Search Results (7,338)

Background: While COVID-19 vaccination significantly reduces acute disease severity, its impact on the incidence of long COVID remains debated, with some observational studies paradoxically suggesting higher symptom rates among vaccinated individuals. This study aimed to resolve this controversy by distinguishing between the protective effects of prior immunity and the confounding influence of reverse causality. Methods: We conducted a retrospective cohort study of 627 adults hospitalised for COVID-19 in London. Participants were stratified into two analytical cohorts based on vaccination timing: a “prevention cohort” (vaccinated ≥ 14 days pre-infection) and a “post-acute cohort” (vaccinated post-infection). Multivariable Bayesian logistic regression was employed to estimate Adjusted Odds Ratios (aOR) for long COVID, controlling for age, gender, BMI, comorbidities, and acute length of hospital stay (LoS). Results: In the prevention cohort, prior vaccination demonstrated a non-significant protective trend against long COVID (aOR 0.81; 95% CI 0.45–1.42; p = 0.45), with no significant difference observed between homologous and heterologous regimens. The post-acute cohort exhibited a strong, significant positive association (aOR 3.41; 95% CI 2.23–5.52; p < 0.001), indicating substantial indication bias, with symptomatic individuals more likely to seek vaccination. The strongest independent predictors of long COVID were comorbidities (aOR 2.78) and prolonged acute hospitalisation (≥4 days; aOR 1.82). Conclusions: Vaccination administered prior to infection demonstrates a protective trend against long COVID, whereas the strong association observed with post-infection vaccination reflects indication bias, with symptomatic survivors being more likely to seek immunisation. Clinical strategies to mitigate post-acute sequelae should prioritise reducing acute disease severity and managing comorbidities, which were identified as the dominant independent predictors of risk in hospitalised patients. Full article

Objective: This study evaluated the effects of a 12-week High-Intensity Functional Training (HIFT) program combined with thylakoid supplementation on plasma adipo-myokine levels (Decorin, Myostatin, Follistatin, Activin A, and TGF-β1) in men with obesity. Secondary outcomes included anthropometric indices, lipid profiles, and insulin resistance markers. Methods: Sixty men with obesity (age: 27.6 ± 8.4 years; BMI: 32.6 ± 2.6 kg/m²) were randomly assigned to four groups (n = 15 per group): Placebo (PG), Supplement (SG), HIFT + placebo (TPG), and HIFT + supplement (TSG). To ensure robustness against the 27% attrition rate, statistical analyses included both per-protocol and intention-to-treat (ITT) models. HIFT was performed for 3 sessions/week (Borg scale: 15–17). Results: Following Bonferroni correction for multiple endpoints, repeated-measures ANOVA showed significant Time × Group interactions for most adipo-myokines and metabolic markers. Both training groups (TPG and TSG) demonstrated improvements in body composition and insulin sensitivity compared to PG (p < 0.05). While no significant differences were observed between TPG and TSG for systemic metabolic markers, preliminary data suggested that thylakoid supplementation might provide modest complementary modulations in specific myokines (e.g., decorin and follistatin). However, these observed trends did not reach clinical superiority over exercise alone in the broader metabolic profile. Conclusions: Twelve weeks of HIFT is an effective primary driver for modulating the adipo-myokine network in obese men. Although thylakoid supplementation showed potential for selective complementary effects on certain myokines, these findings are exploratory given the small sample size. The clinical significance and long-term complementary value of thylakoid-exercise interactions require further validation in larger, more diverse cohorts. Full article

Background: Cervical intraepithelial neoplasia (CIN) represents a precancerous condition whose effective management is crucial for preventing invasive cervical cancer, a disease that remains a leading cause of cancer-related mortality among women worldwide. The long pre-invasive phase of cervical carcinogenesis and the availability of effective screening and treatment procedures make CIN a largely preventable and curable entity. Objectives: This review aimed to analyze therapeutic options applied in CIN, correlating interventions with lesion grade and guideline recommendations, in order to outline a management model adapted to the Romanian clinical setting. Materials and Methods: A structured narrative review of 20 published articles addressing cervical intraepithelial neoplasia (CIN 1–3) published between 2021 and 2023 was performed. Relevant studies were identified through a targeted literature search and analyzed descriptively. This study synthesized data from the recent literature and international clinical guidelines to identify management trends and context-specific adaptations. Results: Extracted variables included lesion grade, reported therapeutic approach (surveillance, excisional, or ablative treatment), reproductive considerations, and patient compliance, with international guidelines used as reference standards. Across the reviewed studies, excisional procedures (conization and LEEP) were predominantly reported for high-grade neoplasia (CIN 2–3), while low-grade lesions (CIN 1) were managed either conservatively or through close surveillance. Treatment decisions described in the literature were strongly influenced by patient age, fertility preservation needs, and obstetric history. Overall, management approaches reported in Romanian and international studies were broadly aligned with current guideline recommendations, although variations were observed in the expectant management of younger patients. Conclusions: The findings emphasize the importance of individualized management in cervical dysplasia, integrating lesion characteristics with patient-specific factors. While international guidelines provide a robust framework, their adaptation to the Romanian healthcare context should prioritize patient education, compliance, and structured post-treatment follow-up strategies. Full article

Background: Multidrug-resistant (MDR) Gram-negative bacilli (GNBs) significantly compromise the effective management of urinary tract infections (UTIs) worldwide. As antimicrobial resistance varies across regions, locally tailored data are essential to guide empirical therapy. This study investigated the prevalence, determinants, and temporal dynamics of MDR GNBs in UTI patients from Central Portugal between 2018 and 2022. Methods: We conducted a retrospective observational study at a hospital center in Central Portugal, analyzing data from 2018 to 2022. Data from 5194 UTI patients with GNB-positive cultures were analyzed. Binary logistic regression was used to identify determinants of MDR GNBs, defined as resistance to ≥1 agent in ≥3 antibiotic classes. Results: The study population had a mean age of 64.5 ± 25.3 years, and females represented two-thirds of the sample (67.0%). The overall prevalence of MDR GNBs was 35.8%. Advanced age (≥75 years), male sex, and specific treatment contexts—particularly day treatment and laboratory-only cases—were independently associated with MDR. SBL-producing Enterobacterales and non-fermenting GNBs showed the highest risk levels. Conclusions: MDR GNBs are highly prevalent among UTI patients in Central Portugal, and their increasing trend—particularly in 2022—highlights an urgent need for strengthened surveillance and updated empirical treatment strategies. The observed temporal increase highlights the urgent need for strengthened regional surveillance and updated empirical treatment guidelines. Full article

The trend toward developing sustainable nanotechnology has driven researchers to explore environmentally friendly techniques for nanomaterial fabrication. This review examines the utilisation of Commelina benghalensis plant extracts as an effective biological tool for the green synthesis of various nanomaterials. The procedures involve reducing metal salt precursors with aqueous or polar solvent extracts rich in phytochemicals such as flavonoids and polyphenols, followed by a calcination step that yields crystalline products. The findings show that the properties of ZnO, TiO₂, Ag, NiO, and their composites are directly influenced by synthesis factors, including solvent, plant component, and extract concentration. This directly influenced their specific sizes, morphologies, and phases. Furthermore, these C. benghalensis-mediated nanomaterials showed high efficiency in the photocatalytic degradation of textile dyes and pharmaceuticals, as well as potential antibacterial and antioxidant properties. The Commelina benghalensis plant is flexible and renewable for efficient nanomaterial synthesis; nevertheless, issues with standardisation and scalability must be overcome to fully realise its promise for commercial and industrial uses. Full article

Heart rate variability (HRV) reflects autonomic nervous system (ANS) activity and provides insight into physiological and emotional regulation. Evaluating HRV during postural and emotional challenges may help characterize autonomic adaptability in healthy individuals. HRV was recorded in 24 young medical residents (17 females, 7 males; mean age 27.04 ± 1.97 years) during four conditions: rest, orthostatic standing, and exposure to positive and negative emotional images. Each session lasted five minutes. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Heart rate increased significantly only during standing, consistent with sympathetic activation with postural change. Spectral and normalized HRV parameters (nLF, nlf, LF/HF, and normalized coherence) were lowest at rest and increased during standing and emotional image exposure, particularly in males. Parasympathetic indices showed opposite trends. Emotional image exposure did not produce significant differences between positive and negative valence at the group level; however, sex- and anxiety-related patterns emerged. Females with anxiety showed increased heart rate during positive image exposure, whereas non-anxious females exhibited higher heart rate responses to negative images. Orthostatic challenge elicited the strongest autonomic response, whereas emotional visual stimuli induced subtler, sex- and anxiety-dependent autonomic modulation without overall changes in heart rate. These preliminary observations suggest that anxiety and sex may be associated with differences in cardiac autonomic regulation in young healthy adults. These results should be interpreted cautiously, given the pilot design, the small sample size (N = 24), the imbalance between sexes, the exclusion of the depression subgroup from inferential analyses, and the use of non-validated emotional visual stimuli Full article

In the male body, zinc accumulates most abundantly in prostatic cells, where it plays a key role in producing high amounts of citrate in seminal fluid. Intraprostatic accumulation of Zn increases during the development of benign prostatic hyperplasia (BPH), one of the most common diseases in men over 50 years of age. Continuing our investigations on intraprostatic androgens, in this study, we analyzed the mineral content (Zn, Ca, Cu, K, Mg, Mn, and Na) in the transitional zone (TZ) of the prostate using inductively coupled plasma optical emission spectrometry (ICP-OES). The concentrations of testosterone (T) and dihydrotestosterone (DHT) were determined by liquid chromatography–mass spectrometry (LC-MS). Group-wise and correlation analyses demonstrated a descriptive trend toward a volume-dependent increase in Zn concentrations within TZ tissue, whereas other elements exhibited heterogeneous covariance patterns; intraprostatic hormone levels, although elevated in larger prostates, showed no consistent linear correlations with elemental concentrations. Given the observational design of the present study, the reported tissue Zn profiles cannot be interpreted as evidence supporting supplementation in BPH, and any potential clinical implications warrant evaluation in rigorously designed interventional studies. Full article

Hepatitis B virus (HBV) infection is a silent epidemic; many infected people are asymptomatic and not aware of the infection. In 2022, it was reported that approximately 254 million people were living with chronic HBV infection globally, majority being in sub-Saharan Africa and Asia. In Kenya, the national HBV prevalence is estimated to be 3.5%. Our study was aimed at identifying key predictors and transmission trends that could inform the development of sustainable prevention models needed to address existing gaps in the national framework towards HBV elimination. We targeted participants seeking health services in Baringo and Kisumu county health facilities and conducted community mass testing in the two counties. Participants were interviewed using a study questionnaire and were tested for hepatitis B surface antigen (HBsAg) using an HBsAg rapid test. Venous blood was collected from participants who tested HBsAg+ for further infection confirmation and linkage to care. Logistic regression was performed to assess factors correlated with HBV infection. Out of 3034 participants, 192 tested positive for HBsAg and the prevalence of HBV infection was 6.3% (95% CI = 0.055–0.072). Intrafamilial infections in Baringo were 15.0%. HBV infection prevalence exceeded 10% among those aged 25–49 years, peaking at 13.1% in the 45–49-year age group and lowest at 1.8% in the 16–19-year age group. Overall, males had a higher prevalence in younger ages, while females above 60 years old were more affected. In multivariable logistic regression, individuals residing in Baringo (aPR = 8.1; 95% CI = 2.2–29.4), users of other injectable drugs (aPR = 6.7; 95% CI = 1.3–204.0), those traditionally circumcised (aPR 1.02; 95% CI = 0.56, 1.88), and staying >5 km from a health care facility (aPR = 10.4; 95% CI = 2.2–49.4) had significantly higher prevalence ratios of being infected with HBV. These different infection predictors underscore the need for different care and prevention approach models. Full article

This study examines the mechanical response of medium-manganese TRIP steels under different stress states, focusing on deformation-induced austenite-to-martensite transformation and ageing phenomena. Two steels with distinctly different ferrite–austenite morphologies and retained austenite (RA) fractions were analysed: a globular microstructure with 18% RA and a lamellar microstructure with 14% RA, produced by single (SA) and double annealing (DA), respectively. Continuous and interrupted tests were performed under in-plane shear, uniaxial tension, and plane strain stress states. Strain fields were analysed using high-resolution digital image correlation, while RA fractions were quantified as a function of strain by ex situ X-ray diffraction. The results demonstrate a pronounced stress-state dependence. SA samples exhibit discontinuous yielding, with uniaxial tests showing clear Lüders band formation. Both steels exhibit dynamic strain ageing manifested by Portevin–Le Chatelier (PLC) serrations and associated strain bands, which are most pronounced under uniaxial tension, weaker in plane strain, and barely detectable in in-plane shear. Static strain ageing is also evidenced by a strengthened yield response upon unloading–reloading in all samples. The SA globular microstructure exhibits higher PLC band inclination angles than the lamellar DA microstructure, consistent with its more pronounced anisotropy. The propagation velocity in uniaxial tensile samples decreases with increasing strain following the work-hardening response. For both steels, the austenite-to-martensite transformation rate is highest in uniaxial tension, slightly reduced in plane strain, and strongly suppressed under in-plane shear. A Beese–Mohr/Johnson–Mehl–Avrami–Kolmogorov formulation incorporating stress triaxiality and Lode angle captures these trends for both steels. For the stress states considered, the DA condition exhibits a consistently higher transformation rate than the SA condition, accompanied by a higher work-hardening rate. These findings highlight the coupled role of stress state and microstructural morphology in governing localisation behaviour and strain-induced transformation in medium-manganese steels. Full article

Background and Objectives: Malaria, a mosquito-borne parasitic disease caused by Plasmodium species, remains a public health concern in many tropical and subtropical regions. In Saudi Arabia, sustained control efforts have substantially reduced malaria transmission; however, regional heterogeneity and the growing contribution of imported infections continue to shape national malaria epidemiology. This study aimed to provide a comprehensive national assessment of malaria patterns in Saudi Arabia within a prevention-of-reintroduction framework. Materials and Methods: National malaria surveillance data reported by the Ministry of Health from 2010 to 2024 were analyzed to describe temporal trends in malaria burden and incidence, parasite species distribution, age structure, and seasonality across 20 health regions. Spatial heterogeneity was assessed using regional heatmaps and endemicity mapping. Transmission classification, parasite species, and age distribution were examined nationally and in greater detail for the Aseer and Jazan regions during 2021–2024. Future malaria trends through 2030 were projected using autoregressive integrated moving average (ARIMA) models. Results: Between 2010 and 2024, a total of 52,627 malaria cases were reported nationally, with marked interannual variability and an increase in incidence observed after 2020. Malaria burden was historically concentrated in seven endemic regions and subsequently became largely restricted to Aseer and Jazan. Plasmodium falciparum and Plasmodium vivax/Plasmodium ovale accounted for the majority of infections, with cases predominantly occurring among individuals aged ≥10 years. From 2021 onward, no indigenous malaria transmission was recorded; introduced cases were uncommon, and most infections were classified as imported. Forecasting analyses indicated stable national and regional malaria trends through 2030. Conclusions: Malaria in Saudi Arabia during 2010–2024 was characterized by pronounced regional heterogeneity and predominantly importation-driven dynamics. These findings underscore the importance of sustained surveillance, targeted interventions in high-burden regions, and continued vigilance to prevent the re-establishment of local transmission. Full article

Introduction: The existence of primary adrenal gland lymphoma (PAGL) has been debated due to lack of lymphoid tissue in the adrenal glands. PAGL is extremely rare, accounting for less than 1% of all types of lymphomas. The aim of this study was to analyze patients with PAGL in Polish population. Material and Methods: We retrospectively reviewed 13 adult patients with PAGL diagnosed in Polish Hematological Centers. Results: A total of 13 patients (5 women and 8 men) with PAGL were included into the study. The median age at the diagnosis was 69.1 years (range: 31–85). The most common histological type was diffuse large B-cell lymphoma (DLBCL)-12 patients, the remaining one was diagnosed with Hodgkin lymphoma (HL). In 7 patients (54%), the left adrenal gland was involved; in 3 patients (23.5%), the right adrenal gland was involved; and 3 patients (23.5%) had bilateral lymphoma. Systemic symptoms (B symptoms) were observed in 11 out of 13 patients (85%). Two patients (15%) were treated with chemotherapy alone and the remaining eleven patients (85%) with immune and chemotherapy together (85%). During the follow-up period, 11 patients died, 8 had relapsed or refractory disease (62%), and 3 patients (23%) had relapse in central nervous system (CNS). The median progression-free survival (PFS) was 14.63 months, while the median overall survival (OS) was 20.30 months. Adrenalectomy of the involved adrenal gland was associated with shorter PFS (p = 0.0165), with trend of shorter OS. Achieving complete remission (CR) after front line treatment was associated with significantly longer OS (p = 0.0239) and PFS (p = 0.0152). Conclusions: Adrenal glands are extremely rare as primary locations of extranodal lymphoma. The prognosis of PAGL is generally poor. In this study, we described demographic, clinical, and pathological characteristics as well as factors that may affect survival among these groups. So far, it is the largest polish multicenter experience describing patients with PAGL. Full article

Background/Objective: To evaluate the association between optical coherence tomography angiography (OCTA)-derived choriocapillaris flow (CCflow), retinal vascular fractal dimension (FD), and drusen burden in eyes with dry age-related macular degeneration (AMD). Methods: This retrospective study included 113 eyes from 73 patients with dry AMD. Eyes were classified into large and small drusen groups based on median drusen area. OCTA-derived CCflow and FD indices of the superficial and deep capillary plexuses were analyzed. Patient-level clustered analyses were performed using linear mixed-effects and generalized estimating equation models to account for inter-eye correlation. Results: Eyes with large drusen showed significantly lower CCflow compared with those with small drusen (p < 0.001), whereas FDsup did not differ between groups, and FDdeep demonstrated only a near-significant trend toward higher values. CCflow was moderately and negatively correlated with drusen area (ρ = −0.452, p < 0.001), whereas FDdeep showed no significant correlation in unadjusted analyses (ρ = 0.137, p = 0.148). In patient-level age-adjusted multivariable models accounting for inter-eye dependency, CCflow remained independently associated with drusen burden, while FDdeep demonstrated an independent association only after adjustment for age. Conclusions: Reduced CCflow is independently associated with increased drusen burden in dry AMD. FD metrics provide complementary descriptive information regarding microvascular remodeling but do not function as independent biomarkers. CCflow may serve as a robust quantitative indicator of early choroidal compromise in dry AMD. Full article

Municipally provided water is low-cost, considered safe in most communities, and usually fluoridated to improve oral health. Yet, many Chicago region families report relying on other water sources. We investigated if safety and quality concerns were associated with these decisions; we also investigated whether there were spatial trends related to lead risk associated with water choice preferences. We used self-reported water consumption behavior data from the Coordinated Oral Health Promotion (CO-OP) Study, a longitudinal cohort of young children and their families. Respondents’ residences (N= 331) were geolocated at the census tract level. We evaluated associations between parent demographics, estimated lead risk and water preferences. Among those who “Never” gave their children tap water, we investigated demographic characteristics associated with viewing tap water as “Not safe”. Sixty-five percent (n = 216) of caregivers report that their child “Never” drinks tap water. Ordinal logistic regression indicates that parents aged <30 years are more likely to respond “Never” relative to “Sometimes” or “Always” (OR = 1.89; CI = 1.04, 3.40). Among those in the “Never” category, we grouped reasons into safety concerns (n = 114), observed quality concerns (n = 48), and preference (n = 40). We found that the decision not to give children municipal water is not aligned with the estimated lead risk. Understanding water consumption choice mechanisms is important for communities seeking safe and quality drinking water. Full article

Background: Electrocardiography (ECG) represents an important noninvasive screening tool for heart disease in preparticipation screening of competitive athletes. However, interpretation of pediatric ECG based on age-specific reference values remains challenging, due to considerable variation among studies, influenced by population characteristics and documentation methodology. The variability of normal values in key pediatric ECG features regarding left ventricular hypertrophy (LVH), QTc prolongation and pre-excitation detection seem to have a significant impact on the efficacy of pediatric ECG as a preparticipation screening tool. Aims and Scope of the Study: This review aims to compare contemporary pediatric ECG reference ranges for key ECG features relevant to LVH, QTc, PR and QRS duration and highlight physiological and methodological sources of observed variability. Methods: A review of the current literature was conducted using common biomedical databases for studies reporting certain quantitative ECG reference values in healthy children from infancy through adolescence regarding the above selected key features. Reported values were summarized descriptively, with emphasis on developmental trends and methodological differences among studies affecting ECG values. Results: Across 16 pediatric studies, ECG parameters demonstrated consistent age-dependent developmental patterns, despite variability in absolute values. R-wave amplitudes in left precordial leads increased from infancy through early childhood and remained stable in older children, whereas S-wave amplitudes in right precordial leads showed greater variation between studies. PR intervals and QRS duration increased progressively with age across all datasets, while QTc values remained relatively stable throughout childhood and adolescence, with minimal sex-related differences. Variability in reported reference ranges was most pronounced for amplitude-based—compared to interval duration—parameters, and was influenced by differences in population characteristics, ECG acquisition techniques, and measurement methodology. Conclusions: This review summarizes contemporary ECG reference data in healthy children for the early detection of LVH, pre-excitation and QT prolongation, which are the main objectives of ECG screening in young athletes. Full article

The northern segment of the Great Xing’an Range, northeastern China, hosts a previously unrecognized near-E–W-trending rhyolite belt in the Tulihe area. We conducted systematic geochronological and geochemical investigations to constrain its formation age, petrogenesis, and regional tectonic significance. Field investigation, petrographic observation, and zircon laser ablation–inductively coupled plasma–mass spectrometry (LA-ICP-MS) U–Pb dating indicate that the rhyolite belt was formed during the Early Cretaceous, with emplacement ages directly determined from three samples ranging from 143.8 to 131.5 Ma. Geochemically, the rhyolites yielded high SiO₂ contents (74.44–75.88 wt.%), high total alkalis (K₂O + Na₂O = 8.50–8.99 wt.%), and low MgO contents (0.16–0.55 wt.%). They displayed strong enrichment in light rare earth elements and depletion in high field strength elements, weakly negative Eu anomalies, A/CNK ratios near unity, and relatively high Nb/Ta ratios. Trace element signatures and incompatible element abundances (Zr + Nb + Ce + Y = 193.2–338.3 × 10⁻⁶) are mostly consistent with highly fractionated I-type volcanic rocks, rather than S-type or M-type affinities. The geochemical data suggest that the rhyolites were mainly generated by partial melting of a medium- to high-K basaltic lower crust, with minor crustal assimilation and limited mantle input. Tectonically, Early Cretaceous magmatism in the northern Great Xing’an Range was governed by flat-slab subduction and subsequent rollback of the Paleo-Pacific (Izanagi) plate, while the local E–W-trending rhyolite belt was controlled by pre-existing faults, reflecting localized post-orogenic extension consistent with regional NE-trending volcanic belts. The northwest-to-southeast younging trend records asthenospheric upwelling and enhanced crust–mantle interaction induced by slab rollback. These results highlight the petrogenetic and tectonic evolution of medium- to high-K magmatism along the NE Asian continental margin and improve our understanding of Mesozoic volcanism in the Great Xing’an Range. Full article