Evidence describing paediatric COVID-19 and influenza co-infection is limited because influenza circulation was minimal during the early COVID-19 pandemic. We used the National Clinical Cohort Collaborative, a multicentre electronic health record repository, to describe the characteristics and clinical outcomes of paediatric COVID-19 and influenza co-infections in the United States from March 2020-April 2024. We defined co-infection as COVID-19 and influenza identified <7 days apart. We reported demographics, pre-existing diagnoses, and clinical outcomes and used generalized estimating equation models. We defined clinical outcomes as Severe/Moderate disease (hospitalization, critical care, or death) versus emergency department/outpatient encounters. We repeated analyses using varying co-infection definitions to assess robustness of findings. Among 1.53 million patients, 10,277 were co-infected, and 647 (6%) were hospitalized. Co-infections occurred predominantly among children aged <12 years. The most common pre-existing diagnoses were obesity (24%), asthma (10%), and congenital/genetic conditions (5%). The risk for Severe/Moderate disease was greatest among persons aged 0-4 years (adjusted risk ratio (aRR) 3.05; 95% confidence interval (CI): 2.35-3.97) and those with ≥2 pre-existing diagnoses (aRR 2.89; 95% CI: 2.43-3.43). Similar distributions of disease severity were observed across varying co-infection definitions. This study provides a large-scale epidemiological characterization of paediatric COVID-19 and influenza co-infection and successfully implemented a practical EHR-based co-infection case definition for future analyses.

Vaccination is a principal method of infectious disease prevention, but its association with rheumatoid arthritis (RA) remains controversial. This study assessed vaccine‑associated RA using the Vaccine Adverse Event Reporting System (VAERS). Data from 1990 to 2026 were extracted. Descriptive statistics, Weibull fitting, and disproportionality analysis using four methods, including the reporting odds ratio (ROR), along with subgroup analyses by age, sex, and pre‑/post‑COVID, were performed. Among 11,532,185 reports, 34,498 RA‑related adverse events (AEs) (0.03%) involved 5006 subjects. Females comprised 77.9% and 18-65 predominated. Serious outcomes occurred in 13.48%. Most AEs (47.49%) were musculoskeletal. 47.0% occurred within 7d (median 5.4), indicating early failure. The COVID‑19 vaccine had the most reports (n = 24,266) but a weak signal (ROR = 1.25); the Lyme disease vaccine (ROR = 27.81), the rubella vaccine (ROR = 5.69), and the anthrax vaccine (ROR = 3.90) exhibited the strongest signals. Subgroup signals: Lyme disease vaccine except 2021-2026; rubella vaccine only in females/≤17; anthrax vaccine in 18-64. RA‑related vaccine AEs are extremely rare, mainly musculoskeletal and within 1 week. High COVID‑19 volume did not align with its weak signal, while strong signals for the Lyme disease, rubella, and anthrax vaccines reflected specific populations. No strong disproportionality signal was found. However, VAERS is passive, cannot establish causality or confirm safety.

Uvular necrosis is an uncommon complication following oesophagogastroduodenoscopy (OGD). We report a case involving a male in his 20s who developed uvular necrosis following a routine OGD performed under conscious sedation. The patient presented three days postprocedure with a worsening sore throat and odynophagia. Examination revealed an erythematous uvula with a necrotic tip. He was managed conservatively with simple analgesia, topical lidocaine and oral antibiotics with eventual full resolution of symptoms with no lasting sequelae. This case highlights a rare yet significant complication of OGD, emphasising the importance of clinician awareness, conservative management and patient reassurance.

Fixed drug eruption is a distinctive cutaneous adverse drug reaction characterised by the recurrence of well-demarcated lesions at the same anatomical site following re-exposure to the offending drug, with residual hyperpigmentation after resolution. Antimicrobials are common triggers, although fluoroquinolones are less frequently implicated. A man in his 30s developed multiple well-defined hyperpigmented patches involving the upper lip, upper limbs and foot within 24 hours of receiving levofloxacin for a lower respiratory tract infection. The lesions were pruritic, non-tender and recurrent at previously affected sites. Clinical findings and a clear temporal relationship supported the diagnosis of fixed drug eruption. Withdrawal of levofloxacin and symptomatic treatment resulted in gradual resolution with post-inflammatory hyperpigmentation. Causality assessment using the Naranjo scale suggested a probable association. This case highlights the importance of recognising fixed drug eruption caused by commonly prescribed antibiotics and the role of careful drug history taking and adverse drug reaction reporting.

Seasonal influenza imposes a substantial global health burden. The COVID-19 pandemic, accompanied by widespread non-pharmaceutical interventions (NPIs), profoundly disrupted respiratory virus circulation, offering a unique opportunity to assess their broader epidemiological impact. This study aimed to quantify changes in influenza burden between the pre-pandemic and intra-pandemic periods. Within the RESPINOW project, we conducted a systematic review following PRISMA guidelines. Studies reporting absolute influenza case counts before and during the pandemic were included. Data extraction and quality assessment were performed using a modified NHLBI tool for before-after studies. Influenza cases were normalized by reporting period length, and relative changes were estimated using incidence rate ratios. Subgroup analyses explored age, setting, hemisphere, human development index, influenza transmission zones, WHO regions, and viral strains. Of 20,676 screened records, 115 studies from 98 countries were included. Globally, influenza incidence declined by -92% (95% CI: -94 to -90) following the onset of the pandemic. Reductions varied geographically, ranging from near-elimination in several countries to more modest declines (e.g., South Korea: -61%, 95% CI: -79 to -26). Decreases were observed across all transmission zones and WHO regions, with descriptively larger reductions observed in high-income countries (-96%, 95% CI: -98 to -94) than in low-income settings (-82%, 95% CI: -88 to -73). Age-specific declines appeared smaller among young children (< 6 years: -66%, 95% CI: -79 to -45) compared with adults aged 18-64 years (-80%, 95% CI: -90 to -63). Influenza A appeared to decline more strongly than influenza B. The COVID-19 pandemic was associated with an unprecedented global reduction in influenza incidence. Data limitations and the need for robust epidemiological indicators highlight the importance of strengthened, integrated global surveillance to inform future pandemic responses.

Engineered stone, a composite material containing high levels of crystalline silica, has led to a surge in silicosis among workers who perform cutting, grinding, and other finishing tasks. To improve our understanding of respirable crystalline silica (RCS) and respirable dust exposures and exposure determinants for these tasks, this study extracted data from previously published studies and (i) calculated the emission rate of respirable dust and RCS (mass per time) from experimental simulation studies, (ii) assessed whether control technology or task are determinants of emission rate, and (iii) applied a 2-zone mathematical model to estimate RCS exposures using the calculated emission rates and evaluated the model predictions against task-duration exposure measurements. Emission rates were calculated from 4 published experimental simulation studies, and regression analysis showed that emission rates of RCS were positively associated with slab crystalline silica content and negatively associated with the use of control technologies. Near-field RCS concentrations predicted by model tended to underestimate exposures, but the distribution overlapped with field-based exposure measurements. The model performance is reasonable, though further simulation studies or field-based studies with detailed exposure determinant data can be used to improve emission rate estimates and model performance. The emission rates calculated in this study can be used to reconstruct past exposures for epidemiologic and risk analyses, and assist with attribution of silicosis and lung cancer to work-related causes. A multifaceted approach is necessary to ensure that employers are providing workplaces that eliminate hazardous exposures to RCS and other components of engineered stone.

We analyzed 2015-2024 national surveillance data on Kudoa septempunctata parasite-associated foodborne disease in South Korea. Monthly cases decreased 95% during the COVID-19 pandemic, with no significant recovery through 2024; affected municipalities dropped from 89 to 27. Our findings are consistent with restaurant-based raw fish consumption as the principal transmission pathway.

Persons with occupational exposure to swine might be at disproportionate risk for zoonotic swine influenza A virus. To evaluate human antibody responses, we tested serum or plasma from swine veterinarian, farm employee, and general population cohorts by hemagglutination inhibition assays against representative swine and human seasonal influenza vaccine strains. We analyzed hemagglutination inhibition data by antigenic cartography to assess strain relationships and reproduction number modeling to evaluate pandemic potential using age-stratified immunity profiles. Occupationally exposed groups had lower human seasonal vaccine uptake (45.5% vs. 70%) and lower odds of seropositivity to several H1 and H3 strains from swine than did general population cohorts. One swine strain exhibited significant antigenic drift (3.62 antigenic units) from its nearest vaccine strain. Multiple strains required lower reproduction number thresholds for pandemic spread (1.09-1.35) than recorded pandemic strains (1.46-1.80), demonstrating that population immunity gaps heighten zoonotic risk to circulating swine H1 and H3 strains.

Varicose veins (VVs) are one of the most common consequences of chronic venous disease. The present multicentric three-arm study aimed to compare the clinical outcomes of endovenous laser ablation (EVLA) versus ligation plus stripping or sclerotherapy for primary lower limb VVs.

The study included 300 patients with VVs. They received EVLA (GI, n = 100), ligation plus stripping (GII, n = 100) or ligation plus sclerotherapy (GIII, n = 100). Groups were matched using propensity score. The primary outcome measures were 1-year total occlusion and recurrence rates.

At 1 year follow up, no significant differences were found between the total occlusion rates for GI (75.0%), GII (76.0%) and GIII (83.0%). It was demonstrated that GII had significantly higher recurrence rate (24.0%) as compared to GI (6.0%) and GIII (5.0%). It was also found that GII group had significantly higher frequency of ecchymosis, hematoma and surgical site infection as compared to the other two groups. In contrast, GI had significantly higher frequency of skin ulceration/burn as compared to the other two groups. Also, it was found that GIII had significantly lower frequency of deep vein thrombosis than GI and GII.

Ligation plus sclerotherapy achieved slightly better total occlusion rate in comparison to EVLA and ligation plus stripping while avoiding important side effects related to them mainly traumatic and thermal injury effects and recurrence.

To generate the evidence base, using national cohort data, to design a clinical trial evaluating whether cesarean section (CS) or vaginal birth (VB) offers better outcomes for very preterm infants.

Severe intraventricular hemorrhage (IVH) remains a major cause of death and brain injury amongst very preterm infants. Observational studies have suggested CS may reduce the risk, but it is not known which infants might benefit and whether a randomized trial, to generate robust evidence to guide clinical decisions, would be feasible.

We examined births in England and Wales between 22 + 0 and 31 + 6 weeks' gestation (2012-2022; n = 74,423) and identified the infants that could take part in a trial. Three emulated target trials (ETTs) were constructed examining intended mode of birth (iVB vs iCS), across different populations, with confounding controlled by inverse probability weighting.

One in four(25.2%) very preterm infants could be considered for participation in a future trial. Infants born by CS had lower rates of severe IVH or death than those born by VB (4,319 (9.6%) vs 5,542 (18.7%)) (p < 0.001), although in the adjusted analyses using intended mode of birth the difference did not persist (e.g. ETT#1: 13.3% vs 13.0%, p = 0.609); except for non‑cephalic (breech) infants. Infants in a non-cephalic presentation in the iCS group had a significantly lower chance of death or sIVH in all three emulated trials (ETT#1, OR 0.73 (0.64-0.83); ETT#2, OR 0.65 (0.56-0.76); ETT#3, OR 0.81 (0.70-0.94).

Only a minority of very preterm births are realistically randomisable in a future trial, particularly babies in breech presentation who may benefit from a CS. An international multi-centre trial is needed to examine this question.