Refractory or unexplained chronic cough (RUCC) represents an unmet clinical need. This study aimed to explore the components constituting the disease burden in patients with RUCC by comparing clinical features, healthcare use, and patient-reported outcomes with those of chronic cough (CC) of recent onset (< 1 year).

A total of 200 individuals were prospectively enrolled from seven referral clinics in South Korea, including 100 with RUCC and 100 with CC of recent onset (< 1 year). Data were obtained through structured interviews and medical record reviews. Measures included general and cough-specific quality-of-life, mood, cough hypersensitivity symptoms, work productivity, and healthcare utilization.

Individuals with RUCC were significantly older than those with CC (57.5 ± 15.1 vs. 48.9 ± 17.6 years) and had markedly longer cough duration (median 80 vs. 4 months). The RUCC group demonstrated higher out-of-pocket costs, more healthcare facility visits, and greater numbers of diagnostic tests and prescribed medications. However, cough-specific and general health-related quality of life scores showed no significant differences. Correlation analysis revealed comparable but stronger associations between cough-specific quality-of-life and general health outcomes in RUCC than in CC.

RUCC imposes a substantial and multidimensional burden that extends beyond symptom severity. Chronicity, healthcare complexity, and psychosocial impact appear to be central features. Future evaluation tools should incorporate time and lived experience to more accurately capture the true burden of chronic cough.

Infants with Robin sequence (RS) are at high risk for obstructive sleep apnea (OSA), but screening with poly(somno)graphy (P(S)G) is challenging. The aim of the study was to assess the relationships between different pulse oximetry (SpO₂) parameters and the mixed obstructive apnea-hypopnea index (MOAHI) in these infants. We also compared the findings to infants having other comorbidities (OSA-III). Different SpO₂ parameters were correlated with MOAHI in infants with RS and with OSA-III having similar OSA severity. The SpO₂ parameters were also compared between the 2 groups. Half of the infants with RS had nap studies. Mean MOAHI did not differ significantly between the 2 groups, and the proportion of infants with MOAHI > 10 events/h or ≥ 3% oxygen desaturation index (ODI 3%) > 10 events/h was also similar. Overall, the different SpO₂ parameters correlated better with MOAHI in infants with OSA-III than in those with RS. The best correlation was observed between ODI 3% and MOAHI in RS patients (r = 0.536, p < 0.001), and between the total hypoxic burden and MOAHI in OSA-III patients (r = 0.720, p < 0.0001). Mean ODI 3% was significantly lower in infants with RS (15.8 ± 22.3 (range 0.0-137.0) vs. 21.5 ± 18.3 (range 0.4-93.6) events/h for OSA-III, p = 0.024). Moreover, infants with OSA-III presented deeper desaturations and greater hypoxemic burdens.

 SpO₂ parameters correlated better with MOAHI in infants with OSA-III compared to RS. These findings question the presence of a different OSA phenotype in infants with RS. Future studies should further investigate the potential role of the different SpO₂ parameters to screen for OSA in infants.

• Infants with Robin sequence (RS) are at high risk of obstructive sleep apnea (OSA). Polysomnography (PSG) is the gold standard for OSA diagnosis, but may be challenging due to its limited access, and the fact that it is time consuming and requires an experienced team. Pulse oximetry (SpO2) represents a simpler alternative and is used in some centers to screen for OSA. However, no pathological thresholds have been validated. Moreover, the oxygen desaturation index (ODI), which is commonly used, was found to correlate only moderately with the mixed and obstructive apnea-hypopnea index (MOAHI).

• We correlated different SpO2 parameters, such as the hypoxemic burden and the Δ12s index, to the MOAHI in infants with RS and compared the findings to infants with OSA associated to other comorbidities. It seems that infants with RS have a less severe OSA-related hypoxemic profile than infants with OSA-III. These findings question if different obstructive patterns exist according to the disorders.

Evaluate variation in care of febrile infants presenting to London hospitals and adherence to national Clinical Practice Guidelines (CPGs). Retrospective multicentre cohort study conducted at 21 London hospitals. Infants ≤ 90 days of age presenting with fever or caregiver reported fever between 1st April 2021-31st March 2022 were included. Outcome measures were variations in patient management and adherence to national CPGs. Of 2,008 presentations, 41.1% were febrile during assessment. 73.7% had blood tests (range across hospital sites: 55.4-96.7%), 40.8% had cerebrospinal fluid (CSF) testing (17.1-70.7%), 63.4% had urinalysis (43.4-85.4%) and 62.2% were investigated for SARS-CoV2 (26.5-91.7%). Antibiotics were started in 57.7% (35.4-90.2%) and 63.5% (46.7-99.2%) were admitted. Infants aged < 28 days and infants febrile during assessment were more likely to undergo investigations and be admitted. Adherence varied significantly across sites: full adherence to CPGs was achieved in 21.9% (site range 8.8-35.4%), partial adherence in 24.4% (18.0-35.3%), non-adherence in 31.2% (10.6-47.4%), and over-adherence in 23.5% (8.0-44.7%). CPG adherence was higher in infants aged < 28 days.Conclusions: There was wide variation in care across London hospitals with limited adherence to guidelines. This highlights the need to focus on refining and updating decision models and CPGs, with more specific recommendations for managing infants who are afebrile during initial assessment. Clear guidance with a focus on reducing missed diagnosis may impact patient safety and economical expenditure.

Pulmonary disease in children with SCD is common and heterogeneous and includes pulmonary function impairment. This study aimed to investigate spirometry patterns in Ghanaian children with SCD and factors that contribute to low lung function.

A case-control study involving children aged 6-16 years with and without SCD was carried out at the Komfo Anokye Teaching Hospital. Demographic, socio-economic, and clinical information were collected. Spirometry was performed for both cases and controls at enrolment and interpreted based on the GLI-Black reference equation. Logistic and linear regression analyses were performed.

A total of 115 cases and 115 controls were recruited for the study. Children with SCD had significantly lower anthropometric measurements, lower lung volumes compared to the controls: median (IQR) BMI z-scores; cases vs controls, -0.5 (-1.3 to 0.3); versus -0.2 (-0.9 to 0.8) p = 0.01, mean z- scores for forced expiratory volume in 1 s (FEV₁₎, cases vs controls, -1.0 (SD1.2) vs -0.4 (SD 1.2) z-score, (p < 0.001), mean z-scores for forced vital capacity (FVC z-scores), cases versus controls, -0.8 (SD1.2) z score vs -0.3 (SD 1.3) z-score, (p < 0.001). Abnormal lung function was significantly more common in cases than controls, 42% (n = 48) and 17.4% (n = 20) respectively. The lung function abnormalities noted were as follows: restrictive pattern, cases versus controls [24.3% (n = 28) vs 12.2% (n = 14)] (p < 0.001), obstructive pattern [14.8% (n = 17) versus 5.2% (n = 6)] (p < 0.001), mixed pattern [2.6% (n = 3) versus 0 (p < 0.001). Being female and having higher BMI z-scores were associated with significantly lower odds of having a restrictive lung function pattern compared to normal lung function, OR 0.31 (95% CI 0.16, 0.58) (p < 0.001).

This study has demonstrated a predominance of low anthropometric measurements and restrictive abnormality on spirometry in children with SCD in Ghana. Females and those with higher BMI z-scores had significantly lower odds of having a restrictive lung function pattern compared to normal lung function.

BackgroundVascular inflammation has an important role in the development and progression of coronavirus disease 2019 (COVID-19). Also, a high cytokine level predicts a poor prognosis for COVID-19. In this study, we aimed to investigate the effect of salusin-α and salusin-β peptides in determining the severity of the disease in the acute period of COVID-19.MethodThe investigation involved studying a group of 74 hospitalized individuals who had tested positive for SARS-CoV-2 through polymerase chain reaction (PCR) tests. The patients were divided into two groups: those who did not reach the primary endpoint and were discharged without complications and those who reached the primary endpoint (a composite of ICU admission and/or mortality). Salusin-α and salusin-β levels of serum samples taken at the time of application were statistically compared.OutcomeThere was no statistically significant difference in salusin-α levels between the groups (p=0.279). However, salusin-β levels were found to be significantly higher in patients who reached the primary endpoint compared to those who did not reach the primary endpoint and the healthy control group.ConclusionThe results of the analysis showed that a salusin-β level of 12.45 ng/mL predicts the risk of complications such as intensive care unit admission or mortality, with a sensitivity of 83.8% and a specificity of 40.5% for the estimation of the primary endpoint. The obtained data support our hypothesis, but observational studies with larger sample sizes are needed to evaluate salusins' determination of COVID-19 prognosis.

Pulmonary infections represent a significant global health concern, contributing substantially to morbidity and mortality worldwide. Metagenomic next-generation sequencing (mNGS) represents an advanced, comprehensive, and unbiased diagnostic approach for pathogen identification, effectively overcoming many limitations inherent in conventional diagnostic methods. This study aimed to systematically evaluate the clinical performance of mNGS in the etiological diagnosis of pulmonary infections, with a particular emphasis on its utility across diverse immune statuses.

This retrospective study included 136 patients with suspected pulmonary infections admitted to the Department of Respiratory Medicine at Shandong Provincial Hospital from June 2023 to April 2025. Bronchoalveolar lavage fluid (BALF) samples were collected from all patients and concurrently subjected to mNGS and conventional microbiological testing (CMT). The pathogen detection spectrum and diagnostic performance of mNGS were systematically compared against those of CMT.

mNGS exhibited a significantly higher overall pathogen detection rate compared to CMT (77.2% vs. 50.0%, P < 0.001). Regarding the pathogen spectrum, mNGS identified a broader array of microorganisms, encompassing 19 bacterial, 9 fungal, and 2 mycobacterial species, in contrast to the 11 bacterial, 5 fungal, and 1 mycobacterial species detected by CMT. Diagnostic performance analysis further revealed that mNGS sensitivity was significantly superior to that of CMT (74.6% vs. 46.7%, P < 0.001). Furthermore, mNGS demonstrated a distinct advantage in detecting mixed infections, with a detection rate of 19.1%, significantly exceeding that of CMT (8.8%, P < 0.05). Subgroup analysis indicated a significantly higher incidence of mixed infections in immunocompromised patients compared to immunocompetent patients (35.1% vs. 13.1%, P < 0.05). Additionally, immunocompromised patients were more frequently subjected to adjustments in antimicrobial therapy guided by mNGS results (56.8% vs. 35.4%, χ² = 5.094, P < 0.05).

In conclusion, mNGS offers superior sensitivity and broader pathogen coverage for the etiological diagnosis of pulmonary infections compared to conventional microbiological testing. Its enhanced capability to detect mixed infections significantly improves diagnostic accuracy in immunocompromised patients and effectively facilitates the dynamic optimization of antimicrobial therapy. Serving as a powerful complement to traditional diagnostic methods, mNGS holds particular value for the rapid diagnosis of complex and immunosuppression-associated pulmonary infections.

Co-infection with Aspergillus and Mucorales in the intensive care unit (ICU) represents a devastating syndrome with high mortality that is frequently clinically occult. Clinically distinguishing this co-infection from invasive pulmonary aspergillosis (IPA) is challenging but critical for tailoring precise antifungal strategies.

We conducted a single-center, retrospective observational study involving 93 critically ill patients (75 with Aspergillus infection and 18 with co-infection) admitted between 2017 and 2025. We compared clinical characteristics, inflammatory markers, and immunophenotypes between groups. A three-stage variable selection strategy integrating univariable regression pre-screening, multi-algorithm importance ranking (LASSO, Ridge, and Random Forest), and clinical applicability filtering was employed to identify predictors for a multivariable logistic regression nomogram.

The co-infection group exhibited substantially higher ICU mortality than the sole Aspergillus group, although the difference did not reach statistical significance (72.2% vs. 53.3%, p = 0.24).Kaplan-Meier analysis demonstrated that initiation of amphotericin B within <7 days of diagnosis or strong clinical suspicion was significantly associated with improved survival (log-rank p < 0.0001). A three-stage variable selection strategy integrating univariable regression, multi-algorithm importance ranking (LASSO, Ridge, and Random Forest), and clinical applicability filtering identified four key predictors. The resulting multivariable logistic regression nomogram - incorporating NK cell count, C-reactive protein, corticosteroid use history, and Gram-positive bacterial co-infection - demonstrated robust discrimination (AUC = 0.878, 95% CI: 0.789-0.967), with good calibration (Hosmer-Lemeshow p = 0.849) and stability on internal validation (cross-validated AUC = 0.860).

Aspergillus and Mucorales co-infection constitutes a distinct, high-mortality clinical entity in the ICU. The developed nomogram, integrating clinical, immunological, and inflammatory features, may facilitate the early identification of high-risk patients and guide timely initiation of Mucorales-active therapy to improve prognosis.

Evidence on student mental health in sub-Saharan Africa (SSA) remains limited, particularly studies examining how mental health patterns intersect with social determinants within higher education institutions (HEIs). This scoping review identifies gaps in the literature documenting student mental health and associated social determinants during the COVID-19 period and highlights priorities for future research in SSA.

Eight databases (MEDLINE, PsycInfo, Open Access Journals, CINAHL, Google Scholar, Cochrane Library, ProQuest, Scopus) and grey literature were searched for English-language studies from 2020 to 2023. Sixty-seven studies from 214 full-text articles screened met the inclusion criteria.

The included studies varied widely in their examination of student mental health and its links to social determinants of health (SDOH). Mental health was most frequently assessed in terms of depression, anxiety, suicidality, substance use disorders, and psychological distress. Mood disorders were the most commonly reported outcomes. Few studies explored help-seeking behavior. Reported social determinants aligned with structural factors (socioeconomic and political contexts, cultural norms, gender disparities) and intermediary factors such as academic stress, service access, and behavioral patterns including substance use, physical activity, sleep, and diet.

Although many studies addressed social determinants of student mental health in SSA, none provided comparable, multi-country data across HEIs. Most research focused on undergraduate particularly medical students, with limited attention to postgraduate populations. Future work should prioritize multi-country comparative studies and context-specific approaches that strengthen help-seeking and support for at-risk students across diverse SSA settings.

Community-acquired pneumonia (CAP) remains a leading cause of hospitalization worldwide. Accurate prediction of length of stay (LOS) is crucial for optimizing hospital bed turnover, improving clinical resource allocation, and facilitating the development of individualized discharge plans, thereby reducing the strain on healthcare systems.

We retrospectively analyzed 423 adults hospitalized with CAP from January 2022 to December 2023. Clinical characteristics, laboratory data, comorbidities, and treatment variables were extracted from electronic health records. Univariate and multivariable linear regression models were initially employed to identify independent predictors of LOS. The predictive performance of the final multivariable model was assessed using R², adjusted R², Akaike Information Criterion, and 10-fold cross-validation. To further explain the complex relationship between specific treatment factors and LOS, restricted cubic splines and piecewise regression were utilized, specifically to evaluate non-linear associations and identify clinical inflection points.

The final model showed strong performance (R² = 0.864; adjusted R² = 0.862). Independent predictors of prolonged LOS included respiratory failure, pressure ulcers, elevated blood urea nitrogen, antibiotic modification during hospitalization, traditional Chinese medicine use, and antibiotic duration. Restricted cubic spline analysis demonstrated a significant non-linear relationship between antibiotic duration and LOS (P < 0.05). Piecewise regression identified an inflection point at 7.398 days, after which LOS increased more rapidly.

Multiple clinical and treatment-related factors were associated with LOS in CAP. Antibiotic duration showed a pronounced non-linear pattern, with treatment beyond 1 week linked to markedly longer hospitalization. These findings may help identify patients at risk of prolonged LOS and support more efficient clinical decision-making.

This study examines the dynamic impact of Economic Policy Uncertainty (EPU) on China's healthcare fiscal expenditures, focusing on the rational allocation of public funds under macroeconomic fluctuations. The study utilize the SV-TVP-FAVAR model to analyze quarterly national data (2007-2025) and inter-provincial data (2009-2019), overcoming traditional static model limitations. EPU shocks exhibit significant time-variability: a negative "squeezing" effect during the 2008 financial crisis but a counter-cyclical expansionary effect during the 2020 COVID-19 pandemic. Regional fiscal strength moderates these impacts. Findings suggest that fiscally robust regions show resiliency through counter-cyclical spending, whereas fiscally fragile areas exhibit pro-cyclical tightening. Policy recommendations focus on long-term healthcare investment mechanisms and optimized transfer payments.