Diseases

12 pages, 2960 KB

Open AccessSystematic Review

Spondylodiscitis Following Oxygen–Ozone Therapy: A Case Report of Lactobacillus iners Infection and a Systematic Literature Review

by Calogero Velluto, Giovan Giuseppe Mazzella, Michele Inverso, Maria Ilaria Borruto, Andrea Perna, Riccardo Totti, Laura Scaramuzzo and Luca Proietti

Diseases 2026, 14(3), 115; https://doi.org/10.3390/diseases14030115 - 23 Mar 2026

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Abstract

Background: Oxygen–ozone (O₂–O₃) therapy is a minimally invasive treatment for discogenic lumbar pain. Although rare, spinal infections—specifically spondylodiscitis—have been reported following intradiscal injections. To date, Lactobacillus iners has not been described as a causative agent in this context. Case [...] Read more.

Background: Oxygen–ozone (O₂–O₃) therapy is a minimally invasive treatment for discogenic lumbar pain. Although rare, spinal infections—specifically spondylodiscitis—have been reported following intradiscal injections. To date, Lactobacillus iners has not been described as a causative agent in this context. Case Presentation: A 55-year-old immunocompetent woman presented with progressive lumbosciatica and elevated inflammatory markers three months after intradiscal O₂–O₃ therapy. MRI revealed L4–L5 spondylodiscitis with paravertebral involvement. Surgical biopsy confirmed L. iners as the pathogen. She underwent decompression and received targeted intravenous antibiotics, achieving full clinical and radiological recovery. Methods: A systematic literature review was performed using PubMed, MEDLINE, and Scopus to identify reports of spondylodiscitis following oxygen–ozone therapy. Six cases were included based on predefined inclusion criteria. Results: The 8 identified cases involved a range of pathogens, including Staphylococcus aureus, Streptococcus beta-haemolyticus, Escherichia coli, Achromobacter xylosoxidans, Mycobacterium abscessus, and Streptococcus intermedius, and one culture-negative infection. Clinical presentations varied from radiculopathy to sepsis. Management strategies encompassed both conservative (antibiotics alone) and surgical approaches, depending on neurological status and abscess formation. Outcomes were favorable in all cases except one fatality. Conclusions: This report is the first to describe L. iners spondylodiscitis in an immunocompetent patient following O₂–O₃ therapy. Clinicians should vigilantly evaluate post-infiltration spinal infections, maintain a low threshold for imaging and biopsy, and implement pathogen-targeted antibiotic regimens, with surgical intervention as needed. Full article

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11 pages, 2029 KB

Open AccessCase Report

Giant Malignant Phyllodes Tumor with Secondary Thyroid Involvement

by Daciana Grujic, Teodora Hoinoiu, Catalin-Alexandru Pirvu, Mihai Iliescu-Glaja, Simona Cerbu, Silviu Cristian Suciu, Daniel Pit, Cristina Marinela Oprean and Horia Cristian

Diseases 2026, 14(3), 114; https://doi.org/10.3390/diseases14030114 - 22 Mar 2026

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Abstract

Background/Objectives: Phyllodes tumors are rare fibroepithelial neoplasms of the breast, accounting for less than 1% of all breast tumors and approximately 2–3% of breast fibroepithelial tumors. They can be benign, borderline, or malignant, depending on cellular atypia and stromal invasion. Although most [...] Read more.

Background/Objectives: Phyllodes tumors are rare fibroepithelial neoplasms of the breast, accounting for less than 1% of all breast tumors and approximately 2–3% of breast fibroepithelial tumors. They can be benign, borderline, or malignant, depending on cellular atypia and stromal invasion. Although most display local behavior, malignant forms can metastasize hematogenously, most frequently to the lungs, bones, and liver, with lymph node metastases being exceptional. Case Presentation: We analyzed the case of a 47-year-old woman with a phyllodes breast tumor weighing approximately 5 kg. The tumor evolved slowly over five years, followed by accelerated growth, cutaneous necrosis, superinfection, and severe anemia. Total mastectomy was performed, and histopathological examination confirmed the diagnosis of a malignant phyllodes tumor. Five months after surgery and adjuvant radiotherapy, the patient developed laterocervical metastases with thyroid invasion and life-threatening tracheal compression, an extremely rare presentation for this type of tumor in adults. Discussion/Conclusions: This case illustrates the aggressive and unpredictable behavior of malignant phyllodes tumors and underscores the necessity of careful oncological monitoring and a multidisciplinary approach, given their potential for dissemination to unusual locations. Full article

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15 pages, 272 KB

Open AccessArticle

Association Between HLA Polymorphisms and Non-Alcoholic Fatty Liver Disease in Patients with Rheumatoid Arthritis: An Observational Study

by Tatjana Zekić, Nataša Katalinić, Filip Blažić, Nada Starčević Čizmarević and Aleksandar Čubranić

Diseases 2026, 14(3), 113; https://doi.org/10.3390/diseases14030113 - 22 Mar 2026

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Abstract

Background/Objectives: This observational study investigated associations between human leukocyte antigen (HLA) polymorphisms and imaging-defined hepatic steatosis (non-alcoholic fatty liver disease—NAFLD) and liver fibrosis in patients with rheumatoid arthritis (RA). Methods: Steatosis was assessed by transient elastography (FibroScan) and defined as controlled attenuation parameter [...] Read more.

Background/Objectives: This observational study investigated associations between human leukocyte antigen (HLA) polymorphisms and imaging-defined hepatic steatosis (non-alcoholic fatty liver disease—NAFLD) and liver fibrosis in patients with rheumatoid arthritis (RA). Methods: Steatosis was assessed by transient elastography (FibroScan) and defined as controlled attenuation parameter (CAP) ≥ 275 dB/m; fibrosis was defined as liver stiffness measurement ≥ 8 kPa. We tested 11 frequent HLA alleles (HLA-A*02, HLA-B*07, HLA-B*08, HLA-B*27, HLA-B*35, HLA-B*44, HLA-B*51, HLA-DRB1*11, HLA-DRB1*14, HLA-DRB1*15, and HLA-DRB1*16). Associations were evaluated using multivariable logistic regression (individual and omnibus models) adjusted for age, body mass index (BMI), triglycerides, and glucose. Results: A total of 176 patients with rheumatoid arthritis were enrolled. NAFLD/steatosis was present in 35.2% of patients (n = 62), and fibrosis in 10.8% (n = 19). No HLA allele was significantly associated with steatosis or fibrosis after correction for multiple testing. BMI and triglycerides were independently associated with steatosis (BMI OR 1.22, 95% CI 1.12–1.34; triglycerides OR 1.48, 95% CI 1.04–2.18). For fibrosis, HLA-DRB1*15 showed the strongest trend-level association (OR ~2.6–2.9) but did not remain significant after correcting for multiple testing. Conclusions: In this RA cohort, metabolic factors (particularly BMI and triglycerides) were the dominant predictors of CAP-defined steatosis. No robust association between the tested HLA markers and steatosis or fibrosis was identified. Trend-level signals—most notably HLA-DRB1*15 for fibrosis—should be considered hypothesis-generating and warrant replication in larger, adequately powered cohorts. Full article

(This article belongs to the Special Issue Treatment Strategies and Immune Responses in Rheumatic Diseases)

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11 pages, 245 KB

Open AccessArticle

Clinical and Demographic Features of Primary Biliary Cholangitis in Kazakhstan

by Aisulu Gainutdin, Alexander Nersesov, Komori Atsumasa, Aigul Raissova, Saltanat Madenova, Laura Yerdaliyeva, Dinara Suleimenova and Balday Issenova

Diseases 2026, 14(3), 112; https://doi.org/10.3390/diseases14030112 - 20 Mar 2026

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Abstract

Background/Objectives: Primary biliary cholangitis (PBC) is a chronic immune-mediated cholestatic liver disease with increasing global prevalence. However, data on this disease from Central Asia are lacking. We aimed to describe the clinical, serological, and treatment characteristics of PBC patients in Kazakhstan. Methods: This [...] Read more.

Background/Objectives: Primary biliary cholangitis (PBC) is a chronic immune-mediated cholestatic liver disease with increasing global prevalence. However, data on this disease from Central Asia are lacking. We aimed to describe the clinical, serological, and treatment characteristics of PBC patients in Kazakhstan. Methods: This study was a multicenter, retrospective, observational study including adults diagnosed with PBC between 2014 and 2022 across seven hepatology centers in Kazakhstan. Clinical presentation, laboratory parameters, autoimmune comorbidities, liver disease severity, and ursodeoxycholic acid (UDCA) treatment response were assessed. Biochemical response at 1 year was evaluated using Paris-1 and Barcelona criteria. Results: A total of 230 patients were included; 93.9% were female and 91.3% were of Asian ethnicity, with a median age at diagnosis of 53 years. Cirrhosis was present at diagnosis in 50.2% of the patients. PBC with autoimmune hepatitis (AIH) features was identified in 56.1% of the patients and was associated with higher rates of cirrhosis, portal hypertension complications, antinuclear antibody (ANA) positivity, and higher elastography indices compared with isolated PBC. Overall, approximately 55% of the patients achieved a biochemical response to UDCA at 1 year, with similar response rates between patients with PBC and those with PBC with AIH features. Conclusions: This first comprehensive study of PBC in Kazakhstan demonstrates late disease presentation with a high burden of cirrhosis and frequent AIH features. Despite advanced disease, about half of the patients achieved biochemical remission on UDCA. These findings underscore the need for earlier diagnosis and optimized management strategies for PBC in Kazakhstan and similar settings in Central Asia. Full article

(This article belongs to the Section Gastroenterology)

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17 pages, 491 KB

Open AccessReview

Pediatric Dialysis: From Acute Kidney Injury to Chronic Renal Replacement Therapies: Challenges and Perspectives in Resource-Limited Countries

by Djilali Batouche, Djamila Djahida Batouche, Zoheir Zakaria Addou, Souhila Fatima Bouchama, Rabia Okbani, Siham Simerabet, Nadia Faiza Benatta, Soulef Saadi-Ouslim and Miloud Lahmer

Diseases 2026, 14(3), 111; https://doi.org/10.3390/diseases14030111 - 19 Mar 2026

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Abstract

Background: Pediatric kidney failure, whether acute or chronic, constitutes a major public health issue because of its impact on survival, linear growth, neurocognitive development, and long-term quality of life. While high-income countries have markedly improved outcomes through early diagnosis, advanced dialysis technologies, [...] Read more.

Background: Pediatric kidney failure, whether acute or chronic, constitutes a major public health issue because of its impact on survival, linear growth, neurocognitive development, and long-term quality of life. While high-income countries have markedly improved outcomes through early diagnosis, advanced dialysis technologies, and kidney transplantation, management remains limited in low- and middle-income countries, particularly in the Maghreb region. Objective: This review aims to provide an updated synthesis of pediatric kidney failure, with emphasis on renal replacement therapy modalities and the specific challenges encountered in resource-limited contexts, particularly in Algeria. Methods and Content: We successively address the pathophysiological and clinical bases of pediatric acute kidney injury and chronic kidney disease, followed by a discussion of available therapeutic strategies: peritoneal dialysis, intermittent hemodialysis, continuous renal replacement therapy, and pediatric kidney transplantation. Particular attention is given to organizational constraints, actual availability of modalities, limited access to consumables and immunosuppressive therapies, and the specificities of pediatric kidney care in the Maghreb region in comparison with international recommendations. Perspectives: Improving outcomes for children with kidney failure in Maghreb countries requires a multidimensional approach integrating early screening, strengthening peritoneal dialysis programs, structured development of pediatric kidney transplantation, and enhanced regional and international collaboration. Reinforcing local research capacity and participation in international registries are essential steps toward reducing disparities in care and adapting global guidelines to local realities. Full article

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17 pages, 730 KB

Open AccessArticle

Healthcare Resource Consumption and Related Costs of People Living with HIV and Antiviral Treatment: A Retrospective Observational Study in Italy

by Luca Degli Esposti, Stefania Mazzoni, Maria Cappuccilli, Franco Maggiolo, Sergio Lo Caputo, Silvia Nozza, Lucia Taramasso, Anna Marra and Mario Pittorru

Diseases 2026, 14(3), 110; https://doi.org/10.3390/diseases14030110 - 18 Mar 2026

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Abstract

Background/Objectives: Among the antiretroviral therapies (ARTs) recently introduced for people living with HIV (PLWH), the fixed-dose combination of bictegravir, emtricitabine and tenofovir alafenamide (B/F/TAF) became reimbursable in Italy in June 2019. Methods: This study evaluated drug utilization, healthcare resource consumption and direct costs [...] Read more.

Background/Objectives: Among the antiretroviral therapies (ARTs) recently introduced for people living with HIV (PLWH), the fixed-dose combination of bictegravir, emtricitabine and tenofovir alafenamide (B/F/TAF) became reimbursable in Italy in June 2019. Methods: This study evaluated drug utilization, healthcare resource consumption and direct costs among ART-naïve adults initiating B/F/TAF or other non-bictegravir-based regimens, identified from June 2019 to September 2022 within administrative databases of healthcare entities covering approximately nine million citizens. Baseline clinical characteristics at first ART prescription were compared across B/F/TAF-treated patients, those receiving other ART regimens, and non-HIV controls, while treatment outcomes during follow-up were evaluated among PLWH receiving B/F/TAF or other ARTs; healthcare consumption and costs were assessed after propensity score matching within the PLWH cohorts only. Results: Overall, 374 individuals initiated B/F/TAF and 5576 other ARTs. Patients treated with B/F/TAF showed greater adherence and persistence, with multivariate analyses confirming a lower risk of discontinuation or switching (HR = 0.66, 95% CI 0.57–0.76, p < 0.001) and a higher likelihood of adherence (HR = 2.40, 95% CI 1.58–3.64, p < 0.001). After matching, the B/F/TAF group exhibited lower 12-month consumption of non-HIV medications, fewer non-HIV hospitalizations, and reduced total healthcare costs, particularly for non-HIV drug prescriptions compared to other ART users. Conclusions: Overall, B/F/TAF was associated with better treatment continuity and meaningful cost savings. Full article

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16 pages, 319 KB

Open AccessReview

Intravascular Lymphoma Associated with the Female Genital Tract—Diagnostic Considerations, Therapeutic Approaches, and Outcomes

by Aleksandar Ristic, Marija Rovcanin, Ana Tomic, Aleksandar Rakic, Nebojsa Zecevic and Svetlana Jankovic

Diseases 2026, 14(3), 109; https://doi.org/10.3390/diseases14030109 - 17 Mar 2026

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Abstract

Intravascular lymphoma (IVL) is an uncommon subtype of non-Hodgkin’s extranodal lymphoma, distinguished by the proliferation of neoplastic cells within the lumen of small- to medium-sized arteries, with various organs recorded as impacted. The objective of this study was to evaluate the current literature [...] Read more.

Intravascular lymphoma (IVL) is an uncommon subtype of non-Hodgkin’s extranodal lymphoma, distinguished by the proliferation of neoplastic cells within the lumen of small- to medium-sized arteries, with various organs recorded as impacted. The objective of this study was to evaluate the current literature about IVL and its involvement in the female genital tract, including an overview of diagnostic methods, imaging, and pathological features, selected therapy modalities, and outcomes in patients afflicted by this malignancy. We performed a narrative review with a systematic identification and presentation of published cases of IVL affecting the female genital tract. A literature search was carried out across PubMed, Scopus, and Web of Science for relevant studies presenting data on IVL affecting the female genital tract. Case reports and series that met predefined inclusion and exclusion criteria specified by the modified PECOS (“Population,” “Exposure,” “Comparison,” “Outcomes,” and “Study design”) framework were included. Patients most commonly presented with abnormal vaginal bleeding, pelvic pain, and B symptoms. Fluorodeoxyglucose positron emission tomography computed tomography (FDG PET/CT), often performed alongside abnormal laboratory findings such as elevated lactate dehydrogenase (LDH), played a key role in raising suspicion for hematologic involvement of the female genital tract and guiding biopsy. Most cases represented B-cell intravascular lymphoma and were treated with Rituximab plus (CHOPR-CHOP) based chemotherapy, frequently combined with hysterectomy. Full article

19 pages, 2133 KB

Open AccessArticle

Integrated Functional and Histopathological Modulation of Chronic Thioacetamide-Induced Liver Fibrosis by Mesenchymal Stem Cell Therapy in a Preclinical Model

by Anthony Brayan Rivera Prado, Luis Lloja Lozano, Daysi Zulema Diaz Obregón, Víctor Hugo Carbajal Zegarra, Joel De León Delgado, Jhon Wilfredo Pando Mayta, Alexis German Murillo Carrasco, Kelly Geraldine Yparraguirre Salcedo and Claudio Willbert Ramirez Atencio

Diseases 2026, 14(3), 108; https://doi.org/10.3390/diseases14030108 - 15 Mar 2026

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Abstract

Background: Chronic liver fibrosis is a progressive pathological condition characterized by excessive extracellular matrix deposition and architectural remodeling, which may ultimately lead to cirrhosis and liver failure. Although mesenchymal stem cells (MSCs) exhibit antifibrotic and immunomodulatory properties, their therapeutic effects in established chronic [...] Read more.

Background: Chronic liver fibrosis is a progressive pathological condition characterized by excessive extracellular matrix deposition and architectural remodeling, which may ultimately lead to cirrhosis and liver failure. Although mesenchymal stem cells (MSCs) exhibit antifibrotic and immunomodulatory properties, their therapeutic effects in established chronic liver fibrosis remain incompletely defined. This study aimed to evaluate the biochemical, hematological, and histopathological effects of MSC therapy in a chronic thioacetamide-induced liver fibrosis model. Methods: A controlled preclinical experimental study was conducted using rats with liver fibrosis induced by intraperitoneal thioacetamide administration for 24 weeks. Animals were allocated into three groups: control, untreated fibrosis, and fibrosis treated with MSCs derived from human umbilical cord tissue after fibrosis establishment. Serum biochemical markers, hematological parameters, and liver histopathology were assessed. Fibrosis severity was evaluated using hematoxylin–eosin and Masson’s trichrome staining and graded according to the METAVIR scoring system. Results: Thioacetamide exposure induced chronic liver injury characterized by marked elevations in serum transaminases, reduced albumin and total protein levels, hematological alterations, and early-to-intermediate fibrosis stages (METAVIR F1–F2). MSC-treated animals exhibited approximately 40–45% reductions in transaminase levels, partial recovery of hepatic synthetic function, and attenuation of hematological alterations. Histopathological analysis demonstrated a reduction in fibrotic burden and limitation of fibrogenic progression within METAVIR F1–F2 stages. Conclusions: MSC therapy partially mitigates biochemical, hematological, and histopathological alterations associated with chronic thioacetamide-induced liver fibrosis, supporting its potential as a modulatory strategy to attenuate fibrogenic progression and stabilize liver function rather than as a curative intervention. Full article

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9 pages, 433 KB

Open AccessArticle

Maternal Outcomes Associated with Delayed Cord Clamping in Hypertensive Disorders of Pregnancy: A Cross-Sectional Study

by Aigerim Turekulova, Nurzhamal Dzhardemaliyeva, Heike Rabe and Mukhtar Kulimbet

Diseases 2026, 14(3), 107; https://doi.org/10.3390/diseases14030107 - 13 Mar 2026

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Abstract

Background/Objectives: Delayed umbilical cord clamping (DCC) is widely recommended for neonatal benefit; however, concerns persist among professionals that DCC may increase the risk of postpartum hemorrhage. There is a higher risk of postpartum hemorrhage in women with hypertensive disorders of pregnancy (HDP). We [...] Read more.

Background/Objectives: Delayed umbilical cord clamping (DCC) is widely recommended for neonatal benefit; however, concerns persist among professionals that DCC may increase the risk of postpartum hemorrhage. There is a higher risk of postpartum hemorrhage in women with hypertensive disorders of pregnancy (HDP). We aimed to evaluate the association between umbilical cord clamping timing and maternal blood loss in term pregnancies, including those complicated by HDP. Methods: We conducted a cross-sectional study of women delivering at three major hospitals in Almaty, Kazakhstan (August 2020–March 2021). The primary outcome was maternal blood loss. Secondary outcomes included hemoglobin (Hb) and red blood cell (RBC) change from pre-delivery to discharge. Multivariable models were adjusted for maternal age, parity and hypertension category. Results: Two hundred and seven women were analyzed (early cord clamping ≤ 60 (ECC) n = 21; delayed cord clamping 60–119 s (DCC60s) n = 161; delayed cord clamping ≥ 120 s (DCC120s) n = 25). Baseline characteristics were similar across groups except for hypertension distribution. Median blood loss did not differ significantly (255–260 mL; p = 0.9128). Adjusted models confirmed no association between clamping category and blood loss (RoM: ECC vs. DCC60s 0.97; 95% CI 0.93–1.01; DCC120s vs. DCC60s 1.01; 95% CI 0.96–1.07). Conclusions: Among term births in Almaty, including HDP-affected pregnancies, delayed umbilical cord clamping was not associated with increased maternal blood loss or hematologic decline. These findings indicate that DCC does not appear to increase maternal bleeding risk in high-risk obstetric populations and are broadly in line with current international recommendations. Further prospective research is warranted to evaluate specific subgroups, including severe preeclampsia. Full article

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13 pages, 778 KB

Open AccessArticle

Trends and Demographics of Hepatorenal Syndrome-Related Mortality in the U.S., 1999–2024: A CDC WONDER Analysis

by Syed Faisal Ali, Julia Natche, Mahendrakumar Achlaram Chaudhari, Hassan Abbasi, Sammy Dawoud, Hany Dawoud, Amna Shoaib, Hersh Tilokani, Harleen Kaur Chela and Arsal Zafar

Diseases 2026, 14(3), 106; https://doi.org/10.3390/diseases14030106 - 12 Mar 2026

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Abstract

Background: Hepatorenal syndrome (HRS) is a severe complication of liver cirrhosis, marked by rapid renal function decline and poor prognosis. Although clinical predictors of HRS outcomes have been extensively studied, less is known about how demographic factors influence mortality patterns. Methods: This analysis [...] Read more.

Background: Hepatorenal syndrome (HRS) is a severe complication of liver cirrhosis, marked by rapid renal function decline and poor prognosis. Although clinical predictors of HRS outcomes have been extensively studied, less is known about how demographic factors influence mortality patterns. Methods: This analysis utilized CDC WONDER data to assess U.S. mortality trends for hepatorenal syndrome (HRS) in adults aged ≥25 years from 1999 to 2024. We calculated crude mortality rates (CMR) and age-adjusted mortality rates (AAMR) per 100,000 and analyzed temporal trends using Joinpoint regression to determine the annual percentage change (APC) and average annual percentage change (AAPC). Results: From 1999 to 2024, 118,894 HRS-associated deaths were recorded. The overall AAMR decreased significantly from 2.43 in 1999 to 2.12 in 2024, with an AAPC of (AAPC −0.69% [95% CI: −0.90% to −0.51%]). Males consistently exhibited higher AAMRs than females (Males: 2.62 vs. Females: 1.63 in 2024). When stratified by race, the highest AAMR in 2024 was observed among non-Hispanic (NH) American Indian or Alaska Native populations (11.02), followed by Hispanic or Latino (2.58), NH White (2.23), NH Black or African American (1.30), and NH Asian or Pacific Islander populations (0.72). Regionally, the highest mortality was observed in the West, followed by the Midwest, South, and Northeast (2.88, 2.00, 1.92, and 1.53, respectively, in 2024). Rural areas (2.44) consistently exhibited higher AAMRs than urban areas (1.91) throughout the study period. Conclusions: HRS-related mortality has decreased modestly in the U.S over the last 26 years, yet significant inequities remain across population subgroups and regions. Mortality is disproportionately higher among males, NH American Indian or Alaska Native individuals, and residents of rural and western areas, highlighting the continued necessity for focused public health strategies. Full article

(This article belongs to the Section Gastroenterology)

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13 pages, 807 KB

Open AccessArticle

Tear Film Interferometry, Meibography, and Optical Coherence Tomography Angiography for Rosacea

by Matteo Capobianco, Marco Zeppieri, Federico Visalli, Francesco Pellegrini, Leandro Inferrera, Rosa Giglio, Irene Gattazzo, Francesco Cappellani, Fabiana D’Esposito and Caterina Gagliano

Diseases 2026, 14(3), 105; https://doi.org/10.3390/diseases14030105 - 12 Mar 2026

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Abstract

Background/Objectives: Rosacea is a chronic inflammatory dermatosis that may involve the eye, causing surface and adnexal damage that can precede cutaneous signs. Detecting subclinical ocular changes is clinically important because early ocular surface dysfunction may be missed on routine examination yet progress to [...] Read more.

Background/Objectives: Rosacea is a chronic inflammatory dermatosis that may involve the eye, causing surface and adnexal damage that can precede cutaneous signs. Detecting subclinical ocular changes is clinically important because early ocular surface dysfunction may be missed on routine examination yet progress to corneal complications, allowing earlier preventive management when identified. We prospectively evaluated subclinical ocular alterations in cutaneous rosacea using a combined, fully non-invasive high-tech imaging workflow—tear film interferometry, infrared meibography, and exploratory retinal optical coherence tomography angiography (OCT-A)—including patients without clinically evident ocular involvement. Methods: Sixteen patients with cutaneous rosacea (mean age 44.3 ± 11.2 years; 4 males, 12 females) were enrolled and divided into: Group 1—rosacea with clinically evident ocular involvement (n = 11); Group 2—rosacea without clinical ocular involvement (n = 5). Six age-matched healthy subjects served as controls (Group 3). All underwent LipiView II^® interferometry and meibography to quantify lipid-layer thickness (LLT, nm) and meibomian gland (MG) loss score (1 = normal–4 = severe), plus retinal OCT-A (Optovue Inc., Fremont, CA, USA). ANOVA with post hoc Tukey test assessed inter-group differences. Results: OCT-A showed no significant alterations in superficial or deep retinal plexuses across groups (p > 0.05). Conversely, LLT was significantly reduced in both rosacea groups vs. controls (OD: 45.5 ± 21.4 nm and 67.4 ± 10.1 nm vs. 92.7 ± 8.2 nm; OS: 40.4 ± 15.3 nm and 66.4 ± 10.1 nm vs. 96.0 ± 6.7 nm; p < 0.001). MG score was markedly higher (worse) in rosacea (OD: 3.63 ± 0.50 and 3.20 ± 0.83 vs. 1.83 ± 0.75; OS: 3.45 ± 0.68 and 3.40 ± 0.54 vs. 1.66 ± 0.81; p < 0.001). Ocular symptoms were reported by 85% of patients yet slit-lamp examination revealed surface alterations in 58% of asymptomatic cases. Conclusions: Tear film interferometry and meibography detect early ocular surface impairment in rosacea—even in the absence of clinical signs—while retinal microvasculature appears unaffected. Routine ophthalmologic screening of all rosacea patients could enable prompt treatment of subclinical dysfunction, potentially preventing corneal complications. Retinal OCTA metrics were not significantly different in this small pilot cohort, and these negative findings should be interpreted cautiously pending larger studies. Full article

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10 pages, 424 KB

Open AccessArticle

Bevacizumab and Tocotrienol in Recurrent Platinum-Resistant Ovarian Cancer, and the Role of HOXA9 as a Prognostic Biomarker

by Elisabeth Emanuel Graae, Louise Faaborg, Rikke Fredslund Andersen, Lars Ulrik Fokdal and Caroline Brenner Thomsen

Diseases 2026, 14(3), 104; https://doi.org/10.3390/diseases14030104 - 12 Mar 2026

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Abstract

Background/Objectives: Platinum resistant ovarian cancer represents a treatment challenge due to lack of efficient treatments and the absence of prognostic biomarkers. The circulating tumor DNA (ctDNA), methylated homebox A9 (meth-HOXA9), has been suggested as a biomarker for ovarian cancer, and might have a [...] Read more.

Background/Objectives: Platinum resistant ovarian cancer represents a treatment challenge due to lack of efficient treatments and the absence of prognostic biomarkers. The circulating tumor DNA (ctDNA), methylated homebox A9 (meth-HOXA9), has been suggested as a biomarker for ovarian cancer, and might have a clinical impact in terms of predicting progression and supporting clinical decision making. Hence, this study investigated the prognostic value of meth-HOXA9 in platinum resistant recurrent ovarian cancer (PR-ROC) treated with bevacizumab and tocotrienol. Methods: Twenty patients with platin-resistant recurrent ovarian cancer were prospectively enrolled in this non-randomized phase II study. The treatment consisted of bevacizumab (Avastin) 10 mg/kg intravenously every three weeks and tocotrienol (Traptol) capsules 300 mg orally three times daily as a continuous treatment. The Level of meth-HOXA9 was measured at baseline and every three weeks. Results: The overall survival (OS) in the cohort was 7.5 months (95% CI 3.0–10.0), and the progression free survival was 4 months (95% CI 1.4–6.6). Comparing meth-HOXA9 ctDNA levels at baseline, there was no statistic significant difference in OS (p = 0.23). Conclusions: Treatment was well tolerated in this heavily pretreated cohort of PR-ROC patients with expected poor prognostic outcomes, with a few individuals showing extraordinary response in terms of progression free survival. The study was not powered to reproduce evidence of potential of meth-HOXA9 as a prognostic biomarker in PR-ROC. Full article

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21 pages, 730 KB

Open AccessReview

Optimizing Aortic Valve Replacement Through Strategic Upsizing: A Modern Framework for Lifetime Valve Management

by Dimitrios E. Magouliotis, Vasiliki Androutsopoulou, Andrew Xanthopoulos, Noah Sicouri and Bo Yang

Diseases 2026, 14(3), 103; https://doi.org/10.3390/diseases14030103 - 12 Mar 2026

Viewed by 279

Abstract

Aortic valve disease is increasingly recognized as a chronic, progressive condition in which the initial valve intervention exerts a decisive influence on all subsequent therapeutic options. The persistence of prosthesis–patient mismatch (PPM), often driven by implantation of small surgical prostheses (≤21–23 mm), is [...] Read more.

Aortic valve disease is increasingly recognized as a chronic, progressive condition in which the initial valve intervention exerts a decisive influence on all subsequent therapeutic options. The persistence of prosthesis–patient mismatch (PPM), often driven by implantation of small surgical prostheses (≤21–23 mm), is associated with higher residual transvalvular gradients, attenuated left ventricular reverse remodeling, inferior long-term survival, and compromised outcomes following valve-in-valve (ViV) transcatheter procedures. Accumulating clinical and imaging evidence indicates that aortic annular enlargement (AAE), particularly using contemporary Y-incision and extended “roof” reconstruction techniques, can safely and reproducibly expand the annulus, sinuses of Valsalva, and sinotubular junction, thereby permitting implantation of larger prostheses and substantially reducing the risk of PPM. Insights from computational fluid dynamics further demonstrate that annular and root enlargement favorably alters postoperative flow dynamics, resulting in lower peak velocities, reduced pressure gradients, and more physiologic flow patterns in both primary surgical valve replacement and simulated ViV settings. From a lifetime management perspective, valve diameter optimization emerges as a critical determinant of both immediate hemodynamic performance and future procedural feasibility. Surgical programs that adopt a systematic approach to anatomic assessment, valve sizing strategy, PPM surveillance, and ViV preparedness may achieve meaningful improvements in short- and long-term outcomes. This review integrates anatomic, operative, hemodynamic, and quality-oriented evidence to support consideration of valve upsizing as a central principle in contemporary aortic valve replacement. Full article

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20 pages, 984 KB

Open AccessReview

Navigating Tuberculosis in Pregnancy and Lactation: A Review of Maternal and Neonatal Considerations

by Tiago Lima, Sandra Trigo, Eduarda Silveira, Gabriela Jorge da Silva and Sara Domingues

Diseases 2026, 14(3), 102; https://doi.org/10.3390/diseases14030102 - 11 Mar 2026

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Abstract

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. Despite the availability of effective treatments and advances in diagnostic methods, TB remains the leading cause of death from infectious disease globally, with its incidence tending to increase. Pregnant women constitute a [...] Read more.

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. Despite the availability of effective treatments and advances in diagnostic methods, TB remains the leading cause of death from infectious disease globally, with its incidence tending to increase. Pregnant women constitute a population group with particular characteristics, as the diagnosis and treatment of certain conditions can be challenging. Early diagnosis and monitoring of TB by a multidisciplinary team are crucial to guide treatment and reduce complications. Congenital TB, although uncommon, is a serious complication that should be assessed in neonates, especially when the mother has previously been diagnosed with the disease. First-line anti-TB drugs are considered safe during pregnancy and lactation. In contrast, second-line drugs have a less well-established safety profile during breastfeeding, and the available evidence regarding their excretion in breast milk remains limited; therefore, their use requires individualised risk-benefit assessment. Data on this specific population group are limited, as physiological changes during pregnancy alter the pharmacokinetics/pharmacodynamics (PK/PD) of drugs and the inclusion of pregnant women in clinical trials remains contentious. Routine TB screening in prenatal care, particularly in high-prevalence regions, is crucial to improving maternal and neonatal outcomes. This narrative review was based on a structured search of PubMed, Scopus, and Web of Science (January 2000–June 2025), using the keywords tuberculosis, Mycobacterium tuberculosis, pregnancy, and breastfeeding. Eligible articles included original studies, reviews, and international guidelines. Full article

(This article belongs to the Special Issue Mycobacterial Infections and Human Disease: Emerging Mechanisms and Therapeutic Strategies/Boundaries)

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13 pages, 377 KB

Open AccessArticle

The Prevalence of Anemia and Diagnostic Usefulness of Ferritin and Hepcidin in Antiphospholipid Syndrome and Systemic Lupus Erythematosus Patients

by Natasa Stanisavljevic, Ljudmila Stojanovich, Aleksandra Djokovic, Violeta Dopsaj, Neda Milinkovic, Dusica Mrdaković, Olivera Markovic, Marija Zdravkovic and Dragomir Marisavljevic

Diseases 2026, 14(3), 101; https://doi.org/10.3390/diseases14030101 - 11 Mar 2026

Viewed by 418

Abstract

Background: Anemia is common among patients with antiphospholipid syndrome (APS). It can persist alone (primary APS—pAPS) or with another associated disease (secondary APS—sAPS), predominantly systemic lupus erythematosus (SLE). There are no systematic reviews addressing the type of anemia (iron deficiency without anemia—IDWA, iron [...] Read more.

Background: Anemia is common among patients with antiphospholipid syndrome (APS). It can persist alone (primary APS—pAPS) or with another associated disease (secondary APS—sAPS), predominantly systemic lupus erythematosus (SLE). There are no systematic reviews addressing the type of anemia (iron deficiency without anemia—IDWA, iron deficiency—IDA, and anemia of chronic disease—ACD) in these patients. Objectives: This study aimed to assess the type of anemia and to compare the usefulness of common diagnostic anemia parameters and their mutual relations. Methods: A cross-sectional study involving 163 patients was conducted at the University Clinical Center Bezanijska kosa from June 2022 to June 2024, including 79 patients with pAPS, 47 with sAPS and 37 patients diagnosed with SLE. We compared the usefulness of iron metabolism markers (serum iron—Fe; total iron-binding capacity—TIBC; ferritin; hepcidin) in the presence of inflammatory markers such as high-sensitivity (hsCRP) and IL6 in determining the type of anemia. Results: The most common types were IDA (61.9%) and IDWA (64.3%) in pAPS patients. In contrast, ACD was equally distributed across the three groups, with prevalences of 32%, 32%, and 36% (pAPS, sAPS, and SLE, respectively). A higher frequency of thrombosis was significantly associated with a high ferritin level ≥100 (p = 0.017) and high IL6 levels (p = 0.033) as well as fetal losses (p = 0.034 and p = 0.019, respectively). The logistic regression model identified ferritin as the only significant predictor of IDA (p = 0.023). For IDWA, both ferritin (p = 0.017) and hepcidin (p = 0.038) were significant predictors of this type of iron depletion. IL-6 levels were significantly correlated with ferritin and hsCRP levels (p = 0.004 and p = 0.007, respectively). In contrast, hepcidin did not show a statistically significant correlation with inflammatory markers. A total of 40% of patients with IDA had hepcidin levels below 10, and 48% of those with ACD had hepcidin levels above 10 (p = 0.036). Conclusions: It was found that iron deficiency anemia was the most common form in pAPS, while anemia of chronic disease was equally present across all patient groups. Ferritin emerged as an independent marker for identifying iron deficiency anemia in APS patients. Although hepcidin reflects a low-inflammatory state in APS, it proved to be a more valuable tool than ferritin in distinguishing the type of anemia, especially when ferritin levels were inconclusive. Clinical manifestations in APS patients correlated with inflammatory markers. Liver function or any drug used alone or in combination had no impact on anemia type. Full article

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11 pages, 621 KB

Open AccessArticle

Association of Fetal Growth Retardation with Postnatal Osteoprotegerin Concentrations and Aortic Intima–Media Thickness

by Ageliki A. Karatza, Eirini Kostopoulou, Sotirios Fouzas, Nikolaos Antonakopoulos, Xenophon Sinopidis, Dimitra Kritikou, Alexandra Efthymiadou, Gabriel Dimitriou and Dionysios Chrysis

Diseases 2026, 14(3), 100; https://doi.org/10.3390/diseases14030100 - 8 Mar 2026

Viewed by 390

Abstract

Background: Fetal Growth Retardation (FGR) is considered a risk factor for atherosclerosis and coronary artery disease in adulthood. Osteoprotegerin (OPG), a member of the tumor necrosis factor receptor superfamily, is reported to be elevated in atherosclerosis. Objectives: In this case-control study, we investigated [...] Read more.

Background: Fetal Growth Retardation (FGR) is considered a risk factor for atherosclerosis and coronary artery disease in adulthood. Osteoprotegerin (OPG), a member of the tumor necrosis factor receptor superfamily, is reported to be elevated in atherosclerosis. Objectives: In this case-control study, we investigated whether FGR affects postnatal OPG serum concentrations and the possible association between OPG levels and aortic intima–media thickness (aIMT), an index of preclinical atherosclerosis. Methods: We studied 30 infants with FGR and 30 appropriate for gestational age (AGA) infants matched for gestational age and sex. Quantitative determination of plasma OPG was performed via enzyme immunoassay on the second (DOL2) and fifth (DOL5) day of life. aIMT was measured in the distal abdominal aorta and adjusted for aortic lumen diameter. Results: Infants with FGR had significantly higher OPG levels on both DOL2 and DOL5 as compared to controls (DOL2: 5.4 ± 1.0 pmol/L vs. 4.6 ± 1.0 pmol/L, p = 0.002 and DOL5: 5.1 ± 0.8 pmol/L vs. 3.9 ± 0.7 pmol/L, p < 0.001). Between DOL2 and DOL5, OPG concentrations did not change significantly in infants with FGR (difference 0.3 ± 0.2 pmol/L, p = 0.087) but decreased slightly in controls (difference 0.7 ± 0.3 pmol/L, p = 0.003). FGR was also associated with increased aIMT (0.11 ± 0.03 vs. 0.06 ± 0.02, p < 0.001). There was a positive correlation between OPG and aIMT on DOL2 (r = 0.494, p < 0.001), which became stronger on DOL5 (r = 0.791, p < 0.001). Conclusions: We report significantly increased concentrations of OPG in infants with FGR and a positive correlation with aIMT. Follow-up studies with repeat OPG and aIMT measurements may be indicated to evaluate whether these findings represent a permanent effect of FGR on the offspring. Full article

(This article belongs to the Section Cardiology)

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17 pages, 1641 KB

Open AccessReview

Autoimmune Diseases and Mycobacterial Infection

by Abraham Chorbajian, Ira Glassman, Akhila Swarna, Manvita Mareboina, Po-En Chen, Jammal Abu-Khazneh, Jiayan Tan, Surbi Dayal, Kian Yazdan, Bianca Urness and Vishwanath Venketaraman

Diseases 2026, 14(3), 99; https://doi.org/10.3390/diseases14030099 - 7 Mar 2026

Viewed by 624

Abstract

Background/Objectives: Mycobacterial infections and autoimmune diseases affect many worldwide, and growing evidence suggests that there is a bidirectional relationship. This review examines mechanisms by which various autoimmune diseases predispose patients to mycobacterial infections, and vice versa. Methods: We conducted a PubMed/MEDLINE search using [...] Read more.

Background/Objectives: Mycobacterial infections and autoimmune diseases affect many worldwide, and growing evidence suggests that there is a bidirectional relationship. This review examines mechanisms by which various autoimmune diseases predispose patients to mycobacterial infections, and vice versa. Methods: We conducted a PubMed/MEDLINE search using the keywords “mycobacterium” and the names of the autoimmune conditions to identify relevant papers. Results: Rheumatoid arthritis therapies, especially TNF-α inhibitors, raise tuberculosis (TB) and non-tuberculous mycobacteria (NTM) risk. Type 1 diabetes features impaired cell-mediated immunity and macrophage dysfunction, with evidence for Mycobacterium avium subspecies paratuberculosis (MAP) mimicry involving HSP65–GAD65. In systemic lupus erythematosus, immune dysregulation plus corticosteroids and cytotoxins elevates TB and NTM risk, amplified in endemic settings. In multiple sclerosis, heightened TLR2/4/9 signaling agents that inhibit pyrimidine synthesis may increase IL-10 and reduce antimycobacterial immunity. Crohn’s disease shows genetic susceptibility (e.g., NOD2 variants) and MAP detection, supporting impaired clearance of intracellular mycobacteria. Conclusions: Overall, evidence supports a bidirectional relationship: mycobacterial antigens can initiate or amplify autoimmunity via molecular mimicry and chronic stimulation, while autoimmune biology and iatrogenic immunosuppression increase susceptibility to infection. Implications include latent TB screening before immunosuppression, attention to local epidemiology, and vigilance for NTM. Research priorities include prospective cohorts, mechanistic studies of mimicry and NOD2–TLR pathways, safety registries, and trials of screening and prophylaxis. Full article

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15 pages, 822 KB

Open AccessSystematic Review

Oxidative Stress Biomarkers in Silicosis: A Systematic Review

by Maria Carmina Pau, Elisabetta Zinellu, Barbara Piras, Alice Nardi, Maria Roberta Lacana, Chiara Scala, Angelo Zinellu, Arduino A. Mangoni, Ciriaco Carru, Alessandro G. Fois, Gaetano Caramori and Pietro Pirina

Diseases 2026, 14(3), 98; https://doi.org/10.3390/diseases14030098 - 6 Mar 2026

Viewed by 374

Abstract

Background: Silicosis is a progressive fibrotic lung disease caused by chronic inhalation of crystalline silica. Increasing evidence indicates that oxidative stress plays a central role in linking silica exposure to inflammation, tissue injury, and fibrosis. We conducted a systematic review to critically appraise [...] Read more.

Background: Silicosis is a progressive fibrotic lung disease caused by chronic inhalation of crystalline silica. Increasing evidence indicates that oxidative stress plays a central role in linking silica exposure to inflammation, tissue injury, and fibrosis. We conducted a systematic review to critically appraise the current evidence on the imbalance between oxidant and antioxidant markers in patients with silicosis compared with unexposed healthy controls. Methods: A systematic literature search was conducted in PubMed, Scopus, and Google Scholar from their inception to 30 November 2025. Eligible studies assessed oxidative stress biomarkers in biological samples from patients with silicosis and non-exposed controls. Results: Malondialdehyde (MDA) and Superoxide Dismutase (SOD) were the most frequently assessed oxidative and antioxidant markers, respectively, with MDA significantly increased and SOD decreased in patients with silicosis, highlighting amplified lipid peroxidation and impaired antioxidant defense. In addition, elevated levels of other oxidant molecules confirmed the presence of lipid, nitrosative, and DNA oxidative damage. Overall, antioxidant defenses were compromised, although some markers appeared to vary with disease stage. Conclusions: This review highlights the central role of oxidative stress in the pathogenesis and progression of silicosis. Future studies with larger cohorts and a broader range of biomarkers are needed to better understand oxidative imbalance and its potential utility for monitoring disease progression and assessing severity in this population. Full article

(This article belongs to the Section Respiratory Diseases)

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14 pages, 1355 KB

Open AccessArticle

Combined Model of Inflammatory-Nutritional Indicators and Tumor Markers for Predicting Prognosis in Patients with Distal Cholangiocarcinoma: A Retrospective Cohort Study

by Fangfei Wang, Jinhao Li, Xin Zhao, Shaocheng Lyu and Qiang He

Diseases 2026, 14(3), 97; https://doi.org/10.3390/diseases14030097 - 5 Mar 2026

Viewed by 330

Abstract

Objectives: The TNM staging system for distal cholangiocarcinoma (dCCA) has limited accuracy due to its anatomical basis. This study developed a prognostic model integrating inflammatory-nutritional markers and tumor biomarkers to improve risk stratification. Methods: We analyzed 208 dCCA patients undergoing pancreaticoduodenectomy (2017–2024). Independent [...] Read more.

Objectives: The TNM staging system for distal cholangiocarcinoma (dCCA) has limited accuracy due to its anatomical basis. This study developed a prognostic model integrating inflammatory-nutritional markers and tumor biomarkers to improve risk stratification. Methods: We analyzed 208 dCCA patients undergoing pancreaticoduodenectomy (2017–2024). Independent prognostic factors for overall survival (OS) were identified via Cox regression, including tumor marker (corrected CA19-9) and host status markers (PLR, CAR, and PNI). A nomogram was constructed and evaluated using calibration, ROC, and DCA. Patients were risk-stratified using the model’s score. Results: Four independent factors were identified: corrected CA19-9 (HR = 2.438), PLR (HR = 2.041), CAR (HR = 2.477), and PNI (HR = 0.415). The nomogram showed excellent discrimination for 1-, 3-, and 5-year OS (AUC: 0.847, 0.824, 0.858), good calibration, and clinical utility per DCA. Risk stratification significantly distinguished high-risk (n = 110) from low-risk (n = 98) groups (log-rank p < 0.0001). Discussion: This multidimensional model (tumor burden, inflammation, nutrition) outperforms TNM staging, highlighting host systemic status. Despite its single-center retrospective design, it shows promise for personalized risk assessment. Conclusion: The CINS (Cholangiocarcinoma Inflammation–Nutrition Score) accurately predicts prognosis and effectively risk-stratifies dCCA patients, aiding personalized treatment planning. Full article

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38 pages, 3421 KB

Open AccessReview

Pesticides Drive Liver Diseases Through Non-Apoptotic Regulated Cell Death Pathways

by Zamza Khairullina, Saulesh Kurmangaliyeva, Rustam Yussupov, Elmira Kelimberdiyeva, Liliya Tryfonyuk, Nasriddin Shapambayev, Aizat Seidakhmetova, Talgat Medetbekov and Anton Tkachenko

Diseases 2026, 14(3), 96; https://doi.org/10.3390/diseases14030096 - 5 Mar 2026

Viewed by 550

Abstract

A compelling body of evidence links pesticide exposure to human diseases. The liver plays a central role in the detoxification of pesticides, suggesting intense pesticide–liver cell interactions. A growing body of studies highlighted in this review supports the contribution of pesticides of various [...] Read more.

A compelling body of evidence links pesticide exposure to human diseases. The liver plays a central role in the detoxification of pesticides, suggesting intense pesticide–liver cell interactions. A growing body of studies highlighted in this review supports the contribution of pesticides of various chemical classes to the development of non-alcoholic fatty liver disease (NAFLD), alcohol-associated liver disease (ALD), liver cirrhosis, viral hepatitis, hepatocellular carcinoma, etc., via disrupting lipid and carbohydrate metabolism and redox homeostasis, promoting endoplasmic reticulum stress and mitochondrial dysfunction, as well as stimulating apoptosis, fibrosis, and inflammation. In this review, we systematically illustrated an underappreciated mechanism of pesticide-induced overall and hepatic toxicity, i.e., the ability to induce non-apoptotic regulated cell death (RCD) pathways such as ferroptosis, necroptosis, and pyroptosis. Our analysis indicates that pesticides are implicated in driving liver diseases by inducing ferroptosis, necroptosis, and pyroptosis. Non-apoptotic RCDs mediate pesticide-induced liver steatosis and fibrosis. Furthermore, these cell death modalities fuel inflammation through the promotion of pro-inflammatory cytokine production and the generation of damage-associated molecular patterns. Understanding of deeper mechanisms of pesticide-induced effects on the non-apoptotic cell death machinery and subsequent immunogenic effects in liver pathology might help develop novel preventive strategies to reduce liver damage. Full article

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21 pages, 927 KB

Open AccessArticle

Thiamine and Micronutrient Deficiencies in Hospitalized Veterans Without Alcohol Use Disorder

by Elisabeth A. Mates, Kellie Watkins, Christopher Sanchez, Nicolas Fiore and Claire Phibbs

Diseases 2026, 14(3), 95; https://doi.org/10.3390/diseases14030095 - 5 Mar 2026

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Abstract

Background: Micronutrient deficiencies (MiDs) can increase medical complexity in hospitalized adults, but the prevalence in those without alcohol use disorder (AUD) is unknown. Our objectives were to prospectively determine the prevalence of thiamine, cobalamin, folate, magnesium, and cholecalciferol deficiencies in hospitalized veterans without [...] Read more.

Background: Micronutrient deficiencies (MiDs) can increase medical complexity in hospitalized adults, but the prevalence in those without alcohol use disorder (AUD) is unknown. Our objectives were to prospectively determine the prevalence of thiamine, cobalamin, folate, magnesium, and cholecalciferol deficiencies in hospitalized veterans without AUD. Methods: Newly hospitalized veterans without AUD were recruited. Plasma thiamine, cholecalciferol, cyanocobalamin, folate, magnesium, C-reactive protein, albumin, and prealbumin were obtained. Interviews, physical exams, and medical record reviews were completed to assess clinical signs of MiDs, food insecurity, malnutrition, and hospitalization metrics. Pearson chi-square, Fisher’s exact, and logistic regression evaluated relationships among MiDs, malnutrition, food insecurity, demographics, and hospitalization metrics. Results: A total of 206 participants were enrolled, and 183 had partial results while 155 had complete results. The prevalences of deficiencies were 31.32% for magnesium, 27.07% for thiamine, 25.27% for cholecalciferol, 4.40% for cyanocobalamin, and 0.55% for folate. Malnutrition was reported by 50.60% of participants, and 56.00% reported food insecurity. Of those with biomarker MiDs, signs and symptoms were found in 97.92% with thiamine, 85.96% with magnesium, 67.39% with cholecalciferol, and 37.5% with cyanocobalamin deficiency. Cholecalciferol deficiency was associated with thiamine deficiency (p = 0.011, OR 3.180, CI 1.556–6.529), food insecurity (p = 0.0073, OR 2.690, CI 1.289–5.662), and longer length of hospital stay (p = 0.0401, IRR 1.295). All other associations were not statistically significant. Conclusions: In this exploratory pilot study, MiDs affected more than half of hospitalized veterans without AUD and were frequently associated with clinical signs and symptoms. TD affected one quarter of participants. Cholecalciferol deficiency was associated with longer hospital stays. Full article

(This article belongs to the Section Clinical Nutrition)

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11 pages, 1397 KB

Open AccessArticle

Global Mortality from Severe Infectious Diseases Among Adolescents Aged 10–19 Years, 1990–2023: Long-Term Trends and Cause Composition from the Global Burden of Disease 2023 Study

by Young Joo Han

Diseases 2026, 14(3), 94; https://doi.org/10.3390/diseases14030094 - 5 Mar 2026

Viewed by 432

Abstract

Background: Severe infectious diseases remain a preventable cause of adolescent mortality worldwide, yet global evidence focused on adolescence as a distinct life-course stage—and its vulnerability to health system disruption—remains limited. We examined long-term mortality rate trends, cause composition, and COVID-19–related changes among adolescents [...] Read more.

Background: Severe infectious diseases remain a preventable cause of adolescent mortality worldwide, yet global evidence focused on adolescence as a distinct life-course stage—and its vulnerability to health system disruption—remains limited. We examined long-term mortality rate trends, cause composition, and COVID-19–related changes among adolescents compared with late childhood. Methods: We analyzed Global Burden of Disease 2023 mortality estimates from 1990 to 2023 for six acute severe infectious causes: lower respiratory infections, meningitis, encephalitis, diarrhoeal diseases, typhoid/paratyphoid fever, and COVID-19. Analyses focused on adolescents aged 10–19 years, with children aged 5–9 years as a comparator. Mortality rates (per 100,000 population) were the primary metric. Trends were quantified using estimated annual percentage change (EAPC), and pre-COVID, COVID peak, and post-COVID periods were compared across Socio-demographic Index (SDI) categories. Results: From 1990 to 2023, mortality rates declined globally across all age groups; however, reductions among adolescents were consistently slower than those among children aged 5–9 years (EAPC −2.27% vs. −3.55% per year). Diarrhoeal diseases and typhoid/paratyphoid fever exhibited the steepest long-term declines, whereas lower respiratory infections and meningitis demonstrated slower reductions and maintained a substantial share of adolescent mortality risk. During the COVID-19 peak, mortality rates modestly increased among adolescents, while children continued their gradual decline. Mortality rates remained highest in low-SDI settings. Conclusions: Despite substantial global progress, severe infectious diseases continue to impose significant and inequitable mortality risk among adolescents. The persistence of a concentrated cause profile and the amplification of mortality during system disruption underscore adolescence as a vulnerable life-course stage requiring sustained prevention and resilient acute care systems. Full article

(This article belongs to the Section Infectious Disease)

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11 pages, 666 KB

Open AccessArticle

Effect of Local Administration of Vancomycin to the Wound on Renal and Hepatic Function After Cardiac Surgery in Neonates

by Vitaliy V. Suvorov and Davlet B. Sayitkuliev

Diseases 2026, 14(3), 93; https://doi.org/10.3390/diseases14030093 - 4 Mar 2026

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Abstract

The development of sternal infection in neonates after cardiac defect correction using median sternotomy is a serious complication, increasing the length of hospital stay, mortality, and treatment costs. One effective method for preventing this complication is the local administration of antibiotics to the [...] Read more.

The development of sternal infection in neonates after cardiac defect correction using median sternotomy is a serious complication, increasing the length of hospital stay, mortality, and treatment costs. One effective method for preventing this complication is the local administration of antibiotics to the wound. The objective of this study was to evaluate the effect of local antibiotic application on renal and hepatic function in the postoperative period. Methods: A retrospective analysis of the treatment of 130 newborns with congenital heart defects (CHDs) was conducted. A local antibiotic (vancomycin, 0.5–1 g) was administered to the wound during sternotomy closure to prevent sternal infection. Liver and kidney function were assessed based on changes in serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and creatinine levels preoperatively and at 1 and 3 days postoperatively. Data were analyzed using repeated-measures analysis of variance (ANOVA) and Friedman’s chi-square test. Results: In total, local vancomycin was administered to the wound during sternotomy closure in 130 newborns after the correction of CHDs. Thirty-three patients were excluded from the study because intraoperative signs of acute kidney injury were noted. Thus, 97 newborns were included in the study and there were no cases of sternal infection in this cohort of patients. According to the results from the statistical data analysis, the preoperative ALT level was lower (Md = 19.2) than the postoperative ALT level on the first day (Md = 23, p = 0.076). On the third day of postoperative observation, after the local application of vancomycin, the ALT level increased slightly, but remained within the normal range (Md = 26, p < 0.001). The AST level on the first day was higher (Md = 43.2) than the preoperative AST level (Md = 39, p = 0.002). However, on the third day after surgery, the AST level decreased (Md = 36.4, p = 0.059) and remained within the normal range. The differences in the dynamics of ALT levels on the third day and AST on the first day after surgery were statistically significant. These levels corresponded to normal levels, leading to the conclusion that the local application of vancomycin has no effect on the levels of AST and ALT. On the first day after surgery, creatinine values were lower (M = 58.3) than before (M = 62.3, p = 0.073). On the third day of postoperative observation, the creatinine values were lower than before surgery (M = 56.8, p = 0.009). Creatinine levels decreased after the local application of vancomycin. Conclusions: The use of vancomycin locally in the wound intraoperatively in newborns after CHD repair did not result in a clinically significant increase in ALT, AST, or creatinine in the blood plasma in the early postoperative period, proving that there were no negative effects on renal and hepatic function during three postoperative days. Full article

(This article belongs to the Special Issue Feature Papers in Section 'Cardiology' in 2024–2025)

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21 pages, 2173 KB

Open AccessArticle

Functional Characterization of POLE1 Variant Fibroblasts Reveals Replication Stress and Increased Sensitivity to Genotoxic Stress

by Enas Khdeda, Nora Naumann-Bartsch, Nawres Khdeda, Giulia Cramer, Laura S. Hildebrand, Paula Schiller, Paul Julian Wagner, Franziska Fahrmeier, Ulrike Hüffmeier, Stefanie Corradini, Luitpold V. Distel and Lukas C. F. Kuhlmann

Diseases 2026, 14(3), 92; https://doi.org/10.3390/diseases14030092 - 4 Mar 2026

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Abstract

Background/Objectives: DNA polymerase ε (Pol ε), encoded by POLE1, plays a pivotal role in high-fidelity DNA replication and in coordinating DNA repair. While pathogenic exonuclease-domain variants are well established in cancer, biallelic POLE1 variants remain largely unexplored in non-malignant human cells. Methods: [...] Read more.

Background/Objectives: DNA polymerase ε (Pol ε), encoded by POLE1, plays a pivotal role in high-fidelity DNA replication and in coordinating DNA repair. While pathogenic exonuclease-domain variants are well established in cancer, biallelic POLE1 variants remain largely unexplored in non-malignant human cells. Methods: Here, we analyzed primary fibroblasts derived from a skin biopsy of a compound-heterozygous patient carrying two POLE1 variants. Western blot analysis confirmed detectable Pol ε protein levels, indicating preserved protein expression despite the underlying variants. Results: Nevertheless, functional alterations were observed across multiple independent assays. Compared with healthy control fibroblasts, this patient-derived Pol ε fibroblast line exhibited reduced clonogenic survival following ionizing radiation. Surviving fractions were consistently lower across radiation doses from 2 to 4 Gy, with an approximately twofold reduction at 2 Gy and progressively greater differences at higher doses. The isoeffect dose corresponding to 10% survival was reduced relative to pooled control fibroblasts. In addition, chromosomal breakage was increased, supporting altered processing of radiation-induced DNA damage in this cellular model. Live-cell imaging and senescence assays revealed delayed proliferation and an increased proportion of senescent or senescence-like cells under baseline and genotoxic stress conditions, including enhanced senescence-associated β-galactosidase activity. Flow-cytometric analysis demonstrated S phase accumulation and G2/M arrest, consistent with replication stress and cell-cycle perturbation. Immunofluorescence staining revealed increased γH2AX foci, consistent with persistent DNA double strand breaks. RAD51 foci formation was not reduced; instead, increased RAD51 recruitment was observed under combined cisplatin and irradiation treatment, arguing against a primary defect in RAD51-mediated homologous recombination. POLE1-variant fibroblasts also showed impaired proliferative recovery, reduced wound closure, increased γH2AX accumulation following cisplatin exposure, suggesting heightened susceptibility to DNA crosslinking stress. Conclusions: Collectively, these findings provide the first functional characterization of a patient-derived POLE1-variant fibroblast cell line and indicate that altered Pol ε function may influence cellular responses to genotoxic stress. While based on primary fibroblasts from a single compound-heterozygous patient, validation in additional patient-derived or isogenic models will be required to determine the broader relevance of these findings. Full article

(This article belongs to the Special Issue ‘Rare Syndromes: Diagnosis and Treatment’ in 2024–2026)

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17 pages, 786 KB

Open AccessReview

First Reported Use of Recombinant Parathyroid Hormone in Kenny–Caffey Syndrome Type 2: A Case Report and Literature Review

by Maja Djordjevic Milosevic, Anita Skakic, Marina Andjelkovic, Angelica Maria Delgado-Vega, Håkan Thonberg, Kristel Klaassen, Jovana Komazec, Bozica Kecman, Nikola Jocic, Erik Björck, Anna Lindstrand and Maja Stojiljkovic

Diseases 2026, 14(3), 91; https://doi.org/10.3390/diseases14030091 - 3 Mar 2026

Viewed by 434

Abstract

Background/Objectives: Hypoparathyroidism (HPT) is a disorder caused by the insufficient production of parathyroid hormone (PTH). Its main features include decreased serum calcium, increased serum phosphorus, and abnormal bone modeling. In children, HPT is most commonly due to genetic disorders. Among rare genetic [...] Read more.

Background/Objectives: Hypoparathyroidism (HPT) is a disorder caused by the insufficient production of parathyroid hormone (PTH). Its main features include decreased serum calcium, increased serum phosphorus, and abnormal bone modeling. In children, HPT is most commonly due to genetic disorders. Among rare genetic syndromes that can include HPT in their clinical spectrum is Kenny–Caffey syndrome (KCS) type 2. Conventional therapy for HPT primarily consists of oral calcium and active vitamin D metabolites. The major limitation of conventional therapy is hypercalciuria with an increased risk of nephrocalcinosis. However, a subset of patients fails to achieve the desired therapeutic response to conventional treatment; the reasons for this remain incompletely understood in some cases. The failure to achieve therapeutic targets and persistent hypercalciuria are the main indications for considering therapy with recombinant human parathyroid hormone (rhPTH). Methods: In addition to the review of the literature on rhPTH use in pediatric hypoparathyroidism, the first application of rhPTH in the treatment of genetically caused HPT in a child with Kenny–Caffey syndrome type 2 (KCS2) was described. Results: In this paper, we present a two-month-old infant who received rhPTH for 14 months. A heterozygous de novo p.Ser541Pro variant in the FAM111A gene was identified through whole-genome sequencing, indicating a diagnosis of KCS2. A biological mechanism linking FAM111A protein function with a more profound disruption of parathyroid development or function was proposed, suggesting that rhPTH therapy may be particularly beneficial in KCS2 cases. Conclusions: This is the first reported use of rhPTH in a child in Serbia and the first reported use in KCS type 2. By reviewing the literature, we analyzed the conditions in which rhPTH has been used, dosing approaches and durations, requirements for concomitant conventional therapy during rhPTH treatment, and the effects of rhPTH on calciuria. We provide an overview of rhPTH use in children. Additionally, based on the pathogenic genetic variant responsible for KCS2 in our patient, we propose possible etiologic explanations. This work aims to encourage a consideration of rhPTH use in children following its official approval. Full article

(This article belongs to the Special Issue Diseases: From Molecular to the Clinical Perspectives)

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14 pages, 304 KB

Open AccessReview

Gut Dysbiosis, Malnutrition and Sarcopenia in Liver Cirrhosis: A Narrative Review

by Marian-Vlad Lăpădat, Claudia Georgeta Iacobescu, Ion Daniel Baboi, Maria Nedelcu, Lavinia Alice Bălăceanu, Valeria Ioana Grigorescu and Ion Dina

Diseases 2026, 14(3), 90; https://doi.org/10.3390/diseases14030090 - 2 Mar 2026

Viewed by 553

Abstract

Liver cirrhosis represents the end stage of chronic liver disease arising from diverse etiologies and is characterized by persistent hepatic injury, architectural distortion, extensive fibrosis, and nodular regeneration. While decompensated cirrhosis is commonly associated with overt, life-threatening complications such as hepatic encephalopathy, hepatorenal [...] Read more.

Liver cirrhosis represents the end stage of chronic liver disease arising from diverse etiologies and is characterized by persistent hepatic injury, architectural distortion, extensive fibrosis, and nodular regeneration. While decompensated cirrhosis is commonly associated with overt, life-threatening complications such as hepatic encephalopathy, hepatorenal syndrome and gastrointestinal bleeding, less apparent manifestations—including sarcopenia and metabolic disturbances—have emerged as major determinants of prognosis. Sarcopenia, defined by the progressive loss of skeletal muscle mass and function, is highly prevalent in cirrhotic patients and is closely linked to frailty, increased morbidity, mortality, and adverse liver transplantation outcomes. Increasing data support the role of gastrointestinal dysfunction in the pathogenesis of sarcopenia in liver cirrhosis. In chronic liver disease, intestinal dysfunction is exacerbated by portal hypertension, which promotes increased intestinal permeability and bacterial translocation. Furthermore, gut dysbiosis, a key feature of advanced liver disease, contributes to impaired digestion, malabsorption of macro- and micronutrients, increased intestinal permeability, malnutrition and systemic inflammation. These alterations promote negative energy balance, reduce muscle protein synthesis and enhance muscle catabolism, thereby accelerating muscle wasting. Despite increasing recognition of the individual roles of gut dysbiosis, malabsorption, and sarcopenia in cirrhosis, their complex interrelationship has not been comprehensively addressed. This narrative review synthesizes current evidence on the interplay between gut dysbiosis, malabsorption and sarcopenia in patients with liver cirrhosis. We discuss underlying pathophysiological mechanisms, clinical implications and potential therapeutic strategies, while highlighting existing knowledge gaps and future research directions. Improved understanding of the gut-liver-muscle axis may offer novel opportunities for early intervention and optimization of outcomes in this high-risk patient population. Full article

(This article belongs to the Section Gastroenterology)

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19 pages, 2719 KB

Open AccessArticle

Functional siRNA Screen Links Ras/MAPK and Wnt Pathway to EV Secretion in HCT-116 Colorectal Cancer Cells

by Sophie Marie Pätzold and Julia Christina Gross

Diseases 2026, 14(3), 89; https://doi.org/10.3390/diseases14030089 - 2 Mar 2026

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Abstract

Background: Extracellular vesicles (EVs) play an important role in tumor progression and intercellular communication, yet the contribution of specific cancer-related genes to EV secretion remains incompletely defined. Methods: To address this, we performed an siRNA-based loss-of-function screen targeting 30 frequently altered [...] Read more.

Background: Extracellular vesicles (EVs) play an important role in tumor progression and intercellular communication, yet the contribution of specific cancer-related genes to EV secretion remains incompletely defined. Methods: To address this, we performed an siRNA-based loss-of-function screen targeting 30 frequently altered (proto-)oncogenes and tumor suppressor genes in the colorectal carcinoma cell line HCT-116 to assess their impact on EV release. EVs were isolated by sequential ultracentrifugation to obtain P14 and P100 fractions pelleting at 14,000× g or 100,000× g, respectively, and were characterized by nanoparticle tracking analysis, EV marker expression, and total protein quantification. Cell viability was assessed to control for potential apoptosis-related effects. Results: With few exceptions, knockdown of the investigated genes led to an increase in EV secretion. Silencing of KRAS and BRAF resulted in significantly elevated P14 EV levels, increased EV marker expression, and higher total protein content, while KRAS knockdown was additionally associated with a shift toward larger particle sizes. Downregulation of CTNNB1 increased P14 and decreased P100 EV secretion, whereas CDH1 knockdown reduced P14 EV levels and slightly increased P100 EVs. No general distinction between tumor suppressor genes and (proto-)oncogenes regarding their effects on EV secretion was observed, and cell viability was not significantly altered under the experimental conditions. Conclusions: These findings suggest that components of the Ras/Raf/MAPK and Wnt signaling pathways may contribute to the regulation of EV secretion in colorectal cancer cells. Full article

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26 pages, 1076 KB

Open AccessSystematic Review

Harmful Effects of Microplastics and Nanoplastics in Human Body Systems: A Systematic Review

by Precious Patrick Edet, Amal K. Mitra, Melissa Dennis and Md S. Zaman

Diseases 2026, 14(3), 88; https://doi.org/10.3390/diseases14030088 - 27 Feb 2026

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Abstract

Background: Microplastics and nanoplastics (MNPs) are ubiquitous environmental contaminants from plastic degradation, leading to human exposure through ingestion, inhalation, and dermal contact. While emerging evidence suggests potential health effects, comprehensive human-specific data remain limited. Objective: To systematically review evidence on MNP exposure and [...] Read more.

Background: Microplastics and nanoplastics (MNPs) are ubiquitous environmental contaminants from plastic degradation, leading to human exposure through ingestion, inhalation, and dermal contact. While emerging evidence suggests potential health effects, comprehensive human-specific data remain limited. Objective: To systematically review evidence on MNP exposure and health impacts across human organ systems. Methods: Following PRISMA guidelines, we searched Embase, Environment Complete, MEDLINE, and Scopus for peer-reviewed English-language studies published between 2020 and 2025 that reported MNP exposure in adult human populations and addressed at least one organ system. Thirty studies met inclusion criteria, and all clinical studies were assessed for risk of bias using the Newcastle–Ottawa Scale (NOS) Results: Clinical studies consistently detected MNPs in human blood, thrombi, feces, and respiratory and reproductive tissues. Higher MNP burdens correlated with increased disease severity across cardiovascular, gastrointestinal, respiratory, musculoskeletal, and reproductive systems. In vitro studies using human-derived cell lines demonstrated that MNPs penetrate cells and disrupt cellular processes, inducing oxidative stress, cytotoxicity, mitochondrial dysfunction, inflammation, DNA damage, and apoptosis. Toxic effects were size-, polymer-, and concentration-dependent, with smaller particles exhibiting greater cellular uptake and toxicity. Conclusions: Human MNP exposure is widespread and associated with adverse biological effects across multiple organ systems. Further interdisciplinary research is needed to establish causal relationships and inform risk assessment and regulatory frameworks for plastic-associated contaminants. Other: This research received no external funding. The research protocol was registered with PROSPERO (Registration ID number CRD420261284559). Full article

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22 pages, 720 KB

Open AccessArticle

The Psycho-Social Impact of Dental Emergencies in COVID-19 Patients: A Cross-Sectional Case–Control Study

by Marius Moroianu, Ramona-Oana Roșca, Laura-Carmen Cristescu-Budala, Valeriu Ardeleanu, Iulian Bounegru and Mădălina Nicoleta Matei

Diseases 2026, 14(3), 87; https://doi.org/10.3390/diseases14030087 - 26 Feb 2026

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Abstract

Background: The COVID-19 pandemic severely restricted access to routine dental care, resulting in delayed treatment and increased presentation of dental emergencies. When combined with SARS-CoV-2 infection, these conditions may significantly impair psycho-social well-being and quality of life (QoL). This study assessed the impact [...] Read more.

Background: The COVID-19 pandemic severely restricted access to routine dental care, resulting in delayed treatment and increased presentation of dental emergencies. When combined with SARS-CoV-2 infection, these conditions may significantly impair psycho-social well-being and quality of life (QoL). This study assessed the impact of dental emergencies on QoL in patients with COVID-19. Methods: A cross-sectional case–control study was conducted between January 2022 and April 2024, including 240 adult patients with confirmed COVID-19. The case group comprised 60 patients presenting with dental emergencies, while the control group included 180 COVID-19 patients without emergency dental needs. Quality of life was evaluated using the 32-item Quality-of-Life Inventory (QOLI), yielding a continuous global score (SBQ) and an ordinal quality-of-life category (CGV). Group comparisons were performed using Welch’s t-test and logistic regression, with effect sizes and 95% confidence intervals reported. Multivariable analyses were adjusted for age and sex. Results: Patients with dental emergencies reported markedly poorer global QoL compared to controls (mean SBQ difference = −2.04 points; Cohen’s d = −1.50; p < 0.001). The presence of a dental emergency was strongly associated with severe QoL impairment, with emergency patients showing substantially higher odds of unfavorable CGV categories (adjusted OR ≈ 20.4; 95% CI: 8.6–48.5; p < 0.001). These associations remained robust after adjustment for demographic covariates. Conclusions: Dental emergencies in patients with COVID-19 are associated with a profound deterioration in quality of life. Ensuring timely access to emergency dental services during public health crises may substantially reduce psycho-social burden and improve patient-centered outcomes. Full article

(This article belongs to the Special Issue Mental Health—Management and Care, Multidisciplinary Approaches and Perspectives)

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10 pages, 1108 KB

Open AccessCase Report

Reversible Causes of Transitory Motor Evoked Potential Decrease During Posterior Spine Fusion in Rapidly Progressive Scoliosis Treatment: A Case Report

by Vladimir Djan, Vladimir Galić, Nemanja Galetić, Rastislava Krasnik, Stanislava Bodonji, Ivana Fratrić, Anna Uram Benka, Izabela Fabri Galamboš, Nikola Bošković and Jelena Mačar Novaković

Diseases 2026, 14(3), 86; https://doi.org/10.3390/diseases14030086 - 26 Feb 2026

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Abstract

Introduction: Idiopathic adolescent scoliosis (IAS) is commonly managed non-surgically; however, patients with a Cobb angle >45° before skeletal maturity often require posterior spinal fusion. Because this procedure carries a risk of neurological complications, intraoperative neurophysiological monitoring (IONM) is essential for early detection of [...] Read more.

Introduction: Idiopathic adolescent scoliosis (IAS) is commonly managed non-surgically; however, patients with a Cobb angle >45° before skeletal maturity often require posterior spinal fusion. Because this procedure carries a risk of neurological complications, intraoperative neurophysiological monitoring (IONM) is essential for early detection of spinal cord compromise. Case report: We present a 13-year-old girl with rapidly progressing scoliosis (Cobb angle 78°) who developed intraoperative changes in motor evoked potentials (MEPs) during posterior fusion from L4 to Th2. Total intravenous anesthesia without muscle relaxants was used, and standard multimodal IONM with somatosensory evoked potentials (SSEPs), MEPs, and spontaneous/triggered electromyography was applied. After induction of general anesthesia and surgical exposure, pedicle preparation at Th8–Th9 was followed by increased bleeding from the vertebral bodies and an abrupt loss of MEPs in both lower limbs, most prominently in the tibialis anterior muscles, whilst SSEPs remained unchanged. Intraoperative radiography confirmed correct screw placement, and anesthetic variables were reassessed with no reversible cause identified. Because MEPs remained absent, a wake-up test was performed and demonstrated intact voluntary movement, allowing the surgery to continue. By the end of the procedure, MEPs recovered fully on the left side and partially on the right. The patient awoke without any postoperative motor deficit. Conclusion: It is well known that motor responses can show variability during surgery, including a gradual decrease due to prolonged anesthesia. After excluding anesthetic and mechanical factors, one of the hypothetical explanations for the transient MEP loss was temporary venous congestion and retrograde flow within the intravertebral and epidural/intraspinal venous networks, resulting in reversible spinal cord drainage impairment. Another hypothetical possibility was transient vasospasm from surgical manipulation without direct neural or vascular injury. This case highlights the critical role of continuous multimodal neuromonitoring in detecting reversible spinal cord dysfunction and guiding safe decision-making during complex scoliosis surgery. Full article

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Diseases, Volume 14, Issue 3 (March 2026) – 32 articles

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