Search Results (611)

Background: Acinetobacter baumannii (AB), particularly carbapenem-resistant strains (CRAB), is a major cause of difficult-to-treat infections associated with substantial mortality. Contemporary data from Central and Eastern Europe remain scarce. We aimed to characterize the epidemiology, clinical features, and survival of patients with AB bloodstream infection in a multicenter Polish cohort. Methods: We conducted a retrospective multicenter study including consecutive adults with microbiologically confirmed AB bloodstream infection. Clinical and demographic data, comorbidities, infection origin, and antimicrobial treatments were collected. Outcomes included all-cause in-hospital mortality and infection-attributed mortality. Survival was assessed using Kaplan–Meier curves and log-rank tests, while factors associated with death were examined with univariable and multivariable Cox regression. Results: Among 245 patients with CRAB bloodstream infection, overall mortality was 69.4%, and infection-attributed mortality reached 51.8%. Most infections (75.1%) were hospital-acquired. In univariable analyses, male sex (HR = 0.66; p = 0.008) and colistin-based therapy (HR = 0.71; p = 0.037) were associated with improved survival. Conversely, hospital-acquired infection (HR = 0.43; p < 0.001) and acute kidney injury (HR = 1.40; p = 0.038) were linked to higher mortality. In the multivariable model, male sex remained protective (HR = 0.61; p = 0.006), while hospital-acquired infection (HR = 0.35; p < 0.001) and COVID-19 (HR = 1.64; p = 0.049) independently predicted death. After adjustment, no other comorbidities or antimicrobial regimens showed significant associations. Conclusions: In this multicenter cohort of patients with CRAB bloodstream infection, mortality remained extremely high. Hospital-acquired infection, acute kidney injury, and COVID-19 were strong independent predictors of poor outcomes, whereas male sex was associated with better survival. Although colistin-containing therapy appeared beneficial in univariable analysis, this effect did not persist after adjustment, underscoring potential confounding. These findings highlight the urgent need for early recognition, optimized antimicrobial strategies, and prevention of healthcare-associated spread to improve outcomes in CRAB bacteremia. Full article

Background: Effectively managing pain in adults remains challenging, particularly in individuals with cognitive impairment or communication difficulties. Digital technologies, including artificial intelligence (AI)-enabled facial recognition and mobile applications, are emerging as innovative tools to improve the objectivity and consistency of pain evaluation. This scoping review aimed to map the current evidence on digital pain-assessment tools used with adult and older populations, focusing on validity, reliability, usability, and contributions to person-centred care. Methods: The review followed the Joanna Briggs Institute methodology and Arksey and O’Malley framework and was reported in accordance with PRISMA-ScR guidelines. Systematic searches were conducted in PubMed, CINAHL Complete, Medline (ALL), and PsycINFO for English-language studies published from 2010 onwards. Eligible studies included adults (≥18 years) using digital tools for pain assessment. Data extraction and synthesis were performed using Covidence, and findings were analyzed thematically. Results: Of 1160 records screened, ten studies met inclusion criteria. Most research was quantitative and conducted in high-income clinical settings. Five tools were identified: ePAT/PainChek^®, Painimation, PainCAS, Pain Clinical Assessment System, and Active Appearance Model. Four key themes emerged: (1) Validity and Reliability of Digital Pain Assessment Tools; (2) Comprehensive Pain Evaluation Across Contexts (Rest vs. Movement); (3) Usability and Integration into Clinical Practice; (4) Enabling Person-Centred Pain Management and Future Directions. Conclusions: Emerging evidence suggests that facial-recognition-based digital pain-assessment tools may demonstrate acceptable psychometric performance and usability within dementia care settings in high-income countries. However, evidence relating to broader adult populations, diverse care contexts, and low-resource settings remains limited, highlighting important gaps for future research. Full article

SARS-CoV-2, the causative agent of COVID-19, has led to over seven million deaths worldwide prior to May 2025. Despite widespread vaccination programs, COVID-19 remains a persistent global health challenge, underscoring the urgent need for new therapeutic approaches. Orientin is a flavonoid with reported antiviral activity, though its potential against SARS-CoV-2 remains poorly explored. This study aimed to investigate whether Orientin interacts with the viral Spike protein and impacts viral replication. Molecular docking simulations using DockThor were employed to predict the binding affinity between Orientin and the receptor-binding domain (RBD) of the Spike protein. Fluorescence spectroscopy assays were performed to assess direct interactions between Orientin and the trimeric form of the Spike protein. Additionally, cytotoxicity and viral replication assays were carried out in Vero cells to evaluate Orientin’s antiviral effects. Docking results indicated that Orientin likely binds to key RBD residues involved in ACE2 receptor recognition. Spectroscopic analyses showed a decrease in intrinsic tryptophan fluorescence, suggesting direct interaction. Orientin demonstrated no cytotoxicity in Vero cells and exhibited moderate inhibition of viral replication. These findings suggest that Orientin interacts with critical regions of the Spike protein and may act as a moderate in vitro inhibitor of SARS-CoV-2, warranting further investigation into its therapeutic potential. Full article

Background: Hospital-acquired influenza remains a persistent threat that amplifies morbidity, mortality, length of stay, and operational strain, particularly among older and immunocompromised inpatients. The COVID-19 era reshaped control norms—normalizing N95 use during surges, ventilation improvements, and routine multiplex PCR—creating an opportunity to strengthen hospital outbreak management. Methods: We conducted a targeted narrative review of WHO/CDC/Infectious Diseases Society of America (IDSA) guidance and peer-reviewed studies (January 2015–August 2025), emphasizing adult inpatient care. This narrative review synthesizes recent evidence and discusses theoretical implications for practice, rather than establishing formal guidelines. Evidence was synthesized into pragmatic practice statements on detection, diagnostics, isolation/cohorting, antivirals, chemoprophylaxis, vaccination, surveillance, and communication. Results: Early recognition and test-based confirmation are pivotal. For inpatients, nucleic-acid amplification tests are preferred; negative antigen tests warrant PCR confirmation, and lower-respiratory specimens improve yield in severe disease. A practical outbreak threshold is ≥2 epidemiologically linked, laboratory-confirmed cases within 72 h on the same ward. Effective control may require immediate isolation or cohorting with dedicated staff, strict droplet/respiratory protection, and daily active surveillance. Early oseltamivir (≤48 h from onset or on admission) reduces mortality and length of stay; short-course post-exposure prophylaxis for exposed patients or staff lowers secondary attack rates. Integrated vaccination efforts for healthcare personnel and high-risk patients reinforce workforce resilience and reduce transmission. Conclusions: A standardized, clinician-led bundle—early molecular testing, do-not-delay antivirals, decisive cohorting and Personal protective equipment (PPE), targeted chemoprophylaxis, vaccination, and disciplined communication— could help curb transmission, protect vulnerable patients and staff, and preserve capacity. Hospitals should codify COVID-era layered controls for seasonal influenza and rehearse unit-level outbreak playbooks to accelerate response and recovery. These recommendations target clinicians and infection-prevention leaders in acute-care hospitals. Full article

Urban Green Space Per Capita (UGSPC) is one of the oldest and most widely applied indicators in urban planning, providing a measure of green areas in relation to the population size. Despite its century-long application and decades of research, no global systematic review has previously synthesized how UGSPC has been applied, interpreted, and evolved across different contexts. This study aims to fill that gap by conducting the first comprehensive systematic review, following PRISMA guidelines, examining the usage, trends, and effectiveness of UGSPC in both developed and developing countries. Thematic analysis revealed that most studies were published in journals focused on sustainability and environmental science. The results show a surge in publications following the COVID-19 pandemic, reflecting a growing recognition of the importance of urban green spaces for public health and livability. Moreover, 67% of the studies were conducted in developing countries, while 30% of the publications were in developed countries. Higher UGSPC values are generally found in developed cities; however, this was not a rule. Time series studies showed a decline in UGSPC in some developed and developing countries, influenced by factors such as population density, urbanization stage, climate, and economic conditions. Although UGSPC is widely used, most municipalities typically develop their plans based on this measurement. In total, 95% of the included research incorporated additional measurements, including accessibility, social equity, spatial patterns, ecological services, ecosystem benefits, and human health. This study suggests that UGSPC is still used as an indicator in urban planning and policy and integrating it with other indicators can serve as contemporary indicators to capture better equity, functionality, and sustainability in urban environments. Full article

Vulnerabilities in local food systems revealed by the COVID-19 pandemic were especially evident in highly tourism-dependent islands. This underscores the crucial role of agriculture in ensuring socio-ecological resilience, food security, and livelihood options in these contexts. Yet despite renewed policy attention, sustaining local farming in remote island settings continues to face numerous challenges. Amid growing recognition of the ways in which collective imagination shapes (and constrains) sustainability transformations, this paper applies the conceptual lens of imaginaries to examine agricultural futures in the Galápagos Islands and to explore the question of why agriculture remains marginal, despite widespread acknowledgement that supporting sustainable farming is central to the archipelago’s long-term sustainability. Through reflexive thematic analysis of policy documents, grey literature, and semi-structured interviews, the paper shows how imaginative spaces of possibility around food futures in Galápagos are conditioned by the powerful entanglement of hegemonic conservationist imaginaries with touristic imaginaries of an uninhabited wilderness. Within this contested terrain, five overlapping and co-constituting imaginaries of agriculture are distinguished, oriented variously around conservation priorities, technocratic planning, entrepreneurial growth, traditional livelihoods, and agroecological transformation. The analysis highlights how these imaginaries mobilize contrasting logics of support and mechanisms of change and illustrates how they complicate simplistic binaries, for example, between pristine and human-managed ecosystems, or between technological and holistic approaches to farming. The paper underscores the importance of paying critical attention to imaginaries of agriculture in order to navigate pathways toward more sustainable and resilient food systems in ecologically fragile island contexts. Full article

Numerous studies have examined the effects of the COVID-19 pandemic on university students’ attitudes. However, little is known about how their career awareness changed and how such changes differed between urban and rural areas. This study analyzed psychological data collected through a questionnaire survey conducted from 9 November 2020, to 19 January 2021, among 516 first- to fourth-year students enrolled in social science faculties in Japan. The analysis compared changes in career awareness by university location. The results indicated that, during the pandemic, urban students placed greater emphasis on self-worth, while rural students placed greater emphasis on working conditions, suggesting a possible widening gap between the two groups. Furthermore, logistic multiple regression and path analyses revealed that, among rural students, greater concern for working conditions was associated with a stronger focus on interpersonal relationships, which in turn enhanced their preference for local employment. In addition, valuing interpersonal relationships was linked to a stronger focus on social recognition, which may foster more intrinsic aspects of career awareness. Full article

The Isles of Scilly are an archipelago of islands in the far southwest of the UK which contain numerous beds of wild bivalve molluscs which are recreationally harvested for local consumption. However, the islands have never previously been assessed for the presence of harmful algae and their shellfish toxin metabolites which can cause serious human health impacts. This study sought to address these knowledge gaps through the analysis of seawater and shellfish tissues for microalgae and toxins utilizing portable and lab-based microscopy, nanopore sequencing, chemical analysis and immunoassay kits. The study design was affected by the national COVID-19 lockdown which enforced implementation of citizen-led sampling and in-field microscopy. Microscopy and sequencing approaches led to the confirmation of multiple HAB species of concern, including those potentially responsible for production of neurotoxic and diarrhetic shellfish toxins. A portable microscope was successfully utilized in the field for recognition of microalgae and for early warning of potential shellfish toxicity events. Chemical analysis of cockle, clam and mussel samples confirmed the detection of paralytic, diarrhetic and amnesic shellfish toxins, with an unusual okadaic acid group toxin profile reaching a maximum toxicity of approximately half the regulatory limit as defined by EU law. The Sensoreal Alert Lateral Flow Assay was used to screen and highlight samples containing higher concentrations of DSP toxins. Furthermore, Tetrodotoxin was detected for the first time in the UK in cockle and grooved carpet shells. Multiple saxitoxin analogues were also detected in two echinoderm species, with this providing the first ever report of paralytic shellfish toxins in the spiny starfish, Marthasterias glacialis. The toxin profiles in the two species varied significantly with a dominance of GTX4 in Luidia ciliaris as opposed to a dominance of STX in Marthasterias glacialis. Overall, the study showed that a multi-method assessment of a previously unexplored region within the UK territory contained microalgae and toxins of concern to human health, and that a citizen-led programme could be instigated using portable microscopy and rapid toxin testing to assess the early warning for potentially harmful microalgae and toxins in the region, with confirmatory analysis being conducted to establish actual levels of risk for local consumers of seafood. Full article

Background: Cutaneous viral infections, defined as viral pathogens that either primarily affect the skin (e.g., herpesviruses, enteroviruses) or frequently produce dermatologic manifestations despite systemic tropism (e.g., HIV, SARS-CoV-2), can trigger systemic inflammatory and neurotropic responses that extend their impact to the nervous system. A growing body of evidence suggests that viruses with dermatologic manifestations may play a significant role in the pathogenesis of neurologic disorders. Summary: Although individual viruses have been studied in isolation, the skin–brain axis in viral infections remains incompletely characterized. This review synthesizes existing knowledge and highlights gaps in understanding the mechanisms linking cutaneous viral infections to neurologic disease. We explore the principal mechanisms linking viral skin infections to central and peripheral nervous system damage, including direct neuroinvasion, immune-mediated injury, and vascular or endothelial dysfunction. Particular attention is given to herpesviruses, retroviruses, enteroviruses, and respiratory viruses, which have been associated with conditions such as dementia, multiple sclerosis, myelopathies, Guillain-Barré syndrome, and the post-acute neurologic sequelae of COVID-19. Furthermore, we discuss the role of neuroinflammation in viral-associated neurodegeneration and highlight emerging evidence supporting the recombinant zoster vaccine (Shingrix) as a potential modulator of neuroinflammatory processes and a protective factor against dementia. Conclusions: Cutaneous viral infections extend beyond local skin pathology, contributing to a broad spectrum of neurologic complications through intertwined infectious and inflammatory mechanisms. A clearer understanding of how peripheral viral activity shapes central nervous system vulnerability remains a major unmet need. A multidisciplinary approach integrating dermatologic and neurologic perspectives is essential for early recognition and prevention. While observational studies suggest that zoster vaccination may reduce viral reactivation and modulate neuroinflammatory pathways, definitive evidence of neuroprotection is still lacking. Future studies should clarify causal relationships, test mechanistic hypotheses regarding skin–brain immune crosstalk, and explore vaccine-mediated neuroprotection as a novel therapeutic strategy. Full article

The present study investigates whether the COVID-19 pandemic had a negative effect on audit opinion and led to differences in the composition of key audit matters (KAMs) observed in the airline industry. This study uses a sample of 55 airlines whose financial statements are based on International Financial Reporting Standards (IFRSs) and whose financial statement audit follows National or International Standards on Auditing (ISAs) for audit opinion, as well as a sample of 42 airlines whose financial statements are based on IFRSs and whose financial statement audit follows ISAs for the composition of KAMs. A textual analysis, a content analysis, a frequency distribution, and a chi-square test were conducted for the periods before, during, and after the COVID-19 pandemic. The findings reveal that the COVID-19 pandemic had no significant effect on audit opinion, except for one airline whose audit report declared a disclaimer of opinion. In contrast, the impairment of goodwill and intangible assets (as an industry-specific KAM) and going concern (as a KAM specific to the COVID-19 pandemic) were the two KAMs that were typically observed during the COVID-19 pandemic due to increased uncertainty. This was found to be the case, even though the main KAMs in the airline industry are usually revenue recognition; lease accounting; property, plant, and equipment (PPE); and hedge accounting. This study contributes to the debate on the effect of the COVID-19 pandemic on audit opinions and KAMs by offering evidence from the underexplored airline industry. Full article

Background: Pediatric SARS-CoV-2 infection is usually mild, but in rare cases may lead to severe complications. Early recognition and comprehensive management are critical for favorable outcomes. Case Presentation: We present the case of a 2-year-old girl, previously healthy and unvaccinated against Streptococcus Pneumoniae (S. pneumoniae), who developed SARS-CoV-2 infection and acute otitis media. Initial laboratory evaluation revealed leukocytosis with neutrophilia and increased inflammatory markers. Antiviral and antibiotic treatment was initiated, but she remained febrile, polypneic, and tachycardic. The diagnosis of MIS-C was excluded; there was no involvement of two organs, and infection with S. pneumoniae serotype 19 F was identified. Given the unfavorable evolution, corticosteroid therapy and immunoglobulin were instituted, and subsequently, following the antibiogram result, antibiotic therapy was escalated to Meropenem and Linezolid. Clinical and laboratory parameters improved, but pericarditis with a small fluid slide and ECG changes were associated. The evolution was favorable with complete cardiac recovery at 30 days. Conclusion: This case highlights the importance of vigilant assessment for secondary bacterial infections and cardiac complications in pediatric COVID-19. Prompt recognition and targeted treatment are essential, and pneumococcal vaccination remains a fundamental preventive measure. Moreover, the scarcity of literature documenting SARS-CoV-2 infections complicated by pericarditis further underscores the uniqueness of this case and its relevance for specialists in the field. Full article

Background/Objectives: The COVID-19 pandemic accelerated the shift toward community- and home-based care models. Within this transformation, Family and Community Nurses (FCNs) have become key in bridging hospital and primary care, supporting continuity, self-care, and quality of life (QoL). Despite increasing recognition, evidence on FCN-led interventions remains fragmented. This systematic review and meta-analysis aimed to synthesize evidence on the impact of FCN interventions on QoL and clinical outcomes in post-COVID and people living with chronic conditions managed in community and home settings. Methods: Following PRISMA 2020 guidelines, we searched PubMed, Scopus, CINAHL, PsycINFO, Embase, and Cochrane Library (January 2020–November 2024). Eligible studies were randomized controlled trials evaluating FCN-led interventions. Primary outcomes were QoL (measured with validated tools) and glycemic control (HbA1c). Secondary outcomes included hospital readmissions, anxiety, depression, and self-care abilities. Risk of bias was assessed using the Cochrane RoB2 tool for randomized controlled trials. Random-effects meta-analyses were performed, with heterogeneity evaluated by I². The protocol was prospectively registered in PROSPERO (CRD42024567890) before data extraction. Results: Seventy-one studies (n = 19,390) were included. Interventions comprised home visits, telehealth, patient education, and case management. Pooled analyses demonstrated significant improvement in QoL (SMD 0.34, 95% CI 0.18–0.50) and reduction in HbA1c (−0.47%, 95% CI −0.69 to −0.25). FCN interventions also reduced hospital readmissions (RR 0.74, 95% CI 0.62–0.89) and improved mental health outcomes. Most studies were judged at low to moderate risk of bias. Conclusions: FCN-led interventions significantly enhance QoL, mental health, and clinical outcomes while reducing hospital readmissions. These findings highlight the strategic importance of integrating FCNs into community-based healthcare models. Full article

PF4-dependent disorders encompass a heterogeneous group of immune-mediated thrombotic syndromes, including heparin-induced thrombocytopenia (HIT), its autoimmune variants such as spontaneous HIT, and vaccine-induced immune thrombotic thrombocytopenia (VITT). The recent identification of VITT and VITT-like entities has significantly expanded the diagnostic spectrum, complicating the retrospective interpretation of cases that occurred before their formal recognition. We report the case of a young patient who initially presented with a clinical and biological presentation suggestive of atypical HIT, at a time when neither spontaneous HIT nor VITT were defined. The patient was re-evaluated during the COVID-19 vaccination campaign, prompting a reassessment of the initial diagnosis in light of current knowledge on PF4-related disorders, which continue to increase in both diversity and complexity. A critical review of clinical and laboratory findings now favors a diagnosis of VITT-like syndrome over spontaneous HIT, although confirmatory testing is no longer feasible given the time elapsed since the acute phase. This case highlights the importance of revisiting historical cases using updated diagnostic criteria to improve the identification and management of these emerging and underrecognized syndromes. Full article

Integrating artificial intelligence (AI) with wearable sensor technologies can revolutionize the monitoring and management of various chronic diseases and acute conditions. AI-integrated wearables are categorized by their underlying sensing techniques, such as electrochemical, colorimetric, chemical, optical, and pressure/stain. AI algorithms enhance the efficacy of wearable sensors by offering personalized, continuous supervision and predictive analysis, assisting in time recognition, and optimizing therapeutic modalities. This manuscript explores the recent advances and developments in AI-powered wearable sensing technologies and their use in the management of chronic diseases, including COVID-19, Diabetes, and Cancer. AI-based wearables for heart rate and heart rate variability, oxygen saturation, respiratory rate, and temperature sensors are reviewed for their potential in managing COVID-19. For Diabetes management, AI-based wearables, including continuous glucose monitoring sensors, AI-driven insulin pumps, and closed-loop systems, are reviewed. The role of AI-based wearables in biomarker tracking and analysis, thermal imaging, and ultrasound device-based sensing for cancer management is reviewed. Ultimately, this report also highlights the current challenges and future directions for developing and deploying AI-integrated wearable sensors with accuracy, scalability, and integration into clinical practice for these critical health conditions. Full article

Background: The intersection between oncology and intensive care has shifted from predominantly end-of-life care to a therapeutic bridge that can preserve anticancer trajectories in carefully selected patients. Yet, criteria separating benefit from futility remain fragmented. Objective: This paper seeks to map contemporary evidence (2015–2025) on outcomes after Intensive Care Unit (ICU) admission in adults with cancer and to identify clinical constellations in which ICU-level care still changes prognosis. Methods: PRISMA-ScR scoping review (PCC framework). PubMed search (2015–2025), dual screening, standardized extraction; narrative/thematic synthesis across six clusters (hematologic, solid tumors, sepsis/non-COVID-19 infection, COVID-19/viral pneumonia, novel/targeted-therapy toxicities, end-of-life/aggressive ICU) were used. No meta-analysis given heterogeneity. Results: Seventy-three studies (>170,000 ICU admissions) were included, mostly cohort designs across 27 countries. ICU mortality ranged 8–72% (weighted mean ≈ 41%); hospital ≈ 38%; 90-day ≈ 46%; 1-year ≈ 62%. About one third of ICU survivors resumed systemic therapy. Benefit concentrated in early admissions, single-organ failure, controlled/remission disease, postoperative/elective monitoring, and reversible treatment-related toxicities (e.g., ICI pneumonitis, CAR-T CRS/ICANS). Futility clustered around ≥3 organ supports, RRT > 7 days, refractory/progressive disease, and ECOG ≥ 3. Sepsis outcomes averaged 45–55% ICU mortality but improved with rapid recognition and source control; COVID-19 mortality was particularly high in hematologic malignancies early in the pandemic, with subsequent declines post-vaccination. Conclusions: In modern oncologic practice, ICU care changes prognosis when the acute physiological insult is reversible and cancer control remains plausible; conversely, high organ-support burden and refractory disease define practical futility thresholds. These signals support time-limited ICU trials, earlier ICU involvement for sepsis/irAEs, and embedded palliative care to align intensity with goals. Full article