Diseases

11 pages, 244 KB

Open AccessArticle

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

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

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

Abstract

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

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

17 pages, 1343 KB

Open AccessArticle

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

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

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

Abstract

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

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

► Show Figures

Figure 1

22 pages, 2747 KB

Open AccessArticle

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

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

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

Abstract

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

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

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

► Show Figures

Figure 1

15 pages, 2420 KB

Open AccessArticle

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

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

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

Abstract

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

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

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

► Show Figures

Figure 1

14 pages, 1273 KB

Open AccessArticle

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

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

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

Abstract

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

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

► Show Figures

Figure 1

14 pages, 1807 KB

Open AccessCase Report

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

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

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

Abstract

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

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

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

► Show Figures

Figure 1

27 pages, 1551 KB

Open AccessReview

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

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

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

Abstract

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

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

► Show Figures

Figure 1

21 pages, 3500 KB

Open AccessArticle

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

by Stanislav Kotlyarov and Alexander Lyubavin

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

Abstract

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

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

(This article belongs to the Section Cardiology)

► Show Figures

Figure 1

15 pages, 815 KB

Open AccessArticle

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

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

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

Abstract

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

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

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

► Show Figures

Figure 1

10 pages, 1112 KB

Open AccessCase Report

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

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

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

Abstract

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

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

(This article belongs to the Section Infectious Disease)

► Show Figures

Figure 1

14 pages, 846 KB

Open AccessArticle

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

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

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

Abstract

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

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

► Show Figures

Figure 1

13 pages, 863 KB

Open AccessArticle

Folate Receptor Alpha Autoantibodies in Vector-Borne Disease Populations

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

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

Abstract

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

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

► Show Figures

Figure 1

15 pages, 1548 KB

Open AccessReview

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

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

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

Abstract

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

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

(This article belongs to the Section Respiratory Diseases)

► Show Figures

Figure 1

13 pages, 915 KB

Open AccessArticle

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

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

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

Abstract

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

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

► Show Figures

Graphical abstract

20 pages, 3474 KB

Open AccessArticle

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

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

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

Abstract

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

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

► Show Figures

Figure 1

12 pages, 6900 KB

Open AccessArticle

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

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

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

Abstract

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

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

► Show Figures

Figure 1

2 pages, 168 KB

Open AccessCorrection

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

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

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

Abstract

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

17 pages, 3905 KB

Open AccessArticle

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

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

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

Abstract

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

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

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

► Show Figures

Figure 1

19 pages, 17979 KB

Open AccessReview

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

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

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

Abstract

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

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

► Show Figures

Figure 1

Journal Description

Diseases

Latest Articles

Journal Menu

Journal Browser

Highly Accessed Articles

Latest Books

E-Mail Alert

News

Topics

Conferences

Special Issues

Topical Collections

Further Information

Guidelines

MDPI Initiatives

Follow MDPI