Diseases

22 pages, 1056 KB

Open AccessArticle

Cancer Patterns and Barriers to Care Among Socioeconomically Vulnerable Populations in Tripoli: A Descriptive Study from a Local NGO

by Mouhamad J. Darwich, Dalal Ksair, Zein Adra, Rafaela-Yomn Naji, Bushra Sayed, Rihab Nasr and Zeina Dassouki

Diseases 2026, 14(5), 170; https://doi.org/10.3390/diseases14050170 - 12 May 2026

Abstract

Background/Objectives: Cancer patterns in low-resource and crisis-affected settings are poorly characterized, particularly among socioeconomically vulnerable populations. This study aimed to describe cancer distribution, age at diagnosis, and barriers to care among patients presenting to a non-governmental organization (NGO) in Tripoli, Lebanon. Methods: We [...] Read more.

Background/Objectives: Cancer patterns in low-resource and crisis-affected settings are poorly characterized, particularly among socioeconomically vulnerable populations. This study aimed to describe cancer distribution, age at diagnosis, and barriers to care among patients presenting to a non-governmental organization (NGO) in Tripoli, Lebanon. Methods: We conducted a retrospective analysis of patients with histopathologically confirmed cancers presenting to a single NGO. Sociodemographic, clinical, and behavioral data were extracted from medical records. Socioeconomic status (SES) was assessed using a validated composite scale. Age-standardized proportions (ASPs) were calculated using GLOBOCAN and WHO standard weights. Barriers to care were categorized into financial, geographic, system-level, and sociocultural domains. Associations were assessed using chi-square tests and regression models. Results: Breast cancer was the most common malignancy (32.0%), followed by colorectal (CRC: 9.8%). A total of 440 patients were included. Colorectal cancer (CRC) was the second-most common malignancy, with 37% of cases occurring before age 50. Breast cancer accounted for nearly half of female cancers. Smoking-related malignancies, particularly bladder and lung cancers, were prominent. Sex differences were cancer-specific, with male sex associated with bladder cancer but not overall cancer distribution. Barriers to care were highly prevalent: 97.3% reported at least one financial barrier, 95.4% system-level barriers, and 72.4% geographic barriers. Low SES was significantly associated with geographic barriers (p < 0.001). Conclusions: Cancer patterns in this vulnerable population are characterized by early-onset disease, a high burden of smoking-related cancers, and pervasive barriers to care. These findings highlight the importance of integrating SES and access-related variables into cancer surveillance systems and support the development of targeted, equity-focused interventions. Full article

(This article belongs to the Topic Multidimensional Disparities in Cancer Care and Outcomes)

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11 pages, 801 KB

Open AccessArticle

Predicting Diagnostic Success and Procedural Efficiency in Robotic Bronchoscopy Using Machine Learning

by Juliana Guarize, Claudia Bardoni, Cristina Diotti, Stefano Maria Donghi and Luca Bertolaccini

Diseases 2026, 14(5), 169; https://doi.org/10.3390/diseases14050169 - 11 May 2026

Abstract

Background. Robotic-assisted bronchoscopy with the ION™ Endoluminal System facilitates precise access to peripheral pulmonary lesions. However, procedural duration and diagnostic performance remain influenced by patient and lesion-specific factors. To investigate the impact of lesion diameter, radiological appearance, and presence of bronchial signs on [...] Read more.

Background. Robotic-assisted bronchoscopy with the ION™ Endoluminal System facilitates precise access to peripheral pulmonary lesions. However, procedural duration and diagnostic performance remain influenced by patient and lesion-specific factors. To investigate the impact of lesion diameter, radiological appearance, and presence of bronchial signs on procedural duration and diagnostic yield using conventional regression and gradient boosting machine learning models. Methods. In this single-center retrospective cohort study, 189 ION™ Endoluminal System procedures (November 2024–June 2025) were analyzed. Procedural duration and diagnostic yield served as primary outcomes. Predictive modeling included multivariable regression and gradient boosting. Feature importance metrics were extracted. Results. The median lesion diameter was 12.3 mm, with a “strict” diagnostic yield of 87.3%. Gradient boosting regression identified lesion diameter as the primary predictor of procedural time (89.2% importance; test MSE = 865.6). Diagnostic classification achieved an ROC-AUC of 0.68, with lesion diameter (85.8%) and bronchial sign (14.2%) as key predictors. Conclusions. Lesion diameter emerged as the most consistent predictor of procedural efficiency and was associated with diagnostic performance, albeit within the limitations of the dataset. Broader datasets are needed for external validation and generalizability. Full article

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8 pages, 1776 KB

Open AccessCase Report

Seven Years of 700 Cholesterol Without Coronary Atherosclerosis: A Lean Mass Hyper-Responder Case Report

by Nicholas G. Norwitz, David Feldman and Adrian Soto-Mota

Diseases 2026, 14(5), 168; https://doi.org/10.3390/diseases14050168 - 11 May 2026

Abstract

Background: While reducing LDL cholesterol (LDL-C) remains central focuses of conventional preventive cardiology, substantial heterogeneity exists in the cardiovascular risk associated with even extreme LDL-C elevations, likely depending heavily on the broader metabolic context. Specifically, the lean mass hyper-responder (LMHR) phenotype—characterized by markedly [...] Read more.

Background: While reducing LDL cholesterol (LDL-C) remains central focuses of conventional preventive cardiology, substantial heterogeneity exists in the cardiovascular risk associated with even extreme LDL-C elevations, likely depending heavily on the broader metabolic context. Specifically, the lean mass hyper-responder (LMHR) phenotype—characterized by markedly elevated LDL-C with elevated high-density lipoprotein cholesterol (HDL-C) and low triglycerides in the setting of a ketogenic diet—has recently been described, though its long-term risk profile remains poorly defined. Case Presentation: We describe a male in his 30s without any congenital dyslipidemia who adopted a ketogenic diet for the management of ulcerative colitis and who subsequently exhibited a sixfold increase in LDL-C from a baseline of 95 mg/dL to 574 mg/dL, with total cholesterol of up to 705 mg/dL, HDL-C at 124 mg/dL, and triglycerides at 34 mg/dL. Despite maintaining these extreme lipid levels for nearly seven years, he demonstrated no coronary plaque or stenosis on coronary computed tomography angiography (CCTA; CAD-RADS = 0). Additionally, quantification of coronary plaque as assessed by AI-guided quantified analysis by Heartflow^® identified 0 mm³ plaque in any vessels, placing him in the lowest percentile for atherosclerotic plaque. Conclusions: This case represents an extreme and extensively characterized example of the LMHR phenotype and highlights the limitations of extrapolating cardiovascular risk from LDL-C levels alone without consideration of broader patient context and the etiology of hypercholesterolemia. While a single case cannot redefine clinical practice, this well-characterized case is consistent with emergent literature on LMHR, and careful study of such individuals may provide valuable insights into lipid metabolism, atherosclerosis biology, and precision cardiovascular risk assessment. Full article

(This article belongs to the Special Issue Metabolic Disorders: Insights into Pathogenesis and Novel Therapeutic Strategies (2nd Edition))

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38 pages, 3203 KB

Open AccessSystematic Review

Vitamin D and Vitamin B₁₂ in Psychiatric Disorders: An Exploratory Systematic Review and Meta-Analysis of Nutrient-Specific Status and Supplementation Evidence

by Lavinia-Alexandra Moroianu, Cecilia Curis, Valeriu Ardeleanu, Roxana Elena Bogdan-Goroftei, Simona-Dana Mitincu-Caramfil, Marius Moroianu and Alina Pleșea-Condratovici

Diseases 2026, 14(5), 167; https://doi.org/10.3390/diseases14050167 - 10 May 2026

Abstract

Background/Objectives: Evidence linking vitamins D and B₁₂ to psychiatric outcomes remains heterogeneous across designs, populations, phenotypes, exposures, and outcome formats. Methods: We conducted a PRISMA 2020 systematic review and exploratory meta-analysis of nutrient-specific status and supplementation evidence. PubMed/MEDLINE, APA PsycInfo, Cochrane Library, [...] Read more.

Background/Objectives: Evidence linking vitamins D and B₁₂ to psychiatric outcomes remains heterogeneous across designs, populations, phenotypes, exposures, and outcome formats. Methods: We conducted a PRISMA 2020 systematic review and exploratory meta-analysis of nutrient-specific status and supplementation evidence. PubMed/MEDLINE, APA PsycInfo, Cochrane Library, Google Scholar, ClinicalTrials.gov, and ProQuest were searched for human studies published in 2016–2025, with a final update on 1 March 2026. Forty-six studies were included (24 randomized controlled trials, 22 observational studies; N = 69,902), and 44 contributed quantitative data. Effects were harmonized to odds ratios (ORs) for cross-family comparability and pooled using Hartung–Knapp random-effects models; supplementation evidence was additionally interpreted on the standardized mean difference (SMD) scale. Results: Across the main evidence families, pooled estimates showed substantial heterogeneity and limited generalizability. Vitamin D supplementation showed an initial inverse estimate on the secondary harmonized OR scale (OR = 0.439, 95% CI 0.272–0.710) and a clinically interpretable SMD of −0.454 (95% CI −0.718 to −0.189), but heterogeneity was high (I² = 84.2%) and trim-and-fill attenuated the OR estimate to the null (OR = 0.88, 95% CI 0.48–1.63). Vitamin D status showed a similar pattern (primary OR = 0.615, 95% CI 0.424–0.890; trim-and-fill OR = 0.90, 95% CI 0.54–1.49). Vitamin B₁₂ status was inversely associated with outcomes (OR = 0.310, 95% CI 0.115–0.834), but heterogeneity was extreme (I² = 94.8%). B₁₂ supplementation evidence was sparse and null. Conclusions: The evidence supports targeted deficiency assessment, not routine supplementation. Full article

(This article belongs to the Special Issue Mental Health—Management and Care, Multidisciplinary Approaches and Perspectives)

21 pages, 1696 KB

Open AccessReview

RHOBTB2-Associated Neurological Phenotypes and Underlying Mechanisms: Alternating Hemiplegia of Childhood Beyond ATP1A3

by Ruzica Kravljanac, Kristel Klaassen, Vladimir Oparnica, Biljana Vucetic Tadic, Marina Andjelkovic, Anita Skakic, Sara Stankovic and Maja Stojiljkovic

Diseases 2026, 14(5), 166; https://doi.org/10.3390/diseases14050166 - 9 May 2026

Abstract

Alternating hemiplegia of childhood (AHC) represents a severe and complex pediatric neurodevelopmental disorder, predominantly characterized by the occurrence of paroxysmal episodes of transient unilateral or bilateral paresis prior to 18 months of age. It belongs to a group of ultra-rare neurological disorders with [...] Read more.

Alternating hemiplegia of childhood (AHC) represents a severe and complex pediatric neurodevelopmental disorder, predominantly characterized by the occurrence of paroxysmal episodes of transient unilateral or bilateral paresis prior to 18 months of age. It belongs to a group of ultra-rare neurological disorders with a prevalence from 1:100,000 to 1:1,000,000. Even though the majority of AHC patients harbor pathogenic variants in the ATP1A3 gene, recent studies have pinpointed to other causative genes in ATP1A3-negative patients, including RHOBTB2. In this review, we report the case of a patient with a severe phenotype of AHC associated with developmental delay, aphasia and epilepsy, caused by a pathogenic de novo variant in the RHOBTB2 gene. Furthermore, we contribute a literature review on ATP1A3-negative AHC with a special focus on RHOBTB2-related AHC phenotypes, along with an overview of the pathophysiological mechanism of variants affecting residues in the BTB domain of the RHOBTB2 protein. The results of our study indicate that RHOBTB2-related AHC might have a more severe clinical presentation compared to ATP1A3-related AHC. Variants in the RHOBTB2 gene should be considered as disease-causing in patients with early-onset seizures, delayed psychomotor development and alternating hemiplegia of childhood. Full article

(This article belongs to the Special Issue Diseases: From Molecular to the Clinical Perspectives)

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31 pages, 1997 KB

Open AccessArticle

A Unified Histopathological Framework of Liver Fibrogenesis in Chronic Viral Hepatitis B, C and Coinfection

by Alina Dumitrache (Păunescu), Nicoleta Anca Ionescu (Șuțan), Liliana Cristina Soare, Maria Cristina Ponepal, Ana Cătălina Țânțu, Monica Marilena Țânțu, Ileana Monica Baniță and Cătălina Gabriela Pisoschi

Diseases 2026, 14(5), 165; https://doi.org/10.3390/diseases14050165 - 8 May 2026

Abstract

Background: Chronic hepatitis B and C remain major causes of progressive liver disease, while HBV–HCV coinfection is associated with accelerated fibrosis and hepatocellular injury. Methods: This study evaluated integrated biochemical, histopathological, and immunohistochemical features in patients with chronic hepatitis B (CHB, n = [...] Read more.

Background: Chronic hepatitis B and C remain major causes of progressive liver disease, while HBV–HCV coinfection is associated with accelerated fibrosis and hepatocellular injury. Methods: This study evaluated integrated biochemical, histopathological, and immunohistochemical features in patients with chronic hepatitis B (CHB, n = 29), chronic hepatitis C (CHC, n = 15), and CHB+C coinfection (CHB+C, n = 10). Liver biopsies were assessed using Ishak and METAVIR scoring systems, alongside immunohistochemical analysis of α-smooth muscle actin (α-SMA), transforming growth factor-β1 (TGF-β1), CD5L, and glial fibrillary acidic protein (GFAP), quantified by H-score. These findings were correlated with biochemical, hematological, and prognostic parameters. Results: Coinfected patients exhibited significantly higher serum ALT, AST, and GGT levels (p ≤ 0.011) and increased CD5L expression (median H-score 197.5 vs. 135 in CHB, p = 0.009), indicating enhanced macrophage-associated inflammatory activity. Although fibrosis stages were comparable across groups, median H-scores for α-SMA, TGF-β1, and GFAP showed a consistent upward trend in CHB+C, suggesting intensified profibrogenic signaling. Principal Component Analysis identified distinct biochemical clusters related to hepatocellular injury, hepatic functional impairment (synthetic and excretory axis), and lipid metabolism. Conclusions: These findings highlight a multidimensional pattern of liver injury in chronic viral hepatitis, with CHB+C coinfection amplifying profibrogenic and hepatocellular markers, both biochemically and histologically. Full article

(This article belongs to the Special Issue Viral Hepatitis: Diagnosis, Treatment and Management—2nd Edition)

15 pages, 1271 KB

Open AccessArticle

Diagnostic Performance and Discordance of Kato–Katz Method, POC-CCA Test, and PCR in Detecting Schistosoma mansoni in a Low-Prevalence South African Setting

by Maryline Vere, Wilma ten Ham-Baloyi, Lucy Ochola, Opeoluwa Oyedele, Lindsey Beyleveld, Siphokazi Tili, Takafira Mduluza and Paula Melariri

Diseases 2026, 14(5), 164; https://doi.org/10.3390/diseases14050164 - 8 May 2026

Abstract

Background/Objectives: Intestinal schistosomiasis caused by Schistosoma mansoni is often underestimated in low-transmission settings due to the limited sensitivity of traditional stool microscopy. More sensitive approaches, including antigen detection and molecular diagnostics, are required to detect infections where egg excretion is low or intermittent. [...] Read more.

Background/Objectives: Intestinal schistosomiasis caused by Schistosoma mansoni is often underestimated in low-transmission settings due to the limited sensitivity of traditional stool microscopy. More sensitive approaches, including antigen detection and molecular diagnostics, are required to detect infections where egg excretion is low or intermittent. This study aimed to determine the prevalence of S. mansoni infection among school-going children in Nelson Mandela Bay (NMB) using a multi-modal diagnostic approach. Methods: This cross-sectional study included 759 schoolchildren aged 5–14 years from 15 primary schools in NMB. Stool samples were analyzed using the Kato–Katz technique to detect S. mansoni eggs, while urine samples were tested using the point-of-care circulating cathodic antigen (POC-CCA) assay for antigen detection. A subset of stool samples from POC-CCA-positive participants (n = 28) was further analyzed using conventional PCR (cPCR), targeting the S. mansoni cox1 gene, for molecular confirmation. Only a single stool specimen was collected per participant. Results: Among the 759 participants (58% male, 42% female), no egg-positive cases were detected. However, POC-CCA testing identified S. mansoni antigen in 3.2% of participants. Of the 28 POC-CCA-positive samples analyzed by cPCR, 9 (32.1%) were PCR-positive, representing molecular confirmation within the antigen-positive subset rather than overall prevalence. Conclusions: Traditional microscopy underestimated S. mansoni prevalence in this low-prevalence setting. Antigen detection combined with molecular diagnostics improved case identification and highlighted ongoing transmission. These findings support the integration of sensitive diagnostic tools into schistosomiasis surveillance and control strategies in South Africa. Full article

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19 pages, 1346 KB

Open AccessArticle

Association Between Lifestyle Factors and the Prevalence of Non-Communicable Diseases in Saudi Adults Across Different Age Groups: A Cross-Sectional Study

by Somia A. Nassar

Diseases 2026, 14(5), 163; https://doi.org/10.3390/diseases14050163 - 7 May 2026

Abstract

Objectives: This cross-sectional study examined associations of lifestyle factors (physical activity (PA), diet, obesity, and smoking), age groups, and sex with the prevalence of non-communicable diseases (NCDs) in Saudi adults, including the World Health Organization (WHO) core NCDs (type 2 diabetes (T2DM), hypertension [...] Read more.

Objectives: This cross-sectional study examined associations of lifestyle factors (physical activity (PA), diet, obesity, and smoking), age groups, and sex with the prevalence of non-communicable diseases (NCDs) in Saudi adults, including the World Health Organization (WHO) core NCDs (type 2 diabetes (T2DM), hypertension (HTN), chronic obstructive pulmonary disease (COPD) and NCD-associated conditions (osteoporosis (OP), chronic kidney disease (CKD)). Methods: A cross-sectional study was conducted across Saudi Arabia involving 2877 participants aged ≥30 years. Data were collected via an electronic survey using a standardized questionnaire. PA was assessed using the International PA Questionnaire (IPAQ-SF), diet using the Alternative Healthy Eating Index (AHEI), and smoking using the WHO Global Adult Tobacco Survey. Results: Prevalence estimates were: OP 22%, diabetes 21.8%, HTN 13.4%, COPD 4.3%, and CKD 5.1%. All conditions were more prevalent among inactive vs. active individuals (e.g., diabetes: 23.5% vs. 18.8%). An unhealthy diet was associated with higher prevalence (e.g., HTN: 16.3% vs. 10.8%). Obesity showed the strongest association with diabetes (37.1% in obese vs. 14.9% in normal-weight). Smoking was associated with higher prevalence (e.g., COPD: 7.9% vs. 3.7%). Women had higher prevalence than men for most conditions (e.g., OP: 23.4% vs. 19.7%), except COPD (5.1% in men vs. 3.8% in women). Prevalence increased with age (e.g., HTN: 7.2% at age 30–40 vs. 17.3% at age > 60). All comparisons were tested using chi-square tests (p < 0.05). Conclusions: The findings underscore an urgent need for targeted public health interventions to promote PA, improve nutrition, combat obesity, and reduce smoking. Full article

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16 pages, 481 KB

Open AccessArticle

Post-Vaccination Surveillance of Invasive Pneumococcal Disease in Ghana

by Fleischer C. N. Kotey, Reuben E. Arhin, Nicholas T. K. D. Dayie, Emmanuel O. Ampah, Abass Abdul-Karim, Deric A. Baah, Ruth M. Afful, Georgina Tetteh-Ocloo, Roland T. Kom-Zuta, Francis K. M. Tetteh, Mary-Magdalene Osei, Yvonne N. A. Brew, Mame Y. Nyarko, Karikari Asafo-Adjei, Patience B. Tetteh-Quarcoo, Edem M. A. Tette and Eric S. Donkor

Diseases 2026, 14(5), 162; https://doi.org/10.3390/diseases14050162 - 7 May 2026

Abstract

Background: Streptococcus pneumoniae, also referred to as pneumococcus, is of immense public health significance. In particular, it causes severe invasive diseases among children. This has led to the recommendation of anti-pneumococcal prophylaxis, including the administration of penicillin and pneumococcal conjugate vaccines (PCVs), [...] Read more.

Background: Streptococcus pneumoniae, also referred to as pneumococcus, is of immense public health significance. In particular, it causes severe invasive diseases among children. This has led to the recommendation of anti-pneumococcal prophylaxis, including the administration of penicillin and pneumococcal conjugate vaccines (PCVs), which have become available in about 90% of the countries in sub-Saharan Africa. Nonetheless, breakthrough disease still occurs. Also, PCVs can cause a shift in the distribution of pneumococcal serotypes, usually towards non-vaccine types. However, in many sub-Saharan African countries where PCVs have been introduced, there are hardly any comprehensive post-vaccination surveillance data on pneumococcus. Aim: To describe the post-vaccination epidemiology of invasive pneumococcal disease (IPD) in Ghana, including the prevalence, serotype distribution and antibiotic resistance. Methods: The study was cross-sectional and involved 14,597 patients recruited at the Korle Bu Teaching Hospital, Greater Accra Regional Hospital, Princess Marie Louise Children’s Hospital, Ho Regional Hospital, Eastern Regional Hospital, and Zonal Public Health and Reference Laboratory, Tamale. Specimens of cerebrospinal fluid (obtained by lumbar puncture) and blood were collected routinely from meningitis patients, while blood specimens were taken from pneumonia patients. These were cultured for S. pneumoniae following standard microbiological methods and subjected to antimicrobial susceptibility testing. The isolates were serotyped by the pneumotest latex agglutination kit, and the results confirmed by Quellung reaction, using serotype-specific antisera. Results: The overall prevalence of IPD was 0.66% (n = 97), varying across syndromes: bloodstream infections (0.53%, n = 38), meningitis (2.45%, n = 43), and pneumonia (0.28%, n = 16). The majority of the cases (56.70%, n = 55) occurred in the 11–20-year-old group. Ten pneumococcal serotypes were identified, with Serotype 1 being predominant (58.76%), followed by Serotypes 23B (11.34%), 33F (9.28%), and 12F (8.24%). Vaccine serotypes accounted for 81.44% of the isolates, while 18.56% were non-vaccine serotypes (23A, 23B, and 38). Antimicrobial resistance was highest against sulphamethoxazole-trimethoprim (52%), ampicillin (51%), and penicillin (46%). No resistance was observed against ciprofloxacin, levofloxacin, and vancomycin. The multidrug resistance proportion was 42.3% (n = 41). Conclusions: Even in the post-vaccination era, vaccine-type IPD remains a significant public health issue in Ghana. The observed serotype distribution and antimicrobial resistance patterns warrant sustained surveillance, more adaptive vaccination policies, and rigorous antibiotic stewardship to effectively mitigate IPD burden. Full article

(This article belongs to the Section Infectious Disease)

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20 pages, 25872 KB

Open AccessArticle

Galectin-3 Mediates Heme-Induced Multi-Organ Dysfunction by Modulating the Splenic Immune Microenvironment

by Mirjana Milinkovic, Marija Milovanovic and Jelena Milovanovic

Diseases 2026, 14(5), 161; https://doi.org/10.3390/diseases14050161 - 6 May 2026

Abstract

Background/Objectives: Acute intravascular hemolysis is associated with the release of labile heme, which contributes to systemic inflammation and organ dysfunction. Galectin-3 (Gal-3) is a known modulator of inflammatory responses. However, its specific role in heme-induced organ injury remains to be fully elucidated. Methods: [...] Read more.

Background/Objectives: Acute intravascular hemolysis is associated with the release of labile heme, which contributes to systemic inflammation and organ dysfunction. Galectin-3 (Gal-3) is a known modulator of inflammatory responses. However, its specific role in heme-induced organ injury remains to be fully elucidated. Methods: We used a phenylhydrazine (PHZ)-induced model of acute hemolysis in wild-type (WT) and Gal-3 knockout (KO) mice to investigate the influence of Gal-3 on tissue alterations and the inflammatory response. Results: Despite equivalent levels of hemolysis and anemia in both genotypes, Gal-3 deficiency was associated with reduced injury in the liver, kidneys, and pancreas. In WT mice, Gal-3 was associated with a pro-inflammatory splenic microenvironment. Conversely, Gal-3 KO mice exhibited a shift toward an immunoregulatory phenotype, characterized by an increased frequency of CD4 + CD25 + FoxP3+ regulatory T cells and IL-10+ macrophages. This shift correlated with preserved organ architecture and a more controlled inflammatory profile. Conclusions: Our findings suggest that Gal-3 may act as a mediator of heme-induced systemic inflammation. By influencing the splenic immune microenvironment and promoting a regulatory phenotype, the absence of Gal-3 appears to alleviate multi-organ stress, suggesting its potential as a target for modulating complications during acute hemolytic crises. Full article

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12 pages, 427 KB

Open AccessArticle

Association Between Abscess Size, Inflammatory Markers, and the Need for Drainage in Renal Abscesses

by Dragoș Puia, Marius Ivănuță, Ovidiu Daniel Bîcă, Nicolae Stoican, Mihaela Corlade-Andrei, Bogdan Doroftei and Cătălin Pricop

Diseases 2026, 14(5), 160; https://doi.org/10.3390/diseases14050160 - 30 Apr 2026

Abstract

Background: Renal abscesses represent a serious complication of urinary tract infections, with management decisions often being guided by abscess size and clinical parameters. However, there is no universally accepted size threshold for intervention, and the role of inflammatory markers such as white blood [...] Read more.

Background: Renal abscesses represent a serious complication of urinary tract infections, with management decisions often being guided by abscess size and clinical parameters. However, there is no universally accepted size threshold for intervention, and the role of inflammatory markers such as white blood cell count (WBC) and C-reactive protein (CRP) in guiding treatment remains uncertain. We aimed to evaluate the relationship between abscess size, inflammatory markers, and the need for drainage in patients with renal abscesses treated in a tertiary urology clinic. Methods: A retrospective analysis was conducted on 103 adult patients diagnosed with renal abscesses between 2020 and 2025. Patients were categorized into two groups based on abscess size: Group A (<50 mm) and Group B (50 mm). Results: The cohort included 59 females and 44 males, with a mean age of 60.5 years. Computed tomography was used for diagnosis in 55.3% of cases. The most common comorbidities were hypertension (46.6%) and diabetes mellitus (40.8%). Microbiological cultures most frequently identified Escherichia coli (38.3%) and Klebsiella spp. (21.7%). Antibiotic resistance was highest to ampicillin (79.5%), while amikacin (5.8%) and piperacillin/tazobactam (6.2%) showed the lowest resistance rates. Conservative antibiotic therapy was effective in 43 patients (42.7%), whereas 60 patients (58.3%) required percutaneous drainage. Abscess size was associated with invasive intervention, with 88.1% of drained abscesses measuring ≥50 mm compared to 9.1% in the conservatively managed group (p < 0.001). Patients with larger abscesses had significantly lower haemoglobin levels (p = 0.003), while no significant differences were observed in WBC or CRP levels. Conclusions: Abscess size was associated with the need for drainage, supporting its role in clinical decision-making. In contrast, inflammatory markers such as WBC and CRP showed limited value in predicting the need for intervention in this cohort. These findings should be interpreted in the context of the retrospective design. Full article

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20 pages, 793 KB

Open AccessArticle

Locked-Window EQ-5D-5L (Index and VAS) Benchmarking in Sarcoma Care: Rule-Based Traffic-Light Classification Across Two Institutions

by Isabel Gloor, Beatrice Meier, Jehona Rexhai, Philip Heesen, Georg Schelling, Bettina Vogel, Gabriela Studer, Bruno Fuchs and on behalf of the Swiss Sarcoma Network

Diseases 2026, 14(5), 159; https://doi.org/10.3390/diseases14050159 - 30 Apr 2026

Abstract

Background: Value-based sarcoma care requires outcome measures that reflect the patient perspective; however, many sarcoma episodes begin with near-normal function and undergo necessary morbidity for oncologic control, making simple “improvement” an unreliable proxy of value. In routine care, patient-reported outcome data are often [...] Read more.

Background: Value-based sarcoma care requires outcome measures that reflect the patient perspective; however, many sarcoma episodes begin with near-normal function and undergo necessary morbidity for oncologic control, making simple “improvement” an unreliable proxy of value. In routine care, patient-reported outcome data are often irregular and incomplete, limiting benchmarking and learning across institutions. We therefore developed a rule-based EQ-5D-5L (index and VAS) traffic-light framework and evaluated its feasibility and benchmarking signal in two institutions. Methods: We performed a retrospective, two-institution cohort analysis of 729 malignant and intermediate episodes, defined using a prespecified histology behavior mapping. PROM evaluation was anchored to a hierarchical T0 (index surgery date; if unavailable, radiotherapy start date; if unavailable, systemic therapy start date where a valid and interpretable start date was available). EQ-5D-5L index and EQ-VAS were assigned to prespecified locked windows: baseline (−90 to +14 days preferred; +15 to +90 days fallback), 12 months (180–365 days; target 270), and 24 months (660–820 days; target 730). A rule-based traffic-light classification was applied at 12 and 24 months (RED if index < 0.75 or VAS < 50; GREEN if index ≥ 0.85 and VAS ≥ 70; otherwise YELLOW). PROM evaluability was defined as the availability of at least one valid EQ-5D-5L index and/or EQ-VAS value within each window. Results: PROM evaluability in locked windows was feasible but incomplete. Baseline PROMs were available for 107/729 episodes (14.7%), 12-month PROMs for 119/729 (16.3%), and 24-month PROMs for 84/729 (11.5%). At 12 months, evaluable episodes included 75 from Institution A and 44 from Institution B; at 24 months, 56 and 28, respectively. Traffic-light outputs showed heterogeneity at both timepoints and clearer cross-institution difference at 24 months than at 12 months. At 12 months, the distribution was predominantly GREEN in both institutions (Institution A: 73.3% GREEN, 9.3% YELLOW, 17.3% RED; Institution B: 65.9% GREEN, 18.2% YELLOW, 15.9% RED; p = 0.373). At 24 months, Institution A maintained a high GREEN proportion with a low RED fraction (76.8% GREEN, 17.9% YELLOW, 5.4% RED), whereas Institution B showed a lower GREEN proportion and higher YELLOW/RED fractions (50.0% GREEN, 25.0% YELLOW, 25.0% RED; p = 0.014). Absolute EQ-5D-5L medians remained high overall, but the follow-up distributions showed a broader lower tail in Institution B. Conclusions: A prespecified EQ-5D-5L (index and VAS) traffic-light framework anchored by hierarchical T0 and evaluated in locked windows yields interpretable patient-perspective benchmarking signals in real-world sarcoma care. The approach was operationally feasible within the evaluable subset and appeared more discriminative at 24 months than at 12 months, while incomplete PROM capture remains a major implementation limitation for representative and reliable network-scale benchmarking and learning. Full article

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11 pages, 892 KB

Open AccessSystematic Review

Physiotherapy Intervention for Diabetic Foot Ulcers: A Scoping Review

by Shinsuke Imaoka, Shohei Minata, Taisuke Teroh, Kotaro Matsuki and Ryotaro Hiramatsu

Diseases 2026, 14(5), 158; https://doi.org/10.3390/diseases14050158 - 29 Apr 2026

Abstract

Background/Objectives: Understanding the available interventions and circumstances under which physical therapy is administered to patients with diabetic foot ulcers is important to provide more evidence regarding physical therapy and associated outcomes in this population. This study aimed to investigate the scope, nature, and [...] Read more.

Background/Objectives: Understanding the available interventions and circumstances under which physical therapy is administered to patients with diabetic foot ulcers is important to provide more evidence regarding physical therapy and associated outcomes in this population. This study aimed to investigate the scope, nature, and extent of literature on physical therapy interventions for adults with diabetic foot ulcers. Methods: Articles on physiotherapy interventions for adults with diabetic foot ulcers published up to 30 June 2024 were included. Relevant articles were identified through searches of PubMed, Scopus, MEDLINE, and the Cochrane Library databases. Opinion articles, study protocols, meeting abstracts, and articles that did not describe physical therapy interventions were excluded. Results: The systematic search identified 13 articles that met the inclusion criteria. Eleven of the 13 articles were specifically related to outpatient physical therapy. Outpatient physiotherapy included unloading gait instruction, ankle stretching instruction, progressive resistance training, and aerobic exercise. In two other cases, exercise instructions were practiced in the early postoperative period of the wound during the hospitalization period. A multidisciplinary approach aimed at improving postoperative activities of daily living was included. The main efficacy indices were the wound reduction rate, plantar pressure reduction, hemodynamics, ankle joint range of motion, walking ability, and other physical function-related parameters. Conclusions: Physiotherapy during outpatient follow-up may contribute to preventing wound deterioration and maintaining physical function in patients with stable DFUs. However, standardized protocols regarding intervention timing, exercise intensity, and wound severity remain unestablished, and interventions should be applied cautiously based on individual clinical conditions. Full article

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14 pages, 291 KB

Open AccessArticle

Depressive Symptoms in Pediatric Tuberculosis: A Retrospective Two-Time-Point Observational Study

by Oana Mariana Mihailov, Loredana Stavăr Matei, George Țocu, Valerii Luțenco, Cosmin George Popovici and Raul Mihailov

Diseases 2026, 14(5), 157; https://doi.org/10.3390/diseases14050157 - 29 Apr 2026

Abstract

Background: Tuberculosis (TB) in children is associated not only with infectious burden but also with potential psychological distress, which remains insufficiently explored. The aim of this study was to evaluate the pattern and evolution of depressive symptoms in pediatric TB patients during treatment [...] Read more.

Background: Tuberculosis (TB) in children is associated not only with infectious burden but also with potential psychological distress, which remains insufficiently explored. The aim of this study was to evaluate the pattern and evolution of depressive symptoms in pediatric TB patients during treatment using a structured screening approach. Methods: We conducted a retrospective observational study including 190 pediatric patients aged 7–18 years diagnosed with tuberculosis between 2019 and 2021. Depressive symptoms were assessed at two time points, namely at diagnosis (T0) and at first follow-up (T1), using a 10-item structured clinical screening tool routinely applied in practice. A threshold of ≥50% affirmative responses was used to identify patients with suspected depressive symptoms. The Children’s Depression Inventory (CDI) was administered to patients with positive screening results, according to standard clinical protocols. Descriptive and comparative analyses were performed to evaluate changes over time. Results: A high proportion of patients screened positive for depressive symptoms at baseline (T0). At follow-up (T1), a reduction in the proportion of patients with suspected depressive symptoms was observed; however, a substantial number of patients continued to report symptoms suggestive of emotional distress. Most symptom changes between T0 and T1 were not statistically significant, with the exception of decreased appetite, which showed a modest improvement. The overall pattern suggests persistence of symptoms in a subset of patients over time. Conclusions: These findings suggest that symptoms indicative of psychological distress are common among pediatric TB patients and may persist during treatment. However, given the use of a non-validated screening tool and the retrospective design, the results should be interpreted with caution. The study highlights the potential value of systematic psychological assessment in this population and supports the need for further research using validated instruments. Full article

(This article belongs to the Special Issue Mental Health—Management and Care, Multidisciplinary Approaches and Perspectives)

16 pages, 446 KB

Open AccessArticle

High-Risk Human Papillomavirus Clearance with a Coriolus versicolor–Based Vaginal Gel

by Haticegul Tuncer, Sevinj Hajiyeva, Betul Gungor Serin, Muhammed Onur Atakul, Ali Can Gunes, Taylan Onat, Utku Akgor, Derman Basaran, Zafer Selcuk Tuncer and Murat Gultekin

Diseases 2026, 14(5), 156; https://doi.org/10.3390/diseases14050156 - 29 Apr 2026

Abstract

Background/Objectives: Non-ablative local therapies are increasingly used in the conservative management of human papillomavirus (HPV) infection. Coriolus versicolor, an immunomodulatory medicinal mushroom, is one such approach. This study aimed to investigate the effect of a Coriolus versicolor–based vaginal gel on [...] Read more.

Background/Objectives: Non-ablative local therapies are increasingly used in the conservative management of human papillomavirus (HPV) infection. Coriolus versicolor, an immunomodulatory medicinal mushroom, is one such approach. This study aimed to investigate the effect of a Coriolus versicolor–based vaginal gel on HPV clearance and cervical cytological outcomes. Methods: This retrospective cohort study included 600 women with cervical HPV infection (300 treated with a Coriolus versicolor–based vaginal gel and 300 receiving standard follow-up). Baseline and six-month follow-up assessments included HPV DNA testing and cervical cytology. Results: Baseline demographic characteristics, HPV genotype distribution, infection type, and cytological findings were comparable between the groups. Overall HPV clearance was significantly higher in the treatment group than in the controls (89.3% vs. 44.7%, p < 0.001). Complete clearance of high-risk HPV genotypes, including HPV 16 (77.0% vs. 25.4%, p < 0.001) and HPV 18 (73.9% vs. 18.5%, p = 0.017), was also significantly more frequent among treated women. Cytological normalization occurred more often in the treatment group (88.4% vs. 60.4%, p < 0.001). Multivariable analysis identified use of the vaginal gel as the strongest independent factor associated with HPV clearance (adjusted odds ratio [aOR] = 10.19; 95% confidence interval [CI]: 3.52–29.47; p < 0.001). Conclusions: Treatment with a Coriolus versicolor–based vaginal gel was associated with significantly higher rates of high-risk HPV clearance and cervical cytological normalization. These findings suggest that this therapy may represent an effective adjunct in the conservative management of HPV infection; however, randomized controlled trials are warranted to confirm these results. Full article

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15 pages, 2236 KB

Open AccessArticle

Temporal Machine Learning Models for Classifying Suspected Dengue Cases in Mexico Using Surveillance Data from 2025

by Jorge Soria-Cruz, Enrique Luna-Ramírez, Iván Castillo-Zúñiga, Jaime Iván López-Veyna, Ma. Angélica Estrada-Ramírez and Juan Antonio González-Morales

Diseases 2026, 14(5), 155; https://doi.org/10.3390/diseases14050155 - 28 Apr 2026

Abstract

Background: Dengue fever remains a major public health challenge in Mexico, exhibiting pronounced seasonal behavior and substantial geographic heterogeneity. Using recent epidemiological surveillance data may improve predictive performance and better reflect the current epidemiological context. Objective: The aim of this study [...] Read more.

Background: Dengue fever remains a major public health challenge in Mexico, exhibiting pronounced seasonal behavior and substantial geographic heterogeneity. Using recent epidemiological surveillance data may improve predictive performance and better reflect the current epidemiological context. Objective: The aim of this study was to develop and compare temporal machine learning models for the binary classification of confirmed and negative dengue cases in Mexico using 2025 national surveillance data. Methods: A total of 68,222 suspected dengue cases reported in 2025 were analyzed. The outcome variable was CASE_STATUS, encoded as 0 for negative cases and 1 for confirmed cases. The dataset was divided chronologically into training (January–September), validation (October), and testing (November–December) subsets. Nine machine learning algorithms were evaluated: Random Forest, Bayesian Network, XGBoost, CatBoost, Naïve Bayes, Logistic Regression, Multilayer Perceptron, Support Vector Machine, and LightGBM. Preprocessing included scaling, encoding, age discretization for Bayesian Network, class imbalance treatment, and model-specific feature-importance analyses. Performance was assessed using accuracy, Precision, Recall, F1-score, ROC-AUC, and PR-AUC. Results: Random Forest achieved the best overall performance, with the highest test F1-score (0.7254) and PR-AUC (0.7300) at an optimized threshold of 0.397, together with a high Recall (0.8938). Bayesian Network achieved the highest test accuracy (0.7023) and ROC-AUC (0.7756), although its overall operational balance was less favorable considering class imbalance. Geographic and institutional variables were the most influential predictors across models, whereas comorbidities generally contributed less. Conclusions: Temporal machine learning models are useful for dengue case classification in Mexico, and Random Forest was the most robust approach, balancing sensitivity and overall predictive performance. From an operational perspective, this finding is especially relevant in dengue surveillance, where failure to identify true confirmed cases may have important public health consequences. Full article

(This article belongs to the Section Infectious Disease)

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13 pages, 1080 KB

Open AccessArticle

Prevalence and Association of Liver Steatosis and Non-Alcoholic Pancreatic Steatosis in Very High Cardiovascular Risk

by Raúl Gómez-Mendoza, Eva Juárez-Hernández, Vicente Toledo-Coronado, César A. Tenorio-Aparicio, Javier Sánchez-Zavala, Misael Uribe, Graciela Castro-Narro and Iván López-Méndez

Diseases 2026, 14(5), 154; https://doi.org/10.3390/diseases14050154 - 28 Apr 2026

Abstract

Background/Objectives: In the last decade, the prevalence of metabolic-associated fatty liver disease (17–46%) and non-alcoholic fatty pancreas disease (NAFPD) (16–33%) has increased due to their association with obesity, both predictors of early atherosclerosis and metabolic risk. Computed tomography (CT) has been proposed as [...] Read more.

Background/Objectives: In the last decade, the prevalence of metabolic-associated fatty liver disease (17–46%) and non-alcoholic fatty pancreas disease (NAFPD) (16–33%) has increased due to their association with obesity, both predictors of early atherosclerosis and metabolic risk. Computed tomography (CT) has been proposed as a diagnostic method. Currently, the factors associated with NAFPD have not been fully described. The aim of this study is to describe the prevalence and association of NAFPD and liver steatosis in patients with very high cardiovascular risk. Methods: A retrospective evaluation was conducted on the medical records of patients classified as very high cardiovascular risk who had undergone a CT scan. NAFPD was determined by the difference in pancreatic and splenic attenuation (−1.9), while liver steatosis was identified by hepatic attenuation <40. Bivariate and multivariate analyses were performed to determine the independent factors associated with NAFPD. Results: 169 medical records were collected; 68.6% (n = 116) were men, with a median age of 70 [IQR 61–78] years and 25.8 [IQR 23.7–28.7] kg/m² of body mass index. According to the CT scans, 80.5% (n = 136) presented NAFPD, 24.3% (n = 41) had liver steatosis, and 21.3% (n = 36) had both. In the multivariate analysis, liver steatosis, abnormal levels of aspartate aminotransferase, and being overweight were independent factors associated with NAFPD. Conclusions: In a very high cardiovascular-risk population, the prevalence of NAFPD is high, and it is independently associated with the presence of liver steatosis. Full article

(This article belongs to the Section Gastroenterology)

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19 pages, 4280 KB

Open AccessArticle

Systemic Protein Biomarkers, Composite Blood Inflammatory Indices and Cellular Ratios in Metastatic Colorectal Cancer: Potential Therapeutic Targets

by Teresa Smit, Ronald Anderson, Helen C. Steel, Theresa M. Rossouw and Bernardo L. Rapoport

Diseases 2026, 14(5), 153; https://doi.org/10.3390/diseases14050153 - 27 Apr 2026

Abstract

Background/objectives: Although informative, current insights into the inflammatory nature of colorectal cancer (CRC) have yet to have a meaningful impact on the prevention of, and development of novel therapies for, the treatment of this prevalent and challenging disease. Accordingly, the current study was [...] Read more.

Background/objectives: Although informative, current insights into the inflammatory nature of colorectal cancer (CRC) have yet to have a meaningful impact on the prevention of, and development of novel therapies for, the treatment of this prevalent and challenging disease. Accordingly, the current study was focused on identifying putative, key, systemic, mostly pro-inflammatory biomarkers of metastatic CRC (mCRC) prognosis and outcome. Methods: Patients with mCRC (n = 38) and matched healthy controls (n = 30) were recruited to the study. A multiplex magnetic bead array system and an ELISA procedure were used to measure the plasma concentrations of selected cytokines (n = 25) and that of C-reactive protein (CRP) by immunonephelometry. Systemic inflammatory indices (n = 5) were derived from the hematological data. Results: Plasma levels of 17/25 of the cytokine biomarkers and CRP were found to be significantly elevated, while the neutrophil/lymphocyte ratio proved to be the most useful of the various inflammatory indices. Subgroup analysis of the data derived from the group of mCRC patients revealed that the intensity of the systemic inflammatory response was mostly unaffected by tumor location, age, gender, and treatment line. The exception was time to progression, with a shorter time (<120 days) being associated with increased levels of IL-6, IL-8 and TNF-α. Hierarchical cluster analysis of the data revealed a possible association with a small group of four cytokines, comprising IL-1β, IL-13, IL-6/CRP and TGF-β1. Conclusions: This study confirms a strong association of established mCRC with cytokine-driven systemic inflammation. Four of these cytokines, IL-1β/IL-13 IL-6/CRP, and TGF-β1, appear prominent and are possibly indicative of novel targetable therapeutic options. Full article

(This article belongs to the Section Oncology)

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15 pages, 685 KB

Open AccessReview

Ocular Clues to Liver Disease: A Strategic Diagnostic Lens

by Muhammad Dahshan, Hassan Dahshan, Ayhan Basoglu and Huseyin Kadikoy

Diseases 2026, 14(5), 152; https://doi.org/10.3390/diseases14050152 - 24 Apr 2026

Abstract

Background/Objectives: Hepatic diseases frequently present with ocular manifestations that aid diagnosis, provide prognostic data, and guide therapy. Despite the clear utility of the liver–eye axis, the literature lacks reviews that categorize these manifestations by etiology. This review evaluates current evidence to identify ocular [...] Read more.

Background/Objectives: Hepatic diseases frequently present with ocular manifestations that aid diagnosis, provide prognostic data, and guide therapy. Despite the clear utility of the liver–eye axis, the literature lacks reviews that categorize these manifestations by etiology. This review evaluates current evidence to identify ocular findings that serve as clinical tools for diagnosis, prognosis, and therapeutic monitoring of hepatic pathologies. Methods: A narrative review was conducted using PubMed and Google Scholar to identify English-language articles addressing ocular manifestations associated with liver disease. The primary search encompassed publications from 2000 to 2025, with inclusion of select foundational works published prior to 2000 when they represented seminal studies establishing diagnostic criteria, pathophysiological mechanisms, or natural history data not superseded by subsequent research. Search terms included combinations of liver, hepatic, hepatitis, cirrhosis, cholestasis, eye, ocular, retina, cornea, sclera, conjunctiva, ophthalmic manifestations, and specific disease names. All study designs were eligible. Society guidelines, systematic reviews, and studies from high-impact journals were prioritized. The final selection comprised 59 references representing the most authoritative sources across the spectrum of hepatic conditions. Results: A spectrum of ocular findings linked to distinct hepatic conditions was identified. Manifestations with established clinicopathologic associations were categorized into congenital and acquired etiologies. Congenital liver pathologies included metabolic disorders (Wilson disease, galactosemia, lysosomal storage disorders) and syndromic/genetic causes (Alagille syndrome, hereditary hemochromatosis). Acquired liver diseases encompassed infectious (hepatitis B/C), drug-induced and iatrogenic (interferon, immune checkpoint inhibitors), nutritional (vitamin A deficiency), neoplastic (metastatic hepatocellular carcinoma), and cirrhotic causes. Conclusions: Specific ocular signs raise clinical suspicion for underlying liver disease and warrant targeted hepatic evaluation. Recognizing these associations facilitates earlier diagnosis and improves outcomes. Systematic screening for these signs is supported in at-risk populations, and prospective validation studies should establish their sensitivity and specificity. Full article

(This article belongs to the Special Issue Viral Hepatitis: Diagnosis, Treatment and Management—2nd Edition)

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