With major therapeutic advances driven by cystic fibrosis transmembrane conductance regulator (CFTR) modulators (CFTRm), increasing numbers of women with cystic fibrosis (CF) are living into adulthood and pursuing pregnancy. Women with CF may face pregnancy-related challenges that influence maternal and fetal outcomes. However, long-term data regarding the safety and effectiveness of CFTRm use during pregnancy remain limited.This scoping review aimed to evaluate the existing literature on the effects of CFTRm use in women with CF during pregnancy and the postpartum period, as well as the potential impact on the developing fetus. We analysed clinical studies, registry data and related literature published between 2003 and 2025 to assess reported differences in lung function, birth weight, pregnancy and neonatal complications, mode of delivery and screening biomarkers among pregnancies in women with CF treated with ivacaftor, lumacaftor/ivacaftor, tezacaftor/ivacaftor or elexacaftor/tezacaftor/ivacaftor, compared with pregnancies not exposed to CFTRm.Available evidence suggests that elexacaftor/tezacaftor/ivacaftor may improve maternal health through better lung function and nutritional status, while inadvertent fetal drug exposure has not been clearly associated with serious adverse outcomes. Reported fetal and neonatal outcomes following maternal CFTRm therapy have generally been reassuring. However, long-term effects in exposed children remain uncertain. There is also insufficient evidence to establish the safety of infant exposure or prolonged maternal CFTRm use during lactation. This review highlights the need for future studies evaluating dose optimisation, long-term follow-up of infants and children, and integration of registry data to better define the safety and effectiveness of CFTRm use during pregnancy.

Iron is an essential micronutrient, but its redox reactivity also renders it potentially toxic. The lungs are particularly vulnerable to iron-dependent oxidative injury due to continuous exposure to high oxygen tension, environmental particles, and microbial pathogens. Pulmonary iron homeostasis is therefore tightly regulated at systemic, cellular, and local levels through coordinated actions of transferrin, ferritin, ferroportin, hepcidin, and the iron responsive element/iron regulatory protein system. Disruption of these pathways contributes to a broad spectrum of pulmonary diseases. In COPD, asthma, idiopathic pulmonary fibrosis, pulmonary arterial hypertension, infectious lung diseases, and lung cancer, iron dysregulation promotes oxidative stress, ferroptosis, inflammation, aberrant repair, vascular remodelling, or pathogen persistence. Notably, systemic iron deficiency may coexist with local pulmonary iron overload, highlighting the compartmentalised nature of lung iron metabolism. Emerging experimental and clinical evidence suggests that therapeutic manipulation of iron availability through supplementation, chelation or targeting iron-dependent pathways may be beneficial in selected contexts. A deeper mechanistic understanding and improved biomarkers will be essential for developing disease-specific iron-modulating strategies.

Nocturnal blood pressure (BP) is a major determinant of cardiovascular risk. In obstructive sleep apnoea (OSA), abnormal nocturnal BP patterns, particularly nondipping and nocturnal hypertension, are common and contribute to excess cardiovascular risk. However, this association remains insufficiently integrated into routine clinical practice, as BP assessment still relies largely on office or home measurements and ambulatory BP monitoring is underused. This narrative review summarises current evidence on the physiological regulation of nocturnal BP, the mechanisms by which OSA disrupts nocturnal BP control, the epidemiology and prognostic relevance of abnormal nocturnal BP patterns in OSA, and the effects of available therapies. Continuous positive airway pressure (CPAP) has the strongest evidence base and lowers nocturnal BP modestly on average, with greater effects in patients with uncontrolled or resistant hypertension and with better treatment adherence. By contrast, evidence for non-CPAP therapies, including mandibular advancement devices, supplemental oxygen, hypoglossal nerve stimulation and upper-airway surgery, remains limited and less consistent. In summary, nocturnal BP abnormalities are common, clinically important and frequently overlooked in OSA. Greater use of ambulatory BP monitoring and more precise identification of patients most likely to benefit from targeted treatment may improve cardiovascular risk stratification and management in OSA.

Despite the widespread implementation of lung-protective ventilation, mortality in acute respiratory distress syndrome (ARDS) remains substantial, underscoring the importance of extrapulmonary determinants of outcome. Right ventricular (RV) dysfunction is recognised as a frequent and clinically meaningful complication of ARDS, affecting a sizeable proportion of patients and consistently associated with adverse outcomes. ARDS-related pulmonary vascular injury, including hypoxic pulmonary vasoconstriction, hypercapnia and acidosis, microangiopathy, and an imbalance in vasoconstrictor/vasodilator signalling, reduces the functional pulmonary vascular bed and increases pulmonary vascular resistance, thereby imposing an acute afterload challenge on the thin-walled right ventricle. Mechanical ventilation may further exacerbate RV stress through alveolar overdistension, increased intrathoracic pressure and decreased venous return, promoting RV dilation, RV-pulmonary arterial uncoupling and circulatory collapse in severe cases. In this review, we summarise the pathophysiological basis of RV injury in ARDS and propose a physiology-informed clinical framework integrating RV phenotyping with multimodal monitoring. This includes echocardiography as the bedside cornerstone, selected invasive haemodynamic assessments and emerging noninvasive techniques such as electrical impedance tomography, as well as advanced cardiac imaging modalities and serological biomarkers for complementary assessment. We further discuss key components of RV-protective ventilation, including limitation of tidal volume and airway pressures, haemodynamics and recruitability-guided positive end-expiratory pressure titration, cautious use of permissive hypercapnia, avoidance of excessive mean airway pressure, prone positioning, appropriate application of spontaneous breathing and extracorporeal support to facilitate ultra-protective lung ventilation. Finally, we highlight unresolved clinical questions and emphasise the need for prospective studies incorporating standardised RV phenotypes and RV-centred end-points.

Scientific interest in small airways emerged in the 1960s. However, despite this early recognition, they long remained a "silent" area of the lung. In this nonsystematic narrative mini-review, we evaluated the different spirometry thresholds used to define small airways dysfunction (SAD), comparing them with other diagnostic techniques. We then examined the various factors associated with SAD, focusing on SAD as defined by spirometry.Maximal mid-expiratory flow, especially below the lower limit of normal (LLN), appears to be the most accurate and reproducible spirometric measure to assess SAD. However, no gold-standard spirometric definition has been endorsed by respiratory academic societies, and forced expiratory volume in 3 s or 6 s <LLN or combined forced expiratory flow could be alternative criteria. Impulse oscillometry or computed tomography scanning represent possible alternative assessment methods, with limitations regarding reproducibility.Globally, prevalence of SAD varies between regions. Air pollution appears to be associated with a higher prevalence of SAD, particularly particulate matter with aerodynamic diameter <2.5 µm. Both active and passive smoking are associated with SAD. SAD is also strongly associated with COPD and the risk of developing it, making SAD a marker of accelerated decline in lung function. Several occupational exposures are associated with SAD, including exposure to organic and inorganic dust. A history of lung infections, especially tuberculosis, is also associated with SAD. Advanced age may also be an associated factor, although the association depends on the criteria used to define SAD. Cardiac events have been associated to SAD, which might explain the association between SAD and higher mortality risk.By integrating these different associations in clinical assessment, it would be possible to screen more reliably and preventively for SAD. This would ensure closer surveillance, which is justified given the strong association with COPD.

Continuous positive airway pressure (CPAP) is first-line therapy for respiratory distress in preterm infants, but optimal interface selection remains controversial. Occlusive interfaces (nasal prongs and masks with tight seals) provide accurate pressure delivery but can cause significant nasal trauma, while non-occlusive interfaces (loosely fitting nasal cannulae) reduce trauma but may compromise therapeutic efficacy.

To synthesise current evidence comparing occlusive with non-occlusive CPAP interfaces regarding pressure delivery accuracy, clinical efficacy, safety outcomes and practical implementation in neonatal intensive care.

Comprehensive review of randomised controlled trials, systematic reviews, bench studies and observational studies comparing CPAP interface types in preterm neonates. Evidence quality assessed using the Grading of Recommendations Assessment, Development and Evaluation criteria where applicable.

Occlusive interfaces deliver pressure within 0.5-1.0 cmH₂O of set values and demonstrate superior efficacy in landmark trials (COIN, SUPPORT), particularly in extremely preterm infants (<28 weeks' gestation). However, nasal trauma rates reach 20-60%. Non-occlusive systems reduce trauma dramatically (0-5.4% injury rates) but consistently underdeliver pressure. Non-occlusive systems have failed to meet non-inferiority criteria in recent trials, with CPAP failure rates of 19.7% versus 17.3% for occlusive systems. This increased to failure rates >50% in extremely preterm infants.

Current evidence supports occlusive CPAP as first-line therapy for moderate-to-severe respiratory distress in preterm neonates, particularly those of <32 weeks' gestation. Non-occlusive interfaces may be appropriate for stable infants, weaning support or apnoea of prematurity management. Adequately powered randomised trials stratified by gestational age and respiratory severity are urgently needed to define optimal interface selection strategies.

Pulmonary arterial hypertension (PAH) with features of venous and/or capillary involvement, formerly pulmonary veno-occlusive disease (PVOD), represents a rare and severe subset of pulmonary hypertension. While PVOD is typically idiopathic, heritable or drug/toxin-induced, "PVOD-like" features have long been recognised in PAH associated with connective tissue diseases (CTDs), especially systemic sclerosis (SSc). This review synthesises the available evidence on this phenotype, integrating published data with an unreported cohort of 25 patients. Venular remodelling is a frequent histological finding in SSc-PAH lung explants, but high-resolution computed tomography (HRCT) signs of PVOD are inconsistently observed at PAH presentation, reflecting a progression of the lung vasculopathy and/or an unmasking effect of pulmonary vasodilators. Patients often exhibit major functional limitation, profound impairment in gas transfer and severe haemodynamic compromise. Assessing venular involvement in SSc-PAH poses unique challenges, due to possible lung fibrosis on HRCT and differential diagnosis with an occult post-capillary component. Despite the lack of robust evidence, PAH-approved therapies are commonly used, although with caution due to a high risk of pulmonary oedema with pulmonary vasodilators. As these patients also display significant arteriolar involvement, which can benefit from these drugs, dedicated treatment strategies warrant further investigation. Prognosis remains dismal, with a 5-year survival around 45-50%. Similar PVOD-like patterns have also anecdotally been reported in systemic lupus erythematosus, rheumatoid arthritis, mixed connective tissue disease, Sjögren syndrome and inflammatory myopathies, with comparable features. Overall, PVOD-like disease in CTD-PAH constitutes a high-risk phenotype with unresolved pathogenic and management challenges, requiring refined patient stratification and improved therapeutic strategies.

Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome is the most common cause of recurrent fever in childhood. Although normal growth and development are included in the diagnostic criteria, this assumption has not been systematically evaluated in controlled studies. This study aimed to compare growth patterns and developmental screening outcomes between children with PFAPA and healthy controls.

A total of 138 children were enrolled, including 69 patients diagnosed with PFAPA according to the modified Marshall criteria and 69 age- and sex-matched healthy controls. The PFAPA group consisted of 26 females (37.7%) and 43 males (62.3%), while the control group included 26 females (37.7%) and 43 males (62.3%). The mean age was 52.1 ± 13.86 months in the PFAPA group and 50.28 ± 13.70 months in the control group. Growth was assessed using anthropometric parameters, including height, weight, body mass index (BMI), weight-for-height, and mid-upper arm circumference. The primary outcome was overall growth pattern, assessed by anthropometric measures, with particular attention to BMI. Developmental screening was performed using the Denver II Developmental Screening Test.

Mean anthropometric measures, including height, weight, and BMI, were comparable between patients with PFAPA and controls. However, overweight/obesity was more prevalent in the PFAPA group than in controls (18.8% vs. 5.8%; odds ratio [OR] 3.77, 95% confidence interval [CI] 1.16-12.24, p=0.020). Patients with PFAPA who were overweight/obese had received a higher number of corticosteroid treatments (p=0.046). Developmental screening outcomes did not differ significantly between groups.

In this case-control study, children with PFAPA demonstrated overall growth patterns and developmental screening results similar to those of healthy peers, although a higher prevalence of overweight/obesity was observed. These findings support, but do not definitively establish, the assumption of preserved growth and development in PFAPA and underscore the need for further longitudinal studies.

Post-COVID-19 condition affects approximately 6% of individuals globally. Most evidence is based on hospitalized patients and is from countries with relatively low vaccination coverage. This study estimates the prevalence of symptoms compatible with post-COVID-19 and explores symptom patterns in a population-based sample from Chile, a country with high vaccination coverage. Moreover, it examines their associations with daily activities and demographic, social, and clinical factors.

A cross-sectional study was conducted in May 2024 in two Chilean Cities, involving 654 participants (88.5% response rate) aged ≥ seven years, from randomly selected households. Ten post-COVID-19 symptoms that persisted for ≥ three months were collected. Latent class analysis identified symptom patterns.

Among 277 participants with a confirmed COVID-19 diagnosis, 114 reported at least one symptom lasting ≥ 3 months. Population-weighted prevalence of at least one post-COVID-19 symptom was 17.4% in the general population and 40.7% among individuals with prior COVID-19. Among those with post-COVID-19 symptoms, 40.1% reported a reduction in daily activities. Three classes were explored: class 1 (38.4%) characterized by fatigue, ageusia/anosmia, and muscular/joint pain; class 2 (40.7%) with predominant cardiorespiratory symptoms; and class 3 (20.9%) with multisystemic symptoms. Class three was associated with a higher frequency of comorbidities (particularly diabetes), hospitalization, multiple COVID-19 episodes, and Aboriginal affiliation. Classes 2 and 3 were independently associated with younger age and diabetes, class 2 was additionally associated with lower educational attainment and lower BMI, while class 3 was additionally associated with Aboriginal affiliation.

This population-based study reveals a substantial burden of at least one post-COVID-19 symptom, with distinct symptom classes highlighting the need for tailored interventions. These findings underscore the importance of targeted public health policies and personalized clinical approaches, particularly for severe symptom classes that impact quality of life and contribute critical data from Latin America to the global understanding of post-COVID-19 condition.

Seasonal influenza control faces challenges from variable vaccine effectiveness and uncertain non-pharmaceutical intervention (NPI) performance. While vaccination remains the primary strategy, its effectiveness varies between vaccine-matched and mismatched seasons. Increased post-COVID-19 NPI acceptance enhances influenza control feasibility, yet optimal combination approaches remain poorly understood. We use an agent-based model to analyze influenza transmission across six seasons in Hong Kong (2009-2013) with varying epidemic characteristics. We integrate surveillance, serological, and school absenteeism data for calibration, enabling accurate estimation of reported and unreported infections. We evaluate age-targeted vaccination, staying home when sick, mask use, and school-based interventions across diverse real-world scenarios. Compared to baseline, child vaccination consistently outperforms other strategies, with targeting those under 12 yielding the greatest population-level attack rate reduction (up to 8.5% relative reduction per 100,000 vaccinated). Among NPIs, 40% mask coverage reduces attack rates by 18%-43%, comparable to 25% of symptomatic individuals staying home. During vaccine-mismatched seasons, combining high-coverage mask use and staying home reduces attack rates by 79%-84%. High-coverage school-based vaccination is more effective than closures, reducing student attack rates by up to 85% versus 33% for 14-day closures. Our multi-source calibration approach provides robust evidence for prioritizing child vaccination and strategic NPI combinations.