Search Results (108)

Obesity is a significant public health crisis with increasing rates worldwide. Chronic kidney disease (CKD) has also emerged as a leading cause of death worldwide. This review explores the intricate connection between obesity and CKD, discussing the underlying biological mechanisms, clinical consequences of their coexistence, and strategies for evidence-based management. We conducted an extensive literature review of peer-reviewed studies examining obesity–CKD relationships, including epidemiological studies, mechanistic research, clinical trials, and meta-analyses from major medical databases. Obesity serves as both a risk factor for de novo CKD development and a paradoxical protective factor observed in some studies of advanced CKD, particularly in dialysis populations. This review synthesizes current evidence on obesity-related glomerulopathy, the impact of obesity on CKD progression to end-stage renal disease, and the phenomenon known as the “obesity paradox”. Management approaches, including lifestyle interventions, pharmacological treatments, and bariatric surgery, show varying efficacy across different CKD stages. The multifaceted relationship between obesity and CKD necessitates individualized, multidisciplinary approaches to optimize patient outcomes while addressing the unique challenges presented by this complex comorbidity. Early intervention in obese patients may prevent CKD development, while careful management is required in advanced CKD stages where the obesity paradox may confer survival benefits. Full article

Background and Objectives: Unlike previous studies that have examined telemedicine primarily in pandemic contexts, this research adopts a dual-crisis perspective, assessing perceptions during both pandemics and armed conflicts. Recent health crises, including the COVID-19 pandemic and armed conflicts, have exposed vulnerabilities in health systems and underscored the need for evidence-based strategies to enhance resilience. Telemedicine has emerged as an essential tool for ensuring continuity of care, mitigating workforce shortages, and improving access for vulnerable groups. This study examines healthcare professionals’ perceptions of telemedicine in Romania across two exceptional contexts—pandemics and armed conflict—focusing on applicability, systemic integration, and limitations. Methods: A cross-sectional descriptive survey was conducted among 409 healthcare professionals. Perceptions were analyzed using a SWOT framework and descriptive statistics (percentiles, median) to identify strengths, weaknesses, opportunities, and threats in both scenarios. Results: Perceptions of telemedicine were shaped by prior experience, with strong support for its use in both contexts. Strengths included adaptability and improved access, while weaknesses highlighted technical barriers, insufficient training, and the risk of clinical errors. Threats referred to poor coordination across facilities and cultural or language barriers. Opportunities highlighted the potential for digital infrastructure and integration into preparedness frameworks. Conclusions: Telemedicine is positioned as a strategic tool for strengthening national health resilience. Adaptive, context-sensitive policies, combined with investments in infrastructure and workforce capacity, are essential for integrating telemedicine into emergency preparedness and ensuring sustainable, inclusive responses to future crises. This dual-crisis approach represents the novelty of our study, demonstrating how telemedicine can serve as a strategic tool for resilience in both epidemiological and conflict-related emergencies. Full article

Antimicrobial resistance has emerged as one of the most critical public health challenges of the 21st century, threatening to undermine the foundations of modern medicine. In 2019, bacterial infections accounted for 13.6% of all global deaths, with more than 7.7 million fatalities directly attributable to 33 bacterial pathogens, most prominently Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Resistance mechanisms are multifactorial, encompassing enzymatic degradation, target modification, efflux pump overexpression, reduced membrane permeability, and biofilm formation, often in combination, leading to multidrug-resistant, extensively drug-resistant, and pandrug-resistant phenotypes. Alarmingly, projections estimate that by 2050 AMR could result in over 10 million deaths annually. This comprehensive review synthesizes global epidemiological data, insights into bacterial resistance mechanisms, and emerging therapeutic solutions, including novel antibiotics such as lasso peptides and macrocyclic peptides (e.g., zosurabalpin), naturally derived compounds (e.g., corallopyronin, clovibactin, chlorotonil A), and targeted inhibitors (e.g., Debio 1453 for Neisseria gonorrhoeae). Addressing the AMR crisis requires coordinated international efforts, accelerated drug discovery, and the integration of innovative non-antibiotic approaches to preserve the efficacy of existing therapies and ensure preparedness against future bacterial threats. Full article

In response to contemporary challenges such as the COVID-19 pandemic, climate change, armed conflicts, and economic instability, healthcare systems worldwide are increasingly confronted with multifaceted and overlapping crises—collectively referred to as polycrisis. These interconnected threats amplify one another, placing unprecedented strain on healthcare infrastructure, governance, and equity. The COVID-19 pandemic alone led to an estimated 16.3 million missed hospitalizations in 2020 and 14.7 million in 2021, revealing systemic vulnerabilities and deepening social inequalities. Armed conflicts, such as in Syria and Gaza, have devastated healthcare access. In Gaza, by mid-2024, 85% of the population had been forcibly displaced, with only 17 of 36 hospitals partially functioning and over 885 healthcare workers killed. Climate change further exacerbates health burdens, with over 86% of urban residents globally exposed to harmful air pollution, contributing to 1.8 million deaths annually. This study introduces a novel perspective by applying social epidemiology to the analysis of polycrisis. While the existing literature often emphasizes political or economic dimensions, our approach highlights how overlapping crises affect population health, social vulnerability, and systemic resilience. By integrating sociodemographic and environmental data, social epidemiology supports crisis-resilient care models, targeted interventions, and equitable health policies. We argue for a stronger mandate to invest in data infrastructure, enhance surveillance, and embed social determinants into health system responses. Full article

Antimicrobial resistance (AMR) has reached a critical situation globally, prompting urgent national responses to this escalating crisis, including the prioritization of novel antibiotic research. In 2016, Japan initiated a national AMR action plan that promoted appropriate antibiotic use in the country and encouraged a national environment conducive to mitigation measures. However, tackling AMR remains difficult. From an epidemiological perspective, this challenge now extends beyond severe infections, impacting common community-acquired infections, including uncomplicated urinary tract infections (uUTls) and gonorrhea. In uUTIs, the rising prevalence of extended-spectrum β-lactamase-producing and fluoroquinolone-resistant Escherichia coli diminishes the effectiveness of current, routinely used oral antibiotics, necessitating an exploration into innovative solutions. Similarly, the growing resistance of Neisseria gonorrhoeae to antibiotics such as azithromycin raises concerns about the efficacy of current therapeutic options for gonorrhea, which is a highly prevalent sexually transmitted infection. In Japan, since the removal of azithromycin as the recommended first-line treatment, there are no oral first-line antibiotics available to treat gonorrhea. Therefore, novel oral antibiotics are urgently needed for both serious and commonly occurring community-acquired infections. This narrative review discusses the limited availability of novel antibiotics in Japan, the distinctive features of the Japanese antibiotic repertoire and AMR epidemiology, and potential alternative oral treatments for community-acquired infections, including uUTIs and gonorrhea. Japan has been making significant advances toward tackling the AMR crisis through an updated national action plan, AMR policy changes, and innovative approaches to developing novel antibiotics. Substantial international cooperation and the engagement of diverse industry sectors are essential to address the pressing issue of AMR. Full article

Obesity is a global health crisis with profound implications for cancer risk, particularly within the gastrointestinal (GI) tract. Mounting evidence demonstrates that excess adiposity contributes to the initiation, progression, and poor outcomes of GI malignancies through a constellation of interrelated mechanisms. This review comprehensively examines the biologic pathways linking obesity to cancers of the esophagus, stomach, colon, liver, pancreas, and gallbladder. Chronic low-grade inflammation, driven by adipose tissue-derived cytokines and immune cell infiltration, plays a central role in tumorigenesis via the activation of NF-κB, STAT3, and other pro-oncogenic signaling cascades. Hyperinsulinemia and insulin resistance increase mitogenic IGF-1 signaling, while dysregulated adipokines, particularly elevated leptin and reduced adiponectin, promote cellular proliferation and impair tumor suppression. Dysbiosis of the gut microbiome and alterations in bile acid metabolism generate carcinogenic metabolites that contribute to DNA damage and immune evasion. Additionally, obesity-induced tissue hypoxia fosters tumor growth through HIF-1α-mediated pathways. We further highlight organ-specific associations, such as visceral adiposity’s role in Barrett’s esophagus and hepatocellular carcinoma emerging from metabolic dysfunction-associated steatotic liver disease (MASLD). Importantly, emerging data suggest that weight loss, achieved via lifestyle, pharmacologic, or surgical interventions, may mitigate these carcinogenic pathways and improve tumor biology. As obesity prevalence continues to rise globally, elucidating its mechanistic ties to GI malignancies is essential for risk stratification, prevention strategies, and personalized care. By integrating epidemiologic and molecular insights, this review underscores the need for multidisciplinary approaches to curb the oncogenic burden of obesity and improve outcomes in GI oncology. Full article

The objective of this study was to determine the epidemiological, clinical, and laboratory characteristics of newborns with sepsis in northwestern Mexico, identify the microorganisms causing early- and late-onset sepsis, and assess antimicrobial resistance. Additionally, it sought to associate neonatal characteristics with antimicrobial resistance or mortality. A retrospective study was conducted from August 2021 to April 2023, during which 8382 neonatal clinical records were analyzed to collect epidemiological, clinical, and laboratory characteristics, as well as microorganisms isolated from neonates and their antimicrobial resistance profiles. Of these, 314 neonates with sepsis were included. The incidence of neonatal sepsis was 4% (314/8382), and the mortality was 12.7% (40/314); late-onset sepsis (65.3%) was more frequent than early-onset sepsis (34.7%). Staphylococcus epidermidis was the most frequently isolated bacterium in neonates with sepsis (both early- and late-onset). Gram-positive bacteria, such as Staphylococcus hominis and Enterococcus faecium, were associated with early-onset sepsis, whereas fungi, particularly Candida albicans, were associated with late-onset sepsis. Of the microorganisms, 52.6% were multidrug resistant (MDR), 10.8% were extensively drug resistant (XDR), and 5.5% were pan-drug resistant (PDR). Low birth weight, prematurity, cesarean section, mechanical ventilation, tachycardia, and low hemoglobin and platelet levels, among others, were associated with XDR or MDR microorganisms. In contrast, low birth weight, mechanical ventilation, stroke, unexpected delivery, respiratory distress, tachycardia, convulsive crisis, high procalcitonin, urea, and AST/TGO levels, among others, were associated with mortality. The incidence, types of sepsis, antimicrobial resistance, and associations identified in this study will aid in diagnosing neonatal sepsis earlier and may reduce mortality in our region. Full article

Background/Objectives: This narrative review provided a broad synthesis of recent epidemiological trends, priority resistance mechanisms, and public health implications of multidrug-resistant (MDR) bacteria. We focused on the most clinically significant MDR pathogens, regional differences in resistance, and the effectiveness of containment strategies. Our goal was to synthesize current knowledge and propose research directions. Methods: Through comprehensive analysis of epidemiological studies, surveillance reports, clinical trials, and meta-analyses, we present a detailed assessment of the evolving landscape of antimicrobial resistance across both developed and developing nations. The review encompasses data from 187 countries, analyzing over 2500 published studies and reports from major health organizations. Results: Our findings reveal a concerning 43% increase in multidrug-resistant infections globally, with particularly sharp rises in healthcare-associated infections (67% increase) and community-acquired infections (38% increase) in regions with high antibiotic misuse. The analysis specifically focuses on critical pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL), and carbapenem-resistant Enterobacteriaceae (CRE), documenting their prevalence, transmission patterns, and treatment outcomes. Economic impact assessments indicate annual global healthcare costs exceeding USD 100 billion due to resistant infections. The review identifies significant gaps in current surveillance systems, particularly in low- and middle-income countries, and proposes standardized approaches for monitoring and containment strategies. We evaluate the effectiveness of various antimicrobial stewardship programs, documenting success rates and implementation challenges across different healthcare settings. Conclusions: The analysis concludes with evidence-based recommendations for policy reforms, research priorities, and international collaboration frameworks necessary to address this growing global health crisis. Our findings highlighted the importance of strengthening stewardship efforts, proposing novel diagnostics and therapeutic interventions, and addressing inequities in access to care and data across different countries. Full article

Objectives: The United States has been greatly impacted by the opioid overdose epidemic, and fentanyl has largely contributed to the rise in overdose deaths in the past decade. We have analyzed trends in fentanyl-related mortality amongst adolescents and young adults (AYAs) to further describe emerging trends by ethnicity, gender, and age. Methods: We used mortality data from the U.S. Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) Multiple Cause of Death file from 2009 to 2022. Drug overdose mortalities were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes. Joinpoint regression was used to examine mortality rates involving fentanyl by ethnicity (Hispanic and non-Hispanic), gender, and age category. Results: The Average Annual Percent Change (AAPC) for fentanyl-involved mortality increased for all adolescents and young adults within the United States from 2009 to 2022. The greatest AAPCs for fentanyl-related mortalities occurred amongst, Hispanic AYAs, Male AYAs, and 13–18-year-olds. Conclusions: Significant increases in fentanyl-related mortalities have occurred in AYAs from 2009 to 2022. Disparities by ethnicity and emerging trends in gender and age category highlight the need for targeted approaches to help aid in reducing fentanyl-involved mortality amongst AYAs. There is an urgent need for harm reduction and public health efforts to address this escalating crisis. Full article

This article is related to Sustainable Development Goal 3: Good Health and Well-Being and focuses on preparedness and response strategies, as well as resilient health systems capable of facing health crises. It presents the implementation and perceived effects of two student volunteering programs during the COVID-19 pandemic, underlining implications for medical education and healthcare. A cross-sectional study was performed using anonymous questionnaires among students from the University of Medicine and Pharmacy in Cluj-Napoca, Romania (April–May 2021); 51 student volunteers involved in activities from the Public Health Directorate of Cluj County (PHDCC) and 78 student volunteers involved in healthcare settings (HCSs) participated. The main reasons to become involved in volunteering activities with the PHDCC were the fact that students found the activity useful and necessary for the pandemic control (100%), an interest in helping other people (98.1%) and the need to be involved in the control of the pandemic (98.1%). Students participated in volunteering activities in hospitals, mainly to develop new medical knowledge and skills (94.8%) but also to apply the medical skills and knowledge they had (89.8%), because of the desire to help other people (88.4%) and the need to be involved in the control of the pandemic (87.1%). More than 90% of volunteers from the PHDCC reported an increase in knowledge regarding the transmission/prevention/clinical manifestations/diagnoses of SARS-CoV-2 and improved their abilities to conduct an epidemiological investigation, their communication skills and their capacity to develop and offer information/educational materials for different population groups and to make informed decisions with medical and legal consequences. Among volunteers in HCSs, the positive outcomes most frequently declared were the belief that this volunteering activity represents an important part of their future career, the opportunity to interact with people who were perceived as competent mentors and the fact that it helped them acquire new medical knowledge as well as made them feel useful. There were several differences noticed based on gender, previous volunteering experiences and volunteering position (student volunteer or student coordinator). Healthcare students might be a relevant resource in crisis situations. Full article

Background: COVID-19 presented many challenges for our health system, one being a suspected change in the epidemiology of severe hand trauma modalities. These complex injuries are traditionally treated at specialized hand trauma centers, but COVID-19 has in many ways disturbed these established pathways and presented new challenges. Methods: We retrospectively analyzed finger amputation injuries treated at the University Hospital of St. Poelten between 2018 and 2022 to examine differences in the management of micro amputation injuries before and during the COVID-19 pandemic. Further challenges in the treatment of hand trauma patients were analyzed and solutions were developed. Results: Overall, the number of occupational finger amputation injuries in Lower Austria declined during the COVID-19 pandemic. Contrarily, more private accidents were treated in the same period, suggesting a lockdown specific change in injury characteristics. Throughout the entire examined period, a total of 130 injured fingers, including 29 thumbs, were treated. In 67 cases, a reconstruction attempt was feasible and successful in 59 cases. Specific challenges were fewer active hand trauma centers, subsequent long transport times, specific COVID-19 prevention measures, and limited postoperative rehabilitation resources. Conclusions: Despite many challenges overall affecting the time to revascularization, good results were achieved by small but meaningful modifications. These included well-established principles such as back table preparation and strengthening novel concepts such as tele-medicine for patient selection. Overall, the reconstruction of severe hand injuries is often challenging, especially during a world-wide health crisis, but with adequate solutions, good results can be readily achieved. Full article

The study of contagion dynamics is a well-established domain within epidemiology, where the spread of infectious diseases is modeled and analyzed. In recent years, similar methodologies have been applied to the financial sector to understand and predict the propagation of risks within banking systems better. This paper examines the application of contagion models to assessing liquidity risk in the banking sector, leveraging optimal control theory to evaluate potential interventions by central banks. Using data from the largest European banks, we simulate the impact of central bank measures on liquidity risk. By employing optimal control techniques, we construct a model capable of simulating various scenarios to evaluate the effectiveness of policy interventions in mitigating financial contagion. Our approach provides a robust framework for analyzing the systemic risk propagation within the banking network, offering qualitative insights into the contagion mechanisms and their implications for the financial and macroeconomic landscape. The model simulates three distinct scenarios, with each representing varying levels of intervention and market conditions. The results demonstrate the model’s ability to capture the intricate interactions among major European banks, reflecting the complex realities of the financial system. These findings emphasize the critical role of central bank policies in maintaining financial stability and underscore the necessity of coordinated international efforts to manage systemic risks. This analysis contributes to a broader understanding of financial contagion, offering valuable insights for policymakers and financial institutions aiming to strengthen their resilience against future crises. The data used for the parameters are historical, which may not reflect recent changes in the banking system. The model could also be improved by incorporating non-financial factors, such as the behaviors of market actors. For future research, several improvements are possible. One improvement would be to make the bank interactions more dynamic to reflect rapid market changes better. It would also be interesting to add financial crisis scenarios to test the system’s resilience. Using more up-to-date data and incorporating new regulations would help refine the model. Finally, it would be relevant to examine the impact of external events, such as geopolitical crises, on the propagation of systemic risk. In conclusion, while the model is useful, there are several avenues for improving it and making it more suitable for our current realities. Full article

Background/Objectives: Bats are the second-largest known order of mammals, accounting for about twenty percent of the species described to date. This group has special importance in health and epidemiology because they are considered hosts of a wide range of antimicrobial-resistant human pathogens. Over the past few decades, the emergence of pathogenic bacteria resistant to antimicrobials has been a growing threat to public health, especially given its repercussions such as deaths associated with antimicrobial resistance and economic losses in the healthcare sector. Results: The diversity of antimicrobial-resistant bacteria, the different methodologies in numeric analysis, and the variety of antibiotics reported in this review make it difficult to establish the scope of the effect of bats on the antimicrobial resistance crisis. Methods: In this systematic review, we focus on the existence of antibiotic-resistant bacteria associated with bats and summarize the main findings of studies conducted on the topic to date. Conclusions: Surveillance is essential to control the emergence of resistant bacteria related to bats, which could eventually affect humans, as this is a problem of a ‘One Health’ nature, with effects on human, animal, and environmental health. Full article

The COVID-19 pandemic has exacerbated the global antimicrobial resistance (AMR) crisis. Consequently, it is more urgent than ever to prioritize AMR containment and support countries in improving the detection, characterization, and rapid response to emerging AMR threats. We conducted a prospective, multicenter study to assess the prevalence of carbapenemase-producing Enterobacterales in infectious processes in Argentina during the post-COVID-19 pandemic period and explore therapeutic alternatives for their treatment (RECAPT-AR study). Methods: A total of 182 hospitals participated by submitting Enterobacterales clinical isolates to the National Reference Laboratory (NRL) during the first three weeks of November 2021. Inclusion criteria were defined as an ertapenem MIC ≥ 0.5 mg/L, a zone diameter ≤ 22 mm. Carbapenemase genes and those coding for major extended-spectrum β-lactamases were molecularly characterized using multiplex PCR at the NRL. Antibiotic susceptibility testing followed international standards (CLSI and EUCAST). Results: The NRL analyzed 821 Enterobacterales isolates. Metallo-β-lactamase (MBL, 42.0%) and KPC (39.8%) accounted for 81.8% of carbapenemases, followed by OXA-163 (7.4%), a variant of OXA-48 with additional activity against extended-spectrum cephalosporins, and enzyme combinations (8.3%). These combinations included NDM plus KPC (3.4%), OXA-163 plus KPC (2.4%), and OXA-163 plus NDM (2.1%). Klebsiella pneumoniae was the main species recovered, representing 76% of the isolates. According to the carbapenemase classes or combinations, tigecycline exhibited a susceptibility range of 33–83%, fosfomycin 59–81%, colistin 27–78%, and amikacin 17–81%. Ceftazidime-avibactam (CZA) and imipenem-relebactam (IMR) showed 92% and 98% susceptibility against serine carbapenemases, respectively. Meanwhile, aztreonam-avibactam (AZA) exhibited 96–98% susceptibility against all carbapenemase classes. Conclusions: A new epidemiological landscape has emerged, characterized by the equivalent circulation of NDM and KPC. K. pneumoniae remains the primary species responsible for their dissemination. The co-production of carbapenemase combinations, particularly KPC plus NDM, was confirmed, mainly in K. pneumoniae. High activity was observed for AZA against MBLs and for CZA and IMR against KPC and OXA-163 carbapenemases. Full article

Background: The current economic and social crisis in Latin America has caused migration to the USA, bringing with it Public Health challenges due to the importation of various infectious diseases. Migrants, particularly those with chronic conditions, such as HIV infection and other sexually transmitted infections (STI), are at greater risk due to pharmacological interruption and access to medical care, so the timely detection of diseases acquired during their migration, such as malaria, is crucial to avoid health complications. Objective: To outline by a multidisciplinary approach (Infectology, Parasitology, Epidemiology, molecular Biology, Venereology, and Public Health) the diagnosis and management of a male case with malaria imported to Mexican territory, HIV chronic infection, and latent syphilis. Methods: A male migrant of Venezuelan nationality attended the Clínica Especializada Condesa Iztapalapa in Mexico City for health complications. A comprehensive analysis of laboratory and molecular tests was performed to confirm HIV infection. During the STI diagnostic algorithm, latent syphilis was detected and microscopic observation of blood smears revealed parasitic forms compatible with malaria. Standard and molecular tests were applied under the operational definition for malaria cases for identification, diagnosis, and treatment. Finally, study of clinical history and migration route by questioning for the investigation of the imported case was performed. Results: The immigrant was diagnosed with HIV chronic-stage infection with interrupted antiretroviral therapy (ART), latent syphilis, and malaria by Plasmodium vivax. The ART administered was chosen based on the possible drug interaction with antimalarials and genetic barrier to the HLA-B* allele. Finally, antimicrobial therapy against syphilis was penicillin. From the analysis of the migratory route, incubation time of imported malaria, and questioning, we speculated that the migrant acquired the P. vivax infection in Panama. Conclusions: This case highlights the complex health problems faced by migrants with HIV infection, particularly when they contract additional infections such as malaria during migration and highlights the need for comprehensive access to healthcare and ART, antimalarial and antimicrobial treatments to mitigate the health risks of this vulnerable population. Full article