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13 pages, 220 KiB  
Article
A Qualitative Evaluation of the Impacts of COVID-19 on Canadian Public Safety Personnel Health and Wellbeing
by Alyssa Smith, Paula M. Di Nota, Rosemary Ricciardelli and Gregory S. Anderson
Psychiatry Int. 2025, 6(2), 67; https://doi.org/10.3390/psychiatryint6020067 - 5 Jun 2025
Abstract
Public safety personnel (PSP) are known to experience difficult and demanding occupational environments, which were further complicated by the COVID-19 crisis. While public safety research typically focuses on the impact of operational stressors on PSP functioning and wellbeing, relatively less is known about [...] Read more.
Public safety personnel (PSP) are known to experience difficult and demanding occupational environments, which were further complicated by the COVID-19 crisis. While public safety research typically focuses on the impact of operational stressors on PSP functioning and wellbeing, relatively less is known about the types and impacts of organizational stressors and how all these affect social wellbeing during the pandemic. The current study surveyed Canadian firefighters (n = 123), paramedics (n = 246), and public safety communicators (n = 48) that continued to serve the public over the course of the pandemic. Participants responded to two open-ended survey questions about how COVID-19 affected their lives at work and home. Using an inductive thematic analysis approach, responses were coded to identify emergent, data-driven themes while drawing on existing theory for analysis. Across occupational groups, qualitative analyses revealed that the public safety measures imposed by the COVID-19 pandemic further exacerbated existing operational and organizational strains, including increased exposure to distressing calls, absenteeism and coping with alcohol, and a lack of support from management. Participants also identified financial strain and housing insecurity as stressors, as well as frustration and helplessness at others’ non-compliance with public health advisories and protocols. Communication surrounding the rationale behind government decision-making, the efficacy of serology tests, and rates of infection were also identified. Together, these findings offer a nuanced understanding of the interplay among operational, organizational, and social stressors experienced by Canadian PSP during the COVID-19 pandemic, illuminating their impact on mental health and wellbeing, and identifying targeted areas of focus for future planning and meaningful intervention to support PSP wellness. Full article
11 pages, 1115 KiB  
Article
Monitoring Multiple Sexually Transmitted Pathogens Through Wastewater Surveillance
by Balghsim Alshehri, Olivia N. Birch and Justin C. Greaves
Pathogens 2025, 14(6), 562; https://doi.org/10.3390/pathogens14060562 - 5 Jun 2025
Abstract
Wastewater-based epidemiology (WBE) offers a promising tool for sexually transmitted infection (STI) surveillance, especially in settings where underdiagnosis or social stigma complicates conventional reporting. To assess its utility, we conducted a year-long study examining six STIs, Chlamydia trachomatis, Treponema pallidum, Neisseria [...] Read more.
Wastewater-based epidemiology (WBE) offers a promising tool for sexually transmitted infection (STI) surveillance, especially in settings where underdiagnosis or social stigma complicates conventional reporting. To assess its utility, we conducted a year-long study examining six STIs, Chlamydia trachomatis, Treponema pallidum, Neisseria gonorrhoeae, human immunodeficiency virus (HIV), hepatitis C virus (HCV), and herpes simplex virus (HSV), in weekly composite samples from the primary influent of a small-sized Midwestern wastewater treatment plant. Pathogen detection and quantification were performed via digital PCR. Among the tested targets, Gonorrhea, HIV, HCV, and HSV were detected at the highest frequencies, often in 40–50% of the samples, while Chlamydia and Syphilis appeared less frequently. Despite the variability in detection patterns, this study demonstrates that even infrequent signals can reveal community-level shedding of poorly reported or asymptomatic infections. Although month-to-month wastewater data were not strongly correlated with corresponding clinical records, which could potentially reflect delayed healthcare seeking and pathogen-specific shedding dynamics, the overall findings underscore WBE’s ability to complement existing surveillance by capturing infections outside traditional healthcare channels. These results not only advance our understanding of STI prevalence and population shedding but also highlight the practical benefits of WBE as an early warning and targeted intervention tool. Full article
(This article belongs to the Special Issue Wastewater Surveillance and Public Health Strategies)
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11 pages, 890 KiB  
Article
Association Between Nutritional Status and Early Postoperative Infection Risk in Kidney Transplant Patients
by Elena González García, Tamara Arroyo, Mercedes Galván, María José Becerra, Margarita Gallego, Israel Mauro, Yanieli Hernández, Almudena Pérez-Torres, María Ovidia López Oliva, María José Santana and Carlos Jiménez
Nutrients 2025, 17(11), 1935; https://doi.org/10.3390/nu17111935 - 5 Jun 2025
Abstract
Malnutrition is one of the stronger predictors of morbi-mortality in end-stage kidney disease patients. Moreover, malnutrition in hospitalized patients severely affects multiple clinical outcomes, increasing the risk of complications. The Nutritional Risk Index and Geriatric Nutritional Risk Index are indexes used to evaluate [...] Read more.
Malnutrition is one of the stronger predictors of morbi-mortality in end-stage kidney disease patients. Moreover, malnutrition in hospitalized patients severely affects multiple clinical outcomes, increasing the risk of complications. The Nutritional Risk Index and Geriatric Nutritional Risk Index are indexes used to evaluate the risk of malnutrition in hospitalized adults, which have been validated for dialysis patients and have been reported to be a validated prognostic index of nutrition-related morbidity and mortality. Objectives: The aim of this study is to evaluate the prevalence of early postoperative infections and their possible relationship with malnutrition in renal transplantation. Methods: We conducted a retrospective observational study, including all patients who received a kidney transplant, a total of 140, between January 2020 and December 2023, at a tertiary-level Spanish hospital. Results: The average GNRI was 110.1 ± 11.6, equivalent to adequate nutrition, and only 16.4% of patients were at risk of malnutrition. The mean NRI was 111.4 ± 11.8, equivalent to no risk of malnutrition, and only 17.2% of patients had a moderate-to-severe risk of malnutrition. A total of 30 patients (21.4%) required oral nutritional supplementation at discharge, especially modular protein supplements (86.7%), and 52 patients (37.1%) presented an infection during their stay. The most frequent infections were urinary tract infections (69.8% of the total). Malnutrition calculated by the GNRI or NRI correlated to a longer postoperative hospital stay and a higher rate of infectious complications (p < 0.05). Conclusions: Malnourished patients have a higher risk of early postoperative complications, including infection, and a longer hospitalization stay. The evaluation of nutritional status for the diagnosis and treatment of malnutrition is strongly recommended in ESKD patients on the waiting list for a kidney transplant. Full article
(This article belongs to the Special Issue Nutrition and Metabolism in Chronic Kidney Diseases)
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11 pages, 1099 KiB  
Article
Improved RSV Neutralization Assay Using Recombinant RSV Expressing Reporter Fluorescent Protein
by Yutaro Yamagata, Michiko Toizumi, Jean-Francois Eleouet, Marie-Anne Rameix-Welti, Makoto Takeda and Lay-Myint Yoshida
Methods Protoc. 2025, 8(3), 60; https://doi.org/10.3390/mps8030060 - 4 Jun 2025
Abstract
Human respiratory syncytial virus (RSV) causes acute respiratory illness, attributing to deaths among young children and older adults worldwide. RSV neutralization assay is an important tool to measure RSV neutralization antibody that can prevent infection and severe complication of RSV. Conventional RSV neutralization [...] Read more.
Human respiratory syncytial virus (RSV) causes acute respiratory illness, attributing to deaths among young children and older adults worldwide. RSV neutralization assay is an important tool to measure RSV neutralization antibody that can prevent infection and severe complication of RSV. Conventional RSV neutralization assays have some limitations of speed and cost, especially for expensive kits, reagents or instruments required for detection. To solve this problem, this paper describes an improved simple and economical RSV neutralization assay protocol using recombinant RSV (rRSV) expressing reporter fluorescent protein to measure RSV growth as reporter activity with plate reader. The condition of 3 days culture demonstrated sufficient fluorescent activity even when small amounts of rRSV were used to inoculate Hep-2 cells. In addition, white 96-well cell culture plate showed better stable reporter activities than black plate. Furthermore, RSV neutralization assay protocol using rRSV-reporter fluorescent protein demonstrated similar signal detection capacity for RSV antibody titer detection compared to other protocols, such as rRSV-Luciferase and ELISA assay. The new RSV neutralization assay protocol can be applied to RSV antibody titration of numerous samples necessary for RSV surveillance or antiviral testing. Full article
(This article belongs to the Section Molecular and Cellular Biology)
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16 pages, 569 KiB  
Systematic Review
Diagnostic Challenges and Management Strategies of Pelvic Inflammatory Disease in Sexually Inactive Pediatric and Adolescent Patients: A Systematic Review of Case Reports
by Adrian Surd, Rodica Mureșan, Andreea Oprea, Kriszta Snakovszki, Lucia Maria Sur, Lia-Oxana Usatiuc, Carmen-Iulia Ciongradi and Ioan Sârbu
J. Clin. Med. 2025, 14(11), 3971; https://doi.org/10.3390/jcm14113971 - 4 Jun 2025
Abstract
Background and objectives: Pelvic inflammatory disease (PID), primarily associated with sexually transmitted infections (STIs), represents a diagnostic challenge in virgin pediatric patients due to the often vague, non-specific symptomatology, which can mimic other conditions. Management prioritizes targeted antimicrobial therapy, with surgical intervention reserved [...] Read more.
Background and objectives: Pelvic inflammatory disease (PID), primarily associated with sexually transmitted infections (STIs), represents a diagnostic challenge in virgin pediatric patients due to the often vague, non-specific symptomatology, which can mimic other conditions. Management prioritizes targeted antimicrobial therapy, with surgical intervention reserved for complications like tubo-ovarian abscess (TOA). The present systematic review aimed to critically evaluate the available evidence from case reports of PID in virgin pediatric and adolescent patients. Methods: The search strategy was in accordance with PRISMA guidelines. Case reports published up to March 2025 were searched through PubMed, Embase, Scopus, and Google Scholar databases. We included English-language case reports on non-sexually active pediatric and adolescent patients with available full text, excluding commentaries, reviews, and editorials. The Critical Appraisal Checklist for Case Reports was used for the quality assessment of case reports. Through descriptive analysis, PID symptoms, diagnostic, and management modalities were reviewed. The quality of the included case reports was assessed using the JBI Critical Appraisal Checklist. This review was not registered and did not receive external funding. Results: Among the 56 case reports searched, 20 reports were selected and analyzed based on eight criteria. The most frequently reported symptoms were lower abdominal pain (95.8%), fever (63.6%), and gastrointestinal symptoms (50%). Common comorbidities included urinary tract infections (22.7%), congenital anomalies (18.1%), and appendicitis history (18.1%). Escherichia coli and Streptococcus species were the predominant pathogens identified. All patients received antibiotic therapy, while 90.9% underwent surgical intervention. Favorable outcomes were achieved in 72.7% of cases, though 27.2% experienced complications or recurrences. Conclusions: Although commonly linked to sexual activity, PID should be considered in sexually inactive pediatric patients presenting with abdominal pain and adnexal masses. Early diagnosis, appropriate imaging, and timely treatment are crucial to improve outcomes and reduce complications. The evidence in this review is limited by its reliance on case reports, which may introduce bias and restrict generalizability. Full article
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25 pages, 1917 KiB  
Review
Deciphering the Complex Relationships Between the Hemostasis System and Infective Endocarditis
by Muhammad Aamir Wahab, Atta Ullah Khan, Silvia Mercadante, Iolanda Cafarella, Lorenzo Bertolino and Emanuele Durante-Mangoni
J. Clin. Med. 2025, 14(11), 3965; https://doi.org/10.3390/jcm14113965 - 4 Jun 2025
Abstract
Infective endocarditis (IE) arises from complex interactions between microbial pathogens and host hemostasis systems, where dysregulated coagulation mediates microbial persistence and systemic thromboembolic complications. Alterations in primary, secondary, and tertiary hemostasis in the acute IE phase have direct clinical implications for vegetation formation [...] Read more.
Infective endocarditis (IE) arises from complex interactions between microbial pathogens and host hemostasis systems, where dysregulated coagulation mediates microbial persistence and systemic thromboembolic complications. Alterations in primary, secondary, and tertiary hemostasis in the acute IE phase have direct clinical implications for vegetation formation and detachment. Staphylococcus aureus is one of the most common pathogens that causes IE, and it is capable of profoundly altering the coagulation cascade through several mechanisms, such as platelet activation, prothrombin activation through staphylocoagulase release, and plasminogen stimulation via staphylokinase production. Understanding these complex and yet unmasked mechanisms is of pivotal importance to promoting targeted therapeutic intervention aimed at reducing IE morbidity and mortality. Moreover, the management of antiplatelet and anticoagulant treatment during IE onset is a controversial issue and needs to be tailored to patient comorbidities and IE-related complications, such as cerebral embolism. This review provides a roadmap to promote clinicians’ understanding of the complex interactions between hemostasis and IE clinical manifestations and complications, discussing pathogen-specific coagulation profiles while addressing critical knowledge gaps for IE management. Full article
(This article belongs to the Special Issue Diagnostic and Therapeutic Challenges in Infective Endocarditis)
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11 pages, 487 KiB  
Review
Canine Distemper Virus in Mexico: A Risk Factor for Wildlife
by Juan Macías-González, Rebeca Granado-Gil, Lizbeth Mendoza-González, Cesar Pedroza-Roldán, Rogelio Alonso-Morales and Mauricio Realpe-Quintero
Viruses 2025, 17(6), 813; https://doi.org/10.3390/v17060813 - 3 Jun 2025
Abstract
Canine distemper is caused by a morbillivirus similar to others that affect livestock and humans. The increase in host range and its persistence in wildlife reservoirs complicate eradication considerably. Canine distemper virus has been reported in wildlife in Mexico since 2007. Dogs were [...] Read more.
Canine distemper is caused by a morbillivirus similar to others that affect livestock and humans. The increase in host range and its persistence in wildlife reservoirs complicate eradication considerably. Canine distemper virus has been reported in wildlife in Mexico since 2007. Dogs were previously considered the main reservoirs, but high vaccination coverage in the USA has helped control the disease, and racoons (Procyon lotor) are now recognized as the main reservoirs of the agent in the USA, since they live in high densities in urban environments (peridomestic), where contact with domestic and wildlife species is common. Racoons are now considered to spread CDV in wildlife species and zoo animals. Mexico is home to at least two wildlife species that have been reported as carriers of the CDV infection in studies in the USA. Raccoons and Coyotes are distributed in several Mexican states and could play the same reservoir role as for the US. In addition, the increase in non-traditional pets expands the availability of susceptible individuals to preserve CDV in domiciliary and peri-domiciliary environments, contributing to the spread of the disease. Combined with incomplete vaccination coverage in domestic canids, this could contribute to maintaining subclinical infections. Infected pets with incomplete vaccination schedules could also spread CDV to other canines or wildlife coexisting species. In controlled habitats, such as flora and fauna sanctuaries, protected habitats, zoo collections, etc., populations of wildlife species and stray dogs facilitate the spread of CDV infection, causing the spilling over of this infectious agent. Restricting domestic pets from wildlife habitats reduces the chance of spreading the infection. Regular epidemiological surveillance and specific wildlife conservation practices can contribute to managing threatened species susceptible to diseases like CDV. This may also facilitate timely interventions in companion animals which eventually minimize the impact of this disease in both scenarios. Aim: The review discusses the circulation of CDV in wildlife populations, and highlights the need for epidemiological surveillance in wildlife, particularly in endangered wildlife species from Mexico. Through an extensive review of recent scientific literature about CDV disease in wildlife that has been published in local and international databases, the findings were connected with the current needs of information from a local to global perspective, and conclusions were made to broaden the context of Mexican epidemiological scenarios as closely related to the neighboring regions. Full article
(This article belongs to the Section Animal Viruses)
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24 pages, 1247 KiB  
Review
Multiplexing 3D Natural Scaffolds to Optimize the Repair and Regeneration of Chronic Diabetic Wounds
by Cezara-Anca-Denisa Moldovan, Alex-Adrian Salagean and Mark Slevin
Gels 2025, 11(6), 430; https://doi.org/10.3390/gels11060430 - 3 Jun 2025
Abstract
Diabetic foot ulcers (DFU) represent a major complication of diabetes mellitus, affecting millions of patients worldwide and leading to high morbidity and amputation risks. The impaired healing process in DFU is driven by vascular insufficiency, neuropathy, chronic inflammation, and infections. Conventional treatments, including [...] Read more.
Diabetic foot ulcers (DFU) represent a major complication of diabetes mellitus, affecting millions of patients worldwide and leading to high morbidity and amputation risks. The impaired healing process in DFU is driven by vascular insufficiency, neuropathy, chronic inflammation, and infections. Conventional treatments, including blood sugar control, wound debridement, and standard dressings, have shown limited efficacy in achieving complete healing. Recent advancements have introduced novel therapeutic approaches such as stem cell therapy, exosome-based treatments, and bioengineered scaffolds to accelerate wound healing and tissue regeneration. Mesenchymal stem cells (MSCs), particularly adipose-derived stem cells (ASCs), exhibit anti-inflammatory, pro-angiogenic, and immunomodulatory properties, enhancing wound repair. Additionally, exosomes derived from ASCs have demonstrated the ability to promote fibroblast proliferation, regulate inflammation, and stimulate angiogenesis. The integration of bioengineered scaffolds, including hydrogels, hyaluronic acid (HA), or micro-fragmented adipose tissue (MFAT), offers improved drug delivery mechanisms and a controlled healing environment. These scaffolds have been successfully utilized to deliver stem cells, growth factors, antioxidants, anti-glycation end products, anti-inflammatory and anti-diabetic drugs, or antimicrobial agents, further improving DFU outcomes. This review highlights the potential of combining novel 3D scaffolds with anti-diabetic drugs to enhance DFU treatment, reduce amputation rates, and improve patients’ quality of life. While promising, further clinical research is required to validate these emerging therapies and optimize their clinical application. Full article
(This article belongs to the Special Issue Recent Advances in Biopolymer Gels (2nd Edition))
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14 pages, 384 KiB  
Article
Opioid Dependence Increases Complications and Costs Following Lumbar Spinal Fusion: Insights from a Nationwide Database
by Assil Mahamid, Lior Laver, Liad Alfandari, Hamza Jabareen, Noa Martonovich, Amit Keren and Eyal Behrbalk
J. Clin. Med. 2025, 14(11), 3929; https://doi.org/10.3390/jcm14113929 - 3 Jun 2025
Abstract
Background: Opioid dependence is prevalent among patients undergoing lumbar spinal fusion and has been linked to poor postoperative outcomes. However, its specific impact on surgical complications and hospital resource utilization remains unclear. This study evaluates the association between opioid dependence and postoperative complications, [...] Read more.
Background: Opioid dependence is prevalent among patients undergoing lumbar spinal fusion and has been linked to poor postoperative outcomes. However, its specific impact on surgical complications and hospital resource utilization remains unclear. This study evaluates the association between opioid dependence and postoperative complications, length of stay (LOS), and hospital charges in lumbar fusion patients. Methods: A retrospective analysis was conducted using the National Inpatient Sample (NIS) database from 2016 to 2021. Adult patients (aged > 18 years) who underwent lumbar fusion surgery were identified and categorized based on opioid dependence using ICD-10 codes. Propensity score weighting (PSW) was employed to balance baseline characteristics. Primary outcomes included inpatient mortality, LOS, hospital charges, and postoperative complications. Statistical analyses were performed using survey-weighted generalized linear models. Results: Among 597,455 lumbar fusion patients, 7715 (1.3%) had documented opioid dependence. After PSW, opioid-dependent patients had significantly increased odds of blood loss anemia (OR 1.79, p < 0.001), respiratory complications (OR 2.17, p < 0.001), surgical site infections (OR 3.94, p = 0.001), and cardiac complications (OR 1.53, p = 0.002). They also had higher hospital charges (mean difference USD 17,739.2, p < 0.001) and prolonged LOS (mean difference 0.83 days, p < 0.001). Differences in urinary tract infections, acute renal failure, and stroke were not statistically significant after PSW. Conclusions: Opioid dependence is associated with increased postoperative complications, longer hospital stays, and higher healthcare costs in lumbar fusion patients. These findings highlight the need for improved perioperative pain management and opioid stewardship strategies to optimize surgical outcomes. Full article
(This article belongs to the Section Orthopedics)
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15 pages, 2121 KiB  
Article
Driveline Relocation and Vacuum-Assisted Closure for Ventricular Assist Device Driveline Infections
by Mehmet Cahit Saricaoglu, Melisa Kandemir, Elif M. Saricaoglu, Ali Fuat Karacuha, Ezel Kadiroglu, Mustafa Farah Abdullahi, Mustafa Bahadir Inan, Alpay Azap and Ahmet Ruchan Akar
J. Cardiovasc. Dev. Dis. 2025, 12(6), 211; https://doi.org/10.3390/jcdd12060211 - 3 Jun 2025
Abstract
Background: Durable mechanical circulatory support (DMCS) infections remain a serious challenge. Ventricular assist device (VAD)-specific driveline infections (DLIs) are the most common type; however, no consensus exists on their surgical management. We aimed to define the incidence, risk factors, and microbiology of DLIs [...] Read more.
Background: Durable mechanical circulatory support (DMCS) infections remain a serious challenge. Ventricular assist device (VAD)-specific driveline infections (DLIs) are the most common type; however, no consensus exists on their surgical management. We aimed to define the incidence, risk factors, and microbiology of DLIs and discuss the surgical treatment modalities. Methods: We retrospectively reviewed 90 patients who underwent a left or biventricular ventricular assist device (LVAD or BiVAD) implantation with either a HeartMate 2 (Abbott), HeartWare HVAD (Medtronic), or HeartMate 3 (Abbott) in a single center between 1 March 2011 and 30 May 2023. Results: DLIs were detected in 20 (21.5%) patients during the follow-up. The mean duration of VAD support was 561.1 ± 833.2 days (1–4124 days), while it was 1277.9 ± 621.6 days in the DLI group. An extended duration of VAD support was associated with higher incidence rates of late-onset DLIs (p < 0.05). A younger age and lower plasma albumin levels were independent predictive factors for the risk of a DLI, with a hazard ratio of 9.77 (95%CI: 1.3–74.5) and 10.55 (95%CI: 1.40–79.35), respectively. The removal of the biofilm with velour and DL relocation through the rectus muscle combined with vacuum-assisted strategies (VAC) were performed in nine patients. One patient developed a recurrent infection, and another patient with a deep DLI subsequently received a heart transplant. No patient underwent a device exchange for an intractable DLI. Conclusions: Our results suggest that DLIs are common infectious complications after VAD implantation, which endanger patient autonomy, and impair their quality of life and overall survival. A DL relocation through the rectus muscles and VAC strategies have a role in controlling DLIs. Full article
(This article belongs to the Collection Current Challenges in Heart Failure and Cardiac Transplantation)
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14 pages, 1571 KiB  
Article
Diagnostic Utility of 18F-FDG PET/CT in Infective Endocarditis
by Corina-Ioana Anton, Alice-Elena Munteanu, Mihaela Raluca Mititelu, Militaru Alexandru Ștefan, Cosmin-Alexandru Buzilă and Adrian Streinu-Cercel
Microorganisms 2025, 13(6), 1299; https://doi.org/10.3390/microorganisms13061299 - 3 Jun 2025
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Abstract
Infective endocarditis (IE) as a diagnosis remains challenging, particularly in prosthetic valve endocarditis (PVE). This study evaluates the diagnostic utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in patients with suspected IE. Seventy patients with suspected IE underwent clinical, [...] Read more.
Infective endocarditis (IE) as a diagnosis remains challenging, particularly in prosthetic valve endocarditis (PVE). This study evaluates the diagnostic utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in patients with suspected IE. Seventy patients with suspected IE underwent clinical, microbiological, echocardiographic, and 18F-FDG PET/CT evaluation. Diagnostic performance of PET/CT was assessed against clinical classification based on modified Duke criteria. Definitive PVE was diagnosed in 18 patients (26%), while 52 (74%) had possible IE. PET/CT reclassified 13 patients from possible to definite IE, demonstrating an overall sensitivity of 83.3%, specificity of 93.7%, positive predictive value (PPV) of 83.3%, and negative predictive value (NPV) of 93.7%. Excluding native valve endocarditis cases, sensitivity and specificity increased to 94.1% and 95.7%, respectively. PET/CT detected septic emboli in five patients and incidental malignancies in three cases, underscoring its role in comprehensive patient evaluation. False-negative results were mostly observed in early post-surgical PVE and native valve endocarditis. PET/CT also identified alternative diagnoses in patients reclassified as rejected IE. 18F-FDG PET/CT provides high diagnostic accuracy for suspected PVE, significantly aiding reclassification of ambiguous cases and detection of extracardiac complications and malignancies. Its integration into diagnostic algorithms may improve clinical management and outcomes in complex IE cases. Full article
(This article belongs to the Section Medical Microbiology)
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13 pages, 234 KiB  
Review
Antibiotic Prophylaxis After Urethroplasty: A Review of the Literature
by Ellen M. Cahill, Hiren V. Patel, George E. Koch and Joshua Sterling
J. Clin. Med. 2025, 14(11), 3915; https://doi.org/10.3390/jcm14113915 - 2 Jun 2025
Viewed by 138
Abstract
Urethroplasty is a highly effective surgical treatment for urethral stricture disease. While overall complication rates are low, surgical site infections and urinary tract infections (UTIs) represent the most common complications. Due to the prolonged need for catheterization following reconstruction, many urologists place patients [...] Read more.
Urethroplasty is a highly effective surgical treatment for urethral stricture disease. While overall complication rates are low, surgical site infections and urinary tract infections (UTIs) represent the most common complications. Due to the prolonged need for catheterization following reconstruction, many urologists place patients on extended antibiotic prophylaxis postoperatively. However, antibiotic stewardship is important given the risks of antibiotic overuse including opportunistic infections and the emergence of multidrug-resistant organisms. There are currently no established guidelines for the management of antibiotics for patients undergoing urethroplasty, specifically with regard to postoperative prophylaxis through the time of foley catheter removal. In this review, we examine the current literature regarding antibiotic prophylaxis and urethroplasty. Research has shown no clear benefit for extended antibiotic prophylaxis in preventing symptomatic urinary tract infections or stricture recurrence. This is congruent with evidence from other urologic procedures requiring indwelling catheters and/or stents including radical prostatectomy, hypospadias repair, and pyeloplasty. Prospective, randomized trials are needed to further understand the impact of antibiotic prophylaxis on both urethroplasty outcomes and its broader impact on recurrent UTIs and microbial resistance. Full article
(This article belongs to the Special Issue Clinical Perspectives in Reconstructive Urethral Surgery)
14 pages, 952 KiB  
Article
Peripheral Prosthetic Vascular Graft Infection: A 5-Year Retrospective Study
by Giovanni De Caridi, Mafalda Massara, Chiara Barilla and Filippo Benedetto
Med. Sci. 2025, 13(2), 71; https://doi.org/10.3390/medsci13020071 - 1 Jun 2025
Viewed by 138
Abstract
Background/Objectives: Peripheral prosthetic vascular graft infection represents a very serious complication after lower limb revascularization, with amputation and mortality rates up to 70% and 30%, respectively. This study was designed to determine the incidence of prosthetic graft infection, amputation, and mortality rate in [...] Read more.
Background/Objectives: Peripheral prosthetic vascular graft infection represents a very serious complication after lower limb revascularization, with amputation and mortality rates up to 70% and 30%, respectively. This study was designed to determine the incidence of prosthetic graft infection, amputation, and mortality rate in our institution, analyzing different types of treatment. Methods: A retrospective cohort single institution review of peripheral prosthetic bypass grafts evaluated patient demographics, comorbidities, indications, location of bypass, type of prosthetic material, and case urgency and evaluated the incidence of graft infections, amputations, and mortality. Results: Between January 2016 and December 2021, a total of 516 bypasses were recorded (318 male, 198 female, mean age 74.2): 320 bypasses in venous material and 196 prosthetic bypasses using Dacron or PTFE. Among patients with a prosthetic bypass, 16 (8.2%) presented a graft infection at a mean follow-up of 39 months. Thirteen other patients who submitted to prosthetic peripheral bypass in other centers presented to our institution with a graft infection, so a total of 29 infected grafts were treated. Infected grafts were removed in 20 patients (68.9%), while a conservative treatment was helpful in nine cases (31.1%). The germs involved were Gram-negative in 27.6% and Gram-positive in 41.4%. During follow-up, we recorded five deaths (17.2%) and six amputations (20.7%) directly after bypass excision; another two amputations (6.9%) occurred after failure of the new bypass replacing the prosthesis removed. Conclusions: Redo-bypass, active infection at the time of bypass, and advanced gangrene were associated with a higher risk for prosthetic graft infection and major extremity amputation. Complete graft removal and replacement by venous material or Omniflow II represents the typical treatment. However, aggressive local treatment including drainage, debridement, vacuum-assisted closure therapy application, and muscle transposition seem to be a better solution in selected patients without the need for graft removal and with rates of limb salvage superior to those obtained with excisional therapy. Full article
(This article belongs to the Section Cardiovascular Disease)
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13 pages, 8591 KiB  
Review
IgG4-Related Disease: Current and Future Insights into Pathological Diagnosis
by Marlon Arias-Intriago, Tamar Gomolin, Flor Jaramillo, Adriana C. Cruz-Enríquez, Angie L. Lara-Arteaga, Andrea Tello-De-la-Torre, Esteban Ortiz-Prado and Juan S. Izquierdo-Condoy
Int. J. Mol. Sci. 2025, 26(11), 5325; https://doi.org/10.3390/ijms26115325 - 1 Jun 2025
Viewed by 178
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibroinflammatory condition marked by tumefactive lesions, IgG4+ plasma cell-rich infiltrates, storiform fibrosis, and obliterative phlebitis. Its multisystem involvement and overlap with malignancies, infections, and immune disorders complicate diagnosis despite recent classification advances. This study summarizes diagnostic [...] Read more.
Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibroinflammatory condition marked by tumefactive lesions, IgG4+ plasma cell-rich infiltrates, storiform fibrosis, and obliterative phlebitis. Its multisystem involvement and overlap with malignancies, infections, and immune disorders complicate diagnosis despite recent classification advances. This study summarizes diagnostic challenges, highlights the role of histopathology as per the 2019 classification criteria established by the American College of Rheumatology and the European League Against Rheumatism (ACR/EULAR), and explores emerging tools to improve diagnostic accuracy. ACR/EULAR classification emphasizes three cardinal histopathological features (storiform fibrosis, obliterative phlebitis, or dense lymphoplasmacytic infiltrates) combined with an IgG4+/IgG+ plasma cell ratio >40% and organ-specific IgG4+ thresholds. While serum IgG4 levels are often elevated, their poor specificity necessitates confirmatory biopsy. Diagnostic limitations include sampling variability due to patchy fibrosis, interobserver discrepancies in immunohistochemical interpretation, and differentiation from mimics like lymphoma. Emerging solutions incorporate novel biomarkers (plasmablasts, anti-annexin A11) and advanced techniques (flow cytometry, digital pathology). Future research directions should focus on AI-assisted pattern recognition, multi-omics profiling, and organ-specific criteria refinement. While histopathology remains the diagnostic cornerstone, a multidisciplinary approach integrating clinical, radiological, and laboratory data is vital. Innovations in biomarkers promise improved diagnostic accuracy and personalized care, balancing novel advancements with foundational pathological evaluation. Full article
(This article belongs to the Special Issue Rare Diseases: A Diagnostic and Therapeutic Challenge)
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Case Report
Diagnostic and Treatment Challenges in the Clinical Curing of MRSA Coxitis in a Tetraplegic Immunocompromised Patient: A Case Report and Literature Review
by Egle Burbaite, Julija Lebedeva, Donatas Senkanec, Meida Rimkeviciene and Danguole Vaznaisiene
J. Clin. Med. 2025, 14(11), 3887; https://doi.org/10.3390/jcm14113887 - 1 Jun 2025
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Abstract
Background/Objective: Coxitis is an inflammation of the hip joint, often resulting in pain and functional decline. It can be caused by various factors, including avascular necrosis, trauma, and infection. Methicillin-resistant Staphylococcus aureus (MRSA) poses a serious threat due to its resistance profile and [...] Read more.
Background/Objective: Coxitis is an inflammation of the hip joint, often resulting in pain and functional decline. It can be caused by various factors, including avascular necrosis, trauma, and infection. Methicillin-resistant Staphylococcus aureus (MRSA) poses a serious threat due to its resistance profile and destructive potential. To the best of our knowledge, there are limited studies on MRSA-induced purulent coxitis, specifically in patients with human immunodeficiency virus (HIV) and tetraplegia, making this case particularly valuable for expanding the understanding of this rare and complicated condition. The aim is to describe the clinical presentation, diagnostic workup, antimicrobial management, surgical intervention, and follow-up of a patient with an atypical hip joint infection. A brief literature review is also provided. Case Report: We report a case of suppurative coxitis caused by MRSA in a 38-year-old man with HIV disease and post-traumatic tetraplegia, which posed significant diagnostic and therapeutic challenges. The patient was diagnosed with MRSA bacteremia and suppurative coxitis after extensive work-up. Synovial fluid cultures were negative, likely due to previous antibiotic use. Targeted antimicrobial therapy was initiated based on blood culture and susceptibility testing. Surgical debridement and femoral head resection were performed. The patient showed progressive clinical and biochemical improvement with combined antimicrobial and surgical therapy. Conclusions: This case highlights the difficulty in diagnosing septic arthritis in patients with neurological disorders and immunosuppression, especially in the absence of classic symptoms. It emphasizes the importance of multidisciplinary care and early imaging in patients with persistent fever and unclear source of infection. Full article
(This article belongs to the Section Orthopedics)
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