Seventeen pediatric encephalitis (n = 12) or stroke (n = 5) cases clustered temporally during the 2023-2024 Mycoplasma pneumoniae epidemic in South Korea; similar patterns had not been noted in previous seasons. Those findings might reflect postpandemic changes in clinical manifestation and underscore the need for neurologic surveillance during M. pneumoniae epidemics.

Lung transplantation (LTx) is a life-saving intervention for pediatric patients with end-stage lung diseases. Understanding its impact on renal function is essential for improving patient management and achieving the primary goals of LTx: enhancing respiratory function, quality of life, and survival. This study analyzes the effect of LTx on renal function in pediatric patients.

This retrospective study assessed renal function in 49 children (age range: 1-204 months; median 144 months, IQR 72 months; 26 females, 23 males) who underwent LTx. Renal function was evaluated quantitatively (using glomerular filtration rate, GFR) and qualitatively (using renal scans) before and after LTx. The lowest post-LTx GFR (post-LTx LGFR) was the assessment endpoint. GFR decline was analyzed as a percentage reduction from pre- to post-LTx LGFR. The impact of age, sex, primary lung disease, and nephrotoxic medications on GFR decline was also examined.

The mean pre-LTx GFR was 151.5 mL/min/1.73 m², while the mean post-LTx GFR was 81.24 mL/min/1.73 m². A decrease in GFR of more than 25% was observed in 72.09% of patients, with 40.48% experiencing a reduction of more than 50%. The prevalence of impaired renal function (GFR < 90 mL/min/1.73 m²) increased from 11.63% pre-LTx to 65.31% post-LTx. Nephrotoxic agents (p = 0.006) and infections (p = 0.001) were significant risk factors.

Lung transplantation significantly reduces renal function in pediatric patients. Frequent renal assessments are recommended for early detection and management of renal impairment, focusing on mitigating nephrotoxic medication and infection risks.

Acute respiratory distress syndrome (ARDS) is a heterogeneous clinical syndrome with high morbidity and mortality. Despite advances in understanding its pathophysiology, definitive biomarkers for ARDS disease stratification and management remain lacking. This study evaluated the utility of circulating PRDX1 in predicting 28-day mortality in ARDS patients.

A retrospective cohort study was conducted at Third Xiangya Hospital, enrolling 90 ARDS patients. Serum PRDX1 levels and clinical data were collected and compared with those from healthy volunteers and non-ARDS pneumonia patients to examine its alterations in ARDS patients; multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were then employed to assess the prognostic value of circulating PRDX1 for 28-day mortality. An independent validation cohort of 20 ARDS patients was recruited from Xiangya Hospital intensive care units. Additionally, serum Prdx1 dynamics were assessed in LPS-induced acute lung injury (ALI) and sepsis-associated ALI murine models.

Serum PRDX1 levels were significantly elevated in a cohort of 90 ARDS patients, particularly among those with multiorgan injury. Multivariate analysis identified PRDX1 and age as independent risk factors for 28-day mortality. ROC curves revealed PRDX1's prognostic utility (area under the curve, AUC=0.776, p<0.0001), which was comparable to the APACHE II score (AUC=0.778, p<0.0001). These findings were validated in the 20-patient cohort. Animal experiments confirmed that serum PRDX1 positively correlated with lung injury severity and exhibited earlier elevation and higher abundance in multiorgan injury contexts.

Serum PRDX1 was significantly elevated in ARDS patients, particularly in those with multiorgan injury, and demonstrated potential as a prognostic biomarker, showing correlation with 28-day mortality. Its integration into the ARDS management framework holds significant potential for improving clinical outcomes.

The early COVID-19 period, with stay-at-home orders, was particularly stressful for parents. Outdoor recreation areas (ORAs), such as green spaces, may have helped alleviate stress.

To estimate the association between ORA visits and self-reported stress using geographical ecological momentary assessment (gEMA) with refined multi-sourced ORA boundaries.

Self-reported stress was collected from a cohort of 286 participants via EMA three times daily over 14 days, alongside continuous GPS tracking. ORA visit durations were derived by spatio-temporal clustering of GPS tracks. Generalized ordinal logistic regression model supporting partial proportional odds was used to estimate the association between ORA visit duration stress, adjusting for baseline covariates and weather.

A minute-wise increase in ORA visit duration was not significantly associated with stress (Odds Ratio=0.99; 95% CI: 0.99 to 1.00). However, when the duration was categorized, ORA visits lasting between 15 and 35 min were associated with a 40% reduction in the odds of reporting higher stress (95% CI: 10% to 60%). A similar association was observed for shorter ORA visits (≤ 5 min), though the effect varied across stress levels. The odds of reporting higher stress were also associated with whether the parent was with their focal child, parental sex, marital status, work status, the time of day, and weekday/weekend.

Spending 15-35 min in ORAs may be optimal for parents to manage stress during challenging periods, such as the stay-at-home phase of the COVID-19 pandemic. Even brief ORA visits (< 5 min) may help parents experiencing high stress.

Weekly county-level COVID-19 mortality and emergency department (ED) visits data are critical data sources for understanding COVID-19 trends, but subject to reporting delays, sampling variability, potential instability and concerns due to statistical reliability as well as data suppression due to small numbers and the need to protect personally identifiable information. Such suppression limits meaningful examination of county-level variation in COVID-19 mortality rates and ED visits.

In this study, we use Bayesian inference on latent Gaussian models in the software R-INLA (Integrated Nested Laplace Approximation) to generate reliable weekly estimates of COVID-19 ED visits and mortality rates at the county level in order to examine spatiotemporal variation.

The results demonstrate that weekly county-level COVID-19 mortality rates and ED visits can be accurately modeled using the INLA method. Model-based estimates reflect marked geographic variability for the years 2020-2025.

Effective public health interventions rely on access to timely and detailed spatiotemporal data. Granular estimates that are subject to less reporting noise, such as those produced via INLA modeling, can be used to guide surveillance, improve response strategies, enhance preparedness, and inform public health policy.

Spatial and sociodemographic disparities in COVID-19 cases have been well documented in the literature although the specific pathways through which the virus spread across territories have received comparatively less attention. Yet, understanding these pathways can offer valuable insights into the progression of the pandemic and the spatial dynamics shaping COVID-19 transmission. In this study, we used a trend-surface analysis to retrospectively examine how COVID-19 diffused across Québec, Canada, drawing on provincial-wide surveillance data from 2020 to 2022. Our work shows how COVID-19 tended to spread outwards from urban centers and that its speed of spread increased substantially over time, from 6.1 km per day during Wave 1 to 24.7 km per day by Wave 7. By characterizing the spatial pathways and velocity of spread of COVID-19 in Québec, this work provides information that could support public health authorities in preparing for future pandemics and strengthening geographically informed surveillance systems.

The nose and mouth are the primary entry points for upper respiratory severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection; however, the influence of different entry routes on viral spread remains unclear. Oral and nasal infection routes in terms of viral distribution and presence of inflammation were compared.

Syrian hamsters were inoculated with SARS-CoV-2 via three routes: nasal inoculation (NI), simulating conventional upper respiratory infection; lingual (supra-lingual) inoculation (LI), simulating exposure during speaking and eating; and sublingual inoculation (SI), simulating exposure to the salivary glands. After three days, the lungs, submandibular glands, nasal turbinates, liver, and brain were examined histologically and immunohistochemically. To assess direct access to the lungs, India ink was administered via each route and analyzed after tissue clearing.

NI resulted in infection in the nasal olfactory sensory epithelium of the nasal cavity and in the lungs. India ink studies suggest that the virus is likely to have infected the nasal mucosa first, followed by secondary infection of the lungs. LI resulted in marked infection of the submandibular glands with vascular involvement. In the LI and SI groups, no viral antigen was detected in the lungs; however, there was inflammation of the lungs, suggesting cytokine-mediated effects.

Different upper respiratory entry routes produced distinct pathological patterns. While nasal infection is well recognized, our findings indicate that salivary gland infection via SI may suggest an alternative pathway for systemic viral dissemination.

To explore the current context in which maternal influenza vaccination (MIV) is delivered in Kuwait and to identify determinants influencing its provision and uptake from the perspectives of preventive medicine professionals (PMPs), including policymakers.

Qualitative semistructured interviews were conducted with purposely selected PMPs including policymakers. Interview questions were obtained from the Tailoring Immunization Programme for improving MIV in Europe.

PMPs from six governmental regions of Kuwait, including hospitals and associated polyclinics. Data collection was conducted between March and June 2022.

A total of 10 participants reflected diverse professional and population contexts, including Kuwaiti and non-Kuwaiti professionals working in rural and urban settings. Cell sampling was used to ensure representation across key roles involved in MIV delivery, including policymakers, vaccination campaign managers and campaign implementers.

Thematic analysis identified four overarching themes: barriers, facilitators, influences on MIV uptake and suggested interventions. Key barriers included limited knowledge among pregnant women and healthcare providers (HCPs), lack of prioritisation of pregnant women within vaccination programmes, shortage of vaccine supply and the COVID-19 pandemic. Facilitators and influential factors included the presence of vaccination champions, targeted health promotion activities and the availability of a Ministry of Health (MoH) hotline for addressing concerns and system-level accessibility and digital facilitation of MIV uptake. Suggested interventions emphasised strengthening HCP education through continuous training aligned with clear national policies and guidelines.

This study highlights the need for clear national policies and clinical guidelines to support consistent MIV provision, alongside ongoing education for HCPs in Kuwait to strengthen MIV recommendation. Future research should include obstetricians, given their central role in antenatal care, to ensure MIV strategies are clinically grounded and integrated into routine maternity services.

Fibrosing interstitial lung disease (F-ILD) are a heterogeneous group of diseases with multiple subtypes. Both idiopathic pulmonary fibrosis and other ILDs associated with a risk of developing progressive pulmonary fibrosis (PPF) are subtypes of this category. A multidisciplinary team discussion, including a chest high-resolution CT (HRCT), is usually considered the gold standard for diagnosis of F-ILD. Repeated HRCT is one of several established methods to assess progression and thus development of PPF, but it is associated with substantial costs and radiation exposure. Thoracic ultrasound (TUS) and other ultrasound (US) methods have emerged as radiation-free methods for both diagnosing and monitoring disease severity in F-ILD. Yet, consistent knowledge on the use of different TUS- and US methods in patients with F-ILD is limited.

The LORD study is a prospective cohort study conducted in participants with F-ILD at a tertiary ILD centre in Denmark. Physiological testing and patient-related outcome measures, together with TUS- and US examinations, will be performed at inclusion, after 6 and 12 months. The correlations between these assessments will be evaluated. HRCT will be conducted between 3 months prior to and 1 month after baseline, and after 1 year. At least 34 participants will be included.

The protocol was approved by the Danish Data Protection Agency (journal number: 22/45135) and the Science Ethics Committee for the Region of Southern Denmark (journal number: S-20220036). Results will be published in peer-reviewed international journals and will be presented at an international congress.

NCT06844331.

Pulmonary embolism (PE) is the third most common cause of cardiovascular death worldwide, with a suspected high number of unreported cases. If left untreated, the mortality rate ranges from 25-30%. With treatment, it decreases to approximately 8% after one year.In addition to the acute thromboembolic event PE can have far-reaching long-term health and personal consequences for the patient including limitations in physical performance, psychosocial effects and significant impairments in health-related quality of life. There is also a significant risk of an embolism recurrence. Furthermore, chronic thromboembolic pulmonary hypertension (CTEPH) or post-pulmonary embolism syndrome (PPS) can develop.The goals of a long-term follow-up strategy - including cardiac rehabilitation (CR) - are to prevent recurrences, achieve sustained improvements in physical performance, and reduce dyspnea in patients with limitations often caused by general muscular deconditioning. Another key objective is to sustainably improve quality of life, with impacts on personal, family, and professional environment.Although PE is common, structured follow-up and rehabilitation programs are largely lacking. In contrast to other cardiovascular conditions, such as myocardial infarction, post-PE care is typically limited to a few follow-up appointments. A stronger scientific evidence base, clearly defined care pathways, and interdisciplinary CR are needed.This article presents the current state of research on CR after a PE event and highlights the specific characteristics and considerations relevant to this setting.