Diseases

11 pages, 953 KB

Open AccessArticle

Early Post-Transplant Protein Biomarkers for Risk Stratification of Renal Allograft Dysfunction: Diagnostic Value and Clinical Chemistry Perspectives

by Andreea-Liana Bot (Rachisan), Paul Luchian Aldea, Bogdan Bulata, Dan Delean, Florin Elec and Mihaela Sparchez

Diseases 2026, 14(1), 36; https://doi.org/10.3390/diseases14010036 - 21 Jan 2026

Viewed by 374

Abstract

Background: Early recognition of renal allograft dysfunction requires biochemical markers capable of detecting molecular injury before functional decline becomes apparent. Serum creatinine, a late and nonspecific indicator of renal function, has limited value for early diagnosis. Protein biomarkers implicated in tubular injury, inflammation, [...] Read more.

Background: Early recognition of renal allograft dysfunction requires biochemical markers capable of detecting molecular injury before functional decline becomes apparent. Serum creatinine, a late and nonspecific indicator of renal function, has limited value for early diagnosis. Protein biomarkers implicated in tubular injury, inflammation, and immune activation—including neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), β2-microglobulin, interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α)—have emerged as promising alternatives. This study evaluated early post-transplant serum profiles of these biomarkers and their prognostic relevance for long-term graft outcomes. Methods: Nineteen adult recipients undergoing primary kidney transplantation were prospectively enrolled. Serum creatinine and protein biomarkers were measured 24 h post-transplant using validated immunochemical assays. Biomarker concentrations were compared with values from healthy controls, and correlations with renal function at 12 months were assessed. Receiver operating characteristic (ROC) analysis was used to evaluate predictive performance. Results: Significant biochemical alterations were observed at 24 h post-transplant. KIM-1 levels were markedly elevated compared with controls (74.50 ± 98.45 vs. 10.54 ± 17.19 ng/mL; p = 0.01), consistent with early tubular injury. IL-1β and NGAL showed upward trends without reaching statistical significance. β2-microglobulin and TNF-α levels did not differ substantially from control values. Serum KIM-1 correlated with serum creatinine both at 24 h (r = 0.35) and at 12 months (r = 0.40). ROC analysis identified a KIM-1 threshold of 24.5 ng/mL (AUC = 0.68) as a potential indicator of future graft dysfunction, outperforming serum creatinine (AUC = 0.64). Six patients experienced graft dysfunction at 12 months post-transplant, five of whom had serum creatinine values > 5 mg/dL at 24 h. Based on early creatinine levels, patients were stratified into low-risk (creatinine < 5 mg/dL; n = 10) and high-risk groups (creatinine > 5 mg/dL; n = 9). Mean KIM-1 concentrations were significantly higher in the high-risk group (110.68 ± 115.29 vs. 26.67 ± 18.05 ng/mL; p = 0.05), consistent with more severe early tubular injury. Conclusions: Among the evaluated biomarkers, KIM-1 demonstrated the strongest potential as an early biochemical indicator of renal allograft dysfunction. Its rapid post-transplant elevation underscores its sensitivity to early tubular injury. Further prospective validation in larger, multicenter cohorts is warranted. Full article

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15 pages, 621 KB

Open AccessArticle

Impact of Chronic Kidney Disease on Clinical, Laboratory, and Echocardiographic Features in Patients with Chronic Heart Failure

by Anastasija Ilić, Olivera Kovačević, Aleksandra Milovančev, Nikola Mladenović, Dragica Andrić, Dragana Dabović, Milana Jaraković, Srdjan Maletin, Teodora Pantić, Branislav Crnomarković, Mihaela Preveden, Ranko Zdravković, Anastazija Stojšić Milosavljević, Aleksandra Ilić, Lazar Velicki and Andrej Preveden

Diseases 2026, 14(1), 35; https://doi.org/10.3390/diseases14010035 - 20 Jan 2026

Viewed by 642

Abstract

Objective: The aim of this study was to evaluate the impact of chronic kidney disease (CKD) on clinical presentation, laboratory parameters, ECG, and echocardiographic features of patients with chronic heart failure (CHF). Methods: This retrospective cross-sectional study included 2227 patients hospitalized in a [...] Read more.

Objective: The aim of this study was to evaluate the impact of chronic kidney disease (CKD) on clinical presentation, laboratory parameters, ECG, and echocardiographic features of patients with chronic heart failure (CHF). Methods: This retrospective cross-sectional study included 2227 patients hospitalized in a tertiary care center due to CHF. Patients were divided into two groups based on the presence of CKD, defined as eGFR < 60 mL/min/1.73 m². Demographic, clinical, laboratory, and echocardiographic data were collected for all patients. Comparative analyses were performed to assess differences in cardiovascular risk factors, comorbidities, laboratory parameters, and echocardiographic findings between the two groups. Results: The proportion of men was significantly higher in the non-CKD group, whereas women predominated in the CKD group (p < 0.001). Dyspnea, orthopnea, leg swelling, claudication, and expectoration were significantly more frequent in patients with CKD, while chest pain and palpitations were more common in the non-CKD group (all p < 0.05). A significant difference in the distribution of NYHA functional classes was observed between the groups (p < 0.001), with NYHA class IV being more prevalent in the CKD group and classes II and III more frequent in the non-CKD group. Levels of CRP and NT-proBNP were significantly higher in the CKD group (p < 0.001). In-hospital mortality was 2.5-fold higher in patients with CKD (28.6% vs. 11.1%; p < 0.001). Conclusions: Coexistence of CKD was associated with a more severe clinical presentation, advanced functional limitation, and a distinct laboratory and echocardiographic profile in CHF patients. Full article

(This article belongs to the Special Issue Insights into the Management of Cardiovascular Disease Risk Factors)

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15 pages, 1147 KB

Open AccessSystematic Review

A Systematic Review and Meta-Analysis on the Effectiveness and Safety of Tranexamic Acid for Postpartum Haemorrhage in Patients with Haemorrhagic Disorders

by Victor Abiola Adepoju, Abdulrakib Abdulrahim, Bukola Olanrewaju Olaniyi, Qorinah Estiningtyas Sakilah Adnani and Shankar Biswas

Diseases 2026, 14(1), 34; https://doi.org/10.3390/diseases14010034 - 19 Jan 2026

Viewed by 654

Abstract

Background: Postpartum haemorrhage (PPH) remains the leading cause of maternal mortality globally. Women with inherited or unexplained bleeding disorders such as von Willebrand disease (VWD), factor XI deficiency (FXI), platelet function disorders, or bleeding disorder of unknown cause (BDUC) face a higher risk. [...] Read more.

Background: Postpartum haemorrhage (PPH) remains the leading cause of maternal mortality globally. Women with inherited or unexplained bleeding disorders such as von Willebrand disease (VWD), factor XI deficiency (FXI), platelet function disorders, or bleeding disorder of unknown cause (BDUC) face a higher risk. While tranexamic acid (TXA) is routinely used in obstetric care, its specific efficacy and safety in these populations remain unclear. Methods: A systematic review and meta-analysis followed PRISMA 2020 guidelines (PROSPERO: CRD420251082349). Databases searched included PubMed, Scopus, Web of Science, and Dimensions. Studies evaluating TXA for PPH prevention or treatment in women with bleeding disorders were included. Six cohort studies (2016–2024) involving 213 deliveries met the criteria. Three contributed to a meta-analysis on primary PPH; the other three were synthesised narratively. Results: TXA use was associated with a 56% reduction in primary PPH risk (risk ratio 0.44; 95% CI: 0.27–0.70; p = 0.0007), with no observed heterogeneity (I² = 0%). Because contributing cohorts were phenotypically heterogeneous (BDUC, FXI, mixed), the pooled effect reflects an average across disorders rather than disorder-specific efficacy. TXA also appeared to reduce secondary and severe PPH in some cohorts. However, bleeding occurred in 26–36% of high-risk deliveries despite prophylaxis. No maternal deaths or thromboembolic events were reported in 136 TXA-exposed cases. Attribution was complicated by concurrent use of desmopressin and platelet transfusions. Most studies had moderate to severe bias. Conclusions: TXA significantly lowers the risk of primary PPH in women with bleeding disorders and appears safe. Despite this, residual bleeding underscores the need for trials to optimise TXA use alongside disease-specific strategies. However, this conclusion is derived from only six observational studies with heterogeneous patient populations and co-interventions. The evidence remains preliminary and should be interpreted cautiously. TXA should be considered as part of a multimodal postpartum haemorrhage management algorithm rather than a stand-alone therapy. Full article

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15 pages, 1887 KB

Open AccessArticle

Annurca Apple Extract and Colorectal Cancer Prevention: Preliminary In Silico Evaluation of Chlorogenic Acid

by Ludovico Abenavoli, Giuseppe Guido Maria Scarlata, Maria Luisa Gambardella, Domenico Morano, Nataša Milošević, Maja Milanović and Nataša Milić

Diseases 2026, 14(1), 33; https://doi.org/10.3390/diseases14010033 - 14 Jan 2026

Viewed by 544

Abstract

Background/Objectives: Colorectal cancer (CRC) is a leading cause of cancer morbidity and mortality worldwide. Despite therapeutic advances, prevention through dietary bioactives remains a promising strategy. The Annurca apple (Malus pumila Miller cv. Annurca), a Mediterranean food rich in chlorogenic acid, exhibits antioxidant [...] Read more.

Background/Objectives: Colorectal cancer (CRC) is a leading cause of cancer morbidity and mortality worldwide. Despite therapeutic advances, prevention through dietary bioactives remains a promising strategy. The Annurca apple (Malus pumila Miller cv. Annurca), a Mediterranean food rich in chlorogenic acid, exhibits antioxidant and anti-inflammatory effects. This study evaluated, via molecular docking, the multi-target interaction profile of chlorogenic acid against key CRC-related proteins. Methods: The optimized 3D structure of chlorogenic acid was docked to ten protein targets implicated in CRC pathogenesis, using the GOLD v.2022.3.0 software. Validation of the docking protocol was achieved by re-docking native ligands (RMSD ≤ 2.0 Å). Binding affinities were assessed by ChemPLP scoring, and interaction networks were visualized in Maestro Schrödinger. Results: Chlorogenic acid displayed consistent binding across all evaluated targets (ChemPLP 57.12–69.66), showing the highest affinity for nAChR (69.66), CXCR2 (65.13), ERβ (63.18) and TGFBR2 (62.94). The ligand formed multiple hydrogen bonds and π-π stacking interactions involving Asp1040 (VEGFR-1), Cys919 (VEGFR-2), Lys320 (CXCR2), and Tyr195 residues (nAChR), contributing to strong complex stabilization. Interaction patterns in CYP19A1, ERβ, and ERRγ suggested potential modulation of hormonal and metabolic signaling. The compound also demonstrated stable binding to mTOR (60.01), indicating a possible inhibitory role in proliferative pathways. Collectively, these findings reveal a broad, polypharmacological binding profile involving angiogenic, inflammatory, and hormonal regulators. Conclusions: Chlorogenic acid acts as a promising multi-target ligand in CRC prevention, with our in silico evidence supporting its ability to modulate diverse oncogenic pathways. Further experimental studies are warranted to confirm its efficacy and translational potential. Full article

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22 pages, 5440 KB

Open AccessArticle

Multi-Task Deep Learning Model for Automated Detection and Severity Grading of Lumbar Spinal Stenosis on MRI: Multi-Center External Validation

by Phatcharapon Udomluck, Watcharaporn Cholamjiak, Jakkaphong Inpun and Waragunt Waratamrongpatai

Diseases 2026, 14(1), 32; https://doi.org/10.3390/diseases14010032 - 14 Jan 2026

Viewed by 618

Abstract

Background/Objectives: Accurate and reproducible grading of lumbar spinal stenosis (LSS) is clinically critical for guiding treatment decisions and patient management, yet manual assessment remains challenging due to imaging variability and inter-observer subjectivity. To address these limitations, this study aimed to evaluate the [...] Read more.

Background/Objectives: Accurate and reproducible grading of lumbar spinal stenosis (LSS) is clinically critical for guiding treatment decisions and patient management, yet manual assessment remains challenging due to imaging variability and inter-observer subjectivity. To address these limitations, this study aimed to evaluate the generalizability of deep learning–based feature extraction methods—VGG19, ConvNeXt-Tiny, and DINOv2—combined with classical machine learning classifiers for automated multi-grade LSS assessment. Automated grading enables objective, reproducible, and scalable assessment of lumbar spinal stenosis severity, addressing key limitations of manual interpretation. Methods: Axial MRI images were processed using pretrained VGG19, ConvNeXt-Tiny, and DINOv2 models to extract deep features. Logistic Regression, Support Vector Machine (SVM), and LightGBM were trained on internal datasets and externally validated using MRI data from the University of Phayao Hospital. Performance was assessed using accuracy, precision, recall, F1-score, confusion matrices, and multi-class ROC curves. Results: VGG19-based features yielded the strongest external performance, with Logistic Regression achieving the highest accuracy (0.9556) and F1-score (0.9558). External validation further demonstrated excellent discrimination, with AUC values ranging from 0.994 to 1.000 across all severity grades. SVM (0.9333 accuracy) and LightGBM (0.9222 accuracy) also performed well. ConvNeXt-Tiny showed stable cross-model performance, while DINOv2 features exhibited reduced generalizability, especially with LightGBM (accuracy 0.6222). Most classification errors occurred between adjacent grades. Conclusions: Deep convolutional features—particularly VGG19—combined with classical machine learning classifiers provide robust and generalizable LSS grading across external MRI data. Despite advances in modern architectures, CNN-based feature extraction remains highly effective for spinal imaging and represents a practical pathway for clinical decision support. Full article

(This article belongs to the Special Issue Frailty and Frequent Hospitalizations in Older Adults: Risk, Management, and Interventions)

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28 pages, 833 KB

Open AccessReview

An Integrative Review of the Cardiovascular Disease Spectrum: Integrating Multi-Omics and Artificial Intelligence for Precision Cardiology

by Gabriela-Florentina Țapoș, Ioan-Alexandru Cîmpeanu, Iasmina-Alexandra Predescu, Sergio Liga, Andra Tiberia Păcurar, Daliborca Vlad, Casiana Boru, Silvia Luca, Simina Crișan, Cristina Văcărescu and Constantin Tudor Luca

Diseases 2026, 14(1), 31; https://doi.org/10.3390/diseases14010031 - 13 Jan 2026

Cited by 1 | Viewed by 1033

Abstract

Background/Objectives: Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide and increasingly are recognized as a continuum of interconnected conditions rather than isolated entities. Methods: A structured narrative literature search was performed in PubMed, Scopus, and Google Scholar for publications [...] Read more.

Background/Objectives: Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide and increasingly are recognized as a continuum of interconnected conditions rather than isolated entities. Methods: A structured narrative literature search was performed in PubMed, Scopus, and Google Scholar for publications from 2015 to 2025 using combinations of different keywords: “cardiovascular disease spectrum”, “multi-omics”, “precision cardiology”, “machine learning”, and “artificial intelligence in cardiology”. Results: Evidence was synthesized across seven major clusters of cardiovascular conditions, and across these domains, common biological pathways were mapped onto heterogeneous clinical phenotypes, and we summarize how multi-omics integration, AI-enabled imaging and digital tools contribute to improved risk prediction and more informed clinical decision-making within this spectrum. Conclusions: Interpreting cardiovascular conditions as components of a shared disease spectrum clarifies cross-disease interactions and supports a shift from organ- and syndrome-based classifications toward mechanism- and data-driven precision cardiology. The convergence of multi-omics, and AI offers substantial opportunities for earlier detection, individualized prevention, and tailored therapy, but requires careful attention to data quality, equity, interpretability, and practical implementation in routine care. Full article

(This article belongs to the Section Cardiology)

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15 pages, 609 KB

Open AccessReview

Inclisiran in Dyslipidemia with High Residual Platelet Reactivity

by Dina Kapsultanova, Sholpan Zhangelova, Friba Nurmukhammad, Zulfiya Makasheva, Orazbek Sakhov, Tamara Galkina, Farida Rustamova, Dana Akhmentayeva and Botakoz Aubakirova

Diseases 2026, 14(1), 30; https://doi.org/10.3390/diseases14010030 - 12 Jan 2026

Viewed by 696

Abstract

Background: High residual platelet reactivity (HRPR) and persistent dyslipidemia remain important unmet needs in cardiovascular risk management, particularly in patients undergoing coronary revascularization. Despite intensive lipid-lowering and antiplatelet therapy, a substantial proportion of patients fail to reach recommended low-density lipoprotein cholesterol (LDL-C) targets [...] Read more.

Background: High residual platelet reactivity (HRPR) and persistent dyslipidemia remain important unmet needs in cardiovascular risk management, particularly in patients undergoing coronary revascularization. Despite intensive lipid-lowering and antiplatelet therapy, a substantial proportion of patients fail to reach recommended low-density lipoprotein cholesterol (LDL-C) targets or exhibit inadequate platelet inhibition. Inclisiran, a PCSK9-targeting small interfering RNA, represents an emerging approach for long-term LDL-C reduction. Methods: A narrative review of the literature published between 2009 and 2025 was performed using PubMed, Scopus, Web of Science, and MEDLINE. Studies evaluating the addition of inclisiran to standard lipid-lowering therapy in patients with dyslipidemia and HRPR, assessed using the VerifyNow assay, were included. Illustrative clinical cases from Kazakhstan were analyzed to demonstrate real-world changes in LDL-C levels and platelet reactivity following insufficient response to conventional treatment. The review had a descriptive design. Results: Available evidence indicates that a significant proportion of high- and very-high-risk patients do not achieve LDL-C targets or are unable to tolerate high-intensity statin therapy. Inclisiran consistently induces sustained reductions in LDL-C and circulating PCSK9 levels. Emerging data suggest a potential indirect modulation of platelet reactivity associated with intensive lipid lowering. In patients at extreme cardiovascular risk—including those after coronary artery bypass grafting (CABG) and with long-standing multivessel coronary artery disease—inclisiran therapy was associated with marked LDL-C reduction and a trend toward normalization of platelet reactivity. Conclusions: Assessment of platelet function using the VerifyNow assay may improve identification of residual thrombotic risk in patients with advanced atherosclerotic disease. Inclisiran appears to be a promising adjunctive therapy for dyslipidemic patients with persistently elevated cardiovascular risk and HRPR despite standard treatment. Further prospective studies are warranted to clarify the relationship between intensive LDL-C lowering, platelet reactivity, and clinical outcomes, and to optimize integrated lipid-lowering and antiplatelet strategies. Full article

(This article belongs to the Special Issue Feature Papers in Section 'Cardiology' in 2024–2025)

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17 pages, 696 KB

Open AccessArticle

Real-World Evidence Evaluation of Respiratory Syncytial Virus (RSV) Vaccines: Deep Dive into Vaccine Adverse Events Reporting System

by Thamir M. Alshammari, Mohammed K. Alshammari and Hind M. Alosaimi

Diseases 2026, 14(1), 29; https://doi.org/10.3390/diseases14010029 - 9 Jan 2026

Viewed by 1199

Abstract

Background: Respiratory Syncytial Virus is a predominant source of morbidity and mortality, particularly among babies, the elderly, and immunocompromised patients. Recent developments in RSV vaccines, approved by the FDA for high-risk groups, have highlighted the necessity for post-marketing surveillance to evaluate their [...] Read more.

Background: Respiratory Syncytial Virus is a predominant source of morbidity and mortality, particularly among babies, the elderly, and immunocompromised patients. Recent developments in RSV vaccines, approved by the FDA for high-risk groups, have highlighted the necessity for post-marketing surveillance to evaluate their real-world safety and efficacy. Method: This study utilized data from the Vaccine Adverse Event Reporting System (VAERS) covering RSV vaccine administration between 2023 and May 2025. The VAERS database reported data on vaccine types, including Arexvy^®, Abrysvo^®, and mRESVIA^® was analyzed for adverse events and vaccination errors. The demographic information, vaccination trends, and hospitalizations post-vaccination among the vaccinated individuals were accessed. Results: The analysis revealed that the most common adverse events were mild, such as injection site pain, erythema, fatigue, and extremity pain. The data also showed a gradual increase in hospitalization rates from 4.8% in 2023 to 7.5% in 2025. Vaccination errors, including inappropriate administration during pregnancy and excess doses, were also observed. A notable trend was the growing proportion of patients who experienced no adverse events, with the highest rate of symptom-free reports seen in 2025 (25.9%). Conclusions: RSV vaccines demonstrate a generally acceptable safety profile based on post-marketing surveillance data. However, the observed increase in hospitalization rates, vaccination errors, and pregnancy-related outcomes warrants continued active surveillance and cautious interpretation. Full article

(This article belongs to the Section Respiratory Diseases)

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12 pages, 816 KB

Open AccessSystematic Review

Can DPP-4 Inhibitors Improve Glycemic Control and Preserve Beta-Cell Function in Type 1 Diabetes Mellitus? A Systematic Review

by Henrique Villa Chagas, Lucas Fornari Laurindo, Victória Dogani Rodrigues, Jesselina Francisco dos Santos Haber, Eduardo Federighi Baisi Chagas and Sandra Maria Barbalho

Diseases 2026, 14(1), 28; https://doi.org/10.3390/diseases14010028 - 9 Jan 2026

Viewed by 854

Abstract

Background/Objectives: The objective was to analyze the effects of Dipeptidyl Peptidase-4 (DPP-4) inhibitors on glycemic control, insulin dose, and preservation of β-pancreatic function (C-peptide) in patients with type 1 diabetes mellitus (T1DM). Methods: A systematic review was performed following the Preferred [...] Read more.

Background/Objectives: The objective was to analyze the effects of Dipeptidyl Peptidase-4 (DPP-4) inhibitors on glycemic control, insulin dose, and preservation of β-pancreatic function (C-peptide) in patients with type 1 diabetes mellitus (T1DM). Methods: A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with a search in the PubMed database. Five randomized clinical trials evaluating the use of different DPP-4 inhibitors in patients with T1DM were selected, measuring parameters including glycated hemoglobin (HbA1c), C-peptide, time in glycemic target/range (TIR), and daily insulin dose. Results: HbA1c showed significant reduction in some studies and no significant alterations in others. TIR increased in one study (~77.87% → ~84.40%). C-peptide showed variable effects across studies. The insulin dose did not show a substantial reduction. Conclusions: DPP-4 inhibitors demonstrated modest benefits for glycemic control and preservation of β-cell function in T1DM, but these effects were inconsistent due to methodological heterogeneity. Standardized studies are needed to define beneficial subgroups and long-term efficacy. Full article

(This article belongs to the Special Issue From Monitoring to Management: Addressing Challenges in Type 1 and Type 2 Diabetes Care)

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11 pages, 1729 KB

Open AccessCase Report

Intradermal Application of Allogenic Wharton’s Jelly Mesenchymal Stem Cells for Chronic Post-Thoracotomy Wound in an Elderly Patient After Coronary Artery Bypass Grafting: Clinical Case with Brief Literature Review

by Anastassiya Ganina, Abay Baigenzhin, Elmira Chuvakova, Naizabek Yerzhigit, Anuar Zhunussov, Aizhan Akhayeva, Larissa Kozina, Oleg Lookin and Manarbek Askarov

Diseases 2026, 14(1), 27; https://doi.org/10.3390/diseases14010027 - 8 Jan 2026

Viewed by 500

Abstract

Background: Chronically non-healing thoracic wounds after cardiac and non-cardiac thoracotomy, including cases when coronary artery bypass grafting (CABG) is performed, represent a great clinical challenge. It is often that a conservative treatment of the wounds does not provide effective regeneration of the damaged [...] Read more.

Background: Chronically non-healing thoracic wounds after cardiac and non-cardiac thoracotomy, including cases when coronary artery bypass grafting (CABG) is performed, represent a great clinical challenge. It is often that a conservative treatment of the wounds does not provide effective regeneration of the damaged tissues. It is especially critical in patients with infected wounds, in patients owning a systemic infection, and in elderly people. Methods: The article presents a case report of successful treatment of a 63-year-old man with refractory chronic osteomyelitis of the sternum and mediastinitis four years after CABG, complicated by COVID-19 at the time of reconstructive surgery. Due to the low effectiveness of conservative treatment methods, a two-stage approach was applied: radical surgical wound debridement followed by infiltration of the wound with allogenic mesenchymal stromal cells (MSCs) of Wharton’s jelly (WJ-MSCs). Results: This double-stage therapy successfully modulated the inflammatory environment and stimulated granulation, facilitating final thoracoplasty and osteosynthesis. The patient achieved complete healing of the sternum, demonstrating benefits of WJ-MSCs in treating conservative treatment-resistant infections in the surgical wound. Conclusions: The advantages of using perinatal mesenchymal stem cells, with WJ-MSCs as a type of this class of MSCs, were demonstrated in treating chronically infected sternal surgical wounds. We also compared their regenerative properties to other stem cell types like bone marrow MSCs. Full article

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21 pages, 1561 KB

Open AccessArticle

Predictors of Severe Herpes Zoster: Contributions of Immunosenescence, Metabolic Risk, and Lifestyle Behaviors

by Mariana Lupoae, Fănică Bălănescu, Caterina Nela Dumitru, Aurel Nechita, Mădălina Nicoleta Matei, Simona Claudia Ștefan, Alin Laurențiu Tatu, Elena Niculet, Alina Oana Dumitru, Andreea Lupoae and Dana Tutunaru

Diseases 2026, 14(1), 26; https://doi.org/10.3390/diseases14010026 - 8 Jan 2026

Viewed by 668

Abstract

Background: Herpes zoster (HZ) represents a substantial public health concern among aging populations, yet regional variability in clinical patterns and risk determinants remains insufficiently documented. In southeastern Romania, epidemiological data are limited, and the combined influence of demographic, behavioral, and metabolic factors on [...] Read more.

Background: Herpes zoster (HZ) represents a substantial public health concern among aging populations, yet regional variability in clinical patterns and risk determinants remains insufficiently documented. In southeastern Romania, epidemiological data are limited, and the combined influence of demographic, behavioral, and metabolic factors on disease severity has not been systematically evaluated. Methods: We performed a retrospective observational study including 100 consecutive patients diagnosed with HZ between 2019 and 2023 in a dermatology department in southeastern Romania. Demographic characteristics, lifestyle behaviors, anthropometric status, clinical manifestations, and outcomes were extracted from medical records. Associations between categorical variables were assessed using Chi-square tests and Cramer’s V, while interaction patterns were explored through log-linear modeling. Heatmaps were generated in Python (version 3.10) using the Matplotlib library (version 3.7.1) to visualize distribution patterns and subgroup relationships. Results: The cohort showed a marked age dependence, with 77% of cases occurring in individuals ≥ 60 years, consistent with immunosenescence-driven reactivation. Women represented 59% of cases, and 84.7% of female patients were postmenopausal. Urban residents predominated (91%). Vesicular eruption (84%) and acute pain (79%) were the most frequent symptoms. Localized HZ was observed in 81% of cases, while ophthalmic involvement (11%) and disseminated forms (8%) were less common. Lifestyle factors significantly influenced clinical severity: smokers, alcohol consumers, and sedentary individuals exhibited higher proportions of postherpetic neuralgia (PHN) and ocular complications (p < 0.001). Overweight and obese patients demonstrated a higher burden of PHN, suggesting a role for metabolic inflammation, although BMI was not associated with incidence. No significant association between age category and complication type was detected, likely due to small subgroup sizes despite a clear descriptive trend toward increased severity with advanced age. Conclusions: These findings support a multifactorial model of HZ severity in southeastern Romania, shaped by age, lifestyle behaviors, hormonal status, and metabolic risk. While incidence patterns align with international data, the strong impact of modifiable factors on complication rates highlights the need for targeted prevention and individualized risk assessment. Results offer a regional perspective that may inform future multicenter investigations. Full article

(This article belongs to the Section Infectious Disease)

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14 pages, 1733 KB

Open AccessArticle

Increasing Numbers of Persons with Sleeping Problems in Sweden

by Mona Nilsson and Lennart Hardell

Diseases 2026, 14(1), 25; https://doi.org/10.3390/diseases14010025 - 8 Jan 2026

Cited by 1 | Viewed by 978

Abstract

Objectives: This study investigated sleeping problems in the Swedish population based on the Swedish National Board of Health and Welfare’s national patient register on numbers of patients in specialized outpatient care diagnosed with codes for sleeping problems. Methods: Numbers of patients per year [...] Read more.

Objectives: This study investigated sleeping problems in the Swedish population based on the Swedish National Board of Health and Welfare’s national patient register on numbers of patients in specialized outpatient care diagnosed with codes for sleeping problems. Methods: Numbers of patients per year and per 100,000 inhabitants in various age groups: 0–4, 5–19, 20–39, 40–59, and 60+ years diagnosed each year between 2001 and 2024 with the ICD codes G47 (sleep disorders) or F51 (non-organic sleep disorders) as main diagnosis were assessed. Results: The highest increase for sleep disorders was seen among children, adolescents, and young adults. All results are given per 100,000 persons. In the age group 0–4 years, the numbers of sleep disorders (G47) increased from 41.5 in 2001 to 215.8 in 2024. The corresponding results in the age group 5–19 years were 13.8 and 235.6, respectively. In the age group 20–39 years, 40.4 were diagnosed in 2001 and 220.9 in 2024. For subjects aged 40–59 years, 169.5 were diagnosed in 2001 and 362.8 in 2024, and for persons aged 60+ years, 116.4 were diagnosed in 2001 and 322.9 in 2024. No major changes in the numbers of persons with F51, non-organic sleep disorders, were observed. Conclusions: Sleeping problems can be caused by several factors; however, the rapid increase in recent years has temporally coincided with an increase in the public’s exposure to microwave radiofrequency (RF) radiation and increasing use of screens. RF radiation and use of screens may negatively impact sleep. Full article

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18 pages, 1786 KB

Open AccessSystematic Review

Comparative Evaluation of the Prognostic Accuracy of IL-6 and Angiopoietin-2 for Early Severity Assessment in Acute Pancreatitis: A Systematic Review

by Kairat Shakeev, Dmitriy Klyuyev, Alina Ogizbayeva, Aigul Baltabayeva, Olga Avdienko and Xenia Derevyashkina

Diseases 2026, 14(1), 24; https://doi.org/10.3390/diseases14010024 - 7 Jan 2026

Viewed by 751

Abstract

Background: Early identification of patients at risk for severe acute pancreatitis (SAP) remains a major clinical challenge. Circulating biomarkers reflecting systemic inflammation (IL-6) and endothelial dysfunction (Ang-2) have emerged as promising tools for improving early prediction of persistent organ failure and other adverse [...] Read more.

Background: Early identification of patients at risk for severe acute pancreatitis (SAP) remains a major clinical challenge. Circulating biomarkers reflecting systemic inflammation (IL-6) and endothelial dysfunction (Ang-2) have emerged as promising tools for improving early prediction of persistent organ failure and other adverse outcomes. Objective: To systematically synthesize and compare the diagnostic and prognostic performance of IL-6 and Ang-2 as early biomarkers of severity in adult patients with acute pancreatitis. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420251177279). PubMed, Scopus, and Web of Science were searched for studies published between 2000 and August 2025. Studies included adult patients (≥18 years) in whom IL-6 and/or Ang-2 levels were measured within 72 h of symptom onset or hospital admission, and where indices of diagnostic accuracy (AUC, sensitivity, specificity, or threshold values) were reported. Results: Fifteen cohort studies met the inclusion criteria. IL-6 demonstrated a consistent association with SAP and persistent organ failure, with AUC values ranging from 0.69 to 0.99; the highest accuracy was observed within the first 24 h. Specificity varied substantially across studies. Ang-2 showed uniformly high prognostic accuracy (AUC 0.79–0.98), reliably predicting persistent organ failure, multiorgan dysfunction, infected necrosis, and mortality. Conclusions: IL-6 exhibits high but heterogeneous diagnostic performance (AUC 0.69–0.99), whereas Ang-2 demonstrates consistently high accuracy (AUC 0.79–0.98) across study designs. Combined evaluation of inflammatory and endothelial pathways appears to offer the most robust strategy for early prediction of persistent organ failure in acute pancreatitis. Full article

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15 pages, 2675 KB

Open AccessReview

Incidental Cardiac Uptake on ^99mTc-HMDP Bone Scintigraphy in Oncology Patients: Two Cases of Transthyretin Amyloid Cardiomyopathy with Literature Review

by Naoya Matsuki, Toru Awaya, Jin Endo, Taeko Kunimasa, Tatsuya Gomi, Yasushi Okamoto and Hidehiko Hara

Diseases 2026, 14(1), 23; https://doi.org/10.3390/diseases14010023 - 7 Jan 2026

Viewed by 937

Abstract

Background: Bone scintigraphy using technetium-99m hydroxymethylene diphosphonate (^99mTc-HMDP) is extensively employed to detect bone metastases. However, incidental myocardial uptake may indicate wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM), a frequently overlooked diagnosis with important clinical implications. Case Presentation: Two elderly female patients with [...] Read more.

Background: Bone scintigraphy using technetium-99m hydroxymethylene diphosphonate (^99mTc-HMDP) is extensively employed to detect bone metastases. However, incidental myocardial uptake may indicate wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM), a frequently overlooked diagnosis with important clinical implications. Case Presentation: Two elderly female patients with a history of breast cancer were subjected to ^99mTc-HMDP bone scintigraphy as part of a routine evaluation for possible bone metastases. Both cases demonstrated incidental myocardial uptake (Perugini Grade 2 and Grade 3, respectively), raising suspicion for ATTRwt-CM, which was subsequently confirmed by endomyocardial biopsy. Review of the Literature: We reviewed published studies reporting cardiac uptake on bone scintigraphy, summarizing the frequency, patient demographics, and tracer types, and emphasizing the clinical relevance of this finding in cancer patients. Conclusions: In oncology patients, bone scintigraphy performed during routine metastatic screening may facilitate early detection of ATTRwt-CM, enabling timely diagnosis and treatment initiation, potentially improving clinical outcomes. Full article

(This article belongs to the Special Issue Feature Papers in Section 'Cardiology' in 2024–2025)

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12 pages, 787 KB

Open AccessCase Report

Clinical Patterns of Rocuronium and Cisatracurium Use in Acute Respiratory Distress Syndrome: A Retrospective Cohort Study

by Imran Khan, Ariel Hendin, Bernadett Kovacs, Dominic Seguin, Caitlin Richler, Christine Landry and Pierre Thabet

Diseases 2026, 14(1), 22; https://doi.org/10.3390/diseases14010022 - 6 Jan 2026

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Abstract

Background: Neuromuscular blockade (NMB) is frequently used in moderate-to-severe acute respiratory distress syndrome (ARDS) to optimize ventilatory synchrony and minimize ventilator-induced lung injury. However, comparative real-world data on different NMB strategies remain limited. Objective: To describe patterns of neuromuscular blockade use in ARDS [...] Read more.

Background: Neuromuscular blockade (NMB) is frequently used in moderate-to-severe acute respiratory distress syndrome (ARDS) to optimize ventilatory synchrony and minimize ventilator-induced lung injury. However, comparative real-world data on different NMB strategies remain limited. Objective: To describe patterns of neuromuscular blockade use in ARDS and describe clinical outcomes across four NMB strategies: intermittent rocuronium, continuous cisatracurium, escalation from rocuronium to cisatracurium, and de-escalation from cisatracurium to rocuronium. Methods: A retrospective chart review was conducted in an 18-bed tertiary ICU at Hôpital Montfort (Ottawa, Canada) between November 2021 and March 2025. Adult ARDS patients who received NMB for >24 h were included. Continuous variables (age, ventilation time, ICU stay) were summarized as means ± SD and median [IQR]; categorical variables (sex, ARDS etiology, mortality) as counts and percentages. Inferential testing was limited to baseline characteristics; clinical outcomes were summarized descriptively. Results: Fifty-one patients met inclusion criteria: rocuronium (n = 20), cisatracurium (n = 14), rocuronium→cisatracurium (n = 8), and cisatracurium→rocuronium (n = 9). Mean ventilation durations were 280, 195, 272, and 262 h, respectively; corresponding ICU stays were 245, 237, 380, and 299 h. Mortality ranged from 25% to 56%. Escalation from rocuronium to cisatracurium typically reflected persistent dyssynchrony or worsening oxygenation, whereas de-escalation occurred in improving patients with residual ventilatory drive. Variability in corticosteroid use, adjunctive proning, and epoprostenol were potential confounders. Conclusions: Distinct NMB use patterns in ARDS reflect bedside clinical judgment rather than predefined thresholds. Patient trajectory and dyssynchrony severity appear to drive NMBA escalation decisions more than oxygenation indices alone. These findings highlight the need for prospective studies defining standardized criteria for NMB initiation, escalation, and weaning in ARDS. Full article

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28 pages, 4255 KB

Open AccessArticle

Segmentation-Guided Hybrid Deep Learning for Pulmonary Nodule Detection and Risk Prediction from Multi-Cohort CT Images

by Gomavarapu Krishna Subramanyam, Kundojjala Srinivas, Veera Venkata Raghunath Indugu, Dedeepya Sai Gondi and Sai Krishna Gaduputi Subbammagari

Diseases 2026, 14(1), 21; https://doi.org/10.3390/diseases14010021 - 6 Jan 2026

Viewed by 825

Abstract

Background: Lung cancer screening using low-dose computed tomography (LDCT) demands not only early pulmonary nodule detection but also accurate estimation of malignancy risk. This remains challenging due to subtle nodule appearances, the large number of CT slices per scan, and variability in radiological [...] Read more.

Background: Lung cancer screening using low-dose computed tomography (LDCT) demands not only early pulmonary nodule detection but also accurate estimation of malignancy risk. This remains challenging due to subtle nodule appearances, the large number of CT slices per scan, and variability in radiological interpretation. The objective of this study is to develop a unified computer-aided detection and diagnosis framework that improves both nodule localization and malignancy assessment while maintaining clinical reliability. Methods: We propose Seg-CADe-CADx, a dual-stage deep learning framework that integrates segmentation-guided detection and malignancy classification. In the first stage, a segmentation-guided detector with a lightweight 2.5D refinement head is employed to enhance nodule localization accuracy, particularly for small nodules with diameters of 6 mm or less. In the second stage, a hybrid 3D DenseNet–Swin Transformer classifier is used for malignancy prediction, incorporating probability calibration to improve the reliability of risk estimates. Results: The proposed framework was evaluated on established public benchmarks. On the LUNA16 dataset, the system achieved a competitive performance metric (CPM) of 0.944 for nodule detection. On the LIDC-IDRI dataset, the malignancy classification module achieved a ROC-AUC of 0.988, a PR-AUC of 0.947, and a specificity of 97.8% at 95% sensitivity. Calibration analysis further demonstrated strong agreement between predicted probabilities and true malignancy likelihoods, with an expected calibration error of 0.209 and a Brier score of 0.083. Conclusions: The results demonstrate that hybrid segmentation-guided CNN–Transformer architectures can effectively improve both diagnostic accuracy and clinical reliability in lung cancer screening. By combining precise nodule localization with calibrated malignancy risk estimation, the proposed framework offers a promising tool for supporting radiologists in LDCT-based lung cancer assessment. Full article

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15 pages, 1479 KB

Open AccessArticle

Optimization of the Convective Dose in On-Line Hemodiafiltration: Prospective Interventional Cohort Study—Conducted at Soissons Hospital, France

by Bedel Lukoki-Beudin, Tchilabalo Kakomkate, Wahiba Ibeghouchene, Céline Carreira, Imene Ouertani, Bruce Shinga Wembulua, Yannick Mayamba Nlandu, Yannick Mompango Engole, Marie-France Mboliasa Ingole, Augustin Luzayadio Longo, Francois Musungayi Kajingulu, Jean Robert Rissassy Makulo, Jean Bonny Nsumbu, Vieux Momeme Mokoli, Nazaire Mangani Nseka, Ernest Kiswaya Sumaili, John Bukasa-Kakamba, Hadrian Hoang-Vu Tran, Audrey Thu, Ayrton Bangolo, Izage Kianifar Aguilar, Simcha Weissman, Janette Mansour and Justine Busanga Bukabau Show full author list Hide full author list

Diseases 2026, 14(1), 20; https://doi.org/10.3390/diseases14010020 - 4 Jan 2026

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Abstract

Background and Objectives: On-line hemodiafiltration (OL-HDF) has been proposed as an alternative to conventional hemodialysis (HD) for patients with end-stage chronic kidney disease (CKD). Randomized controlled trials suggest that OL-HDF may reduce mortality, particularly when the convection volume (CV) exceeds 23 L/1.73 m [...] Read more.

Background and Objectives: On-line hemodiafiltration (OL-HDF) has been proposed as an alternative to conventional hemodialysis (HD) for patients with end-stage chronic kidney disease (CKD). Randomized controlled trials suggest that OL-HDF may reduce mortality, particularly when the convection volume (CV) exceeds 23 L/1.73 m² per session. However, achieving this target depends on local practices and may be limited to selected populations. The CONVINCE trial reported a 97% success rate using a structured optimization protocol, but its applicability to unselected real-world populations remains uncertain. This study aimed to evaluate the incidence of high CV in OL-HDF among unselected patients managed under routine conditions with a standardized optimization protocol. Methods and Materials: This prospective cohort study (May–October 2024) included 67 unselected incident and prevalent patients undergoing HD or HDF in a hospital-based dialysis center. All patients were switched to post-dilution OL-HDF following the CONVINCE optimization protocol, which involved stepwise increases in blood flow, adjustment of filtration fraction, and optimization of session duration. Results: The mean age was 68.8 ± 14.9 years; 56.7% were male. Blood flow increased from 283 to 338 mL/min (p < 0.001), and the use of dialyzers > 2 m² increased from 36% to 68% (p < 0.003). Kt/V improved from 1.22 to 1.6 (p < 0.01). CV increased by ~2 L from M1 onward and was sustained through M6, correlating positively with blood flow, session duration, and Kt/V (all p < 0.01). Conclusions: Stepwise optimization protocol enabled sustained achievement of high CV (23.5 L/session) in 62.3% of patients, improving dialysis adequacy. Full article

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19 pages, 532 KB

Open AccessArticle

Mediterranean Diet Adherence Is Associated with Lower Prevalence of Depression and Anxiety in University Students: A Cross-Sectional Study in Greece

by Olga Alexatou, Gavriela Voulgaridou, Sousana K. Papadopoulou, Constantina Jacovides, Aspasia Serdari, Georgia-Eirini Deligiannidou, Gerasimos Tsourouflis, Myrsini Pappa, Theophanis Vorvolakos and Constantinos Giaginis

Diseases 2026, 14(1), 19; https://doi.org/10.3390/diseases14010019 - 3 Jan 2026

Viewed by 1133

Abstract

Background/Objectives: The Mediterranean diet (MD) constitutes one of the most broadly studied dietary patterns, which has been linked to the prevention of non-communicable diseases and mental health disorders. University students, a population exposed to significant psychosocial stressors and lifestyle changes, may particularly [...] Read more.

Background/Objectives: The Mediterranean diet (MD) constitutes one of the most broadly studied dietary patterns, which has been linked to the prevention of non-communicable diseases and mental health disorders. University students, a population exposed to significant psychosocial stressors and lifestyle changes, may particularly benefit from healthy eating patterns such as the MD. This study was designed to examine the potential associations of MD adherence with symptoms of depression and anxiety among Greek university students. Methods: A cross-sectional study was initially conducted among 7160 active university students from ten diverse geographic regions in Greece. After the enrollment procedure and the application of relevant exclusion criteria, 5191 university students (52.0% female; mean age: 21.3 ± 2.4 years) constituted the study population. MD adherence was assessed using the KIDMED index, while depressive and anxiety symptoms were evaluated using the Beck Depression Inventory-II (BDI-II) and State–Trait Anxiety Inventory (STAI-6), respectively. Sociodemographic and anthropometric data were collected for all the enrolled university students. All the questionnaires were completed by face-to-face interviews with expert personnel. Results: Students with low adherence to the MD were significantly more likely to report symptoms of depression (OR = 2.12; p ˂ 0.001) and anxiety (OR = 2.27; p ˂ 0.001) and to be overweight or obese (OR = 2.45; p ˂ 0.001) after adjustment for multiple confounding factors. Low MD adherence was also associated with male gender (OR = 0.73; p ˂ 0.01), living alone (OR = 0.78; p ˂ 0.01), smoking (OR = 0.75; p ˂ 0.01), low physical activity (OR = 1.84; p = 0.001), and poorer academic performance (OR = 0.83; p ˂ 0.01). Conclusions: Low adherence to the MD is significantly associated with increased likelihood of depression, anxiety, and excess body weight among university students in Greece. These findings underscore the importance of promoting healthy dietary habits and related lifestyle behaviors in young adult populations as a potential strategy for mental health prevention and intervention. Due to the presence of several limitations in the present study, future longitudinal and interventional studies should be performed to confirm the present findings. Full article

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14 pages, 576 KB

Open AccessArticle

Associations Between Triglycerides and Walking Capacity in Community-Dwelling Older Adults with Metabolic Syndrome

by Chiraphat Kloypan, Tichanon Promsrisuk, Boonsita Suwannakul, Chonticha Kaewjoho and Arunrat Srithawong

Diseases 2026, 14(1), 18; https://doi.org/10.3390/diseases14010018 - 2 Jan 2026

Viewed by 795

Abstract

Background and Objectives: Metabolic syndrome (MetS) has been associated with reduced physical function in older adults, but the relative contributions of metabolic components, physiological responses, and functional performance to walking capacity remain unclear. Materials and Methods: This cross-sectional study included 116 [...] Read more.

Background and Objectives: Metabolic syndrome (MetS) has been associated with reduced physical function in older adults, but the relative contributions of metabolic components, physiological responses, and functional performance to walking capacity remain unclear. Materials and Methods: This cross-sectional study included 116 community-dwelling adults aged ≥60 years (mean age 68.5 ± 5.5 years; 65.5% female). Walking capacity was evaluated using the six-minute walk test (6MWT) with associated physiological responses. Functional performance was assessed using the five-times-sit-to-stand test (FTSST), timed-up-and-go (TUG), and handgrip strength. Associations with six-minute walk distance (6MWD) were examined using hierarchical regression analyses, and discriminatory performance was evaluated using receiver operating characteristic analysis. Results: Participants with MetS demonstrated shorter 6MWD, slower FTSST and TUG performance, and higher dyspnea ratings compared to those without MetS (p < 0.05). Triglycerides were inversely associated with 6MWD in intermediate models (β = −0.33, p < 0.001), but after full adjustment, only ΔSBP (β = 0.76, p = 0.008) and FTSST (β = −24.45, p < 0.001) remained significant. The FTSST and TUG demonstrated excellent discriminatory ability, with AUC values of 0.956 (cut-off ≥ 15.5 s) and 0.925 (cut-off ≥ 13.7 s), respectively, whereas triglycerides showed moderate accuracy (AUC = 0.709) with a cut-off of ≥143 mg/dL. Conclusions: Walking capacity was more strongly associated with physiological and functional measures than with metabolic biomarkers. The FTSST and TUG showed strong discriminatory performance for low walking capacity, whereas metabolic markers provided complementary contextual information. Full article

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10 pages, 2100 KB

Open AccessBrief Report

Discrepancies in the Detection of PML::RARA Gene Rearrangement by Fluorescent In Situ Hybridization Using Commonly Used Dual Color Dual Fusion Probes

by Hanan S. Elsarraj, Karsten Evans, Sydney Graham and Shivani Golem

Diseases 2026, 14(1), 17; https://doi.org/10.3390/diseases14010017 - 2 Jan 2026

Viewed by 468

Abstract

Background/Objectives: Acute promyelocytic leukemia (APL) is a medical emergency associated with life-threatening complications such as disseminated intravascular coagulation (DIC), necessitating prompt therapeutic intervention and rapid diagnostic confirmation. APL is characterized by a translocation of the PML gene (15q24) with the RARA gene (17q21), [...] Read more.

Background/Objectives: Acute promyelocytic leukemia (APL) is a medical emergency associated with life-threatening complications such as disseminated intravascular coagulation (DIC), necessitating prompt therapeutic intervention and rapid diagnostic confirmation. APL is characterized by a translocation of the PML gene (15q24) with the RARA gene (17q21), resulting in the PML::RARA fusion gene on the derivative chromosome 15. Atypical PML::RARA rearrangements may escape detection by standard FISH probes. This study highlights limitations of commonly used probe sets and underscores the need for alternative FISH probe sets and complementary molecular testing. Methods: Two unique APL cases with atypical PML::RARA rearrangements were identified in our laboratory. Each case was evaluated at diagnosis using two commercially available FISH probe sets from Abbott Molecular and Cytocell. Metaphase FISH was performed to characterize the atypical FISH signal pattern further, and qRT-PCR was used to confirm the presence of the PML::RARA transcript. Results: Both cases demonstrated atypical rearrangements with a single fusion signal. In the first case, the Abbott probe detected a single fusion signal, while the Cytocell probe was negative. Metaphase FISH revealed an insertion of the PML region near RARA on chromosome 17. In the second case, the Cytocell probe was positive, and the Abbott probe was negative; metaphase FISH demonstrated insertion of the RARA region near PML on chromosome 15. qRT-PCR confirmed the presence of the PML::RARA transcript in both cases. Conclusions: These findings reveal limitations in commonly used PML::RARA FISH probes and support reflex testing with alternative probes and molecular confirmation to ensure accurate diagnosis. Full article

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9 pages, 957 KB

Open AccessArticle

Prevalence and Associated Factors of HPV Infection in the Oropharyngeal Cavity Among University Students in a Southwest Population in Mexico

by Joel Jahaziel Díaz-Vallejo, Daniela Córdoba-Colorado, Dulce del Carmen González-Marcial, Ezri Cruz-Pérez, Magda Olivia Pérez-Vásquez, José Locia-Espinoza and Luz Irene Pascual-Mathey

Diseases 2026, 14(1), 16; https://doi.org/10.3390/diseases14010016 - 31 Dec 2025

Viewed by 664

Abstract

Background: Human papillomavirus (HPV) is the leading cause of sexually transmitted infections (STIs). It is found in extragenital regions, including the oropharyngeal cavity. Its presence in this area is linked to the increased prevalence of oral and pharyngeal cancer cases in young individuals, [...] Read more.

Background: Human papillomavirus (HPV) is the leading cause of sexually transmitted infections (STIs). It is found in extragenital regions, including the oropharyngeal cavity. Its presence in this area is linked to the increased prevalence of oral and pharyngeal cancer cases in young individuals, which is associated with current sexual practices in the young population. Objective, the objective of this study was to estimate the prevalence of HPV infection in the oropharyngeal cavity and identify associated factors within the student community of the Engineering and Chemical Sciences Unit of the University of Veracruz. Methods: an observational, descriptive, and transversal study was conducted. The study included 136 sexually active students aged 18 to 25 without oropharyngeal infection. After obtaining informed consent from all participants, mouthwashes were collected from the oropharyngeal cavity for subsequent detection of viral DNA and HPV genotyping using the PCR-RFLP technique. Risk factors were further assessed through a private questionnaire. For statistical analysis, a bivariate analysis of the main risk factors was performed, and Odds Ratios (OR) and 95% Confidence Intervals (CI) were calculated. Results: The results showed that HPV was detected in 6 participants, resulting in a prevalence of 4.4% (95% CI, 0.92–7.91), with genotypes 11, 52 and 58 identified. Notably, participants with a sexual orientation other than heterosexual had a 7.5-fold higher association with HPV. Conclusions: these findings indicate that low- and high-risk HPV infection in the oropharyngeal cavity is associated with risky sexual behavior in young individuals. Therefore, understanding the specifics of sexual activities is necessary to better comprehend viral transmission and spread among HPV-positive students. Full article

(This article belongs to the Section Infectious Disease)

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16 pages, 245 KB

Open AccessArticle

National and Subnational Burden of Female Breast Cancer in Iran from 2010 to 2021

by Zahra Pasokh, Afrooz Mazidimoradi, Mohsen Hamidian, Zahra Shahabinia, Mohaddeseh Kiani and Hamid Salehiniya

Diseases 2026, 14(1), 15; https://doi.org/10.3390/diseases14010015 - 31 Dec 2025

Cited by 1 | Viewed by 708

Abstract

Background and Objectives: Female breast cancer (FBC) is an increasing public health concern in Iran, with notable geographic disparities that necessitate comprehensive burden assessments at national and provincial levels. This study presented the national and subnational burden and changes in FBC burden [...] Read more.

Background and Objectives: Female breast cancer (FBC) is an increasing public health concern in Iran, with notable geographic disparities that necessitate comprehensive burden assessments at national and provincial levels. This study presented the national and subnational burden and changes in FBC burden from 2010 to 2021 in Iran in comparison with global data. Materials and Methods: The GBD (2021) data on female BC were extracted from the Global Health Data Exchange (GHDx) query tool. Age-standardized incidence, deaths, prevalence, and adjusted years of life with disabilities (DALYs) rates (per 100,000) of FBC were extracted. Data were extracted globally, by continents, for Iran and its provinces, from 2010 to 2021. Results: Although the global FBC burden indicators remained almost stable, in Iran, there was a nearly twofold rise in incidence and prevalence and notable rises in mortality and DALYs. This study showed significant variation at the provincial level; Tehran, Qom, and Alborz consistently had the highest incidence, prevalence, mortality, and DALY rates, whereas Sistan and Baluchistan, Chahar Mahaal and Bakhtiari, Kohgiluyeh and Boyer-Ahmad, and Zanjan had the lowest rates. During 2010–2021, the provinces of Golestan, Ardebil, Sistan and Baluchistan, West Azarbayejan, Kohgiluyeh and Boyer-Ahmad, and North Khorasan experienced the most increasing trend in BC burden, while Yazd and Semnan showed smaller increases or modest decreases. Conclusions: The rising FBC burden in Iran underscores the urgent need to strengthen cancer registries, expand screening programs, ensure equitable resource distribution, and implement targeted regional interventions focused on modifiable risk factors and early detection to reduce health disparities nationwide. Full article

16 pages, 3008 KB

Open AccessArticle

Epidemiological, Clinical, and Biomarker Profile of Male Infertility in Morocco: A Retrospective Single-Center Study of 1399 Cases

by Henri Hubert Kwizera Tsinda, Modou Mamoune Mbaye, Loïc Koumba, Reine Rolande Ada Edou, Achraf Zakaria, Noureddine Louanjli, Bouchra Ghazi, Fatima Maachi, Hakima Benomar, El Turk Joumana and Karima Sabounji

Diseases 2026, 14(1), 14; https://doi.org/10.3390/diseases14010014 - 30 Dec 2025

Cited by 1 | Viewed by 686

Abstract

Objective: The objectives of this study were to characterize the clinical, hormonal, and extended biomarker profile of infertile men in a Moroccan context, based on a retrospective single-center study, and to assess the relevance of selected markers for initial andrological assessment. Methods: This [...] Read more.

Objective: The objectives of this study were to characterize the clinical, hormonal, and extended biomarker profile of infertile men in a Moroccan context, based on a retrospective single-center study, and to assess the relevance of selected markers for initial andrological assessment. Methods: This descriptive, retrospective, single-center study included 1399 men consulting for infertility between January and December 2024 in a specialized center. Collected data encompassed lifestyle habits, medical history, semen parameters (WHO 2021 criteria), sperm DNA fragmentation (TUNEL assay), nuclear decondensation, and hormonal assays (FSH, testosterone, and inhibin B) available in a subset of 156, 56, and 26 patients (for FSH, testosterone, and inhibin B, respectively). Associations with oligozoospermia were explored using univariate logistic regression analysis. Results: The mean age was 39.0 ± 8.0 years; 57% presented with primary infertility, and 82.8% were active smokers. A sperm concentration <16 M/mL was observed in 31.6% of patients. Among the 156 patients analyzed, high FSH levels were observed in 24% of cases. As for inhibin B, among the 26 patients evaluated, a decrease in levels was observed in 38% of cases. Pathological DNA fragmentation was found in 9.6%. In univariate analysis, oligozoospermia was significantly associated with elevated FSH (OR = 7.25; 95% CI: 3.15–16.70), varicocele (OR = 1.81), and smoking (OR = 0.66). Conclusion: This is the first large-scale Moroccan study integrating advanced biomarkers into the assessment of male infertility. The observed associations between elevated FSH, sperm DNA fragmentation, and varicocele support the development of a simplified andrological triage strategy, particularly relevant in resource-limited settings. Full article

(This article belongs to the Special Issue Body Composition, Energy Expenditure and Lifestyle During Obesity Management)

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2 pages, 144 KB

Open AccessCorrection

Correction: Torres-Arroyo et al. Immunoblotting Analysis of Fruit Proteins in Mexican Pediatric Patients Suggests the Existence of New Allergens. Diseases 2025, 13, 284

by Angélica Torres-Arroyo, Maidelen Suárez-Gutiérrez, Andrea Iglesias-Amaya, Aramiz López-Durán, Luisa Díaz-García, Horacio Reyes-Vivas and David Alejandro Mendoza-Hernández

Diseases 2026, 14(1), 13; https://doi.org/10.3390/diseases14010013 - 30 Dec 2025

Viewed by 269

Abstract

In the original publication, there was a mistake in the Supplementary Materials [...] Full article

29 pages, 910 KB

Open AccessReview

Tailored Therapeutic Strategies for Fetuses, Neonates, Pediatrics, Geriatrics, Athletes, and Critical Cases in the Era of Personalized Medicine

by Ahmed Bakr, Youssef Basem, Abanoub Sherif, Alamer Ata, Nada Nabil Saad, Yassmin Emarh Fayed, Maria Tamer, Malak Nasr Elkady and Rehab Abdelmonem

Diseases 2026, 14(1), 12; https://doi.org/10.3390/diseases14010012 - 29 Dec 2025

Cited by 1 | Viewed by 1602

Abstract

Precision medicine, which relies on genomic, multi-omic, phenotypic, and environmental data, has the potential to transform healthcare from population-focused heuristics to individualized prevention, diagnosis, and treatment. Moreover, recent advances in sequencing, molecular profiles, wearable sensors, and machine learning have created opportunities for rapid [...] Read more.

Precision medicine, which relies on genomic, multi-omic, phenotypic, and environmental data, has the potential to transform healthcare from population-focused heuristics to individualized prevention, diagnosis, and treatment. Moreover, recent advances in sequencing, molecular profiles, wearable sensors, and machine learning have created opportunities for rapid translational innovation: rapid genomic diagnosis in neonatal and paediatric rare diseases, targeted oncology, pharmacogenomic-based prescribing strategies, and individual sport performance. Nevertheless, the vast majority of innovations remain in centers of specialism or pilot programs, rather than routinely or equitably integrated into clinical or athletic practice. This narrative review synthesizes translational evidence across the life course—in pregnancy, paediatrics, adult medicine, geriatrics, and sportomics—to find reproducible clinical and performance examples which enable precision-based alternative approaches to management, outcome, or preparation; and to reshape those examples into pragmatic, scalable priorities which minimize inequity, and maximize benefit. We undertook a structured narrative synthesis of peer-reviewed literature, trials, clinician translation programs, implementation studies, and sportomics reports, prioritizing examples that demonstrate utility, reproducibility, and impact. Important findings suggest that multi-omics and rapid sequencing improve diagnostic yield and time to diagnosis. Molecular profiling and circulating tumor DNA help realize adaptive treatment selection. Integrated genomics, metabolomics, wearable physiology, and AI analytics facilitate individualized training, injury-risk stratification, and recovery optimization. But systematic value is limited by insufficient representative validation, dataset bias, poor interoperability, regulatory uncertainty, workforce preparedness, and inequities of access. Converting a promise into population- and performance-level value requires coordinated action across four fronts: representative validation; interoperable, privacy-preserving infrastructures; clinician- and coach-centered implementation; and templates for scalable, cost-sensitive deployment. Full article

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15 pages, 901 KB

Open AccessArticle

Survival Prediction in Septic ICU Patients: Integrating Lactate and Vasopressor Use with Established Severity Scores

by Celia María Curieses Andrés, Maria del Pilar Rodriguez del Tio, Ana María Bueno Gonzalez, Mercedes Artola Blanco, Silvia Medina Díez, Amanda Francisco Amador, Elena Bustamante Munguira and José M. Pérez de la Lastra

Diseases 2026, 14(1), 11; https://doi.org/10.3390/diseases14010011 - 29 Dec 2025

Viewed by 721

Abstract

Background: Accurate prediction of survival in septic patients remains a major challenge in intensive care medicine. Established severity scores such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Sequential Organ Failure Assessment (SOFA) are widely used to estimate [...] Read more.

Background: Accurate prediction of survival in septic patients remains a major challenge in intensive care medicine. Established severity scores such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Sequential Organ Failure Assessment (SOFA) are widely used to estimate prognosis, while biochemical markers such as serum lactate may provide complementary information. However, the prognostic interplay between these scores, lactate dynamics, vasopressor requirement, and infection focus has not been fully elucidated in septic populations. Methods: We conducted a retrospective observational study of 146 adult patients with sepsis admitted to the intensive care unit (ICU) of the Hospital Clínico Universitario de Valladolid (HCUV), Spain, between 2022 and 2024. Demographic data, APACHE II and SOFA scores at admission, lactate levels at admission and 24 h, albumin, and procalcitonin were recorded. Vasopressor use (categorized by intensity) and infection focus (urinary vs. non-urinary) were documented. The primary outcome was ICU mortality. Correlation analyses (Pearson or Spearman as appropriate) were performed separately for urinary and non-urinary subgroups. Multivariable logistic regression models were constructed using APACHE II, SOFA, log-transformed lactate at 24 h, vasopressor use, and urinary focus as predictors. Model performance was assessed using Nagelkerke R², area under the ROC curve (AUC), and classification accuracy. Results: ICU mortality was 23.3%. APACHE II (OR 1.092; p = 0.004) and SOFA (OR 1.185; p = 0.023) were independent predictors of ICU mortality, while log-transformed lactate at 24 h showed a positive trend (OR 1.920; p = 0.066). The addition of urinary focus (protective effect, OR 0.19; p = 0.035) and vasopressor requirement (OR 2.20; p = 0.04) modestly improved model discrimination (Nagelkerke R² = 0.395). ROC analyses showed AUCs of 0.800 for APACHE + SOFA + log-lactate, 0.824 for the vasopressor model, and 0.833 for the urinary focus model. The best-performing models achieved >85% overall accuracy, with specificity consistently above 95%. Conclusions: In septic ICU patients, APACHE II and SOFA scores remain independent predictors of ICU mortality, and lactate at 24 h adds prognostic value—particularly in non-urinary infections. Vasopressor requirement and infection focus modestly improved model discrimination, underscoring their clinical relevance. These findings suggest that integrating severity scores with selected metabolic and clinical variables may modestly refine survival prediction in septic patients. Full article

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14 pages, 526 KB

Open AccessArticle

Clinical Depression in the Last Year in Life in Persons Dying from Non-Cancer Conditions—Real World Data

by Peter Strang, Anette Alvariza, Torbjörn Schultz and Linda Björkhem-Bergman

Diseases 2026, 14(1), 9; https://doi.org/10.3390/diseases14010009 - 28 Dec 2025

Viewed by 858

Abstract

Background/Objectives: Published prevalences of depression are mainly based on measurements of depressive symptoms, whereas data on clinical depressions are lacking. Our aim was to map the prevalence of ICD-10 diagnoses of depression made by physicians in routine healthcare, during the last year of [...] Read more.

Background/Objectives: Published prevalences of depression are mainly based on measurements of depressive symptoms, whereas data on clinical depressions are lacking. Our aim was to map the prevalence of ICD-10 diagnoses of depression made by physicians in routine healthcare, during the last year of life in non-cancer conditions and to study associations with clinical variables. Methods: A registry study on all persons in ordinary accommodation, dying in 2015–2023 in non-cancer conditions. Results: Of 62,228 persons dying from non-cancer conditions, 4391 (7.1%) were formally diagnosed with depression during the last year in life. Depression was significantly more common in women than in men, 8.0% vs. 6.3% (p < 0.001); adjusted odds ratio (aOR) 1.46 (95%CI 1.37–1.55). Prevalence of depression was highest in persons 18–44 years (18.3%) and lowest in persons >85 years old (5.7%) (p < 0.001); aOR 4.12 (95%CI 3.66–4.63). It was also more common in persons living in more affluent areas, aOR 1.19 (95%CI 1.10–1.29). The condition was most frequent in persons with Parkinson’s disease (9.4%) and COPD (8.2%). Depression was associated with more emergency room visits, 89.5% vs. 81.3% (p < 0.001), and visits in psychiatric services in the last year in life, 41.4% vs. 8.8% (p < 0.001). Depression was less prevalent in persons admitted to palliative care (p = 0.007). Conclusions: The highest frequencies were found in women, younger persons, and those living in affluent areas, but also in certain diagnoses such as Parkinson’s disease and COPD. Clinical depression in the last year of life is associated with more emergency room visits and utilization of psychiatric services. Full article

(This article belongs to the Special Issue Mental Health Across the Lifespan: Integrating Multidisciplinary Perspectives)

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22 pages, 3357 KB

Open AccessReview

Cancer Screening and Prevention in MENA and Mediterranean Populations: A Multi-Level Analysis of Barriers, Knowledge Gaps, and Interventions Across Indigenous and Diaspora Communities

by Sebahat Gozum, Omar F. Nimri, Mohammed Abdulridha Merzah and Rui Vitorino

Diseases 2026, 14(1), 10; https://doi.org/10.3390/diseases14010010 - 28 Dec 2025

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Abstract

Cancer is one of the biggest health burdens for women in the Middle East and North Africa (MENA), with the incidence of breast, cervical and colorectal cancer on the rise. Although preventive measures such as the HPV vaccination and population-based screening are available, [...] Read more.

Cancer is one of the biggest health burdens for women in the Middle East and North Africa (MENA), with the incidence of breast, cervical and colorectal cancer on the rise. Although preventive measures such as the HPV vaccination and population-based screening are available, access to them remains very unequal. Women in rural, low-income and refugee communities face additional barriers, cultural stigmatisation, low health literacy, gender norms and fragile health systems, leading to delayed diagnoses and poorer outcomes. This review summarises the results of 724 peer-reviewed publications to assess the current situation of cancer screening in MENA and Mediterranean countries. The studies were classified into four dimensions: cancer type (breast, cervical, colorectal), behavioural constructs (awareness, uptake, education), vulnerability factors (e.g., migrants, refugees, low-literacy groups), and geography (indigenous MENA populations versus diaspora and Mediterranean immigrant communities). The results show large inequalities in access and participation due to fragmented policies, socio-cultural resistance and infrastructure gaps. Nevertheless, promising approaches are emerging: community-led outreach, mobile screening programmes, AI-assisted triage and culturally appropriate digital health interventions. Comparisons between the local and diaspora populations make it clear that systemic and cultural barriers persist even in well-equipped facilities. Closing the screening gap requires a culturally sensitive, digitally enabled and policy aligned approach. Key priorities include engaging religious and community leaders, promoting men’s engagement in women’s health and securing sustainable funding. With coordinated action across all sectors, MENA countries can build inclusive screening programmes that reach vulnerable women and reduce preventable cancer mortality. Full article

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16 pages, 856 KB

Open AccessArticle

Predictors of Escalation of Lipid-Lowering Therapy with Subanalysis of the Influence of Lipoprotein (a) on the Decision-Making Process

by Paweł Muszyński, Kinga Natalia Dudzińska, Marlena Święcicka, Wiktoria Grądzka-Matys, Małgorzata Chlabicz, Dominika Musiałowska, Joanna Kruszyńska, Piotr Kazberuk, Urszula Bajda and Anna Tomaszuk-Kazberuk

Diseases 2026, 14(1), 8; https://doi.org/10.3390/diseases14010008 - 27 Dec 2025

Cited by 1 | Viewed by 827

Abstract

Background/Objectives: Cardiovascular diseases are the leading cause of death worldwide. The preventive efforts to reduce the burden are crucial. Primary causes of cardiovascular diseases include lipid disorders. The variety of available medications influences cardiovascular risk and allows for improvement. However, discontinuation or infrequent [...] Read more.

Background/Objectives: Cardiovascular diseases are the leading cause of death worldwide. The preventive efforts to reduce the burden are crucial. Primary causes of cardiovascular diseases include lipid disorders. The variety of available medications influences cardiovascular risk and allows for improvement. However, discontinuation or infrequent initiation of lipid-lowering therapies remains a problem. This study aimed to investigate predictors of lipid-lowering therapy escalation. Methods: 431 patients with known concentrations of Lipoprotein (a) (Lp (a)) acquired as part of routine cardiovascular risk assessment from the HELPE-R registry, hospitalised in the University Clinical Hospital in Białystok were included in this study. Escalation of treatment was defined as the initiation of any form of lowering therapy or an increase in the potency or dose of statins. The analysis of the influence of various factors on the decision about escalation was performed. Results: The median age was 69.00 years. The escalation of therapy occurred in 48.49% of patients. Not reaching the LDL-C goal was the strongest predictor of escalation (OR: 9.177). The other factors increasing the probability of escalation included acute coronary syndrome (OR: 3.913), prediabetes (OR: 2.372), chronic coronary syndrome (OR: 2.217), dyslipidemia (OR: 2.354), hypertension (OR: 1.734), carotid artery stenosis (OR: 1.625), and obesity (OR: 1.543). There was no effect of past MI and stroke on the escalation of lipid profile. Lp (a) did not affect the escalation. Conclusions: The decision about escalation of lipid-lowering therapy is mainly influenced by classical risk factors and established atherosclerotic disease. Lp (a) did not affect the escalation, despite growing interest among medical practitioners. Full article

(This article belongs to the Special Issue Insights into the Management of Cardiovascular Disease Risk Factors)

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19 pages, 347 KB

Open AccessReview

Genetics of Sudden Cardiac Death

by Martina Lovrić Benčić and Rea Levicki

Diseases 2026, 14(1), 7; https://doi.org/10.3390/diseases14010007 - 27 Dec 2025

Viewed by 1029

Abstract

Introduction: Cardiomyopathies (DCM, HCM, and ACM) and primary arrhythmogenic disorders (BrS, LQTS, and CPVT) represent the most common causes of sudden cardiac death (SCD) in young individuals. Systematic genome-wide single-nucleotide polymorphism (SNP) analyses and genome-wide association studies (GWASs) have enabled the identification of [...] Read more.

Introduction: Cardiomyopathies (DCM, HCM, and ACM) and primary arrhythmogenic disorders (BrS, LQTS, and CPVT) represent the most common causes of sudden cardiac death (SCD) in young individuals. Systematic genome-wide single-nucleotide polymorphism (SNP) analyses and genome-wide association studies (GWASs) have enabled the identification of numerous genetic variants associated with cardiovascular diseases. Body: Genetic testing for cardiomyopathies and inherited channelopathies primarily involves panel testing of genes with definitive and strong evidence of disease association; genes supported by moderate evidence may also be considered. Cardiomyocytes express a variety of proteins implicated in the pathogenesis of genetic cardiomyopathies, including sarcomeric, cytoskeletal, desmosomal, and nuclear envelope proteins. Inherited cardiac channelopathies result from mutations in genes encoding cellular components that influence calcium ion availability or affect membrane ion channels, including sodium, potassium, and calcium channels. Common variants associated with SCD are found in genes encoding cardiac ion channels (e.g., SCN5A, KCNQ1, and KCNH2), calmodulin (CALM2), sarcomeric proteins (MYH7, MYBPC3, TTN, and TNNI3), and desmosomal proteins (RyR2 and DES). Conclusions: This review demonstrates that specific genetic variants are significantly associated with an increased risk of SCD. The evidence underscores the importance of genetic screening and early intervention in individuals with a family history of SCD or other risk factors for inherited cardiac disorders predisposing to SCD. Future research should focus on gene-specific management strategies for familial cardiomyopathies and inherited channelopathies, with the goal of improving targeted genetic therapies and reducing the burden of sudden cardiac death. Full article

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Diseases, Volume 14, Issue 1 (January 2026) – 36 articles

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