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 21.4 days after submission; acceptance to publication is undertaken in 2.7 days (median values for papers published in this journal in the second half of 2024).
- 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:
2.9 (2023)
Latest Articles
Iodine Intake from Universal Salt Iodization Programs and Hashimoto’s Thyroiditis: A Systematic Review
Diseases 2025, 13(6), 166; https://doi.org/10.3390/diseases13060166 (registering DOI) - 23 May 2025
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Background: Hashimoto’s thyroiditis (HT) is characterized by the loss of tolerance to thyroid autoantigens [thyroid peroxidase (TPO) and thyroglobulin (Tg)], usually identifying circulating antibodies (Abs) against these thyroid autoantigens (TPOAb and/or TgAb), together with a significant lymphocytic infiltration, causing an increased risk of
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Background: Hashimoto’s thyroiditis (HT) is characterized by the loss of tolerance to thyroid autoantigens [thyroid peroxidase (TPO) and thyroglobulin (Tg)], usually identifying circulating antibodies (Abs) against these thyroid autoantigens (TPOAb and/or TgAb), together with a significant lymphocytic infiltration, causing an increased risk of hypothyroidism. Among the multiple mechanisms described for the development of HT is the nutritional status of several micronutrients, including iodine. Iodine deficiency or excess is associated with thyroid function disorders and, likely, thyroid autoimmunity. Thus, iodized salt intake [especially through universal salt iodization (USI) programs] may be influencing the prevalence of HT. The objectives of this systematic review are to describe and analyze changes over time in the prevalence of HT following the implementation of USI programs. Methods and results: The following databases were consulted for articles published from January 1965 to January 2025: Pubmed/Medline; ProQuest; Scopus; Biosis; Web of Science; and Google Scholar. The search terms were as follows: “iodine”, “salt”, “intake”, “prevalence”, AND Hashimoto’s thyroiditis. Only English language articles were taken into account, and each of them was scrutinized according to the JBI Critical Appraisal Checklist. Only those studies in which the design, study population, number of participants, country, evaluation post-USI (years), and the prevalence of thyroid Abs positivity were described were included. In total, 74 studies were identified, of which 31 evaluated thyroid Abs values post-USI. Conclusions: Excess iodine intake, mediated by USI programs without an adequate follow-up and monitoring plan, may explain (at least in part) the prevalence and distribution of HT; therefore, it is a real challenge to establish a balance between healthy salt intake, USI program strategies, and possible functional outcomes and thyroid autoimmunity in the population. Registration number: INPLASY202540074.
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Open AccessArticle
Relationships Among Childhood Bullying, Academic Satisfaction, and Mental Health Outcomes in Adults with Disabilities
by
Bryan R. Christ, Bani Malhotra, Ghizlane Moustaid, Olivia Chapman and Paul B. Perrin
Diseases 2025, 13(6), 165; https://doi.org/10.3390/diseases13060165 - 23 May 2025
Abstract
Purpose/Objective: Children with disabilities are at a greater risk of being bullied and experience mental health and academic problems that may persist in adulthood. This study examined the association of childhood bullying experiences with current mental health (anxiety and depression) among adults with
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Purpose/Objective: Children with disabilities are at a greater risk of being bullied and experience mental health and academic problems that may persist in adulthood. This study examined the association of childhood bullying experiences with current mental health (anxiety and depression) among adults with disabilities, and whether academic satisfaction mediated the relationship between childhood bullying and adult mental health outcomes. Research Method/Design: A sample of 409 adult participants with disabilities who had had their disabilities while attending school, and currently, completed an online survey assessing bullying experiences (California Bullying Victimization Scale-Retrospective), academic satisfaction (Academic Satisfaction Scale), depression (Patient Health Questionnaire-9), and anxiety (Generalized Anxiety Disorder-7). Bivariate correlations and two mediation analyses were conducted to identify the direct and indirect effects of school bullying experiences on current mental health outcomes, via academic satisfaction. Results: Participants reported a moderate amount of childhood bullying and relatively high levels of depression and anxiety symptomology (with averages close to or exceeding clinical cutoffs of 10). Bivariate correlations among the four variables were all significantly moderately or strongly correlated. Bullying and academic satisfaction had direct associations with depression and anxiety. Academic satisfaction partially mediated the relationships between bullying and both mental health outcomes. Conclusions/Implications: Bullying prevention interventions and programs, especially geared toward preventing bullying in students with disabilities, are critical to stop the likely long-term impacts of bullying on mental health outcomes in disabled communities.
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(This article belongs to the Special Issue Mental Health Across the Lifespan: Integrating Multidisciplinary Perspectives)
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Open AccessArticle
The Effectiveness of Patient Education Interventions to Oncological Entero-Urostomy Patients and Caregivers: A Small Sample Size Pilot Study
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Alessandro Spano, Fabrizio Petrone, Emanuele Di Simone, Aurora De Leo, Paolo Basili, Irene Terrenato, Maria Antonietta Picano, Marco Piergentili, Albina Paterniani, Laura Iacorossi and Nicolò Panattoni
Diseases 2025, 13(6), 164; https://doi.org/10.3390/diseases13060164 - 22 May 2025
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Background: Patient education (PE) is an integral part of treatment from taking charge to the care, assistance, and rehabilitation of the patient, and consists of structured, organised actions, the orientation of which is aimed at finding solutions supported by scientific evidence. Aim: This
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Background: Patient education (PE) is an integral part of treatment from taking charge to the care, assistance, and rehabilitation of the patient, and consists of structured, organised actions, the orientation of which is aimed at finding solutions supported by scientific evidence. Aim: This prospective, descriptive, exploratory, single-centre pilot study aimed to evaluate the effectiveness of a PE intervention for oncological patients with entero-urostomies and their caregivers through the measurement of quality of life, perceived needs, and caregiver burden. Methods: This study was conducted in a National Cancer Institute between 22 December 2022 and 31 March 2023, and it was organised into three specific therapeutic education event days relative to the real needs measured by the patients and caregivers before it. Results: Our results seem to suggest that the PE intervention in entero-urostomy patients improves their quality-of-life levels, while caregivers’ perceived emotional burden levels are reduced. Conclusions: Targeted and individualised PE interventions positively affect self-care and quality of life in patients with an entero-urostomy and the emotional burden perceived by caregivers.
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Open AccessReview
Recent Developments in Rare Ovarian Carcinosarcoma: Literature Review and Case Report
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Alexandra Nienhaus and Elena Bernad
Diseases 2025, 13(6), 163; https://doi.org/10.3390/diseases13060163 - 22 May 2025
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Background and Objectives: Ovarian carcinosarcoma (OCS) is a rare gynecologic malignancy defined by both epithelial and mesenchymal components, generally associated with advanced clinical stage and poor outcomes. We present a 66-year-old patient initially presenting with right iliac vein thrombosis, ultimately diagnosed with OCS,
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Background and Objectives: Ovarian carcinosarcoma (OCS) is a rare gynecologic malignancy defined by both epithelial and mesenchymal components, generally associated with advanced clinical stage and poor outcomes. We present a 66-year-old patient initially presenting with right iliac vein thrombosis, ultimately diagnosed with OCS, and place these findings in context with a focused literature review from 2000 through to 2024. Methods: A comprehensive account of the patient’s clinical course—spanning diagnostic imaging, surgical pathology, neoadjuvant chemotherapy, and interval debulking—was combined with a review of the current data on OCS pathogenesis, treatment protocols, and outcomes. Results: The patient’s tumor showed predominantly sarcomatous histology (approximately 90%) with high-grade serous features, responded to platinum/taxane chemotherapy, and was resected to no visible residual disease. The updated literature indicates that the majority of OCS cases present at advanced stages (often exceeding 60%), with suboptimal cytoreduction closely tied to worse prognosis. Up to 64% of tumors may harbor homologous recombination deficiency, offering a rationale for PARP inhibitor therapy; nonetheless, five-year survival rarely surpasses 45% in most series. Conclusions: Despite its aggressive course, optimal debulking surgery plus platinum-based chemotherapy remain central in treating OCS. Emerging molecular insights highlight homologous recombination deficiency and BRCA mutations as potential therapeutic targets. Multidisciplinary care and future prospective studies are key to improving long-term outcomes in this challenging malignancy.
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Open AccessCase Report
An Unusual Case of Essential Thrombocythemia and Acute Kidney Injury: Case Report and Literature Review
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Celia Rodríguez Tudero, Alberto Martín Arribas, Patricia Antúnez Plaza, José C. De La Flor, Alexandra Lizarazo Suárez and María Pilar Fraile Gómez
Diseases 2025, 13(5), 162; https://doi.org/10.3390/diseases13050162 - 21 May 2025
Abstract
Background: Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by the uncontrolled proliferation of megakaryocytes and sustained thrombocytosis. Although its impact on renal function is not well established, a few case reports have described glomerular involvement and associated kidney impairment. Case Report: We
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Background: Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by the uncontrolled proliferation of megakaryocytes and sustained thrombocytosis. Although its impact on renal function is not well established, a few case reports have described glomerular involvement and associated kidney impairment. Case Report: We present the case of a 79-year-old man with ET and stage 3b/A2 chronic kidney disease (CKD), who was admitted with severe acute kidney injury (AKI). This episode was associated with a progressive rise in platelet count, reaching 1,350,000/μL after discontinuation of anagrelide and loop diuretics. Renal biopsy (RB) revealed structural lesions compatible with a myeloproliferative neoplasm, including acute tubular necrosis (ATN), glomerulomegaly, and thrombotic microangiopathy (TMA). Cytoreductive therapy with hydroxyurea and corticosteroids was initiated, resulting in improvement of renal function and achievement of complete hematologic remission. Discussion: During follow-up, a linear correlation was observed between increasing platelet counts and declining renal function, underscoring the need for dynamic therapeutic adjustment and close monitoring to prevent progression to end-stage renal disease (ESRD). Conclusion: This case highlights the importance of nephrological evaluation in patients with ET and supports the role of cytoreductive therapy in managing ET-associated renal complications.
Full article
Open AccessArticle
Effects of Sex and Race on Epidemiology and Comorbidities of Patients with Irritable Bowel Syndrome: A Rome III Era Retrospective Study
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Jacqueline Liu, Kathleen Cheng, Yu Lu, Howard Cabral and Horst Christian Weber
Diseases 2025, 13(5), 161; https://doi.org/10.3390/diseases13050161 - 21 May 2025
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Background: Irritable bowel syndrome (IBS) is a prevalent disorder of gut–brain interaction (DGBI) with a negative impact on quality of life and healthcare expenditure. This study aimed to investigate sex-based differences in a large cohort of IBS patients from a multiracial safety-net hospital.
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Background: Irritable bowel syndrome (IBS) is a prevalent disorder of gut–brain interaction (DGBI) with a negative impact on quality of life and healthcare expenditure. This study aimed to investigate sex-based differences in a large cohort of IBS patients from a multiracial safety-net hospital. Methods: An electronic query was performed using the International Classification of Diseases, 9th Revision (ICD-9) coding to identify 740 outpatients with IBS between 1 January 2005 and 30 September 2007. Demographic data and ICD-9 coded comorbidities were extracted from electronic records. Data analysis used descriptive statistics and multiple logistic regression analyses. Results: Comorbid anxiety and depression were significantly more prevalent in female patients (A:24%, p = 0.03; D:29%, p = 0.008) compared with male patients. White female IBS patients had a higher risk for anxiety but not depression compared with non-White patients (p = 0.02). Female sex (p = 0.02), obesity (p = 0.007), and age above fifty (p = 0.02) but not race/ethnicity were significant risk factors for depression. IBS with constipation was more prevalent in female patients (p = 0.005) and in Hispanic compared with non-Hispanic patients (p = 0.03). Conclusions: Significant sex-based and racial/ethnic differences were identified related to body mass index (BMI), age, and IBS subtypes in this study. Comorbid mood disorders occurred significantly more frequently in female patients, and risk factors for comorbid depression included female sex, older age, and obesity but not race/ethnicity.
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(This article belongs to the Section Gastroenterology)
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Open AccessReview
Benefits of Traditional Medicinal Plants to African Women’s Health: An Overview of the Literature
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Fatiha Brahmi, Florence Kampemba Mujinga, Naima Guendouze, Khodir Madani, Lila Boulekbache and Pierre Duez
Diseases 2025, 13(5), 160; https://doi.org/10.3390/diseases13050160 - 20 May 2025
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Background: In many African areas, herbal products still represent a significant source of healthcare. However, a major gender bias is evident in the literature, as most of the work is carried out by male researchers, collecting data from male traditional practitioners, and thus
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Background: In many African areas, herbal products still represent a significant source of healthcare. However, a major gender bias is evident in the literature, as most of the work is carried out by male researchers, collecting data from male traditional practitioners, and thus often neglecting women’s specific health issues. This warrants a detailed review of the current knowledge about the major medicinal plants historically and still used for women’s health. Objective: This study aims to compile and critically analyze published data on the use of traditional herbal remedies by African women in addressing specific health conditions, in order to evaluate the potential of traditional medicine as a viable alternative or complementary approach to modern healthcare for women globally. Methods: Data were retrieved from databases by combining the following relevant keywords: “abortion, adverse, Africa, attendant, birth, botanical, delivery, developing, drug, ethnomedicine, ethnopharmacology, folk, gynecological, healing, infertility, herb, indigenous, lactation, medicine, native, obstetric, phytomedicine, plant, pregnancy, remedy, side, sub-Saharan, traditional, treatment, women”. Results: More than 125 studies, carried out across 12 African nations, revealed that up to 80% of African women resort to herbal medicines. An estimated 200 medicinally important plant species are reported to be utilized by women in different African countries, including Benin, Cameroon, Côte d’Ivoire, Egypt, Ethiopia, Ghana, Kenya, Mali, Nigeria, South Africa, Tanzania, and Zimbabwe. These herbs have many applications, mostly focused on infertility, pregnancy, painful menstruation, breast feeding, breast cancer, and contraception. Interestingly, according to their occurrence of usage, the plants most commonly reported for these conditions that are important to women are ambivalent plants (i.e., used both as foods and medicines) that include Zingiber officinale Roscoe, Allium sativum L., Cucurbita pepo L., and Ricinus communis L. Conclusions: Even though most women, in most African countries, do use traditional medicine, the amount of work published remains quite limited and no data are available in many countries. Therefore, it is desirable to expand African studies in this direction.
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Open AccessArticle
Diffusion Tensor Imaging Magnetic Resonance Imaging Assessment in a Clinical Trial of Autologous Dendritic Cell Transfer for Diabetic Kidney Disease: A Molecular Approach
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Ernaldi Kapusin, Aditya Pratama Lokeswara, Yudo Rantung, Bhimo Aji Hernowo, Jonny Jonny, Chrismis Novalinda Ginting and Terawan Agus Putranto
Diseases 2025, 13(5), 159; https://doi.org/10.3390/diseases13050159 - 19 May 2025
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Background: Continuous rise of type 2 diabetes mellitus (T2DM) global prevalence, has led to a subsequent increase in the prevalence of diabetic kidney disease (DKD). DKD is associated with higher levels of inflammation and impaired kidney function. Many patients do not receive adequate
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Background: Continuous rise of type 2 diabetes mellitus (T2DM) global prevalence, has led to a subsequent increase in the prevalence of diabetic kidney disease (DKD). DKD is associated with higher levels of inflammation and impaired kidney function. Many patients do not receive adequate treatment for this condition. This research aims to evaluate the therapeutic impact of autologous dendritic cell transfer by examining its effects on renal microstructural changes as assessed through Diffusion Tensor Imaging (DTI) MRI, alongside the analysis of key inflammatory biomarkers, namely Matrix Metalloproteinase-9 (MMP-9) and Intercellular Adhesion Molecule-1 (ICAM-1). Methods: A clinical trial with an open-label design was performed with 25 DKD patients receiving outpatient care at Gatot Soebroto Army Hospital. Each participant was administered a single injection of autologous dendritic cells. Evaluations were conducted both prior to and one month following the treatment. The primary measurements included Diffusion Tensor Imaging (DTI) MRI-derived Fractional Anisotropy (FA) scans and the inflammatory biomarker MMP-9. Results: A notable increase in FA was observed, rising from 242.57 ± 63.97 at baseline to 305.61 ± 152.32 one month after the dendritic cell injection. However, there were no significant changes in MMP-9 and ICAM-1 levels. Additionally, a negative correlation was found between FA and MMP-9 (r = −0.324, p = 0.025). Conclusion: The transfer of autologous dendritic cells significantly enhanced FA, which correlates with a reduction in the inflammatory biomarker MMP-9, suggesting a potential impact on renal repair in DKD.
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Open AccessCase Report
A Vitiligo-like Cutaneous Reaction Induced by Ribociclib in Advanced Breast Cancer: An Unusual Case Report from Colombia
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John Fernando Montenegro, Giovanna Patricia Rivas-Tafurt, Sinthia Vidal-Cañas, Miguel Ángel Diaz-Diaz, Cesar Eduardo Bermudez, Daniel Florez, Andres Felipe Bravo-Gustin and Yamil Liscano
Diseases 2025, 13(5), 158; https://doi.org/10.3390/diseases13050158 - 19 May 2025
Abstract
Background: Cutaneous toxicities associated with CDK4/6 inhibitors are uncommon but may affect treatment adherence. We present the case of a patient with advanced breast cancer who developed vitiligo-like lesions after initiating ribociclib, contributing to the growing evidence of this under-recognized adverse effect. Methods:
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Background: Cutaneous toxicities associated with CDK4/6 inhibitors are uncommon but may affect treatment adherence. We present the case of a patient with advanced breast cancer who developed vitiligo-like lesions after initiating ribociclib, contributing to the growing evidence of this under-recognized adverse effect. Methods: We present the case of a 72-year-old woman diagnosed in 2007 with early-stage, luminal A, HER2-negative breast cancer, initially treated with surgery and tamoxifen. In 2022, she experienced locoregional recurrence with bone metastases. In January 2023, she began treatment with ribociclib plus letrozole. Two months later, she developed intense pruritus, xerosis, and paresthesia, followed by hypopigmented lesions on her face and upper extremities. Clinical evaluation, supported by photographs and a skin biopsy (led to a diagnosis of ribociclib-induced vitiligo. Management included dose adjustments to the ribociclib and dermatologic treatments, including topical corticosteroids, antihistamines, and short courses of oral prednisone. Results: By September 2024, her skin lesions had stabilized and her pruritus improved with a reduced dose of ribociclib (one tablet per day). However, the hypopigmented patches persisted, mainly on her face and extremities. Despite these cutaneous effects, she maintained an acceptable quality of life and continued effective oncologic treatment. Conclusions: This case highlights the importance of early recognition and management of ribociclib-related cutaneous toxicities. A multidisciplinary approach is essential to minimize adverse effects without compromising therapeutic efficacy. Further research into the dermatologic manifestations of targeted therapies is needed to optimize patient care.
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(This article belongs to the Section Oncology)
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Open AccessArticle
Evaluating Second-Generation Deep Learning Technique for Noise Reduction in Myocardial T1-Mapping Magnetic Resonance Imaging
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Shungo Sawamura, Shingo Kato, Naofumi Yasuda, Takumi Iwahashi, Takamasa Hirano, Taiga Kato and Daisuke Utsunomiya
Diseases 2025, 13(5), 157; https://doi.org/10.3390/diseases13050157 - 18 May 2025
Abstract
Background: T1 mapping has become a valuable technique in cardiac magnetic resonance imaging (CMR) for evaluating myocardial tissue properties. However, its quantitative accuracy remains limited by noise-related variability. Super-resolution deep learning-based reconstruction (SR-DLR) has shown potential in enhancing image quality across various MRI
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Background: T1 mapping has become a valuable technique in cardiac magnetic resonance imaging (CMR) for evaluating myocardial tissue properties. However, its quantitative accuracy remains limited by noise-related variability. Super-resolution deep learning-based reconstruction (SR-DLR) has shown potential in enhancing image quality across various MRI applications, yet its effectiveness in myocardial T1 mapping has not been thoroughly investigated. This study aimed to evaluate the impact of SR-DLR on noise reduction and measurement consistency in myocardial T1 mapping. Methods: This single-center retrospective observational study included 36 patients who underwent CMR between July and December 2023. T1 mapping was performed using a modified Look-Locker inversion recovery (MOLLI) sequence before and after contrast administration. Images were reconstructed with and without SR-DLR using identical scan data. Phantom studies using seven homemade phantoms with different Gd-DOTA dilution ratios were also conducted. Quantitative evaluation included mean T1 values, standard deviation (SD), and coefficient of variation (CV). Intraclass correlation coefficients (ICCs) were calculated to assess inter-observer agreement. Results: SR-DLR had no significant effect on mean native or post-contrast T1 values but significantly reduced SD and CV in both patient and phantom studies. SD decreased from 44.0 to 31.8 ms (native) and 20.0 to 14.1 ms (post-contrast), and CV also improved. ICCs indicated excellent inter-observer reproducibility (native: 0.822; post-contrast: 0.955). Conclusions: SR-DLR effectively reduces measurement variability while preserving T1 accuracy, enhancing the reliability of myocardial T1 mapping in both clinical and research settings.
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(This article belongs to the Section Cardiology)
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Open AccessReview
Developing a Personalized Approach to Follow-Up Blood Cultures in Gram-Negative Bloodstream Infections: A Narrative Review
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Renatos-Nikolaos Tziolos and Diamantis P. Kofteridis
Diseases 2025, 13(5), 156; https://doi.org/10.3390/diseases13050156 - 17 May 2025
Abstract
The utility of follow-up blood cultures (FUBCs) in Gram-negative bloodstream infections (GN-BSIs) remains controversial. The lack of randomized controlled trials and guidelines has led to the inappropriate use of unnecessary FUBCs, increasing costs, the length of hospital stays, and antibiotic use. In this
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The utility of follow-up blood cultures (FUBCs) in Gram-negative bloodstream infections (GN-BSIs) remains controversial. The lack of randomized controlled trials and guidelines has led to the inappropriate use of unnecessary FUBCs, increasing costs, the length of hospital stays, and antibiotic use. In this review, we aim to evaluate the strengths and limitations of the most significant studies on FUBCs in GN-BSIs, proposing a more personalized approach for using FUBCs in GN-BSIs. FUBCs seem to have a low yield of persistent positive BC in uncomplicated GN-BSIs and no effect on mortality, but some selected patients may benefit. Available studies show different results regarding the mortality and benefit of FUBCs, mainly due to differences in methodology and patient characteristics. However, selected patients with endovascular infections, central venous catheters, unfavorable responses, and no source control seem to benefit the most. Randomized controlled trials are warranted in order to confirm these indications.
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(This article belongs to the Section Infectious Disease)
Open AccessArticle
Increased Degenerative Biomarkers in Females with Patellofemoral Pain: A Cross-Sectional Analysis with 6-Month Progression
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Lori A. Bolgla, Tiana V. Curry-McCoy, Maya Giddens, Madelyn Overton, Bryaunna Barrera, Jasmine Crockett and Monte Hunter
Diseases 2025, 13(5), 155; https://doi.org/10.3390/diseases13050155 - 17 May 2025
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Background/Objectives: Patellofemoral pain (PFP) is considered a risk factor for knee osteoarthritis (OA) onset. The purpose of this study was to compare degenerative biomarkers in females with and without PFP and to determine changes in these levels, along with pain and function, over
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Background/Objectives: Patellofemoral pain (PFP) is considered a risk factor for knee osteoarthritis (OA) onset. The purpose of this study was to compare degenerative biomarkers in females with and without PFP and to determine changes in these levels, along with pain and function, over 6 months. Methods: All subjects received a knee x-ray to ensure that none had degenerative changes. Urine and serum were collected and analyzed for C-telopeptide fragments of type II collagen (CTX-II) and C-propeptide II (CP-II); these were then expressed as a cartilage degradation: cartilage synthesis ratio (CTX-II:CP-II). Subjects with PFP rated pain using a 10 cm visual analog scale, and function using the Knee injury and Osteoarthritis Outcome Scores-Patellofemoral (KOOS-PF) questionnaire. Subjects with PFP were tested at baseline and at 6 months. Results: Females with PFP had higher levels of CTX-II:CP-II than controls (p < 0.001) and these remained elevated at 6 months (p = 0.82). Females with PFP reported similar levels of pain (p = 0.30) but higher function at 6 months (p = 0.002). However, the 9.0-point increase in KOOS-PF values did not exceed the minimum important change. Conclusions: Females with PFP but no evident structural changes had more elevated biomarkers than controls. This finding suggests that this cohort may have excessive cartilage turnover which may contribute to knee OA.
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Open AccessArticle
Curcumin Reverses Antibiotic Resistance and Downregulates Shiga Toxin Expression in Enterohemorrhagic E. coli
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Martin Zermeño-Ruiz, Mirian Cobos-Vargas, Mauro Donaldo Saucedo-Plascencia, Rafael Cortés-Zárate, Leonardo Hernandez-Hernandez, Teresa Arcelia Garcia-Cobian, Teresa Estrada-Garcia and Araceli Castillo-Romero
Diseases 2025, 13(5), 154; https://doi.org/10.3390/diseases13050154 - 17 May 2025
Abstract
Background: Enterohemorrhagic Escherichia coli (EHEC) is a considerable public health concern associated with several foodborne outbreaks of bloody diarrhea (BD) and the potentially lethal hemolytic uremic syndrome (HUS), the pathophysiology of which is attributable to the Shiga toxin (Stx) produced by this bacterium.
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Background: Enterohemorrhagic Escherichia coli (EHEC) is a considerable public health concern associated with several foodborne outbreaks of bloody diarrhea (BD) and the potentially lethal hemolytic uremic syndrome (HUS), the pathophysiology of which is attributable to the Shiga toxin (Stx) produced by this bacterium. In most patients, supportive treatment will be sufficient; however, in some cases, antibiotic treatment may be necessary. Most antibiotics are not recommended for EHEC infection treatment, particularly those that kill the bacteria, since this triggers the release of Stx in the body, inducing or worsening HUS. Azithromycin, which prevents the release of Stx and is a weaker inducer of the SOS system, has been successfully used to reduce EHEC shedding. It is necessary to identify compounds that eliminate EHEC without inducing Stx release. The use of natural compounds such as curcumin (CUR), a polyphenol derived from turmeric, has been highlighted as an alternative bactericidal treatment approach. Objective: The objective of this study was to establish the effect of CUR and its interactions with selected antibiotics on resistant EHEC O157/H7/EDL933. Methods: Bacterial cultures were exposed to CUR at three different concentrations (110, 220, and 330 µg/mL) and 1.2% DMSO, and the antimicrobial activity of CUR was assessed by measuring the optical density at 600 nm (OD600). The synergy of CUR and the antibiotics was determined with the FIC method. RT-PCR was performed to determine the expression levels of the blaCTX-M-15, catA1, acrAB-tolC stx2A, and stx2B genes. Results: Our data indicate that CUR did not affect the growth of EHEC, but when combined with the antibiotics, it acted as a bacterial resistance breaker. Synergistic combinations of CUR and cefotaxime or chloramphenicol significantly reduced colony counts. Conclusions: Our findings support the potential of CUR as a sensitizer or in combination therapy against EHEC.
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(This article belongs to the Section Infectious Disease)
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Open AccessCase Report
Hypertensive Emergency and Atypical Hemolytic Uremic Syndrome Associated with Cocaine Use: A Diagnostic and Therapeutic Challenge
by
Elena Jiménez Mayor, José C. De La Flor, André Rocha Rodrigues, Celia Rodríguez Tudero, Rocío Zamora González-Mariño, Jacqueline Apaza, Esperanza Moral Berrio and Javier Deira Lorenzo
Diseases 2025, 13(5), 153; https://doi.org/10.3390/diseases13050153 - 15 May 2025
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Background: Atypical hemolytic uremic syndrome (HUS) is a rare form of thrombotic microangiopathy (TMA) characterized by complement dysregulation. Cocaine use has been reported to be a potential trigger of TMA; however, the underlying mechanisms remain poorly elucidated. Proposed hypotheses include direct endothelial injury,
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Background: Atypical hemolytic uremic syndrome (HUS) is a rare form of thrombotic microangiopathy (TMA) characterized by complement dysregulation. Cocaine use has been reported to be a potential trigger of TMA; however, the underlying mechanisms remain poorly elucidated. Proposed hypotheses include direct endothelial injury, activation of the complement cascade, and the unmasking of whether HUS is genetic or acquired. Case Report: We report the case of a 47-year-old man who presented with hypertensive emergency and acute kidney injury following intranasal cocaine use. The laboratory findings were consistent with microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and markedly elevated lactate dehydrogenase (LDH) levels. Renal biopsy (RB) revealed classic features of TMA, including glomerular capillary thrombosis, fibrinoid necrosis, and acute tubular injury. Complement studies demonstrated reduced levels of Factor I, indicative of complement dysregulation. The patient was treated with therapeutic plasma exchange and four weekly doses of eculizumab, resulting in hematologic remission and significant improvement in renal function, without the need for dialysis. Genetic testing for known atypical HUS-associated mutations was negative; therefore, maintenance therapy with eculizumab was discontinued without clinical relapses. Discussion: This case underscores cocaine as a rare but important precipitating factor for atypical HUS in predisposed individuals. Early diagnosis, RB, and complement evaluation were essential in determining the etiology and guiding targeted therapy. Complement inhibition with eculizumab was effective in halting disease progression and preventing long-term renal damage. Conclusions: This case highlights the relevance of considering cocaine use as a potential trigger of complement-mediated TMA. Early identification of aHUS features and prompt initiation of complement inhibition therapy may be critical to preventing irreversible kidney injury.
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Open AccessSystematic Review
Uterine Transplantation: Advances, Challenges, and Future Perspectives
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Ana Pereira, Flávia Ribeiro, Sandra Soares and Hélder Ferreira
Diseases 2025, 13(5), 152; https://doi.org/10.3390/diseases13050152 - 15 May 2025
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Background: Infertility is a multifactorial condition with medical, psychological, demographic, and economic impacts. Around 3–5% of cases are due to uterine dysfunction. Absolute uterine factor infertility (AUFI) refers to infertility caused entirely by the absence or abnormality of the uterus, which prevents embryo
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Background: Infertility is a multifactorial condition with medical, psychological, demographic, and economic impacts. Around 3–5% of cases are due to uterine dysfunction. Absolute uterine factor infertility (AUFI) refers to infertility caused entirely by the absence or abnormality of the uterus, which prevents embryo implantation or pregnancy viability. Uterus transplantation (UTx) has emerged as a promising treatment for AUFI and has been successfully performed in over 10 countries. Objectives: This study aims to conduct a systematic review of uterus transplantation, evaluating its efficacy and safety, as well as maternal, neonatal, and long-term outcomes. It also explores current challenges and future directions. Methods: The methodology was registered on the PROSPERO platform. A literature search was performed in January 2025 across PubMed, Web of Science, and Scopus for articles published from January 2002 to December 2024 in English or Portuguese. The query was: “uterus/transplantation AND (pregnancy OR complications OR newborn OR premature OR diseases)”. Study quality was assessed by journal impact factor (IF). Data were analyzed using Microsoft Excel. Results: A total of 10 studies were included: four from Sweden, three from the DUETS group, two from the Czech Republic, and one multi-institutional American study. The UTx success rate was 74.0%; clinical pregnancy rate (CPR) and live birth rates (LBR) per embryo transfer (ET) were 36.3% and 22.0%, respectively. No significant increase in congenital or neurological complications was observed. Adverse psychological outcomes were associated with transplant failure or pregnancy loss. Conclusions: UTx is a promising treatment for AUFI, showing favorable pregnancy and birth outcomes without major fetal or neonatal risks.
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Open AccessArticle
The Inverse Association of Mediterranean Diet with Emotional Eating: A Cross-Sectional Study in Greek Adults
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Maria Mentzelou, Sousana K. Papadopoulou, Aikaterini Louka, Georgia-Eirini Deligiannidou, Evmorfia Psara and Constantinos Giaginis
Diseases 2025, 13(5), 151; https://doi.org/10.3390/diseases13050151 - 14 May 2025
Abstract
Background/Objectives: Emotional eating (EE) is the tendency to overeat in response to negative emotions. Food consumption is influenced by both personal and environmental factors. Emotions are personal factors that can affect food consumption. The objective of this study is to assess the association
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Background/Objectives: Emotional eating (EE) is the tendency to overeat in response to negative emotions. Food consumption is influenced by both personal and environmental factors. Emotions are personal factors that can affect food consumption. The objective of this study is to assess the association between Mediterranean diet (MD), a dietary pattern promoting mental health, and emotional eating via the Three-Factor Eating Questionnaire (TEFQ). Methods: This is a cross-sectional survey including 328 adults aged 18–75 years. Appropriate questionnaires were applied for evaluating adherence to the Mediterranean diet (MedDiet score) and types of feeding and the expression of emotional food consumption (TFEQ). Results: A mean MedDiet score equal to 30.97 ± 4.93 and a total TFEQ score equal to 45.40 ± 6.31 were noted. MedDiet score was significantly inversely associated with TFEQ total score (r = 0.23, p = 0.026) as well as with TFEQ emotional score (r = 0.37, p < 0.0001). Fruits and vegetables consumption was positively associated with TFEQ emotional score (r = 0.25, p = 0.014, and r = 0.20, p = 0.049, respectively). Conclusions: In order to produce data showing improvements in eating behavior, our findings have highlighted the significance of conducting large, prospective, well-designed, randomized, interventional clinical studies to confirm the inverse association of MD with EE. The interpretation of the results is complicated due to cross-sectional design, the social desirability bias and the self-report nature of both dietary and emotional assessments.
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(This article belongs to the Section Clinical Nutrition)
Open AccessArticle
Risk of Insulin Resistance: Comparison of the Commerce vs. Industry Sector and Associated Variables
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María Pilar Fernández-Figares Vicioso, Pere Riutord Sbert, Ángel Arturo López-González, José Ignacio Ramírez-Manent, José Luis del Barrio Fernández and María Teófila Vicente Herrero
Diseases 2025, 13(5), 150; https://doi.org/10.3390/diseases13050150 - 14 May 2025
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Background: Insulin resistance (IR) is a key metabolic alteration that precedes type 2 diabetes and is closely linked to obesity and lifestyle factors. Occupational context may influence IR risk through variations in physical activity, diet, and socioeconomic determinants. Objective: To compare the risk
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Background: Insulin resistance (IR) is a key metabolic alteration that precedes type 2 diabetes and is closely linked to obesity and lifestyle factors. Occupational context may influence IR risk through variations in physical activity, diet, and socioeconomic determinants. Objective: To compare the risk of insulin resistance between workers in the commerce and industry sectors and identify associated sociodemographic and lifestyle factors, in order to improve their occupational health. Methods: This cross-sectional study analyzed data from 56,856 Spanish workers, assessing four IR-related indices: Triglyceride-Glucose Index (TyG), TyG-BMI (Triglyceride-Glucose Body Mass Index), Metabolic Score for Insulin Resistance (METS-IR), and the Single-Point Insulin Sensitivity Estimator (SPISE-IR). The analysis was stratified by sex and sector (commerce vs. industry) and included assessments of age, education level, physical activity, adherence to the Mediterranean diet, and smoking status. Multinomial logistic regressions were performed to determine the factors associated with high IR scores. Results: Across all IR indicators, industry workers—particularly men—presented higher mean values and greater prevalence of high-risk scores compared to those in commerce. Women showed lower values overall but also reflected sector-based differences. In both sexes, non-physical activity, non-adherence to the Mediterranean diet, and smoking were consistently associated with higher IR risk. Males exhibited significantly higher odds of elevated TyG (OR = 2.59, 95% CI: 2.41–2.78), while physical inactivity and poor diet emerged as the most powerful modifiable predictors across all scales (e.g., OR = 10.45 for TyG, OR = 12.33 for TyG-BMI). Industry sector was independently associated with higher odds of insulin resistance compared to commerce. Conclusions: Insulin resistance is more prevalent among industrial workers, especially men and those with unhealthy lifestyles. Occupational health strategies should target sector-specific risk profiles, emphasizing physical activity and dietary interventions.
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Open AccessArticle
Trends and Outcomes of TAVR: An Analysis Using the National Inpatient Sample and Readmissions Database
by
Vivek Joseph Varughese, Vignesh Krishnan Nagesh, Hadrian Hoang-Vu Tran, Olivia Yessin, Harsh Jha, Ashley Mason, Audrey Thu, Simcha Weissman and Adam Atoot
Diseases 2025, 13(5), 149; https://doi.org/10.3390/diseases13050149 - 13 May 2025
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Background: Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for severe aortic stenosis in high- and intermediate-risk patients, with expanding indications for lower-risk populations. However, post-procedural complications, such as stroke, conduction disturbances, and heart failure readmissions, remain concerns. The aim
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Background: Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for severe aortic stenosis in high- and intermediate-risk patients, with expanding indications for lower-risk populations. However, post-procedural complications, such as stroke, conduction disturbances, and heart failure readmissions, remain concerns. The aim of our study is to analyze the national trends in TAVR procedures, in-hospital outcomes, major readmission causes, and the association of risk factors for readmissions following TAVR. Methods: We analyzed NIS data (2018–2022) to assess TAVR utilization trends, patient demographics, and in-hospital outcomes. The NRD (2021–2022) was used to evaluate 60-day readmission rates for stroke, complete heart block, and heart failure. Multivariate regression models were employed to identify risk factors having significant association with major readmission causes. Results: TAVR utilization increased from 10,788 cases in 2018 to 17,784 in 2022, with a concurrent decrease in in-hospital mortality (1.33% to 0.90%) and length of stay (3.88 to 2.97 days). Of 123,376 TAVR index admissions in 2021, 28,654 patients had 66,100 readmission events (53.57%) in the 60 days following discharge. Heart failure (17,566 cases, 26.57% of readmissions) was the most common readmission cause, followed by complete heart block (1760 cases, 2.66% of readmissions) and stroke (284 cases, 0.42% of readmissions). Predictors of post-TAVR stroke included uncontrolled hypertension (OR 2.29, p < 0.001) and chronic heart failure (OR 2.73, p < 0.001). Left bundle branch block (LBBB) was strongly associated with complete heart block (OR 12.89, p < 0.001) and heart failure readmissions (OR 7.65, p < 0.001). Conclusions: TAVR utilization has increased with improving perioperative outcomes, but post-TAVR readmissions remain significant, particularly for heart failure, stroke, and conduction disturbances. Pre-procedural uncontrolled hypertension, hyperlipidemia, congestive heart failure, and atrial fibrillation were risk factors with significant association with stroke in the 60 days following TAVR. The presence of documented pre-procedural LBB, RBB, as well as BFB were risk factors with significant association with complete heart block following TAVR placements. Pre-procedural LBB, RBB, BFB, and atrial fibrillation were risk factors having significant association with heart failure readmissions in the 60 days following TAVR.
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Open AccessArticle
Examining Romosozumab Adherence and Side Effects in Osteoporotic Patients After Surgical Fracture Fixation: A Comparative, Descriptive, and Hypothesis-Generating Study with Non-Fractured Controls
by
Amarildo Smakaj, Umberto Tarantino, Riccardo Iundusi, Angela Chiavoghilefu, Lorenzo Abbondante, Chiara Salvati, Chiara Greggi and Elena Gasbarra
Diseases 2025, 13(5), 148; https://doi.org/10.3390/diseases13050148 - 11 May 2025
Abstract
Objectives: The study aims to evaluate adherence to Romosozumab treatment in osteoporotic patients after surgical fracture fixation and compare side effects with non-fractured controls on the same therapy. Methods: This retrospective case–control study was conducted at the Orthopaedic Department of Policlinico Universitario di
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Objectives: The study aims to evaluate adherence to Romosozumab treatment in osteoporotic patients after surgical fracture fixation and compare side effects with non-fractured controls on the same therapy. Methods: This retrospective case–control study was conducted at the Orthopaedic Department of Policlinico Universitario di Roma “Tor Vergata”, following the principles of the Declaration of Helsinki. It included postmenopausal women aged over 60, with the case group receiving Romosozumab after fracture fixation, and the control group consisting of women on Romosozumab therapy without fracture fixation. Exclusion criteria included psychiatric conditions, contraindications to Romosozumab, high-energy trauma, or other bone metabolism disorders. Data on fractures, surgeries, FRAX (Fracture Risk Assessment Tool) scores, BMD (Bone Mineral Densit) values, and follow-up details were collected. Side effects, including nasopharyngitis and severe events like hypocalcemia, stroke, and myocardial infarction, were recorded. Adherence was assessed via pharmacy records and patient interviews during routine clinical follow-up visits. Statistical analysis was performed using descriptive statistics, t-tests, and chi-square tests. Results: The study included 25 patients, with 12 in the surgical group and 13 in the conservative treatment group. The surgical group had a mean age of 67.3 years and a follow-up of 374 days, while the conservative group had a mean age of 76.4 years and a follow-up of 287 days. The surgical group underwent various fracture treatments, including femoral, humeral, and distal radius fractures, while the conservative group was treated with immobilization. There were no significant differences in FRAX scores or BMD values between the two groups. Vitamin D levels increased significantly in both groups after supplementation, but parathyroid hormone levels showed no difference. No new fractures occurred, and surgical patients had no delayed union or nonunion, though two had superficial wound infections. Conclusions: Both groups adhered well to Romosozumab therapy, with no severe side effects; minor side effects included myalgia in the surgical group and shoulder arthralgia in the conservative group. Romosozumab is well-tolerated and adherent in osteoporotic patients after osteosynthesis surgery, with adverse events similar to non-fractured individuals. While the study design is appropriate, multicenter trials would improve the sample size and allow for subgroup analysis based on fracture type and demographics.
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Long-Term Trends in Respiratory Syncytial Virus A Infections (2007–2024) in Korea
by
Jeong Su Han, Sung Hun Jang, Jae-Sik Jeon and Jae Kyung Kim
Diseases 2025, 13(5), 147; https://doi.org/10.3390/diseases13050147 - 10 May 2025
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Background/Objectives: Respiratory syncytial virus A (RSV A) is the leading cause of respiratory infections, particularly in vulnerable populations. This study aimed to investigate the long-term epidemiological trends of RSV A infection in the Republic of Korea over an 18-year period (2007–2024), with emphasis
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Background/Objectives: Respiratory syncytial virus A (RSV A) is the leading cause of respiratory infections, particularly in vulnerable populations. This study aimed to investigate the long-term epidemiological trends of RSV A infection in the Republic of Korea over an 18-year period (2007–2024), with emphasis on age, sex, and seasonal differences. Methods: A total of 23,284 nasopharyngeal swab specimens were analyzed by multiplex real-time PCR. Statistical comparisons were performed using the chi-square test. Results: The RSV A-positivity rate was highest in 2007 (19.7%) and lowest in 2021 (0.1%) (p < 0.001). Infants (0 years) exhibited the highest infection rate (18.5%, 95% CI: 17.3–19.6), whereas adults aged 20–64 years and older adults showed significantly lower rates (0.7% and 0.9%, respectively). Seasonal peaks occurred in winter (15.3%) and autumn (14.7%), indicating earlier onset of RSV A circulation. No significant difference was found between sexes (p = 0.196). Conclusions: This study provides the first long-term retrospective analysis of RSV A trends in the Republic of Korea and reveals a shift toward an earlier seasonal onset. These findings support the need for earlier preventive strategies and optimized vaccination timing, particularly for high-risk groups, such as infants. These findings underscore the importance of seasonal variation and the potential influence of environmental factors, such as ambient temperature, relative humidity, and geographic latitude, on RSV A transmission patterns in Korea, although these variables were not directly analyzed in the present study and warrant further investigation.
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