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Abstract Rationale There are no risk stratification tools for morbidity and mortality in bronchiectasis. Identifying patients at risk of exacerbations, hospital admissions, and mortality is vital for future research. Objectives This study describes the derivation and validation of the Bronchiectasis Severity Index (BSI). Methods Derivation of the BSI used data from a prospective cohort study (Edinburgh, UK, 2008–2012) enrolling 608 patients. Cox proportional hazard regression was used to identify independent predictors of mortality and hospitalization over 4-year follow-up. The score was validated in independent cohorts from Dundee, UK (n = 218); Leuven, Belgium (n = 253); Monza, Italy (n = 105); and Newcastle, UK (n = 126). Measurements and Main Results Independent predictors of future hospitalization were prior hospital admissions, Medical Research Council dyspnea score greater than or equal to 4, FEV1 < 30% predicted, Pseudomonas aeruginosa colonization, colonization with other pathogenic organisms, and three or more lobes involved on high-resolution computed tomography. Independent predictors of mortality were older age, low FEV1, lower body mass index, prior hospitalization, and three or more exacerbations in the year before the study. The derived BSI predicted mortality and hospitalization: area under the receiver operator characteristic curve (AUC) 0.80 (95% confidence interval, 0.74–0.86) for mortality and AUC 0.88 (95% confidence interval, 0.84–0.91) for hospitalization, respectively. There was a clear difference in exacerbation frequency and quality of life using the St. George’s Respiratory Questionnaire between patients classified as low, intermediate, and high risk by the score (P < 0.0001 for all comparisons). In the validation cohorts, the AUC for mortality ranged from 0.81 to 0.84 and for hospitalization from 0.80 to 0.88. Conclusions The BSI is a useful clinical predictive tool that identifies patients at risk of future mortality, hospitalization, and exacerbations across healthcare systems.

Testing for underlying etiology is a key part of bronchiectasis management, but it is unclear whether the same extent of testing is required across the spectrum of disease severity. The aim of the present study was to identify the etiology of bronchiectasis across European cohorts and according to different levels of disease severity. We conducted an analysis of seven databases of adult outpatients with bronchiectasis prospectively enrolled at the bronchiectasis clinics of university teaching hospitals in Monza, Italy; Dundee and Newcastle, United Kingdom; Leuven, Belgium; Barcelona, Spain; Athens, Greece; and Galway, Ireland. All the patients at every site underwent the same comprehensive diagnostic workup as suggested by the British Thoracic Society. Among the 1,258 patients enrolled, an etiology of bronchiectasis was determined in 60%, including postinfective (20%), chronic obstructive pulmonary disease related (15%), connective tissue disease related (10%), immunodeficiency related (5.8%), and asthma related (3.3%). An etiology leading to a change in patient's management was identified in 13% of the cases. No significant differences in the etiology of bronchiectasis were present across different levels of disease severity, with the exception of a higher prevalence of chronic obstructive pulmonary disease-related bronchiectasis (P < 0.001) and a lower prevalence of idiopathic bronchiectasis (P = 0.029) in patients with severe disease. Physicians should not be guided by disease severity in suspecting specific etiologies in patients with bronchiectasis, although idiopathic bronchiectasis appears to be less common in patients with the most severe disease.

Background/Objectives: Wounds from burns are susceptible to infections, allowing multidrug-resistant microorganisms to complicate treatments and patient recovery. This highlights the development of new strategies to control these microorganisms. This work evaluated the antibacterial activity of hydrogels containing biogenic silver nanoparticles (bio-AgNP) and Origanum vulgare essential oil (OEO) against multidrug-resistant bacteria. Methods: The formulations were subjected to organoleptic, pharmacotechnical, and stability characterization and antimicrobial activity assessment by time–kill tests and alternative methods, an ex vivo model using porcine skin, and an in vivo model using Galleria mellonella. Results: All hydrogels maintained their stability after the thermal stress. The hydrogel containing bio-AgNP + OEO 1% (HAgNP + OEO1) presented bactericidal effectiveness, within 2 h, against both Gram-positive and Gram-negative multidrug-resistant bacteria in the time–kill test. For alternative testing, HAgNP + OEO1 was compared with 1% silver sulfadiazine (SS) and the base formulation. In the ex vivo test, both HAgNP + OEO1 and SS treatments showed a similar reduction in superficial washing of the burn for S. aureus 999, while for P. aeruginosa, the reduction was more expressive for SS treatment. In the burn tissue, HAgNP + OEO1 treatment was more effective against S. aureus 999, while for P. aeruginosa 1461, both formulations were similarly effective. In the Galleria mellonella test, survival rates after 48 h were 84% for the control group (base) and 50% for both HAgNP + OEO1 and SS treatment groups. Conclusions: This study demonstrates that the hydrogel combining antimicrobials is effective against multidrug-resistant microorganisms, offering a promising alternative for the treatment of infected burns.

Onychomycosis is a common fungal nail infection for which new antifungals are needed to overcome antimicrobial resistance and the limitations of conventional treatments. This study reports the development of antifungal nail lacquers containing oregano essential oil (OEO), rosemary essential oil (REO), and biogenic silver nanoparticles (bioAgNPs). The formulations (F) were tested against dermatophytes using agar diffusion, ex vivo nail infection, and scanning electron microscopy techniques. They were evaluated for their pharmacotechnical characteristics and by FTIR-PAS to assess permeation across the nail. F-OEO and F-OEO/bioAgNPs were promising candidates for the final nail lacquer formulation, as they permeated through the nail and showed antifungal efficacy against dermatophytes-contaminated nails after 5 days of treatment. Treated nails exhibited decreased hyphae and spores compared to the untreated control; the hyphae were atypically flattened, indicating loss of cytoplasmic content due to damage to the cytoplasmic membrane. The formulations were stable after centrifugation and thermal stress, maintaining organoleptic and physicochemical characteristics. Both F-OEO and F-OEO/bioAgNPs had pH compatible with the nail and drying times (59–90 s) within the reference for nail lacquer. For the first time, OEO and bioAgNPs were incorporated into nail lacquer, resulting in a natural and nanotechnological product for onychomycosis that could combat microbial resistance.

Navigating health and social care in the United States can be difficult for people of all ages, but older adults often have multiple health problems, chronic illnesses, and disabilities that can increase the complexities of their care. To assist older adult patients and/or their caregivers with coordinating care, and providing information, advocacy, and resources, Henry Ford Health (HFH) implemented a Senior Care Navigation Program (SCNP). Older HFH patients or their caregivers were referred to the SCNP either by a provider or another member of their care team. A senior navigator (SN) then reached out to the patient/caregiver by telephone to discuss the SCNP and their support/care needs. The SN scheduled follow-up calls as needed. Patients/caregivers enrolled in Phase 1 of this pilot program were given the option to join the evaluation group. These patients were interviewed by an independent research interviewer at baseline, 3-, 6-, and 9-month post initial contact to complete 5 patient-reported outcomes measures. Our Phase 1 pilot has demonstrated significant improvements in the EQ5D (health-related quality of life) and two patient-reported outcomes measurement information system (PROMIS) measures (depression and anxiety) suggesting that the SCNP program at HFH is having a positive impact on older adult patients’ health and well-being. In Phase 2, we will further evaluate the impact of the SCNP on healthcare utilization.

Wound infections are feared complications due to their potential to increase healthcare costs and cause mortality since multidrug-resistant bacteria reduce treatment options. This study reports the development of a carbomer hydrogel containing biogenic silver nanoparticles (bioAgNPs) and its effectiveness in wound treatment. This hydrogel showed in vitro bactericidal activity after 2 h, according to the time–kill assay. It also reduced bacterial contamination in rat wounds without impairing their healing since the hydrogel hydrophilic groups provided hydration for the injured skin. The high number of inflammatory cells in the first days of the skin lesion and the greater degree of neovascularization one week after wound onset showed that the healing process occurred normally. Furthermore, the hydrogel-containing bioAgNPs did not cause toxic silver accumulation in the organs and blood of the rats. This study developed a bioAgNP hydrogel for the treatment of wounds; it has a potent antimicrobial action without interfering with cicatrization or causing silver bioaccumulation. This formulation is effective against bacteria that commonly cause wound infections, such as Pseudomonas aeruginosa and Staphylococcus aureus, and for which new antimicrobials are urgently needed, according to the World Health Organization’s warning.

The demand for sustainable cosmetics leads to the search for natural and biotechnological ingredients. The present study reports the development of a multifunctional lip moisturizer containing levan (LEV) from Bacillus subtilis natto, sophorolipids (SOPs) from Starmerella bombicola and Citrus paradisi (OCP) essential oil, using a simplex-centroid experimental design. The formulations were evaluated physicochemically, pharmacotechnically and by DPPH assay. The optimized formulation was selected through the Response Surface Method, and the evaluation of its efficiency in lip hydration was carried out using the bioimpedance method and sensory analysis. The formulations showed pH compatibility with lips and remained stable after a centrifuge test and thermal stress. Spreadability varied between 415.3 and 1217.1 mm2, moisture retention was above 95% and antioxidant capacity was around 50% for all formulations. The optimized formulation, containing 0.4% LEV and 0.8% SOF, maintained the lip hydration already shown by the participants; 85% of them reported improvement in this aspect. For the first time, LEV and SOP were incorporated in lip moisturizers, which is an environmentally friendly product with marketing potential. Furthermore, the use of the Skin Analyzer Digital equipment, a low-cost and non-invasive technique, to evaluate the effectiveness of lip products is innovative; this methodology may help in the development of future cosmetology studies.