Background Scabies is a common, under-reported condition in the Pacific with acute and chronic complications. In this study we explored the prevalence of scabies in Sanma Province, Vanuatu. Methods We randomly selected 30 villages from nine government zones across three islands and examined residents present within these villages for scabies. Bivariate analysis and multilevel models were conducted to investigate associated demographic and household factors. Results Of 1879 participants examined, 563 had scabies (30%, 95% CI 27.9 to 32.1) with the highest prevalence in children aged 6–10 y (38.8%, 95% CI 33.9 to 44). Conclusions Scabies is a significant issue in Sanma with very high prevalence in children.

NETs are experienced as a chronic illness. In addition to ongoing psychological and physical symptom management, improvements to case history documentation and discussions about coping and finance are recommended.

Appendiceal metastasis is a rare complication of primary lung cancer and an extremely rare cause of appendicitis. We present the case of a 62-yearold male who presented with right lower quadrant abdominal pain which revealed not only appendiceal inflammation, but also a lung mass and mediastinal lymph nodes. He then proceeded to appendicectomy and two days post-operatively an endobronchial ultrasound-guided biopsy. His mediastinal lymph node biopsy revealed a lung adenocarcinoma and his subsequent appendiceal immunohistochemistry revealed the same staining pattern for thyroid transcription factor 1 (TTF-1) and cytokeratin 7 (CK-7). We conducted a literature review which revealed 12 previous case reports of lung metastasis to the appendix causing appendicitis including three patients in whom appendicitis was the presenting complaint leading to lung cancer diagnosis. This case highlights the diversity of presentations for patients suffering from metastatic lung cancer.

This manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online.

A 65-year-old woman called paramedics for stridor and neck swelling following an insect bite with a possible anaphylactic reaction. On arrival paramedics administered intramuscular epinephrine without any observed improvement in stridor. Paramedics then prepared 5 mg of 1:1000 epinephrine for nebulised administration, which was inadvertently given intravenously. The patient developed tachycardia, anxiety and a severe headache, with biochemical evidence of cardiac necrosis without any haemodynamic compromise. The patient recovered over the next 24 hours and no long-term sequelae were identified on CT coronary angiogram, electrocardiography (ECG) echocardiography or invasive angiography. This case highlights the risk of cardiac ischaemia during epinephrine administration and the importance of protocols to ensure appropriate dosing. This case also raises questions regarding appropriate management of epinephrine overdose and shines a light on the absence of guidelines on the prevention of complications from epinephrine administration.

Within the wide scope of interstitial lung diseases (ILDs), familial pulmonary fibrosis (FPF) is being increasingly recognized as a specific entity, with earlier onset, faster progression, and suboptimal responses to immunosuppression. FPF is linked to heritable pathogenic variants in telomere-related genes (TRGs), surfactant-related genes (SRGs), telomere shortening (TS), and early cellular senescence. Telomere abnormalities have also been identified in some sporadic cases of fibrotic ILD. Air pollution and other environmental exposures carry additive risk to genetic predisposition in pulmonary fibrosis. We provide a perspective on how these features impact on screening strategies for relatives of FPF patients, interstitial lung abnormalities, ILD multi-disciplinary team (MDT) discussion, and disparities and barriers to genomic testing. We also describe our experience with establishing a familial interstitial pneumonia (FIP) clinic and provide guidance on how to identify patients with telomere dysfunction who would benefit most from genomic testing.

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BACKGROUND Sleepiness is the most common symptom of obstructive sleep apnoea (OSA). Despite this the Epworth Sleepiness Score (ESS) has not been shown to predict OSA severity. We present the preliminary results of a cross-sectional analysis in OSA patients to examine the relationship between sleepiness and physical activity. METHODS Participants aged >18, with an AHI >5, and no other sleep disorders were included. Sleepiness was defined as an Epworth Sleepiness Score (ESS) of >10. Physical activity was defined as quartiles of Metabolic Equivalent of Task (MET) minutes derived from the International Physical Activity Questionnaire (IPAQ). PROGRESS TO DATE 593 participants were included (mean age 53.7, SD 14.4 years; 70.7% male; mean BMI 32.7, SD 8.5 kg/m2). 24.3% had ESS>=10 in the lowest quartile of physical activity, 28.2% in the 2nd quartile, 35.3% in the 3rd quartile and 30.2% in those with most activity. Controlling for OSA severity, gender, age or BMI, logistic regression showed increased sleepiness among participants in the 3rd quartile (3,147–6,426 MET-min/week) compared to the 1st quartile (<924 MET-min/week) with an odds ratio of 1.75 (95%CI 1.04–2.97). There was no interaction between OSA severity and physical activity. INTENDED IMPACT AND OUTCOME Preliminary results suggest increased sleepiness among participants exerting 3,147–6,426 MET-min/week compared to <924 MET-min/week. Further analysis will consider frequency and type of physical activity (in addition to energy expenditure), additional confounding variables (e.g. sedating medication) and alternate measures of sleepiness (e.g. FOSQ-10).