Search Results (120)

Background: Tremor is a common but diagnostically challenging movement disorder due to its clinical heterogeneity and overlapping aetiologies. The 2018 consensus introduced a two-axis classification system that redefined tremor syndromes by distinguishing between clinical phenomenology and underlying causes, and introduced new diagnostic categories, such as essential tremor plus. Methods: This review synthesises recent advances in the epidemiology, classification, pathophysiology, and treatment of tremor syndromes, aiming to provide an integrated and clinically relevant framework that aligns with emerging diagnostic and therapeutic paradigms. Results: We discuss how electrophysiology, neuroimaging, wearable sensors, and artificial intelligence are reshaping diagnostic precision. Syndromes such as essential tremor, parkinsonian tremor, dystonic tremor, task-specific tremor, orthostatic tremor, and functional tremor are examined through syndromic, aetiological, and mechanistic lenses. The limitations of current rating scales and the promise of emerging biomarkers are critically assessed. Conclusions: As therapeutic approaches evolve toward neuromodulation and precision medicine, the need for pathophysiologically grounded diagnostic criteria becomes more urgent. Integrating network-based frameworks, digital diagnostics, and individualised treatment holds promise for advancing tremor care. Full article

Rugby Union is a high-impact sport with considerable injury risk, especially in emerging rugby settings where structured physical preparation may be limited. This study aimed to assess the epidemiological profile and injury incidence among Rugby Union players in Brazil, providing insights to inform strength and conditioning strategies. A cross-sectional observational study was conducted between October 2023 and February 2024 using a digital questionnaire that captured demographic data, sports participation history, and detailed information about injuries sustained in 2022 and 2023. A total of 236 players participated (58.9% male; mean age = 29.4 ± 7.5 years), with males averaging 29.6 ± 7.7 years and females 29.1 ± 7.5 years. Overall, 183 injuries were reported. Most injuries occurred during matches (73.3%) and were contact-related (82.1%), with the shoulder/clavicle and knee being the most affected regions. Ligament injuries (27.3%), dislocations (15.3%), and fractures (16.4%) were the most prevalent types. Female players had a distinct injury pattern, with a greater proportion of non-contact mechanisms. Significant associations were found between injury occurrence and sex (p = 0.012), playing modality (p < 0.001), injury type (p = 0.013), and recovery time (p = 0.006). These findings highlight the urgent need for tailored strength and conditioning interventions focused on injury prevention and athletic preparedness. Such programs should address sport-specific demands, promote neuromuscular resilience, and be accessible across competitive levels to improve performance and minimize injury-related setbacks. Full article

Background and Objectives: Visceral arterial pseudoaneurysms (VAPAs) are rare vascular lesions characterized by the disruption of partial disruption of the arterial wall, most commonly involving the intima and media. They have an estimated incidence of 0.1–0.2%, with the splenic artery most commonly affected. Their management poses unique challenges due to the high risk of rupture. Timely recognition is crucial, as unmanaged pseudoaneurysms have a mortality rate of 90%. This narrative review aims to synthesize current knowledge regarding the epidemiology, etiology, clinical presentation, diagnostic methods, and management strategies for VAPAs. Materials and Methods: A literature search was performed across Pubmed for articles reporting on VAPAs, including case reports, review articles, and cohort studies, with inclusion of manuscripts that were up to (date). VAPAs are grouped by embryological origin—foregut, midgut, and hindgut. Results: Chronic pancreatitis is a primary cause of VAPAs, with the splenic artery being involved in 60–65% of cases. Other causes include acute pancreatitis, as well as iatrogenic trauma from surgeries, trauma, infections, drug use, and vascular diseases. VAPAs often present as abdominal pain upon rupture, with symptoms like nausea, vomiting, and gastrointestinal hemorrhage. Unruptured pseudoaneurysms may manifest as pulsatile masses or bruits but are frequently asymptomatic and discovered incidentally. Diagnosis relies on both non-invasive imaging techniques, such as CT angiography and Doppler ultrasound, and invasive methods like digital subtraction angiography, which remains the gold standard for detailed evaluation and treatment. A range of management options exists that are tailored to individual cases based on the aneurysm’s characteristics and patient-specific factors. This encompasses both surgical and endovascular approaches, with a growing preference for minimally invasive techniques due to lower associated morbidity. Conclusions: VAPAs are a critical condition requiring prompt early recognition and intervention. This review highlights the need for ongoing research to improve diagnostic accuracy and refine treatment protocols, enhancing patient outcomes in this challenging domain of vascular surgery. Full article

Background/Objectives: Mobile healthcare units (MHUs) comprise flexible, ambulatory healthcare teams that deliver community care services, particularly in underserved or remote areas. In Greece, MHUs were pivotal in epidemiological surveillance during the COVID-19 pandemic and are now evolving into a sustainable and integrated service for much-needed community-based healthcare. To support this expanded role, targeted, competency-based training is essential; however, this can pose challenges, especially in coordinating synchronous learning across geographically dispersed teams and in ensuring engagement using an online format. Methods: A nationwide, online training program was developed to improve the knowledge of the personnel members of the Hellenic National Public Health Organization’s MHUs. This program was structured focusing on four core themes: (i) prevention–health promotion; (ii) provision of care; (iii) social welfare and solidarity initiatives; and (iv) digital health skill enhancement. The program was implemented by the University of Crete’s Center for Training and Lifelong Learning from 16 January to 24 February 2025. A multidisciplinary team of 64 experts delivered 250 h of live and on-demand educational content, including health screenings, vaccination protocols, biomarker monitoring, chronic disease management, treatment adherence, organ donation awareness, counseling on social violence, and eHealth applications. Knowledge acquisition was assessed through a pre- and post-training multiple-choice test related to the core themes. Trainees’ and trainers’ qualitative feedback was evaluated using a 0–10 numerical rating scale (Likert-type). Results: A total of 873 MHU members participated in the study, including both healthcare professionals and administrative staff. The attendance rate was consistently above 90% on a daily basis. The average assessment score increased from 52.8% (pre-training) to 69.8% (post-training), indicating 17% knowledge acquisition. The paired t-test analysis demonstrated that this improvement was statistically significant (t = −8.52, p < 0.001), confirming the program’s effectiveness in enhancing knowledge. As part of the evaluation of qualitative feedback, the program was positively evaluated, with 75–80% of trainees rating key components such as content, structure, and trainer effectiveness as “Very Good” or “Excellent.” In addition, using a 0–10 scale, trainers rated the program relative to organization (9.4/10), content (8.8), and trainee engagement (8.9), confirming the program’s strength and scalability in primary care education. Conclusions: This initiative highlights the effectiveness of a structured, online training program in enhancing MHU knowledge, ensuring standardized, high-quality education that supports current primary healthcare needs. Future studies evaluating whether the increase in knowledge acquisition may also result in an improvement in the personnel’s competencies, and clinical practice will further contribute to assessing whether additional training programs may be helpful. Full article

Background and Aim: Digital surveillance, which utilizes data from social media, search engines, and other online platforms, has emerged as an innovative approach for the early detection of infectious disease outbreaks. This scoping review aimed to systematically map and characterize the methodologies, performance metrics, and limitations of digital surveillance tools compared to traditional epidemiological monitoring. Methods: A scoping review was conducted in accordance with the Joanna Briggs Institute and PRISMA-SCR guidelines. Scientific databases including PubMed, Scopus, and Web of Science were searched, incorporating both empirical studies and systematic reviews without language restrictions. Key elements analyzed included digital sources, analytical algorithms, accuracy metrics, and validation against official surveillance data. Results: The reviewed studies demonstrate that digital surveillance can provide significant lead times (from days to several weeks) compared to traditional systems. While performance varies by platform and disease, many models showed strong correlations (r > 0.8) with official case data and achieved low predictive errors, particularly for influenza and COVID-19. Google Trends and X (formerly Twitter) emerged as the most frequently used sources, often analyzed using supervised regression, Bayesian models, and ARIMA techniques. Conclusions: While digital surveillance shows strong predictive capabilities, it faces challenges related to data quality and representativeness. Key recommendations include the development of standardized reporting guidelines to improve comparability across studies, the use of statistical techniques like stratification and model weighting to mitigate demographic biases, and leveraging advanced artificial intelligence to differentiate genuine health signals from media-driven noise. These steps are crucial for enhancing the reliability and equity of digital epidemiological monitoring. Full article

Wastewater-based epidemiology (WBE) has historically proven to be a powerful surveillance tool, particularly during the SARS-CoV-2 pandemic. Effective WBE depends on the sensitive detection of pathogens in wastewater. However, determining the process limit of detection (PLOD) of WBE through a comprehensive evaluation that accounts for pathogen concentration, nucleic acid extraction, and molecular analysis has rarely been documented. We prepared dilution series with known concentrations of S. Typhi, V. cholerae, rotavirus, and SARS-CoV-2 in surface water and wastewater. Pathogen concentration was performed using Nanotrap particles with the KingFisher™ Apex robotic platform, followed by nucleic acid extraction. Quantitative real-time PCR (qPCR) and digital PCR (dPCR) were used to detect the extracted nucleic acids of the pathogens. The PLODs and recovery efficiencies for each of the four pathogens in surface water and wastewater were determined. Overall, the observed PLODs for S. Typhi, V. cholerae, and rotavirus in surface water and wastewater were approximately 3 log₁₀ loads (2.1–2.8 × 10³/10 mL) using either qPCR or dPCR as the detection method. For SARS-CoV-2, the PLOD in surface water was 2.9 × 10⁴/10 mL with both RT-qPCR and dPCR, one log₁₀ higher than the PLODs of the other three pathogens. In wastewater, the PLOD for SARS-CoV-2 was 2.9 × 10⁴/10 mL using RT-qPCR and 2.9 × 10³/10 mL using dPCR. The mean recovery rates of S. Typhi, V. cholerae, rotavirus, and SARS-CoV-2 for dPCR in both surface water and wastewater were below 10.4%, except for S. Typhi and V. cholerae in wastewater, which showed significantly higher recoveries, from 26.5% at 4.6 × 10⁵/10 mL for S. Typhi to 58.8% at 4.8 × 10⁵/10 mL for V. cholerae. Our study demonstrated that combining qPCR or dPCR analysis with automated Nanotrap particle concentration and nucleic acid extraction using the KingFisher™ platform enables the sensitive detection of S. Typhi, V. cholerae, rotavirus, and SARS-CoV-2 in surface water and wastewater. Full article

Hemotrophic mycoplasmas (HMs) are cell wall-less, small and uncultivable pathogens, which can cause infections in pigs with no to severe clinical signs and can contribute to significant economic losses in the pig industry. In addition to the known mechanical transmission routes of HMs (e.g., via blood-contaminated instruments or lesions from ranking fights), transmission to pigs by arthropod vectors such as Stomoxys calcitrans is being discussed. To date, there is scant available data concerning the transmission of HMs by stable flies. The objective of this study is to gain more data concerning the occurrence of HMs in Stomoxys calcitrans. Therefore, quantitative real-time PCR was conducted on different stable fly samples (surface washings and whole flies). We found Mycoplasma (M.) suis in 5.2% of crushed flies and 4.2% of fly wash solutions, and M. parvum was detected in 5.2% of flies and 9.4% of fly wash solutions. ‘Candidatus (Ca.) M. haemosuis’ was not detected in any sample. The mean bacterial loads were 2.0 × 10² M. suis/fly, 9.3 × 10² M. suis/fly wash solution and, for M. parvum, 2.4 × 10³ M. parvum/fly and 2.1 × 10³ M. parvum/fly wash solution. This molecular occurrence of porcine HMs in blood-sucking flies and reasonable bacterial loads in the two- to three-digit range demonstrate that these flies serve as mechanical vectors in stables and are, therefore, of epidemiological importance. Full article

Wastewater-based epidemiology (WBE) offers a promising tool for sexually transmitted infection (STI) surveillance, especially in settings where underdiagnosis or social stigma complicates conventional reporting. To assess its utility, we conducted a year-long study examining six STIs, Chlamydia trachomatis, Treponema pallidum, Neisseria gonorrhoeae, human immunodeficiency virus (HIV), hepatitis C virus (HCV), and herpes simplex virus (HSV), in weekly composite samples from the primary influent of a small-sized Midwestern wastewater treatment plant. Pathogen detection and quantification were performed via digital PCR. Among the tested targets, Gonorrhea, HIV, HCV, and HSV were detected at the highest frequencies, often in 40–50% of the samples, while Chlamydia and Syphilis appeared less frequently. Despite the variability in detection patterns, this study demonstrates that even infrequent signals can reveal community-level shedding of poorly reported or asymptomatic infections. Although month-to-month wastewater data were not strongly correlated with corresponding clinical records, which could potentially reflect delayed healthcare seeking and pathogen-specific shedding dynamics, the overall findings underscore WBE’s ability to complement existing surveillance by capturing infections outside traditional healthcare channels. These results not only advance our understanding of STI prevalence and population shedding but also highlight the practical benefits of WBE as an early warning and targeted intervention tool. Full article

Hepatocellular carcinoma (HCC) remains one of the most lethal cancers globally, driven by chronic liver disease and a complex tumor microenvironment (TME). Recent advances in spatial omics, single-cell analyses, and AI-driven digital pathology have shed light on the intricate heterogeneity of HCC, highlighting key roles for immune suppression, angiogenesis, and fibrosis in tumor progression. This review synthesizes current epidemiological trends, noting a shift from viral hepatitis to metabolic syndrome as a primary etiology in Western populations, and elucidates how TME components—such as tumor-associated macrophages, cancer-associated fibroblasts, vascular endothelial cells, and immunosuppressive cytokines—contribute to resistance against conventional therapies. We detail the evolution of immunotherapeutic strategies from monotherapy to combination regimens, including dual immune checkpoint blockade and the integration of antiangiogenic agents. Emerging circulating and tissue-based biomarkers offer promise for enhanced patient stratification and real-time monitoring of treatment responses. Collectively, these innovations herald a paradigm shift toward TME-directed precision oncology in HCC, emphasizing the need for multi-targeted approaches to synergistically modulate interacting cellular constituents and ultimately improve clinical outcomes. Full article

Wastewater-based epidemiology (WBE) offers valuable insight into viral circulation at the community level. In this study, we combined digital PCR (dPCR) with molecular typing to investigate the prevalence and diversity of human adenoviruses (HAdVs) in untreated wastewater samples collected throughout Italy. HAdV genomes were detected in over 93% of the 168 samples analyzed, with concentrations up to 4.5 × 10⁶ genome copies per liter. For genotypic characterization, we used nested PCR followed by Sanger and Oxford Nanopore Technologies (ONTs) long-read sequencing. While Sanger sequencing identified three dominant genotypes (HAdV-A12, HAdV-B3, and HAdV-F41), ONT sequencing provided enhanced resolution, confirming all previously identified types and revealing seven additional genotypes: HAdV-B21, HAdV-C5, HAdV-D45, HAdV-D46, HAdV-D49, HAdV-D83, and HAdV-F40. This comprehensive approach highlights the added value of ONT long-read sequencing in uncovering the genetic complexity of adenoviruses in wastewater, particularly in detecting rare or low abundance types that conventional methods may miss. Our findings highlight the value of integrating quantitative and high-resolution molecular tools in WBE to improve surveillance and better understand the epidemiology of viral pathogens circulating in the human population. Full article

The Myanmar government aims to eliminate malaria by 2030, but comprehensive summaries of its malaria control efforts are scarce. To support this goal, a literature review and long-term document preservation are essential. This study collected academic papers, master’s and doctoral theses, and policy documents on malaria control in Myanmar and its surrounding regions, published between 1950 and 2016 through Official Development Assistance. The documents were sourced from online databases, medical universities, and research institutions in Yangon. They were categorized by region and WHO-defined malaria control activity areas and archived digitally at the Ministry of Health. A total of 1107 relevant papers were identified, with 818 collected. Epidemiology-related studies accounted for 40%, followed by drug resistance, surveillance, and treatment. Recent years have seen a rise in genetic and molecular epidemiology research. Full-text analysis revealed significant malaria research in border regions, particularly near the borders of Thailand and China. This study highlights the progress and historical trends in Myanmar’s efforts to control malaria. The archive created will be a valuable resource for future policy planning and implementation efforts aimed at achieving malaria elimination. Full article

Tuberculosis (TB) is a global health challenge, particularly in the Central African Republic (CAR), which is classified as a high TB burden country. In the CAR, factors like poverty, limited healthcare access, high HIV prevalence, malnutrition, inadequate sanitation, low measles vaccination coverage, and conflict-driven crowded living conditions elevate TB risk. Improved AI-driven surveillance is hypothesized to address under-reporting and underdiagnosis. Therefore, we created an epidemiological digital representation of TB in Bangui by employing passive data collection, spatial analysis using a 100 × 100 m grid, and mapping TB treatment services. Our approach included estimating undiagnosed TB cases through the integration of TB incidence, notification rates, and diagnostic data. High-resolution predictions are achieved by subdividing the area into smaller units while considering influencing variables within the Bayesian model. By designating moderate and high-risk hotspots, the model highlighted the potential for precise resource allocation in TB control. The strength of our model lies in its adaptability to overcome challenges, although this may have been to the detriment of precision in some areas. Research is envisioned to evaluate the model’s accuracy, and future research should consider exploring the integration of multidrug-resistant TB within the model. Full article

Background: Children with disabilities, particularly in low- and middle-income countries (LMICs), face heightened risks of vaccine-preventable diseases due to a range of systemic and social barriers. Although immunization is a fundamental human right and a proven public health intervention, this vulnerable group is often overlooked in policy and practice. Understanding the factors compromising vaccine equity for these children is critical to reducing zero-dose prevalence and improving health outcomes. Methods: This scoping review examined peer-reviewed, gray literature from 2010 to 2024. Searches were conducted in PubMed, Google Scholar, and relevant organizational reports (WHO, UNICEF). Studies addressing children with disabilities and focusing on immunization barriers, interventions, or lessons learned were selected. English-language publications were screened in title/abstract and full-text stages. Key data extracted included population, barriers, and immunization outcomes. Since this review focused on articles in English, this is a key limitation. Results were synthesized thematically to identify recurring patterns and to guide improved interventions and policies. Results: Twelve articles met the inclusion criteria. Key barriers identified were inadequate healthcare infrastructure, insufficient provider training, limited follow-up services in rural regions, societal stigma, and pervasive misconceptions around both disability and vaccines. Factors such as maternal education, logistical support for caregivers, and using low-sensory, inclusive vaccination settings were consistently linked with better outcomes. Effective strategies included mobile vaccination units, tailored interventions (e.g., distraction or sedation techniques), school-based immunization programs, and robust community engagement to address stigma. Lessons learned underscored the importance of flexible, individualized care plans and empowering families through transparent communication. Conclusions: Children with disabilities continue to experience significant gaps in immunization coverage, driven by intersecting barriers at the individual, health system, and societal levels. Scaling tailored interventions, inclusive policies, strengthened infrastructure, and ongoing research can help ensure these children receive equitable access to life-saving vaccinations. Full article

Dry eye disease (DED), also known as keratoconjunctivitis sicca, is a multifactorial ocular disease characterized by tear film insufficiency due to diverse etiologies including aging, incomplete and infrequent blinking, hormonal changes, medications, and systemic diseases. Classified into aqueous-deficient dry eye (ADDE), evaporative dry eye (EDE), and mixed subtypes, DED presents with symptoms such as irritation, stinging, redness, foreign body sensation, sensitivity to light, and blurred or fluctuating vision. While rare, severe cases may lead to vision loss. With its rising global prevalence across age groups, DED poses a significant public health challenge. Primary care physicians (PCPs), often the first point of contact for DED patients, require timely screening and management strategies. This review explores the epidemiology, pathophysiology, clinical manifestations, diagnosis, and management of DED, emphasizing practical approaches for PCPs. This narrative review was conducted by searching MEDLINE, PubMed, and Google Scholar databases for relevant articles. Diagnostic approaches, including detailed history taking, patient-reported questionnaires, differential diagnosis, and assessments are discussed alongside management strategies, including symptomatic ophthalmic treatment, risk factor mitigation (e.g., reduced digital device screen time), prevention, and nutrition. By providing a synopsis of early symptoms that PCPs are often the first to encounter, practical approaches to screening and managing DED in the primary care setting, and guidelines on when to refer to specialty care, this comprehensive review aims to equip PCPs with the knowledge to improve DED screening and optimize patient outcomes. Full article

Background: Understanding the dynamics of HIV transmission in heterogeneous populations is crucial for effective prevention strategies. This study introduces the Risk Modulation Point (RMP), a novel threshold identifying where HIV transmission transitions from unsustainable spread to self-sustaining epidemic dynamics. Methods: Using a deterministic, risk-stratified compartmental model, we examined HIV transmission across populations stratified into 100–200 risk groups, each characterized by behavioral heterogeneity modeled through a power-law distribution. The model captures key features of HIV progression, with simulations conducted across high- (~20%), moderate- (~5%), and low (~0.2%)-prevalence regimes. Results: Our findings reveal universal patterns in HIV dynamics. The RMP marks a consistent threshold across scenarios, separating low-risk groups where transmission is minimal from higher-risk groups sustaining the epidemic. Logistic growth in HIV prevalence across risk groups, with sharp transitions near the RMP, was observed universally. The force of infection follows power-law scaling, directly reflecting the level and nature of risk behavior within each group. Importantly, the location of the RMP remains largely invariant to the underlying sexual risk distribution, population resolution, and mixing patterns, making it applicable across both generalized and concentrated epidemics. Conclusion: The RMP framework offers actionable public health insights. It identifies key populations and transition regions for targeted interventions such as antiretroviral therapy and pre-exposure prophylaxis. By tracking shifts in the RMP, it also serves as an early warning indicator for epidemic transitions, guiding resource allocation and monitoring. The focus of the model on intrinsic epidemic dynamics, excluding external interventions, highlights its utility in uncovering fundamental transmission patterns. This study bridges theoretical modeling and practical application, providing a flexible framework for understanding HIV and other stratified epidemics. The findings advance HIV modeling by revealing generic patterns that transcend specific contexts, supporting data-driven public health strategies. Full article