Search Results (238)

West Nile neuroinvasive disease (WNND) causes substantial morbidity in endemic regions, yet data on its burden in Serbia remain limited. We conducted a retrospective, population-based study of WNND cases reported in Vojvodina Province, Serbia, from 2012 to 2025. Incidence and mortality trends were analysed by year, residence, age, sex, and week of symptom onset. Multivariable logistic regression was used to identify predictors of fatal outcome. Of 1337 suspected cases, 557 (41.66%) met the WNND case definition (530 confirmed, 27 probable cases) and 98.9% were autochthonous. The mean annual incidence was 2.17/100,000 (95% CI 0.60–3.75), ranging from 0.48/100,000 (2015) to 10.31/100,000 (2018), with additional peaks in 2013 and 2022. Cases clustered predominantly in epidemiological weeks 31–34. The mean mortality was 0.28/100,000 (95% CI 0.02–0.53) and the mean case fatality rate was 12.93% (95% CI 10.14–15.71%). Incidence increased with age, peaking at 5.97/100,000 in those 70–79 years; highest mortality occurred in ≥80 years (1.78/100,000). All districts reported cases, with the highest incidence and mortality in South Banat. Higher Charlson Comorbidity Index, cardiovascular disease, diabetes and malignancy independently predicted fatal outcome. WNND remains a significant public health problem in Vojvodina, requiring improved surveillance, targeted prevention, and early treatment of high-risk patients. Full article

Background: Visceral leishmaniasis (VL) is a life-threatening protozoan disease prevalent in tropical and subtropical regions and a frequent coinfection among people living with HIV. Early identification of patients at high risk of death may reduce case-fatality. This study evaluated the post-test prognostic value of C-reactive protein (CRP) and interleukin-6 (IL-6) as biomarkers of mortality in VL. Methods: A retrospective hospital-based cohort of 101 VL patients was analyzed. CRP and IL-6 concentrations at admission were correlated with clinical findings, the Kala-Cal^® prognostic score, and in-hospital mortality. Results: Eight patients died, most presenting with hemorrhagic manifestations. At admission, 87.1% of patients had both biomarkers above the predefined cut-offs. CRP and IL-6 levels were markedly elevated in patients with hemorrhage or fatal outcomes. The AUC was 0.85 for CRP and 0.87 for IL-6, with no significant difference between markers. Optimal prognostic cut-offs were 150 mg/L for CRP and 90 pg/mL for IL-6. Conclusions: In this sample, CRP and IL-6 showed good prognostic performance in VL. In patients with low initial clinical risk, positive biomarker results substantially increased the probability of death. When combined with Kala-Cal^®, these markers may improve risk stratification and guide referral decisions. Full article

Background: Coronary computed tomography angiography (CCTA) is a well-established key diagnostic modality for ruling out obstructive coronary artery disease (CAD) in patients with suspected chronic coronary syndromes (CCSs) and low to intermediate pre-test probability. The widespread availability of preprocedural CCTA data in CCS patients undergoing percutaneous coronary intervention (PCI), however, creates a new opportunity for image-guided procedural planning. Objective: The PRECISION-CT study (Prospective Evaluation of Coronary CTA Integration for Strategy Improvement and Optimization of Non-Emergent PCI) aims to evaluate the impact of CCTA-guided PCI on patient safety and clinical outcomes. Methods: PRECISION-CT is a prospective, two-center, randomized controlled trial, enrolling patients with CCS scheduled for elective PCI due to obstructive CAD by CCTA. Patients are randomized 1:1 to either CCTA-guided PCI or standard angiography-guided PCI. In patients randomized to CCTA-guided PCI, advanced post-processing of CCTA datasets provides specific procedural planning recommendations based on the detailed assessment of coronary artery takeoff, lesion location and plaque characteristics. In addition, real-time integration of the advanced CCTA post-processing is available in the catheterization laboratory during the PCI procedure. Patients randomized to angiography-guided PCI are treated according to routine clinical practice. Results: The primary endpoint is a composite procedural safety and efficacy score including: (i) need for intravascular imaging, (ii) procedural complications, (iii) post-procedural high-sensitivity troponin T elevation, (iv) contrast media, (v) radiation exposure, and (vi) length of hospital stay. Secondary endpoints include major cardiac adverse events such as cardiac death, non-fatal myocardial infarction, target-lesion reintervention and probable or definitive stent thrombosis during 1 year of follow-up. Conclusions: The PRECISION-CT study will provide pragmatic evidence on the ability of CT-guided PCI in patients with CCS to optimize procedural outcomes. These findings may help inform the broader adoption of image-guided precision revascularization strategies in interventional cardiology. Full article

The objective of this paper was to review the possibility that the QT interval may be a marker of adult human longevity or life expectancy. Following a literature review, data supporting this possibility was assembled and consists of the following. First, in adults, QT interval increases with increasing age. This is analogous to aging-induced hypertension and diabetes mellitus, both of which are associated with shorter longevity. Second, older persons frequently die suddenly regardless of whether or not they have chronic illnesses for which death is expected. Third, longer QTintervals are associated with increased probability of sudden death. Fourth, patients with two conditions associated with accelerated brain aging, namely dementia and Parkinson’s disease, show longer QTcs than age-matched controls. Both of these conditions are associated with sudden cardiac death. Fifth, aging processes may affect the molecular determinants of the QT interval, alter heart composition with increased myocardial fibrosis, or alter the amount of sympathetic and parasympathetic tone, any or all of which can alter myocardial repolarization and the duration of the QTc. Sixth, considering the molecular determinants of the QT interval in the aging heart, which has longer transmembrane action potentials, several factors can account for this change, including changes in late inward Na⁺ current (I_NaL), I_Kr, I_ca, I_to, and K_ATP channels. Transgenic mice overexpressing the Kir6.1 subunit of a K_ATP channel show a prolonged QT interval and reduced longevity, with animals appearing to die suddenly. Seventh, chronic kidney disease, which is associated with a reduced lifespan, is associated with reduced expression of the anti-aging factor Klotho and Klotho-deficient mice have a prolonged QTc and a reduced lifespan. Taken together, there is a cogent case for factors that increase action potential duration in the aging heart, as recognized by increased QTc, to act in concert with other factors to produce fatal arrhythmias leading to sudden cardiac death and shortened longevity. Full article

Background: Prion diseases represent a group of rare, progressive, and invariably fatal neurodegenerative disorders. Their hallmark is the infectious nature of the misfolded prion protein (PrP^Sc), which propagates by inducing conformational changes in the physiological form (PrP^C). Despite advances in basic science, these disorders still pose major clinical and therapeutic challenges. Methods: A narrative review of the scientific literature was conducted across major biomedical databases, including PubMed, Scopus, Web of Science, and Google Scholar, covering publications up to January 2025. In addition, we describe an illustrative clinical case of a young patient with probable iatrogenic Creutzfeldt–Jakob disease following corneal transplantation, used to highlight diagnostic uncertainty and infection-control implications. Findings: Evidence confirms that PrP^Sc drives neurodegenerative processes and transmissibility, with phenotypic and genetic variants influencing clinical course and prognosis. From a diagnostic perspective, neuroimaging techniques and cerebrospinal fluid biomarkers have undergone substantial refinement, with RT-QuIC emerging as a highly specific and sensitive assay. Therapeutic options remain unsatisfactory: no treatment has shown a significant impact on survival. However, innovative strategies (including monoclonal antibodies, gene-based interventions, and modulation of PrP^C) represent promising avenues of investigation. Conclusions: Prion diseases remain an unresolved challenge at the intersection of neurology and infectious diseases. Earlier diagnosis through advanced biomarkers and continued development of targeted therapies are essential to improve patient management, while the persistence of iatrogenic cases underscores the ongoing relevance of surveillance and preventive strategies in clinical practice. Full article

This paper develops simultaneous confidence intervals (SCIs) for pairwise differences of means with zero-inflated Rayleigh (ZIR) distributions, a flexible framework for modeling positively skewed data with excess zeros. Closed-form expressions for the ZIR mean are derived, and several competing interval estimation procedures are investigated, including generalized confidence interval (GCI), parametric bootstrap (PB), method of variance estimates recovery (MOVER), delta-method normal approximation, and highest posterior density (HPD) intervals. The finite-sample performance of the proposed SCIs is examined via extensive Monte Carlo simulations, focusing on empirical coverage probabilities (CPs) and average interval lengths (ALs) over a broad range of parameter configurations and zero-inflation levels. A real data application to road accident fatality counts demonstrates the practical utility of the proposed methodology. The results show that the HPD method consistently achieves the most favorable balance between coverage accuracy and interval efficiency. Overall, this study advances reliable simultaneous inference for zero-inflated models commonly encountered in environmental, biomedical, and reliability studies. Full article

Mental disorders and impairments are part of the occupational risk for emergency personnel. This study examines the impact of a deadly knife attack on police officers’ mental health. Aims: We hypothesized that police officers who knew the deceased team member would report higher levels of psychological distress compared to those who did not, regardless of the deployment status. Methods: Six months after a fatal knife attack in which a police officer was killed, a total of N = 245 officers participated in the study. Of these, n = 115 reported knowing the victim personally, n = 126 did not (n = 78 deployed; n = 176 not deployed), while n = five did not provide any information. Posttraumatic stress disorder (PTSD), posttraumatic stress symptoms (PTSS), anger and adverse childhood experiences (ACEs) were assessed using questionnaires. Chi-square tests examined group differences in probable PTSD prevalence; t-tests assessed differences in anger and Posttraumatic Stress Disorder Checklist for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; DSM-5; PCL-5) symptom scores. Linear regression analyses tested deployment, acquaintance with the victim, gender, and childhood emotional neglect as predictors. Results: Police officers who personally knew the deceased colleague exhibited significantly higher PTSS scores. In addition, the deployed group showed significantly higher trait anger than the non-deployed. Acquaintance with the victim and emotional neglect in childhood were significantly related to negative cognitions, whereas deployment to the knife attack or gender were not. Discussion: Police officers with a personal connection to the deceased showed significantly higher mental health impact than those with direct exposure alone, placing them in a higher-risk group due to increased exposure to feelings of guilt and shame due to their professional role. Police officers who were emotionally neglected in their childhood may be more prone to negative cognitions in adulthood, when faced with critical events. These results underline the importance of addressing risk factors in both pre-deployment training and post-event debriefing, especially with regard to anger management after major critical incidents. Full article

Background and Objectives: Idiopathic pulmonary fibrosis (IPF) is a progressive, unpredictable, fatal interstitial lung disease. Antifibrotic therapy with pirfenidone or nintedanib slows functional decline, yet comparative real-world evidence remains limited. Materials and Methods: This retrospective, single-center, comparative cohort study included 76 IPF patients treated at the Clinic for Pulmonology at the University Clinical Center of Serbia (February 2019–February 2025). Diagnosis of IPF was made according to the guidelines of the American Thoracic Society and the European Respiratory Society. Demographic features, comorbidities, forced vital capacity (FVC), diffusion capacity for carbon monoxide (DLCO), high-resolution computerized tomography (HRCT) patterns, 6-min walk test distance (6MWTD), echocardiography, and survival outcomes were analyzed. Disease progression was defined as a ≥10% decline in FVC and/or DLCO after 12 months. Results: Of the 76 patients, 31 received nintedanib and 45 pirfenidone. Baseline characteristics, comorbidities, and HRCT patterns were comparable between groups. Mean annual decline in FVC was −1.74% with pirfenidone and −2.38% with nintedanib, without a statistical difference. DLCO declined by −4.25% and −6.29%, respectively, with similar downward trends over time in both groups. Progression was recorded in 35 (46.1%) patients, of whom 18 (58.06%) were in the nintedanib group and 17 (37.77%) in the pirfenidone group, with no difference between therapies (p = 0.81). Definite and probable usual interstitial pneumonia (UIP) were evenly represented on HRCT, although progression correlated significantly with the probable UIP pattern (p = 0.006). 6MWTD decreased in both groups over 12 months, again without treatment-related differences (p = 0.566). During up to 6 years of follow-up, overall survival was 4.18 years, with no significant difference between the nintedanib (4.55 years) and pirfenidone (3.81 years) groups (p = 0.159). No association was found between disease stage (FVC or DLCO) and progression. Conclusions: This study demonstrates that pirfenidone and nintedanib are equally effective in the management of IPF in real-world settings. The absence of significant differences in functional decline, progression rates, and survival indicates that treatment choices should be guided by individual clinical profiles rather than efficacy alone, reinforcing antifibrotic therapy as the primary approach to alter the course of IPF. Importantly, disease progression was strongly associated with a probable UIP pattern on HRCT, supporting current guidelines suggesting that probable UIP has a natural history and prognosis similar to those of definite UIP. Full article

The analysis of road traffic accidents often reveals asymmetric patterns, providing insights that support the development of preventive measures, reduce fatalities, and improve road safety interventions. The Rayleigh distribution, a continuous distribution with inherent asymmetry, is well suited for modeling right-skewed data and is widely used in scientific and engineering fields. It also shares structural characteristics with other skewed distributions, such as the Weibull and exponential distributions, and is particularly effective for analyzing right-skewed accident data. This study considers several approaches for constructing confidence intervals, including the percentile bootstrap, bootstrap with standard error, generalized confidence interval, method of variance estimates recovery, normal approximation, Bayesian Markov Chain Monte Carlo, and Bayesian highest posterior density methods. Their performance was evaluated through Monte Carlo simulation based on coverage probabilities and expected lengths. The results show that the HPD method achieved coverage probabilities at or above the nominal confidence level while providing the shortest expected lengths. Finally, all proposed confidence intervals were applied to fatalities recorded during the seven hazardous days of Thailand’s Songkran festival in 2024 and 2025. Full article

Construction safety remains a critical concern, with frequent accidents leading to fatalities, severe injuries, and significant economic losses. To address these challenges and enhance accident prevention, this study adopts a systems thinking approach to investigate the causal factors of construction safety accidents. First, drawing on Rasmussen’s risk management framework, this study developed a Construction Accident Causation System (CACS) model that comprises six hierarchical levels and 23 influencing factors. Through the analysis of 331 investigation reports of construction accidents in China, causal factor correlations were refined, and the topological structure and network parameters of the model were determined. This study integrates diagnostic reasoning, sensitivity analysis, and fuzzy mathematics within a Bayesian Network (BN) framework. Through this approach, it identifies the most probable accident pathways and highlights seven critical and three sensitive factors that jointly exacerbate construction safety risks. A real-world case of a formwork collapse in Baotou City is further analyzed to verify the model’s reliability and practical relevance. The results confirm that the integrated CACS and BN framework effectively captures the multi-level interactions among managerial, behavioral, and technical factors, providing a scientific basis for proactive safety management and accident prevention in the construction industry. Full article

Background/Objectives: To estimate (a) survival after SARS-CoV-2 infection by COVID-19 vaccination status, and (b) COVID-19 vaccine effectiveness in a middle-income country. Methods: In this retrospective cohort study, secondary analysis of data from the national surveillance and vaccination databases was conducted. The primary outcome was COVID-19 death classified based on the WHO criteria. Data were analysed by vaccination status, age, sex, geographic region, and wave period. Kaplan–Meier curves were plotted; log-rank followed by multiple comparison tests were used to compare survival probabilities. Cox proportional-hazards models with time-varying covariates estimated hazard ratios (HR). Vaccine effectiveness was computed as (1-HR) × 100. Results: A total of 55,299 COVID-19 cases were captured by the national surveillance system between 1 April and 31 December 2021. Of these, 45,774 (1581 vaccinated, 44,193 unvaccinated) were included in the analysis. After a follow-up of 327 days, there were 22 deaths (case fatality rate (CFR) 1.5%) among 1581 COVID-19 vaccinated cases and 1821 deaths (CFR 4.1%) among 44,193 unvaccinated cases. There was one COVID-19 death per 10,000 person days in vaccinated cases compared with 2.7 COVID-19 deaths per 10,000 person days in unvaccinated cases. After adjustment for age, sex, and geographic region, the effectiveness against COVID-19 death across all vaccine types (ChAdOx1 nCoV-19, BNT162b2, Ad26.COV2.S, or BBIBP-CorV) was 68% (95% CI: 51–79). Effectiveness was 75% (95% CI: 59–84) for ChAdOx1 nCoV-19. Vaccine effectiveness across all vaccine types was higher in younger cases, (82% (95% CI: 52–93), 18–64 years vs. 63% (95% CI: 41–77), ≥65 years), females (84% (95% CI: 63–93), females vs. 53% (95% CI: 24–71), males) and those vaccinated in the past 3 months (71% (95% CI: 47–85), past 0–3 months vs. 56% (95% CI: 23–75), 3–6 months). Conclusions: COVID-19 vaccines were effective in preventing COVID-19 death in a population with low vaccination coverage. Limitations of the analysis include the use of surveillance data (under-reporting of cases, missing data), exclusion of partially vaccinated cases, and insufficient data on important confounders (circulating variants and comorbidities). Full article

Flooding is one of Africa’s most impactful natural disasters, significantly affecting human lives, infrastructure, and economies. This study examines the spatial and temporal distribution of historical flood events across the continent from 1927 to 2020, with a focus on fatalities, affected populations, and economic damage. Data from the Emergency Events Database (EM-DAT), the fifth generation of bias-corrected European Centre for Medium-Range Weather Forecasts Reanalysis (ERA5), and the Climate Hazards Group InfraRed Precipitation with Stations (CHIRPS) observational datasets were used to calculate extreme precipitation indices—Consecutive Wet Days (CWD), annual precipitation on very wet days (R95PTOT), and Annual Maximum Precipitation (AMP). Spatial analysis tools and the Mann–Kendall test were used to assess trends in flood occurrences, while Pearson correlation analysis identified key meteorological drivers across 16 African capital cities for 1981–2019. A flood frequency analysis was conducted using Weibull, Gamma, Lognormal, Gumbel, and Logistic probability distribution models to compute flood return periods for up to 100 years. Results reveal a significant upward trend with a slope above 0.50 floods per year in flood frequency and impact over the period, particularly in regions such as West Africa (Nigeria, Ghana), East Africa (Ethiopia, Kenya, Tanzania), North Africa (Algeria, Morocco), Central Africa (Angola, Democratic Republic of Congo), and Southern Africa (Mozambique, Malawi, South Africa). Positive trends (at 99% significance level with slopes ranging between 0.50 and 0.60 floods per year) were observed in flood-related fatalities, affected populations, and economic damage across Regional Economic Communities (RECs), individual countries, and cities of Africa. The CWD, R95PTOT, and AMP indices emerged as reliable predictors of flood events, while non-stationary return periods exhibited low uncertainties for events within 20 years. These findings underscore the urgency of implementing robust flood disaster management strategies, enhancing flood forecasting systems, and designing resilient infrastructure to mitigate growing flood risks in Africa’s rapidly changing climate. Full article

Background and Clinical Significance: Creutzfeldt–Jakob disease (CJD) is a rare and fatal neurodegenerative disorder caused by prion protein misfolding. The disease poses significant diagnostic challenges, particularly when its initial symptoms mimic other conditions, such as transient ischemic attacks. Early recognition and differentiation from other neurological conditions are critical, as misdiagnosis may lead to unnecessary interventions. This case highlights a unique presentation of CJD in a male Caucasian patient with a history of cardiac surgery and mitral valve prosthesis, emphasizing the role of multidisciplinary evaluation in complex neurological cases. Case Presentation: A male patient in his mid-sixties with a history of mitral valve mechanical prosthesis and prior infective endocarditis presented with progressive cognitive decline, memory impairment, and episodes of confusion. Initial cardiovascular investigations suggested mitral valve prosthesis thrombosis, while neurological assessment pointed toward transient brain ischemia. However, brain imaging remained inconclusive. Given the rapid deterioration of cognitive and motor functions, further diagnostic workup was performed. MRI findings revealed cortical diffusion restrictions consistent with probable CJD. Despite symptomatic management, the patient’s condition worsened, leading to akinetic mutism and death within eight days of diagnosis. Conclusions: This case underscores the diagnostic complexity of CJD, particularly when initial symptoms overlap with transient ischemic events. It highlights the importance of comprehensive neuroimaging and an interdisciplinary approach in recognizing atypical neurodegenerative diseases to improve diagnostic accuracy and patient management. Full article

Parasitic diseases are some of the most lethal and pervasive infections globally, causing millions of cases of morbidity and mortality annually. Plasmodium falciparum is the predominant vector-borne pathogen, resulting in 0.5 million fatalities annually. Malaria, caused by Plasmodium falciparum, continues to be a significant worldwide health issue, requiring the development of novel treatment medicines to address increasing medication resistance. This study undertakes a focused in silico screening of phytochemicals derived from Centella asiatica against dihydrofolate reductase-thymidylate synthase (PfDHFR-TS), represented by PDB ID: 3BWK. This work investigated molecular modelling to clarify the probable mechanism of its anti-malarial activity through the suppression of falciparum proteins. Campesterol exhibits a maximal binding affinity (docking score: −8.6 Kcal/mol) for FP-2 from Plasmodium falciparum, as determined by our molecular docking investigation of 15 bioactive compounds from Centella asiatica. However, Ursolic acid and rutin also showed potential activity with significant docking scores (−8.5 and 8.4 Kcal/mol). Campesterol, recognized as a possible inhibitor of falciparum, offers a viable pathway for the treatment of malaria, necessitating additional investigation into its therapeutic use. This research provides significant insights into the molecular interactions between phytochemicals, facilitating innovative and successful strategies for malaria treatment. Our research indicates that polyphenols derived from Centella asiatica exhibit significant pharmacological potential against several biological targets. Full article

This study addresses the estimation of the common mean for the zero-inflated inverse Gaussian (ZIIG) distributions, a problem not previously explored. The performance of four interval estimation approaches was evaluated: the generalized confidence interval (GCI), parametric bootstrap, Bayesian, and highest posterior density (HPD). Simulation studies under varying sample sizes, zero-inflation probabilities, mean values, and shape parameters revealed notable differences in coverage probability (CP) and average length (AL). For small samples, the GCI and parametric bootstrap approaches often under-covered, particularly in highly skewed or heavily zero-inflated cases. In contrast, Bayesian and HPD intervals generally maintained coverage closer to the nominal 0.95 level, albeit with longer intervals. As sample size increased, all methods approached nominal coverage and produced shorter intervals, improving precision. Overall, the Bayesian and HPD approaches demonstrated strong robustness across conditions, with HPD intervals frequently achieving accurate coverage with shorter lengths. Finally, the proposed approaches were applied to real-world data on road accident fatalities in Thailand. Full article