Search Results (173)

Background/Objectives: Osteoporosis represents a major yet underdiagnosed public health concern in developing countries, including Tunisia. Limited awareness, delayed diagnosis, and suboptimal adoption of preventive strategies contribute to increased risk of fragility fractures in aging populations. This study aimed to assess post-pandemic knowledge, attitudes, and preventive practices regarding osteoporosis in the Tunisian general population. Methods: A cross-sectional survey was conducted between February and April 2024 in six randomly selected community pharmacies in Tunis. Adults ≥ 40 years old completed a validated 31-item questionnaire assessing socio-demographic factors, osteoporosis knowledge, risk factors, screening practices, and preventive behaviors. A total of 160 fully completed questionnaires were analyzed using SPSS v22. Results: Only 60.6% of respondents reported awareness of osteoporosis. Knowledge levels were significantly higher in men (8.37 vs. 7.40; p = 0.043), urban residents (8.22 vs. 7.21; p = 0.036), participants with higher education (8.73 vs. 7.00; p < 0.001), those with a family history (8.58 vs. 7.49; p = 0.033), and individuals already diagnosed (9.19 vs. 7.63; p = 0.025). Screening rates were low: only 11.3% had ever undergone DXA testing, despite 18.8% reporting prior fractures. Preventive behaviors were inadequate: 80% did not supplement calcium, 88.1% did not use vitamin D, and 58.8% did not engage in <30 min of daily activity. Osteoporosis was reported by 13.1% of participants and 95.2% of diagnosed cases received treatment, predominantly bisphosphonates (75%). Comorbidities were significantly associated with osteoporosis (24.5% vs. 7.5%; p = 0.003). Conclusions: This study reveals suboptimal awareness, limited access to screening, and insufficient preventive behaviors regarding osteoporosis in Tunisia. Targeted educational initiatives, expansion of DXA availability, adoption of national osteoporosis guidelines, and multidisciplinary stakeholder involvement are critical to improve early detection, prevention, and management in the aging Tunisian population. Furthermore, promoting balanced nutrition that includes calcium- and vitamin D-rich foods, along with appropriate dietary supplementation when needed, is an essential preventive strategy to support optimal bone health and reduce osteoporosis risk in the general population. Full article

The Upper Yangtze River National Nature Reserve for Rare and Endemic Fish is a critical sanctuary facing increasing pressure from hydropower development. To assess its current ecological state, we employed environmental DNA (eDNA) metabarcoding on 48 water samples collected from 16 transects in August 2024. Our analysis identified 93 fish species from 3 orders, 13 families, and 67 genera, of which 89 were consistent with historical records. The Cyprinidae family was dominant. The fish community was predominantly characterized by slow-flowing, benthic, omnivorous, and migratory taxa that lay adhesive eggs, with key life-history traits including a sexual maturity age of 1–4 years and a length at first maturity under 20 cm. Spatially, species richness was highest in the Chishui River (64 species), followed by the Minjiang River (61 species). While alpha diversity was largely consistent across most rivers (except the Minjiang), beta diversity analysis revealed significant compositional differences among basins (PERMANOVA, R² = 0.2747, p = 0.001). Notably, the Chishui River supported not only the highest richness but also a distinct community structure. In summary, this study provides a systematic current status assessment of the reserve’s fish resources, revealing significant spatial heterogeneity, Our findings underscore the potential impacts of dam construction and offer a scientific basis for informing effective conservation strategies. Full article

Background: MYH9-related disease (MYH9-RD) is the most common form of inherited thrombocytopenia (IT). It is caused by pathogenic variants in the MYH9 gene. It manifests as early-onset macrothrombocytopenia with variable later-onset extra-hematological features, including hearing loss, renal disease, and cataracts. In pediatric patients, early recognition is critical to avoid misdiagnosis as immune thrombocytopenia (ITP) and unnecessary immunosuppressive therapy. Methods: We conducted a retrospective unicentric study at the Pediatric Oncology and Hematology Department, Fundeni Clinical Institute, Bucharest, Romania, including patients aged 0–18 years with suspected IT, tested between 2017 and 2025 by next-generation sequencing (NGS). Clinical, laboratory, and genetic data were reviewed. Results: Among 66 patients who underwent genetic testing, 31 (48.5%) had IT-associated genetic variants; 8 (25.8%) carried MYH9 mutations. Four patients (50%) had disease onset before age 1 year, three with neonatal presentation; 3 (37.5%) reported a family history of thrombocytopenia. Six variants were previously reported, and two were novel variants. Five variants (62.5%) were pathogenic, while three (37.5%) were initially classified as variants of uncertain significance (VUS). Most mutations were missense in the coiled-coil tail domain, correlating with milder thrombocytopenia and absence of extra-hematological features. No life-threatening bleeding was recorded; hemorrhagic symptoms were limited to minor mucocutaneous bleeding. Conclusions: This is the first Romanian pediatric cohort and one of the few existing pediatric cohorts describing the genetic and clinical spectrum of MYH9-RD. Early genetic confirmation enables precise diagnosis, tailored management, and family screening, while preventing inappropriate therapies. Full article

Background: Lowering lipid levels after an acute coronary syndrome is critical for preventing recurrent adverse cardiovascular events. Multiple medications are now available, but there is limited evidence comparing how frequently they lead to the achievement of guideline-recommended lipid targets. Methods and Results: This observational study evaluated the impact of novel lipid-lowering therapies (alirocumab, evolocumab, inclisiran, and bempedoic acid) in patients with a history of atherosclerotic cardiovascular disease or familial hypercholesterolaemia treated with maximum-tolerated doses of high-intensity statin therapy with or without ezetimibe. Our primary assessment was the achievement of LDL-C below 1.4 mmol/L as per the European Society of Cardiology guidelines. The study comprised of 256 patients. Reduction in LDL-C was greatest with alirocumab and evolocumab, achieving a reduction of 62% (95% confidence interval [CI], 51 to 93; p < 0.001) and 58% (95% CI, 47 to 88; p < 0.001) after 12 months, respectively. This was followed by inclisiran with a reduction of 47% (95% CI, 37 to 78; p < 0.001) and bempedoic acid with a reduction of 36% (95% CI, 22 to 69; p < 0.001). Patients treated with alirocumab and evolocumab started from a higher baseline LDL-C than inclisiran, due to the higher LDL threshold required for initiation of alirocumab and evolocumab in the UK. Despite this, inclisiran, evolocumab, and alirocumab were all associated with similar proportions of patients achieving LDL targets: 35%, 42%, and 37% of patients achieved a guideline-recommended LDL-C target of <1.4 mmol/L. Patients with a baseline LDL-C > 4 mmol/L were more likely to reach the ESC target when treated with alirocumab or evolocumab compared to inclisiran, with results of 33.3% vs. 24.1% (p = 0.016) and 35.7% vs. 24.1% (p = 0.05). Conclusions: Alirocumab and evolocumab were associated with the greatest reductions in LDL-C, followed by inclisiran and bempedoic acid. Overall, alirocumab, evolocumab, and inclisiran led to approximately 40% of patients reaching ESC targets for LDL-C. In patients with a baseline LDL-C > 4 mmol/L, significantly more patients achieved LDL-C targets when treated with alirocumab or evolocumab compared to inclisiran. Strength and limitations: This was the first study to comprehensively compare the efficacy of novel lipid-lowering therapies in achieving guideline-recommended LDL targets within a high-risk cardiovascular population. The sample size was relatively small, especially for patients treated with bempedoic acid. Full article

Background/Objectives: Vaccination is a critical public health measure for older adults in residential aged care facilities (RACFs). In Australia, COVID-19, influenza, pneumococcal, and shingles vaccines are recommended and funded for this group. However, vaccination coverage remains suboptimal, with limited understanding of the underlying causes. Methods: A mixed-methods design explored the enablers and barriers to vaccination from the perspectives of frontline providers, RACF staff, residents and family members. Descriptive statistics were used to quantify the prevalence of perceived enablers and barriers within stakeholder groups. Qualitative data—collected through open-ended questions—were analysed using manual, deductive-iterative coding to identify key themes. Key quotes illustrate the findings. Results: Input was gathered from seven in-reach geriatric staff, 40 general practitioners (GPs), 90 RACF staff, 17 RACF residents, and 84 family members of residents. Results were grouped under four key themes: operational, communication, coordination, and financial. RACF staff identified limited access to vaccination histories as the most significant barrier and relied on external providers to upload data to the Australian Immunisation Register (AIR). On-site clinics were essential, but organisational policies prevented nurse-led vaccination of residents. Most RACFs stored only influenza vaccines and depended on external providers for others. Simplified, translated information was called for. Healthcare provider and RACF endorsement was valued, but RACF staff felt ill-equipped to handle conversations around vaccine hesitancy. Consent processes were burdensome, and responsibility for tracking vaccination schedules was unclear with calls for streamlined processes. Low provider remuneration was also noted, with calls for increased government support. Conclusions: This work identifies key enablers and barriers to resident vaccination in RACFs. Improving delivery requires organisational policy change, staff support, digital access, and continued advocacy. Analysis of targeted interventions and coverage will be reported separately. The approach is replicable for other vulnerable groups. Full article

Background: Diabetes Mellitus (DM) represents a significant public health challenge in Pakistan, with a high prevalence exacerbated by various socio-demographic, clinical, and environmental factors. Community pharmacies offer an accessible setting for managing chronic diseases, yet the combined influence of these factors on diabetes control within Pakistani community settings remains underexplored. Objective: This study aimed to assess the impact of socio-demographic, environmental, and clinical factors on diabetes control among patients attending community pharmacies in Lahore, Pakistan. Methods: A cross-sectional study was conducted involving 321 patients with type 2 diabetes recruited from community pharmacies across three regions of Lahore. A structured questionnaire, developed based on international guidelines, was used to collect data on socio-demographic characteristics, clinical history, lifestyle behaviors, and environmental factors. Diabetes control was categorized as controlled, partially controlled, or uncontrolled. Data were analyzed using descriptive statistics, chi-square tests, and multiple logistic regression in SPSS version 26.0. Results: Key socio-demographic predictors of better diabetes control included higher education levels (AOR = 1.317–2.338, p ≤ 0.006) and non-obese status (AOR = 1.057, p = 0.006). Significant clinical and lifestyle predictors were treatment adherence (AOR = 1.287, p < 0.001), regular physical activity (AOR = 1.387, p < 0.001), healthy dietary patterns (AOR = 1.317, p < 0.001), and longer duration of diabetes (>5 years, AOR = 1.277, p = 0.008). Conversely, a family history of diabetes (AOR = 1.967, p < 0.001) and the presence of comorbidities were associated with poorer control. Rural residence showed lower odds of good diabetes control (AOR = 0.857, p = 0.001). Smoking status was also influential, with ex-smokers demonstrating better control than current smokers. Conclusions: Diabetes control is multifactorial, strongly influenced by education, residence, obesity, lifestyle behaviors, and treatment adherence. Interventions targeting modifiable risk factors through patient education, lifestyle counseling, and personalized care are essential to improve diabetes outcomes in community settings. These findings underscore the critical role of community pharmacists in providing holistic diabetes management. Full article

Accurate estimation of lithium-ion battery (LIB) state of health (SOH) underpins safe operation, predictive maintenance, and lifetime-aware energy management. Despite recent advances in machine learning (ML), systematic benchmarking across heterogeneous real-world cells remains limited, often confounded by data leakage and inconsistent validation. Here, we establish a leakage-averse, cross-battery evaluation framework encompassing 32 commercial LIBs (B5–B56) spanning diverse cycling histories and temperatures (≈4 °C, 24 °C, 43 °C). Models ranging from classical regressors to ensemble trees and deep sequence architectures were assessed under blocked 5-fold GroupKFold splits using RMSE, MAE, R² with confidence intervals, and inference latency. The results reveal distinct stratification among model families. Sequence-based architectures—CNN–LSTM, GRU, and LSTM—consistently achieved the highest accuracy (mean RMSE ≈ 0.006; per-cell R² up to 0.996), demonstrating strong generalization across regimes. Gradient-boosted ensembles such as LightGBM and CatBoost delivered competitive mid-tier accuracy (RMSE ≈ 0.012–0.015) yet unrivaled computational efficiency (≈0.001–0.003 ms), confirming their suitability for embedded applications. Transformer-based hybrids underperformed, while approximately one-third of cells exhibited elevated errors linked to noise or regime shifts, underscoring the necessity of rigorous evaluation design. Collectively, these findings establish clear deployment guidelines: CNN–LSTM and GRU are recommended where robustness and accuracy are paramount (cloud and edge analytics), while LightGBM and CatBoost offer optimal latency–efficiency trade-offs for embedded controllers. Beyond model choice, the study highlights data curation and leakage-averse validation as critical enablers for transferable and reliable SOH estimation. This benchmarking framework provides a robust foundation for future integration of ML models into real-world battery management systems. Full article

Quality-of-life (QoL) needs among gynecologic cancer survivors are multifaceted and culturally mediated, yet limited research has examined how survivors in the Middle East prioritize key domains such as sexual function, emotional well-being, and relational quality. This study aimed to identify subgroups of survivors based on the perceived importance of these domains and to explore demographic and clinical predictors of subgroups within the Saudi Arabian context. We conducted a cross-sectional, survey-based study among 129 women with a history of breast or cervical cancer attending a tertiary oncology center in Jeddah, Saudi Arabia. Participants rated the importance of sexual, emotional, and relational QoL domains using a 4-point Likert scale. Latent class analysis (LCA) was used to segment survivors based on their perceived domain importance. Differences in demographic and clinical characteristics across classes were assessed using chi-square tests. A decision tree classifier was employed. Three latent classes emerged: Class 0 (48.8%) prioritized all domains highly; Class 1 (17.8%) reported low importance across domains; and Class 2 (33.3%) emphasized emotional and relational domains while downplaying sexual function. Class group was significantly associated with age (p = 0.001), education (p = 0.04), nationality (p = 0.03), and number of children (p < 0.001). Decision tree analysis identified number of children, age, and marital status as the strongest predictors of high-importance class group. Gynecologic cancer survivors in Saudi Arabia hold diverse priorities regarding QoL domains, primarily shaped by sociocultural context than clinical variables. Tailored survivorship interventions that reflect survivors’ lived values, particularly in relation to age, family structure, and cultural norms, are critical for person-centered oncology care in the region. Full article

Coronaviruses (CoVs) were first described in poultry in the early 1930s and formally recognized as pathogens of both animal and human populations in the late 1960s. They are now considered among the most abundant viral families in the world. Though their distribution and diversity remain understudied in wild animals, representatives from 13 orders of wild birds worldwide have tested positive for CoVs of the gamma and delta genera over the last 25 years. Many of these wild bird species are in the orders Charadriiformes (shorebirds and their relatives) and Anseriformes (waterfowl including ducks, geese, and swans). Waterfowl are particularly concerning as potential reservoirs for CoVs because they are globally distributed; often congregate in large, mixed-species flocks; and may exist in close proximity to humans and domesticated animals. This review describes the history and current knowledge of CoVs in birds, provides an updated list of global detections of CoVs in 124 species of wild birds as reported in the peer-reviewed literature since 2000, and highlights topics for future research that would help elucidate the role of waterfowl in CoV transmission. Our review reiterates the need for continuous surveillance to detect and monitor CoVs across all bird species and for standardization in data reporting and analysis of both negative and positive results. Such information is critical to understand the potential role of free-ranging birds in the maintenance, evolution, and transmission of the virus. Further, we believe that research on the potential impacts of coronavirus infections and coinfections on avian demographics, especially reproduction in waterfowl, is warranted given known consequences in domestic poultry. Full article

The terror management health model (TMHM) offers a framework to investigate how concerns about mortality can motivate health-related behaviors through actions that bolster self-esteem. This framework may be especially useful for examining how a family history of breast cancer influences preventative breast health behaviors. Women with no family history, a family history where a family member survived breast cancer, and those who lost a family member to the disease were recruited to participate in one of two preregistered online studies. Participants completed measures of perceived susceptibility, associations of breast cancer with death, breast health esteem, and behavioral breast health intentions. In both studies, the effect of family history on behavioral intentions was serially mediated by susceptibility perceptions, breast cancer–death association, and feelings of esteem related to breast health behaviors. There were no effects of priming mortality. Taken together, the results suggest that both susceptibility perceptions and death associations are critical for encouraging breast health behaviors among women with family history, and this works through a mechanism relevant to self-esteem. Interventions may be more effective when they emphasize the esteem value of breast health behaviors for individuals at increased risk. Full article

Background: While survival outcomes for breast and cervical cancer have improved in Saudi Arabia, little is known about the long-term sexual and psychosocial well-being of survivors. This study aimed to assess sexual satisfaction, emotional health, and social relationship quality among Saudi women diagnosed with cervical and breast cancers and to identify sociodemographic predictors of quality of life (QoL) across these domains. Methods: A cross-sectional survey was administered to 129 women with a history of breast or cervical cancer during May–July 2021. The instrument combined validated tools measuring three core QoL domains: sexual function and satisfaction, psychological and emotional well-being, and social and relationship qualities. Multivariable ordinal logistic regression was used. Results: A total of 129 women with cervical and breast cancers (51.2% cervical, 48.8% breast) participated. Most were aged 31–45 years (45.7%), married (83.0%), with 48.1% holding a bachelor’s degree. Overall, 74.4% of participants reported high to moderate emotional well-being; 48.8% reported satisfactory sexual function, and only 41.1% perceived high quality in social relationships. Younger age (21–30 years), higher education, and having more children were significantly associated with lower emotional well-being (p < 0.05). Conversely, current treatment status and higher parity were associated with better sexual function. Social and relationship quality was significantly higher among younger and employed women. Perceived importance of domains varied, with emotional well-being rating the highest (82.9%). Conclusions: Sexual and social QoL are underserved yet critical components of survivorship care. Cultural, familial, and educational contexts play significant roles in shaping post-treatment experiences. Interventions tailored to age, family dynamics, and treatment stage are needed to improve the holistic well-being of survivors in Saudi Arabia. Full article

Background/Objectives: Diabetes Mellitus (DM) remains a critical public health issue in Saudi Arabia, shaped by complex interactions among genetic, lifestyle, and sociodemographic factors. This study explores interplay of modifiable and non-modifiable determinants of DM among Saudi adults. Methods: An analytical cross-sectional study was conducted among 3411 adults aged 18 years and above in the Jazan region, southwest of Saudi Arabia, in May–June 2024. Data was collected via a structured, pretested questionnaire assessing sociodemographic, dietary patterns, physical activity, smoking habits, and family history of DM. Bivariate analysis and logistic regression were used to identify associations with self-reported diabetes. Results: Out of 3411 participants (1735 males and 1676 females), 424 (12.4%) reported DM. Diabetics were older (48 vs. 32 years), more often male, married, had lower education, had larger families, had higher BMIs, and exhibited more tobacco use (p < 0.05), and a family history of diabetes was strongly associated with diagnosis of DM (p < 0.001). Diabetics were more likely to choose low-fat meats, avoid sugary foods, and select low-fat products (p < 0.05). In multivariate analysis, predictors were age (OR = 1.07, 95% CI: 1.06–1.09), male sex (OR = 1.65, 95% CI: 1.26–2.16), family history (OR = 7.68, 95% CI: 5.67–10.57), traditional housing (OR = 1.82, 95% CI: 1.11–3.05), and whole grain intake (OR = 0.67, 95% CI: 0.52–0.85). Conclusions: DM in Saudi Arabia is driven by both inherited and behavioral risks. These findings support the urgent need for integrated, culturally tailored prevention strategies that combine early screening for individuals with higher risk. Targeted actions such as relevant lifestyle interventions can help reduce disease burden and align with Saudi Vision 2030 health priorities. Full article

Eryngium foetidum L. belongs to the Apiaceae family and is a perennial herb. The entire plant is rich in essential oils, which have a distinctive aroma similar to cilantro. This plant exhibits significant biological activity and possesses characteristics such as disease resistance and antimicrobial properties, showing great potential in medical and food applications. Additionally, its essential oil has substantial commercial value. Mitochondria play a crucial role as organelles within plant cells; however, the mitochondrial genome of E. foetidum remains underexplored. To fill this research gap, we conducted sequencing and assembly of the mitochondrial genome of E. foetidum, aiming to uncover its genetic mechanisms and evolutionary trajectories. Our investigation reveals that the mitochondrial genome of E. foetidum is a circular structure, similar to that of other species, with a length of 241,660 bp and a GC content of 45.35%, which is within the range observed in other organisms. This genome encodes 59 genes, comprising 37 protein-coding sequences, 18 tRNA genes, and 4 rRNA genes. Comparative analysis highlighted 16 homologous regions between the mitochondrial and chloroplast genomes, with the longest segment spanning 992 bp. By analyzing 37 protein-coding genes (PCGs), we identified 479 potential RNA editing sites, which induce the formation of stop codons in the nad3 and atp6 genes, as well as start codons in the ccmFC, atp8, nad4L, cox2, cox1, and nad7 genes. Meanwhile, the genome shows a preference for A/T bases and A/T-ending codons, with 32 codons having a relative synonymous codon usage (RSCU) value greater than 1. The codon usage bias is relatively weak and mainly influenced by natural selection. Most PCGs are under purifying selection (Ka/Ks < 1), while only a few genes, such as rps7 and matR, may be under positive selection. Phylogenetic analysis of mitochondrial PCGs from 21 species showed E. foetidum at the basal node of Apiaceae, consistent with the latest APG angiosperm classification and chloroplast genome-based phylogenetic relationships. In summary, our comprehensive characterization of the E. foetidum mitochondrial genome not only provides novel insights into its evolutionary history and genetic regulation but also establishes a critical genomic resource for future molecular breeding efforts targeting mitochondrial-associated traits in this economically important species. Full article

Background: Allergic diseases in early childhood are influenced by genetic predisposition and modifiable early-life exposures, including epigenetic mechanisms. Understanding the interplay between environmental factors and allergy development in children with atopic heredity is critical for prevention strategies. Objective: To investigate the associations between selected early-life environmental exposures and the development of allergic conditions in children with a positive family history of atopy. Methods: A cross-sectional study was conducted among 120 children aged 2 years (±5 months) with atopic heredity, recruited at the Medical University of Varna, Bulgaria (2017–2020). Data on sociodemographic background, prenatal exposures, birth mode, feeding practices, pet contact, daycare attendance, and infectious burden were collected via structured questionnaires and medical records. Allergic outcomes (food allergy and atopic dermatitis) were physician-confirmed. Statistical analyses included t-tests and chi-square tests. Results: Food allergy was diagnosed in 23.3% and atopic dermatitis in 21.7% of participants. Formula feeding was significantly more common in children with food allergy (66.7% vs. 38.1%; p = 0.020). A lower maternal pregnancy experience score was significantly associated with both food allergy (p = 0.021) and overall allergic outcomes (p = 0.004). Indoor smoking was more common in households of non-allergic children (p = 0.034). Children with food allergy had significantly more rhinopharyngitis episodes (p = 0.014) and longer infection duration. Higher gastroenteritis frequency and hospitalization rates were also noted in food-allergic children. Conclusions: In children with atopic heredity, early formula feeding, prenatal maternal stress, and infection burden were associated with increased risk of allergic conditions. This study underscores the importance of early-life psychosocial and environmental influences, possibly mediated by epigenetic mechanisms, in the development of childhood allergies. These findings highlight novel targets for early prevention and warrant further longitudinal research. Full article

Marine shelled organisms exhibit diverse growth strategies shaped by species-specific traits and environmental conditions that critically influence their ecological roles, particularly within Marine Animal Forests (MAF), which are structurally complex habitats and biodiversity-rich habitats. This review compiles and compares empirical growth data for 16 bivalve and gastropod species across seven families, classified as full MAF contributors (Pinna nobilis, Flexopecten glaber, Pecten maximus, and Placopecten magellanicus), partial MAF contributors (Cerastoderma edule, C. glaucum, Chamelea gallina, Ruditapes philippinarum, Mercenaria mercenaria, Panopea generosa, Anadara kagoshimensis, A. inaequivalvis, and Tegillarca granosa), and ecologically relevant non-MAF species (Buccinum undatum, Hexaplex trunculus, and Rapana venosa). Age estimation methods included direct techniques, such as shell growth ring and opercular annulus analysis, alongside indirect approaches, such as length-frequency analysis, stable isotope profiling, and mark–recapture studies. Growth trajectories were modelled using von Bertalanffy growth function (VBGF) parameters to estimate the shell size from ages 1 to 4. Based on these estimates, species were categorised into slow, moderate, fast, and exceptional growth groups. These classifications were further explored through hierarchical clustering that grouped species according to their VBGF-derived growth values, revealing consistent and contrasting life history strategies. This comparative analysis should enhance the understanding of molluscan growth dynamics and support the conservation and management of MAF-associated ecosystems by informing restoration planning, guiding species selection, and contributing to evidence-based policy development. Full article