Diseases

20 pages, 2573 KB

Open AccessArticle

Medication Adherence, Treatment Attitudes, and Beliefs About Medicines in Romanian Psychiatric Patients: A Cross-Sectional Study

by Antonia Ioana Vasile, Andreea Arsene and Ioana Raluca Petru

Diseases 2026, 14(6), 222; https://doi.org/10.3390/diseases14060222 - 21 Jun 2026

Viewed by 648

Abstract

Background: Medication adherence is a major determinant of treatment effectiveness in psychiatric care and is influenced by patients’ attitudes toward medication and beliefs about treatment. Objective: This study aimed to evaluate medication adherence, drug attitudes, and beliefs about medicines, and to examine their [...] Read more.

Background: Medication adherence is a major determinant of treatment effectiveness in psychiatric care and is influenced by patients’ attitudes toward medication and beliefs about treatment. Objective: This study aimed to evaluate medication adherence, drug attitudes, and beliefs about medicines, and to examine their relationships in the study population. Methods: A total of 300 participants were assessed using the Medication Adherence Rating Scale (MARS), Drug Attitude Inventory-10 (DAI-10), and Beliefs about Medicines Questionnaire (BMQ-General and BMQ-Specific). Descriptive statistics, independent-samples t-tests, Pearson correlation analyses, and multiple linear regression were performed. Results: The mean DAI-10 score was 3.57 ± 3.44, indicating an overall positive attitude toward medication, although 27.33% of participants had neutral or negative attitudes. The mean MARS score was 6.27 ± 2.24, suggesting moderate adherence. Mean BMQ-General and BMQ-Specific scores were 21.70 ± 5.81 and 31.64 ± 6.13, respectively. Significant gender differences were found across all scales. DAI-10 was positively correlated with MARS, while BMQ-General was negatively correlated with MARS. Multiple regression showed that DAI-10, BMQ-General, and BMQ-Specific significantly predicted MARS scores, explained 30.8% of variance after adjustment. Conclusions: Medication adherence was moderate and was significantly associated with treatment attitudes and beliefs about medicines. The findings support multidimensional assessment and targeted interventions addressing both positive attitudes and negative medication beliefs. Full article

(This article belongs to the Special Issue The Future of Mental Health: Bridging the Translational Gap Between Mechanism, Practice, and Ethics)

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11 pages, 2095 KB

Open AccessArticle

Patterns of Infectious Disease Identified in Clinical Autopsy at a South African Tertiary Care Setting: A 10-Year Retrospective Study

by Moshawa Calvin Khaba, Morongwa Dikotope, Thato Nkwagatse, Ramokone Maphoto, Thandekile Manzini, Khomotso Maaga and Ndivhuho Agnes Makhado

Diseases 2026, 14(6), 221; https://doi.org/10.3390/diseases14060221 - 19 Jun 2026

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Abstract

Background: Infectious diseases remain a leading cause of mortality in South Africa, compounded by a high HIV prevalence. This study aimed to delineate the spectrum and clinicopathological characteristics of fatal infectious diseases through a postmortem audit to inform clinical practice and public health [...] Read more.

Background: Infectious diseases remain a leading cause of mortality in South Africa, compounded by a high HIV prevalence. This study aimed to delineate the spectrum and clinicopathological characteristics of fatal infectious diseases through a postmortem audit to inform clinical practice and public health strategy. Methods: A retrospective, cross-sectional descriptive study was conducted on all autopsies with a final cause of death attributed to infectious disease at a National Health Laboratory Service, in Northern Pretoria, Gauteng, South Africa, from 2012 to 2021. Using the Systematised Nomenclature of Medicine Clinical Terms (SNOMED) code and word search engines codes, 55 cases were identified. Data on demographics, clinical presentation, HIV status, antiretroviral therapy (ART), comorbidities, and final autopsy diagnosis were extracted from the laboratory information system. Histological confirmation was performed using standard stains. Descriptive statistical analysis was conducted using STATA-18. Results: The cohort (n = 55) had a median age of 31 years (IQR 19–45) and was predominantly female (67%). HIV prevalence was 35%, with 68% of those on ART. The leading cause of death was multilobar pneumonia (36%), followed by bronchopneumonia (22%). AIDS-defining illnesses were present in 27% of cases, with disseminated tuberculosis being the most common (46%). Septic shock was identified in 18% of decedents. A significant proportion (60%) of the cohort was HIV-negative. Conclusions: This autopsy series reveals a high burden of fatal community-acquired pneumonias and HIV-associated opportunistic infections, with a notable proportion of deaths occurring in HIV-negative individuals. The findings underscore diagnostic gaps and highlight the critical role of autopsy in accurate mortality surveillance, advocating for enhanced antemortem diagnostic protocols and targeted public health interventions. Full article

(This article belongs to the Section Infectious Disease)

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10 pages, 251 KB

Open AccessArticle

Individuals with ABO Groups Show Significant Differences in Levels of Circulating Biomarkers Related to Inflammation, Apoptosis, Endothelial Dysfunction, Tissue Remodeling and Neurodegeneration: A Pilot Study

by Alessia Di Salvo, Chiara Motisi, Matteo Bulati, Letizia Scola and Carmela Rita Balistreri

Diseases 2026, 14(6), 220; https://doi.org/10.3390/diseases14060220 - 19 Jun 2026

Cited by 2 | Viewed by 1251

Abstract

Background and Objectives: Blood group antigens are well known for their importance in transfusion medicine and transplant compatibility; however, their biological role extends beyond these functions and includes associations with the risk of several diseases. In this study, we investigated the relationship between [...] Read more.

Background and Objectives: Blood group antigens are well known for their importance in transfusion medicine and transplant compatibility; however, their biological role extends beyond these functions and includes associations with the risk of several diseases. In this study, we investigated the relationship between ABO blood groups and the circulating levels of 73 different molecules. Patients and Methods: Fifty-six healthy donors were enrolled, including 24 individuals with blood group O, 19 with blood group A, and 13 with blood group B. Blood samples were collected and analyzed in a single laboratory using Luminex fluorescent bead-based assay panels to determine the concentrations of 73 circulating molecules. Depending on data distribution, ANOVA or Kruskal–Wallis tests and Student’s t-test or Kolmogorov–Smirnov tests were applied to identify significant differences among groups. Associations were further assessed by binary logistic regression analysis. Results: Subjects with blood group A showed significantly higher circulating levels of IL-1R1, IL-13, IL-23, PDGF-BB, VEGF-A, VEGF-D, soluble VEGF-R2 (KDR), soluble VEGF-R3 (FLT-4), VLA-4, CD141, MMP-1, syndecan-1 (SDC-1), and mannose-binding lectin (MBL) compared with the other blood groups. In contrast, individuals with blood group B exhibited significantly higher levels of IL-22, IL-23, PDGF-BB, CD62P (P-selectin), and amyloid β1–42. Several significant associations were identified by logistic regression analysis. Conclusions: Our findings indicate that ABO blood groups are associated with distinct circulating molecular profiles, supporting the existence of biological differences that may contribute to variations in disease susceptibility among individuals with different blood types. Nevertheless, given the exploratory’s nature and limited sample size of this study, further investigations are required to validate these findings, confirm the observed associations, and clarify their potential clinical implications. Full article

20 pages, 18122 KB

Open AccessArticle

Transcriptomic Signatures Associated with Doxorubicin Treatment in Liposarcoma Reveal Coordinated Regulatory Patterns

by Anas Khaleel, Sara Khaleel, Ruqaya Mohammed Ahmed, Ahmad Al Athamneh, Nour Amin Elsahoryi and Ahmed S. A. Ali Agha

Diseases 2026, 14(6), 219; https://doi.org/10.3390/diseases14060219 - 18 Jun 2026

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Abstract

Background/Objectives: Liposarcoma is a heterogeneous soft tissue sarcoma in which anthracycline-based chemotherapy, including doxorubicin, remains a cornerstone of treatment for advanced disease. However, variable and often limited therapeutic responses highlight the need for improved understanding of disease-associated transcriptional adaptation under chemotherapeutic stress. In [...] Read more.

Background/Objectives: Liposarcoma is a heterogeneous soft tissue sarcoma in which anthracycline-based chemotherapy, including doxorubicin, remains a cornerstone of treatment for advanced disease. However, variable and often limited therapeutic responses highlight the need for improved understanding of disease-associated transcriptional adaptation under chemotherapeutic stress. In this study, a bioinformatics-driven transcriptomic analysis was performed to characterize gene expression alterations associated with doxorubicin treatment in liposarcoma using publicly available data from the Gene Expression Omnibus (GSE12972). Results: Differential expression analysis identified 365 significantly altered genes, including 164 upregulated and 201 downregulated transcripts in treated samples compared with untreated controls. Functional interpretation using Ingenuity Pathway Analysis identified transforming growth factor beta 1 (TGFB1), tumor necrosis factor (TNF), and SMARCA4 as prominent predicted upstream regulators associated with transcriptional programs related to extracellular matrix remodeling, inflammatory and immune modulation, epithelial-to-mesenchymal transition-like states, and chromatin-mediated transcriptional plasticity. Enriched canonical pathways included Liposarcoma tumor microenvironment-associated signaling and fibrosis-related pathways, reflecting stromal activation and immune-related transcriptional changes. Notably, fibroblast growth factor 1 (FGF1) emerged as a supportive regulatory node linked to survival- and anti-apoptotic gene expression patterns. Conclusions: Collectively, these findings provide a disease-oriented, cross-subtype systems-level view of the transcriptional changes associated with doxorubicin treatment in liposarcoma. This work is intended as a hypothesis-generating framework that may inform future functional studies and integrative approaches aimed at understanding therapeutic response and disease progression. Full article

(This article belongs to the Section Oncology)

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13 pages, 1255 KB

Open AccessArticle

Intramedullary Nailing Versus Modular Megaprosthesis in Pathological Humeral Fractures: A 10-Year Retrospective Comparative Study

by Giuseppe Rovere, Federica Messina, Cesare Meschini, Maria Serena Oliva, Matteo Caredda, Fernando De Maio, Pasquale Farsetti, Giulio Maccauro and Antonio Ziranu

Diseases 2026, 14(6), 218; https://doi.org/10.3390/diseases14060218 - 18 Jun 2026

Viewed by 493

Abstract

Background: Pathological fractures of the humerus secondary to metastatic disease represent a significant cause of pain, disability, and reduced quality of life in oncologic patients. Surgical management aims to restore stability, reduce pain, and allow early mobilization. However, the optimal strategy between intramedullary [...] Read more.

Background: Pathological fractures of the humerus secondary to metastatic disease represent a significant cause of pain, disability, and reduced quality of life in oncologic patients. Surgical management aims to restore stability, reduce pain, and allow early mobilization. However, the optimal strategy between intramedullary nailing and modular megaprosthesis remains debated, particularly in relation to functional outcomes and long-term results. Methods: A retrospective observational study was conducted on 48 patients treated for pathological or impending humeral fractures between January 2015 and January 2025. Twenty-six patients underwent intramedullary nailing (IMN group), while twenty-two were treated with tumor resection and modular megaprosthesis reconstruction (MP group). Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) score, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Western Ontario Shoulder Instability Index (WOSI) at 1, 12, 24, 36, and 60 months, and at 10 years. Complications and overall survival were also analyzed. Results: Intramedullary nailing demonstrated significantly superior early functional outcomes, with higher MSTS scores at 1 month (78% vs. 63%, p < 0.001) and lower QuickDASH scores in the first 24 months (p = 0.002). WOSI scores also favored IMN in the early postoperative period (p = 0.004). Megaprosthesis showed a slower initial recovery but a progressive improvement over time, reaching comparable functional outcomes at long-term follow-up (p > 0.05). The overall complication rate was similar between groups (p = 0.28), although periprosthetic infections occurred only in the MP group. Survival analysis did not show significant differences between groups (p = 0.74). Conclusions: Both intramedullary nailing and modular megaprosthesis represent effective surgical options for pathological and impending humeral fractures. Intramedullary nailing provides faster early functional recovery, whereas megaprosthetic reconstruction offers a durable reconstructive solution for extensive proximal lesions. Functional outcomes progressively converged between the two techniques approximately 2–3 years after surgery. Mid-term outcomes up to five years appeared comparable, suggesting that surgical decision-making should be individualized according to lesion characteristics, tumor biology, expected survival, and functional demands. Full article

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24 pages, 888 KB

Open AccessReview

Diagnosis of Prostate Cancer: A Comparative Evaluation of Biological Techniques

by Unathi A. Tshoni, Thokozani P. Mbonane and Phoka C. Rathebe

Diseases 2026, 14(6), 217; https://doi.org/10.3390/diseases14060217 - 17 Jun 2026

Viewed by 1269

Abstract

Prostate cancer (PCa) is the most prevalent cause of cancer-related deaths worldwide. This review aims to synthesize the contemporary literature (2018–2026) on various diagnostic approaches of PCa for clinicians. Currently, the standard approach to PCa diagnosis includes (1) prostate-specific antigen (PSA) testing, (2) [...] Read more.

Prostate cancer (PCa) is the most prevalent cause of cancer-related deaths worldwide. This review aims to synthesize the contemporary literature (2018–2026) on various diagnostic approaches of PCa for clinicians. Currently, the standard approach to PCa diagnosis includes (1) prostate-specific antigen (PSA) testing, (2) its derivatives, and (3) digital rectal examination (DRE). This approach is readily available and cost-effective but lacks specificity, thus resulting in a high incidence of overdiagnosis and overtreatment of PCa patients. This review aims to compare the traditional approaches with the newly developed approaches to PCa diagnosis and investigate their suitability for research purposes, including urine-based markers, liquid biopsy, and histopathology. Each of these approaches has advantages and disadvantages. Advanced imaging techniques like multiparametric magnetic resonance imaging (mpMRI) are helpful in the localization of PCa and can prevent unnecessary biopsies. Histopathology remains the gold standard in the confirmation of PCa diagnosis. Newly developed blood-based markers and advanced imaging techniques are more sensitive and specific in the diagnosis of PCa and are likely to result in a better clinical outcome than the traditional approaches. However, the cost of these approaches remains a global challenge in developing and developed countries alike. PCa diagnosis tools and strategies are presented in a clinical and cost-effective manner and are integrated in a tiered approach with the aim of controlling and managing PCa and its diagnosis. Full article

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18 pages, 1056 KB

Open AccessArticle

Beyond Pain Relief: Quality of Life and Functional Outcomes Following Minimally Invasive Excision of Deep Endometriosis

by Andrei Manu, Elena Poenaru, Arina-Ilinca Gheorghe, Smaranda Stoleru, Alexandra Irma Gabriela Baușic, Bogdan-Cătălin Coroleucă, Ciprian-Andrei Coroleucă, Cristina-Maria Iacob, Mihaela Arina Banu, Anca-Mihaela Hashemi, Maria-Bianca Nițescu, Oana-Miruna Peiu and Elvira Brătilă

Diseases 2026, 14(6), 216; https://doi.org/10.3390/diseases14060216 - 15 Jun 2026

Viewed by 863

Abstract

Background: Deep infiltrating endometriosis (DIE), particularly when involving the bowel, significantly impairs health-related quality of life (HRQoL) and gastrointestinal function. This study aimed to evaluate the short- and mid-term impact of minimally invasive excision on these parameters in a large multicenter cohort. Methods: [...] Read more.

Background: Deep infiltrating endometriosis (DIE), particularly when involving the bowel, significantly impairs health-related quality of life (HRQoL) and gastrointestinal function. This study aimed to evaluate the short- and mid-term impact of minimally invasive excision on these parameters in a large multicenter cohort. Methods: A retrospective observational study was conducted on 837 patients treated for endometriosis in two tertiary referral centers between 2018 and 2024. All patients underwent laparoscopic or robotic-assisted excision. Quality of life was assessed preoperatively and at 6 months (VAS: n = 69; SF-36: n = 100; GIQLI: n = 98) and 12 months (VAS: n = 30; SF-36: n = 46; GIQLI: n = 44) postoperatively, using validated patient-reported outcome measures (PROMs): the Visual Analog Scale (VAS) for pain, the Short Form-36 (SF-36) survey, and the Gastrointestinal Quality of Life Index (GIQLI). Results: The study population presented with predominantly advanced disease (Stage III–IV in 83.4% of cases), with 39.7% of patients undergoing segmental bowel resection. Postoperatively, a statistically significant reduction was observed in dysmenorrhea (VAS 7.6 vs. 5.0, p < 0.001) and chronic pelvic pain. The SF-36 scores improved significantly across all eight domains at 6 months, with the most dramatic recovery seen in Role Physical (p < 0.001) and Bodily Pain (p < 0.001). Regarding digestive function, the mean GIQLI score showed a progressive increase, reaching statistical significance at 12 months compared to baseline (112.6 vs. 106.6, p = 0.027), indicating superior long-term functional outcomes. Conclusions: Multidisciplinary minimally invasive surgery for deep infiltrating endometriosis was associated with significant and sustained improvements in quality of life among patients with available follow-up. Gastrointestinal quality of life, as measured by GIQLI, improved significantly at 12 months postoperatively, including in patients who underwent segmental bowel resection. Systematic use of PROMs is essential for accurate patient counseling and outcome monitoring. Full article

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13 pages, 7524 KB

Open AccessCase Report

A Rare Case of Extensive Relapsing Disseminated Hydatid Disease with Multi-Organ Involvement: A Case Report

by Silviu Gabriel Vlăsceanu, Radu Șerban Matache, Beatrice Mahler, Alexandru Stoichiță, Camelia Alexandra Paruschi, Alina Elena Tucana, Andrei Cristian Bobocea and Cornel Florentin Savu

Diseases 2026, 14(6), 215; https://doi.org/10.3390/diseases14060215 - 15 Jun 2026

Cited by 1 | Viewed by 836

Abstract

Background: Hydatid disease, caused primarily by Echinococcus granulosus, remains a significant public health challenge in endemic regions. While hepatic (80–85%) and pulmonary (15–20%) involvements are common, multi-organ dissemination involving rare sites such as the pericardium, diaphragm, and mediastinum occurs in less than [...] Read more.

Background: Hydatid disease, caused primarily by Echinococcus granulosus, remains a significant public health challenge in endemic regions. While hepatic (80–85%) and pulmonary (15–20%) involvements are common, multi-organ dissemination involving rare sites such as the pericardium, diaphragm, and mediastinum occurs in less than 0.1–2% of cases. Case presentation: We present a rare case of a 26-year-old male, a farmer for 10 years, with occupational exposure to dogs and horses, with a personal history of multiple surgically treated abdominal cysts in 2016, admitted after abdominal computed tomography revealed liver cysts greater than 5 cm, as well as mediastinal and diaphragmatic cysts. Histopathological examination of the surgically resected hepatic cyst material confirmed echinococcosis. Serology was also positive for echinococcosis. Echocardiography revealed a pericardial cyst, posterior to the left atrium. Under these circumstances, antiparasitic treatment was initiated by an infectious disease specialist, followed by surgical treatment of the abdominal cysts, confirming the final diagnosis of hydatid disease, and subsequently, surgical treatment of the thoracic hydatid cysts was performed. The postoperative course was complicated by bronchial superinfection with Stenotrophomonas maltophilia, identified from bronchial aspirate culture after extended incubation and managed with trimethoprim–sulfamethoxazole. Conclusions: This case underscores the necessity of lifelong surveillance in hydatid disease, the potential role of postoperative antiparasitic therapy in preventing long-term recurrence, and the vital role of a multidisciplinary team in managing complex, disseminated relapses. Full article

(This article belongs to the Section Infectious Disease)

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12 pages, 926 KB

Open AccessArticle

Cardiovascular Comorbidities and Advanced Chronic Kidney Disease in Hospitalized Patients with Multiple Myeloma: A Single-Center Retrospective Cohort Study

by Lavinia Alice Bălăceanu, Andreea Taisia Tiron, Ion Daniel Baboi, Claudia Georgeta Iacobescu, Beatrice Bălăceanu-Gurău, Cristian-Dorin Gurău, Ioana Valeria Grigorescu and Ion Dina

Diseases 2026, 14(6), 214; https://doi.org/10.3390/diseases14060214 - 12 Jun 2026

Viewed by 529

Abstract

Background: Advanced chronic kidney disease (CKD) and cardiovascular comorbidities frequently coexist in patients with multiple myeloma and are particularly common among hospitalized patients. However, the relationship between common cardiovascular comorbidities and advanced CKD in routine clinical practice remains incompletely characterized. Methods: We conducted [...] Read more.

Background: Advanced chronic kidney disease (CKD) and cardiovascular comorbidities frequently coexist in patients with multiple myeloma and are particularly common among hospitalized patients. However, the relationship between common cardiovascular comorbidities and advanced CKD in routine clinical practice remains incompletely characterized. Methods: We conducted a retrospective single-center cohort study including 137 hospitalized patients diagnosed with multiple myeloma between January 2015 and February 2026. Demographic, clinical, and laboratory data were extracted from electronic medical records. Advanced CKD was defined as eGFR < 30 mL/min/1.73 m², calculated using the CKD-EPI 2021 equation. Patients with isolated acute kidney injury were excluded. Cross-sectional associations between cardiovascular comorbidities and advanced CKD were assessed using logistic regression models. Results: The median age was 69 years (IQR 63–77), and 56.9% of patients were women. Renal impairment was common, with a median creatinine level of 2.82 mg/dL and a median eGFR of 22.4 mL/min/1.73 m². Advanced CKD was identified in 55 of 116 patients (47.4%) with available CKD classification. Cardiovascular comorbidities were common, including hypertension (42/55, 76.4%), diabetes mellitus (18/55, 32.7%), myocardial ischemia (41/55, 74.5%), and heart failure (25/55, 45.5%). In univariate analysis, atrial fibrillation showed a significant cross-sectional association with advanced CKD (OR 4.43, 95% CI 1.30–15.07, p = 0.017), as was myocardial ischemia (OR 2.89, 95% CI 1.07–7.80, p = 0.039). In multivariable analysis, atrial fibrillation demonstrated a trend toward an association with advanced CKD but did not remain statistically significant after adjustment. Conclusions: Advanced CKD and cardiovascular comorbidities frequently coexist in hospitalized patients with multiple myeloma. Atrial fibrillation and myocardial ischemia were associated with advanced CKD in univariate analyses; however, these associations were attenuated after multivariable adjustment. Overall, these findings provide insight into the coexistence of advanced CKD and cardiovascular comorbidities in hospitalized patients with multiple myeloma. Full article

(This article belongs to the Section Oncology)

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11 pages, 244 KB

Open AccessArticle

The Frequency of Semen Abnormalities Among Jordanian Population: A Retrospective Single-Center Study of 1182 Cases

by Fatina W. Dahadhah, Mohanad Odeh, Adnan A. Dahadha, Heba A. Ali, Eman Hussein Alshdaifat, Emad Freihat, Manal Issam Abu Alarjah and Mazhar Salim Al Zoubi

Diseases 2026, 14(6), 213; https://doi.org/10.3390/diseases14060213 - 12 Jun 2026

Cited by 1 | Viewed by 768

Abstract

Background/Objectives: Male infertility is a significant global public health concern, with sperm abnormalities contributing to nearly half of all cases. This retrospective study addressed a critical gap by analyzing 1182 semen records from subfertile Jordanian men at the IVF unit. Methods: We quantified [...] Read more.

Background/Objectives: Male infertility is a significant global public health concern, with sperm abnormalities contributing to nearly half of all cases. This retrospective study addressed a critical gap by analyzing 1182 semen records from subfertile Jordanian men at the IVF unit. Methods: We quantified the prevalence of specific abnormalities, oligozoospermia, asthenozoospermia, teratozoospermia, and azoospermia, and investigated the interrelationships between sperm count, motility, and morphology. Results: Oligozoospermia was the most prevalent single abnormality (29%), while normozoospermia was found in 28% of cases. Combined defects were frequent; oligoasthenoteratozoospermia, with low count, poor motility, and abnormal morphology, was identified in 17% of cases, highlighting the multifactorial nature of subfertility. Correlation analysis showed significant interdependencies. A strong positive correlation was found between normal morphology and progressive motility (r = 0.484, p < 0.0001), suggesting structural integrity is closely linked to movement. Sperm count showed moderate positive correlations with normal morphology (r = 0.508, p < 0.0001) and non-progressive motility (r = 0.522, p < 0.0001). Abnormal morphology exhibited the strongest positive correlation with immotile sperm (r = 0.559, p < 0.0001), consistent with asthenoteratozoospermia. Conclusions: These findings suggest semen issues in Jordanian men include multiple parameters simultaneously. Comprehensive semen analysis is essential for accurate fertility assessment, as focusing on a single parameter like sperm count may overlook critical factors contributing to infertility. Full article

17 pages, 1343 KB

Open AccessArticle

Functional Recovery and Emotional Burden After Burn Injury: A Quality of Life Assessment in Romanian Burn Survivors

by Andreea Ungureanu, Maria-Cristina Marinescu, Adriana-Nicoleta Trandafir, Valeria Coviltir, Carmen Giuglea and Silviu-Adrian Marinescu

Diseases 2026, 14(6), 212; https://doi.org/10.3390/diseases14060212 - 11 Jun 2026

Viewed by 745

Abstract

Background: Burn injuries are increasingly being recognized as chronic conditions with long-term physical, emotional, and social consequences. As survival after acute burn trauma improves, greater attention has shifted toward health-related quality of life (QoL) in survivors, particularly in regions where data remain [...] Read more.

Background: Burn injuries are increasingly being recognized as chronic conditions with long-term physical, emotional, and social consequences. As survival after acute burn trauma improves, greater attention has shifted toward health-related quality of life (QoL) in survivors, particularly in regions where data remain limited. Methods: This study included burn survivors treated between January 2022 and December 2023 in the Department of Plastic Surgery and Reconstructive Microsurgery of the Emergency Clinical Hospital “Bagdasar-Arseni,” Bucharest, Romania. Patients who survived hospitalization and follow-up were invited to complete a Romanian-adapted version of the Burn Specific Health Scale-Brief (BSHS-B). Demographic and clinical data were collected from medical records, including burn type, total body surface area (TBSA), burn depth, burn localization, and access to rehabilitation services. Statistical analysis included descriptive methods, chi-square tests, t-tests, Kendall’s tau-b, Cramer’s V, Cronbach’s alpha, and exploratory factor analysis. Results: Thirty-eight patients were included. Most burns were thermal (94.74%), while burns involving <10% TBSA were most frequent (60.53%). Functional outcomes were generally favorable, with most patients reporting no difficulty in basic daily activities such as bathing, dressing, and writing. However, fine motor activities and return to previous work were more frequently affected. Emotional recovery appeared less complete, with persistent mild-to-moderate loneliness, sadness, and emotional distress reported by many participants. Women reported higher levels of loneliness (p = 0.015), while third-degree burns were associated with more frequent depressive symptoms (p = 0.008). Depressive symptoms were also significantly associated with functional limitations (such as getting dressed, p = 0.002) and work impairment (p < 0.001). The adapted functional and emotional subscales showed excellent internal consistency. Conclusions: Post-burn recovery extends beyond physical healing. Although most patients regained functional independence, emotional distress and occupational difficulties often persisted. These findings support the need for multidisciplinary long-term burn care integrating physical rehabilitation, psychological screening, and psychosocial support. Full article

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22 pages, 2747 KB

Open AccessArticle

HPT Axis Dysregulation in Mood and Anxiety Disorders: The Clinical Utility of Routine Hormonal Dosing in Psychiatric In-Patients

by Georgiana-Adriana Toma, Elena Coman, Antonia Ioana Vasile and Simona Trifu

Diseases 2026, 14(6), 211; https://doi.org/10.3390/diseases14060211 - 11 Jun 2026

Viewed by 1021

Abstract

Background/Objectives: Thyroid dysfunction is frequently associated with mood and anxiety disorders, yet the directionality and diagnostic specificity of this relationship remain debated. Although numerous studies have examined major depressive disorder (MDD) and bipolar disorder (BD) separately, comparative data including generalized anxiety disorder (GAD) [...] Read more.

Background/Objectives: Thyroid dysfunction is frequently associated with mood and anxiety disorders, yet the directionality and diagnostic specificity of this relationship remain debated. Although numerous studies have examined major depressive disorder (MDD) and bipolar disorder (BD) separately, comparative data including generalized anxiety disorder (GAD) and accounting for non-thyroidal illness (NTI) effects remain scarce. This study aimed to evaluate thyroid function and its correlation with affective symptom severity across MDD, GAD, and BD in an inpatient cohort. Methods: Eighty-eight hospitalized patients with MDD, GAD, or BD were included in the study (MDD = 30, GAD = 30, BD = 28). Serum levels of TSH, FT4, and FT3 were measured 24–48 h after admission to minimize the influence of NTI. Psychiatric assessment included the Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Anxiety Scale (HAM-A), and Young Mania Rating Scale (YMRS). Between-group differences were analyzed using ANOVA, and associations between thyroid parameters and symptom severity were examined using correlation and regression analyses. Results: ANOVA revealed that patients with MDD had significantly higher TSH levels compared with those with GAD and BD (p < 0.01). MDD patients also showed a higher prevalence of subclinical hypothyroidism (33.3%) than patients with GAD (13.3%) and BD (7.1%), as well as a higher prevalence of overt hypothyroidism (13.3%) compared with GAD (0%) and BD (7.1%). TSH levels correlated positively with MADRS scores (r = 0.45, p < 0.05) and HAM-A scores (r = 0.38, p < 0.05), particularly within the MDD group. In BD, FT4 and FT3 levels were elevated and positively correlated with YMRS scores (FT4: r = 0.30, p < 0.05; FT3: r = 0.42, p < 0.05). In regression analysis within the MDD subgroup, both hypothyroidism and male sex were independently associated with higher MADRS scores, indicating greater depressive symptom severity. Conclusions: These findings suggest diagnosis-specific patterns of thyroid dysfunction among psychiatric inpatients. Higher TSH levels and increased rates of hypothyroidism were most prominent in MDD and were associated with greater depressive and anxiety symptom severity, whereas elevated FT4 and FT3 levels in BD were associated with manic symptom severity. The results support systematic thyroid screening in depressive admissions, hormone-informed monitoring in bipolar disorder, and a more integrated endocrine–psychiatric approach to clinical care. Full article

(This article belongs to the Special Issue The Future of Mental Health: Bridging the Translational Gap Between Mechanism, Practice, and Ethics)

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15 pages, 2420 KB

Open AccessArticle

Delayed Radiological Resolution: A Comparative Longitudinal Study of Viral Pneumonia Evolution in Diabetic vs. Non-Diabetic Patients

by Ana Maria Mihai, Ovidiu Rosca, Florina Lucaciu, Alexandra Herlo, Talida Georgiana Cut, Ioana-Melinda Luput-Andrica, Radu Gheorghe Dan, Matilda Radulescu, Andreea Cristina Floruncut, Adelina Marinescu and Alexandra Sima

Diseases 2026, 14(6), 210; https://doi.org/10.3390/diseases14060210 - 10 Jun 2026

Viewed by 1150

Abstract

Background: Diabetic patients face increased severity in viral respiratory infections, yet during the longitudinal progression of lung recovery, the radiological clearance is poorly quantified. Methods: This prospective study at an infectious diseases hospital analyzed 430 patients with confirmed viral pneumonia. Radiological severity (Rx) [...] Read more.

Background: Diabetic patients face increased severity in viral respiratory infections, yet during the longitudinal progression of lung recovery, the radiological clearance is poorly quantified. Methods: This prospective study at an infectious diseases hospital analyzed 430 patients with confirmed viral pneumonia. Radiological severity (Rx) and pleural effusion were scored (0–3) at admission (day 1) and follow-up (day 6). Results: Diabetics presented with significantly higher baseline severity (Median 2.0 vs. 1.0, p < 0.0001). While both groups improved at identical rates (Median Δ = −1.0), a significant radiological lag persisted in diabetics at day 6 (Median 1.0 vs. 0.0, p < 0.0001). Attrition analysis (N = 75) revealed a divergent lethal split: attrition in the non-diabetic cohort was almost exclusively driven by low-severity early departures against medical advice (94.2%), whereas diabetic attrition was primarily characterized by early mortality (60.9%; p < 0.0001). Although the diabetic state was associated with a pronounced radiographic resolution delay in unadjusted comparisons, this disadvantage was substantially attenuated and lost statistical significance after adjustment for admission radiological severity (adjusted OR 2.04, 95% CI 0.88–4.76) and chronic comorbidity burden (adjusted OR 1.37, 95% CI 0.56–3.39), indicating that the diabetic lag is largely explained by a higher presenting severity and comorbidity burden rather than by an independent acute effect of diabetes itself. Sensitivity analyses suggest that the observed lag in survivors likely underestimates the true disease burden, given the concentration of early mortality among high-risk diabetic cases. Full article

(This article belongs to the Special Issue Lung Diseases: Epidemiology, Diagnostics, Management, Prognostics, and Prediction)

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14 pages, 1273 KB

Open AccessArticle

Serum Interleukin-6 as an Inflammatory Biomarker Associated with HBV Viral Load in HBsAg-Positive Chronic Hepatitis B

by Jayakrishna Pamarthi, Sugan Panneerselvam, Nanda Amarnath Rajesh, Venkataratna Bharat Gangireddy, Mohanram Murugan, Leela Kakithara Vajaravelu, Jayaprakash Thulukanam, Mansour Alanazi and Janardanan Subramonia Kumar

Diseases 2026, 14(6), 209; https://doi.org/10.3390/diseases14060209 - 10 Jun 2026

Viewed by 995

Abstract

Background: Chronic hepatitis B virus (HBV) infection remains a major global health challenge and a leading cause of liver cirrhosis and hepatocellular carcinoma. Interleukin-6 (IL-6), a key pro-inflammatory cytokine, plays an important role in immune regulation and hepatic inflammation. However, its relationship with [...] Read more.

Background: Chronic hepatitis B virus (HBV) infection remains a major global health challenge and a leading cause of liver cirrhosis and hepatocellular carcinoma. Interleukin-6 (IL-6), a key pro-inflammatory cytokine, plays an important role in immune regulation and hepatic inflammation. However, its relationship with HBV viral load and disease severity remains incompletely understood. Methods: A hospital-based cross-sectional study was conducted among 293 HBsAg-positive patients. Serum IL-6 levels were measured using ELISA, and HBV DNA was quantified using real-time quantitative PCR. Patients were stratified according to viral load. Statistical analyses included non-parametric tests, Spearman correlation, principal component analysis (PCA), and multiple linear regression. Results: The median age was 45 years (IQR: 34–57), among which 54.6% were male. The median HBV DNA was 3.37 log₁₀ IU/mL (IQR: 2.45–3.75), and IL-6 concentration was 2.38 log₁₀ pg/mL (IQR: 2.21–2.49). IL-6 levels increased significantly across viral load categories (p < 0.001) and were higher in HBeAg-positive patients (p = 0.002), with no significant differences across age, sex, or cirrhosis. IL-6 levels correlated with HBV DNA (r = 0.40, p < 0.001). PCA identified distinct viral-inflammatory and biochemical axes. Regression analysis confirmed HBV DNA as the significant independent predictor (β = 0.461, p < 0.001; adjusted R² = 0.206). Conclusion: IL-6 was closely associated with HBV DNA levels, while the association with conventional biochemical markers of hepatocellular injury was significantly less in this cohort, suggesting that IL-6 may serve as an adjunct biomarker of disease activity in patients with chronic hepatitis B. Full article

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14 pages, 1807 KB

Open AccessCase Report

Bilateral Transient Osteoporosis of the Hip in Pregnancy: Diagnostic Challenges, MRI-Based Approach, and Multidisciplinary Management

by Pavol Zubor, Kristen Olav Lind, Jozef Visnovsky, Petra Zuborova, Guri Grimnes and Cato Kjærvik

Diseases 2026, 14(6), 208; https://doi.org/10.3390/diseases14060208 - 10 Jun 2026

Cited by 1 | Viewed by 1193

Abstract

Background: Pregnancy-related transient osteoporosis of the hip (PR-TOH) is an uncommon and frequently underdiagnosed condition that typically presents with acute hip pain during late pregnancy or the early postpartum period. Because its clinical presentation is nonspecific and overlaps with pregnancy-related pelvic girdle pain, [...] Read more.

Background: Pregnancy-related transient osteoporosis of the hip (PR-TOH) is an uncommon and frequently underdiagnosed condition that typically presents with acute hip pain during late pregnancy or the early postpartum period. Because its clinical presentation is nonspecific and overlaps with pregnancy-related pelvic girdle pain, the diagnosis is often delayed, and the initial management is suboptimal. Although bilateral involvement has been reported, comparative data on diagnostic work-up, multidisciplinary management, and follow-up remain limited. Case Presentation: We report a case of bilateral PR-TOH in a 35-year-old Caucasian primigravida (G1, P0) who presented at 31 + 6 weeks of gestation with progressively worsening bilateral hip pain that culminated in severe functional impairment and wheelchair dependence. Initial ultrasound, laboratory work-up, and rheumatological screening were inconclusive, and intra-articular corticosteroid injections failed to relieve symptoms and were temporally associated with deterioration of glycaemic control and a periorbital and palmar eczematous rash. Magnetic resonance imaging (MRI) demonstrated diffuse bone marrow oedema in both femoral heads with preserved articular cartilage and no evidence of avascular necrosis, supporting a diagnosis of bilateral PR-TOH. Postpartum dual-energy X-ray absorptiometry (DXA) confirmed reduced bone mineral density at both femoral necks (Z-scores below −2.0). Pregnancy was prolonged until 37 + 4 weeks, and delivery was by elective caesarean section. Postpartum care included analgesia, calcium and vitamin D supplementation, structured physiotherapy, and a graded weight-bearing rehabilitation programme. Bone mineral density improved markedly on follow-up DXA at six months, with complete clinical recovery and no further imaging abnormalities at 12, 24, and 30 months. Conclusions: PR-TOH should be considered in pregnant or postpartum women with persistent hip pain and progressive functional limitation. MRI is the key imaging modality for early diagnosis and for excluding alternative causes, whereas DXA remains the reference standard for quantifying bone mineral density and monitoring recovery. Bilateral presentations require a multidisciplinary, individualised approach that addresses both maternal and obstetric outcomes. Full article

(This article belongs to the Special Issue ‘Rare Syndromes: Diagnosis and Treatment’ in 2024–2026)

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27 pages, 1551 KB

Open AccessReview

The Eye and the Brain: Photonic Devices in Neuro-Ophthalmology

by Alessandro Avitabile, Marco Zeppieri, Ludovica Cannizzaro, Giuseppe Gagliano, Maria Francesca Cordeiro, Fabiana D’Esposito, Francesco Cappellani, Maria Vadalà and Vincenza Maria Elena Bonfiglio

Diseases 2026, 14(6), 207; https://doi.org/10.3390/diseases14060207 - 10 Jun 2026

Viewed by 694

Abstract

Photonic imaging technologies have profoundly transformed neuro-ophthalmic diagnostics by enabling non-invasive visualization of neurodegenerative processes at the retinal level. This review examines how advanced light-based modalities provide unprecedented insights into the structural, physiologic, and biologic relationships between the eye and brain in conditions [...] Read more.

Photonic imaging technologies have profoundly transformed neuro-ophthalmic diagnostics by enabling non-invasive visualization of neurodegenerative processes at the retinal level. This review examines how advanced light-based modalities provide unprecedented insights into the structural, physiologic, and biologic relationships between the eye and brain in conditions such as optic neuritis, multiple sclerosis, and glaucoma. Optical coherence tomography has emerged as an essential tool for quantifying thinning of the retinal nerve fiber layer and ganglion cell layer, serving as reliable biomarkers of axonal loss and disease progression across multiple sclerosis subtypes and optic neuropathies. Detection of apoptosing retinal cells imaging enables real-time visualization of retinal ganglion cell apoptosis preceding irreversible structural damage, offering a critical window for early intervention in various neurodegenerative conditions, in particular, glaucoma. Two-photon microscopy with adaptive optics enables subcellular-resolution imaging of retinal neurons, microvascular dynamics, and inflammatory processes in vivo, facilitating the characterization of neurodegenerative mechanisms at unprecedented spatial scales and redefining neuro-ophthalmology by positioning the retina as an accessible extension of the central nervous system. This review critically examines how established and investigational photonic imaging modalities may support earlier disease detection, longitudinal monitoring, and biomarker development in neuro-ophthalmic and neurodegenerative disorders, with potential implications for more timely and targeted management strategies. Full article

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21 pages, 3500 KB

Open AccessArticle

Development and Validation of a Neural Network Model for Predicting Atrial Fibrillation and Detecting Silent Arrhythmias in Patients with Chronic Obstructive Pulmonary Disease Based on Echocardiography Data

by Stanislav Kotlyarov and Alexander Lyubavin

Diseases 2026, 14(6), 206; https://doi.org/10.3390/diseases14060206 - 9 Jun 2026

Viewed by 585

Abstract

Background: Atrial fibrillation (AF) is a common arrhythmia with a high incidence, and patients with chronic obstructive pulmonary disease (COPD) are at particularly high risk. However, there are currently no tools available for early risk stratification of AF in this population. Objectives: To [...] Read more.

Background: Atrial fibrillation (AF) is a common arrhythmia with a high incidence, and patients with chronic obstructive pulmonary disease (COPD) are at particularly high risk. However, there are currently no tools available for early risk stratification of AF in this population. Objectives: To develop and validate a neural network diagnostic model based on transthoracic echocardiography to address two clinical challenges in patients with COPD: risk stratification for AF; and detection of occult supraventricular arrhythmias (including “micro-AF”) based on 24 h ECG monitoring data. Methods: The study consisted of three consecutive stages: development of a neural network (NN) based on transthoracic echocardiography (TTE) parameters, validation of the model’s predictive ability in patients (n = 311, including 99 with COPD), and assessment of the ability to detect occult atrial arrhythmias (n=207) in patients with COPD. The model architecture consists of a fully connected multilayer perceptron (MLP) with 13 inputs, 4 hidden layers of 130 neurons each, and 2 output neurons. Training was performed on 684 TTE scans (292 without AF, 392 with AF). The echocardiographic parameters were validated on an independent test set (n = 100). Statistical analysis included pairwise and multiple comparisons, logistic regression analysis, and ROC analysis with assessment of the area under the ROC curve (AUC). The median follow-up period for study participants was 18 months. Results: The neural network demonstrated high classification metrics for AF on the test set (AUC = 0.80). A threshold value of the first output layer neuron > 0.75 allowed for the identification of a high-risk subgroup, in which the incidence of AF in patients with COPD was 14.8% versus 0% in the low-risk subgroup (p = 0.0073). Logistic regression models of the relationship between AF development and the neural network output value were statistically significant in both patients with COPD and patients without COPD (p < 0.0001). In patients with COPD without a history of AF, the neural network identified a high-risk group. In this group, 24 h ECG monitoring more frequently recorded episodes of AF, group supraventricular extrasystoles, and the combined endpoint (AF + GSE) compared to the low-risk group (55.32% vs. 17.5%; p < 0.0001). The area under the ROC curve for detecting latent AF in patients with sinus rhythm based on the neural network prediction was 0.93. Conclusions: The developed neural network model, which integrates a set of TTE parameters into a single quantitative measure of the severity of myocardial remodeling, is an effective tool for risk stratification for AF. The model may help identify COPD patients who could benefit from intensified rhythm monitoring; however, external validation is required before clinical implementation. Full article

(This article belongs to the Section Cardiology)

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15 pages, 815 KB

Open AccessArticle

Caregiver Burden, Emotional Distress, and Coping Strategies in Romanian Parents of Children with Autism Spectrum Disorder: An Exploratory Cross-Sectional Comparative Study

by Otilia-Rodica Butiu, Ema Burlacu, Rebeca-Isabela Molnar, Adriana Mihai and Teodora Popescu

Diseases 2026, 14(6), 205; https://doi.org/10.3390/diseases14060205 - 8 Jun 2026

Viewed by 1082

Abstract

Background/Objectives: Parents of children with autism spectrum disorder (ASD) often face sustained emotional, practical, and social demands. However, evidence from Romania remains limited, particularly regarding the combined assessment of caregiver burden, emotional distress, and coping strategies of parents. This exploratory study compared these [...] Read more.

Background/Objectives: Parents of children with autism spectrum disorder (ASD) often face sustained emotional, practical, and social demands. However, evidence from Romania remains limited, particularly regarding the combined assessment of caregiver burden, emotional distress, and coping strategies of parents. This exploratory study compared these outcomes between parents of children/adolescents with ASD and parents of typically developing children and examined whether coping patterns varied according to selected sociodemographic characteristics. Methods: We conducted a cross-sectional comparative study in Târgu-Mureș, Romania, between 2024 and 2025. The sample included 92 parents: 46 parents of children/adolescents with clinician-confirmed ASD and 46 parents of typically developing children. Participants completed a demographic questionnaire, the Caregiver Burden Inventory (CBI), the Depression Anxiety Stress Scales-21 (DASS-21), and the Strategic Approach to Coping Scale (SACS). DASS-21 data were available for 44 ASD caregivers and 46 controls. Between-group comparisons were performed using t-tests, Mann–Whitney U tests, chi-square tests, or Fisher’s exact tests, as appropriate. Results: The groups were comparable in sex, age, residence, number of children, and household size, but differed significantly in marital status and educational level. Clinically relevant caregiver burden (CBI ≥ 36) was more frequent among parents of children with ASD than among controls (30% vs. 17%), although this difference was not statistically significant. Parents of children with ASD showed trend-level higher depressive and anxiety symptoms, with small effect sizes, whereas stress scores were similar between groups. Coping patterns varied according to sociodemographic characteristics. Marital status was associated with aggressive coping, urban residence was associated with indirect and aggressive coping, and number of children was associated with seeking social support. Conclusions: Parents of children with ASD showed a higher proportion of clinically relevant caregiver burden and trend-level elevations in depressive and anxiety symptoms, while stress scores were comparable between groups. Exploratory adjusted analyses suggested that ASD caregiver status remained associated with caregiver burden and depressive symptoms after controlling for educational level and marital status. Coping strategies appeared heterogeneous and context-dependent. Given the exploratory design, modest sample size, and multiple comparisons, these findings should be interpreted as preliminary and hypothesis-generating. Full article

(This article belongs to the Special Issue The Future of Mental Health: Bridging the Translational Gap Between Mechanism, Practice, and Ethics)

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10 pages, 1112 KB

Open AccessCase Report

Invasive Haemophilus influenzae Type b (Hib) Infection in a Fully Vaccinated Child: A Case Report

by Ho Yeung Lam, Shalomie Shadrach, Ben Brimblecombe, Hannah Woodall, Brianna Moss, Teresa McGorm, Rikki Graham, Mohana Rajmokan, Gino Micalizzi and Stephen B. Lambert

Diseases 2026, 14(6), 204; https://doi.org/10.3390/diseases14060204 - 7 Jun 2026

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Abstract

Background: Invasive Haemophilus influenzae type b (Hib) infection in children has become rare following the introduction of highly effective conjugate vaccines under national immunisation programmes. However, breakthrough invasive infections in fully immunised individuals can still occur. We report a case of invasive Hib [...] Read more.

Background: Invasive Haemophilus influenzae type b (Hib) infection in children has become rare following the introduction of highly effective conjugate vaccines under national immunisation programmes. However, breakthrough invasive infections in fully immunised individuals can still occur. We report a case of invasive Hib infection presenting as epiglottitis and bacteraemia in a fully vaccinated 5-year-old boy in regional Queensland, Australia. Case presentation: The child, with no history of immunodeficiency, presented with a 3-day history of fever, progressive throat pain and reduced oral intake. Subsequent investigations revealed leukocytosis with left shift, markedly elevated C-reactive protein, and radiographic features consistent with epiglottitis. Blood culture grew H. influenzae type b. He was treated with intravenous cefotaxime and made a full recovery without complications. Immunological evaluation demonstrated Hib-specific IgG levels consistent with prior vaccinations, with normal immunoglobulin and lymphocyte profiles supporting the absence of immunodeficiency. Whole-genome sequencing of the isolate identified sequence type 6, a known circulating strain, and duplication of the capsule (cap-b) locus which has been associated with increased capsular polysaccharide production and reduced susceptibility to immune-mediated clearance. Conclusions: This case demonstrates that invasive Hib disease can occur in fully vaccinated, immunocompetent individuals and highlights the need for continued clinical vigilance. Pathogen-related factors, such as cap-b locus duplication, may reduce the effectiveness of the immune response. Despite this, immunisation can still confer partial protection, potentially contributing to the relatively mild clinical course. Ongoing surveillance and detailed microbiological investigation are essential to better understand and monitor vaccine breakthrough infections. Full article

(This article belongs to the Section Infectious Disease)

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14 pages, 846 KB

Open AccessArticle

Changing Etiological Patterns and Predictors of In-Hospital Mortality in Decompensated Cirrhosis: A 10-Year Cohort Study Before and After COVID-19

by Lavinia Alice Bălăceanu, Claudia Georgeta Iacobescu, Ioana Valeria Grigorescu, Ion Daniel Baboi, Marian-Vlad Lapadat and Ion Dina

Diseases 2026, 14(6), 203; https://doi.org/10.3390/diseases14060203 - 6 Jun 2026

Cited by 1 | Viewed by 721

Abstract

Background: Decompensated cirrhosis is associated with high in-hospital mortality, influenced by disease severity and underlying etiology. The COVID-19 pandemic may have altered both the etiological spectrum and clinical presentation of hospitalized patients. This study aimed to assess longitudinal changes in etiology and identify [...] Read more.

Background: Decompensated cirrhosis is associated with high in-hospital mortality, influenced by disease severity and underlying etiology. The COVID-19 pandemic may have altered both the etiological spectrum and clinical presentation of hospitalized patients. This study aimed to assess longitudinal changes in etiology and identify predictors of in-hospital mortality over a 10-year period. Methods: We conducted a retrospective cohort study including 812 patients hospitalized with decompensated liver cirrhosis between 2015 and 2025. Patients were grouped into pre-COVID-19 (2015–2019), COVID-19 (2020–2021) and post-COVID-19 (2022–2025) periods. Etiological factors and mortality rates were compared using chi-square tests. Independent predictors were identified through multivariate analysis. A clinical risk score based on Child–Pugh stage, platelet count and age was developed and evaluated using ROC analysis. Results: Alcohol-related cirrhosis increased significantly from 51.2% (pre-COVID-19) to 90.4% (COVID-19) and remained high post-COVID-19 (86.3%) (p < 0.001), while HCV decreased from 34.4% to 13.5% and stabilized at 14.8% (p < 0.001). HBV showed no significant variation. All-cause in-hospital mortality increased from 19.7% pre-COVID-19 to 42.3% during COVID-19 and remained elevated post-COVID-19 at 34.5% (p < 0.001). Independent predictors of all-cause in-hospital mortality included advanced Child–Pugh stage, thrombocytopenia and age above 70 years. The risk score (0–7 points) showed good discrimination (AUC = 0.752), with mortality rates of 2.8%, 24.0% and 45.7% across increasing risk categories. A score <5 had a negative predictive value of 84.3%. Conclusions: A significant etiological shift from HCV to alcohol was observed, accompanied by persistently increased mortality after COVID-19. Thrombocytopenia remains an important predictor of mortality. The proposed score enables simple and effective risk stratification. Full article

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13 pages, 863 KB

Open AccessArticle

Folate Receptor Alpha Autoantibodies in Vector-Borne Disease Populations

by Lindsey Wells, Myriah Hinchey, Richard E. Frye and Amelia Morgan

Diseases 2026, 14(6), 202; https://doi.org/10.3390/diseases14060202 - 5 Jun 2026

Viewed by 3884

Abstract

Background: Vector-borne diseases (VBDs) caused by Borrelia spp., Bartonella spp., and Babesia spp. are associated with neuropsychiatric morbidity. Cerebral folate deficiency (CFD), primarily caused by folate receptor-α autoantibodies (FRAAs) impairing folate blood–brain barrier transport, is a treatable contributor to neurodevelopmental disorders including pediatric [...] Read more.

Background: Vector-borne diseases (VBDs) caused by Borrelia spp., Bartonella spp., and Babesia spp. are associated with neuropsychiatric morbidity. Cerebral folate deficiency (CFD), primarily caused by folate receptor-α autoantibodies (FRAAs) impairing folate blood–brain barrier transport, is a treatable contributor to neurodevelopmental disorders including pediatric acute-onset neuropsychiatric syndrome (PANS) and autism spectrum disorder. Despite overlapping clinical manifestations, FRAA prevalence in VBD populations has not been investigated. This study aimed to determine the prevalence of FRAA in patients with confirmed VBDs. Methods: This retrospective cohort study included 68 VBD-positive patients with and without PANS evaluated at a single clinical practice. VBD testing was performed by IGeneX Laboratories; FRAA analysis including binding, blocking, and soluble folate receptor (sFR) testing was performed by Religen Laboratories (Plymouth Meeting, PA). Statistical associations were assessed using Fisher’s exact test with Wilson 95% confidence intervals. Results: Of the 68 VBD-positive patients, 42 (61.8%; 95% CI: 49.9–72.4%) were also FRAA-positive. Soluble folate receptor (sFR) was detected in eight patients (11.8%; 95% CI: 6.1–21.5%), all of whom were binding FRAA-positive, with 87.5% carrying confirmed evidence of Borrelia species infection. Neuropsychiatric symptoms were highly prevalent across both groups but did not significantly differentiate FRAA-positive from FRAA-negative patients (all p > 0.05). Conclusions: This study demonstrates a high prevalence of FRAA in a pediatric VBD cohort. The sFR was strongly associated with Borrelia species infection, suggesting a potential mechanistic link between spirochetal infection and folate receptor autoimmunity. These findings support the consideration of FRAA testing in patients with VBDs and warrant further investigation in larger prospective cohorts. Full article

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15 pages, 1548 KB

Open AccessReview

Cellular Senescence in Idiopathic Pulmonary Fibrosis: Molecular Mechanisms, Pathogenic Networks, and Emerging Therapeutic Targets

by Madina B. Baurzhan, Alexandr E. Gulyayev, Karlygash S. Absattarova, Sayagul A. Kairgeldina, Kuat Abzaliyev, Akmaral Izbassarova, Marzhan Lepessova and Karashash Absatarova

Diseases 2026, 14(6), 201; https://doi.org/10.3390/diseases14060201 - 4 Jun 2026

Cited by 1 | Viewed by 1395

Abstract

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive interstitial lung disease characterized by irreversible extracellular matrix deposition and high mortality, with aging representing its strongest risk factor. Increasing evidence suggests that cellular senescence is not merely a consequence of tissue injury but a [...] Read more.

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive interstitial lung disease characterized by irreversible extracellular matrix deposition and high mortality, with aging representing its strongest risk factor. Increasing evidence suggests that cellular senescence is not merely a consequence of tissue injury but a central driver of disease progression. Senescent alveolar epithelial cells and fibroblasts contribute to impaired tissue repair and persistent fibrotic remodeling through the acquisition of a senescence-associated secretory phenotype (SASP), which promotes chronic inflammation and amplifies profibrotic signaling. This review provides a comprehensive synthesis of current evidence on the role of cellular senescence in IPF, focusing on key molecular mechanisms, including telomere attrition, mitochondrial dysfunction, oxidative stress, DNA damage response activation, and dysregulated transforming growth factor-β (TGF-β) signaling. A structured literature search was conducted using the PubMed, Scopus, and Web of Science databases to identify mechanistic, translational, and clinical studies related to cellular senescence in IPF. Relevant studies were selected based on conceptual relevance and scientific quality, and findings were qualitatively synthesized within a narrative-review framework. These interconnected pathways form self-reinforcing feedback loops that stabilize the senescent phenotype and sustain fibroblast activation. In addition, we critically evaluate emerging therapeutic strategies targeting senescence, including senolytic and senomorphic approaches, highlighting their potential to modify fundamental disease mechanisms rather than solely attenuating fibrotic progression. Preclinical and early clinical studies suggest that selective targeting of senescent cells may represent a promising avenue for intervention, although challenges related to specificity, safety, and biomarker development remain. Overall, this review positions cellular senescence as a central mechanistic link between aging and fibrosis and underscores its relevance as a translational target in IPF. Full article

(This article belongs to the Section Respiratory Diseases)

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13 pages, 915 KB

Open AccessArticle

Psoriasis and Risk of Colorectal Cancer: A Nationwide Population-Based Cohort Study in Korea

by Kyeong Min Han, Dae Myoung Yoo, Ho Suk Kang, Hyo Geun Choi, Joo-Hee Kim, Nan Young Kim, Kyueng-Whan Min and Mi Jung Kwon

Diseases 2026, 14(6), 200; https://doi.org/10.3390/diseases14060200 - 4 Jun 2026

Cited by 1 | Viewed by 805

Abstract

Background/Objectives: Psoriasis is a chronic systemic inflammatory disease associated with increased cancer risk; however, its relationship with colorectal cancer (CRC) remains unclear. This question is particularly relevant in Asia, where CRC incidence has been increasing rapidly in recent decades. Methods: We conducted a [...] Read more.

Background/Objectives: Psoriasis is a chronic systemic inflammatory disease associated with increased cancer risk; however, its relationship with colorectal cancer (CRC) remains unclear. This question is particularly relevant in Asia, where CRC incidence has been increasing rapidly in recent decades. Methods: We conducted a nationwide longitudinal cohort study using the Korean National Health Insurance Service–National Sample Cohort (2002–2019). Patients with psoriasis were identified using validated ICD-10 codes and matched 1:4 with controls by age, sex, income, and region. Propensity score overlap weighting was applied to achieve covariate balance. Incident CRC was defined using both ICD-10 codes and cancer-specific registration codes. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: A total of 16,670 patients with psoriasis and 66,680 matched controls were included. During follow-up, the incidence of CRC was comparable between the two groups. In the weighted model, psoriasis was not associated with an increased risk of CRC (aHR = 0.96; 95% CI: 0.83–1.10). Kaplan–Meier analysis showed no significant difference in cumulative incidence (log-rank p > 0.05). Subgroup analyses stratified by age, sex, income, region, and comorbidity burden yielded consistent null findings. Conclusions: In this large nationwide cohort, psoriasis was not associated with an increased risk of CRC. These findings suggest that psoriasis does not independently contribute to CRC risk at the population level and does not warrant additional CRC surveillance beyond established screening recommendations, even in a high-burden setting such as Korea. Full article

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20 pages, 3474 KB

Open AccessArticle

Pro-Inflammatory Synergy Between IL-17, IL-1 and Hyperuricemia in Psoriatic Arthritis: Clinical Implications of a Pilot Study

by Larisa Ionela Suiu, Florentin Ananu Vreju, Adina Turcu-Stiolica, Cristina Elena Bita, Mihail Virgil Boldeanu and Paulina Lucia Ciurea

Diseases 2026, 14(6), 199; https://doi.org/10.3390/diseases14060199 - 3 Jun 2026

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Abstract

Background: Hyperuricemia is a prevalent comorbidity in psoriatic arthritis (PsA), yet its influence on the IL-1α/IL-17 cytokine balance remains unexplored. We aimed to characterize serum IL-1α and IL-17 profiles in PsA stratified by hyperuricemia status and to compare these with patients with hyperuricemia [...] Read more.

Background: Hyperuricemia is a prevalent comorbidity in psoriatic arthritis (PsA), yet its influence on the IL-1α/IL-17 cytokine balance remains unexplored. We aimed to characterize serum IL-1α and IL-17 profiles in PsA stratified by hyperuricemia status and to compare these with patients with hyperuricemia without psoriatic disease (HU). Methods: This cross-sectional study included 34 consecutively recruited PsA patients (19 hyperuricemic, 15 normouricemic) and 30 HU controls. Serum IL-1α and IL-17 were measured by ELISA. The PsA cohort was stratified by hyperuricemia status, cutaneous psoriasis, disease pattern, obesity grade, hypertension, sex, and enthesitis. Between-group comparisons used Mann–Whitney U and Kruskal–Wallis tests with Bonferroni-corrected post hoc analyses. Bivariate associations were assessed using Spearman’s rank correlation. Results: Within the PsA cohort, hyperuricemic patients had significantly lower IL-17 than normouricemic patients (31.1 ± 15.7 vs. 49.5 ± 25.3 pg/mL; p = 0.01), while IL-1α did not differ significantly (37.3 ± 11.7 vs. 34.0 ± 8.19 pg/mL; p = 0.24). No correlation was observed between IL-1α and IL-17 (ρ = −0.05), indicating independent immunological axes. In the three-group comparison, IL-17 differed significantly across PsA-normouricemic, HU, and PsA-hyperuricemic subgroups (p = 0.022), whereas IL-1α was comparable across all three groups (p = 0.584). None of the traditional clinical classifications—disease pattern, cutaneous psoriasis, or sex—were significantly associated with either cytokine. Conclusions: Hyperuricemia was associated with significantly lower circulating IL-17 in PsA without a corresponding change in IL-1α levels, and this association appeared more pronounced within the inflammatory context of psoriatic disease than in hyperuricemia alone. These exploratory findings suggest that metabolic factors may play a role in defining the immunological profile of PsA and warrant prospective validation in larger cohorts. Owing to the cross-sectional design, this study does not allow inference of causal relationships between hyperuricemia and cytokine alterations. Full article

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12 pages, 6900 KB

Open AccessArticle

Prone Positioning Is a Feasible Approach in the Diagnostic Work-Up of Posterior Pulmonary Nodules and a Means to Limit CT-to-Body Divergence: A Retrospective Cohort Study

by Russell Vo, Tristan Post, Daniel Smith, Valerie Peters, Isha Puri, J. W. Hollingsworth and Sai Karan Vamsi Guda

Diseases 2026, 14(6), 198; https://doi.org/10.3390/diseases14060198 - 2 Jun 2026

Viewed by 857

Abstract

Background: Lung cancer is the second most common cause of cancer with high mortality, thereby emphasizing the importance of early detection. However, the rate of new lung cancer diagnosis has remained relatively unchanged. Despite the advancements in navigational bronchoscopy, the diagnostic yield of [...] Read more.

Background: Lung cancer is the second most common cause of cancer with high mortality, thereby emphasizing the importance of early detection. However, the rate of new lung cancer diagnosis has remained relatively unchanged. Despite the advancements in navigational bronchoscopy, the diagnostic yield of pulmonary nodules, particularly posterior nodules, is often limited by CT-to-body divergence. Our study aims to evaluate the feasibility and safety of prone positioning during navigational bronchoscopy and its impact on the diagnostic yield of posterior pulmonary nodules. Methods: Retrospective cohort study of nine patients who underwent Ion robotic navigational bronchoscopy in prone position and 237 patients in supine position. The study period was July 2024 to December 2024 for the prone cohort and July 2020 to September 2024 for the supine cohort. Results: In the supine cohort, the diagnostic yield was 93.3%, including a malignant yield of 62.3%, and the post-operative complication rates were 1.5% for pneumothorax, 3.5% for bronchopulmonary hemorrhage, and 1.9% for respiratory failure. In the prone cohort, the diagnostic yield was 77.8% and a malignant yield of 85.7%, and the postoperative complication rates were 0% for pneumothorax, bronchopulmonary hemorrhage, and respiratory failure. Conclusions: CT-to-body divergence is a major obstacle in the diagnostic work-up of pulmonary nodules, of which a major contributor is atelectasis. Our study demonstrates that prone positioning combined with a strict anesthesia protocol is both a feasible and safe approach in the diagnostic work-up of pulmonary nodules. Full article

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2 pages, 168 KB

Open AccessCorrection

Correction: Ncongwane et al. Labdane Diterpenoids from Leonotis ocymifolia with Selective Cytotoxic Activity Against HCC70 Breast Cancer Cell Line. Diseases 2025, 13, 140

by Jane Busisiwe Ncongwane, Comfort Nkambule, Gerda Fouche, Douglas Kemboi, Nyeleti Vukea, Candace Davison, Jo-Anne de la Mare and Vuyelwa Jacqueline Tembu

Diseases 2026, 14(6), 197; https://doi.org/10.3390/diseases14060197 - 2 Jun 2026

Viewed by 534

Abstract

Candace Davison was not included as an author in the original publication [...] Full article

17 pages, 3905 KB

Open AccessArticle

Modeling of Vector-Borne Disease Across Governorates and Districts in Oman, 2020–2024

by Abdullah Al-Manji, Adil Al Wahaibi, Amal Al Malehi, Mohammed Al-Azri and Moon Fai Chan

Diseases 2026, 14(6), 196; https://doi.org/10.3390/diseases14060196 - 31 May 2026

Viewed by 728

Abstract

Introduction: Oman has transitioned from travel-related dengue cases to local outbreaks since 2018, with heterogeneous patterns across governorates and districts. Understanding how climate, population, and vector indicators jointly shape dengue risk at different administrative levels is essential for targeted control. Methods: This study [...] Read more.

Introduction: Oman has transitioned from travel-related dengue cases to local outbreaks since 2018, with heterogeneous patterns across governorates and districts. Understanding how climate, population, and vector indicators jointly shape dengue risk at different administrative levels is essential for targeted control. Methods: This study compiled weekly data (2020–2024) on dengue cases, mosquito surveillance, climate, and population from national sources. Using Partial Least Squares Structural Equation Modelling (PLS-SEM) in SmartPLS v4, we modelled constructs for Weather, Population, Vector, and Vector-borne Disease (VBD). Measurement quality was assessed using various statistics and with 5000-sample bootstrapping. Multigroup Analysis (MGA) with permutation and Measurement Invariance of Composite Models (MICOM) tested invariance and compared structural paths across governorates (Muscat, North Al Batinah, Ad Dakhiliyah) and districts (Seeb, Sohar, Bahla). Results: Vector abundance mediated climate and population effects on dengue, with marked spatial heterogeneity. At the governorate level, the Vector → VBD path was strongest in Ad Dakhiliyah (β ≈ 0.436) and negligible in Muscat (β ≈ −0.021); indirect effects from Population and Weather to VBD were significantly higher in Ad Dakhiliyah than comparators. At the district level, Bahla showed stronger Vector → VBD and Weather → Vector relationships than Seeb and Sohar, while Seeb exhibited low explanatory power across paths. MICOM indicated partial measurement invariance, suggesting caution in cross-group comparisons. Conclusions: Dengue risk in Oman is primarily vector-driven but differs by setting. Inland/rural areas are more sensitive to climate–vector dynamics, requiring enhanced surveillance and climate-informed early warning. Urban centers may need models incorporating mobility and behavior. Findings support localized interventions and the integration of trap positivity and density into district-level prediction and control. Full article

(This article belongs to the Topic Surveillance Systems and Predictive Analytics for Epidemics)

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19 pages, 17979 KB

Open AccessReview

Preoperative and Intraoperative Localization of Small Pulmonary Nodules for Sublobar Resection: Practical Insights into Percutaneous, Bronchoscopic/Robotic, RFID (SuReFInD), and Hybrid-OR CT Workflows

by Kanji Tanaka, Masaru Takenaka, Daikichi Meguro, Nobuyuki Take, Teppei Hashimoto, Yasuhiro Fujita, Takehiko Manabe, Katsuma Yoshimatsu, Hiroki Matsumiya, Masataka Mori, Asahi Nagata and Hidetaka Uramoto

Diseases 2026, 14(6), 195; https://doi.org/10.3390/diseases14060195 - 30 May 2026

Cited by 2 | Viewed by 858

Abstract

Thin-slice high-resolution computed tomography (CT) has improved the detection of small pulmonary nodules, increasing the demand for minimally invasive diagnostic and therapeutic resection. While lobectomy with lymph node dissection remains the standard surgical approach for many patients with resectable non-small cell lung cancer, [...] Read more.

Thin-slice high-resolution computed tomography (CT) has improved the detection of small pulmonary nodules, increasing the demand for minimally invasive diagnostic and therapeutic resection. While lobectomy with lymph node dissection remains the standard surgical approach for many patients with resectable non-small cell lung cancer, accumulating evidence supports sublobar resection for selected small, peripheral, and ground-glass-dominant lesions when sufficient margins are achievable. In thoracoscopic and robotic surgery, localization of nodules ≤10 mm or lesions located >5 mm from the pleural surface can be challenging, and failure to identify the target may lead to conversion, larger resection than intended, or prolonged operative time. Several localization strategies have been developed, including CT-guided percutaneous wire/coil/dye marking, bronchoscopic dye mapping, and virtual-assisted lung mapping (VAL-MAP), robotic-assisted bronchoscopic dye or fiducial localization, radiofrequency identification microtag systems (Surgical Real-Time FInger Navigation and Detection) that provide real-time depth information, and single-stage intraoperative CT-guided marking and resection in hybrid operating rooms. This review synthesizes representative evidence and published outcome ranges, and compares workflows, marker-to-lesion precision metrics, complication profiles, operational burden, and cost structures. We emphasize the practical contrast between two-stage and single-stage workflows, the access-route differences between transthoracic and transbronchial techniques, and the need to report localization-to-incision “time at risk”. We also present an expert-consensus decision algorithm aimed at facilitating tailored selection of localization strategies for modern minimally invasive thoracic surgery. Full article

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18 pages, 1794 KB

Open AccessArticle

Beyond Linear Risk: A U-Shaped Association Between Platelet Reactivity and Mortality in Coronary Artery Disease

by Sholpan Zhangelova, Orazbek Sakhov, Lyazat Abisheva, Dmitriy Polyakov, Farida Rustamova, Aizhan Almukhanova, Galiya Umenova, Gulzada Nurgaliyeva, Aigyul Izhanova, Dana Akhmentayeva, Dina Kapsultanova and Friba Nurmukhammad

Diseases 2026, 14(6), 194; https://doi.org/10.3390/diseases14060194 - 29 May 2026

Cited by 1 | Viewed by 626

Abstract

Background: Optimal platelet inhibition is essential for minimizing both thrombotic and hemorrhagic complications in patients with coronary artery disease (CAD). Although high on-treatment platelet reactivity (HPR) has been consistently associated with adverse clinical outcomes, the relationship between platelet reactivity—measured as P2Y12 reaction units [...] Read more.

Background: Optimal platelet inhibition is essential for minimizing both thrombotic and hemorrhagic complications in patients with coronary artery disease (CAD). Although high on-treatment platelet reactivity (HPR) has been consistently associated with adverse clinical outcomes, the relationship between platelet reactivity—measured as P2Y12 reaction units (PRU)—and cardiovascular mortality remains incompletely characterized. In particular, potential non-linear associations have not been adequately explored. Objective: We aimed to investigate the association between PRU and cardiovascular mortality in patients with CAD, with a specific focus on identifying potential non-linear relationships. Methods: We conducted a retrospective observational cohort study including 1000 patients with angiographically confirmed CAD treated at a tertiary cardiology center in Almaty, Kazakhstan, between 2024 and 2025. Platelet reactivity was assessed using the VerifyNow P2Y12 assay. Multivariable logistic regression models were used to identify independent predictors of cardiovascular mortality. To assess potential non-linear associations between PRU and mortality, restricted cubic spline regression was applied with predefined knot placement. Model performance was evaluated in terms of discrimination (C-statistic) and calibration (Hosmer-Lemeshow goodness-of-fit test). Results: In conventional linear regression models, PRU was not independently associated with cardiovascular mortality (odds ratio [OR] ~1.00; p > 0.05). However, spline-based analyses demonstrated a statistically significant non-linear (U-shaped) relationship between PRU and mortality risk (p for non-linearity = X). Both low and high PRU values were associated with increased mortality, whereas intermediate PRU levels corresponded to the lowest observed risk. Additional independent predictors of mortality included advanced age, diabetes mellitus, and elevated inflammatory markers. Conclusions: Our findings reveal a significant non-linear association between platelet reactivity and cardiovascular mortality in patients with CAD. Both insufficient and excessive platelet inhibition appear to confer increased risk, suggesting that optimal PRU targets may lie within an intermediate therapeutic range. These results support a paradigm shift toward more individualized antiplatelet therapy strategies guided by platelet function testing. Full article

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

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14 pages, 917 KB

Open AccessArticle

Early Language Development in Infants and Toddlers with Hemato-Oncological Diseases: Preliminary Outcomes of a Shared Reading Intervention

by Giusy Melcarne, Roberta Maria Incardona, Giulia Marangon, Silvia Sorbara, Alessandra Biffi and Marta Tremolada

Diseases 2026, 14(6), 193; https://doi.org/10.3390/diseases14060193 - 29 May 2026

Viewed by 394

Abstract

Introduction: Children diagnosed with hemato-oncological cancers need intensive medical treatments and prolonged hospitalizations, which are associated with increased risk of impairment across multiple neurodevelopmental domains, particularly when exposure occurs within the first three years of life. Objective: This pilot study aimed to explore [...] Read more.

Introduction: Children diagnosed with hemato-oncological cancers need intensive medical treatments and prolonged hospitalizations, which are associated with increased risk of impairment across multiple neurodevelopmental domains, particularly when exposure occurs within the first three years of life. Objective: This pilot study aimed to explore early language performance in children under 36 months of age hospitalized in a pediatric hemato-oncology unit and to preliminarily investigate changes over time and potential associations with an early speech–language stimulation intervention based on shared reading. Specifically, the study investigated differences between language comprehension and production, as well as variations in linguistic outcomes according to gender and pathology type (liquid vs. solid). Methods: The study employed a sample of 29 children aged 2 to 36 months (M = 20.76, SD = 9.52). Baseline linguistic assessment was conducted using observational measures across multiple language domains, including lexical development (PinG), morphosyntactic abilities (PCGO, GALS), and articulatory skills (BAMF), together with an evaluation of general cognitive functioning (Griffiths). The intervention consisted of in-person shared reading sessions combined with concurrent parental counseling. Exploratory analyses were performed to examine changes over time and group-related differences. Results: Among the sample, lexical comprehension exceeded production (p < 0.001). Sex differences emerged only for lexical comprehension, with males performing worse than females (p = 0.048). Comparisons by diagnosis showed that children with solid tumors had significantly better articulation than those with hematologic malignancies (p = 0.018), with a trend toward higher morphosyntactic production. Longitudinal analyses on 13 children re-evaluated after six months of weekly shared reading intervention showed potential improvements in articulation, lexical production, and morphosyntactic production (all p < 0.01). Conclusions: These preliminary findings suggest that children in pediatric hemato-oncology settings may be vulnerable to expressive language difficulties. Shared reading interventions may represent a promising supportive approach for early language stimulation; however, further studies with larger samples and controlled designs are needed to better understand their potential contribution and effectiveness. Full article

(This article belongs to the Section Oncology)

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Diseases, Volume 14, Issue 6 (June 2026) – 40 articles

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