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The presence of Shiga toxin-producing Escherichia coli (STEC) on bovine and porcine carcasses during 2019-2023 was investigated. A total of 368 bovine and 87 porcine carcasses were tested using the ISO/TS 13136 standard and the STEC isolates were further characterized with whole genomic sequencing (WGS). It was found that 119 (32.3 %) of bovine and 14 (16.1 %) of porcine carcasses were positive for the stx Shiga toxin gene. Further analysis of the stx-positive samples allowed to isolate 32 (26.9 %) bovine and two (14.3 %) porcine STEC, respectively. Bovine isolates were classified into 21 different serotypes with the most prevalent O168:H8 (3 isolates), whereas two porcine STEC belonged to two serotypes that were not identified in bovine strains. Isolates of bovine carcass origin were mainly positive for the stx2 Shiga toxin gene, either alone or in combination with stx1 type (26 of 32; 81.2 % isolates). Two STEC from porcine carcasses were positive for the stx2e variant only. All STEC, irrespective of the origin, were negative for the eae intimin gene. MLST and cgMLST analyses of all strains tested revealed that they were diverse. However, a close molecular relationship between some bovine isolates based on cgMLST schemes was observed. Comparison of the current bovine STEC with those isolated between 2014 and 2018 showed that some of them consisted of the same MLST sequence types. However, based on cgMLST analysis only two cases of three genomes of STEC isolates each (two from period 2019-2023 and one isolated between 2014 and 2018) revealed up to 50 allelic differences., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jacek Osek reports financial support was provided by Polish Government. Kinga Wieczorek reports financial support was provided by Polish Government. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background and Aim: This study aims to explore the clinical significance of antinuclear antibodies (ANA) patterns in liver diseases., Materials and Methods: We included 396 patients with a request for ANA testing for suspected autoimmune liver disease (AILD). For each patient, we collected demographical, clinical, and laboratory data., Results: Among the patients, 33% had AILD, predominantly aiutoimmune hepatitis (AIH). The AC1 pattern was significantly more prevalent in AIH patients, while the AC21 pattern was strongly associated with primary biliary cholangitis (PBC). AC4-AC5 patterns were less frequent in AIH and PBC patients but more common in non-alcoholic hepatitis. Elevated alkaline phosphatase and gamma-glutamyl transferase levels were observed in AILD patients with AC11, AC12, and AC21 patterns., Conclusions: These findings highlight the different distribution of ANA patterns in liver diseases, with specific patterns showing strong associations with distinct liver conditions., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Background: This study evaluated the prevalence of various mental disorders and their influence on mortality outcomes in individuals with cancer., Methods: The authors' institutional database included patients with cancer diagnosed between 2011 and 2015 who had mental disorders and death information up to 2021. Mental disorders included nonaffective psychotic disorders, affective psychotic disorders, anxiety-related and stress-related disorders, alcohol or drug misuse, and mood disorders without psychotic symptoms. The causes of death were classified as all-cause, cancer-related, or suicide. Individual matching was performed to randomly match cancer survivors with and without mental disorders according to age at cancer diagnosis, year of cancer diagnosis, sex, and cancer site. The association between mental disorders and mortality risk was assessed using a Cox proportional hazards model and competing-risk analyses., Results: Among 637,491 cancer survivors (mean age, 58.9 years), there were 238,654 deaths from any cause and 2255 deaths from suicide. Incidence rates varied across disorders, with the highest rates observed for anxiety-related and stress-related disorders and mood disorders without psychotic symptoms. Mental disorders were associated with an increased risk of all-cause and cancer-related mortality. Adjusted hazard ratios (HRs) for nonaffective psychotic disorders, affective psychotic disorders, anxiety-related and stress-related disorders, alcohol and drug misuse, and mood disorders without psychotic symptoms were as follows: HR, 2.49 (95% confidence interval [CI], 2.22-2.80); HR, 2.38 (95% CI, 2.21-2.57); HR, 1.02 (95% CI, 1.01-1.04); HR, 2.13 (95% CI, 1.87-2.43); and HR, 1.27 (95% CI, 1.24-1.30), respectively, for all-cause mortality. Suicide risk was higher in patients who had mental disorders, especially within the first 6 months after diagnosis., Conclusions: The current findings underscore the impact of mental illness on mortality among cancer survivors in Korea, specifically highlighting the elevated rates of anxiety, stress, and mood disorders., (© 2025 American Cancer Society.)

This study examines the relationship between comorbid seizures and dementia among stroke patients using the 2017 Nationwide Inpatient Sample (NIS), the largest publicly available inpatient healthcare database in the United States. We analyzed data from 128,341 stroke patients, including those with ischemic and hemorrhagic strokes, to determine the prevalence of seizures and dementia, and the association between these conditions. Our findings reveal that 7.58 % of stroke patients experienced seizures, while 12.2 % had dementia. Logistic regression analysis demonstrated that stroke patients with seizures had significantly higher odds of also having dementia (OR: 2.08, 95 % CI: 1.95-2.21), with similar trends observed across stroke subtypes. Specifically, the association was strongest among ischemic stroke patients (OR: 2.38, 95 % CI: 2.21-2.56). These results suggest a critical link between seizures and cognitive decline in stroke survivors, underscoring the need for integrated management strategies that address both neurological and cognitive health. Future research should explore the underlying mechanisms and potential therapeutic interventions to mitigate the risk of dementia in stroke patients with seizures., (Published by Elsevier B.V.)

Background: Previous studies suggest that prevalent heart failure (HF) differs based on left ventricular ejection fraction (LVEF) and left ventricular (LV) chamber size. Furthermore, the prevalence of HF with preserved ejection fraction (HFpEF) is often considered approaching, or exceeding that of HF with reduced ejection fraction in the community., Aim: The aim of this study was to evaluate prevalent and incident HF based on LVEF and CMR-determined LV size within a large community-dwelling cohort., Methods: Individuals from the United Kingdom Biobank (UKB) who underwent CMR and had available health record linkage to allow ascertainment of HF diagnosis were included. The cohort was analysed according to LVEF, LV end-diastolic volume (LVEDV) quartiles and LVEDV indexed to body surface area (LVEDVi)., Results: 38,129 individuals were included, comprising those with reduced LVEF (LVEF<50 %, n = 5096) and preserved LVEF (LVEF 50-60 %, n = 22,907, LVEF≥60 %, n = 10,126). Prevalent HF was highest in males with LVEF<50 %, and participants with reduced LVEF had higher rates of incident HF (p < 0.001) during the follow-up period (median = 2.46 years from CMR). Mean LVEDV and LVEDVi were largest in individuals with EF < 50 % (146.9 ± 36.2 ml and 76.8 ± 16.4 ml/m 2 respectively). Compared to the smallest quartiles, the largest quartiles for LVEDV were associated with increased odds of HF (odds ratio 2.14 [95 % confidence interval 1.47-3.12], p < 0.001)., Conclusions: Over 50 % of HF cases occur in individuals with LVEF ≥50 %, however HF prevalence is highest in those with reduced LVEF, particularly in males. Larger LV size is associated with increased HF across the LVEF spectrum., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Symptoms of anxiety and/or depression (SAD) commonly co-exist in severe aortic stenosis. In patients who underwent transcatheter aortic valve implantation (TAVI), these symptoms are associated with increased morbidity and mortality. Despite this, mental health remains under-researched in the TAVI literature. Drawing from the largest registry in Australia, we aimed to characterize the prevalence of SAD in TAVI patients. We also aimed to identify patient phenotypes at the highest risk of these symptoms, examine how they evolve after TAVI, and establish factors predictive of improvement and regression in mental health. A total of 1,279 patients who underwent TAVI between 2018 and 2023 included in a multi-center Australian registry were analyzed. The median age was 82 years (interquartile range 77 to 87), 41% were females, and the median Society of Thoracic Surgeons score was 3.9 (2.3 to 5.9). In addition, 353 patients (28%) reported moderate or worse SAD at baseline. Of this group, 260 (74%) had complete resolution in symptoms within 30 days. Body mass index <25 kg/m 2 (adjusted odds ratio [aOR] 3.4, p <0.001), vascular site complications (aOR 3.4, p = 0.029), and nonhome discharge (aOR 2.4, p = 0.036) independently predicted the persistence of SAD. Only 72 patients (8%) developed new-onset SAD at 30 days after TAVI. Nonhome discharge (aOR 2.12, p = 0.025) and a composite cardiovascular end point, including stroke, acute myocardial infarction, and heart failure readmission (aOR 2.55, p = 0.028), were independent predictors of new-onset SAD. In conclusion, SAD are common but under-recognized in aortic stenosis. TAVI is highly effective at improving these symptoms, and regular screening for mental health should be considered in the management of all TAVI patients., Competing Interests: Declaration of competing interest Professor Stub is on the medical advisory boards of Edwards, Medtronic, and Anteris. Associate Professor Walton is on the medical advisory boards of Medtronic, Abbott, and Edwards. These disclosures had no influence on the manuscript. The remaining authors have no competing interests to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background and Purpose: Anxiety is frequent after stroke; however, little is known about its determinants. This study aims to assess the prevalence and correlates of post stroke anxiety (PSA) within 3-6 months following ischemic stroke., Methods: Three cohort studies from the STROKOG consortium were involved. Demographic and clinical data were standardized. PSA and PSD were assessed using inventories. The criteria for post-stroke cognitive impairment (PSCI) were at least one cognitive domain impaired if applicable, or a Montreal Cognitive Assessment (MoCA) score. Descriptive analyses were conducted to ascertain the prevalence of anxiety. Comparisons between anxious and non-anxious patients in the total sample were made using χ 2 and t-tests. A two-step individual participant data (IPD) meta-analysis was employed to identify factors associated with PSA., Results: 584 patients were included. The total prevalence of PSA was 35 % (95%CI = [31.23;38.97]) and ranged from 27 % to 45 % across cohorts. In the total sample, there was a higher proportion of females in the anxiety group than the non-anxiety group (χ 2  = 19.62; p < 0.001). Anxious patients had lower education, (χ 2  = 6.59; p = 0.03), higher stroke severity (t = 2.77; p = 0.002), and higher rates of PSD (χ 2  = 118.09; p < 0.001), and PSCI (χ 2  = 23.81, p < 0.001). The analysis demonstrates that the odds of presenting with PSA is larger in patients with PSCI (OR = 1.84, 95%CI = [1.14; 2.91])., Conclusions: Anxiety is frequent after stroke, especially in females, and is associated with depression and cognitive impairment., Competing Interests: Declaration of competing interest None of authors do not have any conflicts of interest to declare., (Copyright © 2024. Published by Elsevier B.V.)

Background: Depression is a major global public health concern, often co-occurring with Non-Suicidal Self-Injury (NSSI). Focused on Depressive adolescents, this study aimed to quantify the importance of factors in predicting NSSI and compare them between the only child and non-only child groups, enriching knowledge to leverage tailored intervention strategies., Methods: A large multicenter survey was conducted in China. 2510 adolescents diagnosed with Major Depressive Disorder (MDD) volunteered for the study. 36 factors were included to train random forest models for NSSI prediction in only child and non-only child groups, respectively. The SHapley Additive exPlanations (SHAP) method was utilized to compute the relative importance of each factor in two groups., Results: Adolescents with MDD exhibited a rather high prevalence of NSSI (52.0 %), among them 66.9 % were non-only children. Self-esteem was the most significant factor for both groups, while critical disparities of factors were also found. In the only child group, factors like family support, parental overprotection, drinking alcohol, sleep conditions and romantic relationship involvement showed greater importance, while higher depression degree, anxiety level and emotional abuse were more important factors for non-only children., Limitations: The use of cross-sectional data from Chinese adolescents may limit deeper analysis of NSSI mechanisms and the generalizability to Western cultures., Conclusions: Only and non-only child family structures may have different influence on factors related with NSSI occurrence of adolescents with MDD. Only children were more susceptible to vulnerable family environments, alcohol abuse and romantic experience, while non-only children were more disturbed by abnormal mental states., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Polypharmacy poses a growing concern in military and veteran populations due to complex health needs arising from service-related injuries and mental health conditions. This systematic review and meta-analysis aims to synthesize existing literature on polypharmacy prevalence, focusing on both general and psychotropic medications in military and veteran populations, and to identify contributing factors., Methods: The study protocol adhered to PRISMA guidelines and was registered on PROSPERO. A comprehensive search across PubMed, Embase, Scopus, and Web of Science yielded 19 eligible studies. Two independent reviewers conducted study selection, data extraction, and quality assessment using standardized tools. The primary outcome was prevalence of polypharmacy and secondary outcomes included factors associated with increased polypharmacy risk., Results: Pooled estimates revealed a high prevalence of psychotropic polypharmacy (36 %, 95 % CI: 23-49 %) and general polypharmacy (49 %, 95 % CI: -26-72 %) among active-duty military personnel and veterans. Heterogeneity was substantial (I 2  = 100 %). Subgroup analyses in studies on psychotropic polypharmacy revealed that veterans with PTSD had a higher prevalence of polypharmacy (48 %) than those without PTSD (22 %). No significant differences were found in general and psychotropic polypharmacy prevalence based on medication threshold, mean age, and geographical location. Despite heterogeneity and bias, the study indicates generally high-quality research., Conclusion: The findings emphasize the critical importance of tailored medication management strategies for military and veteran personnel, considering mental health diagnosis like PTSD. Future research should prioritize longitudinal studies to discern long-term implications and develop targeted interventions for optimizing medication use in military and veteran populations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: This study investigated the longitudinal associations between serum BDNF (sBDNF) levels measured early after injury and the onset of post-traumatic stress disorder (PTSD) across two years., Methods: Patients with moderate to severe physical injuries were enrolled from a trauma center. At baseline, sBDNF levels were measured and a comprehensive socio-demographic and clinical data were collected. The range of time from physical injuries to blood collection was 1-28 days, with a median (IQR) of 8.0 (6.0) days. PTSD diagnoses were determined at 3, 6, 12, and 24 months post-injury using the CAPS-5. Linear regression analyses assessed the relationship between sBDNF levels and PTSD diagnoses., Results: Out of 923 patients, 112 (12.1 %) developed PTSD during the study. Prevalence rates were 8.8 % at 3 months, 7.6 % at 6 months, 4.8 % at 12 months, and 3.7 % at 24 months. Significantly, lower sBDNF levels were associated with PTSD at 12 and 24 months, after adjusting for covariates and applying Bonferroni corrections, but not at earlier assessments., Limitations: Focusing on patients with moderate to severe injuries from a single center may limit the findings' generalizability., Conclusion: Early post-injury sBDNF levels are predictive biomarkers for PTSD, especially significant at 12 and 24 months post-injury., Competing Interests: Declaration of competing interest Jae-Min Kim declares research support in the last 5 years from Janssen and Lundbeck. Sung-Wan Kim declares research support in the last 5 years from Janssen, Boehringer Ingelheim, Allergan and Otsuka. All other authors report no biomedical financial interests or potential conflicts of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Sex differences in sleep disturbances during major depressive episodes (MDE) have been suggested. This study compares the prevalence, sociodemographic characteristics, and psychiatric comorbidity associated with sleep complaints specific to each sex among adults with MDE. These findings are crucial for precise diagnosis, personalized treatment, and improved clinical outcomes., Methods: In a large nationally representative prospective survey, we used multi-adjusted logistic regression models including sociodemographic characteristics, psychiatric comorbidity, and depression severity to examine whether associations differ between men and women., Results: Among women, 93.3 % reported at least one type of sleep complaints (i.e., trouble falling asleep, early morning awakening or hypersomnia) while 91.0 % of men did, with respectively 78.3 % and 77.2 % of insomnia complaints, and 46.2 % and 41.3 % of hypersomnia complaints. Women with sleep complaints were more likely to be black, with lower individual incomes, have histrionic personality disorder or a specific phobia. Conversely, men with sleep complaints were more likely to have a lifetime diagnosis of mania spectrum disorder, generalized anxiety disorder, drug use disorder, as well as dependent and schizotypal personality disorders. Surprisingly, being "never married" has emerged as a protective factor against sleep complaints in women, while posing as a risk factor in men compared to other marital statuses. Differences and specificities were also noted concerning subtypes of insomnia and hypersomnia complaints., Limitations: The cross-sectional design means the associations found do not imply causality., Conclusions: These findings provide insights into the complex relationship between sleep and depression in men and women, highlighting the need for personalized interventions., Competing Interests: Declaration of competing interest Authors report no conflicts of interest related to this work., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Telomere length is a cellular aging marker implicated in various health outcomes. A growing body of evidence suggests a link between leukocyte telomere length (LTL) and mental health outcomes. However, there have been no studies focused on the relationship between LTL and the future risk of depression and anxiety. This study aimed to investigate the associations between LTL and depression/anxiety, examining both cross-sectional prevalence and prospective incidence., Methods: Data from 364,331 UK Biobank participants were analyzed. LTL was measured at baseline, and mental health status was assessed through hospital records and online surveys. Logistic regression and Cox proportional hazards models were employed for cross-sectional and prospective analyses with appropriate adjustment, respectively., Results: The mean (SD) age of the subjects was 57.03 (13.34) years and follow-up duration was 8.80 (5.39) years. Cross-sectionally, shorter LTL was associated with increased odds of depression (OR: 1.401, 95 % CI: 1.291-1.521) and anxiety (1.347 (1.198-1.515)) at baseline, which remained significant after adjustment. Among those free of depression/anxiety at baseline, baseline shorter LTL was associated with a higher risk of incident depression (HR: 1.615, 95 % CI: 1.447-1.803) and anxiety (1.430 (1.293-1.581)) during follow-up period. These associations remained robust after adjusting for various covariates., Conclusions: Our findings indicated an association between shorter telomeres and an increased risk of prevalent depression/anxiety and shorter telomeres precede the onset of these mental health conditions. Considering the potential clinical implications, our study underscores the relevance of LTL as a predictive tool for identifying individuals at risk of developing depression and anxiety., Competing Interests: Declaration of competing interest None of the authors have a conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Studies are lacking on the associations between organisational changes and mental disorders and the underlying mechanisms. The objectives were to explore the associations between organisational changes and depression, measured using a validated instrument, and the mediating role of psychosocial work exposures., Methods: The study relied on the national representative sample of 25,977 employees of the French SUMER survey. The PHQ-9 instrument was used to measure depression. Weighted robust Poisson regression analyses were performed to explore the associations between organisational changes, psychosocial work exposures, and depression. The method by Karlson, Holm and Breen (KHB) was used to estimate the mediating role (contributions) of psychosocial work exposures in the associations between organisational changes and depression., Results: The exposure to any organisational change increased the risk of depression (Prevalence Ratio = 1.85, 95 % CI: 1.61-2.13). All types of organisational changes were found to be risk factors for depression. The risk of depression increased with the number of organisational changes. Psychosocial work exposures contributed to mediating the associations between organisational changes and depression. The exposures with the highest contributions were found to be high psychological demands, low esteem, low job promotion, low job security, workplace bullying, and ethical conflict. Taking all the exposures into account mediated the associations by 47-100 %., Limitations: The study limitations included the cross-sectional design and a potential healthy worker effect., Conclusions: More prevention oriented towards work organisation and the psychosocial work environment may help to reduce depression among working populations., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Depression is a significant public health concern, with severe adolescent morbidity and mortality. Promoting adolescents' mental health is increasingly recognized, and schools are proposed as screening and preventive intervention sites. This cross-sectional study aimed to screen self-reported elevated depressive symptom prevalence among secondary school students in Istanbul, Turkey. The secondary objectives were determining behavioral problems, resilience, positive attitudes, and risk factors associated with depressive symptoms., Methods: Data collection was conducted between April-June 2022. Six thousand one hundred ten students from nine randomly selected schools from different city districts were approached. Depression was screened by the Centre for Epidemiological Studies Depression Scale for Children (CES-DC). The Strengths and Difficulties Questionnaire (SDQ) was used for screening behavioral problems and positive attitudes. Resilience was evaluated by the Child and Youth Resilience Measure (CYRM)., Results: The final study sample comprised 2780 participants (response rate 47.7 %) with a mean age of 12.4 ± 1.1 years (females:52.7 %). Elevated depressive symptoms were detected in 31.2 % of the students. Female students exhibited higher scores in CES-DC and total difficulties but lower resilience scores in CYRM than male students. In a multiple regression analysis, female gender, higher total difficulties score, lower resilience score, and lower perceived academic performance significantly predicted CES-DC [F(6,2279) = 421, p < 0.01]., Discussion: Our findings showed high rates of elevated self-reported depressive symptoms in a city sample among Turkish adolescents at middle schools, in addition to coexisting behavioral difficulties and decreased resilience indicating poor psychosocial functioning. Given the prevalent depressive symptoms, screening and intervention programs involving resilience promotion may involve school systems to prevent adolescent depression., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Individuals with disabilities often face a higher risk of concurrent psychological problems, yet comprehensive assessments of the anxiety and sleep disorders in this population remain limited. This study examined longitudinal trends in the incidence and prevalence of anxiety and sleep disorders among people with disabilities and explored their associations with disability type and severity., Methods: Utilizing claim data from the National Health Insurance database and the National Disability Registry, which cover the entire Korean population, we estimated the age-standardized incidence and prevalence of anxiety and sleep disorders between 2006 and 2017. Logistic regression was used to analyze the associations between disability type and severity and these disorders., Results: The unadjusted incidence and prevalence of anxiety and sleep disorders were consistently higher among individuals with disabilities during the study period. A significant gap in the prevalence of these disorders persisted between individuals with and without disabilities in both sexes, even after accounting for socioeconomic status and comorbidities. However, the incidence showed mixed results, with some categories of disabilities showing lower likelihood of developing the conditions compared to individuals without disabilities., Conclusions: Actions should also be taken to identify undiagnosed cases of anxiety and sleep disorders among individuals with disabilities. Moreover, individuals with disabilities who are diagnosed with these disorders should be more actively managed to avert the progression to the chronic stage., Competing Interests: Declaration of competing interest The authors have nothing to disclose., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Study Objectives: REM-associated OSA (REM OSA) has a prevalence of 17-74% of all OSA cases. At high altitude and in Latin America, there are no data on REM OSA and its relationship to daytime sleepiness and comorbidities. This study aimed to determine the prevalence of REM OSA and the differences in clinical and polysomnographic characteristics between OSA and REM OSA in a population living at 2640 m., Methods: A retrospective cross-sectional study was conducted on adults in Bogotá, Colombia between January and December 2022. Patients were considered to have REM- OSA if they had a REM sleep duration of at least 30 minutes and the ratio of REM-AHI to NREM-AHI was > 2, and NREM-AHI < 15. For comparing the OSA and OSA REM groups, the X 2 or Fisher's exact test was used for the qualitative variables and Student's t-test or its non-parametric counterpart for the quantitative variables., Results: Patients with REM OSA and mild OSA had more severe nocturnal desaturation indices compared to mild NREM OSA. Patients with OSA had a higher prevalence of arterial hypertension and ischemic heart disease., Conclusions: REM OSA prevalence in a population living at high altitude was low compared with other studies. The patients with REM OSA and mild OSA had more severe nocturnal desaturation indexes compared to REM OSA at sea level. This study suggests a possible subgroup of patients with mild OSA at high altitude who may benefit from a discussion about initiating CPAP therapy., (© 2025 American Academy of Sleep Medicine.)

The negative effects of lead exposure on human health have attracted widespread attention. Our present study focused on assessing the relationship between urinary lead levels (ULL) and the risk of kidney stones in US adults. We used data from NHANES 2007-2018 for this cross-sectional study, where participants had complete data on ULL and kidney stones. The correlation between ULL and kidney stones was explored by weighted multiple logistic regression analysis. In addition, we also performed subgroup analysis and interaction tests. A total of 8325 subjects were included, and the prevalence of kidney stones was 9.90%. In the fully adjusted model, we observed a positive association between ULL and the risk of kidney stones (OR:1.07, 95% CI: 1.01-1.14, p = 0.03). Participants in the highest quartile of ULL had a 64% higher risk of kidney stones than those in the lowest quartile of ULL (OR:1.64, 95% CI: 1.05-2.57, p = 0.03). Subgroup analysis and interaction test indicated that the association between ULL and the risk of kidney stones was similar in different population settings. The findings of this study indicate a positive correlation between urine lead concentration and the risk of kidney stones. The potential prognostic value of the urine lead concentration for kidney stone outcomes was another new area investigated in this study. However, further prospective clinical trials are needed to confirm the role of urine lead in the pathogenesis of kidney disease and to validate urine lead as a reliable predictor of kidney stone risk., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: The studies involving human participants were reviewed and approved by the NCHS Ethics Review Board. The Clinical Trial Number was Continuation of Protocol #2011-17. Written informed consent was obtained from all participants in this study. Consent to Publish: All authors contributed to the article and approved the submitted version. Our article was published in preprint form on Research Square because we inadvertently clicked into preprint form., (© 2025. The Author(s).)

Aim: The aim of this systematic review is to present the pooled estimated prevalence and risk factors for cognitive impairment (CI) in patients with chronic obstructive pulmonary disease (COPD)., Background: Patients with COPD suffer from progressive and irreversible airflow limitation, resulting in continuous impairment of lung function, which in addition to causing lesions in the lungs, often accrues to other organs as well. In recent years, a growing number of cross-sectional and longitudinal studies have shown that hypoxia is an important factor in causing CI and that there is an important link between them, but the assessment of co-morbid neurocognitive impairment and dysfunction is often overlooked. Some studies suggest that the diagnosis of mild cognitive impairment (MCI) is considered a precursor to dementia symptoms, with an annual conversion rate of 5%-10%, and it has been suggested that MCI is a potentially reversible state that can be used as a window for intervention. There is a lack of evidence on the prevalence and influencing factors of CI and its MCI., Design: A systematic review and meta-analysis., Methods: PubMed, Web of Science, the Cochrane Library, Ovid, Wiley, and Scopus were searched for cohort, case-control, and cross-sectional studies investigating the prevalence and risk factors of CI and MCI in COPD to June 2023 from building. Meta-analyses were performed to identify CI and MCI prevalence and risk factors using a random-effects model. The methodological quality assessment was conducted by the modified Newcastle-Ottawa Scale (NOS) and Agency for Healthcare Research and Quality (AHRQ). This study was registered on PROSPERO (CRD42021254124)., Results: In total, 41 studies (21 cohort studies, 7 case-control studies, and 13 cross-sectional studies) involving 138,030 participants were eligible for inclusion. Current evidence suggests that the average prevalence of CI and MCI in COPD was 20%-30% (95% CI, 0.17-0.28) and 24% (95% CI, 0.17-0.32), respectively. Significant heterogeneity existed both in CI and MCI (I 2 = 99.76%, 91.40%, p < 0.001). Mata-regression analysis showed that different region could be the source of heterogeneity in the pooled results. Cough, FEV1, PaO 2, age, education, depression, and BODE index are influential factors in the development of CI in COPD., Conclusion: Integrated epidemiological evidence supports the hypothesis that the prevalence of CI in the COPD population has shown an increasing trend, with differences by region and by instrument. Cough, FEV1, PaO 2 , age, education, depression, and BODE index are influential factors in the development of cognitive impairment in COPD patients. We should promote early screening and management of COPD patients and take targeted measures to prevent and reduce the incidence of CI., Implications for Practice: This systematic evaluation and meta-analysis identifies seven important risk factors for the development of CI among COPD patients and exposes their current epidemiological findings to provide a theoretical basis for public health administrators and healthcare professionals to effectively increase the screening rate of cognitive impairment in patients with COPD as well as to carry out early intervention., Trial Registration: PROSPERO).crd. york.ac.uk., (© 2025 Wiley Periodicals LLC.)

Background: Salmonella and Shigella are major enteric pathogens that cause diarrhea in children worldwide. They are pathogenic microbes that cause significant diarrheal morbidity and mortality in under five children in resource limited countries. Thus, this systemic review and meta-analysis aimed to investigate the prevalence of Salmonella and Shigella species and their multidrug resistance patterns in pediatric populations in Ethiopia., Methods: The articles were searched extensively in the electronic databases and grey literature using entry terms or phrases. Studies meeting the eligibility criteria were extracted in MS Excel and exported for statistical analysis into STATA version 14 software. The overall pooled prevalence of Salmonella and Shigella species was computed using a random-effects model. Heterogeneity was assessed using the Cochrane Q test and I 2 statistics with corresponding p-values. Publication bias was assessed using a funnel plot and Egger's test. In addition, sensitivity analysis was performed to determine the impact of individual studies on the pooled effect size., Result: Of a total of 742 identified studies, 89 studies were eligible for full-text analysis. Of 89 studies, 21 were included for meta-analysis involving 5318 study participants. These eligible studies reported a total of 593 bacterial isolates. The overall pooled prevalence of Salmonella and Shigella among pediatrics in Ethiopia was 10.70% (95% CI: 8.96-12.45), with substantial heterogeneity (I 2  = 82.1%, p < 0.001) across the studies. The pooled prevalence of Salmonella and Shigella individually among pediatrics in Ethiopia was 15.43% (95% CI: 10.42-20.72) and 15.83% (95% CI: 11.40-20.40), respectively. Moreover, the overall prevalence of multidrug resistance in Salmonella and Shigella isolates was 81.03% (95% CI: 77.39-84.67) with substantial heterogeneity of I 2 of 95%, p < 0.0001 between the pooled prevalence of the two species., Conclusion: The pooled prevalence of Salmonella and Shigella and their multidrug resistance were alarmingly high in pediatric. The initial empirical treatment of pediatrics patients remains challenging and results high prevalence of antimicrobial resistance. Thus, appropriate infection prevention and control strategies should be implemented and treatment should be directed based on antimicrobial stewardship protocols., Competing Interests: Declaration. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Malaria is the parasitic disease with the highest global morbidity and mortality. According to estimates from the World Health Organization (WHO), there were around 249 million cases in 2022, with 3.4% occurring in Angola. The emergence and spread of drug-resistant Plasmodium falciparum have compromised anti-malarial efficacy and threatens malaria elimination campaigns using artemisinin-based combination therapy (ACT). Increased copy number (CNV) of the P. falciparum gene plasmepsin 2 (pfpm2) have been reported to confer parasite tolerance to piperaquine (PPQ) and the multidrug resistance-1 (pfmdr1), resistance to mefloquine (MEF) and decreased susceptibility to lumefantrine (LUM). PPQ, MEF and LUM are ACT partner drugs. Therefore, CNV detection is a useful tool to track ACT resistance risk. The potential for future treatment failure of artemisinin-based combinations (that include PPQ, LUM and AMQ), due to parasite resistance in the region, emphasizes the need for continued molecular surveillance., Methods: One hundred and nine clinically derived samples were collected at Hospital Central Dr. António Agostinho Neto (HCL) in Lubango, Angola. qPCR targeting the small-subunit 18S rRNA gene was used to confirm P. falciparum infection. Copy number estimates were determined using a SYBR green-based quantitative PCR assay., Results: Overall, this study revealed a low number of resistance CNVs present in the parasite population at Lubango, for the genes pfmdr1 and pfpm2. Of the 102 samples successfully analysed for pfpm2 10 (9.8%) carried increased CNV and 9/101 (8.9%) carried increased CNV of pfmdr1., Conclusions: This study provides, for the first time, evidence for the presence of CNVs in the pfpm2 and pfmdr1 genes in P. falciparum isolates from southern Angola., Competing Interests: Declarations. Ethics approval and consent to participate: DNA samples were collected following individual oral consent and signed informed written consent from all participants or their guardians. Ethical clearance for the work was obtained from: Comité de Ética Independente da Faculdade de Medicina da Universidade Agostinho Neto and by the Hospital Central Dr. António Agostinho Neto (HCL) institutional ethics review committee (deliberation Nº08/2020, on 14 November 2020). Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Mosquitoes are important drivers of infectious diseases transmission, with Anopheles mosquitoes being responsible of malaria transmission. In Cambodia, where malaria is prevalent in forested regions, understanding the ecology of these vectors is crucial. This study aimed to investigate the abundance, distribution, seasonal patterns, biting behaviour of Anopheles mosquitoes, and prevalence of Plasmodium, in Mondulkiri province, Northeastern Cambodia., Methods: Conducted in 9 sites, seven in forested and two in neighbouring villages, over one year, the collection of Anopheles mosquitoes was made hourly for a 72-h period every month, using a human-baited double net trap. Each mosquito was collected using a mouth-aspirator and identified morphologically, and screened for the presence of Plasmodium., Results: Primary vectors, including Anopheles baimaii, Anopheles dirus, Anopheles maculatus, and Anopheles minimus, constituted 11.1% of all female mosquitoes, while 12 secondary vector species represented 29.4% of the overall collection. Anopheles species were more prevalent during the late rainy season (August to November), with year-round activity observed. Primary vectors were predominantly found in forest sites, while other vector species were found in both village and forest environments. Notably, primary vectors exhibited a preference for nocturnal biting, yet a significant proportion (19.2%) displayed daytime activity, highlighting a potential risk of daytime malaria transmission. Among 5,056 Anopheles specimens tested, only 36 Plasmodium spp.-infected samples were detected, mainly in forest sites (94%), and in specimens collected at night. This study provides essential insights into the ecology of Anopheles in Mondulkiri Forest., Conclusions: The identification of primary and secondary vectors, their seasonal dynamics, and biting behaviour contribute to enhances our understanding of malaria transmission risks in these areas, guiding future strategies toward effective and context-specific control measures, while stressing the need for individual protection during daytime., Competing Interests: Declarations. Ethics approval and consent to participate: The study protocol was reviewed and approved by the National Ethics Committee for Health research, Ministry of Health, Kingdom of Cambodia (306NECHR, 100NECHR). The study procedures and risks were explained to the collectors and their informed consent was obtained. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests., (© 2024. The Author(s).)

Background: Geographical factors can affect infectious disease transmission, including SARS-CoV-2, a virus that is spread through respiratory secretions. Prioritization of surveillance and response activities during a pandemic can be informed by a pathogen's geographical transmission patterns. We assessed the relationship between geographical factors and SARS-CoV-2 prevalence in Zambia., Methods: We did a cross-sectional study of SARS-CoV-2 prevalence in six districts in July 2020, which was during the upslope of the first wave in Zambia. In each district, 16 Standard Enumeration Areas (SEAs) were randomly selected and 20 households from each SEA were sampled. The SEA PCR prevalence was calculated as the number of persons testing PCR positive for SARS-CoV-2 in the SEA times the individual sampling weight for the SEA divided by the SEA population. We analysed SEA geographical data for population density, socioeconomic status (SES) (with lower scores indicating reduced vulnerability), literacy, access to water, and sanitation, and hygiene (WASH) factors. Gaussian conditional autoregressive (CAR) models and Generalised estimating equations (GEE) were used to measure adjusted prevalence Ratios (aPRs) and 95% confidence intervals (CIs) for SARS-CoV-2 prevalence with geographical factors, after adjusting for clustering by district, in R., Results: Overall, the median SARS-CoV-2 prevalence in the 96 SEAs was 41.7 (Interquartile range (IQR), 0.0-96.2) infections per 1000 persons. In the multivariable CAR analysis, increasing SES vulnerability was associated with lower SARS-CoV-2 prevalence (aPR) = 0.85, 95% CI: 0.78-0.94). Conversely, urban SEAs and poor access to WASH were associated with a higher SARS-CoV-2 prevalence (aPR = 1.73, 95% CI: 1.46-2.03, No soap: aPR = 1.47, 95% CI: 1.05-2.05, households without piped water: aPR = 1.32, 95% CI: 1.05-1.65, 30 min to fetch water: aPR = 23.39, 95% CI: 8.89-61.52). Findings were similar in the multivariable GEE analysis., Conclusions: SARS-CoV-2 prevalence was higher in wealthier, urban EAs, with poor access to WASH. As this study was conducted early in the first wave could have impacted our findings. Additional analyses from subsequent waves could confirm if these findings persist. During the beginning of a COVID-19 wave in Zambia, surveillance and response activities should be focused on urban population centres and improving access to WASH., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval to conduct the primary study was obtained from the University of Zambia Biomedical Research Ethics Committee (IRB00001131 of IORG0000774) study reference (REF. NO. 1030–2020). Consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Metabolic syndrome has become a major public health problem worldwide and is attributable to the spread of different non-communicable diseases such as type 2 diabetes mellitus, coronary artery diseases, stroke, and permanent or temporary disabilities. It is not a single disease entity but encompasses different risk factors. However, there were inconsistencies among previously conducted primary studies, hence this systematic review and meta-analysis aimed to determine the pooled prevalence and determinants of metabolic syndrome among type2 diabetes patients in Ethiopia., Method: First-hand studies about the metabolic syndrome among adult type 2 diabetic patients in Ethiopia were searched through known and international databases (PubMed, Scopus, Web of Science, and Cochran Library) and search engines (Google and Google Scholar). Data was extracted using a standard data extraction checklist developed according to Joanna Briggs Institute (JBI). The I 2 statistics are used to identify heterogeneity across studies. Funnel plot asymmetry and Egger's tests were used to check for publication bias. A random effect model was used to estimate the pooled prevalence of the metabolic syndrome among non-insulin-dependent patients in Ethiopia. The STATA version 11 software employed for statistical analysis was conducted using STATA version 11 software., Result: The overall pooled prevalence of metabolic syndrome among type2 diabetic patients in was 54.56% [95%CI (43.73, 65.38), I 2  = 97.0%, P = 0.001] using NCEP-ATP III, 48.32% [95%CI (42.1, 54.44), I 2  = 97.0%, P = 0.001] IDF diagnosis criteria, 47.0[95%CI(27.01-66.99)], I 2  = 97.5%, p = 0.001 using WHO and 59.37%(95%CI(47.21-71.52), I 2  = 91.2%, p = 0.001 using harmonized diagnosis criteria respectively. This meta-analysis identified several significant predictors of metabolic syndrome among type 2 diabetes patients in Ethiopia. The odds of having metabolic syndrome was reduced for females (Adjusted Odds Ratio [AOR] = 0.55, 95% CI: 0.35-0.87) compared to males. However, the odds of metabolic syndrome increased with alcohol intake (AOR = 1.44, 95% CI: 1.03-2.01), the odds of living in urban areas(AOR = 2.12, 95% CI: 1.55-2.88), and the odds of having a diabetes duration of six or more years since diagnosis (AOR = 2.94, 95% CI: 1.17-7.41) were significant predictors., Conclusion: The pooled prevalence was considerably high among type 2 diabetic patients in Ethiopia. The pooled prevalence of metabolic syndrome varies as per the diagnosis criteria used with the highest observed in harmonized diagnosis criteria. Being female, being rural residency, alcohol intake, and duration of diabetes since diagnosis were significant predictors of metabolic syndrome among type 2 diabetic patients in Ethiopia., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Insulin resistance (IR) and abdominal obesity are key in osteoarthritis (OA) development. The triglyceride glucose (TyG) index, along with indicators such as the visceral adiposity index (VAI), and lipid accumulation product (LAP), are increasingly used to measure IR. This study aims to explore the associations between surrogate IR indexes and OA, assessing their diagnostic efficacy within American populations. This study included 14,715 adults from the National Health and Nutrition Examination Survey 2003-2016. Logistic regression models and restricted cubic spline were used to explore the relationship between surrogate IR indexes and OA. Receiver operating characteristic curves were constructed to assess the diagnostic efficacy of these indices, with the area under the curve (AUC) as the metric. TyG, glucose triglyceride-waist circumference (TyG-WC), glucose triglyceride-body mass index (TyG-BMI), glucose triglyceride-waist height ratio (TyG-WHtR), VAI and LAP were significantly and positively associated with the prevalence of OA (all p < 0.01). After adjusting for various potential confounders, TyG-WC, TyG-BMI, TyG-WHtR and LAP remained significantly correlated with the prevalence of OA. Furthermore, restricted cubic spline revealed a nonlinear association between TyG-BMI, TyG-WHtR and LAP (all P-non-linear < 0.05). Receiver operating characteristic curves indicated that TyG-WHtR (AUC 0.633) demonstrated more robust diagnostic efficacy. Additionally, the sensitivity analysis produced results consistent with the primary findings. TyG and its combination with obesity indicators and LAP, are positively associated with the prevalence of OA, with TyG-WHtR showing the highest diagnostic efficacy., Competing Interests: Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Review Committee of the National Center for Health Statistics (Protocol #98-12, Protocol #2005-06, Continuation of Protocol #2005-06, Protocol #2011-17 and Continuation of Protocol #2011-17). Informed consent was obtained from all the subjects involved in the study. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Erectile Dysfunction (ED) is the leading cause of sexual dysfunction affecting hundreds of millions of men worldwide, and has been described as an important public health problem. The association of five novel anthropometrics related to obesity, lipids and glucose with ED remains unclear. To investigate the association of lipid accumulation products index (LAP), triglyceride glucose index (TyG), waist triglyceride index (WTI), weight-adjusted-waist index (WWI) and a body shape index (ABSI) with ED. Cross-sectional data from the NHANES were used. Participants were adults aged 20-85 y from 2001 to 2004. The analysis of logistic regressions, smooth curve fitting, subgroup analyses and generalized addition model were performed to examine the relationship between five novel anthropometric indicators and the prevalence of ED. An overall 1413 adult men were included in the study. After adjusting for confounding factors, the results of multiple regression analysis showed, ED positively correlated with LAP(OR = 1.0031, P < 0.05), TyG(OR = 1.2981, P < 0.05), WTI(OR = 1.4220, P < 0.05), WWI(OR = 1.6043, P < 0.001), and ABSI(OR = 1.6211, P < 0.05). Smoothed curve fitting and subgroup analyses proved the stability of the relationship. This cross-sectional study showed a positive correlation between these five novel anthropometric indicators (LAP, TyG, WTI, WWI, ABSI) and ED. Further studies are needed to explore their association better and the underlying mechanisms., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethical approval: The study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of the National Centre for Health Statistics. Informed consent: Informed consent was obtained from all subjects involved in the study., (© 2025. The Author(s).)

Background: This study aims to examine the temporal changes in the incidence, prevalence, and disability-adjusted life years (DALYs) of depressive disorders as well as its association with age, period, and birth cohort among Chinese from 1990 to 2021, and forecast the future trends of incidence rates and numbers from 2022 to 2030., Methods: Data for analysis were obtained from the Global Burden of Disease (GBD) 2021. Joinpoint analysis was used to calculate the annual percentage change (APC) and average annual percent change (AAPC) to describe the rates of depressive disorders. Age, period, and cohort model was utilized to disentangle age, period, and birth cohort effects on rates of depressive disorders. Bayesian age-period-cohort (BAPC) analysis was capitalized to forecast the incidence rates and numbers for different sexes and age groups from 2022 to 2030., Results: The age-standardized incidence (ASIR, AAPC: -0.35 [95%CI: -0.65, -0.04]), prevalence (ASPR, AAPC: -0.20 [95%CI: -0.24, -0.16]), and DAYLs (AAPC: -0.28 [95%CI: -0.51, -0.05]) rates of both sexes showed a downward trend from 1990 to 2021, despite a volatility growth in recent years (APC in 2019-2021 of ASPR: 0.96 [95%CI: 0.70, 1.23]). Females exhibited a higher burden of depressive disorders compared to males but experienced a more rapid rate of reduction changes. The burden of depressive disorders was most owing to the age effect and period effect in recent years. The ASIR was predicted to decrease in the whole population (males in 2030: 1,546.3 per 100,000 people; females in 2030: 2,465.8 per 100,000 people), but in children, adolescents, and the elderly demonstrate unfavorable trends in the future., Conclusion: The burden of depressive disorders decreased in China from 1990 to 2021 in terms of age-standardized rates, but increased in recent years. Children, adolescents, and the elderly are the risk groups for future depressive disorders. Considering the large population, the increasing fewer children, and the aging trend, as well as the possible long-term effects of COVID-19 on human psychological burden, more sex-age-sensitive social healthcare programs should be considered in the future to minimize the burden of depressive disorders in China., Competing Interests: Declarations. Ethics approval and consent to participate: The experimental protocol was established, according to the ethical guidelines of the latest revision of the Declaration of Helsinki and was approved by the Human Ethics Committee of Xuzhou Medical University. Written informed consent was obtained from individual or guardian participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Sarcopenia is prevalent among hemodialysis patients and is associated with poor outcomes. The neutrophil-to-lymphocyte ratio (NLR), an easily obtainable marker of inflammation, may predict sarcopenia risk. This study aimed to investigate the association between NLR and sarcopenia risk in maintenance hemodialysis patients, examining this association in the context of obesity., Methods: This cross-sectional study included 411 maintenance hemodialysis patients. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia criteria-2019 (AWGS 2019). Body composition was assessed using bioelectrical impedance analysis. Logistic regression models examined associations between NLR and sarcopenia risk, adjusting for potential confounders. Analyses were stratified by obesity status., Results: The prevalence of sarcopenia was 51% (95% CI: 45.1-54.9%), with 37.2% classified as sarcopenic non-obese and 13.6% as sarcopenic obese. In fully adjusted models, each unit increase in NLR was associated with 10% higher odds of sarcopenia overall (OR 1.10, 95% CI: 1.00-1.21, p = 0.048). This association remained significant in sarcopenic obese patients (OR 1.15, 95% CI: 1.00-1.32, p = 0.049). Patients in the highest NLR tertile had 1.95 times higher odds of sarcopenia compared to the lowest tertile (95% CI: 1.12-3.40, p = 0.018), with a significant trend across tertiles (p-trend = 0.015)., Conclusions: NLR is independently associated with sarcopenia risk in hemodialysis patients, including those with obesity. These findings suggest NLR could serve as a simple, cost-effective tool for identifying hemodialysis patients at high risk of sarcopenia, potentially facilitating early intervention strategies., Competing Interests: Declarations. Ethics approval and consent to participate: Good clinical care guidelines were followed, and the guidelines were established as per the Helsinki Declaration 2008. All the participants were given clear instructions about the study before the start of the study. Written informed consent was obtained from the patients in the vernacular language for study participation. No identifying information or images have been included in the original article, which was submitted for publication in an online open-access publication. The entire methodology and protocol were approved by the Institutional Ethical Committee of Shri M P Shah Government Medical College, Jamnagar, Gujarat, India. The study protocol was reviewed and approved by the institutional review board or ethics committee. (approval number: 03/01/2023).Our study is not a clinical trial(so clinical trial registration number is not applicable). Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: In our previous study, we demonstrated that headaches are highly prevalent among medical students in Vietnam. In the present study, we provide estimates of the associated symptom burden and impaired participation, utilizing these estimates to assess headache-related healthcare needs within this population., Methods: The study followed the standardized methodology established by the Global Campaign against Headache. Participants included medical students who were randomly selected from two medical universities in Vietnam. Data collection utilized the HARDSHIP questionnaire, which included diagnostic questions based on ICHD-3 criteria, measures of symptom burden, quality of life (QoL) assessments using the WHOQoL-8, evaluations of impaired participation through the HALT index, and questions about headache yesterday (HY). The definition of health care "need" was based on the likelihood of benefit from intervention, including all participants with probable medication-overuse headache (pMOH), other headaches occurring on ≥ 15 days/month (H15+), migraine on ≥ 3 days/month, or migraine or tension-type headache (TTH) meeting at least one of two criteria related to symptom burden and impaired participation., Results: A total of 1,362 participants (57.3% female) were included, of whom 1,125 students (61.3% female) were diagnosed with a headache disorder, and 165 students (69.1% female) reported experiencing a HY. The mean frequency of any headache was 3.6 days per month, with an average duration of 5.3 h, and 58% of participants reported an intensity of moderate/severe. For all headache, the mean pTIS was 2.8%. The mean number of lost days over a period of 3 months was 4.3 for work/school tasks, 3.8 for household chore, and 1.7 for social or leisure activities. Among those reporting a HY, 35.8% were able to complete less than half of their expected activities, while 9.7% could complete none. QoL of students with any headache was significantly lower than that of students without headache. A mong students with headache, 43.8% fulfilled atleast one of our needs assessment criteria., Conclusions: This first study on headache burden in Vietnam reveals substantial symptom burden alongside a correspondingly high level of impaired participation among medical students., Competing Interests: Declarations. Ethical approval: The study was conducted in accordance with the Declaration of Helsinki, and informed consent was obtained from all subjects and their legal guardian(s). The protocol and questionnaire were reviewed and approved by the Institutional Review Board at the University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam. All participants were informed of the nature and purpose of the study and gave oral consent prior to enrolment. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Purpose: To compare the prevalence, magnitude, and type of astigmatism among patients with different Duane Retraction Syndrome (DRS) types., Method: This retrospective cross-sectional study reviewed the records of 312 DRS patients. Patients were categorized into DRS Types 1, 2, 3, and bilateral cases. Refractive errors and visual acuity were analyzed, emphasizing the prevalence of astigmatism types, specifically with-the-rule (WTR), against-the-rule (ATR), and oblique, as well as the power vectors for each DRS subtype., Results: Our study included 312 patients with DRS, comprising 44.6% males and a median age of 18.5 years (interquartile range [IQR]: 7-27). Of these, 280 had unilateral DRS and 32 had bilateral DRS. The median age for unilateral DRS patients was 19 years (IQR: 7-27; 43.2% males), whereas for bilateral DRS patients, it was 16 years (IQR: 6-29.2; 56.3% males). In all DRS patients, 180 (57.7%) were diagnosed with Type 1 DRS, 87 (27.9%) with Type 2 DRS, and 45 (14.4%) with Type 3 DRS. In unilateral cases, WTR astigmatism was the most prevalent (56.8%), followed by oblique (23.6%) and ATR astigmatism (19.6%). Bilateral DRS patients exhibited a similar distribution in both eyes, with WTR astigmatism also being predominant. The comparative analysis of power vectors indicated that Type 1 DRS exhibited a greater prevalence of WTR and oblique astigmatism, whereas ATR astigmatism was the predominant pattern in Types 2 and 3. A comparison of cylindrical powers and power vectors among fellow eyes of different DRS subtypes revealed that Type 2 DRS had significantly higher cylindrical power (p = 0.017) and a greater tendency toward ATR astigmatism (p = 0.038) than fellow eyes in other subtypes, suggesting that astigmatic changes may also occur in fellow eyes., Conclusion: Our study demonstrates a high prevalence of astigmatism, particularly WTR astigmatism, in DRS patients. Furthermore, we found significant associations between specific astigmatism patterns and DRS subtypes, suggesting a potential link between extraocular muscle innervation, co-contraction, and corneal shape. These findings highlight the importance of comprehensive astigmatism assessment in DRS patients for optimal refractive management., Competing Interests: Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the Declaration of Helsinki. The study protocol underwent a thorough review and received approval from the Institutional Review Board of Tehran University of Medical Sciences, ensuring adherence to ethical standards and guidelines. Informed consent was obtained from all participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: There is an increased prevalence of mental health problems in various population groups as a result of the COVID-19 pandemic and its consequences, especially regarding anxiety, stress, depression, fear, and sleep disturbances, require to be investigated longitudinally., Objective: This study aimed to determine the impact that the COVID-19 pandemic had on the mental health of Nursing students, as well as to examine other associated factors such as anxiety, fear, sleep disturbances, and coping strategies., Method: This systematic review and meta-analysis were designed following the PRISMA guidelines and were registered in PROSPERO with code CRD42024541904. PubMed, Web of Science, CINAHL, and Scopus electronic databases were utilized. Keywords indexed in the MeSH thesaurus were used (COVID-19, nurs* student and mental health), following the Condition Context Population (CoCoPop) strategy. A total of 3866 studies were obtained of which 36 were selected for inclusion in the review. The Joanna Briggs Institute critical appraisal tool was used to assess the methodological quality of the selected studies, all of which were cross-sectional, finally including those with a cutoff point equal to or greater than 4 out of 8., Results: The prevalence of total anxiety was found to be 33.6% in the meta-analysis. For depression, the prevalence was 37.92%, and for stress, it was 52.46%. The results of this study show increased levels of stress, anxiety, depression, fear, and sleep disturbances among Nursing students that coincide with the different waves of the pandemic, changes in the study methodology, and the increase or decrease in reports of cases of infection. A relationship is observed between variations in these variables and the implementation of protective measures and vaccinations in different countries., Conclusion: As the pandemic progressed, hygiene and prevention measures became more effective, and the lethality of the virus decreased. The prevalence of the negative psychological effects also decreased from the onset in 2020 until the end of 2022. Due to the impact of the pandemic on global health, preventive measures should include personal, family, emotional, economic, educational, professional, and mental health approaches., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Effective antimicrobial stewardship programs require data on antimicrobial consumption (AMC) and utilization (AMU) to guide interventions. However, such data is often scarce in low-resource settings. We describe the consumption and utilization of antibiotics at a large tertiary-level hospital in Uganda., Methods: In this cross-sectional study at Kiruddu National Referral Hospital, we analyzed medicine delivery records for the period July 2021 to June 2022, accessed on 12/08/2022, to extract AMC data expressed as defined daily doses (DDDs) per 1000 inhabitants per day (DID). We used the WHO point prevalence survey (PPS) to analyze AMU data with a systematic sampling of outpatient department (OPD) for a period between June and August 2022 and selected all inpatient department (IPD) patients admitted before 8:00 AM on 27/11/2022. AMU data was analyzed as the proportion of individual antibiotic prescriptions, indications for prescriptions, and compliance with the national treatment guidelines. Both AMC and AMU data were categorized by the WHO AWaRe (access, watch, and reserve) criteria., Results: In the year 2021-2022, a total of 6.05 DID of antibiotics were consumed comprising 3.61 DID (59.6%) access, 2.44 DID (40.3%) watch, and 0.003 (0.1%) reserve antibiotics. The most consumed antibiotics comprised penicillin (1.61 DID, 26.7%), cephalosporins (1.51, 25%), and imidazole (1.10 DID, 18.1%). A total of 119/211 (56%) patients in the OPD and 99/172 (57.5%) patients in the IPD were prescribed antibiotics. Of the 158 OPD antibiotic prescriptions, 73 (46.2%) were access, 72 (45.6%) were watch, 0 (0%) were reserve, and 13 (8.2%) were unclassified antibiotics. Of the 162 IPD antibiotic prescriptions, 62 (38.3%) were access, 88 (54.3%) were watch, 01 (0.6%) was reserve, and 11 (6.8%) were unclassified antibiotics. Indications for antibiotic prescriptions in the OPD comprised respiratory tract infections (53, 38.1%), urinary tract infections (34, 26.6%), gastrointestinal infections (20, 14.4%), sepsis (17, 12.2%), and medical prophylaxis (12, 8.7%). The indications for antibiotic prescriptions in the IPD comprised sepsis (28.2%), respiratory tract infections (18.3%), burn wounds (14.1%), and gastrointestinal infections (14.1%)., Conclusion: Prescription of watch antibiotics in both OPD and IPD hospital settings was high. Establishment of robust antimicrobial stewardship measures could help improve the rational prescription of antibiotics., Competing Interests: No authors have competing interests, (Copyright: © 2025 Kizito et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Previous studies have shown that both the composite dietary antioxidant index (CDAI) and sex are strongly associated with a variety of cardiovascular diseases, but sex differences between CDAI and hyperlipidemia are unknown., Objective: This study utilized data from the National Health and Nutrition Examination Survey (NHANES) to investigate the sex differences between CDAI and hyperlipidemia., Method: We calculated the CDAI of the six dietary antioxidants using data from NHANES, explored the relationship between CDAI and the prevalence of hyperlipidemia using multivariate logistic regression analysis, and analyzed for potential nonlinear associations using restricted cubic spline. Finally, the association between CDAI and hyperlipidemia was further explored using multivariate logistic regression in different genders., Results: The study included a total of 34,754 participants with a mean age of 47.04 years, of whom 49.37% were man. In a fully adjusted multivariable binary logistic regression model, CDAI was negatively associated with the prevalence of hyperlipidemia (OR = 0.99, 95% CI:0.98-0.99). In addition, participants in the highest quartile had a lower risk of hyperlipidaemia compared with the lowest quartile of CDAI (OR = 0.83, 95%CI: 0.76-0.92). We also found a non-linear relationship (non-linear P = 0.003, Inflection point = -0.179). Finally, we found that the association between CDAI and the prevalence of hyperlipidemia was significantly stronger in the female population than in the male population (P for interaction <0.05)., Conclusion: Our study highlights the L-shaped association between CDAI and the prevalence of hyperlipidemia in the general adult population. In addition, this association was more significant in the female population than in the male population., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Miao et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: Catatonia is a neuropsychiatric disorder that is associated with a range of medical and psychiatric illnesses. Although many single-center studies have been conducted, uncertainty over the population-based incidence and prevalence of the disorder remains. This study reports on the incidence and prevalence rates of catatonia extrapolated from two large epidemiologic studies in the United Kingdom and United States., Methods: Incidence rates (defined as the number of catatonic episodes per 100,000 person-years) and prevalence rates (defined as the proportion of individuals with catatonia in a given year) were calculated from the two studies., Results: U.K. data showed an incidence of 4.34 (95% CI=3.98-4.72) catatonic episodes per 100,000 person-years with an average 1-year prevalence of 4.39 (95% CI=4.03-4.77) catatonic episodes per 100,000 persons. U.S. data revealed a 1-year prevalence of 5.15 (95% CI=5.08-5.23) catatonia-related hospitalizations per 100,000 persons., Conclusions: Catatonia is a rare disorder, qualifying as an orphan disease under both European Medicines Agency and U.S. Food and Drug Administration criteria. Further research is needed to rigorously define the epidemiology of catatonia in other populations., Competing Interests: Dr. Luccarelli reports receiving funding from Harvard Medical School, the Rappaport Foundation, and the Foundation for Prader-Willi Research and receiving equity in Revival Therapeutics, Inc. Dr. Smith reports receiving funding from the National Institute of Child and Human Development and support from Axial and Roche. Dr. Kalinich reports receiving compensation from Watershed Informatics and equity from Watershed Informatics and Revival Therapeutics, Inc. Dr. Rogers reports receiving research funding from the Wellcome Trust and NIHR; royalties from Taylor & Francis; payment for reviewing from Johns Hopkins University Press; and speaker fees from the Alberta Psychiatric Association, Infomed Research and Training Ltd., North East London NHS Foundation Trust, and Vanderbilt Medical Center. Dr. Amad reports no financial relationships with commercial interests.

Epidemiological studies combining taxonomic and clinical data have been limited globally, particularly Guiyang, the most under-developed economic provincial capital city in southwestern China. A retrospective analysis was performed of dermatophyte epidemiology involving all culture-positive cases received between May 2017 and May 2023 at the Affiliated Hospital of Guizhou Medical University. Phylogenetic analysis was conducted on 391 dermatophyte isolates collected from patients using the rDNA internal transcribed spacer sequences. Clinical relevance information was analyzed statistically using T-test, one-way ANOVA, Kruskal-Wallis H test, and Chi-square test. Eight species were recognized, and their identity was confirmed on the basis of phylogenetics. Trichophyton rubrum (n = 308, 78.77%) ranked first, followed by T. mentagrophytes (n = 39, 9.97%) and Microsporum canis (n = 32, 8.18%). Tinea unguium (48.56%) was the most common type of dermatophytosis in this study, rates of detection being impacted by the host population's attention for dermatophyte infections. The hypothesized patterns of evolution in the M. canis series, T. mentagrophytes series and T. rubrum series, i.e. from zoophilic to a preponderantly anthropophilic nature, was reflected in clinical parameters such as host age, occupational background, infection pattern, degree of skin involvement and site preference. To the best of our knowledge, we provide the first detailed analysis of epidemiological characteristics and pathogenic patterns of dermatophytosis in Guiyang., Competing Interests: Declarations. Conflict of interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2025. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Exposure to hairs of caterpillars and moths are collectively termed as lepidopterism. Clinical manifestations include cutaneous presentation of localized stinging reaction with wheals or vesiculation, acute urticarial papules and plaques, ophthalmic, oropharyngeal involvement to severe life-threatening anaphylactic reactions with angioedema., Aims: In this study we have determined the prevalence of various cutaneous, oropharyngeal and ophthalmic manifestations of lepidopterism at a tertiary health care center., Methods: All clinically diagnosed cases of lepidopterism were recruited for the study. Characteristics such as age, sex, history of atopy, presence of direct contact with implicated moth/ caterpillar, symptoms and signs, eye, oropharyngeal involvement and systemic findings were noted. Severity of symptoms and signs were quantified according to the Investigator Global Assessment Scale for Dermatitis. Treatment response were noted. The data was analysed and results tabulated., Results: Out of 32 patients 26 had direct exposure and 6 reported symptoms without direct exposure, Itch and pain, urticaria and excoriations were the most common findings, systemic symptoms though less in occurrence were noted., Limitations: There is lack of sufficient literature on these findings for comparative analysis., Conclusion: Caterpillar dermatitis can occur without direct contact and can be treated completely thus an astute index of suspicion is essential for prompt diagnosis and treatment., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Mycetoma is a chronic granulomatous disease affecting the skin, subcutaneous tissues, and bones, particularly in tropical and subtropical regions. Sudan, especially its Eastern Sinnar locality, experiences a significant burden due to environmental conditions and limited access to healthcare, while the population's lack of awareness and understanding often leads to delays in diagnosis and treatment., Methods: We conducted a descriptive cross-sectional, community-based study in Eastern Sinnar, Sudan, to investigate the prevalence, risk factors, and awareness of mycetoma among local residents. Using Cochran's formula, we calculated a required sample size of 400 participants from a total population of 245 201. Then, we randomly selected these participants from five villages chosen through stratified sampling. Data were collected via a validated questionnaire assessing sociodemographic characteristics and mycetoma-related information, a review of medical records to confirm infection types and prevalence, and interviews with the Directorate of the Mycetoma Centre in Sinnar. We used χ 2 tests for associations in our analysis, with P-values ≤0.05 indicating statistical significance., Results: The mycetoma prevalence was 5.4%, with males comprising 76.4% of infected cases. However, the difference in infection rates between genders was not statistically significant (P = 0.248). While infection rates were higher among certain occupational groups, such as farmers and shepherds, the association between occupation and mycetoma infection was non-significant (P = 0.107). We also found no significant associations with educational level (P = 0.104) or age (P = 0.514), but did detect significant associations for family history of infection (P < 0.001), animal ownership (P = 0.004), and not wearing shoes during work (P = 0.05). Awareness of mycetoma was relatively high, with 78.3% of respondents acknowledging the disease, though knowledge gaps remained, especially regarding its transmission, with only 36.1% believing it to be transmissible., Conclusions: The study highlights the need for targeted health education programmes, particularly emphasising protective footwear and safe animal-handling practices. These findings are crucial for informing public health strategies aimed at reducing the burden of mycetoma in endemic regions such as Eastern Sinnar., Competing Interests: Disclosure of interests: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclosed no relevant interests., (Copyright © 2025 by the Journal of Global Health. All rights reserved.)

Background: Gallstone disease (GSD) is a prevalent gastrointestinal disorder, few studies have examined the combined effects of dietary and lifestyle factors on GSD. This study aims to investigate the relationship between oxidative balance score (OBS) and GSD, and explores the potential mediating role of oxidative stress., Methods: Cross-sectional data from 6,196 participants in the NHANES 2017-2020 were analyzed. OBS, encompassing 16 dietary and 4 lifestyle factors, was assessed alongside GSD prevalence. Weighted multivariate logistic regression, restricted cubic spline (RCS) analysis were used to explore the relationship between OBS and GSD and mediation analysis was used to test the indirect effect of oxidative stress indicators. Subgroup analysis and sensitivity analysis were used to determine the stability of results., Results: A higher OBS was significantly associated with a reduced risk of GSD (OR: 0.701, 95% CI: 0.492-0.999, P < 0.05). RCS analysis revealed a linear association between OBS and GSD risk. Mediation analysis indicated significant mediating effects of albumin and uric acid, with a combined mediation proportion of 19.540% (P < 0.05). Subgroup analysis revealed differences and interrelationships based on education level, providing additional insights into the relationship between OBS and GSD and sensitivity analysis confirmed the stability of these associations., Conclusions: A higher OBS is associated with a reduced risk of GSD, especially among higher education levels groups, and albumin, uric acid may act as mediators of this association. These findings underscore the potential role of oxidative stress in GSD and the significance of maintaining a healthy diet and lifestyle to decrease GSD risk., Competing Interests: Declarations. Ethics approval and consent to participate: Data of this research was taken from the NHANES. The NHANES was approved by the National Center for Health Statistics Research Ethics Review Board. All participants were informed and provided their consent prior to their participation, and signed the related documents. The study was conducted in accordance with the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Human bocaviruses (HBoVs) can cause respiratory illness in young children. Although the first HBoV infection in India was reported in 2010, very little information is available about its prevalence, clinical features, or geographic distribution in this country. This study was conducted using 136 respiratory samples from paediatric patients in a tertiary care hospital in Kerala, 21 of which tested positive for HBoV1 and were further characterized through VP1/VP2 gene sequencing. We found that different strains of HBoV1 are co-circulating in the region and that HBoV1 can be detected in children with severe acute respiratory infections, either alone or coinfections with other pathogens, without any significant differences in their clinical characteristics., Competing Interests: Declarations. Ethical approval: This study was approved by the Institutional Human Ethics Committee of IAV (IHEC-IAV-2023-07), and informed consent was obtained from the parents of the paediatric patients enrolled. Conflict of interest: The authors have no relevant financial or non-financial interests to disclose., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

In recent years, wheat- and gluten-free diets have increased in demand due to reported increases in various conditions reported to be driven by ingredients of these food products. Celiac disease, wheat allergy and non-celiac wheat sensitivity constitute the three main categories of wheat-related disorders. Celiac disease is a well-characterized immune-mediated disease caused by immune reaction against specific gliadin epitopes, the main protein in wheat. Screening studies of samples collected over time bring evidence that there is a true increase in prevalence not only driven by increased testing activity. Clinical presentation of CeD is diverse and there is an increased risk of autoimmune co-morbidities. Wheat allergy consists of IgE- and non-IgE-mediated reactions, driven by Th2-cells directing eosinophil and basophil responses. Rapid IgE-mediated reactions are characterized by specific IgE antibodies in conjunction with symptoms originating especially from the respiratory and gastrointestinal tract. There is an increased risk of other allergies and the majority recover during adolescence. Non-IgE-mediated wheat allergy is a less-well defined condition, which is often diagnostically challenging due to a longer interval between exposure and symptoms and lack of non-invasive biomarkers. In this condition, wheat as a trigger needs to be established by exclusion followed by dietary challenge. Non-celiac wheat sensitivity, despite being the most recently recognized, has the highest reported prevalence among the three wheat-related entities. It remains, however, particularly poorly characterized due to unclear pathophysiology and lack of diagnostic markers. This narrative review will scrutinize the shared and distinct clinical features of the three wheat-related conditions, focusing on epidemiology, clinical presentation, co-morbidities, diagnosis, treatment and prognosis., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The C-reactive protein-triglyceride glucose index (CTI) is a promising new marker for evaluating the severity of inflammation. Endometriosis (EM) is a prevalent chronic inflammatory condition influenced by estrogen, primarily affecting women of reproductive age. However, no study has demonstrated an association between the CTI and EM., Methods: This cross-sectional study sourced data from females 20-50 years of age from the National Health and Nutrition Examination Survey (NHANES) 1996-2006, and included those with self-reported diagnoses of EM and sufficient information to calculate the CTI, computed as 0.412 × ln (C-reactive protein [CRP]) + ln (triglycerides [mg/dL] × fasting plasma glucose [mg/dL]/2). Multivariate logistic regression, restricted cubic splines, and subgroup analyses were performed to examine the association between the CTI and EM., Results: Data from 2235 women (175 [7.82%] with EM, 2060 [92.18%] without EM [controls]), were included: those with EM exhibited a tendency toward higher CTI (p = 0.005), and CTI was positively associated with the prevalence of EM (p = 0.011). In Model 1, a 1 mg/dL increment in CTI was associated with a 56% higher prevalence of EM (odds ratio [OR] 1.563 [95% confidence interval (CI) 1.295-1.885]; P < 0.001). This association in Model 2 (OR 1.609 [95% CI 1.334-1.941]; p < 0.001) and Model 3 (OR 1.565 [95% CI 1.246-1.966]; p < 0.001) remained significant. Notably, individuals in the uppermost remnant cholesterol tertile exhibited a notably higher prevalence of EM than those in the lowest tertile (OR 3.029, p = 0.051). Restricted cubic splines revealed a nonlinear positive association between CTI and the prevalence of EM. In addition, greater EM prevalence was observed with CTI in those > 40 years of age (OR 1.57 [95% CI 1.16-2.13]), body mass index ≥ 25 kg/m 2 (OR 1.38 [95% CI 1.06-1.80]), smoking ≥ 100 cigarettes (OR 1.43 [95% CI 1.06-1.96]), married or living with partner (OR 1.41 [95% CI 1.09-1.85]), and oral contraceptive use (OR 1.35 [95% CI 1.07-1.69])., Conclusions: CTI was positively associated with EM in women in the United States. Use of the CTI as an indicator of inflammation may provide new insights for the prevention and management of EM., Competing Interests: Declarations. Ethics approval and consent to participate: The portions of this study involving human participants, human materials, or human data were conducted in accordance with the Declaration of Helsinki and were approved by the NCHS Ethics Review Board. The patients/participants provided written informed consent to participate in this study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Hypertension is a major cause of cardiac dysfunction. The earliest manifestation is left ventricular remodeling/hypertrophy. The occurrence of adverse cardiac remodeling and outcomes occurs irrespective of age in blacks. This necessitated an estimate of the prevalence of left ventricular hypertrophy (LVH) and an assessment of the roles of the mammalian target organ of rapamycin (mTOR) and angiotensin-II (Ang II) as possible pathogenic markers of LVH among young hypertensives., Methods: This prospective case-control study involved 110 hypertensive and 60 normotensive (control) participants aged 18-45 across tertiary hospitals in Ekiti state. Ethical approval was obtained from all the various institutions. Participants were recruited consecutively after giving informed consent. Sociodemographic/clinical information, resting electrocardiogram and echocardiography were obtained. Venous blood was obtained to estimate mTOR, Ang II, Chemerin, lipids - triglyceride (TG), high-density lipoprotein (HDL), total cholesterol (TC), troponin-T, NF-Kβ, and Galectin-3 using enzyme-linked immunosorbent assay., Results: The prevalence of LVH among the hypertensive group was 20.9%, 39%, 11.01%, and 15.74% using 2D-transthoracic echocardiography, Sokolow-Lyon, Cornell's and Cornell product ECG criteria. Also, hypertensives with LVH had a significantly increased blood pressure, body mass index, serum level of TG, TG/HDL, TC/HDL, chemerin, troponin T, Galectin-3 and total mTOR compared to normotensive and hypertensives without LVH. At the same time, serum NF-kβ and Ang II were only significant when compared with normotensive but not hypertensives without LVH. The total mTOR moderately correlated positively with ANG-II., Conclusions: The results suggest an interaction between mTOR and Ang II in the development of LVH. In addition, it shows that LVH is associated with dyslipidemia, inflammation, and fibrosis., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval was obtained from the ethics and research committee of ABUAD Multisystem Hospital (AMSH/REC/BOO/184), Ado-Ekiti; Ekiti State University Teaching Hospital Ado-Ekiti (EKSUTH/A67/2023/11/005) and Federal Teaching Hospital, Ido-Ekiti (ERC/2024/01/15/1066B) respectively. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Lynch Syndrome (LS) is a common genetic cancer condition that allows for personalized cancer prevention and early cancer detection in identified gene carriers. We used data from the All of Us (AOU) Research Initiative to assess the prevalence of LS in the general U.S. population, and analyzed demographic, personal, and family cancer history, stratified by LS genotype to compare LS and non-LS carriers. The results suggest that population-based germline testing for LS may identify up to 63.2% of carriers who might remain undetected due to lack of personal or family cancer history. LS affects about 1 in 354 individuals in this U.S. cohort, where pathogenic variants in the genes MSH6 and PMS2 account for the majority of cases. These results underscore the need to optimize the identification of LS across diverse populations and population-based germline testing may capture the most individuals who can benefit from precision cancer screening and prevention., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Psoriatic arthritis (PsA) significantly contributes to increased morbidity, reduced life expectancy, and higher healthcare costs due to the burden of comorbidities. This study assessed the prevalence of comorbidities in PsA patients in India and explored the influence of age and disease duration on these comorbidities., Methods: The prospective, multicenter observational study was conducted across seven centers in India, utilizing data from the Indian Rheumatology Association. Data were collected using expert-validated proformas, with comorbidities classified according to the ICD-10 Charlson Comorbidity Index. Participants were divided into two age groups: <40 years and ≥ 40 years., Results: The study included 533 participants (median age: 50 years, range: 17-81). Comorbidities were more common among older patients (median age: 54 years, range: 41-79). About 38% had at least one comorbidity, with hypertension (17.07%) and diabetes (15.19%) being most prevalent, followed by thyroid disorders (10.13%) and hyperlipidemia (3.94%). Comorbidities were significantly more common in patients ≥ 40 years (45.04%) compared to those < 40 years (18.57%) (P < 0.001). The older group also had higher rates of hyperlipidemia (4.83% vs. 0.71%, P = 0.035) and hypertension (22.14%). Logistic regression revealed a significant association between age and the prevalence of diabetes, hypertension, and thyroid disorders (P = 0.003). Among patients over 40, 44.27% had at least one comorbidity., Conclusion: The study underscores the significant association between age and the prevalence of comorbidities in PsA patients, particularly in those over 40 years. These findings highlight the importance of targeted screening and management in older PsA patients., Competing Interests: Declarations. Research involving human participants and/or animals: All participating centers received approval from their respective institutional ethics committees (listed in the appendix). Since this is an observational study, no direct human intervention was involved. Informed consent: Written informed consent was obtained from all selected patients following institutional guidelines. Open data sharing note: The data will be will be provided on request. Disclaimer: It is confirmed that no part of this manuscript has been copied or published elsewhere, in whole or in part, in any language. This manuscript is original and has not been submitted for publication in any other journal. Conflict of interest: None. Disclosure of potential conflicts of interest: None., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Functional gastrointestinal disorders (FGIDs), now known as disorders of gut-brain interaction (DGBIs), such as Irritable Bowel Syndrome (IBS) and Functional Dyspepsia (FD), significantly impact global health, reducing quality of life and burdening healthcare systems. This study addresses the epidemiological gap in Poland, focusing on the West Pomeranian Voivodeship., Methods: We conducted a cross-sectional study of 2070 Caucasian patients (58.2% female, mean age 57.5 ± 15.1 years) undergoing gastrointestinal endoscopic examinations at Pomeranian Medical University from 2021 to 2023. Data were collected using Rome IV diagnostic questionnaires and correlated with gastroduodenoscopy and colonoscopy findings. Exclusion criteria were age under 18, pregnancy, Crohn's disease, ulcerative colitis, severe comorbidities, cancer, immunosuppressive therapy, ileostomy/colostomy, incomplete questionnaires, or lack of consent., Results: Using Rome IV criteria, IBS was diagnosed in 436 participants (21.1%) and FD in 248 participants (12.0%). Post-endoscopic evaluation revised FD diagnoses to 184 individuals (8.9%). Females had a higher prevalence of IBS and FD (OR 1.64 and 1.61, respectively). No significant association was found between higher BMI and increased risk of IBS and FD. Hypertension and diabetes prevalence were 35.1% and 13.0%, respectively. Individuals with a history of COVID-19 had a higher risk of developing IBS (OR 1.47, P = 0.050)., Conclusions: Our study provides crucial epidemiological data on IBS and FD in Poland, emphasizing the importance of endoscopic evaluations. Our findings highlight the need for regional studies to understand local DGBI prevalence, aiding targeted healthcare strategies., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the ethics committee of the Pomeranian Medical University in Szczecin (resolution no KB-0012/197/19) and all participants gave written informed consent to participate. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Vaginal colonization by Candida can lead to vulvovaginal candidiasis, which is the second most prevalent vaginal condition globally. It is frequently associated with sepsis and adverse neonatal outcomes in pregnant women. This issue is worsening in Sub-Saharan Africa, including Ethiopia. However, evidence of the existing problem is very scarce yet crucial. Thus, this study aimed to determine the vaginal colonization and vertical transmission of Candida species and their associated factors among pregnant women and their neonates in public health facilities of northeast Ethiopia., Methods: A facility-based cross-sectional study was conducted at selected public health facilities in Dessie town from April 1 to June 30, 2023, among 348 pregnant women and their newborns, using convenience sampling techniques. Socio-demographic, and clinical-related data were collected using a pre-tested, semi-structured questionnaire. Vaginal swab samples from pregnant women and pooled swabs from the external ear, nasal area, and umbilical areas of the newborns were collected and transported using Amies transport media. The samples were inoculated into Sabouraud Dextrose Agar for isolation, followed by inoculation onto a standard CHROM agar Candida plate for species identification, and a germ-tube test confirmed pseudophyphae of C.albicans. Data was entered into Epi Data version 4.6.0 software and exported and analyzed by SPSS version 25.0. A stepwise logistic regression model was used to identify the associated factors. Variables with p < 0.05 and their 95% confidence interval were considered statistically significant., Result: A total of 348 pregnant women attending vaginal delivery were included in the study. The maternal and neonatal colonization rates of Candida species were 14.1% (49/348) and 6.3% (22/348), respectively. The overall proportion of vertical transmission of Candida species was 44.9% (22/49, 95% CI: 41.2, 49.7). Among Candida isolates, 63.3% (31/49) were C. albicans and 36.7% (18/49) were C. krusei. Gestational diabetes mellitus (AOR: 4.2, 95% CI: 1.23-38.6, P = 0.047) and HIV (AOR: 1.58, 95% CI: 1.11-6.12, P = 0.049) were independently associated with maternal colonization of Candida species. Moreover, rural residence (AOR = 3.6, 95% CI: 1.37-9.5, P = 0.010) and maternal age above 28 years (AOR = 2.39, 95% CI: 1.97-5.89, P = 0.048) were independently associated with vertical transmission of Candida species., Conclusion: The findings of this study highlight the need for effective screening and treatment of Candida colonization during antenatal care., Competing Interests: Declarations. Ethical approval and consent to participate: Ethical clearance was obtained from the ethical review Board of the College of Medicine and Health Sciences, Bahir Dar University (Protocol number 749/2023). Permission for the study was granted in a letter from DCSH and DHC, where the study was conducted. After briefly describing the significance of the study, written informed consent from the pregnant mother and assent for the newborns were obtained. Confidentiality of the data was maintained. Finally, based on a microbiologically confirmed positive result, the clinician responsible for the participant was informed and the participant was treated with an appropriate treatment protocol. This study was conducted in accordance with the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable., (© 2024. The Author(s).)

Postoperative delirium has the potential to impact individuals of all age groups, with a significant emphasis on the elderly population. Its presence leads to an increase in surgical morbidity and mortality rates, as well as a notable prolongation of hospital stays. However, there is a lack of research regarding the prevalence, risk factors, and implications of postoperative delirium in developing nations like Ethiopia, which affects both patients and healthcare institutions. An observational study was conducted at hospitals in the South Gondar Zone to diagnose postoperative delirium in the Post-Anesthesia Care Unit (PACU) using the Nursing Delirium Screening Scale. Both bivariable and multivariable logistic regression techniques were employed to analyze the association between independent factors and postoperative delirium. The strength of the association was indicated by the odds ratio with a 95% confidence interval (CI). Any p-values below 0.05 were considered statistically significant. The incidence of postoperative delirium was determined to be 41%. In the multivariate logistic regression analysis, several factors were identified as significantly associated with postoperative delirium. These factors include an age of 75 or older (AOR, 11.24; 95% CI, 4.74-26.65), ASA-PS IV (AOR, 3.25; 95% CI, 1.81-5.85), severe functional impairment of activities of daily living (AOR, 3.29; 95% CI, 1.06-10.20), premedication with benzodiazepine (AOR, 4.61; 95% CI, 2.48-8.57), intraoperative estimated blood loss exceeding 1000 ml (AOR, 2.74; 95% CI, 1.50-4.98), and intraoperative ketamine use (AOR, 3.84; 95% CI, 2.21-6.68). Additionally, postoperative delirium was found to significantly prolong the duration of stay in the post-anesthesia care unit (PACU) and the length of hospital stay (p-value < 0.05). Patients aged 75 or older, ASA-PS IV, experiencing severe functional impairment of ADL, patients premedicated with benzodiazepine, patients with intraoperative estimated blood loss exceeding 1000 ml, and intraoperative ketamine use were identified as risk factors for post-operative delirium., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: Ethical approval for the study was granted by the Ethical Review Committee of Debre Tabor University. Permission to conduct the study was obtained from the respective hospital administrative bodies. Before participation, informed written consent was obtained from each participant, following a thorough explanation of the study’s objectives. The study ensured the confidentiality and anonymity of all participants throughout the research process. Methodology statement: All methods, including citations, competing interests, and the data availability statement, were conducted by relevant guidelines and regulations., (© 2025. The Author(s).)

Cardiovascular diseases (CVDs) are the leading cause of mortality and morbidity globally. It is estimated that 17.9 million people died from CVDs in 2019, which represents 32 % of all deaths worldwide. Cardiovascular drugs are the most common medical intervention for the prevention of cardiovascular events. CV medications have many benefits however their application is often complicated by multimorbidity and polypharmacy. Drug-drug interactions (DDIs) can lead to adverse drug events, hospitalizations, prolonged hospital stays, increased healthcare costs, and increased risk of mortality. Hospital admission provides an opportunity for pharmacotherapy analysis and for identifying DDIs which can jeopardize medication safety. The aim of this study is to determine the type and prevalence of potential clinically significant DDIs in patients with CVD and to examine factors associated with exposure to DDIs. A prospective study was conducted at the Dubrava University Hospital at the Clinic of Cardiology during a 6-month period (September 2023 - February 2024). Demographic, clinical and pharmacotherapy data were collected for each patient. The first prescribed pharmacotherapy was analyzed. The research was approved by the Hospital's Ethics Committee and each patient involved in the study signed an informed consent. Lexicomp ® Lexi-InteractTM Online (Lexi-Comp, Inc., USA) was used for DDI analysis. Poisson regression was used for regression analysis for determining risk factors associated with exposure to DDIs. Total of 151 patients admitted to Cardiology ward were included in the research, and the average age was 67 years. Patients had an average of 9 medications in their therapy and 8 diagnoses. Overall, 1268 potential clinically significant DDIs were determined, of which the most frequently determined interactions were grade C (90.9 %), then grade D (8.6 %) and grade X (0.6 %). CV medications were involved in 88 % DDIs. The most common interventions regarding identified DDIs included exclusion one of the drugs, dose adjustment, increased monitoring of signs of bleeding, cardiac disorders, hypoglycemia, CNS depression and rhabdomyolysis, blood pressure, markers of renal function and electrolyte status. Factors associated with the prevalence of potential clinically significant DDIs were decreased renal function, recent hospitalization, total number of comorbidities and polypharmacy. Specific comorbidities associated with DDIs were arrhythmia, heart failure, diabetes mellitus and disease of the respiratory system. A high prevalence of DDIs of CV medications in all categories of clinical significance was determined. Managing medication safety in specific patient groups with CVDs can represent a greater challenge regarding DDIs. Certain medical conditions, such as arrhythmia, heart failure, diabetes, and diseases of the respiratory system, multimorbidity, polypharmacy, impaired renal function and recent hospitalization are identified in this research as additional factors associated with DDIs occurrence in patients with CVDs at hospital admission. Hospital admission is one of the crucial points for managing medication safety. Clinical pharmacists should regularly analyze DDIs in prescribed pharmaco-therapy which enhances medication safety and also contributes to the quality of provided health care., (© 2024 Iva Marović et al., published by Sciendo.)

Purpose: To quantitatively pool the overall prevalence of self-neglect in older adults and provide evidence-based information for healthcare professionals to develop preventive measures., Methods: Systematically and thoroughly searched ten databases from inception to September 1, 2024 and we pooled the prevalence of self-neglect in older adults using a random-effects model based on the Stata 15.0 software., Results: In our meta-analysis, 21 studies were included, and the estimated prevalence rate of self-neglect among older adults was 27% (95% CI: 23%-30%). We found that the incidence of self-neglect was higher in males, aged 80 years, developing countries, hospitals, and using the Elder Self-Neglect Questionnaire assessment tool., Conclusion: Self-neglect is a common and underestimated phenomenon in older adults, and the prevalence rate of self-neglect is high. Several epidemiological characteristics such as gender, age, countries, settings, and definition criteria were associated with its prevalence. It deserves early screening and targeted intervention by using a globally accepted definition of self-neglect to prevent older adults from self-neglect., Implications for Nursing Practice: Our study can provide clinical evidence for nursing staff and healthcare professionals to identify high-risk groups of self-neglect in older adults., (© 2025 NANDA International, Inc.)

There is a reported association between oral contact allergy and oral lichen planus (OLP). Likewise oral squamous cell carcinoma (oSCC) is associated with OLP. It is hypothesized that chronic inflammation may contribute to oSCC risk. Ostensibly, we hypothesized that allergy testing positivity may increase inflammation and thus may be associated with oSCC in OLP. As a secondary objective, we assessed oSCC prevalence in OLP, allergen prevalence in OLP, and associations between allergy testing and OLP phenotype. To do this, we performed a retrospective cohort evaluation of OLP patients seen at the University of Utah from 2015 to 2022. Odds of oSCC occurrence by allergy testing status, clinical/demographic factors and asssociations between allergy testing and OLP phenotype were assessed using univariable and multivariable logistic regression. The prevalence of oSCC and allergy testing (patch + scratch testing) results were summarized descriptively. OLP diagnoses were confirmed by our OLP-specialized clinicians, and/or histologic assessment. Allergy testing was performed by two specialized dermatologists. oSCC diagnosis was identified via chart review and histologic data. Among 587 OLP patients identified, 133 were allergy tested and 77.4% were positive (52.4% metals, 55.3% flavorings/fragrances, 47.6% preservatives). Of those with a positive allergy test, 10 (25.6%) developed oSCC compared with 2 (5.1%) of patients with a negative allergy test. There was insufficient evidence to support an association between allergy positivity and oSCC (OR = 1.55, 95% CI 0.76-3.15). A higher percent of symptomatic visits was the only other clinical and/or demographic factor associated with oSCC occurrence (median 87.5% vs. 66.7%, p = 0.03). Of the OLP disease characteristics assessed (mouth area involved, extent of disease involvement, erosive subtype, etc.), only OLP involving the gingiva was associated with positive allergy testing (OR = 2.54,1.11-5.81). These data suggest that allergy test positivity may not be associated with oSCC. However, it was associated with more pervasive symptomatology, suggesting a possible association with more severe or recalcitrant disease., Competing Interests: Declarations. Patient consent: Not applicable. Conflict of interest: Authors report no conflicts of interest., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Elimination of lymphatic filariasis (LF) is a World Health Organization goal, with several countries at or near prevalence thresholds. Where LF cases remain after mass drug administration, they tend to be spatially clustered, with an overdispersed individual worm burden. Both individual and spatial heterogeneities can cause aggregation of infection; however, few studies have investigated the drivers of heterogeneity and implications for disease elimination., Methods: We used a spatially explicit lymphatic filariasis model to investigate LF transmission in American Samoa at three spatial scales - a territory-level model, a village model with 64 groups and a subvillage model with 316 groups., Results: To reproduce American Samoan survey data, models with less spatial structure required increased individual-level bite aggregation. Threshold behaviour was present in the territory model but less evident in the models with spatial structure. As such, mass drug administration was most effective in the territory model, while in the spatially structured models, successive rounds of mass drug administration only gradually increased the likelihood of elimination. With the addition of spatial structure, residual infections remained in limited groups, and infection resurgence was slowed., Conclusions: Due to the impacts on potential intervention and surveillance strategies, it is critical that studies incorporate individual and spatial sources of heterogeneity to accurately model transmission and inform potential policy decisions., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Competing interests: The authors declare that they have no Competing interest. Consent for publication: Not applicable., (© 2024. The Author(s).)