Search Results (188)

Elite athletes are at an increased risk of infections due to behavioral and social factors and frequent travel. Furthermore, heavy physical exercise may induce immunosuppression. Most infections in athletes are acute respiratory illnesses (ARIs) with various viral etiologies. Although athletes, as young, healthy adults, are not at risk for severe infections, a prolonged ARI may ruin a training season or a significant competition or may spread within a sports team. Many common infections are vaccine-preventable. This Opinion advocates for more active vaccination among athletes, although some of the vaccines are not officially recommended for young adults. New respiratory syncytial virus (RSV) protein vaccines are effective and well-tolerated. Yearly influenza and COVID-19 vaccinations are strongly recommended. Conjugated polyvalent pneumococcal vaccines are recommended because they may also induce protection against respiratory viral infections. Pertussis and measles outbreaks are occurring globally. The history of measles vaccination should be reviewed, and consideration should be given to a pertussis booster vaccination (Tdap). A recombinant vaccine can effectively prevent herpes zoster. The vaccination of elite athletes is a cost-effective and powerful tool, but it is currently underused. The sports medicine community can address vaccine hesitancy among athletes by listening to their concerns and giving accurate information. Full article

Background: Although the expansion of medical resources has largely alleviated challenges of “more diseases but fewer medicines”, the growing urbanization and rapid aging in China have led to increasing demands of healthcare services in metropolitan cities. The uneven distribution of medical facilities makes services unequal for residents in the city. To achieve fair and rapid access to medical services, healthcare accessibility and equity have become key concerns. The introduction of tele-health, i.e., online visits or digital health, can help balance the distribution of medical resources to improve accessibility and equity, particularly for elderly patients with chronic diseases. Methods: To quantitatively assess the spatial accessibility of healthcare facilities, an improved two-step floating catchment area method with tele-health (i2SFCA-TH) is proposed to study the demand–supply ratio by considering traveling time, chronic diseases, and online visits based on services provided by community and tertiary hospitals. An optimization model using mixed-integer programming to maximize average accessibility under resource constraints could help improve overall accessibility and reduce differences in access among all residential divisions to achieve better equity in the region. Results: By applying the method in a metropolitan city in China, it is observed that the overall spatial accessibility of residential divisions in the city is 0.72, but the gap between the highest and the lowest reaches 2.36; i.e., significant differences exhibit due to uneven allocation of medical resources. By introducing tele-health, the gaps of access among different divisions can be decreased, with the largest gap reduced to 1.49, and the accessibility in divisions with poor medical resource allocation can be increased. Finally, the mean healthcare accessibility and equity in the study region can be improved to 0.75. In addition, it is shown that proper management of medical resources and patients’ willingness to accept online visits could help improve accessibility and equity, which can provide insights for hospital management and urban planning. Conclusions: An integrated framework to quantitatively assess and optimally improve healthcare accessibility and equity of medical resource allocation through tele-health is presented in this paper. An i2SFCA-TH method and an optimization model are used in the framework, which provides hospital management and urban planners a quantitative tool to improve accessibility and equity in metropolitan cities in China and other countries. Full article

Human brucellosis is a zoonotic, bacterial infection caused by the intracellular, Gram-negative Brucella spp., which is common globally but rare in the United Kingdom, with approximately 20 imported cases per annum following travel to countries with high endemicity. Transmission typically occurs via the ingestion of infected animal products, including unpasteurised dairy products. Human-to-human transmission is rare, and routes include postpartum vertical transmission through breastfeeding. We report here on a familial cluster of three cases within a single UK-based Kurdish household of four, including a 11-month-old infant infected through the consumption of breast milk. Four months prior to presentation, the family had travelled together to northern Iraq for a 5-week holiday and all consumed local dairy products except for the children, including the 11-month-old, who was exclusively breastfed at the time. All three patients, including one adult male with complicated brucellosis, had a favourable outcome with medical therapy.: Brucellosis is an important differential diagnosis in returning travellers and specialist advice should be obtained early to prevent sequelae. It is also important for active case-finding, especially in family units with shared exposure. Paediatricians and adult physicians who may manage brucellosis should consider the possibility of vertical transmission in breastfeeding mothers. Full article

Objective—To identify effective data analytics and machine learning solutions that can help in the decision-making process in the medical domain and contribute to the understanding of COVID-19 disease. In this study, we analyze data from anonymized electronic medical records of 4711 patients with COVID-19 disease admitted to hospital in Atlanta. Methods—We used random forest, LightGBM, XGBoost, CatBoost, KNN, SVM, logistic regression, and MLP neural network models in this work. The models are evaluated depending on the type of prediction by relevant metrics, especially accuracy, F1-score, and ROC AUC score. Another aim of the work was to find out which factors most affected severity and mortality risk among the patients. To identify the important features, different statistical methods were used, as well as LASSO regression, and explainable artificial intelligence (XAI) method SHAP values for model explainability. The best models were implemented in a web application and tested by medical experts. The model for prediction of mortality risk was tested on a validation cohort of 45 patients from the Department of Infectiology and Travel Medicine, L. Pasteur University Hospital in Košice (UNLP). Results—Our study shows that the best model for predicting COVID-19 disease severity was the LightGBM model with accuracy of 88.4% using all features and 89.5% using the eight most important features. The best model for predicting mortality risk was also the LightGBM model, which achieved a ROC AUC score of 83.7% and a classification accuracy of 81.2% using all features. Using a simplified model trained on the 15 most important features, the ROC AUC score was 83.6% and the classification accuracy was 80.5%. We deployed the simplified models for predicting COVID-19 disease severity and for predicting the risk of COVID-19-related death in a web-based application and tested them with medical experts. This test resulted in a ROC AUC score of 83.6% and an overall prediction accuracy of 73.3%. Full article

Background: Infectious proctitis remains an underrecognized entity, although sexually transmitted diseases, especially bacterial infections, exhibit a marked increase in their incidence. Methods: Here, we report a case of a 44-year-old man who presented to the emergency department with lower abdominal and rectal pain, tenesmus, fever and night sweats for the past 6 days. Results: The computed tomography initially revealed a high suspicion of metastatic rectal cancer. The endoscopic findings showed a 5 cm rectal mass, suggestive of malignancy. The histologic examination showed, however, no signs of malignancy and lacked the classical features of an inflammatory bowel disease, so an infectious proctitis was further suspected. The patient reported to have had unprotected receptive anal intercourse, was tested positive for Treponema pallidum serology and received three doses of intramuscular benzathine penicillin G. A control rectosigmoidoscopy, imaging at 3 months and histological evaluation after antibiotic treatment showed a complete resolution of inflammation. Conclusions: Syphilitic proctitis may mimic various conditions such as rectal cancer or inflammatory bowel disease and requires a high degree of suspicion. Clinicians need to be aware of infectious proctitis in high-risk populations, while an appropriate thorough medical history may guide the initial diagnostic steps. Full article

Background: Electronic waste (e-waste) recycling in informal settings like Agbogbloshie in Accra, Ghana, releases toxic metals into the environment, posing serious health risks to nearby residents, particularly children. This study assessed the body burdens of lead (Pb), manganese (Mn), cadmium (Cd), chromium (Cr), nickel (Ni), and arsenic (As) and their association with cognitive function in schoolchildren living within 1 km of the Agbogbloshie site. Method: A cross-sectional study involving 56 pupils collected demographic data and blood and urine samples and administered the Wechsler Intelligence Scale for Children—Fourth Edition (WISC-IV). Blood was tested for Pb and Mn and urine for Cd, Cr, Ni, and As. Associations between metal levels and cognitive outcomes were examined using regression analyses, adjusting for confounders. Result: Children showed elevated metal levels, with mean blood Pb of 60.43 µg/L and urinary s of 21.50 µg/L. Symptoms of cognitive dysfunction were common: 75% reported confusion, 67.9% poor memory, and 66% poor concentration. Urinary Cr levels were significantly associated with lower Full-Scale IQ (β = −18.42, p < 0.05) and increased difficulty in decision-making (OR = 0.1, p < 0.05). Conclusion: These findings underscore the neurodevelopmental risks of heavy metal exposure from e-waste in low- and middle-income countries and call for urgent public health interventions and policy actions. Full article

Background: Mucosal immunity plays a pivotal role in preventing infections with SARS-CoV-2. While COVID-19 mRNA vaccines induce robust systemic immune responses in patients with inflammatory bowel disease (IBD), little is known about their efficacy in the mucosal immune compartment. In this sub-investigation of the ongoing STAR-SIGN study, we present the first analysis of mucosal immunity elicited by XBB.1.5 mRNA vaccines in immunocompromised patients with IBD. Methods: IgG and IgA antibodies targeting the receptor-binding domain of the SARS-CoV-2 JN.1 variant were quantified longitudinally in the saliva of IBD patients using the multiplex immunoassay MultiCoV-Ab. Antibody levels were quantified before and 2–4 weeks after vaccination with XBB.1.5 mRNA vaccines. All patients previously received three doses with original COVID-19 vaccines. Results: Mucosal IgG antibodies were readily induced by XBB.1.5 mRNA vaccines (p = 0.0013 comparing pre- and post-vaccination levels). However, mucosal IgA levels were comparable before and after vaccination (p = 0.8233). Consequently, mucosal IgG and IgA antibody levels correlated only moderately before and after immunization (pre-vaccination: r = 0.5294; p = 0.0239; post-vaccination: r = 0.4863; p = 0.0407). Contrary to a previous report in healthy individuals, vaccination did not induce serum IgA in patients with IBD (p = 0.5841 comparing pre- and post-vaccination levels). These data suggest that COVID-19 mRNA vaccines fail to elicit mucosal IgA in patients with IBD. Conclusions: Since mucosal IgA plays a pivotal role in infection control, the lack of IgA induction indicates that patients lack sufficient protection against SARS-CoV-2 infections which warrants the development of mucosal COVID-19 vaccines. Full article

Interest in explainable machine learning has grown, particularly in healthcare, where transparency and trust are essential. We developed a semi-automated evaluation framework within a clinical decision support system (CDSS-EQCM) that integrates LIME and SHAP explanations with multi-criteria decision-making (TOPSIS and Borda count) to rank model interpretability. After two-phase preprocessing of 2934 COVID-19 patient records spanning four epidemic waves, we applied five classifiers (Random Forest, Decision Tree, Logistic Regression, k-NN, SVM). Five infectious disease physicians used a Streamlit interface to generate patient-specific explanations and rate models on accuracy, separability, stability, response time, understandability, and user experience. Random Forest combined with SHAP consistently achieved the highest rankings in Borda count. Clinicians reported reduced evaluation time, enhanced explanation clarity, and increased confidence in model outputs. These results demonstrate that CDSS-EQCM can effectively streamline interpretability assessment and support clinician decision-making in medical diagnostics. Future work will focus on deeper electronic medical record integration and interactive parameter tuning to further enhance real-time diagnostic support. Full article

Background: Locally acting gastrointestinal (GI) drugs present challenges for generic drug development because traditional bioequivalence measures, which rely on systemic drug levels, do not reflect local efficacy. This review examines regulatory guidelines for establishing therapeutic equivalence for such drugs, using rifaximin—a minimally absorbed, gut-localized antibiotic—as a case study. Methods: We reviewed bioequivalence guidelines from the United States Food and Drug Administration (FDA) and European Medicines Agency (EMA), along with the literature on rifaximin’s biopharmaceutical and clinical properties, to identify strategies and challenges for establishing equivalence for locally acting GI drugs. Results: Rifaximin exemplifies the limitations of standard bioequivalence methods: as a Biopharmaceutics Classification System (BCS) class IV drug with minimal absorption and low solubility, in vitro dissolution may not predict local drug availability. Clinical endpoint trials (e.g., traveler’s diarrhea, hepatic encephalopathy, IBS-D) are resource-intensive and insensitive to formulation differences. Pharmacokinetic (PK) studies in healthy volunteers show low, variable plasma levels, which may inaccurately discriminate between formulations. The EMA requires evidence of non-saturable absorption to accept PK data, a difficult-to-establish but potentially irrelevant criterion. Differences between FDA and EMA approaches highlight a lack of harmonization, complicating global generic development. Conclusions: A tailored, multifaceted approach is needed to demonstrate bioequivalence for GI-localized drugs like rifaximin. This case underscores the need for more sensitive surrogate methods (e.g. advanced in vitro or pharmacodynamic models) and flexible regulatory criteria. Harmonization across international guidelines and innovative bioequivalence study designs are key to facilitating the approval of safe and effective generic alternatives in this drug class. Full article

Yellow fever (YF) is an acute hemorrhagic zoonotic disease that causes severe liver damage, renal failure, and hemorrhagic shock. No antiviral treatment is available; thus, vaccination is a critical preventive measure. Although the World Health Organization (WHO) revised the guidelines regarding the need for booster vaccination for YF with the rationale that a single vaccination provides sufficient long-term immunogenicity, no studies have evaluated long-term immunity in Japanese adults who received a single dose of YF vaccine. This study evaluated the long-term persistence of immunogenicity in Japanese adults vaccinated with the YF vaccine. This observational study enrolled Japanese adults who received a single YF vaccination >5 years previously. Blood samples were collected after confirming eligibility for the study. The serum levels of anti-yellow fever virus (YFV)-neutralizing antibodies were measured using the 50% plaque reduction neutralization test (PRNT₅₀). The 65 participants comprised 35 males and 30 females, with a median age at vaccination of 34 years. The time between YF vaccination and registration was between 5 and 26 years. All participants remained seropositive even after a long time. Statistical analysis showed no correlation between the time elapsed since YF vaccination and PRNT₅₀. Our results indicate that a single dose of YF vaccine provides adequate long-term immunity in Japanese adults and that booster vaccinations are not routinely required. These findings strongly aid in the development of travel medicine guidelines and the optimization of vaccination strategies by reducing the usage of medical resources and simplifying the health requirements for travelers. Full article

Background: The epidemiology, characteristics and outcomes of coinfections in COVID-19 are still poorly understood. Methods: We investigated the prevalence of coinfections in COVID-19 patients hospitalized in Switzerland over the first three epidemic waves between 1 March 2020 and 1 June 2021, as well as risk factors and outcomes. Patients were identified from six hospitals of the Swiss prospective surveillance system database (CH-SUR). Details of the type and treatment of coinfections were retrieved retrospectively from medical charts. We assessed the proportion of patients with suspected coinfections and analyzed risk factors and 90-day in-hospital survival using logistic and Cox regression. Results: Of 13,265 identified patients, 36.6% (4859/13,625) had suspected coinfections, and 44.8% (5941/13,625) received antibiotics. Respiratory coinfections (25.6%) were the most common, followed by bloodstream (19.8%) and urinary tract infections (14.6%). Escherichia coli (14.8%), Staphylococcus aureus (10.7%) and Klebsiella pneumoniae (6.1%) were the most frequently isolated pathogens. The risk factors for coinfections included increasing age, male gender, certain underlying medical conditions and immunosuppression. Suspected coinfections were associated with a longer hospital stay (13 vs. 7 days, p < 0.001), more frequent ICU admission (26% vs. 6.7%, p < 0.001) and higher rates of in-hospital death (24% vs. 9.5%, p < 0.001). Hospitalization in the ICU at the time of COVID-19 diagnosis had the strongest association with coinfections. Conclusions: A high proportion of COVID-19 patients had coinfections, particularly respiratory infections, and received antibiotics. Coinfections were associated with severe illness and worse outcomes. Full article

Airports are critical global transit points, yet their medical services often overlook emergency dental care—a vital component of comprehensive passenger assistance. This study examines the availability of dental services at 28 European airports accommodating over 20 million passengers annually. Using content analysis of official airport websites, the presence of terms like “dental” and “dentist” was documented. Results reveal that only six airports provide dental services, with Istanbul Airport being the sole facility offering 24/7 emergency care airside. Other airports limit services to landside and operate within standard hours. The lack of widespread dental care in airports highlights a significant gap in passenger health services, with implications for traveler satisfaction, operational efficiency, and overall public health. This analysis underscores the need for broader integration of dental facilities into airport infrastructures to meet the diverse and urgent needs of global travelers and staff. Full article

Bayanaul State National Nature Park (BSNNP), which was established in 1985 and is one of the biggest natural parks in the Republic of Kazakhstan, conserves and rehabilitates the natural flora and fauna of the Bayanaul mountain range. This article expands the floristic inventory of BSNNP and identifies the ecological and ethnobotanical importance of the park. The literature revealed that 681 plant species inhabited the BSNNP region but it was hypothesized that the park’s plant diversity was greater than the documented 681 plant species. Following our expedition travels to BSNNP, we extended the flora summary with an addition of 81 new plant species. Now, according to this study, the flora of BSNNP comprises 762 plant species belonging to 335 genera and 81 families. The leading families are Asteraceae Dumort., Poaceae Barnhart, Brassicaceae Burnett, Fabaceae Lindl, Rosaceae Juss., Caryophyllaceae Juss, Lamiaceae Lindl., Apiaceae Lindl., and Scrophulariaceae Juss. They comprise 57.7% of the total plant species in the national park and 58.5% of the total genera. The largest genera are wormwood, sedge, onion, cinquefoil, speedwell, and astragalus, based on which these genera can be considered polymorphic. Moreover, 16 species of endemic plants belonging to 14 genera and 7 families were also reported. The flora is characterized by high biological diversity with the participation of boreal relicts. The largest group among useful species is medicinal plants, represented by 186 species (24.4%) belonging to 83 genera, and 39 families. Our findings enhance the scientific understanding of plant diversity in BSNNP and provide the groundwork for future conservation research. Full article

Nazarbayev University School of Medicine selected the University of Pittsburgh School of Medicine to guide their curricular development. University of Pittsburgh faculty members teaching in the medical school were asked to help develop the curriculum in Nazarbayev. Some were asked to travel to Nazarbayev University to provide mentoring. Realizing that this would be a new activity, we wanted to investigate the perceived motivations, rewards, and barriers to participation. We conducted open-ended interviews of University of Pittsburgh faculty members, who were asked to participate in a project about motivations for accepting or rejecting the offer. We asked those accepting about the benefits and negatives. Nineteen faculty members agreed to 30 min interviews, which were digitally recorded and transcribed. All interviews were coded. Participating faculty members felt that reviewing their courses improved them. Most noted increased altruism and felt improved as educators. Some felt angst in providing their curricula. Several felt that traveling was challenging, but video conferencing technologies facilitated communication. Interviewees desired tangible rewards. This study highlights faculty perceptions of international curricular development. Faculty members felt that rewards included an improved native curriculum and personal and professional enrichment. Time constraints and distance were the main challenges and the primary reason others declined. The faculty perceived multiple benefits from this curricular development and collaboration. More transparency regarding expectations and the degree of assistance Nazarbayev University needed may have assuaged these fears. Full article

Background. Despite dentistry’s alarmingly high energy use, plastic waste, and travel emissions, research on Romanian dental students’ sustainability awareness is absent. This study aimed to assess their knowledge of the environmental impact of dental materials and practices, hypothesizing that early exposure to sustainability education would benefit preclinical students most. Materials and Methods. A cross-sectional survey using a form questionnaire with 15 items was conducted on 1800 dental students at Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, for one week in March 2022. The questionnaire, consisting of socio-demographics, students’ perspectives on sustainability in dentistry, and personal sustainability, was analyzed using SPSS 26. Data analysis included the Shapiro–Wilk test for normality, Fisher’s exact test for categorical variables, the Mann–Whitney U test for non-parametric quantitative comparisons, and Z-tests with Bonferroni correction for contingency tables. Results. A response rate of 26.06% was achieved, with 469 participants. The majority (51.1%), particularly males (66.1%), perceived sustainability as promoting durability. The most common definition of sustainability (33.8%) was related to environmental protection, with significantly higher agreement among female students (39.4%) (p = 0.001). While 49.3% of participants identified single-use plastics in patient care as having the greatest environmental impact in dental practices, 39.2% of female students, primarily from clinical study years (50%), ranked patient paperwork and records as the most significant factor (p = 0.031). The highest-carbon-footprint dental procedures were considered to be amalgam and composite fillings (50.7%), with clinical year students indicating this as the most relevant issue (62.8% vs. 47.7%) (p = 0.011). Students aged 25–30 were more actively engaged in sustainability initiatives compared to the younger group (p = 0.005), while all students over 30 identified scaling and polishing as the most impactful procedure (p < 0.001). A majority of students supported future university sustainability initiatives (62.7%) and an elective course on sustainability in dentistry (65%). Female students showed significantly greater interest than male students in both initiatives (66.3% vs. 52.7%, p = 0.003 and 70.8% vs. 49.6%, p < 0.001, respectively). Conclusions. Greater awareness of sustainability was found in preclinical-year dental students and among female students, with knowledge gaps in clinical-year students, particularly regarding the environmental impact of dental practices and materials. Introducing sustainability courses could better prepare future dentists for sustainable practices in dentistry. Research collaborations and curriculum reforms to further promote sustainability would also be beneficial. Full article