Although short-term CAT score variability has been associated with COPD exacerbations, evidence supporting its integration into virtual assistant-based monitoring remains limited. The aim of this study was to assess the short-term variability in CAT scores using a virtual management tool in patients with COPD and to examine its relationship with the prediction of exacerbations. A prospective observational single-center study was conducted in patients aged >35 with COPD and an exacerbator phenotype (≥2 outpatient exacerbations or ≥1 hospitalization in the previous year). Follow-up was performed weekly, including the CAT questionnaire, through calls were conducted by the virtual assistant Tucuvi Health Manager^® during a period of one year. A total of 106 patients were included; 64.2% were male, with a mean (SD) age of 66.8 (7.9) years and a median FEV₁(%) of 38.8 (30.1-45.0). The mean follow-up was 25 weeks [IQR 20-35], during which 73 (69%) patients experienced ≥1 exacerbation, accounting for 192 episodes (26% of which required hospitalization). A total of 2550 CAT scores were collected. The mean baseline CAT score was 17.9 (7.6), and scores increased significantly during exacerbations compared with non-exacerbation periods and according to exacerbation severity. Each one-point increase in absolute CAT score was associated with an 11.1% increase in the odds of exacerbation (OR: 1.11; 95% CI: 1.08-1.13), while a weekly variation of ≥2 points (MCID) was associated with more than sixfold higher odds (OR: 6.30; 95% CI: 4.28-9.27). The optimal cut-off for CAT change in the prediction of exacerbation risk was 3 points with a ROC curve of 0.773. Weekly deterioration in CAT scores was associated with increased exacerbation risk in patients with COPD. Short-term increases in CAT may serve as clinically useful warning signals for exacerbation.

Background: The asthma-COPD overlap is widely recognized, but its characteristics are not fully understood. This is largely true for the clinical presentation characterized by various ACO definitions. The purpose of this study was to investigate the pattern of comorbidities among patients with ACO, defined by various criteria. Methods: The data came from the multicenter cross-sectional study conducted in a mixed population of patients with asthma and COPD. Patients were classified into five groups according to five different definitions of ACO (GINA/GOLD/30%, Spanish criteria, COPD + asthma < 40, Gibson's criteria, clinician's diagnosis), reference ACO groups, and a group of patients with obstructive pulmonary diseases who were not diagnosed with ACO. To demonstrate the differences between groups, we compared the prevalence of comorbidities between all ACO and non-ACO groups. Data on age, severity of airflow obstruction, and smoking history were recorded for all patients. Results: For the final analysis, 1609 patients were included. Patients belonging to the ACO groups had a higher burden of comorbidities, poorer lung function, and a higher number of pack-years of smoking history compared to patients without an ACO diagnosis. Comorbidities were significantly more prevalent in ACO groups. Compared to the non-ACO group, nine diseases were more common in the GINA/GOLD/30% group, seven in both the COPD + asthma < 40 group and the clinician's diagnosis group, five in the Gibson's criteria group, and two in the Spanish criteria group. The most common comorbidities in the ACO groups were hypertension, coronary artery disease, GERD, musculoskeletal disorders, diabetes, and chronic sinusitis. Chronic sinusitis was more frequent in ACO groups defined by more precise asthma criteria. Conclusions: The definitions of ACO used in clinical practice vary widely and describe different populations. ACO populations vary in terms of comorbidities, lung function, smoking history, and age. Chronic sinusitis is a comorbidity that occurs more frequently in ACO groups defined by more precise asthma criteria. Patients with ACO differ in their clinical outcomes from those with other obstructive airway diseases.

Uganda hosts one of Africa's largest refugee populations, yet displaced and migrant communities face persistent barriers to routine immunisation. Despite commitments to vaccine equity, many remain unprotected against preventable diseases. This narrative review synthesises evidence from peer-reviewed studies, national surveys, and institutional reports up to September 2025 to assess immunisation coverage, challenges, and potential solutions among refugees and migrants in Uganda. The findings indicate that vaccination rates in refugee communities are generally lower than national averages due to administrative barriers, vaccine shortages, long distances to health facilities, language difficulties, misinformation, and challenges intensified during the COVID-19 pandemic. Economic hardship further limits healthcare access. However, several strategies show promise: integrating refugees into national immunisation systems, simplifying registration processes, strengthening mobile outreach, engaging community health workers, and improving cross-border data coordination. Addressing these inequities requires both technical and social commitment through adequate financing, inclusive policies, and meaningful community engagement. Achieving equitable immunisation for refugees in Uganda is essential for public health protection and the realisation of universal health coverage.

Coagulopathy in the context of COVID-19 is a major threat due to deep vein thromboses and pulmonary embolisms.

To assess whether therapeutic anticoagulation on top of standard of care (SOC) compared with prophylactic anticoagulation as part of SOC can improve objective patient-relevant end points.

This prospective, assessor-blinded, multicenter, parallel-group (1:1), placebo-controlled, superiority randomized clinical trial (HERO-19) assessed patients with a confirmed diagnosis of COVID-19 who were hospitalized in an intensive care unit or non-intensive care ward at 1 of 10 university hospitals in Germany from November 12, 2020, to January 15, 2023. Data analysis was conducted after the final database lock in February 2024.

Patients were treated for 42 days. Patients enrolled in the experimental group received therapeutic anticoagulation using low-molecular-weight heparin (LMWH) body weight adapted during the hospital stay and oral anticoagulation using edoxaban, 60 mg daily, after being discharged from the hospital. Patients enrolled in the control group received prophylactic anticoagulation using LMWH as part of SOC while in the hospital and placebo after discharge.

The primary end point was time to the first occurrence of all-cause mortality and/or venous thromboembolism and/or arterial thromboembolism within up to 42 days. Potential thromboembolic events were assessed by duplex ultrasonography of arms and legs at day 14 or discharge and day 42. The primary safety outcome was major and clinically relevant nonmajor bleeding according to International Society on Thrombosis and Haemostasis classification.

A total of 139 patients (mean [SD] age, 58.4 [13.7] years; 93 [67%] male and 46 [33%] female) were included in the study. Of these, 71 patients (51%) were randomized to prophylactic anticoagulation group, whereas 68 (49%) were randomized to the therapeutic anticoagulation group. The primary outcome occurred in 14 of 67 patients (21%; 2.31 incidence per patient-year) assigned to therapeutic anticoagulation and 20 of 70 (29%; 3.37 incidence per patient-year) assigned to prophylactic anticoagulation (primary end point assessment not available for 2 patients) with primary end point assessment (hazard ratio, 0.74; 95% CI, 0.38-1.48; P = .40). In the per-protocol analysis, the hazard ratio was 0.66 (95% CI, 0.32-1.37; P = .26). A total of 7 bleeding events occurred in the intervention group, whereas 6 bleeding events occurred in the control group.

In patients hospitalized with COVID-19, in-hospital therapeutic anticoagulation with LMWH followed by edoxaban to day 42 did not statistically significantly reduce death and/or thromboembolic events compared with prophylactic anticoagulation followed by placebo.

ClinicalTrials.gov Identifier: NCT04542408.

This study aims to evaluate associations between PCA-derived cardiovascular components and respiratory burden during high-frequency oscillatory ventilation with volume guarantee (HFOV-VG). This retrospective cohort study included infants born before 30 weeks of gestation who received HFOV-VG and underwent targeted neonatal echocardiography during respiratory support. Echocardiography assessed ventricular systolic function, cardiac output, myocardial deformation, and pulmonary vascular loading. Principal component analysis (PCA) derived integrated cardiovascular components. Multivariate regression models evaluated associations with respiratory support, haemodynamic support, and clinical outcomes, including mortality, moderate-to-severe bronchopulmonary dysplasia (BPD), and the composite outcome of death or moderate-to-severe BPD. Sixty-two infants were included (gestational age 26.0 [25.0-27.0] weeks; birth weight 860 [700-1000] g). Median FiO₂ during HFOV-VG was 0.35 (0.31-0.52). Right ventricular strain demonstrated the strongest association with FiO₂ (rho = 0.53, q < 0.001). The first principal component (PC1), representing a cardiopulmonary loading component characterised by less favourable ventricular performance, reduced cardiac output, altered myocardial deformation, and increased septal loading, explained 65.9% of echocardiographic variance. Each one standard deviation increase in PC1 was associated with a 0.60 standard deviation increase in FiO₂ (95% CI 0.38-0.82; p < 0.001). Higher PC1 was independently associated with mortality (OR 3.01, 95% CI 1.44-6.29; p = 0.004), higher peak vasoactive-inotropic score, longer inotropic support, increased odds of inotrope use, and lower odds of haemodynamically significant patent ductus arteriosus (all p < 0.05).

In preterm infants receiving HFOV-VG, the first cardiovascular principal component was independently associated with oxygenation burden, haemodynamic support requirements, and mortality. PCA-derived cardiovascular assessment may complement conventional respiratory assessment during HFOV-VG.

• Oxygenation during high-frequency oscillatory ventilation is influenced by both respiratory and cardiovascular factors. • Targeted neonatal echocardioghraphy can assess multiple aspects of cardiovascular function, but most studies have evaluated individual haemodynamic variables rather than integrated cardiovascular profiles.

• Exploratory principal component analysis identified a cardiovascular component independently associated with oxygen requirements during HFOV-VG. • The first principal component  was independently associated with oxygenation burden, haemodynamic support requirements, and mortality, supporting an integrated cardiorespiratory approach to physiological assessment during HFOV-VG.

BackgroundPulmonary fibrosis (PF) is associated with substantial symptom burden, complex diagnostic pathways and varied access to specialist services. It is important to understand patient and carer experiences to highlight disparities and inform improvements in care.ObjectivesTo explore reported insights from patients and carers regarding PF symptomology, initial healthcare experiences, access to support services, and whether experiences differ by sex and PF subtype.DesignA cross-sectional analysis of the 2025 PF State of the Nation Survey, conducted by Action for Pulmonary Fibrosis.MethodsUsing the survey results which included information from 1,270 individuals (73.78% patients) with lived experience of PF. Differences in symptoms, diagnostic pathways and patient experience were examined using Chi-squared and Fishers exact tests.ResultsRespondents with idiopathic pulmonary fibrosis (IPF) were more likely to be male, whilst female dominance was observed in those reporting diagnosis of non-IPF-PF. Males were diagnosed at an older age than females, were referred to respiratory services more quickly, and had fewer primary care appointments prior to referral. More than 90% of the cohort reported symptoms prior to diagnosis, but symptomology differed by PF subtype; breathlessness was more commonly reported by those with hypersensitivity pneumonitis (p=0.004) and cough was more commonly reported by people with sarcoidosis (p=0.025). Almost one quarter (24.93%) of people reported symptoms to a physician only after experiencing them for at least one year. Treatment burden was high, antifibrotic side effects were common and differences with respect to age and sex were observed.ConclusionsImportant differences in symptom burden, diagnostic experiences and access to support exist across PF subtypes and between sexes. These findings highlight potential weaknesses in current diagnostic pathways, as well as unmet needs related to referral delays, treatment side effects and support services. Enhancing patient-centred care and targeted service provision may help to reduce inequalities and improve outcomes.

Healthcare workers (HCWs) play a key role in recommending influenza vaccination. Few studies have examined HCWs' influenza vaccination and recommendation behavior in China.

A cross-sectional survey was conducted among HCWs in primary health centers, secondary and tertiary hospitals, and schools in Guangzhou, China, in January 2026.

Among 3,153 HCWs, 46.2% reported vaccination in at least one of latest four influenza seasons. Average seasonal uptake was 28.2%. Uptake varied by occupation, with higher uptake among public health practitioners (OR = 2.53, p < 0.001) and lower among school healthcare providers (OR = 0.64, p < 0.001), compared with physicians. Knowledge of influenza was negatively associated with vaccination (OR = 0.90, p < 0.001), whereas knowledge of influenza vaccines was positively associated with vaccination (OR = 1.09, p < 0.001) and recommendation behavior (OR = 1.11, p < 0.001). Personal vaccination was positively associated with recommendation behavior (OR = 3.12, p < 0.001). Exploratory generalized path analysis showed knowledge of influenza vaccines was positively associated with recommendation behavior (β = 0.131), mainly through recommendation attitude and personal vaccination, whereas opposite indirect pathways for knowledge of influenza resulted in no significant association.

Influenza vaccine uptake remained insufficient among HCWs. Different knowledge domains showed diverse association with vaccination and recommendation behavior. Vaccine-specific knowledge and risk-benefit perceptions were more consistently associated with HCWs' vaccination and recommendation practices.

Donation after brain death (DBD) has declined in Spain despite sustained transplantation activity and marked growth in donation after circulatory death (DCD). We examined whether this transition was driven by controlled or uncontrolled DCD and contextualized it alongside national trends in neurocritical care and organ utilization.

We conducted a descriptive ecological analysis of aggregated national data from the Spanish National Transplant Organization, healthcare registries, and epidemiological sources for 2015-2024. Annual DBD, controlled DCD (cDCD), uncontrolled DCD (uDCD), donation-potential indicators, mechanical thrombectomy, decompressive craniectomy, and organ recovery and utilization were examined.

Actual DBD decreased from 1537 (33.0 per million population [pmp]) to 1246 donors (25.6 pmp). cDCD increased from 211 (4.5 pmp) to 1294 donors (26.6 pmp), whereas uDCD decreased from 103 (2.2 pmp) to 22 donors (0.5 pmp); thus, cDCD accounted for 98.3% of DCD activity in 2024. Donation-potential indicators fell during the COVID-19 pandemic and partially recovered thereafter. Mechanical thrombectomy increased from 2160 to 8762 procedures and decompressive craniectomy from 456 to 729. In 2024, DBD donors generated more recovered and implanted organs per donor than Maastricht category III cDCD donors (3.6 vs. 3.1 and 2.8 vs. 2.3, respectively).

Spain's DCD expansion was almost entirely driven by controlled donation, while uDCD declined. These findings demonstrate a reconfiguration of deceased-donation pathways but do not establish patient-level substitution between DBD and cDCD. Linked individual-level studies are required to determine the contributions of neurocritical care, end-of-life decisions, and perfusion technologies.

Coronavirus disease 2019 (COVID-19) increases the risk of bloodstream infections (BSI), but associated risk factors remain incompletely characterized. We aimed to evaluate BSI risk factors in patients admitted to the intensive care unit for COVID-19.

This nationwide multicenter study, conducted across 22 university-affiliated hospitals in South Korea, included COVID-19 patients treated with high-flow nasal cannula (HFNC) therapy or mechanical ventilation. Baseline characteristics were compared between patients who developed BSI within 30 days and those who did not. Pathogens were analyzed, risk factors were evaluated using multivariable logistic regression, and supplementary Cox proportional hazards analyses were performed to address time-dependent outcomes.

Of 573 included patients, 206 (35.9%) developed at least one BSI episode. Staphylococcus species were the most frequent isolates. Gram-negative bacteria became increasingly prevalent over time, while fungal infections were associated with prolonged hospitalization. Multivariable analysis identified chronic neurological disease, higher baseline Sequential Organ Failure Assessment score, mechanical ventilation, prone positioning, and extracorporeal membrane oxygenation (ECMO) use prior to infection as independent BSI predictors. Notably, although crude in-hospital mortality was significantly higher in the BSI group (41.5% vs. 31.7%, p=0.012), BSI was not an independent predictor of in-hospital mortality in either logistic regression or Cox analyses.

In critically ill patients with COVID-19, high baseline severity, chronic neurological disease, and pre-infection advanced life support (mechanical ventilation and ECMO) were independent predictors of BSI. Rather than acting as an independent cause of death, BSI primarily serves as a clinical marker of extreme illness severity and prolonged invasive interventions.

Despite decades of clinical experience, the physiological rationale for extracorporeal life support (ECLS) in acute respiratory distress syndrome (ARDS) remains incompletely defined. Existing trials have primarily evaluated ECLS as a rescue intervention, with limited attention to the physiological adaptations required to sustain extracorporeal gas exchange. We propose that the maternal-fetal circulation, the only naturally occurring example of prolonged extracorporeal gas exchange, provides a hypothesis-generating physiological analogy. In this paradigm, gas exchange is externalized through a low-resistance, high-flow circuit while systemic physiology reorganizes to unload the native lung. Translating this concept to severe ARDS suggests that ECLS should be viewed not simply as an adjunct to conventional support, but as a transition to an alternative physiological state centered on extracorporeal gas exchange. This perspective may inform physiology-based patient selection, management strategies, and the design of future clinical trials.