Chronic obstructive pulmonary disease (COPD) is thought to increase mortality risk in elderly patients with hip fracture, but its independent effect remains unclear. This study aimed to determine whether COPD is an independent predictor of mortality in this population.

A retrospective cohort study was conducted on elderly patients with hip fractures. Through propensity score matching, confounding factors between patients with chronic obstructive pulmonary disease (COPD) and those without COPD were balanced. LASSO and Cox regression methods were used to identify predictors of mortality. The performance of the model was evaluated via ROC curves, calibration curves, and decision curve analysis. Restrictive cubic spline analysis and subgroup analysis were also performed to assess nonlinear effects and interactions.

A total of 151 (11.08%) of the 1362 participants who were enrolled in the trial had COPD. After PSM, 537 data points were analysed. The COPD group presented a significantly greater incidence of postoperative respiratory failure (6.04%) and delirium (12.08%) and significantly greater 1-year mortality (22.82% vs. 5.93%). COPD was identified as a strong independent predictor of mortality (HR 7.291, 95% CI: 3.619 ~ 14.691). Other independent risk factors included age (HR 1.066, 95% CI: 1.016 ~ 1.118), HCT (HR 0.922, 95% CI: 0.872 ~ 0.975), CAR (HR 1.476, 95% CI: 1.209 ~ 1.801), and BNP (HR 1.001, 95% CI: 1.000 ~ 1.001). The prediction model showed good predictive efficiency, achieving an AUC of 0.834 (95% CI: 0.766, 0.902) in the training set and 0.892 (95% CI: 0.819, 0.965) in the validation set. Restricted cubic splines confirmed linear relationships between continuous predictors and mortality risk (all P values for nonlinearity > 0.05). Subgroup analysis revealed a significant interaction effect between sex and COPD (p = 0.028).

COPD is a strong independent risk factor for 1-year mortality in elderly hip fracture patients. The developed prediction model can help clinicians identify high-risk patients early and implement personalized management strategies.

Calcium oxalate nephrolithiasis is more common in persons living with cystic fibrosis (PwCF) than in the general population. A primary risk factor is exocrine pancreatic insufficiency (EPI) causing enteral hyperoxaluria. However, the relationship between nephrolithiasis and degree of EPI control has not been assessed.

A retrospective cohort study was conducted including all PwCF seen at our institution from 2018 to 2023 (n = 332). Collected data included socio-demographics, Charlson comorbidity index, EPI control status adjudicated by treating clinicians (classified as controlled, uncontrolled, or unknown), and nephrolithiasis events, which were classified as symptomatic or asymptomatic when nephrolithiasis were discovered incidentally on imaging. Incidence and lifetime prevalence rates were calculated for the entire sample and according to EPI control. A multivariable logistic regression model for the outcome of nephrolithiasis was performed using likelihood-ratio-based backwards stepwise selection.

The cumulative lifetime prevalence of any nephrolithiasis event in our study population was 32%. The lifetime prevalence was higher in EPI (32%) than no EPI (24%), but there was no significant difference in prevalence according to EPI control status. The multivariable model identified that small bowel resection (odds ratio [OR] 3.0, 95% confidence interval (CI) 1.0-9.0)), alcohol use (OR 1.7, 95% CI 1.0-2.9), and decreased BMI (OR 0.9, 95% CI 0.9-1.0) were independently associated with nephrolithiasis. Among 105 individuals with nephrolithiasis, 51% (n = 54) had recurrent events. An invasive procedure was required by 10% (n = 3) with a single nephrolithiasis event and was required by 61% (n = 33) with recurrent nephrolithiasis.

Nephrolithiasis events are common in PwCF. We observed an increased prevalence among PwCF with EPI, but did not observe a difference based on the degree of EPI control although this may be limited by reliance on clinician assessment of EPI control rather than a more objective measure. Prospective investigation with detailed assessment of risk factors including dietary habits and EPI control is warranted.

BackgroundDespite global declines in HIV incidence, new infections continue to rise in Latin America. Oral tenofovir-based HIV pre-exposure prophylaxis (PrEP) is effective and can reduce incidence where implemented. PrEP PERU is a prospective cohort study evaluating daily oral PrEP delivery at HIV/AIDS service organizations (ASOs) in Peru.MethodsWe assessed 12-month PrEP retention and adherence among men who have sex with men (MSM) enrolled at 4 ASOs in Lima before the COVID-19 pandemic. The analysis included participants with ≥12 months of follow-up before the March 2020 lockdown. Follow-up visits occurred at weeks 4, 12, and quarterly thereafter. We used robust Poisson regression to evaluate associations between baseline characteristics and 2 outcomes: retention (attending ≥3 follow-up visits within 12 months) and optimal adherence (proportion of days covered ≥80%).ResultsAmong 264 MSM who initiated PrEP, median age was 31 years (IQR: 27-37). Retention at 12 months was 71%, and 55% achieved optimal adherence. Retention was associated with age ≥30 and bisexual identity in adjusted models. Optimal adherence was associated with being employed at baseline.ConclusionsPrEP delivery through ASOs in Lima is feasible and supports sustained engagement among MSM. Targeted strategies are needed to improve outcomes among younger individuals.

Understanding the geographic spread of emerging respiratory viruses is critical for pandemic preparedness, yet the early spatiotemporal dynamics of the 2009 H1N1 pandemic influenza and severe acute respiratory syndrome coronavirus 2 in the United States remain unclear. While mobility and genomic data have revealed important aspects of pandemic spatial spread, several key questions remain: Did the two pandemics follow similar spatial transmission routes? How rapidly did they spread across the United States? What role did stochastic processes play in early spatial transmission? To address these questions, we integrated high-resolution disease data with a robust, data-efficient inference framework combining air travel, commuting flows, and pathogen superspreading potentials to reconstruct their spatial spread across US metropolitan areas. The two pandemics exhibited distinct transmission pathways across locations; however, both pandemics established local circulation in most metropolitan areas within weeks, driven by several shared transmission hubs. Early spatial spread was more strongly associated with air travel than with commuting, though stochastic dynamics introduced substantial uncertainty in transmission routes, creating challenges for timely detection and control. Simulations indicate that broad wastewater surveillance coverage beyond top transmission hubs coupled with effective infection control may slow initial spatial expansion. Our findings highlight the rapid, stochastic spread of pandemic respiratory pathogens and the difficulties of early outbreak containment.

The long-term immune and metabolic effects of COVID-19 in vaccinated populations remain incompletely characterized. This study aimed to analyze dynamic changes in lymphocyte subpopulations (T, B, and Natural Killer [NK] cells [TBNK]) and key metabolic indicators among college students post-Omicron infection with prior vaccination.

A prospective observational cohort of 71 male students infected with the Omicron variant of COVID-19 (Beijing, China; March-April 2022) and 18 uninfected controls was followed for 2 years. TBNK subsets and metabolic parameters (uric acid, lipid profiles, β2-microglobulin) were analyzed at 3, 6, 12, and 24 months post-infection.

Immunologically, total lymphocytes were elevated at 3 months when compared with controls (P = 0.0063). Total T cells declined at 6 and 12 months but rebounded by 24 months (P < 0.0001). NK cells increased until 12 months, then declined (P < 0.0001). B cells decreased persistently (P < 0.05). Metabolically, uric acid and lipid parameters (total cholesterol, LDL-C, lipoprotein [a]) showed significant fluctuations, with notable increases at 1 year post-infection (P < 0.05). β2-microglobulin levels decreased significantly over time (P < 0.0001).

Omicron infection induces immune and metabolic disturbances lasting at least 1 year, with gradual but incomplete recovery by 2 years. The interplay between immune dysregulation and metabolic alterations may contribute to the long-term health effects of COVID-19. Monitoring both lymphocyte and metabolic dynamics may guide the long-term management of post-COVID-19 sequelae.

Obstructive sleep apnea syndrome (OSAS) is a common disease with systemic effects associated with inflammation and metabolic disorders. In recent years, asprosin, an adipokine secreted from adipose tissue and involved in energy balance and insulin resistance, has attracted attention in relation to metabolic diseases. This study aimed to evaluate whether asprosin is a potential biomarker by examining the relationship between serum asprosin levels and disease severity and body fat tissue distribution in OSAS patients.

This prospective, single-center, cross-sectional observational study was conducted between January 2024 and January 2025 at Atatürk University Faculty of Medicine Sleep Laboratory. Patients presenting with symptoms suggestive of OSAS and undergoing polysomnography (PSG) were included in the study. Participants were grouped according to the apnea-hypopnea index (AHI). In order to minimize potential confounding factors, individuals with diabetes, malignancy, chronic organ diseases, or recent use of drugs or antioxidant supplements affecting metabolism were excluded. Serum asprosin levels were measured using the ELISA. Skinfold thickness measurements evaluated subcutaneous adipose tissue distribution. Statistical analyses were performed with SPSS version 25.0 software.

The overall mean age of the participants was 47.2 ± 12.6 years, and 58.7% were male (n = 71). Serum asprosin levels were significantly higher in OSAS patients than in the control group (p < 0.001). As the disease severity increased, serum asprosin levels also increased. In addition, a positive correlation was found between serum asprosin levels and AHI, neck circumference, subscapular, abdominal, and thigh skinfolds (R = 0.896, 0.726, 0.582, 0.677, 0.671; p < 0.001, respectively). As a result of ROC analysis, a cut-off value of 22.49 ng/mL was determined for serum asprosin level in distinguishing the severe OSAS group. At this threshold value, sensitivity was calculated as 82%, specificity as 97%, and area under the curve (AUC) as 0.886.

This study observed that serum asprosin levels were higher in OSAS patients than in the control group and increased with disease severity. In addition, asprosin levels were determined to be related to body fat tissue distribution. These findings suggest that asprosin can be used as a potential biomarker in diagnosing OSAS and assessing disease severity.

The purpose of this study is to evaluate the feasibility, safety, and effectiveness of an individualized online exercise therapy (IOET) designed to improve physical capacity and quality of life in children and adolescents with long-COVID. In a prospective, randomized, single-center exploratory trial, 14 patients aged 9-17 years with long-COVID (median symptom duration: 21 months) received either 6 or 12 weeks of IOET. Sessions were held twice weekly via telemedicine and individually adapted to physical ability and symptoms. Primary outcomes were functional performance (6-minute walk test [6MWT], sit-to-stand test [STST], and handgrip strength test [HST]). Secondary outcomes included school attendance, quality of life (PedsQL), safety, and self-reported recovery. All participants showed clinically improvements. In the 12-week IOET group, 6MWT increased from 396.0 to 616.3 m (+ 220.3 m, 95% CI 98.2-342.4), STST from 25.4 to 32.6 repetitions (+ 7.2, 1.9-12.5), and HST from 16.6 to 27.1 kg (+ 10.5 kg, 4.8-16.1). The 6-week group improved comparably (6MWT: 429.0 m to 601.6 m, (+ 172.6 m, 64.7-280.6); STST: 21.6 to 31.7 (+ 10.1, 3.1-17.1); HST: 17.3 to 22.1 kg (+ 4.8 kg (0.7-8.9)). School attendance rose from 58 to 97%, and PedsQL reflected improved quality of life and reduced fatigue. No adverse events or post-exertional symptom exacerbations occurred. Improvements persisted at the 3-month follow-up.

 IOET is feasible, safe, and associated with improved physical function, reintegration in everyday life, and its quality in pediatric long-COVID. These findings highlight IOET as a promising rehabilitation strategy and justify larger multicenter trials to confirm effectiveness and define optimal duration.

• Children and adolescents with long-COVID often experience persistent fatigue, impaired physical capacity, and reduced quality of life, with limited evidence-based treatment options available. • Exercise therapy has shown beneficial effects in other chronic pediatric conditions such as cancer- or fatigue-related syndromes, improving strength, well-being, and social participation.

• This exploratory randomized controlled trial demonstrates that individualized online exercise therapy is feasible, safe, and associated with clinically relevant improvements in physical function, quality of life, and school attendance in pediatric long-COVID, without negative side effects. • The findings highlight the potential of telemedicine-based rehabilitation strategies as accessible and effective treatment approaches for children and adolescents with post-infectious conditions such as long-COVID.

Digital vaccination campaigns are increasingly used to address declining vaccine confidence, yet evidence from large-scale, real-world interventions in middle-income countries is limited. Meta's Brand Lift Studies (BLS), which use randomized test-control exposure, provide Bayesian estimates of attitudinal shifts resulting from digital content. Mexico, with over 88.6 million active internet users, provides a setting to evaluate the impact of targeted campaigns on vaccine attitudes.

This study evaluated the impact of 5 digital vaccination campaigns implemented by the Asociación Mexicana de Vacunología (@Vacunologia) on Facebook (Meta Platforms Inc) and Instagram (Meta Platforms Inc) in Mexico between 2021 and 2022 on key attitudinal constructs related to COVID-19 vaccine confidence.

This study used a retrospective ecological design. We analyzed aggregated BLS results for 5 campaigns targeting different audiences and vaccination themes. Measured outcomes included standard ad recall, perceived importance, perceived safety, perceived efficacy, and concerns about side effects. Statistical significance within the BLS framework was defined as an incremental lift of ≥2 percentage points with ≥90% posterior probability of replication-a threshold consistent with Meta's operational Bayesian approach. Exploratory comparisons across campaigns were conducted using 1-way ANOVA, unpaired 2-tailed t tests, and Fisher exact tests.

Campaigns reached 84.9 million accounts and generated 179.4 million impressions with a total investment of US $215,600. All campaigns produced statistically significant improvements in at least one attitudinal outcome (Bayesian threshold ≥90%). Standard ad recall increased in 4 campaigns (ANOVA, P<.001), and concerns about side effects decreased in 2 campaigns (t test, P=.049; P=.006). Perceived safety, importance, and efficacy improved in selected audiences, with stronger effects observed among younger users and women (ANOVA, P=.005). No direct behavioral outcomes (eg, vaccination uptake) were measured; therefore, the findings reflect attitudinal rather than behavioral change. However, these constructs are recognized as proximal predictors of vaccine decision-making and constitute health-related outcomes.

Large-scale digital vaccination campaigns can meaningfully strengthen attitudinal determinants of vaccine confidence in a middle-income context. These social media advertising campaigns effectively increased standard ad recall and improved perceptions of vaccine importance and safety, particularly among younger audiences and women in urban areas. However, changes in efficacy perceptions and concerns about side effects were limited. The innovation and implications of this study lie in evaluating large-scale, real-world digital vaccine campaigns in Latin America using experimental BLS data. Findings highlight that audience segmentation yields stronger perceptual shifts, suggesting that tailored digital strategies can complement traditional public health communication. While the BLS does not measure behavioral end points, the observed attitudinal improvements represent foundational steps toward influencing vaccine-related behaviors. Future work should link digital attitudinal metrics with vaccination and epidemiological data to assess real-world health impact.

Preschool children with refractory respiratory symptoms often undergo diagnostic bronchoscopy to exclude anatomical and functional abnormalities and to detect suspected chronic lower respiratory tract infections by bronchoalveolar lavage (BAL). The objective of this retrospective analysis was to analyze BAL fluid findings with respect to bacterial colonization and cytology. Additionally, we aimed to determine associations with bacterial colonization of the airways and allergic sensitization status and symptoms as well as to identify comorbidities like gastroesophageal reflux disease (GERD) or eosinophilic esophagitis (EoE).

In a retrospective analysis, the electronic medical records of 355 children aged 1-5 years who underwent bronchoscopy for refractory respiratory symptoms between 2010 and 2019 were evaluated. Differential cytology and bacterial cultures from BAL, laboratory parameters, oesophagogastroduodenoscopy (OGDS) and histology from esophageal biopsies were analyzed.

A positive bacterial culture from BAL fluid was found in 214 children (61.7%). Of these, 105 children (49%) subsequently received antibiotic treatment. The most frequently identified bacteria were Haemophilus influenzae (34%), Streptococcus pneumoniae (25%) and Moraxella catarrhalis (16%). The percentage of neutrophils in differential cell counts from BAL samples was significantly higher with positive bacterial cultures compared to negative cultures (29.2 + 28.1% vs. 21.2 + 25.4%, p = 0.02). Children with insufficient S. pneumoniae antibody titers had significantly more positive cultures for S. pneumoniae in BAL fluid (28.3% vs. 12.8%; p = 0.0024). GERD was identified in 115 children (32%) and EoE was diagnosed in nine children (2.8%).

Bronchoscopy is a valuable diagnostic tool in the evaluation of persistent respiratory symptoms in preschool children. Bacterial colonization of the airways was common and associated with significantly elevated airway neutrophil counts.

Asthma is a prevalent chronic condition in children, and is often not sufficiently controlled. Children and parents may have a different interpretation of the level of asthma control, which can lead to suboptimal treatment. This systematic review aims to synthesize literature regarding concordance between children and their parents in the perception of asthma control.

A systematic literature search was conducted in EMBASE, MEDLINE, Web of Science, and Google Scholar up to February 5, 2025. Studies were included if they involved children aged 4-18 with asthma and their parents, assessed asthma control using questionnaires validated for children or derived from guidelines, and compared results of children and their parents. All healthcare settings were included. Four reviewers independently screened the studies and two extracted the data. Methodological quality was assessed using the Newcastle Ottawa Scale.

Nine publications were included, with a total of 1,693 children and 1,693 parents. Various questionnaires and guidelines were used to assess asthma control. The quality of the majority of the studies was rated satisfactory or good. The agreement between children and parents ranged from weak to very good. In many cases, there was a significant difference between the answers of the children and their parents: children often perceived their asthma to be less controlled compared to their parents.

The perception of asthma control is frequently discordant between children and parents, with children often reporting lower levels of asthma control. These findings highlight the importance and potential beneficial effects of shared decision-making between children, caregivers, and healthcare providers in improving treatment outcomes.