Energy poverty is a critical global challenge, with profound implications for health, climate, and sustainable development. Energy poverty is generally examined within the framework of indoor air pollution, considering acute respiratory infection (ARI) among young children in low- and lower-middle-income countries (LLMICs) acknowledged as one of its most significant health consequences. The present study employs a multidimensional perspective to comprehensively measure the association between ARI and energy poverty. A sample of 344,160 children in the under-five age group (mean age 2.05 years; 50.3% female) across 26 LLMICs, obtained from the Multiple Indicator Cluster Surveys, was analyzed. The Multidimensional Energy Poverty Index, composed of five fundamental dimensions of energy essential, was used to compute energy poverty. The results from binary logit models showed that the odds of ARI increased by 53% (aOR 1.53; 95% CI 1.46-1.60) with every unit increase in MEPI. Electricity deprivation, lack or absence of entertainment/education and household appliances, and reliance on biomass fuels for cooking were also independently associated with a greater ARI risk. These findings demonstrate that multidimensional energy poverty is a major contributor to child respiratory health. Therefore, to design result-oriented policies and interventions to minimize ARI among children in LLMICs, it is essential to address energy accessibility and affordability.

To explore the relationships among continuity of care needs, patient empowerment and eHealth literacy in patients with stable chronic obstructive pulmonary disease (COPD), and to further identify the potential mediating role of eHealth literacy.

Cross-sectional study.

A tertiary care hospital (Level 3A, the highest level in the Chinese hospital classification system) in Shanghai, China.

The study participants consisted of 219 patients with stable COPD who visited or underwent follow-up at the outpatient clinic between December 2023 and May 2024.

The Continuity of Care Needs Questionnaire, COPD Patient Empowerment Evaluation Scale and eHealth Literacy Scale (eHEALS) were used to assess 219 patients with stable COPD. Univariate analysis, Pearson correlation analysis and mediation analysis were performed.

The mean Continuity of Care Needs score was 24.17 (SD=2.74), with medication guidance needs being the highest-scoring domain. The COPD Patient Empowerment score was 84.37 (SD=11.58), and the eHEALS score was 23.37 (SD=6.06). Pearson correlation analysis showed that continuity of care needs were negatively correlated with patient empowerment (r=-0.930, 95% CI -0.946 to -0.910) and eHealth literacy (r=-0.976, 95% CI -0.982 to -0.969), while patient empowerment was positively correlated with eHealth literacy (r=0.919, 95% CI 0.895 to 0.937) (all p<0.001). Mediation analysis suggested that eHealth literacy partially mediated the relationship between patient empowerment and continuity of care needs, with an indirect effect of -0.169 (95% CI -0.247 to -0.091), accounting for 74.91% of the total effect. The direct effect was -0.051 (95% CI -0.067 to -0.035) and the total effect was -0.220 (95% CI -0.231 to -0.208).

Patients with stable COPD demonstrated high continuity of care needs, with eHealth literacy partially mediating the relationship between patient empowerment and continuity of care needs. Healthcare providers should consider patients' eHealth literacy to enhance patient empowerment and develop personalised continuity of care strategies.

Exogenous lipoid pneumonia (ELP) following hydrocarbon aspiration is an unusual but severe condition. This study aimed to summarize the cases of pneumonitis following fuel aspiration from a single center to serve as a useful reference for clinicians in the future. The clinical courses and outcomes of 11 patients with pneumonitis following fuel aspiration were collected and presented. Among them, four representative cases were described in detail to summarize the management experience of this disease, and these cases were analyzed to better understand the clinical features and management strategies of hydrocarbon pneumonitis following fuel aspiration. Almost all patients were found to present with cough and dyspnea, and the most common symptoms were dyspnea and chest pain. A high proportion (90.9%) of patients presented with bilateral lower pulmonary field involvement, and half of the patients showed pneumonic consolidation. One patient with irreversible lung injury received extracorporeal membrane oxygenation (ECMO) and a lung transplant. The other patients received oxygen support, antibiotics, steroids, and other supportive care. Antibiotics and steroids were the most commonly used treatments. While bronchoalveolar lavage (BAL) was beneficial for removing irritants, its utility could also be reduced due to significant risks. Finally, all patients had favorable outcomes. In conclusion, ELP was definitely harmful to patients' health, and hypoxemia was common among these patients. Supportive care, including antibiotics, steroids, and respiratory support, was the main treatment modality. It is recommended that the decision to employ BAL is made selectively. ECMO serves as a critical bridge to recovery or transplantation, and patients with timely and efficient treatment usually have a positive outcome.

Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) is the most common periodic fever syndrome in children. On-demand corticosteroids stop attacks but may shorten fever-free intervals. This systematic review assessed the effectiveness of daily colchicine prophylaxis in pediatric PFAPA. Furthermore, MEFV status association with colchicine efficacy has been explored. PubMed, Scopus, and Web of Science were systematically searched from inception to 6 November 2025 to identify trials and observational studies presenting participants with a diagnosis of PFAPA, colchicine prophylaxis as interventions, and attack frequency/attack-free interval as outcomes. All eligible records identified up to that date were screened.

Colchicine reduced attack frequency, lengthened attack-free intervals, and lowered steroid use, with benefits often within 1 month. A short randomized comparison showed similar 3-month efficacy to cimetidine. Adverse events were mostly mild gastrointestinal; discontinuations were uncommon. MEFV variants as predictors of response remain uncertain. Current evidence supports colchicine as an efficacy and generally well-tolerated preventive option.

• PFAPA is the most common periodic fever in children. On-demand corticosteroids stop attacks but may shorten symptom-free intervals; preventive options include cimetidine, selective tonsillectomy, and biologics. • Colchicine modulates innate immunity and it is effective in familial Mediterranean fever; MEFV variants occur in a subset of PFAPA, supporting interest in repurposing.

• Continuous colchicine reduced attack frequency, prolonged attack-free intervals, and lowered steroid use; adverse events were mostly mild gastrointestinal, with few treatment discontinuations. • Clinical improvement often appeared by about 1 month and stabilized by 3 months; this supports early reassessment to adjust dose or change therapy. MEFV is not clearly associated.

Systemic sclerosis-associated interstitial lung disease (SSc-ILD) is characterised by progressive pulmonary fibrosis. This study aimed to investigate the role of programmed death-1 (PD-1)-expressing T cells in SSc-ILD pathogenesis and evaluate the therapeutic potential and mechanism of mesenchymal stromal cells (MSCs) in mitigating fibrosis.

PD-1 expression in T cells from 30 patients with SSc (including SSc-ILD and SSc-non-ILD (nILD) subgroups) and 15 healthy controls (HCs) was analysed via flow cytometry. A bleomycin (BLM)-induced SSc-ILD mouse model was established to evaluate the effects of MSCs in the treatment of lung collagen deposition and inflammation in SSc-ILD. MSCs were administered intravenously to BLM-treated mice, with programmed death-ligand 1 (PD-L1) knockdown (using small interfering RNA targeting PD-L1, siPD-L1) used to explore the mechanism of MSCs on PD-1/PD-L1 pathway. The effects of MSCs on CD4⁺PD-1⁺ T cell proliferation and apoptosis were evaluated by in vitro co-culture experiment.

PD-1 expression was significantly elevated in CD3⁺ and CD4⁺ T cells of patients with SSc-ILD compared with HCs and SSc-nILD subgroups. In BLM-induced mice, CD4⁺PD-1⁺ T cells in the lung tissues increased progressively, which was correlated with the severity of lung fibrosis. CD4⁺PD-1⁺ T cells directly stimulated fibroblasts to upregulate the expression of collagen and transforming growth factor β1. Treatment with MSCs reduced pulmonary inflammation, fibrosis and PD-1⁺ T cell frequencies in lung tissues of BLM-induced mice. This therapeutic effect was PD-L1-dependent, as it was mediated by the MSC-induced suppression.

CD4⁺PD-1⁺ T cells drive fibrosis in SSc-ILD, and MSCs ameliorate disease by suppressing PD-1⁺ T cells through PD-L1-mediated mechanisms. These findings highlight PD-1 as a therapeutic target and support the clinical investigation of MSC-based interventions for SSc-ILD.

Minimally invasive direct coronary artery bypass (MIDCAB) surgery is a beating-heart procedure that causes minimal tissue injury and leads to faster recovery. It also helps in reducing blood loss, postoperative discomfort, reduced incidence of sternal wound infection leading to sternal non-union. It is performed through an anterolateral mini-thoracotomy that usually requires one-lung ventilation. Anaesthetic management of these surgeries can be very challenging, especially in patients with bullous lung disease who could develop spontaneous pneumothorax and haemodynamic instability, which can be detrimental with underlying ischaemic heart disease. Early recognition of tension pneumothorax intraoperatively, with clinical judgement being supported by various monitoring strategies and early intervention, can be lifesaving in such scenarios. In this case report, we describe the anaesthetic management of a middle-aged patient with ongoing chest pain and an incidental finding of multiple bullae in the bilateral lungs who developed tension pneumothorax during MIDCAB and was managed with intraoperative chest drain.

Globally, millions of young children affected by acute respiratory infections every year, which is the leading cause of death and serious illness among children. Though strategies, including promoting improved stoves, have been implemented to combat this public health challenge, the effectiveness of local improved stoves introduced during pregnancy in reducing household air pollution and related respiratory illnesses remains limited.

Following the main trial randomization, 343 infants born to mothers in the study groups were followed for six months, with assessments of acute respiratory infections (ARI) occurring every two months. The stove intervention's impact was evaluated by comparing the acute respiratory infection incidence rate between the intervention and control groups. Respiratory illnesses were assessed using Integrated Management of Childhood Illness (IMCI) guidelines. The incidence rate ratio (IRR) was estimated using a marginal Poisson model fitted via Generalized Estimating Equations (GEE).

During the six-month follow-up period, a total of 43 infants (18 intervention, 25 control) experienced at least one acute respiratory infection (ARI) episode, resulting in a cumulative incidence of 12% (95% CI: 10, 14%). Although the intervention group consistently showed a reduction in ARI incidence rates compared to the control group (a 20% reduction), the adjusted Incidence Rate Ratio (IRR = 0.81; 95%CI: 0.56, 1.16; P = 0.252) was not statistically significant. A non-significant trend toward benefit was noted overall, with the subgroup analyses suggesting promising, non-significant reductions primarily among female infants and infants from larger families.

The overall study did not find a statistically significant protective effect of the intervention stoves on ARI incidence. However, the observed non-significant trend suggests a potential protective effect. Further research with larger sample sizes and longer follow-up periods is warranted to confirm this potential benefit.

The main trial was registered at the Pan African Clinical Trial Registry website under the code PACTR202111534227089, (https://pactr.samrc.ac.za/ (Identifier) on the registration date of (11/11/2021).

Human metapneumovirus (HMPV) is a major respiratory pathogen belonging to the Pneumoviridae family that primarily affects children, the elderly, and immunocompromised individuals. Since its discovery in 2001, HMPV has been recognized as a significant cause of acute respiratory infections (ARIs) worldwide, exhibiting seasonal peaks and recurring outbreaks. In recent years, the virus has shown an unusual resurgence, particularly in the post-COVID-19 era, emphasizing the need for renewed clinical and epidemiological attention. This review provides a comprehensive overview of HMPV, encompassing its epidemiology, virion structure, replication mechanisms, host-pathogen interaction, clinical manifestations, diagnostic strategies, and current therapeutic approaches. Special attention is given to recent epidemiological trends, molecular insights derived from structural studies of viral proteins, and the challenges faced in developing vaccines and antiviral agents. Additionally, the review discusses the potential of plant-derived bioactive compounds as alternative or complementary therapeutic options. By consolidating the latest global data and highlighting existing knowledge gaps, the work aims to facilitate a better understanding of HMPV pathogenesis and guide future research directions for improved surveillance, diagnosis, and management of HMPV infections.

Pulmonary arterial hypertension (PAH) is a chronic, severe cardiopulmonary disease characterized by the progressive increase in pulmonary vascular resistance (PVR) because of the proliferation and fibrosis of the pulmonary arterioles. Although the disease originates in the pulmonary vasculature, it ultimately leads to right heart failure and death. PAH is associated with high mortality rates and poor prognosis, with no therapies currently available to reverse pulmonary vascular remodeling, imposing substantial socioeconomic burdens. Growing interest in the gut-lung axis has highlighted the role of gut microbiota and their metabolites in the occurrence and development of PAH. Evidence showed that gut dysbiosis and metabolite imbalances, involving reduced short-chain fatty acids (SCFAs), increased trimethylamine-N-oxide (TMAO), and dysregulated tryptophan metabolism, contributed to pulmonary vascular remodeling. This review systematically compares gut microbiota and metabolites across PAH murine models (including chronic hypoxia, SU5416/hypoxia [SuHx], monocrotaline [MCT], and non-classical models) and patients (adults and children). The analysis aims to identify disease-specific microbial and metabolic signatures. It is also discussed how the microbiota and their metabolites may influence inflammation around the pulmonary vasculature. Furthermore, the potential of probiotic therapy, fecal microbiota transplantation (FMT), and mesenchymal stem cells (MSCs) therapies as novel treatment strategies for PAH is discussed.

Immunosuppressed patients have increased morbidity and mortality due to SARS-CoV-2 infection. They can have reduced protective antibodies levels or reduced cellular immunity resulting in inability to clear the virus and persistent viremia and virus-induced inflammation. We present the case of a 52-year-old male, immunosuppressed due to use of rituximab for treatment of chronic inflammatory demyelinating polyneuropathy, who developed pneumonitis from SARS-CoV-2 infection. The patient required hospitalization 4 times over a 3-month period due to recurring pneumonitis symptoms, including fever, dyspnea, and a severe cough. The final diagnosis was delayed due to negative SARS-CoV-2 polymerase chain reaction tests on 7/8 of nasopharyngeal specimens, as well as failure to clinically improve with administration of remdesivir after the sole positive test. He was thought to have rituximab-induced organizing pneumonia, but his condition gradually worsened with additional immunosuppression directed against that condition. His active SARS-CoV-2 infection was eventually confirmed from a bronchoalveolar lavage specimen on the final hospitalization, and he was then treated with a multimodal regimen that included an antiviral agent (nirmatrelvir/ritonavir), a Janus Kinase inhibitor (baricitinib), intravenous immunoglobulin, and intravenous methylprednisolone. He had a prompt and sustained clinical response to this multimodal regimen. Persistent COVID-19 should be considered in the differential diagnosis in patients with unexplained organizing pneumonia, and can be treated effectively with multimodal therapy as above.