Over the past half-century, perceptions of human coronaviruses have evolved from their initial characterisation as causes of the common cold to recognition of their capacity to trigger severe disease and global epidemics. The emergence of three zoonotic coronaviruses-severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002, Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, and SARS-CoV-2 in 2019, has had profound health, economic, and societal consequences and continues to influence global epidemic-preparedness strategies. All three viruses remain on the WHO Blueprint of priority pathogens for research and development. This Review summarises current knowledge on human coronaviruses, drawing lessons from the past 25 years of epidemic outbreaks. The shared and divergent features of SARS-CoV, MERS-CoV, and SARS-CoV-2, including their origins, evolution, transmission determinants, zoonotic transmission, viral entry pathways, pathogenesis, spectrum of clinical manifestations, long-term sequelae, and case-fatality profiles are highlighted. The full range of clinical manifestations, from asymptomatic or atypical presentations to severe acute respiratory and multisystem disease, are outlined together with risk factors for progression and populations with the greatest susceptibility. Diagnostic approaches, including molecular assays, antigen-based tests, and imaging modalities are described alongside current therapeutics, antiviral strategies, immunomodulators, supportive care principles, and evidence from clinical trials. Advances in diagnostics, vaccines, therapeutics, and infection-control practices are examined together with persistent challenges in early recognition, particularly in resource-limited settings. Strengthening multinational clinical trial capacity, leveraging digital innovations, and embedding One Health approaches are essential to mitigating spillover risks and improving global readiness. We review the latest data, identify gaps and opportunities, and outline forward-looking strategies to anticipate and prepare for the threat of future coronaviruses, and other existing or new respiratory pathogens with epidemic potential. Clinicians and other health-care workers play a central role in detecting and reporting possible lethal coronavirus infection including atypical presentations, enabling rapid, coordinated infection control and management responses.
To describe current clinician-reported postextubation noninvasive respiratory strategies after cardiac surgery with a focus on variability across centers and emerging combined strategies. Cross-sectional 25-item survey with descriptive analysis. Cardiac surgery units across Europe, North Africa, the Middle East, and South America. Ninety-two clinicians from European and French cardiothoracic anesthesia societies; 86% worked in cardiac-dedicated ICUs, 73% had >5 years of experience. No clinical interventions were undertaken. Respondents reported institutional protocols and individual postextubation respiratory support practices. Institutional protocols were reported by 40% of respondents. Noninvasive respiratory support was used prophylactically by 77% of them, most often in high-risk patients (62%). Obesity (93%), severe chronic obstructive pulmonary disease (FEV1 ≤50%, 93%), and obstructive sleep apnea (78%) were the main risk factors used for stratification. High-flow nasal oxygen (HFNO) and noninvasive ventilation (NIV) were available in almost all units. Combination HFNO-NIV was the most frequently selected prophylactic strategy (37%) and the dominant option for established postextubation respiratory failure (54%). The duration of prophylaxis varied widely, reflecting marked heterogeneity in practice. Decisions were influenced by training and experience (63%), protocol availability, and equipment constraints. Postextubation respiratory practices after cardiac surgery are highly variable, with increasing adoption of combined HFNO-NIV strategies. The absence of standardized pathways contributes to inconsistency in patient selection, timing, and duration. These findings highlight the need for harmonized postoperative respiratory protocols and pragmatic multicenter trials to define optimal respiratory support strategies in cardiac surgical patients.
Preclinical models are essential for understanding respiratory physiology and disease, but their translational impact is limited by the absence of standardized reference frameworks. Unlike clinical practice, where lung function is interpreted using prediction equations and z-scores, preclinical studies report absolute values, hampering comparability. We established reference equations for airway resistance, tissue damping, tissue elastance, and end-expiratory lung volume in 182 healthy Sprague Dawley and Wistar rats. Using generalized additive models for location, scale, and shape (GAMLSS), we modeled mean and variability as functions of body mass, sex, strain, and positive end-expiratory pressure. The models showed excellent fit and cross-validation, enabling accurate z-score derivation at the individual level. Sex and strain significantly influenced outcomes. Open-source calculators support direct integration into workflows. This framework introduces clinical-style reference equations into preclinical respiratory research, enhancing reproducibility and aligning animal measurements with clinical standards, with implications for computational models, study design, and translational research.
Due to the unpredictable exposure of linezolid with a standard dosing regimen, therapeutic drug monitoring (TDM) has been recommended to guide it despite limited evidence on clinical endpoints. The primary objective was to determine whether achieving therapeutic linezolid concentrations at the first TDM measurement is associated with clinical cure. Microbiological eradication and 7 day and 30 day mortality were also assessed. We conducted a retrospective study in a cohort of patients with confirmed Gram-positive (Enterococcus/Staphylococcus spp.) infections and undergoing TDM. A steady-state linezolid trough concentration (Cmin,ss) of 2-8 mg/L was considered therapeutic. A multivariable logistic regression model assessed predictive factors associated with clinical cure. Four hundred patients (median age 68 years, 66.5% male) were included. Infections were mainly intra-abdominal (29.3%), skin/soft tissue or bone/joint (25.5%) and respiratory (21%). At first measurement only 34% of patients reached the therapeutic range, with 34.5% below range and 31.5% above range. Clinical cure rate was 76.3% and 30 day all-cause mortality was 20%. Multivariable logistic regression showed that achieving therapeutic Cmin,ss significantly increased the likelihood of clinical cure (OR 1.78, 95% CI 1.02-3.19). Conversely, a higher Charlson index, liver cirrhosis and sepsis/septic shock requiring ICU admission were risk factors for failure. Other clinical outcomes were not independently related to Cmin,ss. This study suggests that achieving early therapeutic linezolid concentrations is associated with a higher likelihood of clinical cure and highlights the limitations of an initial standard dosing. In this scenario, an early TDM may help to identify patients out-of-range who need guided dosing to ensure the achievement of pharmacokinetic/pharmacodynamic targets. Further prospective studies are needed to assess the impact of TDM on survival, microbiological outcomes and cost-effectiveness.
Measles remains a major public health concern despite the availability of effective vaccines. Recent global resurgences, including in Türkiye, have been partly attributed to disruptions in routine immunization and declining vaccination coverage during the COVID-19 pandemic. Data on children with measles requiring pediatric intensive care are limited. We aimed to describe the clinical characteristics and outcomes of children with measles admitted to pediatric intensive care units (PICUs) in a large metropolitan area. This multicenter retrospective study included children < 18 years with laboratory-confirmed measles admitted to ten PICUs in Istanbul, Türkiye, between January and December 2023. Demographic data, vaccination status, clinical features, laboratory findings, treatments, and outcomes were collected. Patients were stratified by vaccination status. Among 5,685 PICU admissions, 53 children (median age 1.3 years) had laboratory-confirmed measles. Ten (18.9%) were vaccinated and 43 (81.1%) were unvaccinated. The median rash duration was longer in vaccinated children (3 vs. 2 days; p = 0.027). Rash onset most frequently involved the face in vaccinated children (70%), whereas trunk onset predominated in unvaccinated children (51.2%) (p < 0.001). Unvaccinated children were admitted closer to rash onset, indicating a more rapidly evolving clinical course. Rhinorrhea was more common in unvaccinated children (69.8% vs. 20%; p = 0.009). Median oxygen saturation at PICU admission was lower in unvaccinated patients (91% vs. 95%; p = 0.015). Although ARDS, inotropic support, and invasive ventilation were more frequent in unvaccinated children, these differences were not statistically significant. In multivariable analysis, abnormal chest radiographic findings showed a trend toward association with respiratory support, although this did not reach statistical significance. Overall mortality was 2.3% (1/53), occurring in an unvaccinated infant. Measles continues to cause critical illness in young children requiring PICU care. Unvaccinated children tended to present with lower oxygen saturation at admission, suggesting more pronounced respiratory involvement. Maintaining high vaccination coverage remains essential to reduce severe measles-related morbidity. • Measles outbreaks persist in areas with suboptimal vaccination coverage, with unvaccinated children at higher risk of severe complications. • Data on critically ill children with measles, particularly those requiring intensive care, remain limited. • This multicenter study provides contemporary PICU-based data from a recent measles outbreak in a large European metropolitan area, where most critically ill children were unvaccinated and very young. • Unvaccinated children showed trends toward lower oxygen saturation and more pronounced respiratory involvement, though findings should be interpreted cautiously due to the small sample size.
We present MIMIC-III-Ext-PPG, a large-scale, quality-assessed photoplethysmography (PPG) dataset derived from the matched waveform subset of MIMIC-III. Our dataset provides 30-second PPG segments with annotations tailored for various cardiovascular and respiratory analyses. In particular, with 6.3 million segments from 6,189 subjects, it represents the largest publicly available resource for heart rhythm classification, with heart rhythm annotations derived from bedside charted observations. For subsets where arterial blood pressure (ABP), respiratory (RESP), and/or electrocardiography (ECG) signals are available, we also provide systolic/diastolic blood pressure, respiratory rate, and heart rate annotations, extracted using best practice from the underlying signals. We provide signal quality assessments for all signals. This ensures a high-quality, publicly available dataset of unprecedented size that can be used as a benchmarking resource for machine learning approaches for a broad range of prediction tasks, which remains easily extendable by leveraging additional clinical metadata from the MIMIC-III clinical database.
Rapid urbanisation over the past century has led to increased traffic density and higher levels of ambient air pollutants. We aimed to investigate whether the prevalence of respiratory symptoms, asthma, and chronic bronchitis increases with the level of self-reported exposure to traffic and occupational-related pollution. The study population comprised 25,889 general population subjects ages 16-75 years participating in the Swedish part of the GA2LEN study. Data were collected in the cities of Umeå, Uppsala, Stockholm, and Gothenburg. Self-reported data on disturbance of fumes from traffic in the residential area or occupational exposure to gas, dust, or smoke, as well as on patient demographics, respiratory symptoms, asthma and chronic bronchitis, were obtained from questionnaires. The prevalence of respiratory symptoms, asthma, and chronic bronchitis was higher both among participants reporting traffic-related exposure and those with a history of occupational exposure to fumes, smoke, and dust than among those unexposed; (wheeze 27 vs 13%), nocturnal cough (35 vs 22%), asthma (11 vs 6%) and chronic bronchitis (22 vs 8%); all p < 0.0001. When combining traffic and occupational exposure, the highest prevalence was found amongst those exposed to both. Associations with occupational exposure were generally stronger in women, and those with traffic exposure were stronger in men. In this large population-based sample, self-reported residential traffic exposure and occupational exposure to dust, fumes, or smoke were associated with increased prevalence of respiratory symptoms, asthma, and chronic bronchitis. Although causality cannot be inferred, these findings underscore the importance of assessing environmental and occupational exposures in evaluating respiratory health.
Background/Objectives: Developing novel strategies to combat respiratory infections caused by multidrug-resistant "priority pathogens" like the ESKAPEE Pseudomonas aeruginosa and Staphylococcus aureus is an urgent priority. Methods: We investigated two shortened variants of the proline-rich antimicrobial peptide (PrAMP) B7-005, B7-006 (15-mer) and B7-007 (13-mer). Evaluation included MIC assays against laboratory and clinical multidrug-resistant isolates, mechanistic studies of membrane permeabilization, cytotoxicity testing on BEAS-2B bronchial epithelial cells, and proteolytic stability assays in human elastase and sputum. Results: Despite their reduced size, lower positive charge, and decreased proline content, both variants retained full antimicrobial activity against clinical pathogens with consistent MIC values ≤ 25 µM. These variants exhibit membrane permeabilization in P. aeruginosa but may also relay on a hybrid mode of action involving also intracellular targets. Notably, B7-006 and B7-007 displayed low cytotoxicity compared to the lytic peptide BMAP-18. While B7-007 showed greater susceptibility to proteolytic degradation than its parent B7-005, it preserved partial integrity during the initial hours of exposure. Conclusions: Overall, these findings demonstrate that the B7 scaffold tolerates substantial truncation while preserving potency and selectivity, identifying a minimal 13-amino-acid active core. This work provides critical insights into structure-activity relationships and supports the development of compact, mechanistically versatile antimicrobial peptides to address the growing threat of multidrug-resistant respiratory pathogens.
Common and rare variants that are associated with the risk of developing idiopathic pulmonary fibrosis (IPF) have been identified predominantly in European ancestry populations. To better understand the genetic variants that contribute to IPF in individuals with Asian ancestry, we conducted a genome-wide association study of IPF in East Asian populations. We included 1,026 patients with IPF and compared them to 1,723 unaffected controls of Japanese and Korean ancestry. Genome-wide association analysis was conducted in the Japanese and Korean ancestry cohorts separately and combined using meta-analysis. Restricted maximum likelihood was used to estimate the SNP-based heritability and local ancestry of chromosome 11 was inferred for each subject. We identified loci on chromosomes 4 (FAM13A; rs7690839), 5 (TERT; rs7734992), 6 (DSP; rs2076295), and 11 (MUC5B; rs35705950) that were significantly associated with risk of IPF. Importantly, the sentinel variants in each of these loci are the same as, or in strong linkage disequilibrium with, the risk variants that have been observed in studies of European ancestry populations. In aggregate, common variants (not including the MUC5B promoter variant) account for approximately 25% of the risk of developing IPF in these East Asian ancestry cohorts. Moreover, local ancestry analysis indicates that the presence of MUC5B promoter variant in the East Asian population is not a result of admixture with European ancestry populations. We conclude that the IPF risk loci in East Asian populations are shared with those of European ancestry populations, although their risk allele frequencies and effect sizes differ. These findings indicate shared genetic risk factors of IPF across ancestries.
The tracheostomy procedure in adults is an invasive intervention usually performed for complicated respiratory problems that cannot be managed conservatively. The proximity of the trachea and esophagus, along with shared pathways, can increase the likelihood of swallowing challenges in individuals with a tracheostomy. A post-tracheostomy care bundle provided by a multidisciplinary service significantly improves decannulation rates and oral diet tolerance. Eleven experts within the Union of European Phoniatricians (UEP) Swallowing Committee were selected based on their experience and practice in the field. Each working group conducted a bibliographic search on the assigned topics using Medline (PubMed), covering articles from the last 10 years or earlier if deemed of interest. Based on bibliographic research, each working group formulated a text supporting the position statements. The reference texts were revised through a series of periodic meetings, held at least quarterly, over a year (from June 2023 to June 2024), until a unanimous agreement was reached for all. A review group reviewed the material produced, providing final suggestions that were incorporated by the panel until the final document was reached, which was then proposed to a group of reviewers from the UEP Board. Dysphagia is a common complication in patients with tracheostomy tubes, with significant implications for patient safety and quality of life. They are susceptible to aspiration, and if it does occur, it is likely to be silent and difficult to detect during a clinical evaluation. It is necessary to prioritize the assessment and management of dysphagia alongside respiratory and ventilator considerations. Addressing swallowing difficulties early in the weaning process can help minimize complications and improve patient outcomes.
Evidence supporting lung-protective ventilation in children overwhelmingly stems from adult trials. This study aimed to assess the epidemiology, ventilation management, and outcomes across predefined age groups of invasively ventilated critically ill children with or without paediatric acute respiratory distress syndrome (PARDS), and to identify potentially modifiable factors associated with outcome. This 10-year, investigator-initiated, international, multicentre, observational prospective cohort study was conducted in 83 ICUs across 34 countries worldwide. Paediatric intensive care units were invited to participate in a registry. This phase of the study enrolled children (younger than 18 years) admitted to a participating centre who received invasive ventilation for at least 12 h. Preterm infants of a postconceptional age younger than 40 weeks and those receiving extracorporeal membrane oxygenation were excluded from participation. All data collected, including patient demographics, baseline characteristics, and ventilation data, were part of standard clinical care and retrieved from medical records. The primary outcome was 28-day intensive care unit (ICU) mortality. This study is registered at ClinicalTrials.gov (NCT06220825), the first phase of the study is completed, subsequent phases on different topics are currently running. 1427 children (median age 24 months [IQR 7-96]; 799 [56%] were male and 628 [44%] were female) were enrolled between April 1, and June 30, 2024, and Oct 1, and Dec 31, 2024. PARDS was identified in 164 (11%) of 1427 children and occurred most frequently in preschool-aged children (aged 3 years to younger than 6 years). Ventilator management varied by age and PARDS status; decreased age and the presence of PARDS were associated with exposure to high airway pressures. 28-day ICU mortality was 14% (201 of 1427 children), and it was lowest in neonates (3 [3%] of 112 children) and higher in patients with PARDS than those without PARDS (44 [27%] of 164 vs 157 [12%] of 1263). Positive end-expiratory pressure (PEEP), driving pressure (ΔP) and fractional concentration of oxygen (FiO2) were identified as potentially modifiable factors independently associated with ICU mortality. Ventilation management in children varies substantially by age and PARDS status. Among potentially modifiable ventilation factors, only PEEP, ΔP, and FiO2 were associated with 28-day mortality. Amsterdam University Medical Centre and University Medical Centre Groningen.
Esketamine, the S-enantiomer of ketamine, has emerged as a rapid-acting antidepressant with unique mechanisms. This narrative review synthesizes current evidence on its clinical applications, safety, and regulatory status based on peer-reviewed literature published between January 2000 and March 2024, searched in PubMed, Web of Science, and the Cochrane Library. Esketamine exerts its effects primarily through noncompetitive antagonism of N-methyl-D-aspartate receptors, leading to rapid modulation of glutamatergic signaling and neuroplasticity. In anesthesia, it provides effective sedation with minimal respiratory depression. In psychiatry, intravenous and intranasal esketamine have demonstrated rapid antidepressant effects in treatment-resistant depression, with response rates of 50% to 70% within 24 hours. However, long-term safety data remain limited, and concerns persist regarding dissociative symptoms, cognitive impairment, and abuse potential. Regulatory approvals vary: the Food and Drug Administration approved intranasal esketamine for treatment-resistant depression in 2019, while European and Asian countries have adopted differing restrictions. Esketamine represents a paradigm shift in depression treatment, but its use requires careful patient selection, monitoring, and risk management. Future research should focus on head-to-head comparisons with other rapid-acting interventions, long-term outcomes, and integration into stepped-care models.
Although breathing seems like a simple action, many individuals encounter difficulties under ever-changing and complex circumstances, which can become increasingly problematic as the individuals age. In this Review, we comprehensively assess the ageing respiratory system. We begin with the physiological structural changes and their effect on lung function associated with ageing, before exploring the genetic and molecular factors that contribute to the loss of respiratory function with age. Defining how biological ageing manifests in the respiratory system and understanding disease-driven hallmarks of accelerated ageing conditions will enable the development of interventions to improve health across age groups, which will be crucial to address population health challenges over the coming decades.
Porcine reproductive and respiratory syndrome virus (PRRSV) is a major pathogen causing substantial economic losses to the global swine industry. The two genotypes, PRRSV-1 (European type) and PRRSV-2 (North American type), differ markedly in genetic characteristics and epidemiological patterns. The co-circulation and co-infection of these genotypes are increasingly reported. Concurrently, viral recombination events continue to shape PRRSV evolution. These scenarios collectively drive the need for rapid and accurate differential diagnostics. We aimed to establish and systematically optimize a dual-fluorescent enzymatic recombinase amplification (ERA) assay for simultaneous PRRSV-1 and PRRSV-2 identification. Highly conserved regions within the ORF7 gene of both genotypes were selected as targets, and genotype-specific primers and differentially labeled fluorescent probes were designed and screened. Reaction temperature, primer volume ratio, and probe volume ratio were optimized using an orthogonal experimental design, enabling efficient and synchronous dual-target amplification under isothermal conditions (42 °C). The developed assay exhibited high analytical specificity for PRRSV-1 and PRRSV-2. The limits of detection for PRRSV-1 and PRRSV-2 were 102 and 10 copies/μL, respectively. Clinical evaluation revealed an overall agreement rate of 98.78%. The developed dual-fluorescent ERA assay offered rapid reaction kinetics, simple operation, and high sensitivity and specificity. It enabled reliable differentiation of PRRSV-1 and PRRSV-2 without complex instrumentation, providing a practical and efficient tool for on-site diagnosis, epidemiological surveillance, and precise control of PRRS.
Porcine reproductive and respiratory syndrome virus genotype 1 (PRRSV-1), particularly the BJEU06-1-like subgroup, has shown increasing detection in China; however, the biological characteristics of newly emerging strains in southwestern regions remain insufficiently defined. Therefore, this study aimed to isolate and characterize a PRRSV-1 strain circulating in Southwestern China and to compare its biological properties and pathogenicity with those of a representative NADC30-like PRRSV-2 strain. In this study, a PRRSV-1 field strain (CDAC-SC2025) was isolated from a lung sample collected in Sichuan Province and characterized by immunofluorescence, full-genome sequencing, and maximum-likelihood phylogenetic analysis. Recombination was assessed using RDP4 and SimPlot (Baltimore, MD, USA). Pathogenicity was evaluated in newborn piglets following intranasal challenge, with monitoring of clinical signs, viremia, viral shedding, tissue viral loads, and histopathology. CDAC-SC2025 clustered within the BJEU06-1-like subgroup and showed the closest relationship to HENZMD-10 without detectable recombination. A three-amino-acid deletion (373-375 aa) was identified in nsp2. In vivo, CDAC-SC2025 induced fever, respiratory signs, growth retardation, and mortality, but the onset of death was delayed and lesion severity was lower than those caused by the NADC30-like strain DJY. Both strains exhibited predominant viral loads in the lung and tonsils, although quantitative differences were observed across tissues. Histopathology revealed moderate lesions in CDAC-SC2025-infected piglets compared with more severe multisystemic damage caused by DJY. These findings provide updated data on the biological properties of BJEU06-1-like PRRSV-1 circulating in southwestern China.
Pregnancies among people with cystic fibrosis (PwCF) have increased in the CFTR modulator (CFTRm) era. However, pregnant PwCF were excluded from CFTRm trials, limiting evidence on offspring outcomes after in utero and breast milk exposure. Follow-up practices for exposed children vary, and no widely accepted recommendations exist. We aimed to develop the first international recommendations for clinical follow-up of children exposed to CFTRm in utero and/or via breastfeeding. An international survey of follow-up practices and a literature review informed item generation for a Delphi consensus survey. We recruited panellists from four clinician groups (paediatric CF, adult CF, non-CF physicians, and other healthcare professionals) and a group of PwCF. An a priori consensus threshold was set at ≥70 % overall agreement and ≥50 % agreement within each group, with up to three survey rounds. The Imperial College Research Ethics Committee granted ethical approval. The protocol was prospectively registered (DOI:10.17605/OSF.IO/VJ2Z8). Completed responses were submitted by 106, 101 and 107 panellists in rounds 1-3, respectively, representing 26 countries. Clinician panellists had a median of 18 years' clinical experience (IQR 10-25). Eight PwCF participated. Consensus was reached on 73 items, including follow-up setting, liver function monitoring, cataract screening, and potential false-negative CF newborn screening. In total, we received 941 free-text comments which we used to refine existing items and generate new ones for subsequent rounds. International consensus recommendations are now available to support consistent, implementable follow-up of children exposed to CFTRm in utero and/or via breastfeeding, adaptable to local practice.
Background/Objectives: Allergen immunotherapy (AIT), involving subcutaneous (SCIT) or sublingual (SLIT) administration of the culprit allergen, is the only treatment capable of modifying the natural course of allergic diseases, and provides lasting benefits in terms of symptom reduction and medication use. AIT for allergic rhinitis is acknowledged as safe and effective in both adults and children; however, no studies have comprehensively evaluated the safety and efficacy of AIT in these populations, integrating results from randomized controlled trials (RCTs) and real-world evidence (RWE). Methods: We evaluated data in the literature including studies from RCTs and RWE in which the safety and efficacy of AIT in both children and adults have been analyzed. A narrative literature search was conducted in PubMed up to January 2026 using the following keywords for the search string: "allergen immunotherapy," "AIT," "safety," "efficacy," "clinical outcome," and "clinical evaluation." Results: RCTs and meta-analyses showed that both SCIT and SLIT significantly reduced allergic symptoms and medication use and improved quality of life (QoL). Large SLIT tablet trials have confirmed its efficacy in adults and children, whereas RWE supports its effectiveness in broader populations. Safety data indicated that SCIT carries a small but higher risk of systemic reactions than SLIT, which mainly causes mild local effects. Conclusions: AIT was effective and safe for treating allergic rhinitis across RCT and RWE studies. Integrating RWE with RCT findings is essential for guideline development, particularly for capturing long-term outcomes and real-world applications.
Hypertension (HTN) is one of the most prevalent cardiovascular comorbidities in patients with obstructive sleep apnoea (OSA). Although OSA severity measured by the apnoea-hypopnoea index (AHI) is a known risk factor, the role of hypoxic load in HTN remains less well established. We analysed data from 12,141 patients with OSA enrolled in the European Sleep Apnea Database (ESADA). Clinical and sleep study parameters were assessed to identify factors associated with HTN. The cohort included 2650 patients with mild OSA, 3339 with moderate OSA, and 6152 with severe OSA. The mean age was 53.1 ± 12.5 years, the mean body mass index (BMI) 31.7 ± 6.2 kg/m², and 73.1% were male. HTN was present in 41.8% of the patients. In univariate analyses, older age, female sex, obesity, larger neck circumference, greater OSA severity as measured by AHI or oxygen desaturation index (ODI), minimum oxygen saturation (SpO₂), and increased hypoxic load (T90% ≥ 5%) were significantly associated with HTN. After adjustment for age, sex and BMI, increased neck circumference, higher AHI and T90% ≥ 5% remained independently associated with HTN. Notably, HTN prevalence was higher in mild-to-moderate OSA patients with T90% ≥ 5 than in severe OSA patients with T90% < 5 (51.5% vs. 42.8%, p < 0.001). Following propensity score matching, only minimum SpO₂ (p = 0.022) and T90% ≥ 5% (p = 0.044) remained significantly associated with HTN. Hypoxic load as reflected by T90% and minimum SpO2, rather than AHI alone, is independently associated with hypertension in patients with OSA, underscoring the importance of oxygenation metrics in cardiovascular risk assessment.
In this study, the results of equine blood cultures sampled during the period from 2022 to 2024 were evaluated. Samples were submitted as routine samples by veterinary practices to a veterinary diagnostic laboratory in Germany. The study focused mainly on the differentiation of the bacterial isolates. In order to place the results in a clinical context, the study was complemented by a questionnaire sent to the practices enquiring for sepsis-associated clinical signs. The study was carried out retrospectively. A total of 199 blood culture samples submitted by practices located in Germany and other European countries were included into the evaluation. A questionnaire asking for the reason of the individual blood collection and possible presence of sepsis-associated clinical signs was sent to the relevant practices and the returning responses were analyzed. 50.3% (n=100) of the blood culture samples showed a positive result, divided into 71% monomicrobial and 29% polymicrobial samples. Staphylococci were most frequently detected (30.2%), followed by bacteria of the genus Enterobacterales (18.9%). Nearly half of the horses (41.3%) was pretreated with antibiotics at the time of sample collection. Respiratory infection was the most frequently listed reason (17.4%) for initiation of a blood culture analysis. The results of the present study are comparable to previous studies. The isolates were not classified into clinically relevant pathogens and contaminants, as for the majority of patients only one sampling timepoint was available, making any isolate a potential causative agent for bacteremia. Sepsis is not a specific condition, but is based on the clinical findings and the result of the performed blood culture analysis. Considering the duration of a bacteriological culture procedure as well as the commonly critical condition of the patient, availability of data concerning the most frequently occurring pathogens is essential in rapidly initiating adequate treatment. In der vorliegenden Studie wurden die Ergebnisse von Blutkulturen von Pferden ausgewertet, welche als Routineproben in den Jahren 2022–2024 von tierärztlichen Praxen an ein veterinärmedizinisches Diagnostiklabor in Deutschland übermittelt wurden. Der Fokus lag auf der Differenzierung der bakteriellen Isolate und wurde durch einen Fragebogen an die Praxen komplementiert, um sepsisassoziierte Symptome zu erfassen und die Ergebnisse in klinischen Kontext einordnen zu können.Die Auswertung der bakteriologischen Kulturen erfolgte retrospektiv anhand der vorliegenden Befundergebnisse. Die insgesamt 199 inkludierten Proben stammten aus Deutschland sowie dem europäischen Ausland. Zusätzlich wurde ein Fragebogen, der unter anderem den Grund für die Durchführung der Blutkultur sowie mögliche sepsisassoziierte Symptome abfragte, an die zugehörigen Praxen versendet und ausgewertet.Der Anteil positiver Blutkulturen lag bei 50,3% (n=100), die sich in 71% monomikrobielle und 29% polymikrobielle Proben aufteilten. Am häufigsten nachgewiesen wurden Staphylokokken (30,2%) gefolgt von Bakterien der Gattung Enterobacterales (18,9%). Knapp die Hälfte der Tiere (41,3%) war zum Zeitpunkt der Probennahme antibiotisch vorbehandelt. Atemwegsinfektionen waren mit 17,4% der am häufigsten genannte Grund für die Einleitung einer Blutkultur.Die Ergebnisse der vorliegenden Studie sind mit vorangegangenen Auswertungen vergleichbar. Auf eine Einteilung der Isolate in klinisch relevante Erreger und Kontaminanten wurde verzichtet, da bei dem Großteil der Patienten nur ein Entnahmezeitpunkt vorlag und daher potenziell jedes Isolat als verursachendes Agens infrage kam.Sepsis ist kein spezifisches Krankheitsbild und gründet sich auf die klinische Diagnose und das Ergebnis der Blutkultur. Vor dem Hintergrund der Dauer einer bakteriologischen Kultur und des oftmals kritischen Zustands der Patienten ist das Wissen um wahrscheinlich zugrundeliegenden Erreger essenziell, um eine adäquate Therapie schnellstmöglich einleiten zu können.
Children are extremely vulnerable to climate-related environmental impacts and air pollution due to both biological and behavioral factors. Despite the emerging evidence of the increasing effects of climate change on the world and on children's health, policies to drive change and halt the effects are lacking. Climate change is causing Europe to heat up faster than other continents. Here, we assessed the evidence-based effects of climate change and air pollution on child health in Europe. A scoping review was performed to map the impact of climate-related exposures on the health of children in Europe. A literature search was conducted in three bibliographic databases (PubMed, Embase.com, and Cochrane Database of Systematic Reviews/Cochrane Central Register of Controlled Trials), for studies published between January 1, 2014, and November 11, 2024. Studies were included if they met the following criteria: original studies performed in Europe, addressing climate-related exposures (i.e., the effects of air pollution, heat stress and/or wildfires) on clinical outcomes in neonates, infants, and children (<18 years). The literature search generated a total of 3838 unique articles; upon screening, 73 articles were included in this scoping review. Most studies were conducted in South and West Europe. Climate-related exposures were linked to negative neonatal outcomes, increased risk of respiratory and allergic disease, adverse neurological development, and a higher incidence of metabolic conditions in children. Most studies assessed the impact of air pollution (mainly particulate matter with a diameter smaller than 2.5 micrometers PM2.5 and PM10 exposure); few studies assessed other climate-related outcomes such as heat stress or wildfires.  Climate change is an active driver of pediatric morbidity in Europe, posing urgent respiratory, neurological, and perinatal risks amplified by social inequality. Protecting future generations demands a paradigm shift in healthcare that moves beyond treating acute symptoms to addressing upstream environmental drivers, including the integration of environmental exposure data into clinical practice. • Children are biologically vulnerable to environmental hazards and more prone to climate-related exposures. • Europe is warming up faster than other continents; therefore, children in Europe are at increased risk of climate-related adverse health outcomes. • This scoping review confirms climate change may lead to increased pediatric morbidity in Europe, linking air pollution, heat stress, and wildfires to perinatal, respiratory, metabolic, and neurological risks. • European studies regarding climate change and children's health have mainly focused on the impact of air pollution, but hardly focused on the impact of heat stress, highlighting the need for broader research and a coordinated pan-European change in political interventions tackling climate change.