To identify barriers and facilitators to the timely detection and optimal management of chronic wet cough (CWC) in children from the perspectives of carers, across multiple, diverse First Nations Australian communities.

Qualitative participatory action research study.

Eight Australian communities across three states and territories. Semi-structured interviews and focus groups with 167 parents and carers of Aboriginal children were conducted between May 2021 and July 2023.

Barriers to and facilitators of detection and management of CWC in Aboriginal children in a primary care setting.

Key barriers identified included inadequate health promotion, the common perception that CWC is normal and high turnover among health staff, leading to mistrust of newly onboarded health staff. The overarching facilitator identified was knowledge dissemination through health promotion, delivered in person by Aboriginal health staff using culturally secure resources, supplemented by posters placed in the community and the use of radio and social media. Individual communities expressed varied preferences regarding specific health promotion methods and designs. Communities valued staff who had spent considerable time within the community, allowing for the development of trust and rapport.

The barriers and facilitators to detecting and managing CWC in children were generally consistent across the settings we studied. Implementation approaches to facilitate care require tailoring to local settings. Further, to reduce identified barriers for the detection and management of CWC in children, the incorrect perception that CWC is normal must be addressed and the potential harms of staff turnover need to be recognised.

Over the past decade, there has been a steady increase in myocarditis cases, paralleling the expanded availability and use of cardiac magnetic resonance imaging. Although some have speculated that COVID-19 or its vaccines may be contributing to this increase, recent studies have not provided conclusive proof. Therefore, this study aims to analyse the association between COVID-19 and myocarditis in hospitalised patients.

In this nationwide cohort study, the primary outcome was trends in hospitalisations with myocarditis before (years 2012-2019) and during (years 2020-2022) the COVID-19 pandemic. Trends were calculated using linear mixed-effects segmented regression models. Secondary outcomes included in-hospital mortality, intensive care unit admission, length of stay, and 30-day hospital readmission. Results were stratified by sex and age for subgroup analyses.

During the pre-pandemic period, 4,304 hospitalisations with myocarditis were recorded, compared with 2,749 during the pandemic. The incidence rate of myocarditis increased from 26.7 cases per 100,000 hospitalisations in 2012 to 73.8 per 100,000 in 2022 (p for trend <0.001). The quarterly slope of incidence rose significantly during the pandemic (slope, 2.008 [95% CI: 2.006 to 2.011]) compared with that during the pre-pandemic period (slope, 1.141 [95% CI: 1.140 to 1.141]). Subgroup analyses showed the steepest increases in young and middle-aged males. Sensitivity analyses based on the Swiss population confirmed this pattern, with a population-adjusted quarterly increase in myocarditis hospitalisations from 1.0 to 2.6 per 100,000 inhabitants between 2012 and 2022 (p for trend <0.001).

This nationwide cohort study found a marked increase in the incidence of hospitalisations with myocarditis during the COVID-19 pandemic, suggesting a causal relationship between COVID-19 infection and/or its vaccination and the increased incidence of myocarditis.

Ventilator-associated pneumonia (VAP) is a serious infection in ICUs, contributing to prolonged mechanical ventilation and higher mortality.

This study aimed to enhance ICU nurses' knowledge and compliance with ventilator care bundle practices to reduce the incidence and mortality of VAP among mechanically ventilated patients at Benha University Hospitals.

This quasi-experimental study included all nurses working in the central and intermediate ICUs (N = 262). The intervention comprised 12 structured educational sessions and bedside demonstrations. Data collection included pre-questionnaires and post-questionnaires to assess nurses' knowledge, observation checklists to measure compliance with the VAP care bundle, and patient surveillance records to track VAP incidence and mortality rates.

Postintervention analysis revealed a significant improvement in nurses' knowledge scores on general infection control and VAP prevention guidelines, as well as a significant increase in compliance with the VAP care bundle (P < .001). General infection control knowledge score was a significant predictor of VAP prevention knowledge (B = 0.632, P < .01). Clinically, the program resulted in a nearly one-third reduction in VAP incidence (central ICU: -29.1%; intermediate ICU: -28.5%), preventing ∼1 infection for every 10 ventilated patients. Mortality among ventilated cases was cut by almost half in the intermediate ICU (-53.8%) and by one-third in the central ICU (-30.9%).

The care bundle training program significantly improved ICU nurses' knowledge, boosted adherence to evidence-based ventilator care practices, and contributed to lowering the VAP incidence rate and related mortality. These results represent not only statistical significance but also a substantial, life-saving impact.

Roflumilast demonstrated anti-inflammatory activity in COPD. While bronchiectasis is also characterised by neutrophilic inflammation, there is a lack of evidence on the use of roflumilast in bronchiectasis.

An open‑label observation study with an exploratory nature was conducted in Hong Kong. The primary outcome measure was 24-hour sputum volume. The extent of airway inflammation was indicated by sputum leucocyte density, pro-inflammatory cytokines and neutrophil elastase. All eligible patients were treated with roflumilast, starting at 250 µg daily with possible escalation to 500 µg daily if tolerated.

A total of 39 patients were started on roflumilast with 24 (61.5%) completed 12 weeks of treatment and 9 of them escalated to 500 µg daily. There were no significant changes in mean daily sputum volume. The median sputum leucocyte density and TNF-α significantly decreased from the recruitment visit to 12 weeks. In extrapolatory analyses, patients with a baseline daily sputum volume ≥ 20 mL might be more likely to respond with a reduction in sputum volume.

Roflumilast treatment in non-CF bronchiectasis could provide anti-inflammatory effects with a significant reduction in sputum leucocyte density and TNF-α level over 12 weeks of treatment. Extrapolatory analyses suggested potential benefits in sputum volume reduction among the subgroup with baseline daily sputum volume ≥ 20 mL.

Measles is resurgent worldwide, and although vaccine-preventable, severe disease can progress to cardiorespiratory failure refractory to conventional support. This study aimed to determine whether extracorporeal membrane oxygenation (ECMO) is feasible in children with measles. A retrospective case series at a tertiary pediatric intensive care unit (PICU) with a regional ECMO program, of all children younger than 18 years with laboratory-confirmed measles who received ECMO during the August 2025-May 2026 outbreak. Of 49 children with measles admitted to the PICU, 10 received ECMO. Five were male; median age was 11 months (IQR, 10-24), and none had completed age-appropriate vaccination. Indications were septic shock or cardiorespiratory failure (n = 5), acute respiratory distress syndrome with septic shock (n = 2), hypoxemic respiratory failure (n = 2), and suspected myocarditis (n = 1). Seven received venoarterial, 1 veno-venoarterial, and 2 venovenous ECMO. Bacteremia preceded ECMO in 5 children and positive sputum culture in 8. Candida tropicalis candidemia developed in 3 of the first 5 patients, with none among the subsequent 5 after antifungal prophylaxis at cannulation. Left ventricular dysfunction was present in 7 of 9 assessed, 4 required decompression, and neuroimaging was abnormal in 4 of 8 imaged. Six children (60%) survived to discharge.

 ECMO was feasible and potentially lifesaving in measles-associated cardiorespiratory failure, with survival comparable to other high-acuity pediatric indications, but the course was complicated by bacterial and fungal coinfection, cardiac dysfunction, and neurologic injury. These resource-intensive presentations occurred exclusively in unvaccinated children and were preventable, underscoring measles vaccination coverage as a public health priority.

• Measles is resurgent worldwide and can cause severe respiratory, cardiac, and immune complications in children. • Measles-induced immune suppression predisposes to secondary bacterial and fungal infection.

• First reported series of ECMO for measles: feasible, with 60% survival, but marked by coinfection, cardiac dysfunction, and neurologic injury. • Antifungal prophylaxis at ECMO cannulation was associated with elimination of candidemia in this cohort.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disorder in which type 2 inflammation predominates but varies in its local organization, clinical context, and downstream tissue effects. Biologics targeting interleukin-4 receptor alpha, immunoglobulin E, the interleukin-5/interleukin-5 receptor axis, and thymic stromal lymphopoietin have expanded treatment options for severe disease and can improve polyp burden, nasal obstruction, olfactory function, quality of life, and corticosteroid- or surgery-related outcomes. However, responses remain variable across patients and clinical domains, and incomplete control may reflect target mismatch, persistent parallel inflammatory pathways, comorbid airway disease, or established tissue remodeling rather than insufficient pathway coverage alone. In this review, we summarize the mechanisms and clinical evidence for current monospecific antibodies and examine biological contexts that may contribute to variable treatment responses, including local IgE activity, microbial and antigenic amplification, nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD), comorbid asthma, and persistent epithelial remodeling. We then discuss biomarkers, multidimensional response assessment, and clinical positioning of biologic therapy before evaluating the rationale, boundaries, molecular design, and current pipeline of dual- and multispecific antibodies. Attention is given to whether broader pathway targeting can provide incremental benefit over optimized monospecific therapy, while maintaining acceptable long-term safety, treatment practicality, and economic value. The future role of multispecific biologics in CRSwNP will depend on rational target pairing, comparative clinical evidence, and improved identification of patients most likely to benefit.

Tuberculosis (TB) remains a major global health concern, particularly among immunologically and nutritionally vulnerable individuals. Although celiac disease (CD) has been associated with an increased risk of TB, extensive and complicated forms remain rarely reported. We report the case of a 27-year-old man with CD, poor adherence to a gluten-free- diet (GFD), schizophrenia, and substance use disorders, who presented with extensive cavitary pulmonary TB (PT) complicated by pyopneumothorax and severe undernutrition. Concerns were raised regarding anti-TB drug absorption. In the absence of injectable anti-TB agents, standard oral treatment was initiated alongside a strict GFD, nutritional rehabilitation, and cessation of substance use. The patient showed very gradual general health improvement and required prolonged chest drainage, ultimately resulting in clinical recovery with residual pleuroparenchymal sequelae. This case highlights that PT in active CD can achieve recovery with oral anti-TB therapy when associated malabsorption is strictly managed.

Post-tuberculosis lung disease (PTLD) is an important cause of persistent respiratory morbidity, yet clinical factors associated with structural lung abnormalities during anti-tuberculosis treatment remain poorly understood. This study explored routinely available clinical factors associated with early structural lung damage following completion of the intensive treatment phase.

This prospective cohort study included 38 adults with newly diagnosed, microbiologically confirmed, drug-susceptible pulmonary tuberculosis. Baseline demographic, clinical, and laboratory data were collected before treatment initiation. Early structural lung damage was evaluated by chest radiography after the 2-month intensive phase. Univariable and multivariable logistic regression analyses were performed to identify clinical factors associated with early structural lung damage. Receiver operating characteristic analysis was conducted to describe the performance of significant laboratory variables.

Radiographic evidence of early structural lung damage was identified in 31 participants (81.57%). Underweight nutritional status was more frequent among participants with fibrosis ( P = 0.002). After multivariable adjustment, platelet count remained independently associated with early structural lung damage (adjusted OR 0.986, 95% CI 0.972-1.000; P = 0.047), whereas random blood glucose was not. Platelet count and random blood glucose yielded AUC values of 0.742 and 0.776, respectively.

Platelet count remained independently associated with early structural lung damage after the intensive phase of anti-tuberculosis treatment, whereas underweight nutritional status was more common among participants with radiographic fibrosis. These findings warrant validation in larger multicenter prospective studies before informing clinical risk assessment.

Improving the effectiveness of pulmonary tuberculosis (TB) treatment is one of the main objectives of the healthcare system in Russia. The aim of this study was to search for a relationship between the composition of long-chain fatty acids and aldehydes detected in bronchial lavage samples from patients with TB and the features of the TB infection during the treatment.

This study included 262 patients with pulmonary TB with varying treatment durations and different drug sensitivity profiles of the pathogen. Patients' samples were collected during routine bronchoscopy using the minilavage technique. Each sample was examined for Mycobacterium tuberculosis by standard laboratory methods and for long-chain fatty acids and aldehydes by gas chromatography-mass spectrometry analysis.

We found that a higher proportion of aldehydes (18:1d9a, 18:1d11a, and i17:0a) and monounsaturated fatty acids (20:1d9 and 20:1d11) in bronchial lavage samples was associated with worse treatment outcomes (presence of bacterial shedding and cavities at the time of sampling and 6 months later), as well as with smoking and the M. tuberculosis Beijing genotype. In contrast, favorable treatment outcomes were associated with an increased proportion of saturated fatty acids, including branchedchain fatty acids (i16:0, a17:0, 17:0, a15:0, and i15:0).

The identified marker profile may have prognostic value and warrants further prospective validation.

Drug-resistant tuberculosis (TB) hinders global TB control. Rifampicin-resistant TB (RR-TB) prevalence, in Côte d'Ivoire, was 4.6% (95% confidence interval [95% CI]: 2.4-6.7) for new cases and 22% (95% CI: 13.7-30.3) with retreatment cases in 2016. The TB drug resistance survey (DRS) conducted in 2023 aimed to determine the updated prevalence of resistance among new, previously treated TB cases and to characterize the genotypes of circulating Mycobacterium tuberculosis strains.

A nationwide, cluster-based cross-sectional DRS was conducted in a 6-month timeframe in 44 health facilities across the country, grouped into 45 clusters according to the World Health Organization guidance. Bacteriologically confirmed pulmonary TB cases were recruited after giving informed consent. Xpert ® MTB/RIF Ultra, Hain MTBDR plus and MTBDR sl were carried out on sputum samples. All samples with resistance detected and 10% of rifampicin (RIF) susceptible TB cases were cultured in liquid medium with Mycobacterium growth incubator tube (MGIT) (MGIT 960). Phenotypic drug susceptibility testing was performed for isoniazid (INH), RIF, amikacin (AMK), moxifloxacin, levofloxacin, clofazimine, bedaquiline, and linezolid. Whole-genome or targeted next-generation sequencing was conducted on 120 selected drug-resistant and susceptible strains. KoboCollect v2013.1.2 was used for data collection and storage. For statistical and cluster analysis, STATA 19.5 and core genome multilocus sequence typing in Ridom SeqSphere + were used, respectively.

1024 participants were enrolled, 947 (92.5%) were new cases. INH monoresistant TB prevalence was 4.8% (95% CI: 3.6-6.4) in new cases and 5.6% (95% CI: 1.5-18.8) in retreatment cases. Multidrug-resistant TB (MDR-TB) prevalence was 2.5% (95% CI: 1.7%-3.8%) in new and 14.1% (95% CI: 7.0%-26.5%) in previous treated cases. Among RR-TB, MDR-TB prevalence was 89.5% (95% CI: 73.8-96.3), of whom 2 pre-extensively drug-resistant (XDR) TB and 1 XDR-TB were detected. Sequencing revealed a predominant circulation of lineage 4.6.2.2 and 4.1 (28% each) following by lineage 6 (11%).

Progress has been made in combating TB drug resistance in Côte d'Ivoire compared to the previous DRS. Molecular tools have permitted to detect heteroresistance or mixed infection and the existence of circulating virulent strains associated with alarming rates of drug resistance.