Journal Description
Diseases
Diseases
is an international, peer-reviewed, open access, multidisciplinary journal which focuses on the latest and outstanding research on diseases and conditions published monthly online by MDPI. The first issue is released in 2013.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, ESCI (Web of Science), PubMed, PMC, CAPlus / SciFinder, and other databases.
- Journal Rank: JCR - Q2 (Medicine, Research and Experimental)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 22.7 days after submission; acceptance to publication is undertaken in 2.5 days (median values for papers published in this journal in the first half of 2025).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
- Sections: published in 8 topical sections.
Impact Factor:
3.0 (2024);
5-Year Impact Factor:
3.4 (2024)
Latest Articles
Global Epidemiology of Smoking and Liver Cancer from 1990 to 2021
Diseases 2025, 13(11), 356; https://doi.org/10.3390/diseases13110356 - 3 Nov 2025
Abstract
Liver cancer is a prevalent and highly malignant tumor worldwide, and smoking has been suggested as a potentially significant risk factor, but this association remains understudied and not widely recognized. This study utilized global epidemiological data (1990–2021) from open access databases, analyzing smoking-related
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Liver cancer is a prevalent and highly malignant tumor worldwide, and smoking has been suggested as a potentially significant risk factor, but this association remains understudied and not widely recognized. This study utilized global epidemiological data (1990–2021) from open access databases, analyzing smoking-related liver cancer burden and trends by age, sex, region, and country using mortality, disability-adjusted life years (DALYs), and age-standardized rates (ASRs), with projections for disease burden in 2040. The results show that from 1990 to 2021, the global number of smoking-attributable liver cancer deaths increased (cumulative growth: 67.10%; annual growth rate: 1.63%), while the age-standardized mortality rate (ASMR) declined. Similarly, global DALYs rose (cumulative growth: 49.5%; annual growth rate: 1.32%), yet age-standardized DALY rates (ASDRs) decreased. Significant disparities were observed across gender, age groups, regions, and countries, with higher burdens in males and in regions such as East Asia. Projections indicate that by 2040, both the ASMR and ASDR for smoking-associated liver cancer will decline significantly, particularly among the male population. In conclusion, although the burden of liver cancer related to smoking is on a downward trend, there are still significant demographic and regional differences. Future efforts should prioritize strengthened public health policies, targeted interventions, and further research into the smoking–liver cancer relationship to enhance prevention and control strategies.
Full article
(This article belongs to the Topic Dietary Habits in Liver Health and Disease: Preclinical and Clinical Studies)
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Open AccessReview
Navigating the Latest Hepatitis B Virus Reactivation Guidelines
by
Zeyad Elharabi, Jowana Saba and Hakan Akin
Diseases 2025, 13(11), 355; https://doi.org/10.3390/diseases13110355 - 1 Nov 2025
Abstract
Hepatitis B virus (HBV) infection is a global health concern with an estimated 254 million people with chronic HBV infection. The utilization of immunosuppressive therapies (ISTs) is increasing and expanding continuously with new agents being implemented across multiple medical disciplines. The occurrence of
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Hepatitis B virus (HBV) infection is a global health concern with an estimated 254 million people with chronic HBV infection. The utilization of immunosuppressive therapies (ISTs) is increasing and expanding continuously with new agents being implemented across multiple medical disciplines. The occurrence of HBV reactivation (HBVr) during or after IST varies from 15% to 50% in HBsAg-positive individuals and can be higher than 75% after stem cell transplantation. HBVr is gaining increasing significance in contemporary clinical practice. The American Gastroenterological Association (AGA) in 2025, the European Association for the Study of the Liver (EASL) in 2025, and the Asian Pacific Association for the Study of the Liver (APASL) in 2021, published their most recent clinical guidelines as major societies in the area, which enables us to better predict and manage HBVr. This narrative review focuses on comparing these three current guidelines, highlighting key similarities and differences to provide valuable guidance for practitioners navigating the complex, sometimes conflicting recommendations, thereby aiding clinicians in their decision-making. The risk of HBVr during IST has been stratified into three categories in all three guidelines: high (>10%), moderate (1–10%), and low (<1%). The effectiveness of prophylaxis scales with baseline risk for HBV reactivation. Prophylaxis is clearly cost-effective for high-risk patients, potentially beneficial for those at moderate risk, and generally may not be justified for low-risk individuals. Entecavir (ETV), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF) are all highly effective in preventing HBV reactivation during immunosuppression and all are considered to be economically viable options for HBVr high risk patients. When selecting among these agents, safety considerations—particularly renal and bone toxicity—and insurance coverage remain the primary factors directing clinical decision-making.
Full article
(This article belongs to the Special Issue Viral Hepatitis: Diagnosis, Treatment and Management)
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Open AccessReview
The Systemic Link Between Oral Health and Cardiovascular Disease: Contemporary Evidence, Mechanisms, and Risk Factor Implications
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Florinel Cosmin Bida, Florin Razvan Curca, Raoul-Vasile Lupusoru, Dragos Ioan Virvescu, Mihaela Scurtu, Gabriel Rotundu, Oana Maria Butnaru, Teona Tudorici, Ionut Luchian and Dana Gabriela Budala
Diseases 2025, 13(11), 354; https://doi.org/10.3390/diseases13110354 - 31 Oct 2025
Abstract
Background: Oral health plays a critical role in systemic wellbeing, with growing evidence supporting strong associations between oral conditions and cardiovascular disease (CVD). These connections extend beyond periodontal disease and involve oral microbiota imbalance, systemic inflammation, and oral side effects of cardiovascular pharmacotherapy.
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Background: Oral health plays a critical role in systemic wellbeing, with growing evidence supporting strong associations between oral conditions and cardiovascular disease (CVD). These connections extend beyond periodontal disease and involve oral microbiota imbalance, systemic inflammation, and oral side effects of cardiovascular pharmacotherapy. Objective: To explore these links, a narrative literature review was performed using PubMed, Scopus, and ScienceDirect, covering studies published between 2000 and 2025. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and ScienceDirect for studies published between January 2000 and May 2025. Both MeSH and free-text terms related to oral health, periodontal disease, systemic inflammation, endothelial dysfunction, and atherosclerosis were used. Eligible studies included observational and interventional research, systematic reviews, and meta-analyses. Key findings: The evidence consistently supports an association between chronic periodontal inflammation and cardiovascular risk, mediated by systemic dissemination of proinflammatory cytokines (IL-6, TNF-α, CRP) and microbial products that promote endothelial activation and atherogenesis. Interventional data indicate that periodontal therapy may reduce systemic inflammatory burden and improve vascular parameters, though heterogeneity across studies limits causal inference. Conclusions: Current findings highlight a significant oral–systemic connection through inflammatory and endothelial mechanisms. Strengthening interdisciplinary collaboration between dental and cardiovascular care providers is essential to translate this evidence into preventive and therapeutic practice. Further longitudinal and mechanistic studies are required to confirm causality and guide clinical integration.
Full article
(This article belongs to the Special Issue Insights into the Management of Cardiovascular Disease Risk Factors)
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Open AccessArticle
Impact of Becoming a Certified Oncologic Center of Pancreatic Surgery: Evaluation of Single-Center Perioperative Results and Quality of Life Before and After Implementation of a Certified Center
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Jan-Paul Gundlach, Thorben Fedders, Steffen Markus Heckl, Thomas Becker and Julius Pochhammer
Diseases 2025, 13(11), 353; https://doi.org/10.3390/diseases13110353 - 31 Oct 2025
Abstract
Background: Centralization and certification mark constant processes in everyday clinical routine. Despite the continuously rising number of certified pancreatic cancer (PAC) centers in recent years, fewer than 40% of PAC resections are still performed in certified institutions nationwide. The main objective of the
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Background: Centralization and certification mark constant processes in everyday clinical routine. Despite the continuously rising number of certified pancreatic cancer (PAC) centers in recent years, fewer than 40% of PAC resections are still performed in certified institutions nationwide. The main objective of the certification is the enhancement of patient survival. Furthermore, certification is intended to improve structural quality, multidisciplinary cooperation, and the transparency of treatment pathways. In addition, it should have a positive effect on patient satisfaction. However, it requires the substantial effort of all partners involved. We aim to illustrate both advantages and limitations of the certification process. Methods: We analyzed perioperative outcomes of patients undergoing pancreatic resection for PAC (ICD C25) before and after our center’s first certification, and benchmarked these results against national data from the German Cancer Society. In addition, we analyzed quality of life (QoL) longitudinally using the validated QLQ-C30 questionnaire administered preoperatively and at 1, 4, and 18 months postoperatively. Results: The study cohort included 47 patients treated in the three years prior to certification and 130 patients during the subsequent seven years as a certified center. The mean annual number of PAC resections increased from 15 (ranged 14–18) to 19 (ranged 10–26). In-hospital mortality, length of stay, and rate of exploration-only procedures remained unchanged. Indicators of procedural quality, such as the number of harvested lymph nodes (p = 0.1485) and the precision of histopathological assessment, improved slightly but not significantly. QoL scores generally improved after discharge in both groups; however, functional scales and symptom measures demonstrated unexpectedly inferior values following certification, possibly reflecting higher case complexity. Conclusion: Achieving and maintaining certification requires substantial and continuous effort from all disciplines involved. While major improvements in morbidity, mortality, and long-term QoL were not observed, certification ensured clearer delegation of responsibilities, standardized documentation, and structured quality control. We therefore consider the certification process valuable for promoting multidisciplinary collaboration, maintaining high treatment volumes, and ensuring transparent oncological care pathways.
Full article
(This article belongs to the Section Oncology)
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Open AccessArticle
Quantitative Analysis of Selected Circulating Hematological Biomarkers, Essential Minerals, Vitamins, and Thyroid Hormones in Females Affected by Hair Loss
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Saad Al-Fawaeir and Ibrahim Al-Odat
Diseases 2025, 13(11), 352; https://doi.org/10.3390/diseases13110352 - 29 Oct 2025
Abstract
Purpose: To assess the association between hair loss in females and various biomarkers including hemoglobin, iron, ferritin, zinc, selenium, calcium, vitamin D, vitamin B12, folic acid, and thyroid hormones. Patients and methods: This study enrolled 100 women presenting with hair loss and 100
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Purpose: To assess the association between hair loss in females and various biomarkers including hemoglobin, iron, ferritin, zinc, selenium, calcium, vitamin D, vitamin B12, folic acid, and thyroid hormones. Patients and methods: This study enrolled 100 women presenting with hair loss and 100 age-matched healthy controls. Venous blood samples were collected for analysis of hematological, hormonal and biochemical parameters. Results: The mean age of participants was comparable between groups (43.06 ± 10.76 vs. 41.39 ± 7.94 years; p = 0.88). Hair loss in females had significantly lower mean levels of Hb (11.45 ± 0.39 vs. 13.09 ± 0.46 g/dL; p < 0.001), iron (70.14 ± 7.85 vs. 94.42 ± 5.61 µg/dL; p < 0.001) and ferritin (39.34 ± 3.71 vs. 48.09 ± 5.31 ng/mL), all with p < 0.001. Serum levels of selenium (67.11 ± 5.53 vs. 71.45 ± 4.05 µg/L), zinc (86.07 ± 3.98 vs. 88.87 ± 2.03 µg/L), copper (90.71 ± 3.48 vs. 104.84 ± 5.38 µg/L), and calcium (8.61 ± 0.28 vs. 9.11 ± 0.27 mg/dL) were significantly reduced in women with hair loss (p < 0.001). Thyroid hormones were also significantly lower in the hair loss group, including TSH (1.74 ± 0.25 vs. 2.35 ± 0.39 µIU/mL) and FREE T4 (1.11 ± 0.11 vs. 1.32 ± 0.12 ng/dL), despite remaining within the normal reference ranges. Patients also showed lower serum folate (6.17 ± 0.63 vs. 6.96 ± 0.41 ng/mL), vitamin B12 (185.52 ± 35.27 vs. 258.30 ± 52.84 pg/mL), and vitamin D (26.32 ± 2.98 vs. 32.20 ± 3.76 ng/dL) levels (p < 0.001). Conclusions: Hair loss in females is significantly associated with reduced levels of circulating hemoglobin, iron, copper, selenium, vitamin D, vitamin B12, folate, thyroid-stimulating hormone and FREE T4 hormone.
Full article
Open AccessArticle
Risk Factors for Recurrent Hip Fractures Following Surgical Treatment of Primary Osteoporotic Hip Fractures in Chinese Older Adults
by
Yuzhu Wang, Wenhui Shen, Jiayi Jiang, Lin Wang, Qing Xia, Yunchao Shao and Lu Cao
Diseases 2025, 13(11), 351; https://doi.org/10.3390/diseases13110351 - 27 Oct 2025
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Objectives: Hip fractures associated with osteoporosis are indicative of high rates of both disability and mortality. The objective of this study was to analyze the risk factors for recurrent hip fractures following primary osteoporotic hip fracture surgery in older adult patients. Methods: A
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Objectives: Hip fractures associated with osteoporosis are indicative of high rates of both disability and mortality. The objective of this study was to analyze the risk factors for recurrent hip fractures following primary osteoporotic hip fracture surgery in older adult patients. Methods: A single-center, retrospective cohort study was conducted on 376 patients suffering from primary osteoporotic hip fractures from 1 January 2020 to 31 December 2021. Multivariate logistic regression was used to identify risk factors for recurrent hip fractures. Results: The study observed 376 patients over a period of three years. The incidence of recurrent hip fractures was 20.5% (77/376). Multiple logistic regression analysis revealed that age ≥ 85 years (odd ratios [OR] = 3.127, 95% confidence interval [CI] = 1.672–5.849, p < 0.001), chronic obstructive pulmonary disease (COPD) (OR = 3.794, 95%CI = 1.747–8.236, p < 0.001), and Parkinson’s disease (PD) (OR = 2.744, 95%CI = 1.249–6.028, p = 0.012) were independent risk factors for recurrent hip fractures; antiosteoporosis drugs (OR = 0.243, 95%CI = 0.131–0.451, p < 0.001), duration of antiosteoporosis drug therapy (OR = 0.564, 95%CI = 0.283–0.830, p = 0.003) and serum albumin ≥ 35 g·L−1 (OR = 0.413, 95%CI = 0.194–0.881, p = 0.022) were independent protective factors for recurrent hip fractures. The receiver operating characteristic (ROC) curve demonstrated that the AUC was 0.802, the sensitivity was 77.8%, and the specificity was 75.5%. A significantly higher three-year mortality rate was observed among patients with recurrent hip fractures (26.0% vs. 15.4%, p = 0.029). Conclusions: Older patients with advanced age, COPD and PD were at greater risk of recurrent hip fractures. Early nutrition intervention and antiosteoporosis drug therapy may decrease the incidence of recurrent hip fractures in older patients, thereby reducing mortality.
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Open AccessArticle
Proportion and Correlates of Psychiatric Morbidity Among Psychiatry-Assessed Oncology Inpatients
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Ana-Maria Paslaru, Iulian Bounegru, Catalin Plesea-Condratovici, Moroianu Marius and Anamaria Ciubară
Diseases 2025, 13(11), 350; https://doi.org/10.3390/diseases13110350 - 24 Oct 2025
Abstract
Background/Objectives: Psychiatric morbidity is frequent in oncology, yet prevalence and correlates differ across tumour sites. Urogenital cancers, in particular, involve psychosocial stressors related to sexuality, fertility, continence, and body image, which may intensify anxiety and depression. This study aimed to estimate the proportion
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Background/Objectives: Psychiatric morbidity is frequent in oncology, yet prevalence and correlates differ across tumour sites. Urogenital cancers, in particular, involve psychosocial stressors related to sexuality, fertility, continence, and body image, which may intensify anxiety and depression. This study aimed to estimate the proportion of psychiatric morbidity among psychiatry-assessed oncology inpatients in a real-world hospital setting to compare urogenital with non-urogenital malignancies and to examine clinical correlates and hospitalisation outcomes. Methods: We conducted a retrospective analysis of 174 oncology inpatients who were evaluated by liaison psychiatry and completed the Hospital Anxiety and Depression Scale (HADS) during admission to a tertiary hospital in Galați, Romania, between 2019 and 2022. All patients completed the Hospital Anxiety and Depression Scale (HADS) and underwent liaison psychiatry evaluation. Mixed anxiety–depressive disorder (ICD-10 F41.2) was the primary psychiatric outcome. Demographic, clinical, and functional data—including Eastern Cooperative Oncology Group (ECOG) performance status—were extracted from medical records. Comparative and multivariable analyses were performed to identify predictors of severe depressive symptoms (primary outcome, HADS-D ≥ 11) and to explore associations with length of stay and costs. Results: Overall, 59% of patients had elevated HADS-Anxiety and 62% elevated HADS-Depression, while 40% received a psychiatric diagnosis. Mixed anxiety–depressive disorder predominated, especially in cervical (95%), bladder (100%), and prostate (≈70–75%) cancers. Urogenital cancers showed significantly higher rates of anxiety/depression than non-urogenital cancers (85% vs. 46%, p < 0.01). Poorer ECOG status independently predicted severe depressive symptoms (OR 3.6, 95% CI 2.1–6.2, p < 0.001). Psychiatric morbidity was associated with a trend toward longer LOS (median 12 vs. 9 days, p ≈ 0.08) and ≈10% higher hospital costs. Conclusions: Anxiety and depression were highly frequent among psychiatry-assessed oncology inpatients, particularly in urogenital malignancies. Functional impairment strongly correlates with psychiatric morbidity. These findings underscore the need for systematic screening and risk-stratified psycho-oncologic interventions to improve patient outcomes and resource utilisation.
Full article
(This article belongs to the Special Issue Mental Health—Management and Care, Multidisciplinary Approaches and Perspectives)
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Open AccessArticle
Exploring the Role of Presepsin in the Prediction of Atrial Fibrillation Recurrence: Results from the PLACEBO Study
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Aristi Boulmpou, Christodoulos Papadopoulos, Theocharis Koufakis, Kalliopi Kotsa, Dimitrios Kouroupis, Georgios Dimakopoulos, Aikaterini Balaska, Georgios Zormpas, Michael Doumas and Vassilios Vassilikos
Diseases 2025, 13(10), 349; https://doi.org/10.3390/diseases13100349 - 20 Oct 2025
Abstract
Background: Presepsin, a soluble CD14 subtype released during immune activation, has emerged as a marker of inflammation in cardiometabolic disorders. Given the links between inflammation, metabolic dysregulation, and atrial fibrillation (AF), presepsin may represent a novel biomarker for predicting AF recurrence. Aims: To
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Background: Presepsin, a soluble CD14 subtype released during immune activation, has emerged as a marker of inflammation in cardiometabolic disorders. Given the links between inflammation, metabolic dysregulation, and atrial fibrillation (AF), presepsin may represent a novel biomarker for predicting AF recurrence. Aims: To evaluate whether presepsin levels, alone or in combination with other biomarkers and clinical parameters, are associated with paroxysmal AF (PAF) recurrence in a well-characterized cohort from the PLACEBO trial. Methods: This was a retrospective exploratory substudy of 62 patients from the PLACEBO cohort with available baseline presepsin measurements. All patients had a history of PAF and were in sinus rhythm at inclusion. Presepsin and other biomarkers were measured at baseline. Reduced multivariable Cox regression models, limited to two or three predictors, were constructed to avoid overfitting. Results: During 12 months of follow-up, 27 patients (43.5%) experienced AF recurrence. Across the reduced multivariable models, each containing a limited number of predictors, obstructive sleep apnea (OSA) consistently emerged as an independent predictor (HR 3.13–3.36, p < 0.05). The use of HR ranges reflects the inclusion of these variables in more than one model. Galectin-3 (GAL3) and standard deviation of R-R intervals (SDRR) did not retain statistical significance, and presepsin was not independently associated with recurrence (HR 1.00, 95% CI 0.92–1.10, p = 0.94). Conclusions: In this exploratory study, OSA emerged as the only independent predictor of AF recurrence. Presepsin was not significantly associated with recurrence in the present cohort; however, given the limited sample size and exploratory design, these results do not exclude a potential association. Larger, adequately powered studies are needed to clarify the role of presepsin in AF recurrence risk.
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Open AccessReview
The Radiologists’ Guide to Spinal Separation Surgery: What Does the Surgeon Want to Know?
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Mohsin Khan, Labeeba Haq, Sai Niharika Gavvala, Petr Rehousek, Simon Hughes and Rajesh Botchu
Diseases 2025, 13(10), 348; https://doi.org/10.3390/diseases13100348 - 18 Oct 2025
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Spinal tumours are an uncommon but significant cause of pain, fractures, instability, and cord compression, leading to poor quality of life and mortality. Separation surgery is a rapidly advancing technique that has seen increased utilisation in the field of spinal oncology surgery. Separation
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Spinal tumours are an uncommon but significant cause of pain, fractures, instability, and cord compression, leading to poor quality of life and mortality. Separation surgery is a rapidly advancing technique that has seen increased utilisation in the field of spinal oncology surgery. Separation surgery can be described as a resection technique that decompresses the spinal cord whilst creating an ablative target for high-dose stereotactic radiotherapy to achieve durable local control while minimising the risk of radiation myelopathy. This has facilitated the delivery of stereotactic radiotherapy, as well as created potential for use in managing primary bone tumours of the spine. From a radiology standpoint, optimal outcomes depend on meticulous preoperative characterisation of tumour volume and stability (e.g., ESCC grade and SINS), clear communication of anatomic constraints relevant to approach and fixation, and systematic postoperative surveillance to distinguish expected postoperative appearances from early recurrence or complications. We present our radiological experience and report recommendations while evaluating spinal oncology separation surgery.
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Open AccessReview
Diabetic Ketoacidosis in Young Adults with Type 1 Diabetes: The Impact of the Ketogenic Diet—A Narrative Literature Review
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Joanna Cielecka, Zuzanna Szkamruk, Maciej Walędziak and Anna Różańska-Walędziak
Diseases 2025, 13(10), 347; https://doi.org/10.3390/diseases13100347 - 17 Oct 2025
Abstract
(1) Background: diabetic ketoacidosis (DKA) remains one of the most serious acute complications of type 1 diabetes, especially among young adults. At the same time the ketogenic diet, characterized by high fat and very low carbohydrate intake, is becoming increasingly popular, raising concerns
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(1) Background: diabetic ketoacidosis (DKA) remains one of the most serious acute complications of type 1 diabetes, especially among young adults. At the same time the ketogenic diet, characterized by high fat and very low carbohydrate intake, is becoming increasingly popular, raising concerns about its appropriateness and safety for individuals with type 1 diabetes, (2) Methods: a literature review was conducted using MEDLINE and SCOPUS databases, complemented by additional searches in Embase, Cochrane Library, and Web of Science to ensure broad coverage of both international and European studies with the focus on keywords including “diabetic ketoacidosis”, “type 1 diabetes”, and “ketogenic diet”. The most relevant and up-to-date studies were selected to evaluate both risks and potential clinical applications of this diet in T1D in young adults, (3) Results and Conclusions: While nutritional ketosis under controlled conditions is typically safe, individuals with T1D, especially young adults, may be more vulnerable to DKA due to factors such as inconsistent insulin administration, lack of ketone monitoring, and lifestyle changes. Reports of euglycemic DKA further highlight the importance of regular ketone tracking, even when blood glucose appears within target ranges. Although low-carbohydrate diets may offer improved glycemic profiles, their use in young adults with T1D must be carefully evaluated, emphasizing individualized care plans, close metabolic monitoring, and comprehensive patient education. Ongoing research is essential to clarify whether ketogenic diet can be safely integrated into diabetes management in this population.
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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Open AccessReview
Management and Clinical Outcomes of Scleredema Diabeticorum: A Scoping Review
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Weeratian Tawanwongsri and Chime Eden
Diseases 2025, 13(10), 346; https://doi.org/10.3390/diseases13100346 - 17 Oct 2025
Abstract
Background/Objectives: The objective of this scoping review was to systematically map the available evidence for the management of scleredema diabeticorum (SD) to summarize the documented clinical outcomes with the aim to inform clinical practice and identify research gaps. Methods: We conducted a scoping
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Background/Objectives: The objective of this scoping review was to systematically map the available evidence for the management of scleredema diabeticorum (SD) to summarize the documented clinical outcomes with the aim to inform clinical practice and identify research gaps. Methods: We conducted a scoping review identifying studies published in English from January 2005 to July 2025 through a comprehensive search of Scopus, MEDLINE, and the Cochrane Library. Eligible studies included randomized controlled trials, observational studies, case series, and case reports on treatment interventions and clinical outcomes. Two reviewers independently screened records, extracted data, and narratively and descriptively synthesized data. Results: Forty-five studies met the inclusion criteria: 39 single-patient case reports, five case series, and one multicenter observational study. The most common interventions were PUVA (8 studies, 14 patients; 12/14 improved, 85.7%), methotrexate (8 studies, 22 patients; 8/22 improved, 36.4%), and improved glycemic control (9 studies, 12 patients; mixed responses). Across small case reports/series, PUVA, UVA-1, and IVIG were most frequently reported as beneficial. Methotrexate monotherapy showed low and inconsistent effectiveness, with higher responses when combined with other agents. Other reported therapies included colchicine, electron-beam radiation, tranilast, and topical hyaluronidase. Conclusions: PUVA, UVA-1, and IVIG may offer benefit, while methotrexate alone is often ineffective. Evidence is predominantly from case reports and small series, which makes it difficult to generalize. Multicenter trials with standardized protocols are needed to develop evidence-based treatment recommendations.
Full article
(This article belongs to the Special Issue ‘Rare Syndromes: Diagnosis and Treatment’ in 2024–2026)
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Open AccessReview
Application and Challenges of Using Probiotic Lactobacillus and Bifidobacterium to Enhance Overall Health and Manage Diseases
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Kawaljit Kaur
Diseases 2025, 13(10), 345; https://doi.org/10.3390/diseases13100345 - 17 Oct 2025
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Probiotics are known for their health benefits, and new studies suggest they could help with various conditions. However, the specific formulations and mechanisms of probiotics in addressing these issues are still being explored. This review focuses on four key areas: cancer, aging, autoimmune
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Probiotics are known for their health benefits, and new studies suggest they could help with various conditions. However, the specific formulations and mechanisms of probiotics in addressing these issues are still being explored. This review focuses on four key areas: cancer, aging, autoimmune diseases, and neurodegenerative disorders, highlighting the potential benefits of Lactobacillus and Bifidobacterium probiotics. Their interaction with the immune system plays a crucial role in offering protection and therapeutic effects, particularly in enhancing immunity in older adults. The review sheds light on how these probiotics affect the immune system, gut microbiome, and related processes to manage or combat these health problems. It emphasizes the importance of customizing probiotic formulations for specific conditions, as different combinations of Lactobacillus and Bifidobacterium uniquely activate immune cells. Some combinations work as effective treatments for diseases, while others boost immunity in aging. While the potential of these probiotics is significant, challenges remain in using them for cancer, age-related diseases, autoimmune diseases neurodegenerative disorder treatments. Limited evidence calls for further research to define their role and establish guidelines. Future approaches like strain engineering, nanoencapsulation, synbiotics, and personalized microbiome analysis aim to overcome these challenges, making probiotics a more viable option for disease prevention and care. Additionally, there is an urgent need for clinical trials to ensure patients can benefit from these probiotics.
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Open AccessArticle
Right Ventricular Strain and Left Ventricular Strain Using Speckle Tracking Echocardiography—Independent Prognostic Associations in COPD Alongside NT-proBNP
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Silvana-Elena Hojda, Teodora Mocan, Alexandra-Lucia Pop, Ramona Rusnak, Cristina Bidian and Simona Valeria Clichici
Diseases 2025, 13(10), 344; https://doi.org/10.3390/diseases13100344 - 16 Oct 2025
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Background/Objectives: Cardiovascular diseases are the most important cause of mortality in chronic obstructive pulmonary disease (COPD). Speckle-tracking echocardiography (2D-STE) can be used for assessing atrial and ventricular function, and its role in COPD is underexplored. The main objective of this study was to
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Background/Objectives: Cardiovascular diseases are the most important cause of mortality in chronic obstructive pulmonary disease (COPD). Speckle-tracking echocardiography (2D-STE) can be used for assessing atrial and ventricular function, and its role in COPD is underexplored. The main objective of this study was to investigate prognostic associations in patients with COPD using 2D-STE echocardiography and laboratory biomarkers. Methods: The study included 70 participants, divided into two groups: 55 patients diagnosed with COPD and 15 healthy controls. All four cardiac chambers were analyzed with standard ultrasound and 2D-STE techniques. We measured NT-proBNP and several oxidative stress biomarkers: reduced glutathione (GSH), the GSH/GSSG ratio, malondialdehyde (MDA), and Caspase-3. Results: An NT-proBNP level above 325 pg/mL independently predicts advanced COPD stages (GOLD grades 3 and 4), with statistically significant results at a 95% confidence interval (CI) (p = 0.001). Additionally, 2D-STE identified reduced right ventricular (RV) and left ventricular (LV) strain in COPD patients before changes in LV ejection fraction. RV and LV strain measurements (RV4CLS < −16.15%, RVFWSL < −18.6%, LV GLS < −19.45%) along with PASP > 37.5 mmHg are independent predictors of advanced COPD stages, demonstrating significance at a 95% CI (p = 0.001). A positive correlation was observed between NT-proBNP, ultrasound parameters assessing RV systolic function, LV longitudinal strain impairment, and PASP. Conclusions: NT-proBNP serves as an independent biomarker of pulmonary hypertension and secondary right heart overload and independently predicts advanced COPD stages (GOLD grades 3 and 4) alongside RV and LV strain measurements.
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Open AccessReview
Evolving Role of Coronary Computed Tomography Angiography (CCTA) in Quantifying Atherosclerotic Coronary Artery Disease: A Narrative Review
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M. A. Manal Smail, Ram B. Singh, Jan Fedacko, Galal Elkilany, Krasimira Hristova, Sarthak Sharma, Ahmed Bathallah, Sherif A. Baathallah, Monika Jankajova and Fabiola Sozzi
Diseases 2025, 13(10), 343; https://doi.org/10.3390/diseases13100343 - 16 Oct 2025
Abstract
Background: There have been 20.5 million deaths due to cardiovascular diseases (CVDs), including atherosclerotic coronary artery disease (CAD) and stroke, so far in 2025. Atherosclerosis, which begins in newborns, may be influenced by preconception factors and continues to develop in adults, requiring a
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Background: There have been 20.5 million deaths due to cardiovascular diseases (CVDs), including atherosclerotic coronary artery disease (CAD) and stroke, so far in 2025. Atherosclerosis, which begins in newborns, may be influenced by preconception factors and continues to develop in adults, requiring a proper assessment of the burden of atherosclerotic plaque, as it is the direct cause of CAD. This review aims to emphasize the role of a staging system proposed by the Lancet Commission for the quantification of atherosclerotic coronary artery disease (ACAD) with an emphasis on preconception risk factors and protective factors, based on coronary computed tomography angiography (CCTA). Methods: It is suggested that the use of CCTA scanning makes it possible to quantify the atherosclerotic plaque burden into four stages. Results: CCTA enables us to see how much plaque has built up, as well as the type of plaque, but not the biochemistry of the plaque, to determine its vulnerability. However, if the plaque is a non-calcified fatty plaque, it is considered to be a strong predictor of the risk of myocardial infarction (MI), whereas a more stable calcified plaque is known to be protective against MI. There are several risk factors and protective factors which may influence the process of the rupture or vulnerability of the plaque. A randomized trial revealed that, after a median follow-up of 10·0 years, deaths due to CAD or non-fatal MI were less frequent in the CCTA group compared with a control group. Conclusions: Despite a few gaps in knowledge about the value of a staging system of ACAD, the available evidence indicates that it is helpful in decreasing morbidity and mortality with available therapies.
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(This article belongs to the Section Cardiology)
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Open AccessArticle
Utility of a Multimodal Biomarker Panel and Serum Proapoptotic Activity to Refine Diagnosis of Ovarian Adnexal Masses
by
Andrea Molina-Pineda, Francisco Osiel Jauregui-Salazar, Aleyda Guadalupe Zamudio-Martínez, Sayma Vizcarra-Ramos, Jesús García-Gómez, Benjamín González-Amézquita, Lizeth Montserrat Aguilar-Vazquez, Raquel Villegas-Pacheco, Rodolfo Hernandez-Gutierrez, Luis Felipe Jave-Suárez and Adriana Aguilar-Lemarroy
Diseases 2025, 13(10), 342; https://doi.org/10.3390/diseases13100342 - 16 Oct 2025
Abstract
Background/Objectives: Ovarian adnexal masses present diagnostic challenges due to their heterogeneous etiologies. Accurately differentiating these conditions is critical for timely and effective clinical intervention. This study evaluated circulating molecules and serum-induced apoptosis as complementary tools to conventional diagnostic methods (CA125, HE4, and the
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Background/Objectives: Ovarian adnexal masses present diagnostic challenges due to their heterogeneous etiologies. Accurately differentiating these conditions is critical for timely and effective clinical intervention. This study evaluated circulating molecules and serum-induced apoptosis as complementary tools to conventional diagnostic methods (CA125, HE4, and the ROMA index) for distinguishing benign masses from malignant masses. Methods: A cohort of 136 participants (9 healthy controls, 87 women with benign ovarian adnexal masses and 40 with malignant ovarian adnexal masses) was analyzed. The induction of apoptosis in Jurkat cells by patient serum was assessed using flow cytometry. Serum concentrations of sFas/CD95, HE4, CA125, and additional molecules were measured by ELISA and LEGENDplex™. Clinical, ultrasonographic, and histopathological data were correlated with tumor malignancy. To improve diagnostic performance beyond individual biomarkers, we developed two multiparametric classifiers that integrate the dominant parameters identified through group divergence analysis and ROC evaluation across multiple clinical comparisons. Results: Malignant tumors were associated with older age (51.45 ± 8.35 years, p = 0.0002), postmenopausal status (61.1%, p = 0.0013), and larger tumor size (>10 cm). Ultrasonographic features of complexity were observed exclusively in malignant masses. Functional assays revealed reduced apoptosis in Jurkat cells exposed to malignant sera, suggesting tumor-mediated immune evasion. Although higher sFas levels were observed in tumors, no significant differences were identified between the groups. Among the circulating biomarkers, CA125, HE4, MRP8/14, OPN, and SAA levels were significantly higher in malignant tumors than in benign tumors and controls. Conclusions: The evaluation of CA125, HE4, MRP8/14, and apoptosis (Classifier 1) and, more prominently, the measurement of additional molecules: OPN, SAA, IL-6, IL-8, and IGFBP-4 (Classifier 2), systematically outperformed the ROMA. Both achieved superior specificity and balanced accuracy (Youden’s J index) across all clinical comparisons by capturing the biological diversity of malignancies.
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(This article belongs to the Section Oncology)
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Open AccessReview
The Yin and Yang of Antibodies in Viral Infectious Diseases
by
Jianning He, Yiu-Wing Kam and Fok-Moon Lum
Diseases 2025, 13(10), 341; https://doi.org/10.3390/diseases13100341 - 15 Oct 2025
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Antibodies are a cornerstone of the adaptive immune response, serving as key defenders against viral infections; however, they can also act as a double-edged sword, contributing to immune-mediated pathologies. This review advances a “Yin-Yang” framework to integrate the dual activities of antibodies. The
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Antibodies are a cornerstone of the adaptive immune response, serving as key defenders against viral infections; however, they can also act as a double-edged sword, contributing to immune-mediated pathologies. This review advances a “Yin-Yang” framework to integrate the dual activities of antibodies. The protective ‘Yin’ functions are driven by high-affinity antibodies generated through processes like somatic hypermutation and class-switch recombination. These antibodies execute viral neutralization, activate the complement system, and engage Fc receptors (FcRs) to drive antibody-dependent cellular cytotoxicity (ADCC) and phagocytosis. These mechanisms form the immunological basis of effective vaccines, which aim to elicit durable and functionally specialized antibody isotypes like IgG and mucosal IgA. Conversely, the pathogenic ‘Yang’ of the response can be detrimental. This includes antibody-dependent enhancement (ADE) of infection, notably observed with flaviviruses, and the development of autoimmunity through mechanisms like molecular mimicry and bystander activation, which can lead to conditions such as multiple sclerosis and Guillain-Barré Syndrome. The balance between protection and pathology is tipped by a confluence of factors. These include viral evasion strategies like antigenic mutation and glycan shielding, as well as host-based determinants such as genetic polymorphisms in FcRs, immune history, and the gut microbiome. Understanding these molecular determinants informs the rational design of next-generation interventions. Promising strategies, such as Fc-region glyco-engineering and the design of tolerogenic vaccines, aim to selectively promote protective functions while minimizing pathological risks, offering a clear path forward in combating viral threats.
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Open AccessArticle
Pioneering Endoscopic Calcium-Electroporation in Gastric Cancer: A Case Series of an Emerging Therapeutic Approach
by
Giuliano Francesco Bonura, Noemi Gualandi, Paola Soriani, Pablo Cortegoso Valdivia, Tommaso Gabbani, Valentina Zadro, Federica Indulti, Gabriella Frassanito, Germana de Nucci and Mauro Manno
Diseases 2025, 13(10), 340; https://doi.org/10.3390/diseases13100340 - 15 Oct 2025
Abstract
Background/Objectives: Gastric cancer often presents at advanced stages with complications such as iron-deficiency anemia (IDA) due to chronic bleeding, representing a significant global health burden. Palliative management of bleeding tumors in frail patients remains challenging. This study evaluates the feasibility, safety, and efficacy
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Background/Objectives: Gastric cancer often presents at advanced stages with complications such as iron-deficiency anemia (IDA) due to chronic bleeding, representing a significant global health burden. Palliative management of bleeding tumors in frail patients remains challenging. This study evaluates the feasibility, safety, and efficacy of endoscopic calcium-electroporation (Ca-EP), a novel non-thermal ablation technique, for controlling bleeding in end-stage gastric cancer. Methods: Retrospective case series including consecutive patients with end-stage, bleeding gastric cancer and IDA requiring transfusions. Ca-EP was performed using the EndoVE system, which delivers bipolar electrical pulses (250 kHz) to induce reversible electroporation, enabling calcium influx and tumor cell apoptosis. Primary endpoints were clinical success (hemoglobin stabilization/reduced transfusions) and safety. Secondary endpoints included tumor regression, procedural time, and hospital stay. Results: Five patients (median age 81 years) were included. Clinical success was achieved in 80% (4/5) of patients, with reduced transfusion needs and stable hemoglobin levels. One patient required adjunctive hemostatic radiotherapy. No major or minor adverse events were reported, and all patients were discharged within 24 h. Procedural median time was 38 min (range: 22–65). Endoscopic follow-up in three patients showed mild tumor regression or stability. Three patients required repeat Ca-EP sessions due to recurrent bleeding. Conclusions: Endoscopic Ca-EP is a safe, minimally invasive palliative option for bleeding gastric cancer, offering sustained hemostasis and potential antitumor effects without systemic toxicity. Its feasibility in frail patients underscores its clinical relevance, though larger prospective studies are needed to optimize parameters and validate long-term outcomes.
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(This article belongs to the Special Issue Gastric Cancer: New Trends in Endoscopic Diagnosis Staging and Treatment)
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Open AccessCase Report
COVID-19 and Superimposed Aspergillosis in a Dual Organ Recipient with Diagnosed B-Cell Lymphoproliferative Disorder: A Rare Case Report and Literature Review
by
Vidna Karadžić-Ristanović, Jelena Pavlović, Voin Brković, Ana Bontić, Marko Baralić, Dragan Vasin, Maja Životić, Novica Boričić, Darko Antić, Vojin Vuković and Milan Radović
Diseases 2025, 13(10), 339; https://doi.org/10.3390/diseases13100339 - 14 Oct 2025
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Post-transplant lymphoproliferative disorder (PTLD) poses significant risks following organ transplantation, characterized by potential aggressiveness. This report aims to discuss a case of PTLD presenting as B-cell large-cell lymphoma (DLBCL) post kidney and pancreas transplantation. A 44-year-old female with type 1 diabetes underwent simultaneous
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Post-transplant lymphoproliferative disorder (PTLD) poses significant risks following organ transplantation, characterized by potential aggressiveness. This report aims to discuss a case of PTLD presenting as B-cell large-cell lymphoma (DLBCL) post kidney and pancreas transplantation. A 44-year-old female with type 1 diabetes underwent simultaneous cadaver kidney and pancreas transplantation. She presented with fever, night sweats, and weakness, revealing multiple lesions on CT, including in transplanted and native kidneys and pancreas. A biopsy of the transplant kidney confirmed PTLD, DLBCL subtype, with complex immunohistochemical findings. Chemotherapy (R-CHOP) was initiated but complicated by bowel perforation necessitating surgery and antibiotics, transplant renal vein thrombosis, pyelonephritis, and neutropenia. Despite the complications, the normal function of the transplanted kidney was maintained, which made it possible to implement the standard chemotherapy protocol. This case underscores the diagnostic challenges and therapeutic complexities of PTLD, specifically DLBCL, in transplant recipients. The co-infection of COVID-19 and aspergillosis in a multiple immunocompromised patient indicated a possible rapid course of the disease with global respiratory insufficiency and a fatal outcome despite all applied therapeutic modalities.
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Open AccessArticle
Vaginal Microbiota in Short Cervix Pregnancy: Secondary Analysis of Pessary vs. Progesterone Trial
by
Antonio G. Amorim Filho, Roberta C. R. Martins, Lucas A. M. Franco, Juliana V. C. Marinelli, Stela V. Peres, Rossana P. V. Francisco and Mário H. B. Carvalho
Diseases 2025, 13(10), 338; https://doi.org/10.3390/diseases13100338 - 14 Oct 2025
Abstract
Background/Objectives: Preterm birth (PTB) is a leading cause of neonatal mortality, particularly in women with a short cervix. Vaginal dysbiosis has been associated with increased PTB risk. Progesterone (PR) and Arabin pessary (PE) are commonly used for PTB prevention, but their impact on
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Background/Objectives: Preterm birth (PTB) is a leading cause of neonatal mortality, particularly in women with a short cervix. Vaginal dysbiosis has been associated with increased PTB risk. Progesterone (PR) and Arabin pessary (PE) are commonly used for PTB prevention, but their impact on vaginal microbiome composition is unclear. This study aimed to compare the effects of these interventions on the vaginal microbiome in women at risk of PTB. Methods: In a secondary analysis of a randomized trial at Hospital das Clínicas, Universidade de São Paulo, 203 women with singleton pregnancies and cervical length ≤ 25 mm at the second trimester were assigned to daily vaginal PR (200 mg) or PE. Vaginal swabs from 44 participants (n = 22 per group) were collected at baseline and 4 weeks post-treatment and analyzed via 16S rRNA gene sequencing. Results: From 88 samples analyzed, 80 showed a low-diversity, Lactobacillus-dominated microbiota, 42 classified into Lactobacillus iners-dominated community state type (CST-III), and 38 presented other Lactobacillus species dominance (termed CST-I/II/V). The remaining eight samples presented non-Lactobacillus dominance (CST-IV). Comparing the two groups, no significant changes in CST were observed between sampling timepoints (PE group, p = 0.368; PR group, p = 0.223). Similarly, Shannon alpha diversity did not change (PE group, p = 0.62; PR group, p = 0.30), and Bray–Curtis dissimilarity also did not change after treatment (p = 0.96, before; p = 0.87, after treatment). Conclusions: Arabin pessary and vaginal progesterone maintain vaginal microbiome stability in women at high PTB risk, supporting the microbiological safety of both interventions.
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(This article belongs to the Special Issue Microbiota in Human Disease)
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Severe Acute SARS-CoV-2 Infection and Long COVID: What Do We Know So Far? New Challenges in Diagnosis and Management
by
Sara Mazzanti, Francesco Barchiesi, Francesco Pallotta, Ilenia Luchetti, Andrea Giacometti and Lucia Brescini
Diseases 2025, 13(10), 337; https://doi.org/10.3390/diseases13100337 - 13 Oct 2025
Abstract
Background/Objectives: The long-term impact of the COVID-19 pandemic is not just limited to socioeconomic aspects; there are also important health issues to consider. Among these, one of the most important and obvious is long COVID. Despite a significant amount of scientific work having
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Background/Objectives: The long-term impact of the COVID-19 pandemic is not just limited to socioeconomic aspects; there are also important health issues to consider. Among these, one of the most important and obvious is long COVID. Despite a significant amount of scientific work having been published, this condition is still semi-unknown. The objective of this study was to collect useful information for the clarification of some epidemiological, clinical, and laboratory characteristics of this disease. Methods: This was a single-center study carried out at the Infectious Diseases Clinic of the hospital “AUO delle Marche” on all patients hospitalized for COVID-19 between November 2021 and March 2022. Results: From the data, it emerged that, following the resolution of the acute phase of SARS-CoV-2 infection, the majority of people experienced health problems that persisted for at least 6 months. The manifestations and outcomes affect different systems; therefore, long COVID, like COVID-19, has systemic involvement and the clinical manifestations may be residues of the damage caused by the disease during the acute phase, or new manifestations whose pathogenesis is still a matter of discussion. Conclusions: The persistence of inflammation and the dysregulation of the immune system represent some of the pathogenetic hypotheses. Inflammation could therefore represent one of the physiopathogenetic mechanisms of long COVID, and it is possible that it is responsible for the clinical symptoms that appear in the months following the resolution of the acute phase of the disease.
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(This article belongs to the Section Infectious Disease)
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