Search Results (6,983)

Tuberculosis remains a serious infectious disease that causes over 1.3 million deaths annually. Following the COVID-19 pandemic, the global incidence of tuberculosis has increased to 10.8 million cases. Pregnant women represent a particularly vulnerable population requiring tailored approaches to the prevention, diagnosis, and treatment of tuberculosis. SARS-CoV-2 infection may have impacted existing clinical protocols. Implementing updated methods of tuberculosis prevention, diagnosis, and treatment in pregnant women could help reduce adverse maternal and fetal outcomes. The aim of this review was to explore potential modifications in tuberculosis management among pregnant women in the post-COVID-19 era, including co-infection with SARS-CoV-2. Methods: A review was conducted, incorporating a systematic literature search across major international databases, including Medline, PubMed, Web of Science, Scopus, and Google Scholar. The search covered publications released between December 2019 and September 2024 and used targeted keywords such as “COVID-19” OR “SARS-CoV-2”, “tuberculosis” OR “TB” OR “latent tuberculosis infection” OR “pulmonary tuberculosis”, and “pregnancy” OR “pregnant women”. Results: Pregnant women living with HIV are at increased risk of developing tuberculosis, which can negatively affect both maternal and perinatal outcomes. Screening for tuberculosis is recommended for all HIV-positive pregnant women, even in the absence of clinical symptoms. Notably, immunological testing before and during pregnancy facilitates the timely and safe detection of tuberculosis infection, enabling preventive and therapeutic interventions during any stage of gestation and the early postpartum period, for the benefit of both mother and child. Drug–drug interactions play a significant role in tuberculosis management, both among anti-tuberculosis agents and with medications for comorbid conditions. Current knowledge of the pharmacokinetics and pharmacodynamics of antituberculosis agents, coupled with therapeutic drug monitoring, supports the development of individualized and effective treatment regimens, which are particularly critical for pregnant patients. Recommendations for managing tuberculosis in pregnant women after COVID-19 infection include measuring D-dimer levels, performing echocardiography, and consulting cardiologists to prevent treatment-related complications. Conclusions: Pregnant women represent a distinct subgroup of tuberculosis patients requiring individualized management. Changes observed in tuberculosis progression and treatment responses in pregnant women before and after SARS-CoV-2 infection should inform therapeutic choices, especially in cases of drug-resistant tuberculosis treated with bedaquiline. COVID-19 has been associated with increased cardiovascular risk, which may heighten the likelihood of adverse drug reactions in this population, especially given the limited therapeutic options. Further research is required to assess the long-term outcomes of latent tuberculosis infection in pregnant women and to evaluate the safety and efficacy of novel regimens for drug-resistant TB during pregnancy. Full article

Background/Objectives: In patients with metastatic castration-resistant prostate cancer (mCRPC) and osseous metastases only, ²²³Radium therapy represents a valuable therapeutic option. Bone scintigraphy (BS) is typically performed to assess metastasis load, with the BS-derived automated bone scan index (aBSI) used for response assessment. This study aimed to evaluate the prognostic value of aBSI in patients receiving three or six cycles of ²²³Ra therapy. Methods: We included patients that were diagnosed with extensive osseous tumor load on BS, had no visceral or nodal metastases, had undergone ²²³Ra therapy. The aBSI prior to and following three or six cycles of therapy, total tumor volume (TTV), SUV_max, and overall survival were analyzed. Results: This study included 49 mCRPC patients (mean age: 70 ± 9 years) with 42 (85.7%) receiving six and 7 (14.3%) receiving three cycles. After three cycles, the mean aBSI (p = 0.369), TTV (p = 0.902), and SUV_max (p = 0.149) remained unchanged. After six cycles, the mean aBSI (p = 0.247) and TTV (p = 0.784) were unchanged, while SUV_max decreased significantly (p = 0.001). The aBSI did not significantly correlate with the mean aBSI (six cycles: χ² = 1.823, p = 0.177; three cycles: χ² = 0.308, p = 0.579). Conclusions: Although quantitative changes in TTV and aBSI did not significantly correlate with each other, their respective absolute values consistently indicated stable disease burden under therapy. This highlights its potential as a useful tool for monitoring disease burden while indicating that aBSI alone is insufficient for predicting overall survival. Full article

Background: Refractory epilepsy refers to a type of epilepsy in which anti-epileptic medications do not yield results, necessitating alternative medical interventions. The ketogenic diet (KD) is utilized as a non-pharmacologic treatment for refractory epilepsy. This study aims to assess details regarding caregivers’ awareness and practices, challenges faced, and other details regarding the KD as a treatment option for children with refractory epilepsy. Methods: A cross-sectional study included 15 caregivers of children with refractory epilepsy who adhere to the KD. Data were collected using an online, self-administered questionnaire including socio-demographic characteristics and descriptive aspects of KD on 15 caregivers. Results: Caregivers’ awareness scores varied, over half of the caregivers (53.3%) demonstrated low awareness levels, scoring below the midpoint on the awareness scale, while both caregivers’ adherence (t value = 31.5; p < 0.001) and patients’ adherence levels (t value = 26.1; p < 0.001) significantly exceeded the minimum expected thresholds, indicating effective implementation of the diet protocols. Challenges faced by caregivers were categorized as follow: logistical challenges (e.g., issues related to KD availability, cost, and weighing (15.6%)), behavioral challenges (e.g., avoiding prohibited foods (18.8%), feelings of hunger, the social environment, and never eating without caregivers), and medical challenges (e.g., frequent blood glucose monitoring (25%)). The most common side effects of the KD were gastrointestinal symptoms, including constipation (33.3%) and gastroesophageal reflux disease (GERD). Physical symptoms such as dyslipidemia were also reported by 13.3% of participants. In terms of neurological and behavioral improvements, the three most reduced symptoms following KD adoption were hyperactive attention deficit (25%), tremors (20%), and insomnia (20%). Conclusions: This study reveals a significant gap between high adherence and low awareness of the KD among caregivers of children with refractory epilepsy. While adherence is crucial for the success of KD, this discrepancy highlights the need for comprehensive caregiver education that not only focuses on practical implementation but also on the underlying rationale of the diet. This study underscores the importance of multidisciplinary support, by including dietitians, to bridge the knowledge gap. These findings suggest that dietary education programs should aim to improve caregivers’ understanding, ultimately enhancing adherence and long-term outcomes. Future research should explore the psychosocial factors influencing adherence and the role of trust in healthcare professionals in shaping caregiver behaviors. The findings also call for further exploration into the impact of caregiver education on child health outcomes in the long term. The varied knowledge among caregivers indicates a need for further educational interventions or increased visits from dietitians. Strategies need to be framed to overcome the challenges faced and improve adherence. Full article

The present study aimed to systematically review the anxiolytic and analgesic effects of gabapentin and pregabalin in domestic cats to assess the quality of using these medications for stress, fear, and anxiety management, and the treatment of both acute and chronic pain. The search was carried out between March and May 2025 using four databases: PubMed, Scopus, ScienceDirect, and Google Scholar. The keywords used were the combination of “pregabalin,” “gabapentin,” “analgesia,” “anxiety,” “stress”, and “cats”. Narrative reviews, as well as experimental and observational studies, were included. Experimental studies were classified as randomized controlled trials, controlled clinical trials, and prospective clinical trials, using the GRADE Pro GDP software (FP7-HEALTH.2010.3.1-1-two stage) to assess the certainty and confidence of the evidence. The initial search identified 57 manuscripts, of which 40 met the inclusion criteria. These studies focused on the management of stress, fear, and anxiety, as well as the control of acute and chronic pain in cats. Of these, 21 mention the use of gabapentin as an anxiolytic, while five report similar therapeutic effects of pregabalin. Regarding pain treatment, 12 papers and 2 papers support the use of gabapentin and pregabalin, respectively. This study confirms the validity of both drugs as therapeutic options for the management of stress, fear, and anxiety that impact the emotional welfare of cats. Furthermore, these drugs have been included in therapeutic guidelines for the control and treatment of acute and chronic pain in domestic cats. In conclusion, this systematic review supports the use of both drugs. Still, it highlights the need for more in-depth research and additional clinical trials to complement the existing evidence on the use of gabapentin and pregabalin. Full article

Background: Pneumonectomy is a major surgical option for non-small cell lung cancer (NSCLC). This study evaluates the predictive value of three-dimensional computed tomography (3D-CT)-based lung volume analysis for postoperative function and explores its potential role in preoperative planning, risk assessment, and surgical decision-making. Methods: We evaluated 59 NSCLC patients who underwent pneumonectomy. Pre- and 12-month postoperative spirometry results were compared with anatomical and 3D-CT-based predictions. Residual lung expansion was calculated, and patients were grouped by a 3D-CT-derived volume ratio of ≥1.2 or <1.2. Results: There was a significant correlation between 3D-CT-based predicted FVC and FEV1 and postoperative spirometric values (p < 0.001). The mean residual lung volume expansion ratio was 1.23. Patients with a ratio ≥1.2 had significantly higher postoperative FVC (p = 0.028). Lung expansion was observed in 81.4% of cases. Predicted postoperative FVC (p = 0.023) and FEV1 (p = 0.013) were significantly higher in patients with left pneumonectomy compared to right. Conclusions: 3D-CT-based lung volume calculation reliably predicts postoperative function and matches conventional methods. Contralateral lung expansion positively affects respiratory outcomes. Additionally, 3D-CT analysis supports preoperative planning and risk assessment, contributing to more accurate diagnosis and surgical decisions in NSCLC management. Full article

Background/Objectives: Burn wound infections present significant clinical challenges due to multidrug-resistant pathogens and the limitations of traditional antimicrobials. While antimicrobial peptides (AMPs) have broad-spectrum effectiveness, their instability in wound environments limits their use. This study compares properties of AMP-decorated nanostructured lipid carriers (NLCs) to free AMPs, focusing on their dermal penetration, retention, and antimicrobial efficacy in simulated ex vivo burn wound models. Methods: AMP-decorated NLCs (smart-AMPs) were produced by electrostatic and hydrophobic surface adsorption and characterized regarding their size, zeta potential, and physical short-term stability. The distribution of AMPs within the wounds was evaluated using an ex vivo porcine ear model with various wound types. The antimicrobial efficacy was assessed by monitoring the bioluminescence of Aliivibrio fischeri as a live bacterial marker for 24 h. Results: The size and zeta potential measurements confirmed the successful formation of smart-AMPs. The dermal penetration of AMPs was influenced by the type of wound and the type of AMP formulation (free AMPs vs. smart-AMPs). In the chronically infected burn wounds, which were characterized by the formation of a biofilm in a protein-rich wound fluid, the smart-AMPs resulted in a 1.5-fold higher and deeper penetration of the AMPs, and the antimicrobial activity was 6-fold higher compared to the free AMPs. Conclusions: smart-AMPs present an innovative approach for treating chronic, biofilm-associated wounds more efficiently than the current treatment options. Full article

Background and Objectives: Minimally invasive distal metatarsal osteotomy (DMMO) has established itself as an effective surgical technique for the treatment of metatarsalgia, notable for its reduced postoperative pain and faster recovery. However, doubts remain regarding the frequency and nature of postoperative complications. The objective of this systematic review and meta-analysis was to evaluate the incidence of the most frequent complications associated with the DMMO technique, including prolonged edema, delayed bone healing, transfer metatarsalgia, floating toe, and persistent pain. Materials and Methods: A systematic review was conducted following the PRISMA 2020 guidelines, with the protocol registered in the PROSPERO database (CRD420251067666). Searches were conducted in the PubMed, Scopus, and Web of Science databases, including clinical studies published between 2010 and 2025. The inclusion criteria covered studies in adults treated with DMMO and reporting postoperative complications. The methodological quality assessment was performed using Joanna Briggs Institute (JBI) tools according to the design of each study. Random-effects models were used for the meta-analyses, assessing heterogeneity using the I² statistic. Results: Fifteen studies with a total sample of more than 493 patients were included. Prolonged edema was the most common complication (30.91%), followed by delayed bone healing (14.9%), transfer metatarsalgia (12.73%), floating toe (10.45%), and persistent pain (8.5%). Less frequent complications included nonunion, infections, necrosis, and bone misalignments. The combined incidence of floating toe was 40% (I² = 0%), while prolonged edema showed considerable heterogeneity (I² = 88.3%). The overall quality of the evidence was considered moderate to low, mainly due to the predominance of observational studies. Conclusions: The DMMO technique represents a minimally invasive surgical option with generally favorable results. However, some complications, such as prolonged edema and floating toe, have a significant incidence. The methodological variability between studies highlights the need for standardized protocols and higher-quality prospective studies to establish the safety profile of this technique more accurately. Full article

Background: Arterial hypertension (HTN) is the leading modifiable cardiovascular risk factor for overall mortality worldwide. In Austria, 1.6 million individuals above the age of 15, representing 20% of the total population and 70% of adults aged 65 and older, suffer from HTN. Despite numerous antihypertensive treatment options on the European market, only 38.8% of patients on optimal medical treatment (OMT) reach their treatment goal. Primary prevention remains a challenge, particularly for HTN and the consequential risk of cardiovascular diseases (CVDs). Thus, there is an urgent need for Disease Management Programs (DMPs). We sought to study a possible trial to diagnose hypertension in a non-medical setting at a very early stage of the disease and raise awareness for hypertension in affected people to avoid future complications of unrecognized and untreated HTN. For a non-medical setting, hairdressers fulfil many criteria for an optimal blood pressure (BP) measurement. Methods: This is a pilot study. A total of 193 individuals were included at a Viennese hairdresser. Metric data were described either using mean ± SD given normal distribution or median otherwise. Categorical data were described using absolute frequencies and percentages. For comparison, either independent t-tests or Mann–Whitney U tests or chi² tests were assessed. The staff received expert training on how to measure blood pressure in a guideline-compliant way. All members signed the written and informed consent and received a questionnaire about their demographic data and cardiovascular risk factors. Results: Of the 193 participants in this study, 56.5% (109/193) were female and 43.5% (84/193) were male. The mean age was 54 ± 15.1 years. In the automatically measured office blood pressure (AOBP) measurement, the mean systolic BP was 137.1 ± 17.8 and the mean diastolic BP was 91.6 ± 11.2. Of all participants, 65.8% (127/193) were hypertensive, whereof 74.8% (95/127) had no treatment at all. Among 127 individuals evaluated, 63% (80/127) were unaware of their elevated blood pressure levels, while 28% (44/127) had a prior diagnosis of HTN. The control rate of the individuals with previously diagnosed HTN was very low, with only 18.5% [10.4; 30.9] reaching normotensive values in the current measurement. There was no difference in BP values of patients with previously diagnosed HTN and patients who were unaware of their disease. Antihypertensive treatment was being received by 20.2% (39/193), while 62.2% had not taken their prescribed blood pressure medication on the day of recruitment. Conclusions: This is the first Austrian study to show that screening for HTN in an unconventional non-medical setting is effective to diagnose HTN and raise awareness. Based on the even-higher-than-expected prevalence of HTN, we plan to conduct a cohort study in Vienna, inviting all hairdressers in socially deprived districts to act as gate openers for hypertensive subjects to raise awareness and to contact a regional GP for provision of medical care. An implementation of such a cost-effective and feasible disease management program in Austria might therefore reduce the burden of preventable cardiovascular events associated with HTN. Full article

Biofouling presents a major challenge for maritime industries, leading to the widespread use of copper-based biocidal coatings that, while effective, release harmful substances into marine environments. Biocide-free alternatives, such as silicone-based, hydrogel, and natural product-derived coatings, offer more sustainable solutions. This systematic review and meta-analysis assesses the functional, economic, and environmental performance of both coating types using PRISMA guidelines and literature from Scopus and ISI Web of Knowledge (2003–2025). Data from experimental, field, and modeling studies were synthesized, covering fouling intensity, coating durability, toxicity, cost-effectiveness, and regulatory compliance. Biocidal coatings generally performed better short-term, but biocide-free options showed comparable efficacy in some cases and clear environmental benefits. Although initial costs for biocide-free coatings are higher, they may yield savings over time. The meta-analysis found no significant differences in fouling or hydrodynamic performance, though quantitative evidence is limited. Research gaps remain, particularly in long-term studies, highlighting the need for standardized testing and lifecycle assessments to guide sustainable antifouling practices. The outcome of the review also showed that some evidence was excluded due to being in non-indexed sources. This highlights the importance of combining systematic and traditional review methods to ensure a more comprehensive assessment. Full article

Background: Kidney-related pain can be chronic, disabling and negatively impact quality of life. In this prospective case series, we assessed whether a stepwise multidisciplinary treatment protocol, originally developed to treat ADPKD-related pain, can provide significant pain relief in non-ADPKD patients with kidney-related pain. Methods: Patients were eligible if they had incapacitating kidney-related pain with a visual analogue scale (VAS) score ≥50 out of 100, lasting ≥3 months and with insufficient response to previous treatments. The main exclusion criterion was ADPKD. Treatment options were, in order when indicated, nonpharmacological treatments, analgesics, cyst aspiration and fenestration, nerve blocks and nephrectomy. The effect of treatment on pain was investigated by means of VAS scores, defined daily dose of pain medication and quality-of-life scores. Results: Twelve patients (67% female, median age 50 [IQR: 36–59] years), with a median duration of pain of 1.9 [1.0–4.7] years, were included. In 50% of cases, chronic pain remained after an acute episode of kidney stones. Median follow-up after treatment was 3.8 [IQR: 2.5–4.4] years. The VAS before treatment (70 (48–90)) was reduced at short-term (35 [28–53], p = 0.01) and long-term follow-up (40 [38–53], p = 0.01). In addition, the defined daily dose of both opioids and non-opioids was reduced at short-term follow-up (p = 0.04 and 0.04, respectively) as well as at long-term follow-up (p = 0.03 and p = 0.02, respectively). Conclusions: We found that our multidisciplinary treatment protocol is effective in achieving sustained pain relief as well as a reduction in the use of pain medication in non-ADPKD patients with chronic, refractory kidney-related pain. Full article

This research presents a novel methodology for lightweighting and cost reduction of components with high structural demands by integrating advanced design and manufacturing techniques. Specifically, it combines topology optimization (TO) with additive manufacturing (AM), also known as 3D printing. Unlike conventional approaches, the proposed method first determines the optimal geometry using an artificially stiff material, and only then evaluates real materials for structural and manufacturing feasibility. This design-first, material-second strategy enables broader material screening and maximizes weight reduction without compromising performance. The proposed workflow is applied to the design of a turbofan air intake—an aeronautical component operating under supersonic conditions—addressing both structural integrity and manufacturing feasibility. Three materials from distinct classes are assessed: two metallic alloys (aluminum alloy 6061 and titanium alloy, Ti6Al4V) and a high-performance polymer (polyetheretherketone, PEEK). This last option is preliminarily discarded after being analyzed for this specific application. Finite element (FE) simulations are used to evaluate the mechanical behavior of the optimized geometries, including bird-strike conditions. Among the evaluated manufacturing techniques, Selective Laser Melting (SLM) is identified as the most suitable for the metallic materials selected, providing an effective balance between performance, manufacturability, and aerospace compliance. This study illustrates the potential of TO–AM synergy as a sustainable and efficient design approach for next-generation aerospace components. Simulation results demonstrate a weight reduction of up to 71% while preserving critical functional regions and maintaining structural integrity in Al 6061 and Ti6Al4V cases, under the diverse loading conditions typical of real flight scenarios, while PEEK remains an attractive option for uses where mechanical demands are less stringent. Full article

Background/Objectives: Digital pathology has the potential to revolutionize pathology diagnostics, especially in geo-graphically isolated and underserved regions. By leveraging technology, telepathology, and integration with computer-aided diagnostic tools, digital pathology can improve access to prompt and accurate diagnostics. Methods: Our key steps to implementing digital pathology and transitioning operations to a digital network are assessing existing infrastructure, identifying gaps in connectivity and resources, and creating a workflow tailored to the needs of the healthcare system. Results: We present an approach of implementing digital pathology in Timmins, Northern Ontario, Canada, focusing on addressing regional disparities and the improvements that come alongside utilizing digital pathology. Our results show that digital pathology can provide prompt, efficient and better-quality diagnostic services to rural and un-deserved areas, improving patient care and outcomes. It also represents a cost-effective option with savings from eliminating travel costs, courier costs and additional operational efficiencies. Conclusions: Implementing digital pathology in rural settings presented with challenges related to infrastructure, technical abilities, workforce readiness, cost and other aspects involved in transitioning from traditional microscopy to a fully digital pathway. Digital pathology systems can help ensuring seamless data flow and improving overall healthcare delivery. Telepathology also allows pathologists to provide diagnostic services from a distance, which is particularly beneficial in areas with a shortage of pathologists. Full article

Objectives: To evaluate the safety and efficacy of the simultaneous implantation of a monofocal capsular bag-fixated and a trifocal supplementary sulcus-fixated intraocular lens (duet procedure) in eyes with co-existing pathologies undergoing cataract or refractive lens surgery. Methods: In total, 80 eyes of 40 consecutive patients, who underwent refractive lens exchange or cataract surgery and received the duet procedure due to minor co-pathologies, were included in this retrospective case series. Preoperative assessment comprised slit-lamp biomicroscopy, optical biometry, posterior-segment optical coherence tomography, corneal endothelial specular microscopy, corneal tomography, manifest refraction and distance and near visual acuity testing. Three months postoperatively, uncorrected distance (UDVA) and uncorrected near visual acuity (UNVA) were recorded. Results: The preoperative manifest refractive spherical equivalent (MRSE) was −0.31 ± 4.29 diopters (D), with a mean refractive astigmatism of −0.80 ± 0.60 D. At three months postoperatively, monocular UDVA and binocular UNVA significantly improved from 0.52 ± 0.42 logMAR and 0.32 ± 0.27 logMAR to 0.05 ± 0.09 logMAR and −0.03 ± 0.10 logMAR, respectively (both p < 0.0001). Conclusions: Reversible multifocality provided by the duet procedure appears to be a feasible option in eyes with mild co-existing pathologies, as it yields satisfactory visual and refractive outcomes with high safety. Full article

Introduction: The combination of ceftazidime−avibactam (CAZ-AVI) with aztreonam (ATM) may be an option for the treatment of infections due to metallo-β-lactamases (MBLs) producing bacteria, as recommended by current guidelines. MBLs protect the pathogen from any available β-lactam/β-lactamase inhibitor (BL/BLI). Moreover, in vitro and clinical data suggest that double carbapenem therapy (DCT) may be an option for such infections. Materials and Methods: This retrospective study was conducted in two mixed intensive care units (ICUs) at the University Hospital of Larissa, Thessaly, Greece, and the General Hospital of Larissa, Thessaly, Greece, during a three-year period (2022−2024). Mechanically ventilated patients with bloodstream infection (BSI) caused by K. pneumoniae resistant to all BL/BLI combinations were studied. Patients were divided into three groups: in the first, patients were treated with CAZ-AVI + ATM; in the second, with DCT; and in the third, with antibiotics other than BL/BLIs that presented in vitro susceptibility. The primary outcome of the study was the change in Sequential Organ Failure Assessment (SOFA) score between the onset of infection and the fourth day of antibiotic treatment. Secondary outcomes were SOFA score evolution during the treatment period, total duration of mechanical ventilation (MV), ICU length of stay (LOS), and ICU mortality. Results: A total of 95 patients were recruited. Among them, 23 patients received CAZ-AVI + AZT, 22 received DCT, and 50 patients received another antibiotic regimen which was in vitro active against the pathogen. The baseline characteristics were similar. The mean (SE) overall age was 63.2 (1.3) years. Mean (SE) Acute Physiology and Chronic Health Evaluation II (APACHE II) and SOFA scores were 16.3 (0.6) and 7.6 (0.3), respectively. The Charlson Index was similar between groups. The control group presented a statistically lower SOFA score on day 4 compared to the other two groups [mean (SE) 8.9 (1) vs. 7.4 (0.9) vs. 6.4 (0.5) for CAZ-AVI + ATM, DCT and control group, respectively (p = 0.045)]. The duration of mechanical ventilation, ICU LOS, and mortality were similar between the groups (p > 0.05). Comparison between survivors and non-survivors revealed that survivors had a lower SOFA score on the day of BSI, higher PaO₂/FiO₂ ratio, higher platelet counts, and lower lactate levels (p < 0.05). Septic shock was more frequent among non-survivors (60.3%) in comparison to survivors (27%) (p = 0.0015). Independent factors for mortality were PaO₂/FiO₂ ratio and lactate levels (p < 0.05). None of the antibiotic regimens received by the patients was independently associated with survival. Conclusions: Treatment with CAZ-AVI + ATM or DCT may offer similar clinical outcomes for patients suffering from BSI caused by K. pneumoniae strains resistant to all available BL/BLIs. However, larger studies are required to confirm the findings. Full article

A comprehensive techno-economic assessment was undertaken to determine the viability of bioethanol production from sugarcane bagasse in Thailand through organosolv fractionation, incorporating three distinct catalytic systems: sulfuric acid, formic acid, and sodium methoxide. Rigorous process simulations were executed using Aspen Plus, facilitating the derivation of detailed mass and energy balances, which served as the foundational input for downstream cost modeling. Economic performance metrics, including the total annualized cost and minimum ethanol selling price, were systematically quantified for each scenario. Among the evaluated configurations, the formic acid-catalyzed organosolv system exhibited superior techno-economic attributes, achieving the lowest unit production costs of 1.14 USD/L for ethanol and 1.84 USD/kg for lignin, corresponding to an estimated ethanol selling price of approximately 1.14 USD/L. This favorable outcome was attained with only moderate capital intensity, indicating a well-balanced trade-off between operational efficiency and investment burden. Conversely, the sodium methoxide-based process configuration imposed the highest economic burden, with a TAC of 15.27 million USD/year, culminating in a markedly elevated MESP of 5.49 USD/kg (approximately 4.33 USD/L). The sulfuric acid-driven system demonstrated effective delignification performance. Sensitivity analysis revealed that reagent procurement costs exert the greatest impact on TAC variation, highlighting chemical expenditure as the key economic driver. These findings emphasize the critical role of solvent choice, catalytic performance, and process integration in improving the cost-efficiency of lignocellulosic ethanol production. Among the examined options, the formic acid-based organosolv process stands out as the most economically viable for large-scale implementation within Thailand’s bioeconomy. Full article