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Background & aimsDiscerning whether laryngeal symptoms result from gastroesophageal reflux is clinically challenging and a reliable tool to stratify patients is needed. We aimed to develop and validate a model to predict the likelihood of gastroesophageal reflux disease (GERD) among patients with chronic laryngeal symptoms.MethodsThis multicenter international study collected data from adults with chronic laryngeal symptoms who underwent objective testing (upper gastrointestinal endoscopy and/or ambulatory reflux monitoring) between March 2018 and May 2023. The training phase identified a model with optimal receiver operating characteristic curves, and β coefficients informed a weighted model. The validation phase assessed performance characteristics of the weighted model.ResultsA total of 856 adults, 304 in the training cohort and 552 in the validation cohort, were included. In the training phase, the optimal predictive model (area under the curve, 0.68; 95% CI, 0.62-0.74), was the Cough, Overweight/obesity, Globus, Hiatal Hernia, Regurgitation, and male seX (COuGH RefluX) score, with a lower threshold of 2.5 and an upper threshold of 5.0 to predict proven GERD. In the validation phase, the COuGH RefluX score had an area under the curve of 0.67 (95% CI, 0.62-0.71), with 79% sensitivity and 81% specificity for proven GERD.ConclusionsThe externally validated COuGH RefluX score is a clinically practical model to predict the likelihood of proven GERD. The score classifies most patients with chronic laryngeal symptoms as low/high likelihood of proven GERD, with only 38% remaining as indeterminate. Thus, the COuGH RefluX score can guide diagnostic strategies and reduce inappropriate proton pump inhibitor use or testing for patients referred for evaluation of chronic laryngeal symptoms.

BackgroundNon-sputum-based triage tests for tuberculosis are a priority for ending tuberculosis. We aimed to evaluate the diagnostic accuracy of the late-prototype Xpert MTB Host Response (Xpert HR) blood-based assay.MethodsWe conducted a prospective diagnostic accuracy study among outpatients with presumed tuberculosis in outpatient clinics in Viet Nam, India, the Philippines, Uganda, and South Africa. Eligible participants were aged 18 years or older and reported cough lasting at least 2 weeks. We excluded those receiving tuberculosis treatment in the preceding 12 months and those who were unwilling to consent. Xpert HR was performed on capillary or venous blood. Reference standard testing included sputum Xpert MTB/RIF Ultra and mycobacterial culture. We performed receiver operating characteristic (ROC) analysis to identify the optimal cutoff value for the Xpert HR to achieve the target sensitivity of 90% or more while maximising specificity, then calculated diagnostic accuracy using this cutoff value. This study was prospectively registered with ClinicalTrials.gov, NCT04923958.FindingsBetween July 13, 2021, and Aug 15, 2022, 2046 adults with at least 2 weeks of cough were identified, of whom 1499 adults (686 [45·8%] females and 813 [54·2%] males) had valid Xpert HR and reference standard results. 329 (21·9%) had microbiologically confirmed tuberculosis. Xpert HR had an area under the ROC curve of 0·89 (95% CI 0·86-0·91). The optimal cutoff value was less than or equal to -1·25, giving a sensitivity of 90·3% (95% CI 86·5-93·3; 297 of 329) and a specificity of 62·6% (95% CI 59·7-65·3; 732 of 1170). Sensitivity was similar across countries, by sex, and by subgroups, although specificity was lower in people living with HIV (45·1%, 95% CI 37·8-52·6) than in those not living with HIV (65·9%, 62·8-68·8; difference of 20·8%, 95% CI 13·0-28·6; p

Cough is a common and commonly ignored symptom of lung disease. Cough is often perceived as difficult to quantify, frequently self-limiting, and non-specific. However, cough has a central role in the clinical detection of many lung diseases including tuberculosis (TB), which remains the leading infectious disease killer worldwide. TB screening currently relies on self-reported cough which fails to meet the World Health Organization (WHO) accuracy targets for a TB triage test. Artificial intelligence (AI) models based on cough sound have been developed for several respiratory conditions, with limited work being done in TB. To support the development of an accurate, point-of-care cough-based triage tool for TB, we have compiled a large multi-country database of cough sounds from individuals being evaluated for TB. The dataset includes more than 700,000 cough sounds from 2,143 individuals with detailed demographic, clinical and microbiologic diagnostic information. We aim to empower researchers in the development of cough sound analysis models to improve TB diagnosis, where innovative approaches are critically needed to end this long-standing pandemic.

Background: For patients with advanced non‐small cell lung cancer (NSCLC) who have received frontline immunochemotherapy, subsequent treatment options are limited. As the first dual programmed cell death‐1 (PD‐1)/cytotoxic T lymphocyte‐associated antigen‐4 bispecific antibody approved globally, cadonilimab demonstrated potential antitumor activity in advanced NSCLC patients resistant to anti‐PD‐1/PD‐L1 antibodies. Methods: We retrospectively collected efficacy and safety data from advanced NSCLC patients treated with cadonilimab‐based regimens in later therapy lines. Results: A total of 41 advanced NSCLC patients refractory to anti‐PD‐1/PD‐L1 therapy were enrolled. More than half of the patients received cadonilimab‐based regimen as a fourth or later line of treatment. At the data cutoff date, treatment efficacy could be evaluated in 23 patients. One patient (4.3%) achieved partial response, eight patients (34.8%) experienced stable disease, and 14 patients (60.9%) progressed. The objective response rate and disease control rate were 4.3% and 39.1%, respectively. The median progression‐free survival for all evaluated patients was 108.0 days. Due to the short follow‐up period, the median overall survival has not yet been reached. Treatment‐related adverse events (TRAEs) and immune‐related AEs occurred in 63.4% and 22% patients, respectively. The most common TRAEs included gamma‐glutamyl transferase elevation (17.1%), coughing (14.6%), and fatigue (12.2%). Five patients (12.2%) experienced grade ≥3 TRAEs. Conclusions: In this heavily pretreated cohort of advanced NSCLC patients, cadonilimab‐based regimens showed moderate antitumor efficacy with a generally tolerable and manageable safety profile. However, more evidence is needed to support the administration of cadonilimab in NSCLC patients refractory to previous anti‐PD‐1/PD‐L1 therapy. [ABSTRACT FROM AUTHOR]

Background: Pertussis, also known as whooping cough, is an acute respiratory illness primarily caused by Bordetella pertussis. Highly contagious, it poses significant morbidity and mortality risks, especially in infants. Despite widespread vaccination efforts, pertussis cases have recently resurged globally. This case report details possible complication in a 48-year-old woman, involving a cough-induced rib fracture and recurrent pneumothorax, highlighting the need for considering pertussis in patients with severe cough and back pain. Case presentation: A 48-year-old female non-smoker with hypertension, treated with ACE inhibitor (perindopril), presented with a runny nose, productive cough, and back pain. Initial treatment for a common cold provided temporary relief. However, her symptoms worsened, and further examination revealed a fractured rib, pneumothorax, and subcutaneous emphysema. Laboratory tests confirmed elevated Bordetella pertussis toxin antibodies. She was treated with antibiotics, and despite recurrent symptoms, a conservative management approach was successful. Follow-up indicated resolution of symptoms, but significant anxiety related to her condition. Conclusion: This case emphasises the importance of considering pertussis in adults, as early symptoms resembling a common cold can lead to misdiagnosis. It also highlights the potential for significant musculoskeletal and pulmonary injuries due to intense coughing associated with pertussis. Prompt diagnosis and comprehensive management, including antibiotics and supportive care, are essential for favorable outcomes. [ABSTRACT FROM AUTHOR]

COVID-19 may induce a state of hypercoagulability, particularly in critically ill patients, for reasons that remain unknown. Numerous studies have identified the presence of antiphospholipid antibodies in patients with COVID-19; however, the definitive diagnosis of antiphospholipid syndrome continues to pose challenges. Here, we present the case of a patient infected with SARS-CoV-2 who developed life-threatening severe thrombocytopenia, profound anaemia, acute pulmonary hypertension, right ventricular failure, and renal insufficiency. Laboratory investigations revealed significantly elevated levels of antiphospholipid antibodies. We conducted a one-year follow-up study with blood sampling performed every 12 weeks. The patient exhibited persistent high titres of antiphospholipid antibodies and ongoing renal dysfunction necessitating daily oral warfarin antithrombotic therapy. Antiphospholipid syndrome is a complex clinical condition that poses challenges for clinicians, particularly in critically ill patients, and is often associated with delayed and inaccurate diagnosis and treatment. Therefore, we extensively reviewed the literature and international guidelines to conduct a comprehensive analysis of the aetiology, pathogenesis, and treatment strategies of APS. We hope this work will provide a valuable reference for health care professionals. [ABSTRACT FROM AUTHOR]

The article "Gut permeability and its correlation with patient's traits and blood inflammatory markers in severe asthma: Real-world assessment from the Korean severe asthma registry-2 (KoSAR-2)" explores the relationship between gut permeability and severe asthma in Korean patients. The study found that patients with severe asthma exhibited increased gut permeability, with atopy identified as the most significant patient trait influencing this condition. The research suggests a bidirectional interaction between gut permeability and airway inflammation, emphasizing the importance of addressing gut permeability in managing severe asthma. [Extracted from the article]

The article presents the 2024 National Academy of Medicine (NASEM) definition of long Covid, emphasizing its complexity and the need for a comprehensive, standardized approach. Topics discussed include the challenges of defining long Covid, the committee's engagement process with affected patients and experts, and the wide range of symptoms and conditions associated with the condition.

The article presents a case study of a 51-year-old man who initially presented with dysphnea, cough, and fatigue, later developing a rash after antibiotic treatment, raising concerns of Stevens-Johnson syndrome. Topics discussed include the differential diagnosis of pneumonia and exanthematous drug eruptions, the role of laboratory findings in diagnosis, and the challenges in distinguishing between infectious and drug-related rashes.

Background: Asthma, a chronic respiratory disease, has been steadily increasing in prevalence and significantly impacts global health. In Bangladesh, it remains a major public health concern. The relationship between asthma and body mass index (BMI) is complex, with higher rates observed among overweight individuals. This study aims to explore the association between BMI, respiratory symptoms, and asthma in Khulna City, Bangladesh, addressing the lack of comprehensive data for this region. Methods: This study was a cross-sectional study. For data collection purposes, we considered Khulna Medical College and Hospital (KMC). Data collection involved a well-structured questionnaire during in-person meetings held from September 18 to November 6, 2022. We selected a total of 310 participants through simple random sampling and performed statistical analyses, including chi-square tests and logistic regression, to examine associations. Results: The majority of participants were aged above 60 years (36.5%), with most having a normal BMI (74.8%) and being male (69.0%). We found significant associations between the prevalence of asthma, age, BMI categories, and respiratory symptoms such as wheezing, coughing, chest tightness, and shortness of breath. Overweight individuals showed a higher likelihood of developing asthma (AOR 7.01; 95% CI 5.04–7.11), as did those with primary education (AOR 1.51; 95% CI 1.11–2.95) and smokers (AOR 2.80; 95% CI 1.27–6.15). Conclusion: This study identifies a higher asthma prevalence in Khulna City, associated with older age, overweight status, primary education level, and respiratory symptoms such as wheezing, coughing, chest tightness, and shortness of breath. Smoking further exacerbates the severity of the condition. We recommend public health strategies such as promoting healthier lifestyles, improving healthcare access, raising awareness about smoking risks, enhancing air quality, and establishing specialised asthma clinics for effective management and improved quality of life. [ABSTRACT FROM AUTHOR]