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Rapid Respiratory Microbiological Point-of-Care Testing and Antibiotic Use in Primary Care: A Randomized Clinical Trial.

Hay AD et al. · Jul 1, 2026

Importance Most antibiotic prescribing takes place in primary care, driving antimicrobial resistance, a top-10 threat to global public health. There is considerable international interest in whether rapid multiplex microbiological point-of-care testing (RM-POCT) can safely reduce antibiotic prescribing in primary care. Objective To investigate whether the use of a RM-POCT can safely reduce same-day antibiotic prescribing for children and adults presenting to primary care with respiratory infections. Design, setting, and participants This parallel-group randomized clinical trial was conducted at 16 general practices in Southwest England between December 2022 and April 2024. Patients were eligible if they were aged 12 months or older, presented with any clinician-diagnosed acute (≤21 days) respiratory tract infection, and the patient or clinician believed antibiotic treatment was, or might be, necessary. Participants were randomized (1:1) to RM-POCT or usual care. The research team, including those conducting statistical analyses, were unaware of group allocation. Data were analyzed from November 21, 2024, to March 13, 2025. Intervention Patients in the intervention group were tested with RM-POCT to indicate the presence or absence of 19 respiratory viral pathogens and 4 atypical bacteria in approximately 45 minutes. Main outcomes and measures The primary outcome was same-day antibiotic prescribing. The safety outcome was patient-reported symptom severity on days 2 to 4. Results Among 552 included patients (mean [SD] age, 40.0 [21.2] years; 349 [63%] female), 276 were randomized to the intervention group and 276 to usual care. Primary outcome data were available for all participants, and safety outcome data were available in 216 intervention participants (78%) and 203 usual care participants (74%). Same-day antibiotics were prescribed to 124 participants (45%) in each group (odds ratio [OR], 1.00 [95% CI, 0.71 to 1.41]; P > .99). Prespecified subgroup analyses showed evidence of differentially reduced antibiotic prescribing in participants from whom a virus was detected (OR, 0.35 [95% CI, 0.20 to 0.63]; P for interaction Conclusions and relevance In this randomized clinical trial among patients with respiratory tract infections being considered for antibiotic treatment in primary care, use of an RM-POCT did not reduce same-day antibiotic prescribing or worsen patient outcomes. Trial registration isrctn.org Identifier: ISRCTN16039192.

Immunology and Microbiology

Utility of sentinel surveillance as an early warning system for emerging pathogens in a low-resource setting: Correlations of dengue, chikungunya, Zika, and COVID-19 trends between sentinel and passive surveillance systems in Puerto Rico, 2012-2023.

Hernandez-Romieu AC et al. · Jun 12, 2026

The representativeness and timeliness of sentinel surveillance for endemic and emerging arboviral and respiratory diseases in low-resource settings are understudied. We compared laboratory-confirmed epidemic dengue, non-epidemic dengue, Zika, chikungunya, and COVID-19 (pre-Omicron and Omicron periods) cases reported in Puerto Rico's Sentinel Enhanced Dengue Surveillance System (SEDSS) with island-wide trends reported by the Department of Health's passive disease surveillance system (PADSS). We plotted trends over time to assess representativeness and used lagged cross-correlations to determine whether SEDSS reporting preceded PADSS. SEDSS trends were representative of island-wide trends for all pathogens. SEDSS preceded reporting in PADSS by up to three, eight, and two weeks for epidemic dengue, Zika, and pre-Omicron COVID-19, respectively. Increasing case trends for chikungunya occurred at broadly similar times in both systems, while temporal concordance was lower for non-epidemic dengue. In Puerto Rico, sentinel surveillance was representative of island-wide trends and could provide early warning for dengue epidemics and emerging diseases, such as Zika and COVID-19.

Medicine

Prevalence and Grade of Patellar Luxation in Cavalier King Charles Spaniels Attending Primary-Care Veterinary Practices in Australia.

Son Y et al. · Jul 1, 2026

Objectives To identify risk factors associated with the prevalence and grade of patellar luxation in Cavalier King Charles Spaniels (CKCSs) attending Australian veterinary practices. Methods Patient records (n = 321,517) were obtained from VetCompass Australia, data were cleaned, and diagnoses of patellar luxation were identified by keyword search. Two risk factor analyses were performed for dogs over 18 months of age: comparing case and control groups and assessing risk factors influencing the grade of patellar luxation within the case group. Results The 10-year prevalence of patellar luxation in this study was 12.5% (95% confidence interval [CI], 0.12-0.13). The greatest risk of patellar luxation diagnosis was in neutered dogs (odds ratio (OR): 3.00; 95% CI, 1.97-4.71) and dogs weighing 11 to Clinical significance Patellar luxation is a prevalent disorder in CKCS and awareness of this condition is important for early examination of at-risk animals and to avoid breeding from the affected population.

Veterinary

A cell atlas of the developing human outflow tract of the heart and its adult aortic valve derivatives.

Leshem R et al. · Jun 25, 2026

The outflow tract (OFT) of the heart carries blood away from the heart into the great arteries. During embryogenesis, the OFT divides to form the aorta and pulmonary trunk, creating the double circulation present in mammals. Defects in this area account for one-third of all congenital heart defect cases. Here, we present comprehensive transcriptomic data on the developing OFT at two distinct time points (embryonic and fetal) and its adult derivatives, the aortic valves, and use spatial transcriptomics to define the distribution of cell populations. We uncover that distinctive embryonic signatures persist in adult cells and can be used as labels to retrospectively attribute relationships between cells separated by a large timescale. Single-cell regulatory network inference identifies GATA6, a transcription factor linked to common arterial trunk and bicuspid aortic valve, as a key regulator of valve precursor cells. Its downstream network reveals candidate drivers of human cardiac defects and illuminates the molecular mechanisms of both normal and pathological valve development. Our findings define the cellular and molecular signatures of the human OFT and its distinct cell lineages, which is critical for understanding congenital heart defects and developing cardiac tissue for regenerative medicine.

Biochemistry, Genetics and Molecular Biology

Initiation of High-Potency Benzodiazepine Prescriptions Among Survivors of Severe Trauma.

Oldner A et al. · Jul 1, 2026

Background Trauma is a major public health concern that often leads to long-term psychological distress and chronic pain. Benzodiazepines (BZDs) are sometimes prescribed for anxiety, insomnia, or acute stress-related symptoms, but long-term use is associated with dependence and adverse outcomes. The extent to which BZDs are initiated after trauma, and their implications for long-term health, remain poorly understood. This study aimed to assess the association between trauma exposure and initiation of high-potency BZDs, identify risk factors within the trauma cohort and examine the association between new BZD use and long-term mortality. Methods We conducted a population-based cohort study using data from a regional trauma registry linked to Swedish national health registers. New initiation of BZD prescriptions was defined as filling at least one prescription within 6 months after trauma. Multivariable logistic regression was used to assess associations between trauma exposure and BZD initiation and to identify risk factors within the trauma cohort. Cox proportional hazards regression evaluated the association between new BZD use and 6-18-month mortality. Results The study included 12,206 BZD-naive trauma patients and 66,801 matched controls. Trauma exposure was independently associated with new high-potency BZD use. Within the trauma cohort, risk factors included older age, psychiatric comorbidity, substance abuse, pre-traumatic opioid or sedative-hypnotic drug use, penetrating trauma, and higher injury severity. New BZD use was associated with markedly elevated 6-18-month mortality (adjusted HR 2.9, 95% CI 2.0-4.2, p Conclusions Trauma exposure independently predicted initiation of high-potency BZDs among previously BZD-naive patients. Psychiatric comorbidity, substance use, and greater injury severity were important risk factors. The association between new BZD use and increased long-term mortality underscores the need for cautious prescribing and structured follow-up after trauma. Editorial comment This study examines initiation of high-potency benzodiazepines among previously naive survivors of severe trauma using linked registry data. It shows that trauma exposure is strongly associated with new benzodiazepine use, particularly in older, comorbid, and vulnerable patients. Initiation is also associated with higher subsequent mortality, likely reflecting underlying clinical and psychosocial risk rather than a causal drug effect.

Psychology

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