Plain Language SummaryDiagnosis of respiratory diseases in newborns requires safe, reliable imaging. Lung ultrasound (LUS) is a promising alternative to other diagnostic imaging modalities, such as chest X-ray or CT scan, as it is free of radiation and helpful in assisting the diagnosis and monitoring respiratory diseases. However, LUS results depend heavily on the operator’s skill in acquiring and interpreting images, raising concerns about consistency across different clinicians and clinical situation. While many studies have demonstrated the utility of LUS in newborns care, its reliability, both between different examiners (inter-rater) and when the same examiner repeats scans (intra-rater), remains poorly understood. This study will comprehensively review LUS reliability to ensure its findings are accurate and reproducible in neonatal care, guiding safer clinical use and future improvements.

Introduction: Transposition of the great arteries (TGA), especially with intact ventricular septum (TGA-IVS), presents unique challenges during fetal-to-neonatal transition, which can contribute to developing persistent pulmonary hypertension of the newborn (PPHN). Case Presentation: A male newborn with TGA-IVS, delivered via caesarean section, presented with hypoxemia and tachycardia immediately after birth (preductal SpO2: 50–60%, post-ductal SpO2: 70–75%). Echocardiography revealed a floppy interatrial septum and two interatrial connections with bidirectional shunting. Ductal flow showed systolic right-to-left shunting, suggesting high pulmonary vascular resistance. Immediate post-birth management included non-invasive respiratory support with continuous positive airway pressure at 100% oxygen and administration of prostaglandin E2 to maintain ductal patency. Despite initial low oxygen saturation levels, escalation of intensive treatments was deferred based on continuous trend monitoring of vital signs and echocardiographic indicators. Oxygenation and circulation gradually improved within the first 2 h after birth to normal values, obviating escalation of intensive interventions like intubation, nitric oxide and/or balloon atrial septostomy. Arterial switch operation at day 3 post-birth was successful. Conclusion: This case highlights the possible contribution of fetal-to-neonatal transition in TGA-IVS to developing PPHN, which may subside after transition. Moreover, this case highlights the potential for providing a gentle hemodynamic transition without invariably needing early invasive interventions after birth.

Introduction: Infants are at risk for thrombotic conditions due to multiple risk factors such as congenital heart defects and sepsis. According to the American College of Chest Physicians (ACCP) 2012 guidelines, enoxaparin may be given for thrombotic conditions at a dose of 1.5 mg/kg/dose every 12 h for patients less than 2 months of age and 1 mg/kg/dose every 12 h for those older than 2 months. Several studies have reported that infants typically require a higher initial dose of enoxaparin to reach therapeutic antifactor Xa levels than what is currently recommended. Methods: This is a single-center retrospective case-control study of hospitalized infants less than 12 months of age who received treatment with enoxaparin while admitted to the neonatal intensive care unit (NICU) at a freestanding children’s hospital. The primary objective was the difference between the initial enoxaparin dose (mg/kg) compared to the enoxaparin dose in which the patient first achieved a therapeutic antifactor Xa level of 0.5–1.0 units/mL. Results: A total of 56 infants were included in this study. The median enoxaparin dose at initiation was 1.5 mg/kg/dose, and the median enoxaparin dose at the first therapeutic antifactor Xa level was 1.9 mg/kg/dose (z = −12.7, p < 0.0001). There was no correlation between gestational age and weight with the enoxaparin dose required to reach a therapeutic antifactor Xa level. Conclusion: Infants admitted to the NICU, specifically those less than 4 months of age, require higher initial enoxaparin dosing to reach therapeutic antifactor Xa levels than what is currently recommended.

Introduction: Human cathelicidin LL-37 is a salivary antimicrobial peptide (AMP) with broad-spectrum activity against oral diseases, but few studies have assessed its role in children and adolescents living with HIV (CALHIV). We assessed salivary LL-37 levels and correlates in a long-term cohort of Kenyan CALHIV followed since antiretroviral therapy (ART) initiation. Methods: Saliva was collected from 76 CALHIV who were recruited from two ongoing pediatric HIV studies in Nairobi, Kenya. Oral examinations documenting oral manifestations of HIV, dental caries, and gingivitis were completed. Additional variables included age, sex, HIV treatment (initial ART regimen) and disease parameters, caregivers’ demographics, and oral pathologies were conducted. Data were statistically analyzed using the independent T test on the log-transformed LL-37. Results: At the oral exam visit, the mean age of participants was 13.3 years (±SD = 3.4), and the median CD4 count was 954 cells/mm3. Mean salivary cathelicidin values of the cohort were 23.7 ± 21.1 ng/mL. Children with permanent dentition at time of oral examination, and children who initiated ART at ≥2 years old had higher mean LL-37 concentrations compared to those with mixed dentition and those who initiated ART <2 years old (p = 0.0042, 0.0373, respectively). LL-37 levels were not found to differ by initial type of ART regimen, CD4 count, or oral disease. Conclusion: Further research and longitudinal studies are necessary to evaluate and improve the innate immunity of CALHIV in Kenya.

Introduction: Airflow obstruction (AO) is evidenced by reduced forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) with the threshold for diagnosis often being set at <0.7. However, currently the ATS/ERS standards for interpretation of lung function tests recommend the lower limit of normal (LLN), calculated by reference equations of the Global Lung Initiative from 2012 (GLI-12), as a threshold for AO diagnosis. The present study aims to investigate phenotypes, with focus on hyperinflation, which influence AO prevalence defined by FEV1/FVC < LLN when compared to the fixed 0.7 threshold. Methods: Data from 3,875 lung function tests (56.4% men, aged 18–95) including 3,824 body plethysmography recordings performed from July 2021 to June 2022 were analysed. The difference between both classifiers was quantified, before and after stratification by sex, age, and hyperinflation. Results: AO diagnosis was significantly less frequent with the LLN threshold (18.2%) compared to the fixed threshold (28.0%) (p < 0.001) with discordance rate of 10.5%. In the presence of mild or moderate hyperinflation, there was substantial agreement (Cohen’s kappa: 0.616, 0.718) between the classifiers compared to near perfect agreement in the presence of severe hyperinflation (Cohen’s kappa: 0.896). In addition, subgroup analysis after stratification for sex, age, and hyperinflation showed significant differences between both classifiers. Conclusion: The importance of using the LLN threshold instead of the fixed 0.7 threshold for the diagnosis of AO is highlighted. When using the fixed threshold AO, misdiagnosis was more common in the presence of mild to moderate hyperinflation.

Background: Menopause in women marks the knot of reproductive life, and menopause is defined as the last menstrual period in a woman, but this is caused by the failure of the ovarian reserve. The average age of natural menopause in the general population of women has remained around 50–52 years. Premature ovarian insufficiency (POI) is a debilitating clinical syndrome that manifests as a decline in ovarian function in women under 40. This condition is a prominent cause of female infertility. Summary: POI is a debilitating condition that not only wreaks havoc on patients’ physical and mental well-being but also imposes substantial mental, psychological, and economic burdens, particularly on women. In addition to diminished fertility, individuals afflicted with POI face an elevated risk of developing debilitating conditions such as osteoporosis and cardiovascular disease. The etiologies of POI are highly heterogeneous, and it can be caused by spontaneous genetic defects or induced by autoimmune diseases, infections, and iatrogenic or environmental factors. Alarmingly, idiopathic POI, a subtype characterized by an unknown etiology, accounts for more than half of all POI cases. Currently, clinical interventions for POI primarily consist of hormone replacement therapy. Fertility preservation methods are cryopreservation of embryos, oocytes, and ovarian tissue. Immunological interventions, gene editing techniques, and stem cell-based therapies are being explored to unravel the diverse etiologies and underlying mechanisms of POI, thereby enabling the identification of optimal therapeutic interventions. These innovative approaches offer unprecedented opportunities to advance the field of reproductive medicine. Key Messages: The main aim of this paper was to offer a succinct summary of the latest research breakthroughs concerning the elucidation of the mechanisms governing the origin and management of POI.

Introduction: Life satisfaction is a strong indicator of well-being for older adults. In this study, we aimed to assess the level and correlates of life satisfaction among older adults in urban and rural Mongolia. Methods: We recruited 304 community-dwelling older adults in urban and rural regions of Mongolia. We compared levels of life satisfaction for the two groups, and then used hierarchical regression to examine the association of sociodemographic, health, psychosocial factors, and urban/rural status with life satisfaction. Results: Older adults in urban areas reported higher levels of life satisfaction than their rural counterparts. In the final step of the hierarchical regression model, more grandchildren in the household, better self-rated health, and reporting more positive than negative affect were associated with better life satisfaction at p < 0.05 as were engaging in paid work and lower levels of loneliness at p < 0.10. Net the effects of all other variables in the analysis, older adults in rural areas reported lower levels of life satisfaction. Conclusion: Our findings indicate that living in rural areas of Mongolia leads to lower levels of life satisfaction. We identify potential points to intervene through policies, programs, and practices that target the strengths and needs of older adults in rural areas by addressing inequities in socioeconomics, health, mental health, and opportunities for social integration.

Introduction: The aim of this study was to investigate the variance components in TP53 mRNA expression after in vivo exposure to double threshold dose of ultraviolet radiation B (UVR-B). Methods: Twelve six-week-old female albino Sprague-Dawley rats were exposed to double threshold dose (8 kJ/m²) of UVR-B unilaterally and sacrificed at 1, 3, 8, and 24 h after exposure. Lenses were enucleated, and TP53 mRNA expression was detected by qRT-PCR. Variance components for groups, animals, and measurements were estimated with analysis of variance. Results: The variance for groups is 0.15 rel.². The variance for animals is 0.29 rel.². The variance for measurements is 0.32 rel.². Conclusion: The variance for animals is in the same order as the variance for measurements. The reduction of the variance for measurements is needed in order to obtain the acceptable level of detection of the difference in TP53 mRNA expression and the reduction in sample size.

Introduction: Physical inactivity has been linked to various noncommunicable diseases and their related health problems. As primary health care physicians (PHCPs) play a crucial role in promoting health and preventing disease, this study aims to determine the extent of physical inactivity among PHCPs and its impact on their counseling practices. Methods: A cross-sectional study was conducted across all primary health care centers in Qatar, targeting 511 physicians. A modified self-administered WHO stepwise tool was used to measure physical activity (PA) with another questionnaire to assess the counseling practices among PHCPs. Results: Out of 511 physicians, 306 (59.9%) responded to the survey. The majority of the participants were male (58.1%) with an average age of 45.8 ± 7.9 years. The majority of PHCPs were from the UK (44.3%), while only 4.1% were Qatari. Family physician consultants made up 51% of the respondents, while 30.2% were general practitioners, and the average years of experience were 14 ± 8.3 years. Only 39.5% of the respondents met the WHO PA recommendations. 50.5% of the physicians were overweight, and 23.1% were obese. The median percentage of patients counseled about PA was only 60 [IQR: 40–80]%, and there was no link found between a physician’s PA level and the percentage of patients they counseled on the subject. Conclusion: Physicians reported a high prevalence of physical inactivity. Furthermore, the practice of counseling the public on PA was low. Interventions are needed inside and outside the workplace to improve the PA among PHCPs and their counseling practices.

Background: Endophthalmitis is an infection of ocular tissues, often with devastating outcomes for vision. Immunomodulation is an emerging avenue for therapeutic intervention in endophthalmitis, with the expression of cytokines central to potential mechanisms. This literature review with a systematic approach characterizes the cytokine expression in both animal and human staphylococcal and streptococcal endophthalmitis. Method and Results: Four online databases were searched for studies profiling cytokine levels in animal models or human populations with staphylococcal and/or streptococcal endophthalmitis. Of the 1,060 articles identified, 14 studies were included in this review comprising eight animal models and six human populations. Mouse, rat, and rabbit models of Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus pneumoniae endophthalmitis had elevated levels of IL-1β, IL-6, IFN-γ, TNF-α, and IL-8, with earlier peaks observed in S. epidermidis infection. Human endophthalmitis demonstrated significantly increased mediator levels compared to controls for a range of pro-inflammatory and anti-inflammatory cytokines, chemokines, and growth factors. Several associations were established between cytokine concentrations and both initial visual acuity and visual prognosis, with no consistent correlations across trials. Conclusions: It may be that virulence factors and the combinations of toll-like receptors activated influence the pathogen-specific visual outcomes observed in endophthalmitis. Furthermore, disease severity and potential therapeutic targets may be dependent on synergistic and compensatory cytokine pathways and the expression of anti-inflammatory mediators. Future research should aim to better characterize the roles of inflammatory mediators and solidify associations between pathogens, inflammation, and endophthalmitis outcomes. This has exciting implications for the prevention and treatment of endophthalmitis in clinical settings.