A man in his 60s presented with acute hypoxaemic respiratory failure secondary to post-COVID-19 fibrotic pneumonia, requiring 3 L/min oxygen therapy (peripheral oxygen saturation (SpO2) 75%), peripheral cyanosis, modified Borg Dyspnoea Scale score 4 and exertional desaturation. An 8-week physiotherapy protocol progressed from diaphragmatic breathing/gravity-assisted postures (days 1-3) through segmental percussion/proprioceptive neuromuscular facilitation (day 4 to week 2), short-lever/long-lever upper limb exercises (weeks 3-4), to trunk mobility/ambulation (weeks 5-8). Outcomes included oxygen weaning to 0.5 L/min, SpO2 94% on room air, Borg score 1 and 50 m unsupported ambulation. The interventions enhanced secretion clearance, alveolar recruitment and ventilation-perfusion matching via titration matched to clinical stability (SpO2 ≥90% phase thresholds). This demonstrates the role of structured physiotherapy in resource-limited settings for post-COVID-19 recovery.

Background: Hypotonic-hyporesponsive episode (HHE) is a recognised adverse event following immunisation (AEFI) in infants, characterised by sudden hypotonia, hyporesponsiveness, and pallor or cyanosis. Although considered benign, its abrupt and often dramatic presentation often leads to acute medical evaluation. Contemporary data on HHE are limited, and awareness among healthcare professionals needs attention. Methods: We conducted a retrospective analysis of all spontaneous reports of HHE submitted to the national pharmacovigilance centre Lareb between 1 January 2012 and 22 July 2025. Cases were included only when meeting Brighton Collaboration (BC) Level 1 criteria, requiring clear documentation of hypotonia, hyporesponsiveness, and pallor or cyanosis in children younger than 24 months. Demographic and clinical characteristics, vaccine combinations, latency, duration, seriousness, and medical care utilisation were described. Results: A total of 294 Level 1 HHE cases were identified. Most episodes followed combinations of hexavalent vaccines with pneumococcal conjugate vaccines. The median age at onset was 9 weeks, with slightly more reports involving boys. The median latency to onset was 5 h (range 4-8 h), and the median episode duration was 10 min (range 3-30 min), aligning with the historical literature. All children recovered fully, and no long-term sequelae were reported. Although HHE is clinically benign, 27% of cases were classified as serious, primarily due to hospital admission. Among non-serious cases, one third involved medical assessment or emergency services. Healthcare professionals submitted 44% of reports, notably community child health physicians. Conclusions: Contemporary Dutch pharmacovigilance data confirm that the clinical characteristics of HHE remain highly consistent with long-standig evidence. Despite its benign and self-limiting nature, HHE frequently triggers substantial medical care consumption. Improved awareness of the typical presentation, course, and prognosis, supported by the Brighton Collaboration criteria, may help clinicians recognise HHE more readily, reduce unnecessary medical consumption, and provide reassurance to caregivers.

We report a 33-year-old woman with systemic lupus erythematosus (SLE) who developed fulminant multiorgan ischemic manifestations and hematologic abnormalities. She presented with persistent fever, newly developed painful fingertip cyanosis, and acute kidney injury. Laboratory tests showed severe thrombocytopenia, hemolytic anemia with fragmented red blood cells, positive direct and indirect Coombs tests, hypocomplementemia, and positivity for multiple autoantibodies, including a triple-positive antiphospholipid antibody profile. Within the first week of hospitalization, in addition to digital ischemia, she developed multiple cerebral infarctions and acalculous cholecystitis, findings consistent with catastrophic antiphospholipid syndrome (APS). Unexpectedly, the activity of a disintegrin and metalloproteinase with thrombospondin type 1 motifs member 13 (ADAMTS13) was severely reduced to 5%, whereas ADAMTS13 inhibitor was not detected by the Bethesda assay. There was no past medical or family history suggestive of congenital thrombotic thrombocytopenic purpura. After treatment with high-dose glucocorticoids and nine sessions of plasma exchange (PE), abdominal pain resolved and digital ischemia improved, accompanied by improvement in hematologic and renal abnormalities and disappearance of fragmented red blood cells. Subsequently, ADAMTS13 activity normalized to 63% and remained stable after completion of PE. Later, non-inhibitory anti-ADAMTS13 autoantibodies were detected by enzyme-linked immunosorbent assay in a stored serum sample obtained on admission. ADAMTS13 deficiency due to non-inhibitory anti-ADAMTS13 autoantibodies may modify the complications of SLE and APS by promoting thrombotic microangiopathy.

Objective: To analyze the epidemiological and clinical characteristics of pertussis in children diagnosed at the Affiliated Children's Hospital of Fudan University in Shanghai in 2024, as well as the antimicrobial resistance patterns of Bordetella pertussis. Methods: Demographic information and vaccination status were collected from the pertussis cases confirmed by nucleic acid testing at the Children's Hospital of Fudan University in 2024. Clinical data from all hospitalized pertussis cases and a portion of outpatient pertussis cases were collected to analyze their clinical characteristics. Bordetella pertussis was isolated from nasopharyngeal swab specimens of some cases, and antimicrobial susceptibility was tested. Results: Among the 9 899 cases diagnosed in 2024, 5 272 were males and 4 627 were females. The peak epidemic season occurred from April to July. Children aged 4-10 years accounted for 7 744 cases (78.2%). Among 6 947 cases with available vaccination records, 6 676 (96.1%) had completed the full course of pertussis vaccination. A total of 2 085 pertussis patients were included for analysis of clinical characteristics, including 1 779 outpatient cases and all 306 hospitalized cases. The incidence rates of paroxysmal cough, whoop, cyanosis, apnea, fever, and white blood cell counts ≥20×10⁹/L in hospitalized patients were 94.8%, 35.0%, 24.2%, 21.6%, 44.8%, and 26.1%, respectively, all significantly higher than those in outpatient cases (75.0%, 14.6%, 1.7%, 1.3%, 23.5%, and 4.0%; all P<0.001). The proportions of complications and co-infections in hospitalized patients were 64.1% and 70.6%, respectively, also significantly higher than those in outpatient cases (19.3% and 13.8%; both P<0.001). Among both outpatient and hospitalized patients, infants under 7 months were more prone to whoop, cyanosis, apnea, post-tussive vomiting, and peripheral white blood cell counts≥20×10⁹/L compared to those older than 7 months, with statistical significance (all P<0.001). The hospitalization rates were highest among infants aged 0~2 months at 64.8% (83/128). The median length of hospital stay [M (Q1, Q3)] was 3.5 (2.5, 5.5) days, and the median hospitalization cost [M (Q1, Q3)] was RMB 8 351.6 (6 934.6, 12 086.4) among hospitalized cases. There were 14 severe cases (4.6 %), including 2 deaths. Twelve severe cases were unvaccinated, of which 9 were infants aged 0~2 months. The average length of hospital stay for severe cases was (30.7±17.7) days, with a median average cost [M (Q1, Q3)] of RMB 107 996.2 (42 066.9, 133 530.9). Based on minimum inhibitory concentration (MIC) testing of 166 Bordetella pertussis isolates, 165 (99.4%) exhibited high-level resistance to azithromycin (MIC>256.000 μg/ml). The isolates remained susceptible in vitro to trimethoprim-sulfamethoxazole, levofloxacin, ceftazidime, cefoperazone-sulbactam, and doxycycline. Conclusion: Children aged 4-10 years are the primary affected group during the 2024 pertussis outbreak in Shanghai. Unvaccinated infants under 2 months of age are at high risk for severe disease. Empirical use of macrolides for pertussis treatment is not recommended.

We present a challenging case of truncus arteriosus type II repair in a 2-month-old, 3.3 kg infant admitted with heart failure and cyanosis. Right ventricular-to-pulmonary arterial continuity was restored using a right atrial free-wall autograft, while a neopulmonary valve was constructed from the right atrial appendage, providing an autologous valved connection. The patient also exhibited moderate-to-severe truncal valve stenosis and mild regurgitation, which were addressed with concomitant valve repair. The patient also had a single coronary artery.

Cornelia de Lange syndrome (CdLS) is a rare genetic disorder characterized by a wide spectrum of clinical severity, ranging from mild to severe forms, and is typically associated with distinctive facial features, growth retardation, and multiple congenital anomalies. We report the case of a 10-day-old male newborn, born at term to non-consanguineous parents, who was admitted for respiratory distress, feeding refusal, and hypotonia. On examination, the patient presented with shock, cyanosis, severe respiratory distress, and marked hypotonia. Dysmorphic facial features were noted, along with bilateral ectrodactyly of the hands, micropenis, and bilateral cryptorchidism. Biological and radiological investigations did not identify any infectious or structural etiology. The diagnosis of CdLS was established based on clinical findings. Despite intensive care management, the patient's condition rapidly worsened, culminating in cardiac arrest with unsuccessful resuscitation. This case highlights a severe neonatal presentation of CdLS with a fatal outcome and underscores the importance of early recognition, multidisciplinary management, and genetic counseling, given the poor prognosis associated with severe forms.

We report a novel fetal hemoglobin variant, HBG2:c.308A > G [Gγ(102(G4)Asn > Ser], in a male neonate presenting with cyanosis and low oxygen saturation that resolved three months after birth, coinciding with the temporal decrease in the variant hemoglobin. Further molecular analysis confirmed maternal inheritance of this variant. The HBG2:c.308A > G variant parallels known low-oxygen-affinity mutations at the same position in the HBB and HBG2 genes, supporting its role in transient neonatal cyanosis. This variant has been designated Hb F-SickKids. Identifying such variants is important for timely diagnosis, avoiding unnecessary interventions, and facilitating accurate genetic counseling and reproductive planning.