Advances in cancer diagnosis and treatment have improved patient survival significantly. However, immunosuppression and the various invasive medical interventions often involved in these treatments increase infection risks. The core concept of "Chain of Infection" is used in this article to elaborate systematically on practical infection control strategies for cancer patients in three dimensions: the susceptible host, the infectious agent, and the mode of transmission. Strategies related to the susceptible host focus on enhancing host defense mechanisms and protecting potential portals of entry through the prophylactic use of granulocyte colony-stimulating factor, appropriate vaccinations, mucosal care, and skin integrity maintenance as well as the stringent management of invasive catheters. Strategies related to infectious agent control focus on environmental and dietary source management, including the restriction of live plants, implementation of water management plans, infection-control risk assessment and protection during construction, rigorous environmental cleaning and disinfection, and adherence to food safety protocols. Strategies related to mode of transmission focus on the management of both physical infrastructure and personnel behavior, recommending that protective/isolation rooms and material selection be incorporated into facility planning and that personnel should consistently practice hand hygiene, respiratory hygiene, and cough etiquette; use personal protective equipment properly; and surveil their own health condition. In applying these multi-level and systematic strategies, the incidence of infections may be effectively reduced and treatment safety and quality of care ensured.

Persistent cardiac symptoms are common in post-COVID syndrome, even without structural heart disease. Evidence implicates immune dysregulation, endothelial dysfunction and low-grade cardiovascular inflammation. Yet no targeted treatment exists. Myoflame-19 is a multicenter, double-blind clinical trial of 279 participants with inflammatory cardiac involvement defined by cardiovascular magnetic resonance, randomized 1:1 to losartan plus prednisolone (n = 139) or matching placebos (n = 140) for 16 weeks. The modified intention-to-treat population comprised 124 and 122 participants. The primary endpoint, change in left ventricular (LV) ejection fraction, was neutral: between-group difference 0.74 percentage points (pp), 95%CI -0.14 to 1.62, p = 0.10, unpaired t-test; supportive baseline-adjusted ANCOVA 0.99, 95%CI 0.15-1.83, p = 0.021. Among prespecified secondary endpoints, several symptom and imaging measures showed numerical differences favoring intervention, including Average Symptom Score components (modified Canadian Chest Pain Scale -4.8 pp, 95%CI -17.3 to 7.6; NYHA class -8.1 pp, -20.6 to 4.3; Long COVID symptom burden -7.7 pp, -18.9 to 3.6), native T1 and T2 values (native T1 -2.46 ms, -8.35 to 3.42; native T2 -0.31 ms, -1.16 to 0.53), and LV end-diastolic volume ( + 1.45 ml/m², -0.09 to 3.00); however, confidence intervals included the null value and these findings should be regarded as hypothesis-generating.Treatment was safe and well-tolerated. These findings indicate a neutral treatment effect on the primary endpoint. They inform targeted immunomodulation and design of future trials in post-COVID syndrome and inflammatory cardiac involvement. Trial registration: EudraCT 2022-001682-12; NCT05619653.

The COVID-19 pandemic disrupted schooling worldwide. While there is evidence of declines in academic performance, the links between early vulnerabilities in school readiness, learning difficulties, and lifestyle changes during the pandemic and their impact on postcrisis academic achievement are not well understood.

This longitudinal study followed 3871 children across three time points over 6 years (50.3% boys). In 2017, teachers assessed children's school readiness at kindergarten. In 2021, parents assessed the impact of COVID-19 on their child's learning difficulties and lifestyle changes. In 2022, teachers assessed children's academic achievement.

Structural equation modeling showed that children with school readiness vulnerabilities experienced greater learning difficulties during the pandemic, but not significantly greater lifestyle disruptions. Learning difficulties partially mediated the association between school readiness vulnerabilities and lower postcrisis academic achievement. Analyses were adjusted for child sex, age, native language, and cumulative socioeconomic risk.

Support systems should monitor learning difficulties that emerge during periods of educational disruption and not rely solely on preexisting indicators of vulnerability.

Learning difficulties during the pandemic emerged as a distinct predictor of later academic achievement, emphasizing the need for timely educational support during periods of disruption.

Complicated pneumonia in children can result in an empyema. The management options include chest drain insertion with fibrinolytic therapy (CDF) and video-assisted thoracoscopic surgery (VATS) with decortication. No studies have compared the long-term cardiopulmonary impact of treatment interventions using sensitive static and dynamic assessments of lung function.

To compare long-term cardiopulmonary function outcomes in children with empyema treated with CDF with those who underwent VATS using highly sensitive static and dynamic lung function measures.

Children aged >8 years at the time of testing who were previously hospitalised with empyema and treated with either CDF or VATS were prospectively recruited. At one hospital, children were only treated by VATS, whereas CDF was used exclusively at the other site. As both sites belonged to the same network, all other aspects of treatment protocols were identical, and clinicians worked across both sites. Healthy controls were assessed as a comparison. Lung function testing included spirometry, lung volumes, multiple-breath washout (lung clearance index), oscillometry and cardiopulmonary exercise testing, all performed according to international standards.

51 children treated with CDF, 28 treated with VATS and 24 healthy controls participated in this study. Spirometry and lung clearance index were normal across all groups. However, oscillometry revealed significantly lower reactance in both treatment groups compared with controls (respiratory system reactance at 5 Hz: CDF -2.54 (0.98), VATS -4.08 (0.94), controls -0.24 (0.85)), with VATS showing greater impairment. The ratio of minute ventilation to oxygen uptake was highest in the VATS group compared with CDF and controls (39.7 (2.8), 36.8 (3.2) and 32.2 (2.7), respectively).

Long-term pulmonary outcomes following both CDF and VATS were generally reassuring. However, oscillometry and exercise testing revealed subtle differences in ventilatory strategies, with children post-VATS demonstrating mild residual impairment.

Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease in which both environmental exposures and genetic predisposition contribute to disease susceptibility. Studying the burden of rare variants in a genetically homogeneous founder population may help identify disease-associated alleles that are difficult to detect in more heterogeneous populations.

Whole exome sequencing was performed on 123 patients with IPF and 1110 unrelated controls from Sardinia (Italy). Variant prioritisations were conducted according to the American College of Medical Genetics (ACMG) guidelines. In parallel, gene burden of rare predicted loss-of-function variants was assessed using the Cohort Allelic Sums Test (CAST) algorithm to identify genes significantly enriched in IPF cases compared with controls.

Pathogenic or likely pathogenic variants in known telomere-related genes were identified in 11.4% of patients. These variants were associated with younger age at diagnosis and a higher prevalence among never-smokers. CAST analysis identified a significant enrichment of loss-of-function variants in 82 genes, including MUC5B (OR=443.1, false discovery rate=3.7E-05), functionally related to cilium organisation and motility, with a significant overrepresentation of dynein-related genes.

This study supports the contribution of telomere-related variants to IPF susceptibility and suggests a possible role for rare variants affecting mucociliary pathways. Together, these findings broaden the current understanding of IPF biology in this cohort. The distinctive genetic background of the Sardinian population may have facilitated the identification of rare or population-specific variants, underscoring the potential value of founder populations in complex disease genetics.

Tuberculosis (TB) remains underdiagnosed in many high-burden countries due to high costs and limited availability of rapid molecular tests. Globally, only half of people with TB receive a molecular test as their initial diagnostic test. Pooled testing combines sputum samples from multiple individuals into a single molecular assay, offering cost savings by optimising existing resources, particularly in resource-constrained health systems. Although pooled sputum testing has now been recommended by the World Health Organization in 2026, evidence on real-world feasibility and acceptability for people with TB and healthcare providers remains limited. This study explored multisectoral stakeholder perspectives on the feasibility and acceptability of pooled sputum testing for TB.

Multicountry qualitative study using key informant interviews and focus group discussions. Data were analysed using a framework approach guided by established feasibility and acceptability models.

Facility and community settings across seven high-TB-burden countries: Bangladesh, Brazil, Cameroon, Kenya, Malawi, Nigeria, and Viet Nam.

Thirty-eight key informant interviews and 18 focus group discussions were conducted with National TB Programme (NTP) representatives, laboratory technicians, people with TB and international experts.

Pooled testing was considered feasible and acceptable in facility and community settings with greater confidence in countries with prior implementation experience. Feasibility depended on alignment with diagnostic algorithms and laboratory workflows, biosafety, training and clear standard operating procedures.Acceptability operated at two levels: early NTP engagement with healthcare providers to secure professional buy-in and clear communication between healthcare providers and people undergoing testing to support understanding.

Pooled testing was considered feasible and acceptable in settings with robust laboratory systems and routine practices. Readiness varied across countries, with some suitable for rapid implementation and scale-up while others required system strengthening. In settings perceived as having suitable infrastructure and readiness, pooled testing was viewed as a pragmatic strategy to optimise molecular TB testing.

Antimicrobial resistance is a significant threat to healthcare worldwide. The appropriate use of antimicrobials could decrease the excess morbidity of respiratory infections and contribute to reducing the emergence of multidrug resistance. For this purpose, the European Union has funded the VALUE-Dx project to assess the value of rapid diagnostic tests in combatting antimicrobial resistance by optimising antibiotic use in community-acquired lower respiratory tract infections (CA-LRTI). In this context, the current statement aims to review the literature and current practice regarding the role of rapid diagnostic tests in managing CA-LRTI for antibiotic stewardship purpose and combatting antimicrobial resistance. In particular, the present paper evaluates the accuracy of rapid diagnostic tests for the aetiological diagnosis of CA-LRTI, the usefulness of biomarkers and clinical algorithms in the management of CA-LRTI, the differences in aetiology according to the diagnostic protocol and tests applied for CA-LRTI after the introduction of rapid diagnostic tests for a complete microbiological investigation and, finally, the role of rapid diagnostic tests in antibiotic stewardship protocols in improving clinical outcomes.

Myocardial injury in severe community-acquired pneumonia (SCAP) is often under-recognized, and interpretation of high-sensitivity cardiac troponin I (hs-cTnI) may be complicated by renal dysfunction and critical illness. We evaluated whether admission interleukin-8 (IL-8) and soluble suppression of tumorigenicity 2 (sST2) could support early risk stratification of guideline-consistent myocardial injury in patients with SCAP.

In this prospective cohort of 146 patients with SCAP, guideline-consistent myocardial injury was defined as hs-cTnI elevation above the assay-specific 99th percentile upper reference limit. Admission IL-8, sST2, and their combination were assessed using receiver operating characteristic curve analysis and 10-fold cross-validation. Fixed and estimated glomerular filtration rate (eGFR)-stratified hs-cTnI thresholds were compared in an exploratory analysis. An exploratory subgroup analysis was performed among patients with CURB-65 ≤ 1.

The median age was 71 years; 91 patients (62.3%) were male and 55 (37.7%) were female. Myocardial injury occurred in 88 patients (60.3%). The IL-8 + sST2 model showed good discrimination for myocardial injury, with an AUC of 0.825 (95% CI: 0.751-0.895) and an internally cross-validated AUC of 0.812. Admission IL-8 showed stronger individual discrimination than sST2. eGFR-stratified hs-cTnI thresholds did not reduce discordant hs-cTnI elevations in this cohort, likely because few patients had moderate-to-severe renal dysfunction. Among patients with CURB-65 ≤ 1 (n = 38), IL-8 > 43.53 pg/mL was associated with a higher prevalence of myocardial injury (76.2% vs. 29.4%, p = 0.004). An exploratory 0-2 biomarker score showed a graded increase in myocardial injury prevalence across score categories: 15.4%, 62.5%, and 78.6%.

Admission IL-8 was associated with guideline-consistent myocardial injury in patients with SCAP, whereas sST2 showed weaker individual discrimination. The combined model had numerically higher discrimination than IL-8 alone, but the incremental contribution of sST2 remains uncertain. These findings represent an initial evaluation and require external validation before clinical implementation.

Globally, 85% of the population uses traditional medicine. Ethiopia is a country with various traditional medicinal practices. However, various studies also reported traditional medicine used in children by their parents has had adverse outcomes and hospitalized them with complications. Various studies had also reported that traditional medicine use was high during COVID-19. Despite the fact that, children are particularly vulnerable population, limited studies exists regarding the prevalence, types, and determinants of parental TM use during COVID-19. In addition the existing studies were also confined to quantitative methods. Therefore, this study uses a mixed study design to explore indigenous methods of traditional medicine knowledge acquisition, preservation, preparation, storage, and dosage of herbs; barriers of disclosure; and prevalence of concomitant use.

A community-based concurrent mixed study design was conducted among 941 randomly selected parents from Dec 01/2023 to March 01/2024. The data was cleaned, coded, and entered in Epi-Data version 4.6 and transferred to Stata version 14.1 for analysis. Finally, an AOR with a 95% CI was computed, and variables with a p-value < 0.05 in the multivariable analysis were taken as significant factors. The qualitative data was collected from 16 selected key informants by in-depth face-to-face interviews and analyzed by using thematic analysis.

The prevalence of parental TM use for children was 87.6%. Sibling relation to child (AOR: 0.45, 95% CI, 0.01-0.77), religion (AOR: 0.11, 95% CI, 0.04-0.29), parental TM use for themselves (AOR: 6.55, 95% CI, 1.67-25.69), easy accessibility (AOR: 2.72, 95% CI, 1.16-6.40), safety & efficacy (AOR: 4.53, 95% CI, 2.3-13.61), and TM skill in the family (AOR: 0.47, 95% CI, 0.19-0.84) were determinants of TM utilization. Lack of awareness, misperception of TM, lack of trust in HCP and negative judgment from HCP were the main-barriers for non-disclosure of TM use.

This result indicated traditional medicine use was high; nearly 9 out of 10 parents had used TM for their children during COVID-19. There was high concomitant utilization (90.6%) and high non-disclosure rate (98.1%) of traditional medicine use to health workers. Hence, it is better to give priority to strengthening the implementation of TM policy and manage accordingly.

The elevation of neutrophil-lymphocyte ratio (NLR) has been shown to be critically involved in unfavorable outcomes among patients with chronic obstructive pulmonary disease (COPD). The mechanism underlying NLR changes during COPD progression remains unclear. This study evaluates the association between neutrophil PD-L1 expression and acute exacerbation of AECOPD and examines its correlation with the NLR.

In this prospective observational study from June 1 to December 30 2024, we enrolled 14 patients with acute exacerbation, 27 with stable conditions, and 9 healthy control subjects. Blood samples were collected for neutrophil isolation, and the CD15+CD274+ neutrophil percentage was measured using flow cytometry. We also recorded and analyzed smoking history, pulmonary function test results, and blood routine test data.

The percentage of CD15+CD274+ neutrophils was notably higher in patients with COPD compared to healthy controls and was even more elevated in those experiencing acute exacerbations of COPD (AECOPD) than in patients with stable COPD. This increased percentage was positively correlated with NLR but negatively correlated with FEV1% (FEV1 percentage of the predicted value). The AUC of CD15+CD274+ neutrophil percentage for predicting AECOPD was 0.894 with 95% CI 0.8-0.989 and a ratio above 3.273 (odds ratio 1.386; 95% CI 1.016-1.891; P = 0.039) independently associated with AECOPD.

Peripheral blood neutrophil PD-L1 expression was elevated in AECOPD and independently associated with exacerbation status in this pilot cohort. Larger, multi-center studies with mechanistic validation are required to determine its clinical utility.