Search Results (4,568)

Background: Antimicrobial resistance (AMR) is a growing global health threat, disproportionately affecting low- and middle-income countries such as Sudan. Conflict-related health system disruption has further intensified inappropriate antibiotic use and weakened stewardship capacity. Objective: This narrative review synthesizes contemporary evidence on antibiotic prescribing practices in Sudan, with emphasis on ambulatory care, and examines their implications for AMR control in the context of ongoing conflict. Methods: A non-systematic, structured narrative review was conducted successfully. PubMed, Google Scholar, WHO/EMRO databases, and Sudan’s National Action Plan (NAP) materials were examined for literature published between January 2010 and December 2025. Peer-reviewed research, government guidelines, surveillance reports, and gray literature were among the eligible sources. A total of 78 studies were included after titles, abstracts, and full texts were screened. Two reviewers independently confirmed the data extraction, and the synthesis aligned with SANRA guidelines. Results: Antibiotic prescribing in Sudan is frequently inappropriate, particularly in ambulatory and community settings, where empirical treatment, polypharmacy, and extensive use of Watch antibiotics are common. Alignment with WHO AWaRe recommendations remains suboptimal. Recent clinical and molecular evidence demonstrates increasing multidrug resistance among Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus, including ESBL production and emerging carbapenemase genes (e.g., NDM 1, IMP 1). Conflict-related disruptions—such as reduced laboratory capacity, supply chain breakdown, and unregulated community dispensing—have further accelerated AMR. Pilot stewardship interventions show promise but remain limited in scale. Conclusions: Inappropriate antibiotic use in Sudan is driven largely by ambulatory and community practices and has been exacerbated by conflict. Strengthening stewardship beyond hospitals, enforcing prescription-only regulations, operationalizing the AWaRe framework, and aligning empirical therapy with local resistance patterns are critical for mitigating AMR in Sudan and similar conflict-affected settings. Full article

In recent years, diseases caused by species of the genus Campylobacter have increased, due to improvements in identification methods, but also because, as part of global travel and trade, these species have spread to countries where no cases had previously been reported. The methodologies for their identification, whether classic through culture media and morphological characteristics, or using molecular biology or even proteomics techniques, play a fundamental role in establishing their diagnosis and providing timely treatment. Likewise, epidemiology will help guide this diagnosis when dealing with poorly defined diarrhoea, as well as the control and prevention of these infections. Similarly, expanding information on the relationship between these species and Guillain-Barré syndrome will lead to a better understanding and timely identification. We must not forget that both intrinsic and acquired antimicrobial resistance are key factors to consider for the successful treatment of infections caused by Campylobacter species. Full article

African swine fever virus (ASFV) is an evolving threat to global swine health and food security, driven by its complex epidemiology, multi-host transmission cycles, and ongoing spread across countries. This review summarizes the global scenario and transmission pathways of ASFV, highlighting the outbreaks associated with evolving risk patterns to support effective disease prevention and control. ASF has been reported in pig-producing regions across Africa, Europe, and, more recently, Asia, largely driven by the spread of genotype II strains. The virus is transmitted through direct contact with infected pigs or pig-products, indirectly via contaminated materials, and through soft ticks of the genus Ornithodoros spp., with epidemiological patterns varying according to wildlife reservoirs and regional factors. Control measures mainly rely on early detection, movement control, strict quarantine, robust biosecurity measures, and international trade regulations. Despite significant advances, persistent challenges, including the absence of a widely available commercial vaccine, long-term stability of the virus, human activities, and inconsistencies in global response capacities, continue to hinder disease eradication efforts. This review underscores the need for transnational strategies and policies that integrate economically sustainable disease management systems and reduce the long-term impact of ASFV. Full article

Healthcare cleaning services are essential for infection prevention but contribute significantly to the environmental footprint of hospital operations through the intensive use of chemicals, water, and energy. This study presents an integrated assessment of a conventional cleaning protocol (TT) and a CAM-compliant environmentally oriented protocol (GREEN, TG) in a real hospital setting (Bufalini Hospital, Cesena, Italy), combining microbiological monitoring with Life Cycle Assessment (LCA). Surface contamination was evaluated across different risk areas using standardized culture-based methods, while environmental impacts were quantified using a cradle-to-grave LCA approach, focusing on Global Warming Potential (GWP100). Both protocols achieved significant reductions in microbial load, with post-cleaning values consistently below established hygienic thresholds. No pathogenic indicator organisms were detected after cleaning, and the GREEN protocol demonstrated microbiological performance equivalent to or slightly better than the traditional system across all risk categories. LCA results revealed a substantial environmental advantage for the GREEN protocol, with a 43.7% reduction in carbon footprint (−273 g CO₂e m⁻² year⁻¹), corresponding to an annual saving of approximately 13.3 t CO₂e at the facility scale. These reductions were primarily driven by decreased chemical consumption, optimized dosing, and lower laundering temperatures. The findings demonstrate that environmentally sustainable cleaning strategies can maintain high standards of microbiological safety while significantly reducing environmental impacts. This integrated approach supports the adoption of CAM-compliant protocols in healthcare facilities and highlights the importance of combining infection control metrics with life-cycle environmental evaluation to inform sustainable procurement and hospital management practices. Full article

Background: Respiratory syncytial virus (RSV) is a serious disease in older adults and is associated with various comorbidities; however, comparative data across epidemic waves, both clinically and in terms of inflammatory profiles and their diagnostic and prognostic utility, remain limited. Methods: We conducted a retrospective study of adults hospitalized with RSV infection across two epidemic waves (2022–2023 and 2024–2025). Data on clinical characteristics, comorbidities, severity scores, and outcomes were collected, and serum interleukin-6 (IL-6), C-reactive protein (CRP), and hematological parameters were analyzed and compared with those in healthy controls. Results: A total of 152 patients were included in this study (81 in wave 1 and 71 in wave 2). Patients in wave 2 were older and had a higher burden of comorbidities, although ICU admission and in-hospital mortality were similar across waves. RSV induced a consistent systemic inflammatory response in both waves, characterized by elevated IL-6 and CRP levels, neutrophilia, lymphopenia, and increased neutrophil-to-lymphocyte ratios, with no relevant inter-wave differences. All biomarkers demonstrated good diagnostic performance. The neutrophil-to-lymphocyte ratio showed the highest accuracy, while IL-6 exhibited high rule-in capacity. However, none of the evaluated biomarkers were associated with disease severity or mortality. Conclusion: RSV infection in older adults is associated with a similar inflammatory profile across waves. Although biomarkers showed strong diagnostic utility, they did not show any significant prognostic discrimination in this cohort. We suggest that disease severity is primarily associated with host-related factors, particularly comorbidities, rather than with differences in the inflammatory response, highlighting the need for improved preventive and risk-stratification strategies in this population. Full article

Background: Tacrolimus is currently the most commonly used immunosuppressive agent after liver transplantation, administered to prevent allograft rejection, but it is also associated with numerous adverse effects. Purpose: The aim of this review was to summarize the most clinically relevant and well-documented adverse effects of tacrolimus after liver transplantation, focusing on their mechanisms, clinical presentation, approximate incidence, and overall clinical significance. Methods: We searched the PubMed and Medline databases and included articles, randomized controlled trials, cohort studies, review articles, and case reports published between 2016 and 2026. Results: The most common causes of morbidity in the early days following liver transplantation and initiation of tacrolimus therapy are acute nephrotoxicity, systemic infections, and signs of neurotoxicity. In the majority of patients, these manifestations resolved after dose reduction or complete discontinuation of the drug. During the early post-transplant period, opportunistic infections were the main cause of morbidity, with bacteria being the most frequent pathogens, while mortality in certain fungal infections reached up to 50%. While acute toxicities are primarily influenced by drug dose, long-term use of tacrolimus, regardless of dose, can lead to the development of malignancies, metabolic disorders, cardiovascular diseases, and chronic kidney disease, with incidence estimates varying widely. Conclusions: Consistent monitoring of patients on tacrolimus is crucial to ensure maximum therapeutic benefit and to reduce the risk of associated adverse effects. Full article

Background: Peptides are promising tools in medicine for viral, bacterial, and parasitic infections. MAP1 and MAP2 are peptides with antimicrobial activity. Aiming to increase selectivity, enhance antimicrobial activity, and reduce its cytotoxicity, two bioconjugates (GVL1-MAP2 and GVL1-MAP1) with the guanidine derivative group in the N-terminus position were synthesized. Methods: The peptides and bioconjugates were synthesized by SPPS. The biological activity and inhibition of the CPB enzyme were evaluated. Results: Antileishmanial activity was evaluated, and the bioconjugates exhibited higher activity in both the promastigote and amastigote forms than isolated GVL1 and peptides alone. Discussion: GVL1-MAP2 bioconjugate demonstrated not only the greatest activity against L. amazonensis in the promastigote (IC₅₀ = 3.2 μM) and amastigote (IC₅₀ = 0.6 μM) forms but also prevented the parasite from infecting new host cells, reducing the infection rate by 3-fold compared to the untreated control. Similar results were obtained in L. infantum, with IC₅₀ = 2.5 and 1.0 μM for promastigote and amastigote forms, respectively. In active serum, GVL1-MAP2 continued to show high activity. GVL1-MAP2 also showed bactericidal activity against most strains tested. The bioconjugate GVL1-MAP2 showed lower cytotoxicity than GVL1-MAP1 and amphotericin B in macrophages. Permeabilization studies and enzyme inhibition revealed that the peptide acts via at least two distinct mechanisms, with the primary mechanism targeting the membrane and inner targets as an inhibitor of the CPB enzyme. Conclusions: These data demonstrated that the synthesis of bioconjugates can be a tool for the development of bactericidal and antileishmanial compounds with improved potency and selectivity. Full article

Background/Objectives: Primary cytoreductive surgery for advanced ovarian cancer is associated with a high risk of postoperative complications, particularly surgical site infections, which may delay recovery and adjuvant treatment. This study aimed to evaluate the impact of a revised infection-prevention bundle, centered on chlorhexidine-alcohol skin antisepsis, on surgical site infection rates and cost-effectiveness. Methods: In this single-center cohort study, 636 patients undergoing primary cytoreductive surgery between January 2019 and December 2023 were included. A historical control group (n = 300) received povidone-iodine for intraoperative skin preparation, while a prospective intervention group (n = 336) received chlorhexidine gluconate 2% in 70% isopropyl alcohol. Both groups were managed within a standardized perioperative care pathway. Surgical site infections within 30 days were defined according to established criteria. Comparative and descriptive statistical analyses were performed. Results: Baseline clinicopathological characteristics were comparable between groups. The overall surgical site infection rate was significantly lower in the chlorhexidine-alcohol group compared with the povidone-iodine group (8.3% vs. 14.0%; p = 0.0226). The reduction was particularly evident in procedures lasting more than 180 min (9.5% vs. 17.1%; p = 0.0199), while no significant difference was observed in shorter procedures. Cost analysis demonstrated a net saving of approximately EUR 451 per procedure in the chlorhexidine group, driven by reduced infection-related costs and improved operating room efficiency. Conclusions: Baseline clinicopathological characteristics were comparable between groups. The overall surgical site infection rate was significantly lower in the chlorhexidine-alcohol group compared with the povidone-iodine group (8.3% vs. 14.0%; p = 0.0226). The reduction was particularly evident in procedures lasting more than 180 min (9.5% vs. 17.1%; p = 0.0199), while no significant difference was observed in shorter procedures. Cost analysis demonstrated a net savings of approximately EUR 451 per procedure in the chlorhexidine group, driven by reduced infection-related costs and improved operating room efficiency. Full article

During 2022–2024, a highly pathogenic avian influenza virus (HPAIV) H5N1 strain, designated A/Seagull/Hebei/qhd6/2024 (H5N1), was isolated from migratory birds in Beidaihe National Wetland Park, North China. Phylogenetic analyses revealed that its hemagglutinin (HA) gene belongs to the 2.3.4.4b clade, while the neuraminidase (NA) gene and internal genes clustered with strains originating from multiple continents, consistent with a transcontinental reassortment event. The virus also exhibited 90.1–98.1% nucleotide homology with human-derived H5N1 isolates. Molecular characterization identified key virulence-associated mutations, including the classic HPAIV HA cleavage site, HA-T160A (associated with enhanced human receptor-binding capacity), and NA-I117T (potentially linked to drug resistance). BALB/c mouse infection experiments confirmed systemic replication and high pathogenicity of strain qhd6, with a 50% lethal dose (LD50) of 0.95 log₁₀EID₅₀/mL. Antigenic analysis revealed good cross-reactivity with the widely used H5-Re14 vaccine strain. This study reports the identification, in Beidaihe National Wetland Park, of an HPAIV H5N1 strain whose genetic characteristics suggest intercontinental reassortment and indicate cross-species transmission risk. It clarifies the genetic characteristics and pathogenicity of this strain, providing an important theoretical and practical basis for precise surveillance, risk early warning, and comprehensive prevention and control of AIV at migratory bird stopover sites in North China. Full article

Bovine viral diarrhea virus (BVDV), a significant global pathogen threatening cattle industries worldwide, presents substantial challenges for disease control. Its ability to infect cattle across all age groups, coupled with incompletely understood transmission mechanisms, complicates prevention and treatment strategies. We previously reported that BVDV induced tunneling nanotubes (TNTs)—F-actin-rich cytoplasmic connections between adjacent cells—and utilizes these structures for intercellular transmission. In this study, we used lentiviral transfection to express various structural and non-structural proteins of BVDV and identified NS5A as a critical viral protein that induces the formation of TNTs. RNA-seq analysis revealed that CKAP2, a host protein, plays a key role in TNT generation, with the PI3K/AKT/mTOR signaling pathway being essential for this process. Further investigation demonstrated that CKAP2 interacts with BVDV NS5A, triggering the activation of the PI3K/AKT/mTOR pathway, thereby promoting TNT formation and enhancing viral dissemination. Our data highlight a previously unknown mechanism of BVDV spreading and replication, which could have significant implications for within-host spread and immune evasion. Full article

Triplophysa siluroides, a unique species of plateau fish, holds significant economic value. However, its natural population has sharply declined due to overfishing and the construction of water conservancy projects. Investigating the various conditions necessary for its growth is a crucial prerequisite for successful artificial breeding. This study used Edwardsiella tarda as the pathogenic bacterium to determine the median lethal concentration following infection of T. siluroides, as well as to examine changes in tissues, organs, and gene expression. The study found that dead T. siluroides displayed symptoms such as abdominal distension, fluid accumulation, and a reddened anus, and the median lethal concentration of E. tarda for T. siluroides was calculated to be 1.00 × 10⁶ CFU/mL. Following infection with E. tarda, the liver, intestine, gills, spleen, and kidneys exhibited varying degrees of lesions. Transcriptome sequencing identified a total of 54,667 genes. Compared to the blank control group, 192 genes were downregulated and 125 genes were upregulated in T. siluroides infected with E. tarda. In contrast, after infection with the poly(I:C) viral mimic, 225 genes were downregulated and 436 genes were upregulated. This study determined the median lethal concentration of E. tarda for T. siluroides via intraperitoneal injection under laboratory conditions. The results may contribute to disease prevention and control in the breeding of T. siluroides, as well as inform future risk assessments of infection in aquaculture water bodies. Full article

Background: Metabolic and bariatric surgery is an established therapeutic option for severe obesity and obesity-related medical problems. Although minimally invasive techniques and enhanced recovery pathways have reduced postoperative morbidity, infectious complications remain clinically relevant because they may lead to readmission, reoperation, prolonged antimicrobial therapy, and mortality. Methods: We conducted a narrative review of the literature on infectious complications after metabolic and bariatric surgery. Evidence was synthesized across five clinically relevant domains: host-related pathophysiology, microbial epidemiology, preoperative optimization, antimicrobial prophylaxis and pharmacokinetic considerations, and diagnosis and management of postoperative infectious complications. Results: Patients with obesity present specific infection-related vulnerabilities, including chronic low-grade inflammation, altered immune responses, impaired tissue oxygenation, obesity-related medical problems, and procedure-specific risks. Contemporary prevention relies on multidisciplinary preoperative optimization, appropriate skin antisepsis, weight-based antimicrobial prophylaxis, intraoperative redosing when indicated, and adherence to enhanced recovery principles. Anastomotic leaks and intra-abdominal abscesses represent the most severe organ/space infections and require early recognition, source control, antimicrobial therapy, nutritional support, and coordinated surgical, radiological, and endoscopic management. Conclusions: Infectious complications after metabolic and bariatric surgery result from the interaction between host physiology, microbial factors, pharmacological considerations, and surgical technique. A structured approach integrating prevention, early diagnosis, and multidisciplinary management may improve outcomes. Further bariatric-specific studies are needed to strengthen the evidence base for several preventive and therapeutic strategies. Full article

In this study, a fractional-order epidemic compartmental model is formulated using the Caputo derivative to account for the memory effects of the chikungunya virus. Based on Banach contractions, fixed-point theorems are used to prove existence and uniqueness, and fundamental properties such as positivity and boundedness are established. Normalized forward sensitivity indices are employed to evaluate the relative impact of model parameters on the transmission dynamics and control of the disease. To reduce the spreading of infection, an optimal control problem is formulated by introducing time-dependent control measures with four control strategies that include public health prevention, treatment enhancement, and vector-control measures. Necessary conditions for optimality are derived using Pontryagin’s Maximum Principle. The predictor–corrector Adams–Bashforth–Moulton scheme is applied across different fractional orders and effectively reduces infection levels. The influence of the fractional order $\xi$ on the epidemic dynamics is investigated, showing that lower values of $\xi$ slow disease progression through a memory effect inherent in the Caputo operator. Moreover, an artificial neural network (ANN) trained via the Levenberg–Marquardt algorithm independently validates the numerical solutions. Full article

Background/Objectives: The impact of postnatal CMV infection in extremely premature newborns is poorly characterized. We aimed to determine the impact and outcomes of postnatal CMV infection in a population of extremely premature newborns of gestational age of less than 29 weeks hospitalized in the Department of Perinatology, Division of Gynecology, University Medical Center Ljubljana. Methods: We included all extremely premature newborns of gestational age of less than 29 weeks treated in the Department of Perinatology between December 2022 and December 2024. Newborns were screened for CMV infection at set timepoints and congenital infection was excluded with PCR testing. Additional PCR testing for CMV was performed if newborns developed clinical features suspect for postnatal CMV infection. Clinical characteristics and treatment outcomes of newborns were noted. Mothers of infected newborns had their CMV serostatus determined. Results: In total, 63 extremely premature newborns were included, and 14 newborns had confirmed postnatal CMV infection. Postnatal CMV infection was associated with hepatosplenomegaly and lower platelet and leukocyte counts compared to controls. We found no association between postnatal CMV infection and other neonatal comorbidities. Conclusions: In our study, postnatal CMV infection was associated with a more severe and prolonged clinical course of extremely premature newborns compared to uninfected controls; however, in multivariable analysis, the association with a prolonged length of stay was no longer statistically significant. The results suggest that preventing postnatal CMV infection in this population is important. Full article

Background/Objectives: Term and preterm premature ruptures of membranes (PROM and PPROM) are serious pregnancy complications associated with adverse maternal and neonatal outcomes. Although widely studied in the global literature, data on the risk factors and outcomes of PROM and PPROM in the Middle East and North Africa (MENA) region remain limited. This mapping review aimed to identify and assess existing evidence and highlight gaps in knowledge regarding risk factors for PROM, including preterm PROM, and related maternal and neonatal outcomes among women in the region. Methods: We conducted a comprehensive and systematic search of articles published in English and Arabic between January 2000 and June 2025 across Scopus, Embase, Web of Science, and PubMed/Medline. Eligible studies included observational and interventional studies conducted in MENA countries. Data were extracted and synthesised using thematic mapping. Results: Out of 5359 retrieved records, 136 met the inclusion criteria. The main study design was cross-sectional (51 studies), followed by case–control (41), cohort (26), and 15 randomised controlled trials. The geographic distribution of the evidence varied significantly. Research has mainly focused on PROM and its biological risk factors, such as infections and chronic medical conditions. Psychological and environmental factors have been the least reported. Neonatal and gestational outcomes have frequently been addressed, whereas maternal outcomes have received less attention. Conclusions: The findings reveal significant geographic, thematic, and methodological disparities in research throughout the MENA region. The results underscore the need for further studies on the prevention and identification of women at higher risk of PROM. Full article