Search Results (7,247)

Cutaneous leishmaniasis (CL) is a vector-borne parasitic disease caused by protozoa of the Leishmania genus. Once confined to endemic regions such as the Middle East, Americas, North Africa, and Central Asia, CL is increasingly emerging in non-endemic areas due to a multitude of drivers, including population displacement, environmental disruption, and political instability. These overlapping drivers contribute to expanding sand fly habitats, degrading living conditions, and weakening health systems, increasing transmission. Rising global temperatures further facilitate vector expansion into new regions, where clinical unfamiliarity often leads to misdiagnosis, delayed treatment, increased morbidity, and greater financial burden. Despite its rising incidence and global spread, CL remains a neglected tropical disease since it is seldom fatal, with scant interest by public health authorities and financial donors, limiting activities that further research and prevent spread of the disease. This review synthesizes current evidence on how geopolitical instability, forced migration, and climate-driven ecological changes collectively reshape CL epidemiology and complicate diagnosis, treatment, and surveillance. As CL extends beyond traditional geographic boundaries, it requires integrated strategies that address its multifaceted drivers through strengthened cross-border surveillance, provider education, and international coordination—focusing on prevention, diagnosis, and equitable access to diagnostics and therapeutics, especially among displaced and underserved populations. Full article

Pregnant and postpartum people (PPPs) face heightened risk for HIV acquisition, yet depression and trauma-related symptoms can undermine adherence to pre-exposure prophylaxis (PrEP). To inform the development of a brief mental health-focused adherence intervention, we explored the impacts of depression and posttraumatic stress disorder (PTSD) symptoms on PrEP use among PPPs in Cape Town, South Africa. Twenty-eight PPPs with elevated symptoms of depression and/or PTSD and recent PrEP adherence challenges completed qualitative interviews. Six antenatal providers were also interviewed. Thematic analysis revealed three key findings with subthemes that deepen exploration of each theme: (1) depression and PTSD symptoms contributed to missed PrEP doses or late pickups by increasing doubt about PrEP efficacy, amplifying pill burden, intensifying avoidance and withdrawal (e.g., hypersomnia and disengagement from providers), and disrupting memory through rumination and emotional overload; (2) most PPPs preferred support from professional counselors, while a minority preferred informal support; and (3) intervention design considerations included aligning patient and provider goals, selecting between individual or group formats, and addressing integration barriers such as staffing and space constraints. Providers affirmed the need for embedded mental health support. Intervention strategies that increase PrEP knowledge and motivation while targeting emotional withdrawal, fatigue, and cognitive overload may improve adherence and reduce HIV risk in this population. Full article

Physical hazards are the most common source of health effects among waste recyclers, frequently leading to worker injuries. South Africa’s formal buy-back centres (BBCs) have emerged as key nodes in the recycling chain, yet the burden of non-fatal workplace injuries among BBC recyclers is not characterised. We conducted a cross-sectional study at ten BBCs in Johannesburg, enrolling 160 waste recyclers (median age 32 years; 55.6% female). A structured, interviewer-led questionnaire captured workers’ characteristics and self-reported injuries in the past six months. Robust Poisson regression was fitted to determine associations with frequent workplace injury. Overall, 69.4% of participants reported at least one injury. Cuts and lacerations (67.6%) and sprains or muscle strains (39.6%) predominated. Each additional year of age raised the risk of frequent workplace injury by 1% (adjusted relative risk [aRR] 1.01; 95% CI 1.00–1.02), each extra hour worked per day by 22% (aRR 1.22; 95% CI 1.04–1.42), and presence of hearing or vision problems by 45% (aRR 1.45; 95% CI 1.14–1.83). Targeted interventions—such as work hour regulation, sensory-friendly accommodations, and comprehensive, fit-focused PPE programs—are needed to reduce injury risk in this vulnerable workforce. Full article

Background/Objectives: Heart failure (HF) remains a major global cause of morbidity and mortality, exerting substantial health and economic burdens. Increasing evidence suggests that systemic inflammation plays a pivotal role in HF pathophysiology, with key cytokines; interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) contributing to disease progression and worsening cardiac function. This study aimed to evaluate serum levels of IL-1, IL-6, and TNF-α in patients with HF compared to control subjects, to assess differences in these inflammatory mediators between groups, and to explore their relationship with left ventricular ejection fraction (LVEF). Methods: A case–control study was conducted at the Madinah Cardiac Center between October 2024 and April 2025, including 61 patients diagnosed with HF and 65 age- and sex-matched controls without HF. Serum concentrations of IL-1, IL-6, and TNF-α were measured using enzyme-linked immunosorbent assay (ELISA). Clinical parameters, including LVEF and echocardiographic data, were recorded and analyzed. Results: Patients with HF demonstrated significantly elevated levels of IL-1 (6.77 ± 1.17 vs. 1.27 ± 0.42 pg/mL, p < 0.001), IL-6 (54.12 ± 4.64 vs. 9.29 ± 1.72 pg/mL, p < 0.001), and TNF-α (235.56 ± 18.88 vs. 67.37 ± 6.28 pg/mL, p < 0.001) compared to controls. Higher inflammatory marker levels were associated with reduced LVEF and more advanced New York Heart Association (NYHA) functional class, indicating a clear link between systemic inflammation and HF severity. Conclusions: The significant elevation of IL-1, IL-6, and TNF-α in HF patients highlights the pivotal role of inflammation in disease progression and severity, offering valuable insights into the underlying mechanisms that may inform future therapeutic strategies. By providing a comprehensive evaluation of these key pro-inflammatory cytokines in relation to LVEF, this study presents an integrated perspective on the inflammatory profile associated with HF. Full article

The health risks of PM_2.5-bound metals highlight the need for burden assessment, metal prioritization, and key factor analysis to support effective air quality management, yet relevant studies remain limited. Shandong Province is one of the most polluted regions in northern China, providing an ideal setting for this investigation. We monitored 17 PM_2.5-bound metals for three years across Shandong, China and performed disease burden assessment based on disability-adjusted life years (DALYs). Furthermore, key influencing factors contributing to high-hazard metals were identified through explainable machine learning. The results showed that PM_2.5-bound metal concentrations were generally higher in inland areas than in coastal regions, with Ni concentrations elevated in coastal areas. K, Ca, Zn, and Mn exhibited the highest three-year average concentrations among the metals, while Cr averaged 6.12 ng/m³, significantly exceeding the recommended annual limit of 0.025 ng/m³ set by Chinese Ambient Air Quality Standards. Jinan carried the greatest burden at 4.67 DALYs per 1000 people, followed by Zibo (3.78), Weifang (2.98), and Rizhao (2.80). CKD, interstitial pneumonia, and chronic respiratory diseases account for the highest DALYs from PM_2.5-bound metals in Shandong Province. Industrial emissions are the largest contributors to the disease burden (>34%), with Cr, Cd, and Pb as the primary contributing metals requiring priority control. Fractional vegetation cover was identified as the key factor contributing to the reduction in their concentrations. These results underscore that prioritizing the regulation of industrial combustion, particularly concerning Cr, Cd, and Pb, and enhancing fractional vegetation cover could reduce disease burden and provide public health benefits. Full article

Enteroviruses, a diverse genus within the Picornaviridae family, are responsible for a wide range of human infections, including hand, foot, and mouth disease, respiratory disease, aseptic meningitis, encephalitis, myocarditis, and acute flaccid paralysis. Despite their substantial global health burden and the frequent emergence of outbreaks, no specific antiviral therapies are currently approved for clinical use against non-polio enteroviruses. This review provides a comprehensive overview of the current landscape of antiviral strategies targeting enteroviruses, including direct-acting antivirals such as capsid binders, protease inhibitors, and viral RNA polymerase inhibitors. We also examine the potential of host-targeting agents that interfere with virus–host interactions essential for replication. Emerging strategies such as immunotherapeutic approaches, RNA interference, CRISPR-based antivirals, and peptide-based antivirals are also explored. Furthermore, we address key challenges, including viral diversity, drug resistance, and limitations in preclinical models. By highlighting recent advances and ongoing efforts in antiviral development, this review aims to guide future research and accelerate the discovery of effective therapies against enterovirus infections. Full article

Colorectal cancer (CRC) remains a significant global health burden. While early-stage CRC has a high survival rate, most patients are diagnosed with advanced disease, necessitating more effective and less toxic therapeutic targets. This review examines recent advancements, challenges, and future directions in targeted therapies for CRC, focusing on HER inhibitors. We assess the efficacy of monoclonal antibodies (mAbs) and tyrosine kinase inhibitors (TKIs) and explore strategies to overcome resistance mechanisms. Targeted therapies like cetuximab and panitumumab have improved outcomes for CRC patients with wild-type KRAS. However, resistance mechanisms and intra- and inter-tumour heterogeneity limit their effectiveness. Recent advancements include the development of dual TKIs, antibody/drug conjugates (ADCs), bispecific antibodies, and CAR-T cells against HER family members and other targets that are showing promise in preclinical and clinical trials. Targeted therapies have transformed CRC treatment, but more research is needed to overcome some of the current challenges, such as late diagnosis and the heterogenous nature of CRC, as well as the discovery of more reliable biomarkers for response to the therapy and patient selection. Future research should focus on identifying novel biomarkers of diagnostic, prognostic, and predictive value, developing next-generation inhibitors, drug repurposing, and combining small-molecule targeted therapies with immunotherapy. Such advances could ultimately help increase both the treatment options and outcomes for patients with CRC. Full article

Ticks are hematophagous ectoparasites capable of transmitting a wide array of pathogens. The recent proliferation and geographic expansion of tick populations have intensified concerns regarding the escalating risk of tick-borne pathogen transmission. Among these, Anaplasma phagocytophilum poses a notable threat to both public and veterinary health due to its zoonotic potential. In this study, a total of 4316 ticks were collected from 16 pasture sites near livestock farms in Gyeonggi and Gangwon Provinces, Republic of Korea, between April and October 2024. Molecular epidemiological analysis was subsequently performed. Of the 400 tick pools tested, Ixodes nipponensis accounted for two Anaplasma-positive pools, Haemaphysalis spp. larvae for two pools, and Haemaphysalis longicornis for one pool. This study is the first to examine the infection rate of A. phagocytophilum in ticks collected from pasture sites near livestock farms in Gyeonggi and Gangwon Provinces. Although the observed infection rate was low, the presence of A. phagocytophilum in regions with potential human exposure emphasizes the risk of transmission. Importantly, the detection of A. phagocytophilum in larval-stage ticks suggests the possibility of transovarial transmission, meriting further investigation. These findings underscore the need for conducting surveillance and targeted preventive strategies to reduce the burden of tick-borne diseases in livestock-associated settings. Full article

Background: Hepatocellular carcinoma (HCC) is a major global health burden and a leading cause of cancer-related deaths. While aspirin has shown potential chemopreventive effects in chronic liver disease, its impact on clinical outcomes among patients hospitalized with HCC remains under-investigated. Methods: Using the National Inpatient Sample (NIS) from 2016 to 2022, we conducted a retrospective cohort study to evaluate the association between aspirin use and clinical outcomes in adult HCC hospitalizations. Patients were stratified based on documented aspirin use, and propensity score matching with inverse probability of treatment weighting (IPTW) was applied to minimize confounding. The primary outcome was in-hospital mortality; secondary outcomes included morbidity-related complications, hospital length of stay, and total charges. Results: Among 337,730 hospitalizations with HCC, 8.37% involved aspirin use. Aspirin users demonstrated significantly lower in-hospital mortality (5.2% vs. 10.09%), with an adjusted odds ratio (OR) of 0.58 (95% CI: 0.50–0.68; p < 0.001). Aspirin use was also associated with shorter hospital stays (5.42 vs. 6.39 days), lower total charges ($80,310 vs. $95,098), and reduced incidence of complications, including acute liver failure, hepatic encephalopathy, ascites, spontaneous bacterial peritonitis, sepsis, ICU admission, and acute kidney injury. Importantly, no statistically significant increase in gastrointestinal or variceal bleeding was observed among aspirin users. Conclusions: These findings suggest that aspirin use may reduce mortality, morbidity, and healthcare burden in patients hospitalized with HCC. Full article

Hepatocellular carcinoma (HCC), the most prevalent primary liver cancer, continues to pose a significant global health burden due to its high mortality rate. In addition to genetic alterations, epigenetic aberrations, including DNA methylation, histone modifications, chromatin remodeling, and noncoding RNA (ncRNA) dysregulation, play critical roles in HCC initiation and progression. Notably, miR-375 and miR-483-5p are among the most dysregulated miRNAs in HCC, with their altered expression levels closely associated with tumor stage and patient survival. These epigenetic modifications offer promising therapeutic avenues due to their reversibility and dynamic nature. Furthermore, specific epigenetic signatures such as CDH1 promoter hypermethylation and HOTAIR overexpression are being explored as potential biomarkers for early detection and treatment response. In this chapter, we review recent advances in the epigenetic landscape of HCC and discuss their diagnostic and therapeutic implications, highlighting their potential to improve patient outcomes through personalized medicine approaches. Full article

Periodontal disease is a widespread chronic condition linked to systemic illnesses such as cardiovascular disease, diabetes, and adverse pregnancy outcomes. Despite its global burden, population-specific studies on its risk factors remain limited, particularly in Central and Eastern Europe. The SANA-biome Project is a cross-sectional, community-based study designed to investigate the biological and social determinants of periodontal disease in Romania, a country with disproportionately high oral disease rates and minimal microbiome data. This protocol will integrate metagenomic, proteomic, and metabolomic data of the oral microbiome from saliva and dental calculus samples with detailed sociodemographic and lifestyle data collected through a structured 44-question survey. This study is grounded in two complementary frameworks: the IMPEDE model, which conceptualizes inflammation as both a driver and a consequence of microbial dysbiosis, and Ecosocial Theory, which situates disease within social and structural contexts. Our aims are as follows: (1) to identify lifestyle and behavioral predictors of periodontal disease; (2) to characterize the oral microbiome in individuals with and without periodontal disease; and (3) to evaluate the predictive value of combined microbial and sociodemographic features using statistical and machine learning approaches. Power calculations based on pilot data indicate a target enrollment of 120 participants. This integrative approach will help disentangle the complex interplay between microbiological and structural determinants of periodontal disease and inform culturally relevant prevention strategies. By focusing on an underrepresented population, this work contributes to a more equitable and interdisciplinary model of oral health research and supports the development of future precision public health interventions. Full article

Background: China’s rapidly ageing population faces a double burden of social frailty (SF) and social isolation (SI), both of which accelerate functional decline and increase healthcare use. Clarifying their interplay is essential for nurses, who are often the first to assess and intervene in older adults’ social health. Method: In a cross-sectional study, 451 community-dwelling adults aged ≥ 60 years (median = 71) completed the HALFT Social Frailty Scale and the Social Isolation Scale for Older Adults. A mixed graphical model based on Spearman correlations mapped symptom-level associations between SF and SI and identified central nodes. Result: SF was present in 22.8% of participants, and the median SI score was 13 (IQR = 9–16). The strongest edge linked “inability to help others” (SF1) with reduced “face-to-face contact frequency” (SI1) (edge weight = 1.85). Central nodes were “lack of social participation” (SI2), “sense of belonging” (SI4), and “lack of someone to talk to” (SF5), indicating key points where SF and SI converge. Conclusions: The tight network connecting SF and SI suggests that nursing assessments should screen for both constructs simultaneously. Interventions that increase social participation, foster belonging, and create opportunities for reciprocal helping may mitigate both syndromes, supporting healthier ageing and reducing downstream healthcare utilization. Full article

Background: Cervical cancer remains a major global health burden, particularly in regions with limited early detection. The Loop Electrosurgical Excision Procedure (LEEP) is commonly used to diagnose and treat cervical intraepithelial neoplasia (CIN). The lymphocyte-to-monocyte ratio (LMR) is a potential biomarker for cancer risk stratification. It reflects immune function and tumor-related inflammation. Lower LMR values suggest reduced antitumor immunity and increased tumor-promoting inflammation, which are linked to cancer development and progression. This study examines relationships between preoperative LMR and histopathological outcomes after LEEP. Methods: This retrospective study included 374 patients undergoing the LEEP for cervical dysplasia. Preoperative LMR values were compared across four histopathological categories: negative, low-grade, high-grade lesions, and invasive carcinoma. The Kruskal–Wallis test assessed group differences, with Mann–Whitney U tests for pairwise comparisons. ROC curve analysis (n = 369) evaluated LMR’s diagnostic performance, and logistic regression evaluated its independent predictive value. Results: LMR significantly differed across cytological (p = 0.04) and histological groups (p = 0.036). Post hoc analysis revealed significantly lower LMR in invasive carcinoma versus low-grade lesions in cytology and for both low- and high-grade lesions in histology. ROC analysis yielded an AUC of 0.680. An LMR cutoff <4.49 showed 82.6% sensitivity and 50.0% specificity. Stricter cutoff (<3.89) increased specificity (66.8%) but decreased sensitivity (60.9%). Both had high negative predictive values (97.7% and 96.2%) but low positive predictive values (9.9% and 10.9%). Conclusions: LMR may serve as a complementary biomarker to predict higher-grade cervical lesions and help rule out invasive disease, aiding patient triage in resource-limited settings. Full article

Advancements in the medical field, particularly in cardiovascular diseases, have significantly improved the diagnosis, management, and prevention of life-threatening presentations and comorbidities. Despite this progress, cardiovascular diseases continue to place a substantial burden on healthcare systems, contributing to nearly 32% of all global deaths according to the World Health Organisation. A predominant complication arising from the treatment of cardiovascular diseases is cardiac ischaemia–reperfusion (I/R) injury, which occurs when blood supply is restored to the myocardium following a period of ischaemia, paradoxically resulting in further tissue damage. There are multiple factors involved in complex pathophysiology and complicated clinical outcomes. Although various therapeutic strategies have been explored to mitigate this injury, an optimal solution has yet to be identified. Therapeutic approaches such as pharmacological interventions and molecular therapy have shown promising prospects in this field. Ongoing research aims to address this unresolved issue, which continues to pose significant challenges for both patients and healthcare professionals. This review aims to explore the multitude of underlying mechanisms of ischaemia–reperfusion injury, and identify current knowledge gaps and new emerging therapeutic interventions. Full article

Background: Implementing effective interventions for specific cognitive symptoms is critical to reducing the disease burden of dementia. Previous studies have identified associations between overall cognitive function and dietary patterns in older adults with multimorbidity. However, the relationship between specific cognitive symptoms and different foods remains largely unknown. Methods: We included 3443 older adults with multimorbidity, aged 65 years or older, from the Chinese Longitudinal Health Longevity Survey (CLHLS, 2017–2018). We used the Chinese version of the Mini-Mental State Examination (MMSE) to assess cognitive function and selected 13 common foods to evaluate food consumption. Network analysis was used to identify central symptoms and bridge symptoms between the food consumption and cognitive symptom networks. Finally, the stability of the networks was examined using the case-dropping bootstrap procedure. Results: Network analysis revealed that B6 (mushrooms or algae), B4 (dairy products), and B5 (nut products) were the most influential in the food–cognition network model, and A5 (language ability), A1 (orientation ability), and B5 (nut products) were considered bridging symptoms in the food–cognition network. Bootstrap analysis showed that the 95% confidence interval of the edge weights in the network is narrow, indicating that this study accurately assesses the edge weights. The correlation stability coefficient of the centrality of the expected influence and bridge strength is 0.75, indicating that the network has good stability. Conclusions: Central symptoms as well as bridge symptoms play a key role in food and cognitive networks. Timely systematic and multilevel interventions targeting central symptoms and bridge symptoms may help to delay the risk of dementia in older adults with multimorbidity. Full article