Search Results (6,879)

Cytisine is a plant-derived quinolizidine alkaloid found, among other sources, in the seeds of the common laburnum (Laburnum anagyroides). It has properties that enable it to act as a partial agonist of brain nicotinic α4β2 receptors, which play a key role in the development and maintenance of nicotine addiction. Clinical studies have shown that cytisine is a more effective smoking cessation aid than nicotine replacement therapy and at least as effective as varenicline in treating tobacco cigarette addiction. It may also be an effective agent in treating addiction to electronic cigarettes. Cytisine is also significantly cheaper than other anti-nicotine medications. This is of great importance for the population of smokers in developing countries, who cannot afford anti-nicotine treatment. In recent years, the role of cytisine in the pharmacotherapy of nicotine addiction worldwide has increased significantly. This drug is becoming available in an increasing number of countries, and in 2025 the World Health Organization (WHO) added cytisine to the list of essential medicines. The need for further development of the drug poses additional challenges for scientists, including the creation of new pharmaceutical forms, optimization of dosing regimens, and expansion of indications to include the treatment of nicotine addiction supplied into the body in forms other than traditional tobacco products. This review describes the use of cytisine in the treatment of nicotine addiction, the drug’s mechanism of action, pharmacokinetics, efficacy, safety of use, and the available pharmaceutical preparations. It also presents research directions on cytisine related to the development of innovative pharmaceutical products, new dosing regimens, and new indications associated with the treatment of addiction to various nicotine-containing products. Conclusions indicate that cytisine has a difficult dosing regimen, which is why patients do not adhere to it, limiting the effectiveness of the therapy. This necessitates optimizing the dosage of existing capsules and tablets or introducing, for example, new extended-release forms of the drug containing cytisine. Full article

Background: Saudi Arabia has made significant progress toward malaria elimination; however, imported cases continue to occur, particularly in the southwestern regions. This study aimed to describe the clinical characteristics and outcomes of patients with malaria in the Aseer Region, Saudi Arabia. Methods: A retrospective observational study was conducted at Khamis Mushait General Hospital, Aseer Region, Saudi Arabia, including all patients with malaria from January 2022 to December 2025. Demographic, clinical, laboratory, and outcome data were extracted from the electronic medical records. Severe malaria was defined according to the World Health Organization criteria. Multivariate logistic regression using Firth’s penalized maximum likelihood estimation was performed to identify independent predictors of severe malaria (≥1 WHO criterion). Statistical analysis was performed using R software (version 4.2.1). Results: A total of 311 patients were included, predominantly male (90.0%), with a mean age of 28.8 ± 11.3 years. Ethiopian nationals comprised nearly half the cases (48.2%), followed by Saudi (16.4%) and Yemeni (15.1%) nationals. Plasmodium vivax was the most common species (51.1%), followed by Plasmodium. falciparum (40.2%). Fever was the most frequent symptom (89.4%), followed by fatigue (50.8%), chills (46.9%), and vomiting (39.5%). Low parasitemia (<1%) was the most frequent finding (33.8%), followed by moderate (27.3%) and mild (18.3%) levels, while high (4.2%) and very high parasitemia (1.9%) were uncommon. Severe malaria (≥1 criterion) was diagnosed at 43.7%, with severe anemia (26.0%) and jaundice (23.2%) being the most frequent WHO severity criteria. Notably, 84% of the cases occurred during 2024–2025, indicating a recent outbreak, with a sharp peak of 43 cases in October 2024. Multivariate logistic regression identified two independent predictors of having at least one WHO severity criterion: higher parasitemia level (adjusted OR = 1.70 per 1% increase, 95% CI: 1.40–2.11, p < 0.001) and non-Saudi nationality (adjusted OR = 2.40, 95% CI: 1.10–5.62, p = 0.027). Conclusions: Malaria in the Aseer Region predominantly affects young adult male expatriates, suggesting its imported nature. The predominance of P. vivax represents a shift from historical patterns. Parasitemia level and being of non-Saudi nationality independently predict severe malaria and may therefore support risk stratification and clinical decision-making. The dramatic case surge in 2024–2025 highlights regional vulnerability to outbreaks despite control progress. These findings support enhanced screening for at-risk populations, maintenance of clinical capacity for severe malaria management, and robust surveillance systems for early outbreak detection. Full article

Background/Objectives: In 2020, the World Health Organization (WHO) launched a strategy to eliminate cervical cancer by ensuring high vaccination coverage, effective screening, and access to treatment. This systematic review assesses how this strategy has been implemented in different world regions, what results have been achieved, and what disparities and challenges have been faced. Methods: A systematic search was performed in PubMed, Web of Science, GLOBOCAN, IARC, ASCO, and ESMO for publications issued between November 2020 and December 2024. A total of 721 records were reviewed and assessed, resulting in the inclusion of 47 studies in the final analysis. Results: Considerable regional variations were identified between the regions analyzed. Countries with organized vaccination programs, structured screening systems, and stronger treatment infrastructure generally reported more favorable outcomes. In contrast, several settings in Eastern Europe, parts of Asia, and sub-Saharan Africa remained below the WHO targets, with lower vaccination uptake, limited screening participation, and a persistently high cervical cancer burden. Progress was further constrained by inequalities in access to healthcare, differences in program organization, and limited comparability of available national data. Conclusions: Although many countries demonstrate that eliminating cervical cancer is achievable, global alignment with WHO targets remains uneven. Strengthening health infrastructure, improving vaccination uptake, and ensuring equitable access to screening and treatment are essential to turning this strategy into a realistic global outcome. Full article

Life expectancy (LE) varies widely across Organization of Islamic Cooperation (OIC) countries, reflecting differences in economic, social, environmental, and health-system conditions. This review aimed to synthesize quantitative evidence on determinants of LE at birth in OIC member countries. The study was conducted in accordance with the PRISMA guidelines, and a systematic search of electronic databases was performed up to September 2025. After screening 5312 records and assessing full texts, studies were appraised using the Joanna Briggs Institute checklists, with an inclusion threshold of ≥80%. A total of 54 studies, mainly ecological, time-series, and panel analyses using national-level data, were included. Higher gross domestic product per capita, education, employment, and health expenditure were consistently associated with longer LE. In contrast, poverty, income inequality, air pollution, and carbon dioxide emissions were associated with shorter LE. Clear differences were observed across World Bank income groups, with LE being lowest in low-income OIC countries and highest in high-income Gulf Cooperation Council states, where gains were driven more by health-system resources than by income growth. Improving LE in OIC countries requires integrated economic, social, environmental, and health-system policies. Full article

Aspergillus fumigatus is a leading cause of invasive fungal disease in humans and is classified as a critical priority threat by the World Health Organization. Triazole antifungals remain the cornerstone of therapy, yet their effectiveness is steadily being eroded by the continuous rise in drug resistance. Most resistance mechanisms trace back to mutations in Cyp51A, spawning well-defined genotypes such as TR₃₄/L98H and TR₄₆/Y121F/T289A. However, the Cyp51A genotype–phenotype landscape in A. fumigatus is far from straightforward. Isolates that share an identical TR genotype can display strikingly divergent susceptibility profiles, and mutational hotspots in Cyp51A, such as G54, M220 and G448, are linked to varying resistances, challenging assumptions about predictable resistance behavior. Complicating matters further, an expanding array of resistance mechanisms, independent of Cyp51A, is now being uncovered. This review summarizes the current state of knowledge on azole resistance in A. fumigatus, dissecting the intricate genotype–phenotype relationships, spotlighting emerging non-Cyp51A pathways and outlining future strategies to enhance the detection and clinical management of antifungal resistance. Full article

Mercury (Hg) decontamination in active and decommissioned mining areas is a difficult task since Hg may affect environmental matrices and man-made materials. Despite its toxicity as an inorganic form being rather limited with respect to organic compounds (e.g., methyl-Hg), severe effects to human health and ecosystems are recognized. In this work, we review the geochemical activities carried out in the last 13 years at the Abbadia San Salvatore (AbSS) mining and production area. This site belongs to Mt. Amiata (Tuscany, central Italy), which is considered the third-largest Hg-district in the world. Air, water, soil and man-made materials within the AbSS area were investigated to verify to what extent such matrices were affected by Hg contamination. The geochemical investigations are used as important tools to proceed with specific remediation operations of edifices, mining structures and machineries as well as the local groundwater system. To the best of our knowledge, restoration of decommissioned areas affected by Hg contamination at a large scale, such as the AbSS exploitation and production site, is rather uncommon. Currently, the remediation activities in the AbSS area are going on and they are expected to be concluded at the end of 2026 or the beginning of 2027, when the former mining area will turn into a public archeometallurgical museum. Full article

The definition of hypertension and the values of systolic and diastolic blood pressure (BP) that should be considered as therapeutic targets have changed over time and vary across scientific societies, which may generate uncertainty in the decision-making process among clinicians and patients. We traced the evolution and described the differences in all the 32 Clinical Practice Guidelines for the management of hypertension released by the following national and international scientific societies: World Health Organization—WHO; International Society of Hypertension—ISH; Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure—JNC; American Heart Association—AHA; American College of Cardiology—ACC; European Society of Cardiology—ESC; European Society of Hypertension—ESH; and UK National Institute for Health and Care Excellence—NICE. Throughout the decades, the BP values used for hypertension definition, treatment initiation, and targets to achieve started from SBP/DBP ≥ 160/95 mmHg, established at the end of the 70s, progressively decreased, and were differentiated by individual cardiovascular risk. In the last decade, a divergent approach emerged across scientific societies: while WHO/ISH and NICE recommended thresholds and targets for the general population at SBP/DBP < 140/90 mmHg, ESH/ESC and ACC/AHA guidelines further and markedly reduced both BP threshold values and therapeutic targets, recommending as ideal SBP/DBP values < 130/80 mmHg and encouraging an SBP < 120 mmHg. Discrepancies also emerged in the assessment of the quality of the evidence: although the methodological approaches largely improved over time and across all the institutions assessed, various degrees of incompleteness on the adopted scales were reported, and potentially conflicting situations emerged, particularly when weaker evidence was used to build strong recommendations. Although some degree of discrepancy among guidelines is expected, some of the differences are large and can lead to widely different approaches in the management of BP control. A standardization of the methodology and interpretation of the evidence supporting the guidelines may help to reduce the variability in order to provide the best possible guidance for clinical practice and patient health. Full article

Antimicrobial resistance is a serious global public health concern, with Acinetobacter baumannii recognized as one of the most problematic multidrug-resistant (MDR) pathogens. This Gram-negative bacterium is highly persistent in the environment, possesses a remarkably adaptable cell envelope, and forms biofilms. As the effectiveness of conventional antibiotics declines, alternative strategies are being actively explored, particularly membrane-targeting approaches based on synthetic copolymers. These compounds mimic antimicrobial peptides, offer enhanced stability and structural tunability, and have a lower propensity to develop resistance. Recent advances in polymer chemistry have led to the design of antibacterial polymers with activity against MDR A. baumannii. Some of these act synergistically with existing antibiotics, restoring bacterial susceptibility or disrupting biofilms. However, their non-degradability remains a concern due to its potential implications for body/environment accumulation and related toxicity and/or selection of resistant strains. This review examines the biology of the A. baumannii cell envelope, its resistance mechanisms, and treatment limitations, while emphasizing the promise of membrane-active copolymers. By bridging materials science and microbiology, these approaches offer promising strategies for combating World Health Organization priority pathogens. Full article

Air pollution remains a critical environmental and public health threat, particularly in highly populated urban areas such as the Lisbon Metropolitan Area (LMA). This study provides a refined and detailed assessment of the spatial distribution of air pollution and associated attributable mortality across the LMA. High-resolution (1 km²) annual mean concentrations of key pollutants (PM_2.5, PM₁₀ and NO₂) for 2022 and 2023 were estimated by integrating outputs from the URBAIR dispersion model with ground-based monitoring observations using advanced geostatistical data-fusion techniques. Air pollutant concentrations were combined with gridded population data and age-stratified baseline mortality rates within a Geographic Information System framework to quantify spatial variations in health impacts. Using the World Health Organization AirQ+ framework and established concentration–response functions, we estimated a total of 3195 air-pollution-attributable deaths across the Lisbon Metropolitan Area (LMA) in 2022, increasing to 4010 deaths in 2023. Fine particulate matter (PM_2.5) was identified as the dominant contributor, accounting for more than 40% of the total health burden. At a high spatial resolution (1 km² grid), estimated mortality exhibited substantial variability, ranging from 0 to 29 deaths per cell in 2022 and from 0 to 36 deaths per cell in 2023. These results highlight the importance of fine-scale spatial analysis, revealing intra-urban disparities that are not captured by aggregated estimates of total attributable mortality. The proposed methodological framework, integrating dispersion modelling, data fusion, and spatially explicit health impact assessment at fine spatial scales, provides a robust and transferable approach to support evidence-based air quality management and urban health policy development in European metropolitan contexts. This integrated approach enhances comparability, improves exposure assessment accuracy, and strengthens the scientific basis for designing targeted mitigation strategies that could prevent hundreds of premature deaths annually while addressing documented spatial inequalities in pollution exposure. Full article

Biological E’s BEVAC^® is a recombinant DNA hepatitis B vaccine that has been used in India for more than a decade in routine early-life immunization and has recently been prequalified by the World Health Organization (WHO). This multicentre, single-blind, parallel-group, randomized phase IV trial, conducted at seven study sites in India, compared the immunogenicity and safety of BEVAC^® with a licensed comparator vaccine (GeneVac-B^®, Serum Institute of India Pvt. Ltd, Pune, India.) in healthy term neonates and infants. Participants received three 0.5 mL doses administered intramuscularly at birth (within 24 h), 6 weeks of age, and 14 weeks of age. The primary endpoint was seroprotection (anti-HBs IgG ≥10 mIU/mL) at 28 days after the third dose (Day 126), compared using a non-inferiority margin of −10%. Secondary endpoints included safety and tolerability outcomes through Day 126. A total of 468 neonates were randomized (234 per group), of whom 44% were female. At Day 126, seroprotection rates were 98.2% (95% CI: 95.39, 99.50) with BEVAC^® and 99.1% (95% CI: 96.78, 99.89) with the comparator; the between-group difference was −0.9% (95% CI: −3.09, 1.24), meeting the prespecified non-inferiority criterion. Solicited adverse events within 7 days after any dose occurred in 29.1% (95% CI: 23.3, 35.3) of BEVAC^® recipients and 35.0% (95% CI: 28.9, 41.5) of comparator recipients, most commonly pyrexia, injection-site pain, and swelling; all were mild-to-moderate. No serious adverse events were reported. BEVAC^® demonstrated non-inferior immunogenicity to the licensed comparator and a comparable safety profile. Full article

School handwashing facilities in rural areas without piped water and drainage systems often discharge wastewater directly into the ground, leading to environmental contamination and loss of a valuable water resource, particularly in water-scarce regions. This study evaluates a decentralised three-stage handwashing wastewater treatment system combining biochar and sand filtration with chlorination. The integrated system effectively improved water quality by reducing turbidity, colour, suspended solids, nutrients, organic matter, and microbial contamination. While biochar and sand filtration provided substantial physicochemical treatment, chlorination was essential to ensure complete microbial inactivation. The treated water met several water quality standards for potable use (handwashing only) set by the World Health Organization (WHO) and the United States Environmental Protection Agency (USEPA) standards. Additionally, it complied with international guidelines for greywater reuse in toilet flushing, irrigation, and floor washing. This innovative water treatment strategy could help clean and reuse handwashing wastewater on-site. This could provide rural schools with clean water to support water needs in water shortage periods, such as hand hygiene, garden irrigation, toilet flushing, and floor washing. Overall, integrating biochar and sand filtration with disinfection could help remote rural schools recover water, advancing towards the achievement of the Sustainable Development Goals (SDG) for good health (SDG 3), clean water and sanitation (SDG 6), and sustainable communities (SDG 11). Full article

Background and Objective: After SARS-CoV-2 infection, Long COVID (LC) syndrome has occurred in a high proportion of patients, affecting their health. The aim of this study was to estimate the incidence of LC, as well as its risk and protective factors. Materials and Methods: We conducted a prospective population-based cohort study of the Borriana COVID-19 cohort (Castellon Province, Valencia Community, Spain) from May 2020 to August 2023, with a follow-up of 40 months, using the LC definition given by the World Health Organization. Inverse probability-weighted regression adjustment was applied in the statistical analysis. Results: With a participation rate of 63.8% and a total of 722 participants, the mean age was 37.7 ± 17.4 years, and 460 (62.3%) were female. Among them, 644 had experienced a SARS-CoV-2 infection, and 184 developed LC, corresponding to a cumulative incidence of 28.6%. At the time of follow-up, 135 patients remained affected by LC, and one LC-related death was recorded. Significant risk factors for LC included older age, female sex, being part of a small family, having a chronic disease, SARS-CoV-2 exposure, and disease severity. Asymptomatic COVID-19 infection and SARS-CoV-2 vaccination were significantly protective factors. Conclusions: A substantial incidence of LC was observed, along with a low recovery rate. Several risk and protective factors were identified. Continued follow-up of this cohort, improved medical care for patients with non-recovered LC, ongoing surveillance of SARS-CoV-2 infections, and vaccination of the at-risk populations against SARS-CoV-2 are recommended. Full article

Background: Antimicrobial resistance (AMR) is a global health threat arising from inappropriate antibiotic use. Data on the prescription of antibiotics in emergency departments (EDs), critical care points for infection management, are limited. Objective: This study aimed to assess systemic antibiotic use in an Indonesian ED. Methods: This retrospective observational study was conducted in the Cilacap Teaching Hospital ED in 2022. Data, including patient demographics and systemic antibiotic prescription details (World Health Organization Anatomical Therapeutic Chemical (WHO ATC): J01) were extracted from electronic medical records. Antibiotic use was analyzed according to age groups (children [0–14 years], adults [15–64 years], and the elderly [≥65 years]), administration route, and the World Health Organization Access, Watch, and Reserve classification. Results: Among all ED visits during the study period, 52.1% (14,396/27,640) received systemic antibiotics, and adults comprised 68.5% (9861/14,396) of antibiotic-exposed cases. Cephalosporins were the most frequently prescribed antibiotics in all age groups (42.4–50.9%). Penicillins were more frequently prescribed in children (29.9%) than in adults (10.0%) and the elderly (6.6%), whereas fluoroquinolones were more commonly prescribed in the elderly (21.1%) than in adults (16.2%) and children (3.8%). Watch-class antibiotics, comprising 63.9% of all prescriptions, were commonly prescribed in the elderly (71.9%). Oral route was the predominant form (65.8%), particularly in children (76.5%). The most frequently prescribed antibiotics differed across age groups, with amoxicillin followed by cefixime in children, and cefixime followed by ceftriaxone in both adults and the elderly. Conclusions: This study showed high antibiotic exposure and identified age-related differences in antibiotic prescribing, and patterns that warrant further evaluation within antimicrobial stewardship frameworks, to optimize antibiotic use and mitigate AMR. Full article

Background and Objectives: Poor sleep is common in community and primary-care settings, yet very brief sleep measures suitable for routine use remain limited. We developed and evaluated the five-item Promoting Evaluation and Awareness of Comfort in Sleep (PEACE) scale and examined its associations with well-being and fatigue. Materials and Methods: In a cross-sectional, clinician-mediated online survey, 312 community-dwelling adults in Italy who were not receiving active treatment for major diseases completed PEACE, the World Health Organization-Five Well-Being Index (WHO-5), and a short fatigue questionnaire. The sample was stratified and split into exploratory and confirmatory subsamples for factor analyses. Results: Factor analyses supported the use of a single total score and showed acceptable reliability. Results were broadly similar in women and men, with no evidence of item-level bias, although some model-comparison indices were mixed. Higher PEACE scores were associated with better well-being and lower fatigue. Adding PEACE to a model predicting well-being from body mass index and sex increased explained variance from 4.0% to 11.5%. Conclusions: PEACE is a brief sleep-quality measure with promising initial psychometric properties. In this sample, it was associated with well-being and fatigue and may add information beyond body mass index and sex in community and primary-care settings. Full article

Objective: Primary extranodal lymphomas of the head and neck region are relatively rare and represent a biologically distinct subset. The diagnosis and differential diagnosis of head and neck lymphomas are important and deserve special attention. The aim of the present study was to retrospectively evaluate patients diagnosed with primary head and neck lymphomas at the Department of Pathology between January 2020 and January 2026. Histopathological subtypes, localization, relative frequencies, and overall survival were analyzed. Materials and Methods: This retrospective study included 31 cases diagnosed with lymphoma involving the head and neck region. Medical records were reviewed. Histopathological slides were re-evaluated under light microscopy by experienced pathologists. All cases were classified according to the current World Health Organization (WHO) classification of tumors of hematopoietic and lymphoid tissues. An extensive immunohistochemical panel was applied. Statistical analysis was performed using SPSS statistical software (version 27.0; IBM Corp., Armonk, NY, USA). Results: The study group included 31 patients with head and neck lymphoma. The most common histological type was diffuse large B-cell lymphoma (DLBCL) (54.8%). Other histological subtypes included follicular lymphoma (FL), mantle cell lymphoma (MCL), extranodal NK/T-cell lymphoma (NKTCL), anaplastic large cell lymphoma (ALCL), and Hodgkin lymphoma (HL). The most common location was the tonsil (38.7%). Other locations included the nasopharynx, oral cavity, nasal cavity, salivary glands, and thyroid. Epstein–Barr virus (EBV) positivity was detected in two patients (6.5%), and human immunodeficiency virus (HIV) infection was identified in two patients (6.5%). At the time of the last follow-up, 27 patients (87.1%) were alive, whereas four patients (12.9%) had died. The mortality rate was 12.9%. The median overall survival was 28 months (95% CI: 10–45). Conclusions: Malignant lymphoma should be considered when evaluating head and neck masses, and histopathological assessment of the affected tissue remains the cornerstone of diagnosis. Full article