Acrolein is a highly toxic chemical substance commonly found in industrial production. This article analyzes the clinical data of 5 patients suspected of acute acrolein poisoning. The patients presented symptoms such as bilateral bronchitis, cyanosis of the lips and face, pharyngalgia, chest tightness, shortness of breath, etc. Severe poisoning patients also experienced acute respiratory failure and acute respiratory distress syndrome (ARDS). After comprehensive treatments including high-flow humidified oxygen inhalation, corticosteroid pulse therapy, and blood purification, 4 of the moderate-to-severe poisoning patients gradually improved and were discharged from the hospital, while 1 severe poisoning patient significantly improved after treatment with extracorporeal membrane oxygenation (ECMO), but died later due to secondary infection. This article provides valuable experience for clinicians in identifying, diagnosing, and treating acrolein poisoning, and highlights the risk of secondary infection in severe patients during treatment, which is significant for improving the success rate of treatment.

Cough is one of the most common symptoms among children. While most acute cough episodes are viral and resolve within 4 weeks, chronic cough persisting beyond 4 weeks warrants further evaluation. Pediatric-specific cough guidelines emphasizing algorithmic evaluation assist in early and accurate diagnosis for preventing long-term pulmonary complications. This article reviews evidence-based approaches to evaluating and managing acute and chronic cough in children, highlighting key diagnostic strategies and targeted treatment options.

Firstly, we would like to thank the author of the letter [...].

I read with interest the recently published open-label randomized trial comparing a single ivy extract with two herbal combination therapies (ivy/thyme and thyme/primrose) for the treatment of acute bronchitis [...].

Acute chest syndrome (ACS) is one of the leading causes of morbidity and mortality in children with sickle cell disease (SCD) and is commonly precipitated by respiratory infections. Among viral triggers, influenza A is a recognized cause of severe ACS and may contribute to rapid clinical deterioration. We report a case of a nine-year-old girl with homozygous sickle cell disease (HbSS), with irregular follow-up and poor adherence to hydroxyurea therapy, who presented with severe influenza A-associated ACS. Her course was complicated by plastic bronchitis, posterior reversible encephalopathy syndrome (PRES), and markedly elevated transcranial Doppler velocities. She required admission to the pediatric intensive care unit, bronchoscopy with removal of bronchial casts, transfusion therapy, and coordinated multidisciplinary management. The case illustrates a severe and unusual constellation of pulmonary and neurological complications occurring in the setting of poorly controlled SCD. This case highlights the potential for influenza A to precipitate life-threatening ACS in children with SCD, particularly in the context of suboptimal disease control. It also underscores the complex interplay between pulmonary and neurological complications and emphasizes the importance of early recognition, timely escalation of care, and multidisciplinary management in severe presentations.

We aimed to assess whether Pelargonium sidoides extract (EPs®7630) reduces symptom duration or antibiotic use compared with usual care in adults with acute bronchitis. We conducted a pragmatic randomised-controlled trial across 36 primary care practices and five walk-in clinics in Switzerland. Adults (≥ 18 years) consulting a general practitioner for the first time for a new episode of acute bronchitis, with a cough of up to eight days' duration, were eligible for inclusion. The co-primary outcomes were (1) number of days required to achieve a 50% reduction in symptoms from the peak value, assessed using the Acute Bronchitis Severity Score (ABSS), and (2) the proportion of participants who used antibiotics. Missing data in intention-to-treat (ITT) analyses were multiply imputed. 332 participants were enrolled and randomly assigned: 155 to EPs®7630 and 177 to usual care. Neither co-primary outcomes showed a statistically significant difference between groups. No significant difference in time to 50% reduction of symptoms between the EPs®7630 and usual care groups was observed (adjusted regression coefficient 0.05 [95% CI - 0.13-0.23]; p = 0.578). Antibiotic use was 7 percentage points lower (31% relative reduction) in the EPs®7630 group (17.4%, 20 of 155) than in the usual care group (25.2%, 33 of 177), although the difference was not statistically significant (adjusted risk ratio 0.78 [95% CI 0.49-1.26]; p = 0.309). Adverse events were reported more frequently in the EPs®7630 group (32.3%, 50 of 155) than in the usual care group (21.5%, 38 of 177; hazard ratio 1.40 [95% CI 1.03-1.89]; p = 0.030); all adverse drug events were mild. EPs®7630 did not reduce symptom duration or antibiotic use significantly and was associated with more frequent events, that were all mild and previously described. Despite the absence of statistical significance, the observed reduction in antibiotic use warrants further investigation in larger trials to clarify its potential role within antimicrobial stewardship strategies.