrease). In routine practice, ritlecitinib produced rapid, clinically meaningful improvement with good tolerability. The on-treatment ΔSALT at 12 weeks is a pragmatic predictor of 24-week success and supports a treat-to-target checkpoint to inform continuation/optimization decisions alongside ClinRO and PROs.

BackgroundAntimicrobial resistance (AMR) is a major global health threat, with sub-Saharan Africa bearing a disproportionate burden. Community-level antibiotic dispensing practices remain poorly described in Kenya outside Nairobi.MethodsA total of 504 antibiotic dispensing events were recorded across 22 community pharmacies in Kakamega County, western Kenya, between 3rd and 22nd August 2025. Data collected included dispensing source (over-the-counter [OTC] versus prescription), clinical indication, antibiotics dispensed, course completion, and self-reported repeat antibiotic use within the preceding month. Descriptive analyses were performed, and χ² tests were used to examine associations between dispensing source and selected non-antibiotic dispensing characteristics.ResultsOf the 504 dispensing events, 224 (44.4%) involved OTC dispensing and 278 (55.2%) were prescription-based. The most frequent indications for antibiotic dispensing were upper respiratory tract infections (URTI; n = 156, 31.0%), lower respiratory tract infections (LRTI; n = 95, 18.8%), gastrointestinal infections (n = 65, 12.9%), and skin or soft-tissue infections (n = 55, 10.9%). Across all events, amoxicillin, azithromycin, and metronidazole were the most frequently dispensed antibiotics, with cephalosporins and other broad-spectrum agents used across several indications. Partial antibiotic courses were supplied in 33 (6.5%) dispensing events, most commonly due to financial constraints (15/33, 45.5%). Self-reported antibiotic use within the preceding month occurred in 156 (31.0%) cases.ConclusionsOTC antibiotic access remains widespread in Kakamega County, with substantial use of broad-spectrum agents across multiple clinical indications. Financial barriers contribute to incomplete antibiotic courses. These findings highlight the importance of incorporating community pharmacy dispensing data into county-level antimicrobial stewardship programmes and informing national strategies to optimise antibiotic use.

Primary ciliary dyskinesia in pediatric persons: A microscopic movement malady.

Development of a clinical prediction model for discriminative factors of lower respiratory tract infections in patients presenting with fever: A single-center retrospective study.

To evaluate the efficacy and safety of secukinumab in patients with active psoriatic arthritis (PsA) through a systematic review and meta-analysis of randomized controlled trials (RCTs). A comprehensive literature search of PubMed, Embase, Cochrane Library, and ClinicalTrials.gov was conducted from inception until February 2026 to identify relevant RCTs. Eligible studies included randomized, placebo-controlled trials assessing secukinumab in adults with active PsA. Two independent reviewers screened studies, extracted data on clinical efficacy (American College of Rheumatology [ACR] 20/50 responses, Health Assessment Questionnaire-Disability Index [HAQ-DI]) and safety outcomes (overall adverse events [AEs], infections, and treatment discontinuation) and assessed the risk of bias. Pooled analyses demonstrated that secukinumab significantly improved ACR20 and ACR50 response rates and reduced HAQ-DI scores compared with placebo. Dose-related trends suggested greater efficacy with the 300 mg regimen for selected outcomes. Safety analysis showed no significant increase in overall AEs, upper respiratory tract infections, or discontinuations compared with placebo. These findings support secukinumab as an effective and well-tolerated biologic therapy, particularly for patients with an inadequate response to conventional disease-modifying antirheumatic drugs or tumor necrosis factor inhibitors, thereby facilitating individualized treatment strategies. Secukinumab is associated with significant clinical and functional benefits and demonstrates a favorable safety profile, reinforcing its role in optimizing long-term disease control in active PsA.

As a zoonotic opportunistic pathogen, adhesion to the porcine upper respiratory tract epithelium is a prerequisite for Streptococcus suis serotype 2 (SS2) to breach epithelial barriers and cause systemic infections under certain conditions. In this study, we first demonstrated the adhesive function of the autolysin Atl of SS2 to swine tracheal epithelial cells. We found that Atl functions as a molecular bridge for epithelial adhesion. The Bsp-like domain (AtlBsp) specifically binds bacterial lipoteichoic acid, anchoring to the bacterial surface, while the C-terminal hydrolase domain (AtlCOOH) directly interacts with host epithelial receptor Fibronectin (Fn). With the purified recombinant Atl (rAtl), we demonstrated that both membrane-bound and secreted forms of Atl could mediate adhesion to the epithelial cells. Moreover, the rAtl was able to restore the adhesive capacity of the Atl-deficient SS2 mutant (Δatl) to both porcine and murine upper respiratory tract epithelium. This study reveals a novel function of the autolysin Atl in promoting SS2 adhesion to the upper respiratory tract epithelium, which elucidates the underlying molecular mechanism and identifies the key functional domains involved. These findings offer new insights into autolysin biology and provide a theoretical basis for developing anti-adhesion strategies against streptococcal infections in pigs.

BackgroundDecision fatigue, based on Baumeister’s “Strength Model of Self-Control”, suggests that the quality of decision-making declines with the accumulation of decisions over time. This phenomenon, previously observed in various professional fields, may impact military physicians who make critical and organizational decisions. We aimed to assess how decision-making changes throughout the workday among military physicians in a clinic setting.MethodsA retrospective observational analysis was conducted using a database of 2 million medical encounters from the military medical record system between 2015 and 2019. Decision outcomes were tracked for exemptions from specific duties granted, sick leave issued, days of sick leave, emergency department referrals, antibiotic prescriptions for upper respiratory tract infections and spinal X-ray referrals for low back pain – in accordance with appointment time and physician employment type.ResultsFindings showed a decrease in specific-duty exemptions granted by physicians until lunchtime, a peak post-lunch and a subsequent decline in the afternoon (p < 0.001). Referrals to the emergency department increased through the morning, dipped post-lunch and rose again by day’s end (p < 0.001). Sick leave issuance and the number of days granted both declined as the day progressed, with the steepest decline in the afternoon (p < 0.001). Rates of antibiotic prescription for URTIs and spinal X-ray referrals for LBP did not vary significantly throughout the day. Civilian physicians tended to issue more sick leave, exemptions and referrals than regular duty physicians, though both groups demonstrated similar trends throughout the day.ConclusionsThis study highlights the influence of decision fatigue on clinical decision-making among military physicians, showing a time-based decline in granting sick leave and specific-duty exemptions, with an increase in emergency referrals towards the end of the workday. These might have system-wide implications such as overutilization of healthcare, and increased health expenditure. Recognizing and addressing decision fatigue is important to mitigate its effects.

Cerebellar Abscess Caused by Rare Bacteria: A Case Report.

Antibiotics are commonly overused to treat upper respiratory tract infections (URTIs) in HIV-infected adults in primary healthcare settings, even though viruses cause most URTIs. Therefore, a de-implementation of unnecessary antibiotic prescribing for URTIs was implemented in these settings. Thus, this study aimed to evaluate a strategy to de-implement unnecessary antibiotic prescriptions among ambulatory HIV-infected adults with acute URTI symptoms using the reach-effectiveness-adoption-implementation-maintenance (RE-AIM) framework. We conducted a three-phase (pre-implementation, adaptation-implementation, and post-implementation), hybrid type II effectiveness-implementation study utilizing a two-arm, parallel cluster-randomized controlled trial design involving HIV-infected adults recruited from six primary healthcare facilities (intervention 1o de Maio, Bagamoyo, and Matola-2, whilst Alto Maé, Hulene, and Ndlavela as control) in Mozambique. Quantitative data were collected from June to September 2024, while qualitative data were collected from October to December 2024. The intervention included a clinical decision support algorithm (CDSA), training and supervision of clinicians, and prescription audits. The intervention was evaluated using four dimensions of the RE-AIM framework: reach, effectiveness, adoption, and implementation. We used Pearson's chi-square test and relative risk to assess the effect of the intervention. Among 387 HIV-infected adults approached, 379 (97.9%) were successfully recruited, with 182 (48%) in the intervention and 197 (52%) in the control group. Among the recruited patients, the mean age was 44 ± 12.3 years, and 286 (75.5%) were female. The intervention resulted in 33.2% fewer antibiotics prescribed compared to controls (RR = 0.41; 95% CI: 0.31-0.55). The antibiotic prescribing rate was 23.1% in the intervention and 56.3% in the control group. All three intervention sites (100%) and all clinicians (100%) demonstrated a commitment to de-implementing antibiotics. The implementation protocol was delivered as planned. Almost all participants (n = 21) in focus group discussions (FGD) were either satisfied or very satisfied with the intervention. They reported the effectiveness of the CDSA and the change in attitudes and antibiotic prescribing practices. Based on the RE-AIM evaluation, the implementation of the planned intervention was successful as it effectively promoted de-implementation and reduced unnecessary antibiotics for URTIs. The strategy employed in this study should be evaluated in other areas to determine if the same findings are observed elsewhere. ISRCTN, ISRCTN88272350. Registered 16 May 2024, https://www.isrctn.com/ISRCTN88272350.