ObjectivesTo evaluate maternal and fetal outcomes of aortic surgery during pregnancy.MethodsWe retrospectively analyzed eight pregnant patients undergoing aortic intervention between 2012 and 2025.ResultsThe mean age was 30 years, and the mean gestational age was 19.5 weeks. Seven underwent open surgery in the second trimester, while one underwent thoracic endovascular aortic repair in the third trimester. Pathologies included aortic root aneurysm, often associated with Marfan syndrome. Procedures included valve-sparing root replacement (n = 4), Bentall (n = 3), and thoracic endovascular aortic repair (n = 1). There was no maternal mortality. Six pregnancies resulted in live births, while two were complicated by intrauterine fetal demise.ConclusionAortic surgery during pregnancy is associated with excellent maternal outcomes, though fetal risk remains significant.
BACKGROUND:Seasonal influenza, especially in persons with underlying medical conditions, is a substantial global burden. Influenza vaccination effectiveness (VE) varies annually, requiring continuous evaluation due to evolving viruses and vaccination coverages. Our aim was to investigate influenza VE in preventing hospitalization for confirmed influenza among people aged 15-64 years with underlying medical conditions. METHODS:We conducted a multicentre case-control study across 17 Spanish hospitals in hospitalized patients aged 15-64 years with underlying medical conditions in three influenza seasons. Influenza VE was estimated using two types of controls: test-negative controls and non-acute respiratory infection controls. Data on demographics, underlying medical conditions, vaccination status and clinical outcomes were collected. Adjusted VE was analysed using multivariable logistic regression models. RESULTS:Recruited were 1220 hospitalized adults with underlying medical conditions, of whom 25.2% were vaccinated. VE varied by season, age group, and virus subtype. Statistically significant protection was observed for all seasons jointly against influenza A(H3N2) subtype, whereas VE estimates for specific seasons and subtypes were not significant. CONCLUSIONS:These findings underscore the importance of continuous VE monitoring and tailored vaccination strategies to protect adults with underlying medical conditions and highlight low seasonal influenza vaccination coverage in this population. Influenza seasonal vaccination should be improved in people aged 15-64 years with underlying medical conditions.
BACKGROUND:Respiratory syncytial virus (RSV), a single-stranded negative-sense RNA virus, causes respiratory tract infections in children and adults, leading to hospitalization and mortality. However, the national disease burden and economic impact of RSV in Thailand remain undetermined. This study aims to estimate the national disease and economic burden of RSV infections in 2023 in Thailand. METHODS:An incidence-based approach was employed to estimate the economic burden of RSV from a societal perspective. RSV incidences were calculated from the data obtained from six sentinel surveillance sites across Thailand. The distribution of adjusted age-specific incidence was employed to estimate RSV cases across different age groups. A micro-costing technique with a bottom-up method was used to calculate direct medical costs, direct non-medical costs, and indirect costs. The results were reported in Thai Baht (THB) and USD (34.96THB = 1 USD). RESULTS:An estimated 122,631 RSV cases occurred in 2023 (186 per 100,000 person-years), with 20,842 hospitalizations (17.0%) and 1156 premature deaths (5.5%). The total economic burden was 6.2 billion THB (177 million USD), or 0.03% of Thailand's gross domestic product (GDP). This included 1 billion THB (29 million USD) in direct medical costs, 349 million THB (9.9 million USD) in direct non-medical costs, and 4.8 billion THB (138 million USD) in indirect costs. Productivity loss from RSV-related premature deaths was the main cost driver, accounting for 69.35% of the total burden. CONCLUSION:RSV infection poses a substantial economic burden in Thailand, emphasizing the urgent need for targeted interventions and public health policies to reduce its impact.
IntroductionBlood lactate level (LL) is a useful predictor of physiological issues during extracorporeal circulation (ECC) treatment. To determine variations in LL depending on the hemocompatible coatings used for ECC, in vitro experiments were performed using whole human blood samples.MethodsThree types of experimental circuits were used, consisting of polymer-coated (PC), heparin-coated (HC), or noncoated (NC) membrane oxygenators (n = 5), in which blood was circulated while heparin diluted with a glucose solution was continuously administered. Blood was collected at 0, 1, 3, 6, 12, and 24 h of circulation to measure LL, glucose level (GL), partial pressure of oxygen (PO), and oxygen saturation (SA) in each experiment. Each value was categorized according to coating type and compared using two-way repeated-measures or one-way analysis of variance.ResultsThe mean LL values at each time point were significantly lower in the PC circuits than in the HC and NC circuits, whereas those in the HC and NC circuits were not significantly different. The mean GL values at each time point were significantly lower in the NC circuits than in the PC and HC circuits, whereas those in the PC and HC circuits were not significantly different. The mean PO and SA values at each time point were not significantly different among the different coating types.ConclusionsIn ECC circuits, PC may inhibit lactate production because of its hemocompatibility. Additionally, NC may enhance glucose consumption; however, the underlying mechanism remains unclear. Further research on the relationship between NC and GL is warranted.
BACKGROUND:H5Nx goose/Guangdong (Gs/GD) lineage highly pathogenic avian influenza (HPAI) viruses pose a significant public health threat due to their global spread, mutation accumulation, and expanding host range. The descendant clade 2.3.4.4b has been causing widespread infections in birds and increasing spillover events in mammals. METHODS:This report documents the first fatal case of highly pathogenic avian influenza virus (HPAIV) H5N1 clade 2.3.4.4b infection in a domestic cat in Italy, detected in early January 2025. The cat (CAT 1) resided on a backyard poultry farm experiencing a high pathogenicity avian influenza outbreak and succumbed rapidly following the onset of respiratory signs. A second exposed cat (CAT 2) developed clinical disease without fatal outcome. Comprehensive outbreak investigations were conducted, including pathological, serological, molecular analyses, and genomic characterization. RESULTS:Pathological examination of CAT 1 revealed acute necrotizing bronchointerstitial pneumonia, non-suppurative meningoencephalitis, and disseminated foci of hepatic necrosis. Interestingly, the PB2-E627K mutation associated with mammalian virus adaptation was observed in the feline viral isolate compared to avian isolates. Such polymerase complex mutations are key determinants of host range and increase pathogenicity in mammals. CAT 2 from the same farm tested negative for AIV genome detection but subsequently seroconverted for antibodies against NPA, H5, and N1. CONCLUSION:Sharing these findings is crucial for surveillance aimed at enabling early identification of increased risks to human and animal health, preventing cross-species viral transmission and mitigating the risk of potential spillover events.
BACKGROUND:In Kenya, influenza and other respiratory viruses circulate year-round. The Ministry of Health monitors severe acute respiratory infections (SARI), including influenza-associated hospitalizations, through a sentinel surveillance network. We developed intensity thresholds (ITs) to assess seasonal severity based on respiratory illness- and influenza-associated hospitalizations. METHODS:Nine surveillance sites contributed data from January 2019 through December 2025 (with rolling start dates). Weekly all-cause admissions, respiratory illnesses, and influenza testing in pediatric (0-13 years) and adult (≥ 14 years) medical wards were collected using retrospective record review (prior to June 2023) and SARI surveillance platform reporting (June 2023 onwards). Four sites had sufficient historical data to calculate ITs for the 2024 assessment; eight sites were included for 2025. We used the moving epidemic method to calculate annual and biannual ITs for moderate (50th percentile; IT50), high (IT90), and very high (IT98) severity for the percentage of hospitalizations for respiratory illness and influenza, overall and by age group. RESULTS:During 2024 and 2025, respiratory illness-associated hospitalizations remained below the IT50 for most of the year across age groups, with 1-2 weeks above the IT50. Influenza-associated hospitalizations also remained below the annual IT50 in both years but exceeded the biannual IT50 for several weeks at each wave's peak. CONCLUSIONS:In 2024 and 2025, respiratory illness-associated and influenza-associated hospitalization severity was low to moderate. This approach can guide public health activities in Kenya, contribute to global influenza surveillance, and provide a framework to assess influenza severity in countries without clear Northern or Southern Hemisphere seasonality.
BACKGROUND:Influenza vaccination is an effective public health intervention to lessen influenza effect on healthcare and has been recommended to prevent severe outcomes. Previous studies present higher influenza vaccine effectiveness (IVE) estimates against primary care medically attended (outpatients) compared to hospitalised cases (inpatients). Inconsistencies in study designs may hinder comparisons of IVE in preventing mild (outpatient consultations) versus severe influenza (inpatient admissions). We aimed to compare IVE against mild and severe influenza within primary care and hospital networks in Portugal from 2015/16 to 2023/24. METHODS:Using the test-negative design, we analysed 3393 RT-PCR-tested patients with influenza-like illness in outpatients or severe acute respiratory infection in inpatients. IVE was estimated using a generalised linear mixed model with fixed effects for sex, age category, comorbidities, month of symptom onset and random effects for season. For difference estimation, 95% confidence intervals (CI) were obtained through bootstrapping. RESULTS:IVE was 40.4% (22.7; 54.0) for outpatients and 38.7% (17.6; 54.5) for inpatients. The 1.7% difference was not statistically significant (-22.0; 26.8). Subgroup analyses for individuals aged ≥ 65 years, patients with comorbidities and by influenza A subtype showed similar non-significant differences, ranging from -1% to 17%. CONCLUSION:We found no statistically significant difference in IVE against mild or severe influenza infection. However, comparison across care settings should be interpreted cautiously, as patients differ in sociodemographic characteristics and comorbidity burden. Although limited sample size may reduce statistical power, the small magnitude of observed differences suggests that patients benefit from current vaccination strategies across care settings.
INTRODUCTION:Respiratory syncytial virus (RSV) is one of the most common causes of acute respiratory infections in both children and adults over 60. RSV can cause severe lower respiratory tract infections in older adults, leading to an increase of morbidity and mortality. The aim of this study was to assess the incidence of hospitalizations due to RSV infections in the Abruzzo region of Italy among patients aged over 60 years. METHODS:A retrospective study was performed in the Abruzzo region, evaluating all hospitalizations performed during years 2018-2023. Age- and gender-standardized hospitalization rates for RSV were calculated. Patients' comorbidities and hospitalization-related outcomes were also assessed. RESULTS:During 2018-2023, 42 RSV-coded hospitalizations were identified among adults aged ≥ 60 years. An additional RSV-attributable burden was estimated by applying a literature-derived attributable fraction to hospitalizations for unspecified viral bronchiolitis and pneumonia, resulting in an estimated total of 67 RSV-attributable admissions. Annual age- and sex-standardized RSV-coded hospitalization rates showed substantial year-to-year variability. Poisson regression with correction for overdispersion identified no statistically significant temporal trend during the study period (IRR per calendar year 1.08, 95% CI 0.86-1.34; p = 0.516). Among patients with RSV-coded admissions, the median length of stay was 11 days (IQR 6-18), and four patients (9.52%) died during hospitalization. CONCLUSIONS:RSV was associated with a measurable burden of hospitalization among older adults in Abruzzo. However, substantial year-to-year variability and the small number of RSV-coded admissions warrant cautious interpretation of temporal patterns. No statistically significant temporal trend was identified during the study period.
A 2-month-old male infant weighing 2.8 kg developed a deep sternal wound infection on postoperative day 16 following repair of an atrial septal defect, ventricular septal defect and patent ductus arteriosus. Staphylococcus aureus was isolated on wound swab, and culture-sensitive antibiotics were given for 14 days. The infant remained intubated with an unstable chest wall, so conventional higher negative pressures were considered unsafe near the exposed mediastinum. After debridement, polyurethane-foam vacuum-assisted closure (VAC) was applied at a deliberately low -40 mmHg on day 1, increased to -50 mmHg thereafter, and changed every third day. Four cycles were completed over 12 days. The wound granulated progressively ( Figure 1) and healed by secondary intention; the infant was extubated, recovered well and was discharged on postoperative day 42. This case illustrates that stepwise low-pressure VAC is a safe, effective option for deep sternal wound infection in the ventilated, very-low-weight infant.
BackgroundNorwood surgery is the first stage in the surgical palliation of hypoplastic left heart syndrome (HLHS) and its variants. Postcardiotomy extracorporeal membrane oxygenation (ECMO) may be required in some patients undergoing the Norwood procedure given its complexity.MethodsKids Inpatient Database (2000-2022) and National Inpatient Sample (2016-2022) datasets were used. 2284 patients underwent a Norwood procedure. The cohort was dichotomized into ECMO (EG, n = 147) and Non-ECMO (NEG, n = 2137) groups; Survivor and Nonsurvivor. Demographic and clinical characteristics were extracted. Overlap weights were used to attain covariate balance and perform overlap-weighted analysis.ResultsPostcardiotomy ECMO utilization was 6% (147/2284). The EG was more likely to have HLHS as compared to its variants, total anomalous pulmonary venous return, small for gestational age, congestive heart failure, and arrhythmias. Overall discharge mortality for the entire cohort is 10%. The EG experienced higher mortality compared to NEG "44% versus 8%" and higher morbidity such as cardiac arrest, pericardial complication, cardiogenic shock, respiratory complications, acute kidney injury (AKI), postoperative bleeding, sepsis and reoperation, longer length-of-stay, and higher hospital charges than NEG. ECMO utilization rose over time, peaking after 2015, while mortality progressively declined. The Midwest had the highest ECMO use (8.93%). In multivariate analysis, ECMO use and AKI were independent predictors of mortality.ConclusionsPostcardiotomy ECMO utilization for the Norwood procedure remains rare, but utilization is increasing with regional variation. Postoperative AKI and ECMO utilization were independent predictors of mortality among Norwood.
BACKGROUND:Acute respiratory tract infections (ARTI) remain a major public health burden in children globally. Nevertheless, regional data regarding postpandemic pathogen shifts, coinfection profiles, and risk factors associated with severe pediatric ARTI in Hangzhou, China, remain scarce. METHODS:A retrospective observational study was conducted on 6701 hospitalized pediatric patients (0-18 years) with ARTI in Hangzhou, China, from July 2023 to June 2025. Eleven respiratory pathogens were detected using fluorescence PCR-capillary electrophoresis. Univariate and multivariable logistic regression analyses, alongside three machine learning models, were employed to identify risk factors. Age-stratified and coinfection analyses were also performed. RESULTS:Rhinovirus (RV), Mycoplasma pneumoniae (Mp), and respiratory syncytial virus (RSV) were the most prevalent pathogens. The coinfection network was centered on RV, Mp, and adenovirus, with RV-Mp being the most common dual infection. Mixed infections were associated with severe illness (4.3% vs. 3.5% in single infections vs. 1.6% in pathogen-negative cases). Mp, bocavirus (Boca), and RV infections, along with reduced percentages of lymphocytes, monocytes, and eosinophils, were independent risk factors associated with severe illness, whereas older age was a protective factor. Logistic regression demonstrated the best predictive performance. CONCLUSIONS:This study elucidates the dynamics of pediatric ARTI pathogens and coinfection characteristics 2 years postpandemic in Hangzhou, China. It identifies key risk factors associated with severe pediatric ARTI, providing essential evidence to inform age-specific clinical prevention, targeted interventions, and public health strategies for pediatric ARTI in the region.
Thoracoabdominal aortic aneurysm (TAAA) repair remains associated with significant morbidity and mortality, especially in elderly and comorbid patients. Although total endovascular repair using fenestrated or branched endografts has broadened therapeutic options, anatomical limitations, patient frailty, and logistical constraints still prevent a purely endovascular approach in many cases. For this subset, hybrid repair with visceral debranching has emerged as an alternative strategy, though its role remains controversial. This narrative review explores the rationale, indications, technical approaches, perioperative management, and outcomes of visceral debranching in hybrid TAAA repair. Particular attention is given to frailty assessment, anatomical complexity, staging strategies, and quantitative outcome data, with the goal of defining the position of hybrid repair within current algorithms compared with open and fully endovascular techniques. Hybrid repair is mainly used in high-risk patients who are unsuitable for open surgery and anatomically unfit for total endovascular reconstruction. Reported early mortality varies widely from 5% to over 20%, reflecting heterogeneity in aneurysm extent, operative strategies, and patient selection; elective series from experienced centres more commonly report mortality between 5% and 10%. Long-term bypass durability is generally good, with overall graft patency around 85%-90% at 5 years. Superior mesenteric artery grafts show the highest durability, while renal bypasses - particularly right-sided - have lower patency rates. Acute kidney injury occurs in 20%-40% of patients, with permanent dialysis dependence in 5%-15%. Mesenteric ischaemia is uncommon but highly lethal, while spinal cord injury occurs in 5%-15%, with permanent deficits in 3%-10%. Staged hybrid approaches may reduce physiological burden and neurological risk but require careful surveillance due to interval risks. Overall, visceral debranching remains a relevant and durable option when applied selectively, particularly in patients with hostile anatomy or prior aortic interventions. Optimal outcomes depend on careful patient selection, meticulous technique, appropriate staging, and structured long-term follow-up.
ObjectiveSurgical access to the mitral valve can be achieved through various techniques, with the transseptal (TS) and left atrial (LA) approaches being the most commonly used in mitral valve surgery (MVS). However, the optimal approach remains a subject of debate, as studies report differing perioperative and postoperative outcomes associated with each technique. This meta-analysis aims to systematically compare the clinical outcomes of TS versus LA approaches in MVS.MethodsThis meta-analysis followed the PRISMA guidelines. A comprehensive literature search of PubMed, Embase and Scopus databases was performed until June 2025. The primary outcome was permanent pacemaker (PPM) implantation.ResultsTwenty-five studies were included. The TS approach was associated with higher risk of PPM implantation (risk ratio: 1.44, 95% confidence interval [1.07-1.95]; P = 0.01), postoperative atrial fibrillation, postoperative junctional rhythm, atrioventricular block, need for temporary pacing and longer cardiopulmonary bypass time, aortic cross-clamp time (CCT), hospital-stay and bleeding. No significant differences were found in intensive care unit stay, mortality, infections, stroke and renal failure. Subgroup analysis of isolated MVS showed no differences in most outcomes except for a higher risk of PPM implantation and postoperative atrial fibrillation in the TS group.ConclusionOur meta-analysis demonstrates that the TS approach is associated with longer operative times and a higher risk of postoperative conduction disturbances and PPM implantation. However, no significant differences were observed in other major clinical outcomes. These findings do not support the overall superiority of either approach, and surgical access should be individualized according to patient anatomy, procedural requirements, and surgeon experience. Further high-quality studies are needed to strengthen the available evidence.
Surgical left atrial appendage (LAA) exclusion has transitioned from a disease-specific therapy for atrial fibrillation (AF) to an increasingly routine adjunct during cardiac surgery, including in patients who present in sinus rhythm. This shift has occurred not through definitive evidence, but through a convergence of technical feasibility, biologic plausibility, and expanding clinical momentum. Contemporary studies in non-AF populations have largely focused on risk-enriched cohorts and suggest a possible reduction in late cerebrovascular events, yet these findings remain heterogeneous and context-dependent. At the same time, real-world data highlight a consistent early clinical burden, including postoperative AF, anticoagulation exposure, and variability in downstream management. The central issue is therefore not simply one of efficacy or safety, but of sequencing and definition: a preventive intervention has entered routine use before its net clinical value and care pathway have been clearly established. In this setting, prophylactic LAA exclusion in sinus rhythm should not be viewed as a settled extension of surgical practice, but as an evolving strategy that warrants selectivity, transparency, and disciplined evaluation.
Enterovirus D68 (EV-D68) is a cause of severe acute respiratory infections (SARI) and is associated with acute flaccid paralysis. However, data on EV-D68 in Africa, where SARI remains a leading cause of morbidity and mortality among children, remain limited. We conducted a retrospective analysis to detect EV-D68 in archived samples collected from hospitalized children with SARI in Zambia from 2018 to 2020. We identified eight positive samples in 2020, and genetic sequence analysis showed that all sequences belonged to subclade A2. Continuous monitoring is crucial to enhance understanding of the epidemiology and molecular characteristics of EV-D68 in Africa.
BACKGROUND:Seasonal influenza causes substantial morbidity and hospitalisation each year. We estimated influenza vaccine effectiveness (VE) against laboratory-confirmed influenza-associated hospitalisation among patients in Northern Ireland (NI) during the 2024/25 influenza season. METHODS:We used a test-negative design to estimate VE against hospitalisation. Influenza-positive cases and test-negative controls were identified through the national laboratory surveillance system and linked to hospital admission and vaccination records. VE was estimated by influenza type/subtype, age group, sex, vaccine type and time since vaccination. RESULTS:Among 15,133 hospitalised patients, 2024 (13.4%) tested positive for influenza. Among the 2024 patients admitted with laboratory-confirmed influenza, the vast majority tested positive for influenza A (n = 1803; 89.1%), whereas 221 cases (10.9%) were influenza B. Subtyping of influenza A identified 606 A(H1) infections and 93 A(H3) infections; the remaining 1104 influenza A samples were not subtyped. VE against laboratory-confirmed influenza infection was 46.0% (95% CI: 39.7% to 51.8%), with higher VE in children aged 2-17 years (60.8%; 95% CI: 48.3% to 70.5%) than in adults aged 18-64 years (40.5%; 95% CI: 24.9% to 53.2%) and ≥ 65 years (42.3%; 95% CI: 33.2% to 50.1%). VE against influenza A across all ages was 41.4% (95% CI: 34.2% to 47.9%). Vaccination reduced the odds of hospitalisation due to influenza A(H1) by 44.3% (95% CI: 33.2% to 53.7%) and A(H3) by 49.9% (95% CI: 20.3% to 69.3%). VE against influenza B was higher at 76.4% (95% CI: 64.9% to 84.7%). For influenza A, VE was highest 2-8 weeks after vaccination at 51.9% (95% CI: 42.1% to 60.1%) and declined with time since vaccination to 44.6% (95% CI: 35.6% to 52.5%) at 9-16 weeks and 41.4% (95% CI: 15.4% to 60.1%) at ≥ 16 weeks. VE against influenza B remained high throughout the season. No statistically significant differences in VE by vaccine type were found. CONCLUSIONS:Influenza vaccination reduced the risk of hospitalisation with laboratory-confirmed influenza during the 2024/25 season, offering meaningful protection at individual and population levels, with the greatest benefit observed in children.
BACKGROUND:In 2016, the World Health Organization (WHO) initiated the global RSV surveillance programme, which aimed to strengthen laboratory diagnostic capacity and evaluate molecular detection test performance. External quality assessments (EQAs) are conducted regularly as part of this programme to ensure ongoing laboratory proficiency. The third (2021-2022) and the fourth (2023-2024) WHO RSV EQAs were conducted to evaluate the ability of participating laboratories to accurately detect and subtype RSV. METHODS:For each EQA panel, 12 lyophilised RSV isolates were prepared using both recently circulating and RSV strains used in previous EQAs. The isolates were shipped to 81 and 85 laboratories in the third and fourth EQA, respectively. Participants tested the specimens using their routine molecular diagnostic protocols and reported the results through the UK NEQAS online platform. Performance was evaluated based on detection and subtyping accuracy, and a scoring system was used that ranged from good performance (24/24 correct results) to unacceptable (≤ 16 correct results). RESULTS:A total of 73 (90.1%) and 74 (87.1%) laboratories returned results for the third and fourth RSV molecular EQAs, respectively. In the third EQA, 69.9% of laboratories were classified as good, 15.1% as acceptable and 1.4% as satisfactory, resulting in 86.3% within the desirable range; 12.3% were unacceptable and 1.4% poor. In the fourth EQA, 60.8% were good, 28.4% acceptable and 2.7% satisfactory, with 91.9% in the desirable range; 8.1% were unacceptable, and none were poor. CONCLUSION:The third and fourth WHO RSV EQA demonstrated good overall laboratory performance for RSV molecular detection and subtyping. These findings highlight the importance of EQA to document high-quality diagnostics, especially with the introduction of RSV vaccines and monoclonal antibodies. Ongoing EQAs, including the first WHO RSV sequencing EQA initiated in 2024, will further enhance global laboratory capacity for RSV surveillance and outbreak response.
In 2025, Taiwan implemented paired sera surveillance among occupational contacts of avian influenza viruses (AIVs). Of 122 contacts analyzed, 117 (95.9%) remained asymptomatic with high personal protective equipment compliance (91.8%). No seroconversion was detected against AIV A(H5N2) clade 2.3.4.4b. These findings suggest a low risk of human infection despite persistent poultry outbreaks, provide timely serological evidence during the ongoing outbreak, and demonstrate the effectiveness of Taiwan's integrated human-animal surveillance in early risk characterization.
