Influenza is a leading cause of pediatric hospitalizations, with clinical presentations and outcomes varying between types A and B. This study compared the clinical characteristics and complications of children hospitalized with influenza A and B at the Sydney Children's Hospitals Network (SCHN) in the post-COVID era.

We conducted a retrospective cohort study of children < 18 years admitted to SCHN with influenza during 2022-2023. Data on patient demographics, clinical presentations, complications, and management were extracted from electronic medical records. Group comparisons used chi-square or Fisher's exact tests, and modified Poisson regression estimated adjusted risk ratios (RRs) with 95% confidence intervals (CIs) for key clinical outcomes.

Among 704 influenza hospitalizations, 480 (68.2%) were due to influenza A and 224 (31.8%) to influenza B. Influenza B hospitalizations were more frequent in older children aged 5-< 18 years (67.4% vs. 57.7%) and associated with myalgia and pharyngitis, whereas influenza A hospitalizations were more common in children < 5 years (42.3% vs. 32.6%) and linked to cough, wheeze, and seizures. Although less common, influenza B hospitalizations exhibited greater clinical severity, with higher risks of noninvasive respiratory support (RR = 2.94; 95% CI 1.49-5.81) and intensive care unit (ICU) admission and/or mechanical ventilation (RR = 3.23; 95% CI 1.43-7.32).

Influenza B, though less prevalent, was associated with greater severity, particularly in older children. These findings underscore the importance of continued protection against both influenza types and support consideration of expanding vaccine access to children aged 5 years and older.

To investigate lung function and ventilatory response during cardiopulmonary exercise testing in adults with cerebral palsy and assess the relationship between perceived breathlessness and breathing reserve at maximal exertion.

Prospective, cross-sectional study. Inclusion period October 2023-June 2024.

Adults with spastic cerebral palsy, Gross Motor Function Classification Score (GMFCS) I-III (n = 100).

Spirometry and cardiopulmonary exercise testing were conducted. Ventilatory response during exercise was assessed via tidal volume and respiratory rate. Perceived breathlessness was compared with breathing reserve at maximal exertion.

89 participants completed all tests (GMFCS I = 62, GMFCS II = 20, GMFCS III = 7); 90% had lung function within normal limits. Age- and sex-adjusted maximal oxygen uptake was lowest in group III (p < 0.01). At maximal exertion, 70% had breathing reserve  < 20%, indicating ventilatory limitation. Breathing reserve did not significantly differ between those who did and did not report breathlessness as the limiting factor at maximal exertion. Tidal volume and respiratory rate showed expected values at maximal exertion.

Lung function was normal in most participants, yet ventilatory limitations were common during maximal exercise. Perceived breathlessness was not related to breathing reserve at maximal exertion.

In recent years, vascular endothelial growth factor D (VEGF-D) has been recognized as a promising biomarker for disease severity stratification in coronavirus disease, as well as an indicator of endothelial dysfunction, hypoxia, and pathological angiogenesis - all of which are hallmarks of severe COVID-19. However, there is limited evidence on the specific role of VEGF-D in children with COVID-19, and its relevance in multisystem inflammatory syndrome in children (MIS-C) has not been thoroughly explored.

This study included 200 children with confirmed COVID-19 (through PCR or rapid antigen test), 40 children with MIS-C, and 24 healthy children without SARS-CoV-2 infection. Serum VEGF-D concentrations, acute-phase markers (C-reactive protein, procalcitonin, ferritin), and interleukin levels (IL-1β, IL-6, TNF-α) were measured using enzyme-linked immunosorbent assay (ELISA) with commercial kits.

The results showed that VEGF-D levels were significantly higher in children with COVID-19 (325.61 (189.93; 535.85) pg/ml) and MIS-C (920.92 (473.45; 1157.70) pg/ml) compared with the control group (195.88 (115.58; 256.70) pg/ml), with the highest levels observed in patients with MIS-C and severe COVID-19. The increase in VEGF-D was more prominent in boys infected by SARS-CoV-2, but there were no significant differences based on age within the groups. Multivariable logistic regression analysis showed that VEGF-D was independently associated with severe COVID-19 and MIS-C in children. Receiver operating characteristic (ROC) analysis established clinically relevant cut-off values for VEGF-D: 387.87 pg/mL for identifying severe COVID-19 and 461.96 pg/mL for differentiating MIS-C from acute COVID-19. In children with COVID-19, exceeding the VEGF-D cut-off was associated with more severe hypoxia and higher levels of C-reactive protein and ferritin, while in MIS-C it was associated with elevated CRP and IL-6. Principal component analysis showed that VEGF-D, along with acute-phase markers and pro-inflammatory cytokines, contributes to an integrated inflammatory-endothelial profile in both COVID-19 and MIS-C.

VEGF-D is an independent marker associated with disease severity in pediatric COVID-19 and MIS-C and may be useful for severity stratification, differentiating clinical phenotypes, and informing patient management.

Lower respiratory tract infections (LRTIs) progress swiftly and require timely, accurate pathogen detection to enhance patient outcomes. This study aims to utilize the targeted metagenomic next-generation sequencing (tNGS) technology as a novel approach to investigate the types of pathogens involved in infections following different structural lung diseases.

This retrospective cohort study enrolled 329 patients with suspected LRTIs admitted to three medical centers from June 2023 and June 2024. The study analyzed the pathogenic spectrum of lung infections and compared the diagnostic outcomes of tNGS with those of conventional microbiological techniques (CMTs).

tNGS demonstrated significantly higher sensitivity (97.8% vs. 28.9%, p<0.05) and accuracy (96.6% vs. 30.3%, p<0.05) than CMTs, along with a high concordance rate (87.8%) with clinically confirmed pathogens. Pathogen profiling revealed that Mycoplasma pneumoniae (21.88%), Aspergillus fumigatus (5.17%), and influenza A virus subtype H3N2 (13.07%) were the predominant bacterial, fungal, and viral pathogens, respectively. Several key pathogens, including Pseudomonas aeruginosa, Haemophilus influenzae, Nocardia abscessus, Aspergillus fumigatus, Influenza A virus H3N2, and Influenza B virus, were detected more frequently in the SLD group than in the non-SLD group. Among 193 patients whose treatment was adjusted based on tNGS results, 35.2% initiated new treatment regimens, 25.4% continued their original treatment, and 7.3% required treatment escalation, with 90.2% of these patients showing clinical improvement.

These findings showed that tNGS demonstrates significant promise for the etiological diagnosis and tailored management of LRTIs.

Western studies have reported associations between facial wrinkling and chronic obstructive pulmonary disease (COPD), suggesting a shared susceptibility to tissue aging. However, data on Asian populations are limited, and population-specific differences in skin biology may modify these relationships.

To investigate the association between facial wrinkle severity and COPD characteristics in Thai patients and to identify independent predictors of wrinkle severity.

This cross-sectional study enrolled 93 Thai patients with COPD. Facial wrinkles were assessed using the Daniell grading scale (a validated six-point subjective clinical grading system) and the Antera 3D imaging system (an objective three-dimensional topographic imaging device). Multivariable linear and logistic regression analyses were performed to identify independent predictors of wrinkle severity after adjustment for age, sex, body mass index (BMI), cumulative smoking exposure, occupational sun exposure, and post-bronchodilator FEV₁ % predicted.

Mean age was 72.6±8.8 years (90.3% male). Severe facial wrinkling, defined as a Daniell score ≥4, was present in 41.9% of the patients. The Daniell grading scale and Antera 3D measurements showed a moderate-to-strong correlation (Spearman's ρ=0.68, p<0.001). In multivariable analyses, age was consistently associated with both objective wrinkle depth (β=0.08; 95% CI: 0.01-0.24; p=0.042) and severe wrinkling (OR=1.15; 95% CI: 1.06-1.23; p<0.001). Higher body mass index was inversely associated with objective wrinkle severity (β=-0.34; 95% CI: -0.65 to -0.03; p=0.031) but not with severe Daniell-grade wrinkling. COPD-related characteristics, including FEV₁ % predicted, cumulative smoking exposure, and smoking-related COPD status, showed no significant associations with wrinkle severity after adjustment.

Among Thai patients with spirometry-confirmed COPD, no significant association was detected between facial wrinkle severity and the COPD-related characteristics assessed. Age was the most consistent independent predictor of wrinkle severity, while higher BMI showed an inverse association with objective wrinkle measurements only. These findings differ from those reported in Western populations and support population-specific validation before applying facial wrinkling as a cutaneous marker of COPD-related disease burden.

Social distancing and reduced physical activity during the COVID-19 pandemic may have adversely affected children's physical fitness and visual health. This study compared physical fitness indicators and the prevalence of suspected myopia among Chinese children aged 6-11 years in 2019 (pre-pandemic) and 2020 (during the pandemic) using cross-sectional school screening data.

Data were collected in 2019 (N = 1,183) and 2020 (N = 1,120), and analyzes complete cases for each outcome (maximum n = 1,069 and n = 1,116, respectively). Physical fitness outcomes included body mass index (BMI), flexibility, and athletic performance. Visual acuity (unaided distance) was used to define suspected myopia as visual acuity < 5.0 (Chinese standard logarithmic chart) in either eye. Year differences were evaluated using regression models adjusted for age and sex with class-level cluster-robust standard errors. Prevalence ratios for suspected myopia were estimated using modified Poisson regression, and multiple tests were controlled using the Benjamini-Hochberg false discovery rate.

During the pandemic period, BMI increased among children aged 6-8 years. Flexibility declined among 6-year-olds and girls aged 7 years. Rope-jumping performance improved in most age groups, except for boys aged 6 and 10 years, while no statistically significant changes were observed in 50 m sprint performance across age groups. The prevalence of suspected myopia increased significantly in 2020 compared with 2019, with age- and sex-specific differences, including higher risks among girls aged 7 and 11 years and boys aged 10 years.

These findings highlight the need for targeted interventions-particularly for younger children-to mitigate the potential impacts of the pandemic on weight management, physical fitness, and visual health, considering age- and sex-specific differences.

China remains a high tuberculosis (TB) burden country, and large urban centers such as Shanghai continue to face persistent transmission challenges driven by high population mobility. Whole-genome sequencing (WGS) provides high-resolution discrimination between recent transmission and reactivation; however, evidence at the district level remains limited. This study aimed to integrate WGS with epidemiological data to characterize local TB transmission dynamics in Xuhui District, Shanghai, and to identify demographic risk factors for recent transmission.

A retrospective study was conducted among culture-positive pulmonary TB cases diagnosed between August 2021 and February 2025. WGS was performed for all available Mycobacterium tuberculosis isolates, and genomic clusters were defined using a threshold of ≤12 single-nucleotide polymorphisms. Epidemiological links were assessed through routine field investigations. Multivariable Firth penalized logistic regression and population attributable fraction (PAF) analyses were used to identify demographic predictors of recent transmission.

Among 170 genotyped patients, the Beijing lineage predominated (90.0%, 153/170). Fluoroquinolone resistance mutations were detected in 12.4% of strains. Demographic disparities in sex and age were observed between local and migrant residents (both p < 0.05). Six genomic clusters involving 17 patients (10.0%) were identified, and 50% of clusters contained at least one student case. Field investigations revealed close spatial proximity among clustered cases, including one pair residing within 50 meters. Multivariate analysis identified younger age as an independent correlate of genomic clustering. Compared with patients aged ≥45 years, the adjusted odds ratios for clustering were 42.75 (95% CI: 5.79-315.50) for those aged 15-24 years and 18.06 (95% CI: 3.76-86.73) for those aged 25-44 years (both p < 0.001). Notably, the joint PAF for individuals aged 15-44 years was 88.69%, with the 25-44-year age group accounting for the largest share of clustered cases (52.9%).

Recent TB transmission in Xuhui District was predominantly driven by younger and middle-aged populations. Although students represent a high-risk subgroup, the broader working-age population contributed most to the overall transmission burden. These findings highlight the importance of integrating school-based interventions with community-level strategies targeting the active workforce in order to effectively interrupt transmission.

Organizational health literacy (OHL) remains a critical yet underexplored dimension of health equity, particularly at the interface between clinical training and patient care. This article proposes a conceptual reframing of the Mini-Clinical Evaluation Exercise (Mini-CEX) as an OHL-oriented formative assessment tool within case-based learning for pediatric pneumonia. The OHL-Mini-CEX model integrates three assessment domains-teach-back evaluation, de-jargonization capacity, and empowering guidance-to systematically evaluate residents' communicative competence in addressing health literacy barriers. We delineate the mechanisms through which this instrument operates: embedding equity-conflict scenarios into teaching cases, generating bidirectional formative feedback for both clinicians and organizations, and constructing a closed loop from micro-level training to macro-level health equity outcomes. Implementation challenges, including faculty preparedness gaps and psychometric rigor, are examined alongside integrated strategies drawing on public health collaboration. This perspective advances a theoretically grounded and practically actionable pathway for transforming clinical education into an institutional driver of health equity.

Vaccine hesitancy among healthcare workers (HCWs) affects pandemic preparedness and public trust. This study used the theoretical domains framework to examine COVID-19 vaccination uptake, attitudes, and information sources among staff at Singapore's National Center for Infectious Diseases (NCID).

A cross-sectional anonymous electronic survey was distributed to all 695 NCID employees between July and October 2022. Participation was voluntary, and 207 staff who agreed to participate completed and submitted the survey. The questionnaire captured demographics, vaccination history and timing, intentions for future boosters, information sources, and determinants mapped to domains such as knowledge, beliefs about consequences, social role, intentions, social influences, and sentiments.

Of 695 staff, 207 responded (29.8%); 99.5% of the respondents had received at least one COVID-19 vaccine dose and 84.5% reported yearly influenza vaccination. Government or official sources, local news, hospital teaching, and scientific journals were key information sources. Overall, 22.7% reported reservations about COVID-19 vaccines, mainly concerning short- and long-term side effects, perceived low efficacy, and underlying medical conditions.

COVID-19 vaccine uptake among responding HCWs was high, but nearly one-quarter still reported reservations, mainly related to side effects, perceived efficacy, and pre-existing medical conditions. Trusted institutional and official information sources, together with workplace education, appear to support vaccine confidence. These findings suggest that future vaccination strategies for HCWs should prioritize clear risk communication, trusted education channels, and approaches that support sustained voluntary booster acceptance.

Seasonal variation influences the transmission dynamics of communicable diseases, yet limited evidence describes these patterns in the Eastern Province of Saudi Arabia. This retrospective study analyzed surveillance data from Johns Hopkins Aramco Healthcare (JHAH) over 6 years (2019-2024) to describe temporal and monthly patterns in nine common notifiable communicable diseases (influenza, salmonellosis, respiratory syncytial virus [RSV], chlamydia, campylobacteriosis, varicella [chickenpox], gonorrhea, scabies, and animal bites) and to describe the epidemic patterns of COVID-19 (analyzed separately from March 2020 to December 2024). The cases were organized by weekly epidemiological data and visualized through monthly line plots, illustrating temporal patterns. Descriptive statistics were used to determine annual totals, peak years and months, and case fatality rates for COVID-19. Results indicated 2,518 cases of nine notifiable diseases, predominantly influenza (686 cases), followed by salmonellosis (592), RSV (293), chlamydia (250), and campylobacter (240). Temporal trends suggestive of seasonal variations were noted, with influenza, RSV, campylobacter, and scabies peaking in winter, while salmonellosis and chickenpox peaked in October. The incidence of chlamydia, gonorrhea, and animal bites was highest in late spring and early summer. From March 2020 to December 2024, there were 36,280 COVID-19 cases and 718 deaths, with three epidemic waves and a decline in monthly cases post-2023. This exploratory study underscores the potential association of climatic and behavioral factors with disease transmission and provides preliminary observations to support public health strategies, including vaccination timing, surveillance, and further research into predictive modeling.