Strenuous respiratory effort has been proposed as a second hit in severe acute lung injury (ALI), introducing the concept of "patient self-inflicted lung injury" (P-SILI). In an experimental setting, noninvasive continuous positive airway pressure (CPAP) attenuates lung and diaphragmatic injury, but the underlying mechanisms remains elusive. Here we investigate the effects of noninvasive CPAP on global and regional lung strain and diaphragm velocity of contraction and relaxation in an experimental P-SILI model.

Lung injury was induced in Sprague Dawley rats through surfactant depletion followed by either three hours of standard oxygen therapy (Control group) or CPAP support (CPAP group). Subjects were assessed through inspiratory and expiratory muscle activation. Regional lung and diaphragmatic deformation amplitude (strain) and the rate of change (strain rate) maps were developed using a micro-computed tomography (µCT) scan. Morphometric tissue assessment was carried out to study biological damage.

Compared with the Control group, the CPAP group resulted in: (1) higher SpO₂ and lower respiratory rate, nasal flaring, inspiratory and expiratory muscle activation, and minute ventilation at the end of the study; (2) lower global and regional tidal ventilation at the beginning of the study; (3) lower regional inspiratory and expiratory lung strain rate over time; and (4) higher muscle area in the diaphragm morphometric analysis. Furthermore, intragroup analysis showed that only the CPAP group reduced the inspiratory and expiratory muscle activation, the global and regional expiratory lung strain rate and the regional velocity of relaxation of the diaphragm over time.

Standard oxygen therapy resulted in worse patterns of lung strain rate and diaphragm velocity of relaxation, consistent with P-SILI and load-induced diaphragm injury. CPAP resulted in improved lung function, decreased lung strain rate, and diaphragmatic relaxation velocity throughout the respiratory cycle. We conclude that CPAP promotes biomechanical protection in injured lungs and diaphragm, more noticeably during the expiratory phase.

Tonsillar tuberculosis, a rare observed presentation of Mycobacterium tuberculosis affecting the palatine tonsils. Often secondary and associated with concurrent pulmonary tuberculosis, it may clinically manifest as chronic or recurrent tonsillitis, occasionally mimicking malignant conditions. Diagnosis of this condition is often delayed and complex, frequently necessitating histopathological examination for confirmation. Its management predominantly hinges on antitubercular medications.We present two distinct cases of tonsillar tuberculosis. The first case involves a 64-year-old male receiving anti-TNF therapy for ulcerative colitis. He was hospitalized for lateral neck swelling and persistent ulceronecrotic angina despite initial antibiotic treatments. Tonsillar tuberculosis was suspected and confirmed by histopathological analysis. The second case involves a 46-year-old female presenting with right ulceronecrotic angina associated with ipsilateral jugulo-carotid adenopathy. The diagnosis of caseous-follicular tonsillar tuberculosis was confirmed by biopsy. The patient was initiated on antitubercular treatment for a period of 6 months, resulting in a significant improvement in symptoms. Neither patient had pulmonary tuberculosis.

Chronic obstructive pulmonary disease (COPD) may partly originate in early life under influence from prenatal or early postnatal risk factors, including genetic predisposition.

We investigated to which extent the genetic predisposition to adult obstructive lung function manifests already at birth and throughout childhood in terms of impaired lung function, bronchial responsiveness and asthma-related symptoms.

We constructed a polygenic risk score (PRS) for adult obstructive lung function (FEV1/FVC) and associated it with neonatal and childhood lung function, bronchial responsiveness, asthma, and respiratory tract infections in the COPSAC birth cohorts, and with hospitalization for wheeze, asthma, and infections in 114,283 unrelated individuals from the IPSYCH cohort.

The FEV1/FVC PRS was associated with obstructive lung function shortly after birth (e.g., neonatal FEV0.5/FVC (β: -0.20 [-0.31;-0.09], P < 0.0003)), with continued progression into adolescence. A higher PRS was also linked to an increased risk of severe wheeze/asthma episodes (OR 1.24 [1.19;1.29], P = 1.6∙10-26) and lower respiratory tract infections (OR 1.09 [1.06-1.12], P = 3.5∙10-8) requiring hospitalization, which was evident a few months after birth. In COPSAC₂₀₀₀, there was no evidence of asthma exacerbations mediating the association between FEV₁/FVC PRS and lung function by age 18 years.

Genetic predisposition to obstructive lung function was evident shortly after birth in terms of impaired neonatal lung function and increased susceptibility to severe wheeze, asthma, and lower respiratory tract infections. This indicates prenatal life and early childhood as a window of opportunity for improving lung health in adulthood.

Chronic respiratory disease is considered by reduced airflow and heightened airway inflammation, a pattern that has progressively increased in past few decades. Currently, chronic respiratory disease is considered one of the main leading causes of death worldwide. The gut-lung axis, which connects these two organs, facilitates bidirectional communication and may be influenced by microbiome populations in the context of disease interactions. The human microbiome, particularly in the gastrointestinal tract is thought to play a pivotal role in affecting diseases and maintaining homeostasis. Dysbiosis, defined as an imbalance in the gut microbiota, is associated with an elevated risk of lung infections. Studies have shown that modifying the gut microbiota by the use of probiotics, prebiotics, and synbiotics can reduce the duration and extent of respiratory infections. Probiotics have been observed to significantly alter serum cytokine and IgE levels in allergic conditions, as well as reduce eosinophilia in individuals with asthma. However, there has been no discernible improvement in clinical symptoms, although this approach may diminish eosinophilia in chronic obstructive pulmonary disease (COPD) patients and mitigate serum cytokine and IgE levels. Several factors such as illness severity, treatment duration, patient-specific, environmental characteristics, and treatment regimen seem to influence the effectiveness of these interventions. Research indicates that direct interaction and colonization of respiratory epithelial cells by probiotic microbes can enhance the success of intranasal probiotic delivery compared to oral administration. Although allergic rhinitis is a chronic inflammatory ailment, nasal probiotics have been utilized to address acute infections and respiratory disorders, offering a promising therapeutic avenue for a range of chronic inflammatory conditions.

We present the case of a newborn with respiratory aspiration of barium and the management of this complication by serial bronchoalveolar lavage through bronchoscopy.

Female newborn, who underwent barium esophagogram for suspected esophageal atresia, who presented subsequent torpid evolution and radiological changes with persistent radiopaque image, metal density in the left apical and right basal region. Three bronchoalveolar lavages were performed with a decrease in the radiopacity generated by the contrast medium and clinical improvement.

Barium aspiration is a possible complication of digestive tract imaging studies and there is no specific management. In our patient, we found a possible benefit from performing serial bronchoalveolar lavages.

Early diagnosis of pathogens is key to reducing their spreading and to preventing severe health risks. The COVID-19 pandemic showed us the need for rapid point-of-care tests. Here, we describe the preparation of an amplification master mix for point-of-care diagnostics. Therefore, two off-patent amplification enzymes were designed, expressed and purified. The preparation of the key components enables independence from delivery issues, manufacturer portfolio and product information's. For long-term storage and cold-free transport, our fabricated amplification mix was lyophilised. Finally, we applied our lyophilised master mix on an integrated point-of-care diagnostic system and could detect 10 copies/μL COVID-19 RNA. The combination of stable, cold-free reagents with the mobile and low-cost device will allow molecular diagnostics of pathogens in a field or home setting.

We describe predeparture COVID-19 test positivity and vaccination coverage for US-bound refugees. During November 24, 2020-June 11, 2022, a total of 23,972 refugees received 28,465 tests (87% reverse transcription PCR); 2.6% of refugees tested positive. During November 24, 2020-December 31, 2022, vaccination coverage rose from 0% to 71% among 24,831 adult refugees.

The rapid expansion of testing capacity is imperative for an adequate response to infectious diseases, such as COVID-19. South Korea rapidly secured large-scale testing during the early stages of COVID-19 in 2020 by leveraging the country's experience with the 2015 Middle East respiratory syndrome outbreak; the initial response was relatively successful. A key difference between the 2 outbreak responses was the expansion from public to private testing laboratories during the COVID-19 pandemic. Expanding testing capacity during an infectious disease crisis should involve consideration of the overall response system and social conditions and not just the number of patients. If there are concerns about a crisis developing, testing capacity expansion should begin as soon as possible. Furthermore, accuracy should be ensured, especially when testing capacity is expanded. South Korea's experience in developing diagnostic systems and adopting testing strategies underscores the value of proactive and well-timed preparedness for emerging infection disease outbreaks.

Stellate ganglion block (SGB) is a specific type of peripheral nerve block in which local anesthetics and/or steroids are injected around the stellate ganglia.In the past,SGB was mainly used to alleviate pain-related syndromes.With the development of ultrasound technology,SGB has been widely used in non-analgesic fields,demonstrating significant therapeutic effects on arrhythmias,hot flashes,psychiatric disorders,cerebrovascular diseases,insomnia,and post coronavirus disease-2019 conditions in recent years.This study reviews the progress in the application of SGB in the non-analgesic fields.

Viral respiratory pathogens have become the leading cause of acute undifferentiated febrile illness (AFI). We determined the fraction of AFI attributable to influenza and SARS-CoV-2 in Ethiopia, along with an understanding of their epidemiological characteristics.

From February 2021 to June 2022, we enrolled patients meeting an AFI case definition (age >5 years with fever ≥38°C) who presented at one of four selected sentinel hospital sites in Jimma, Harari, Addis Ababa, and Gonder. Clinical and epidemiological information was collected, Nasopharyngeal swab samples were collected and analyzed using real-time PCR for respiratory viruses (influenza and SARS-CoV-2). A quasi-binomial regression model and multivariable regression were performed to compute fractions and establish associations with the agent detected.

A total of 737 AFI cases were enrolled. The overall proportion of SARS-CoV-2, influenza A, and influenza B among AFI patients were 7.8, 1.9, and 0.5 per 100,000 population, respectively. Among the enrolled AFI cases tested for SARS-CoV-2 and Influenza virus, SARS-CoV-2 was the most detected pathogen with a positivity rate of 13.7% (95% CI:11.3-16.4), followed by influenza A and influenza B, which have a positivity rate of 3.3% (95% CI: 2.2-5.1) and 0.8% (95% CI:0.3-1.8), respectively. The positivity rate of SARS-CoV-2 peaked at 37.4% in September 2021. Per the multivariable analysis, cases ≥65 years of age were three [AOR = 3.3,95% CI:(1.9-5.7)] times more likely to be positive for SARS-CoV-2.

SARS-CoV-2 and influenza viruses were highly prevalent among AFI cases. The proportion of SARS-CoV-2 was higher among older adults. Further study is recommended to characterize influenza subtypes, SARS-CoV-2 variants and determine their attributable fraction among a broader panel of AFI-causing pathogens that contributes for guiding the proper diagnostics, treatment and surveillance measures.