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Search Results (633)

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Keywords = fever management

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13 pages, 269 KiB  
Review
From Genotype to Guidelines: Rethinking Neutropenia Risk in Clozapine Use
by Amir Agustin Estil-las, William C. Sultan, Carla Sultan, Martena Grace, Mark Elias and Kristal Arraut
Psychiatry Int. 2025, 6(3), 93; https://doi.org/10.3390/psychiatryint6030093 (registering DOI) - 4 Aug 2025
Viewed by 190
Abstract
Clozapine, a second-generation antipsychotic known for its effectiveness in treating resistant schizophrenia, is often linked with serious hematological side effects, particularly neutropenia and agranulocytosis. This review investigates the underlying pathophysiological mechanisms of clozapine-induced neutropenia (CIN) and agranulocytosis (CIA), outlines associated risk factors, and [...] Read more.
Clozapine, a second-generation antipsychotic known for its effectiveness in treating resistant schizophrenia, is often linked with serious hematological side effects, particularly neutropenia and agranulocytosis. This review investigates the underlying pathophysiological mechanisms of clozapine-induced neutropenia (CIN) and agranulocytosis (CIA), outlines associated risk factors, and evaluates current clinical management strategies. Clozapine’s pharmacological profile, marked by its antagonism of dopamine D4 and serotonin receptors, contributes to both its therapeutic advantages and hematological toxicity. Epidemiological data show a prevalence of CIN and CIA at approximately 3.8% and 0.9%, respectively, with onset typically occurring within the first six months of treatment. Key risk factors include older age, Asian and African American ethnicity, female sex, and certain genetic predispositions. The development of CIN and CIA may involve bone marrow suppression and autoimmune mechanisms, although the exact processes remain partially understood. Clinical presentation often includes nonspecific symptoms such as fever and signs of infection, necessitating regular hematological monitoring in accordance with established guidelines. Management strategies include dosage adjustments, cessation of clozapine, and the administration of granulocyte colony-stimulating factors (G-CSF). Advances in pharmacogenomics show promise for predicting susceptibility to CIN and CIA, potentially improving patient safety. This review emphasizes the importance of vigilant monitoring and personalized treatment approaches to reduce the risks associated with clozapine therapy. Full article
11 pages, 393 KiB  
Article
Group A Streptococcal Invasive Infections Among Children in Cyprus
by Maria Koliou, Gavriella Ioannou Vassiliadou, Athina Aristidou, Petros Ladas, Andreas Sergis, Maria Argyrou, Myria Charalambous, Markella Marcou, Maria Alexandrou, Juliana Coelho, Yan Ryan, Androulla Efstratiou and Stella Mazeri
Microorganisms 2025, 13(8), 1783; https://doi.org/10.3390/microorganisms13081783 - 31 Jul 2025
Viewed by 231
Abstract
An increase in invasive group A streptococcal (iGAS) infections among children under 15 years of age was reported in several countries between late 2022 and early 2023. This retrospective study aims to describe the epidemiology and clinical features of iGAS infections in children [...] Read more.
An increase in invasive group A streptococcal (iGAS) infections among children under 15 years of age was reported in several countries between late 2022 and early 2023. This retrospective study aims to describe the epidemiology and clinical features of iGAS infections in children in Cyprus during the same period. Medical records of patients under 16 years old admitted with iGAS infection to the Archbishop Makarios Hospital, the only tertiary paediatric referral centre in Cyprus, between 1 January 2021 and 30 June 2024, were reviewed. Twenty-two cases were identified, of which twenty were classified as confirmed and two as probable. Half of the cases occurred in children aged 0–4 years, and 59% were recorded between December 2022 and April 2023. Scarlet fever was diagnosed in six children, five of whom developed pneumonia and empyema. Streptococcal toxic shock syndrome (STSS) was observed in five patients, resulting in two deaths and one case requiring prolonged extracorporeal membrane oxygenation (ECMO). The overall case fatality rate was 9.1%. Emm 1, belonging to the M1UK clone, was the predominant strain (66.6%). The findings underscore the severity of iGAS infections, particularly in younger children, and highlight the importance of timely diagnosis, appropriate management and continued epidemiological surveillance. Full article
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15 pages, 1321 KiB  
Article
The Role of Inflammatory Biomarkers in Predicting Postoperative Fever Following Flexible Ureteroscopy
by Rasha Ahmed, Omnia Hamdy, Atallah Alatawi, A. Alhowidi, Nael Al-Dahshan, Ahmad Nouraldin Alkadah, Siddique Adnan, Abdullah Mahmoud Alali, Yazeed Hamdan O. Alwabisi, Saleh Alruwaili, Muteb Bandar Binmohaiya, Amany Ahmed Soliman and Mohamed Elbakary
Medicina 2025, 61(8), 1366; https://doi.org/10.3390/medicina61081366 - 28 Jul 2025
Viewed by 270
Abstract
Background and Objectives: Flexible ureteroscopic surgery is a common minimally invasive procedure utilized for the management of various urological conditions. While effective, postoperative complications such as fever can occur, necessitating the identification of reliable biomarkers for early detection and management. In this [...] Read more.
Background and Objectives: Flexible ureteroscopic surgery is a common minimally invasive procedure utilized for the management of various urological conditions. While effective, postoperative complications such as fever can occur, necessitating the identification of reliable biomarkers for early detection and management. In this study, we specifically evaluated the predictive performance of three preoperative hematologic indices: the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune–inflammation index (SII). Materials and Methods: By systematically comparing these biomarkers through receiver operating characteristic (ROC) curve analysis and logistic regression modeling, we aimed to identify the most accurate predictor of postoperative fever development. Our cohort included patients who developed postoperative fever, many of whom exhibited normal WBC counts, allowing us to evaluate the discriminatory power of alternative inflammatory biomarkers. Results: Among the 150 patients, 32 developed postoperative fever. Conventional WBC counts did not predict fever, with 91% of feverish individuals having normal WBC values. In the ROC curve analysis, NLR outperformed SII (AUC 0.847, cutoff 796) and PLR (AUC 0.743, cutoff 106), with an AUC of 0.996 at 2.96. A combined logistic model achieved 100% sensitivity and 91% specificity (AUC = 0.996). Conclusions: This study addresses a critical gap in perioperative monitoring by validating readily available complete blood count-derived ratios as clinically meaningful predictors of postoperative inflammatory responses. Full article
(This article belongs to the Section Urology & Nephrology)
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16 pages, 3032 KiB  
Article
Severe Scrub Typhus with Acute Kidney Injury: Urine PCR Evidence from an East Coast Malaysian Cluster
by Siti Roszilawati Ramli, Nuridayu Arifin, Mohd Fahmi Ismail, Shirley Yi Fen Hii, Nur Suffia Sulaiman, Ernieenor Faraliana Che Lah and Nik Abdul Hadi Nik Abdul Aziz
Trop. Med. Infect. Dis. 2025, 10(8), 208; https://doi.org/10.3390/tropicalmed10080208 - 25 Jul 2025
Viewed by 492
Abstract
Background: Scrub typhus (ST) is caused by Orientia tsutsugamushi (OT) infection, which is transmitted to humans through the bites of infected chiggers. The clinical presentations range from mild to life-threatening multi-organ dysfunction. This report describes a cluster of ST cases involving five oil [...] Read more.
Background: Scrub typhus (ST) is caused by Orientia tsutsugamushi (OT) infection, which is transmitted to humans through the bites of infected chiggers. The clinical presentations range from mild to life-threatening multi-organ dysfunction. This report describes a cluster of ST cases involving five oil palm estate workers in Pekan district, Pahang, Malaysia. Methods: The clinical history, laboratory, and entomological investigation were conducted on the patients, including the index case and four suspected cases in the cluster. Polymerase chain reaction (PCR) tests for OT and genotyping were performed on the patients’ blood and urine samples. Serological testing by indirect immunoperoxidase (IIP) test against Rickettsial diseases was also conducted. Principal Findings: Patients presented with fever, myalgia, headache, rash, cough, and eschar. The index case developed severe ST complicated by acute kidney injury (AKI) and respiratory distress, requiring intubation and ventilation at the intensive care unit of a tertiary hospital. ST was confirmed through PCR analysis of a urine sample, showcasing a novel diagnostic approach. The other four cases were confirmed by a four-fold rise in immunoglobulin G (IgG) antibody titers. Conclusions: oil palm estate workers are at high risk for chigger exposure in Malaysia. Awareness among clinicians and the public of ST is crucial for effective prevention, accurate diagnosis, and optimal management. Full article
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16 pages, 554 KiB  
Systematic Review
Ocular Manifestations in Congenital Insensitivity to Pain with Anhidrosis: A Window into a Rare Syndrome
by Mohammed Baker, Kenda Abedal-Kareem, Sadeen Eid, Mahmoud Alkhawaldeh, Yahya Albashaireh, Jihan Joulani, Sara Bani Amer, Ethar Hazaimeh, Omar F. Jbarah, Abdelwahab Aleshawi and Rami Al-Dwairi
Vision 2025, 9(3), 62; https://doi.org/10.3390/vision9030062 - 21 Jul 2025
Viewed by 335
Abstract
Background: Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive syndrome caused by loss-of-function mutations in the Neurotrophic Tyrosine Kinase Receptor 1 gene, characterized by recurrent episodes of infections and unexplained fever, anhidrosis, absence of reactions to noxious stimuli, [...] Read more.
Background: Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive syndrome caused by loss-of-function mutations in the Neurotrophic Tyrosine Kinase Receptor 1 gene, characterized by recurrent episodes of infections and unexplained fever, anhidrosis, absence of reactions to noxious stimuli, intellectual disability, self-mutilating behaviors, and damage to many body organs, including the eyes. Main text: We systematically searched the Medline/PubMed, Scopus, and Web of Science databases from their inception until March 2025 for papers describing the clinical manifestations of patients with CIPA. The inclusion criterion was papers reporting ocular manifestations of patients diagnosed with CIPA. We excluded non-English papers or those reporting ocular manifestations of patients diagnosed with syndromes other than CIPA. Also, we excluded review articles, clinical trials, gray literature, or any paper that did not report ocular manifestations of patients with CIPA or that reported patients with previous ocular surgeries. Out of 6243 studies, 28 were included in the final analysis, comprising 118 patients. The mean age was 7.37 years, and males represented 63.5% (n = 75). Of the patients, fifty-six had bilateral ocular manifestations. The most common ocular manifestations were the absence of corneal reflex in 56 patients (47.5%, bilateral in 56), whereas corneal ulcerations were the second most common manifestation in 46 patients (38.98%, bilateral in 8), followed by corneal opacity in 32 patients (27.11%, bilateral in 19). Topical lubricants, topical antibiotics, and lateral tarsorrhaphy were common management modalities for these patients. Absent corneal sensitivity, corneal ulcers, and corneal opacities, among other manifestations, are common ocular presentations in patients with CIPA. Conclusions: Self-mutilation, intellectual disability, decreased lacrimation, and absence of the corneal reflex are factors that may explain the development of these manifestations in CIPA. The early detection of these manifestations can improve patient conditions and prevent further complications, in addition to helping to guide the clinical diagnosis of CIPA in these patients. Full article
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15 pages, 2600 KiB  
Article
Machine Learning Approach to Predicting Rift Valley Fever Disease Outbreaks in Kenya
by Damaris Mulwa, Benedicto Kazuzuru, Gerald Misinzo and Benard Bett
Zoonotic Dis. 2025, 5(3), 20; https://doi.org/10.3390/zoonoticdis5030020 - 21 Jul 2025
Viewed by 293
Abstract
In Kenya, Rift Valley fever (RVF) outbreaks pose significant challenges, being one of the most severe climate-sensitive zoonoses. While machine learning (ML) techniques have shown superior performance in time series forecasting, their application in predicting disease outbreaks in Africa remains underexplored. Leveraging data [...] Read more.
In Kenya, Rift Valley fever (RVF) outbreaks pose significant challenges, being one of the most severe climate-sensitive zoonoses. While machine learning (ML) techniques have shown superior performance in time series forecasting, their application in predicting disease outbreaks in Africa remains underexplored. Leveraging data from the International Livestock Research Institute (ILRI) in Kenya, this study pioneers the use of ML techniques to forecast RVF outbreaks by analyzing climate data spanning from 1981 to 2010, including ML models. Through a comprehensive analysis of ML model performance and the influence of environmental factors on RVF outbreaks, this study provides valuable insights into the intricate dynamics of disease transmission. The XGB Classifier emerged as the top-performing model, exhibiting remarkable accuracy in identifying RVF outbreak cases, with an accuracy score of 0.997310. Additionally, positive correlations were observed between various environmental variables, including rainfall, humidity, clay patterns, and RVF cases, underscoring the critical role of climatic conditions in disease spread. These findings have significant implications for public health strategies, particularly in RVF-endemic regions, where targeted surveillance and control measures are imperative. However, this study also acknowledges the limitations in model accuracy, especially in scenarios involving concurrent infections with multiple diseases, highlighting the need for ongoing research and development to address these challenges. Overall, this study contributes valuable insights to the field of disease prediction and management, paving the way for innovative solutions and improved public health outcomes in RVF-endemic areas and beyond. Full article
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12 pages, 1017 KiB  
Case Report
Acute Rheumatic Fever in Caucasians: A Case Report and Systematic Review
by Fuad Hasan, Mrinalini Dey and Arvind Nune
Life 2025, 15(7), 1131; https://doi.org/10.3390/life15071131 - 18 Jul 2025
Viewed by 377
Abstract
Acute Rheumatic Fever (ARF) is more common in children in the developing world. The current incidence in the United Kingdom is reported to be less than 1 in 100,000 children. It is, however, rare in the developed world, particularly in the adult Caucasian [...] Read more.
Acute Rheumatic Fever (ARF) is more common in children in the developing world. The current incidence in the United Kingdom is reported to be less than 1 in 100,000 children. It is, however, rare in the developed world, particularly in the adult Caucasian population. We present a case of ARF in a 39-year-old Caucasian female who needed multiple hospital admissions before the ARF diagnosis was made. A comprehensive, up-to-date literature review of ARF in Caucasians is lacking. Therefore, a systematic literature review (SLR) of Medline, PubMed, and Google Scholar was conducted to investigate the characteristics, management, and prognostic outcomes of new cases of ARF among Caucasians. A total of 10 cases were reported from six countries between 1990 and 2022. The mean age of patients was 33.2 (range 18–41), and most were females (6, 60%). The most common presenting symptoms were fever, arthralgia, and malaise. All patients met the modified Jones criteria for ARF diagnosis. All patients received antibiotics, with only one patient requiring corticosteroids. Two patients developed rheumatic heart disease (RHD), and none died as a result of ARF. This case-based literature review underscores the critical importance of a high index of clinical suspicion in promptly diagnosing ARF to mitigate long-term sequelae of RHD. Full article
(This article belongs to the Special Issue Infection, Inflammation and Rheumatology)
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14 pages, 347 KiB  
Review
Is Ghana Prepared for Another Arboviral Outbreak? Evaluating the 2024 Dengue Fever Outbreak in the Context of Past Yellow Fever, Influenza, and COVID-19 Outbreaks
by Godfred Amoah Appiah, Jerry John Babason, Anthony Yaw Dziworshie, Abigail Abankwa and Joseph Humphrey Kofi Bonney
Trop. Med. Infect. Dis. 2025, 10(7), 196; https://doi.org/10.3390/tropicalmed10070196 - 15 Jul 2025
Viewed by 1122
Abstract
Arboviruses are a growing concern in many nations. Several reports of arboviral outbreaks have been recorded globally in the past decade alone. Repeated arboviral outbreaks in developing countries have consistently highlighted vulnerabilities in disease surveillance and response systems, exposing critical gaps in early [...] Read more.
Arboviruses are a growing concern in many nations. Several reports of arboviral outbreaks have been recorded globally in the past decade alone. Repeated arboviral outbreaks in developing countries have consistently highlighted vulnerabilities in disease surveillance and response systems, exposing critical gaps in early detection, contact tracing, and resource allocation. The 2024 Dengue fever outbreak in Ghana, which recorded 205 confirmed cases out of 1410 suspected cases, underscored the urgent need to evaluate the country’s preparedness for arboviral outbreaks, given the detection of competent vectors in the country. A retrospective analysis of Ghana’s 2009–2013 pandemic influenza response plan revealed significant deficiencies in emergency preparedness, raising concerns about the country’s ability to manage emerging arboviral threats. This review assessed Ghana’s current arboviral outbreak response and preparedness by examining (a) the effectiveness of vector control measures, (b) the role of early warning systems in mitigating outbreaks, (c) laboratory support and diagnostic capabilities, and (d) community engagement strategies. It highlights the successes made in previous outbreaks and sheds light on several gaps in Ghana’s outbreak response efforts. This review also provides recommendations that can be implemented in many countries across Africa as they brace themselves for any arboviral outbreak. Full article
(This article belongs to the Special Issue Emerging Vector-Borne Diseases and Public Health Challenges)
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10 pages, 426 KiB  
Article
Pulmonary Function Among COVID-19 Patients in Home Isolation Program
by Narongkorn Saiphoklang, Pitchayapa Ruchiwit, Apichart Kanitsap, Pichaya Tantiyavarong, Pasitpon Vatcharavongvan, Srimuang Palungrit, Kanyada Leelasittikul, Apiwat Pugongchai and Orapan Poachanukoon
Med. Sci. 2025, 13(3), 88; https://doi.org/10.3390/medsci13030088 - 9 Jul 2025
Viewed by 317
Abstract
Background: Patients with mild coronavirus disease 2019 (COVID-19) are usually managed in an outpatient setting. Pulmonary functions in this setting have not been explored. This study aimed to determine abnormal lung functions in COVID-19 patients under a home isolation program. Methods: [...] Read more.
Background: Patients with mild coronavirus disease 2019 (COVID-19) are usually managed in an outpatient setting. Pulmonary functions in this setting have not been explored. This study aimed to determine abnormal lung functions in COVID-19 patients under a home isolation program. Methods: A prospective study was conducted in asymptomatic or mild COVID-19 patients with normal chest radiographs at two medical centers in Thailand. Spirometry data, including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), forced expiratory flow at 25–75% of FVC (FEF25–75), and bronchodilator responsiveness (BDR), were collected. Spirometry was performed after disease resolution at baseline and 3-month follow-up. Abnormal lung functions were classified into airway obstruction, restrictive defect, mixed defect, small airway disease, and BDR. Results: A total of 250 patients (58% female) were included. The mean age was 37.4 ± 15.2 years. Asymptomatic patients accounted for 7.6%. Common symptoms included fever (55.6%) and cough (60.0%). Abnormal lung functions were observed in 28.4% of patients, with a restrictive lung pattern (14.4%), airway obstruction (4.8%), mixed defect (0.4%), small airway disease (8.4%), and BDR (2.8%). Significant changes from baseline were noted in FVC (1.21%), FEV1/FVC (−1.51%predicted), PEF (0.06%), and FEF25–75 (−2.76%). Logistic regression analysis indicated that a higher body mass index was associated with a lower risk of abnormal lung function. Conclusions: Ventilatory defects were observed in one-third of patients with mild COVID-19 who did not require hospitalization, mainly presenting as restrictive patterns and small airway disease. Even mild cases may have residual pulmonary impairment, warranting further long-term studies. Full article
(This article belongs to the Section Pneumology and Respiratory Diseases)
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12 pages, 574 KiB  
Review
An Overview of Dengue Knowledge, Attitudes, and Practices (KAPs) Among the General Public in Sri Lanka: A Review and Meta-Analysis of Questionnaire-Based Surveys from 2000–2023
by Nilmini Chandrasena, Dileepa Ediriweera, Deshaka Jayakody, Nayana Gunathilaka and Ranjan Premaratna
Trop. Med. Infect. Dis. 2025, 10(7), 189; https://doi.org/10.3390/tropicalmed10070189 - 6 Jul 2025
Viewed by 530
Abstract
The objective was to conduct a review and meta-analysis of questionnaire-based surveys of dengue knowledge, attitudes, perceptions, and practices (KAP)s among the general public in Sri Lanka as no prior island-wide survey existed. The electronic database PubMed and other bibliography were searched for [...] Read more.
The objective was to conduct a review and meta-analysis of questionnaire-based surveys of dengue knowledge, attitudes, perceptions, and practices (KAP)s among the general public in Sri Lanka as no prior island-wide survey existed. The electronic database PubMed and other bibliography were searched for literature on dengue questionnaire-based KAP surveys in Sri Lanka from 2000–2023. Data pertaining to the three domains were extracted from sixteen eligible articles, pooled, and analyzed separately using random effect models. Meta-analyses of the three domains were performed using R version 3.6.3. The population surveyed (8955) was <0.045% of the total Sri Lankan population. The publication frequency increased over time and surveys were distributed in Colombo and suburbs 43.7% (7/16), Kandy 25% (4/16,) Gampaha 12.5% (2/16), and 6.3% (1/16) one each in Kurunegala, Matara, Batticaloa, and Jaffna. Knowledge on dengue transmission, vector breeding, and fever as a symptom was >80%, while on vector species, preferred feeding times, recurrence of dengue it was > 55% and on warning signs of severity it was 25%. Attitudes towards community participation in dengue prevention activities and knowledge of dengue risk factors (avoidance of aspirin and dark colored drinks) were poor, while practice of control measures (removal of water collecting receptacles, roof-gutter management) lacked regularity. Full article
(This article belongs to the Special Issue Beyond Borders—Tackling Neglected Tropical Viral Diseases)
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12 pages, 204 KiB  
Case Report
Multiorgan Failure Resembling Grade 5 (Fatal) Cytokine Release Syndrome in Patient with Multiple Myeloma Following Carfilzomib Infusion: A Case Report
by Strahinja Gligorevic, Nebojsa Brezic, Joshua Jagodzinski, Andjela Radulovic, Aleksandar Peranovic and Igor Dumic
J. Clin. Med. 2025, 14(13), 4723; https://doi.org/10.3390/jcm14134723 - 3 Jul 2025
Viewed by 438
Abstract
Background: Cytokine release syndrome (CRS) is a life-threatening systemic inflammatory condition marked by excessive cytokine production, leading to multi-organ dysfunction. It is commonly associated with T-cell-engaging therapies such as chimeric antigen receptor (CAR) T cells, T-cell receptor bispecific molecules, and monoclonal antibodies. Carfilzomib, [...] Read more.
Background: Cytokine release syndrome (CRS) is a life-threatening systemic inflammatory condition marked by excessive cytokine production, leading to multi-organ dysfunction. It is commonly associated with T-cell-engaging therapies such as chimeric antigen receptor (CAR) T cells, T-cell receptor bispecific molecules, and monoclonal antibodies. Carfilzomib, a proteasome inhibitor, is known to cause a range of adverse effects, primarily hematologic and cardiovascular. However, multiorgan failure grade 5 (fatal), resembling CRS has not been previously reported in association with Carfilzomib. Case Report: A 74-year-old male with relapsed multiple myeloma developed grade 5 multiorgan failure 60 min after the third dose of Carfilzomib, resulting in death within 24 h of symptom onset. The patient tolerated the first doses of Carfilzomib well with only fever and headache developing post infusion. Before the second dose, the patient developed worsening pancytopenia, prompting the discontinuation of Lenalidomide. After the second Carfilzomib infusion, he experienced fever and transient encephalopathy, which resolved with acetaminophen, corticosteroids, and supportive care. However, following the third dose, he rapidly deteriorated—developing fever, tachycardia, hypotension, hypoxia, and encephalopathy. Despite aggressive management with intravenous fluids, broad-spectrum antibiotics, corticosteroids, and tocilizumab, the patient progressed to refractory shock and multi-organ failure, culminating in death within 24 h. A comprehensive infectious workup was negative, ruling out sepsis and suggesting possible Carfilzomib-induced CRS. Conclusion: Grade 5 multiorgan failure with signs and symptoms similar with CRS following Carfilzomib administration is a rare but potentially fatal adverse drug reaction. Further research is needed to better define the risk factors and optimal management strategies for Carfilzomib-induced multiorgan failure and possible CRS. Full article
(This article belongs to the Special Issue Multiple Myeloma: Advances in Diagnosis and Treatment)
24 pages, 2803 KiB  
Review
Mammal Fauna Changes in Baltic Countries During Last Three Decades
by Linas Balčiauskas, Valdis Pilāts and Uudo Timm
Diversity 2025, 17(7), 464; https://doi.org/10.3390/d17070464 - 1 Jul 2025
Viewed by 672
Abstract
We examined three decades of changes in the mammal fauna of Estonia, Latvia, and Lithuania in the context of climate variability, land use transformation, and anthropogenic pressures. We compiled distributional, abundance, and status data from publications, atlases, official game statistics, and long-term monitoring [...] Read more.
We examined three decades of changes in the mammal fauna of Estonia, Latvia, and Lithuania in the context of climate variability, land use transformation, and anthropogenic pressures. We compiled distributional, abundance, and status data from publications, atlases, official game statistics, and long-term monitoring programs, and we evaluated trends using compound annual growth rates or temporal indices. Our review identified losses such as regional extinctions of garden dormice and European mink, declines in small insectivores (e.g., pond bats and shrews) and herbivores (e.g., Microtus voles), and the contraction of boreal specialists (e.g., Siberian flying squirrels). However, we also identified gains, including increases in ungulate numbers (e.g., roe deer, red deer, fallow deer, moose, and wild boars before African swine fewer outbreak) and the recovery of large carnivores (e.g., wolves and lynxes). Invasions by non-native species (e.g., American mink, raccoon dog, and raccoon) and episodic disturbances, such as African swine fever and the “anthropause” caused by the SARS-CoV-2 pandemic, have further reshaped community composition. The drivers encompass climatic warming, post-socialist forest succession, intensified hunting management, and rewilding policies, with dispersal capacity mediating the responses of species. Our results underscore the dual legacy of historical land use and contemporary climate forcing in structuring the fauna dynamics of Baltic mammal communities in the face of declining specialists and invasive taxa. Full article
(This article belongs to the Special Issue Diversity in 2025)
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16 pages, 515 KiB  
Article
Fever and Pain in Italian Children: What Pediatricians Really Do
by Giacomo Biasucci, Maria Elena Capra, Antonella Giudice, Delia Monopoli, Roberta Rotondo, Daniela Petracca, Cosimo Neglia, Beatrice Campana and Susanna Esposito
Life 2025, 15(7), 1048; https://doi.org/10.3390/life15071048 - 30 Jun 2025
Viewed by 484
Abstract
Background: Fever and pain are among the most frequent symptoms in pediatric care, requiring timely and appropriate management. While evidence-based guidelines are available, adherence in real-world practice remains variable. This study aimed to explore the attitudes and prescribing behaviors of Italian Primary Care [...] Read more.
Background: Fever and pain are among the most frequent symptoms in pediatric care, requiring timely and appropriate management. While evidence-based guidelines are available, adherence in real-world practice remains variable. This study aimed to explore the attitudes and prescribing behaviors of Italian Primary Care Pediatricians (PCPs) in the management of fever and pain, and to assess their alignment with current clinical recommendations. Materials and Methods: An anonymous, cross-sectional survey consisting of 30 multiple-choice questions was administered to 900 PCPs between 1 July and 30 October 2024. The questionnaire assessed therapeutic preferences, dosing strategies, and perceived knowledge gaps. Invitations were distributed via pediatric scientific societies and regional professional networks. Results: A total of 244 PCPs completed the survey (response rate 27.1%). The majority were aged over 55 years (72.1%), worked in urban settings (71.3%), and had more than 20 years of clinical experience (74.6%). Most respondents (77%) reported managing pediatric fever or pain on a daily basis. Paracetamol was the preferred first-line treatment for fever (95.9%), primarily due to its perceived safety (82.4%). Ibuprofen was favored by 51.6% of those who selected it for its greater effectiveness. The alternating use of paracetamol and ibuprofen for fever was never adopted by 49.6%, while 31.6% employed this strategy, believing it to be more effective. For pain, 67.6% used paracetamol and 26.2% used ibuprofen as first-line treatments; 15.2% reported alternating the two drugs. Correct dosage practices were followed by 63.9% for both medications, although 40.2% did not differentiate dosages between fever and pain management. Conclusions: While general trends showed alignment with current guidelines, notable inconsistencies were observed in drug selection, dosage, and the use of alternating therapies. These findings highlight a pressing need to improve the dissemination and implementation of pediatric fever and pain management guidelines among PCPs in order to reduce unsafe practices, avoid therapeutic errors, and prevent unnecessary strain on emergency care services. Full article
(This article belongs to the Special Issue Pain and Therapy: Historical Perspectives and Future Directions)
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18 pages, 783 KiB  
Review
COVID-19 and Myocarditis: Trends, Clinical Characteristics, and Future Directions
by Mohammad Abumayyaleh, Tobias Schupp, Michael Behnes, Ibrahim El-Battrawy, Nazha Hamdani and Ibrahim Akin
J. Clin. Med. 2025, 14(13), 4560; https://doi.org/10.3390/jcm14134560 - 27 Jun 2025
Viewed by 736
Abstract
Summary: COVID-19, caused by SARS-CoV-2, has been associated with a range of cardiovascular complications, including myocarditis. This review aims to systematically present the clinical manifestations, underlying pathophysiological mechanisms, diagnostic approaches, and management strategies for both COVID-19-associated myocarditis and myocarditis related to SARS-CoV-2 vaccination. [...] Read more.
Summary: COVID-19, caused by SARS-CoV-2, has been associated with a range of cardiovascular complications, including myocarditis. This review aims to systematically present the clinical manifestations, underlying pathophysiological mechanisms, diagnostic approaches, and management strategies for both COVID-19-associated myocarditis and myocarditis related to SARS-CoV-2 vaccination. We conducted a literature search using the PubMed database, covering studies published up to early 2024. Search terms included combinations of “COVID-19”, “Coronavirus”, “SARS-CoV-2”, and/or “vaccination” with “cardiac injury”, “cardiac inflammation”, “myocarditis”. The reported prevalence of COVID-19-associated myocarditis varies between 2.3% and 5.0%, though myocardial injury is more frequently observed than confirmed myocarditis. Pathophysiological mechanisms include direct viral damage, immune-mediated injury, and molecular mimicry. Clinically, patients may present with chest pain, dyspnea, and fever. Diagnostic workup includes electrocardiography (ECG), troponin measurement, echocardiography, cardiac magnetic resonance imaging (cMRI), and in selected cases, endomyocardial biopsy (EMB). The management and disposition of COVID-19-associated myocarditis varies according to severity, especially to allow targeted treatment of complications. Glucocorticoids are a mainstay of treatment in severe cases. Myocarditis following SARS-CoV-2 vaccination is rare, more frequently reported in males under 30 years, and is generally associated with a favorable prognosis. Despite this, the benefits of vaccination continue to outweigh the risks. COVID-19 is associated with an increased risk of heart failure and other cardiovascular complications, underlining the importance of long-term follow-up and preventive strategies. Further research is needed to better understand the pathogenesis and optimal management of myocarditis in the context of COVID-19, with the goal of developing evidence-based therapeutic algorithms. Full article
(This article belongs to the Section Cardiology)
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Article
Impact of COVID-19 Vaccination on Hospitalization and Mortality: A Comparative Analysis of Clinical Outcomes During the Early Phase of the Pandemic
by Brenda Garduño-Orbe, Paola Selene Palma-Ramírez, Eduardo López-Ortiz, Gabriela García-Morales, Juan Manuel Sánchez-Rebolledo, Alexis Emigdio-Loeza, Anel Gómez-García and Geovani López-Ortiz
Infect. Dis. Rep. 2025, 17(4), 74; https://doi.org/10.3390/idr17040074 - 27 Jun 2025
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Abstract
Background: Although COVID-19 vaccination has been effective in reducing severe illness and mortality, its differential clinical behavior in vaccinated and unvaccinated individuals during the early stages of the pandemic—especially in settings with partial coverage and real-world conditions—remains insufficiently characterized. Objective: To [...] Read more.
Background: Although COVID-19 vaccination has been effective in reducing severe illness and mortality, its differential clinical behavior in vaccinated and unvaccinated individuals during the early stages of the pandemic—especially in settings with partial coverage and real-world conditions—remains insufficiently characterized. Objective: To assess differences in clinical presentation, comorbidity prevalence, hospitalization, and mortality between vaccinated and unvaccinated patients diagnosed with SARS-CoV-2 during the early phase of the pandemic. Methods: An analytical cross-sectional study was conducted using 4625 electronic medical records of patients diagnosed with COVID-19 in Guerrero, Mexico, between 1 January and 31 December 2021. Variables included vaccination status, age, sex, comorbidities, symptom severity, clinical outcomes, and mortality. Statistical analyses involved chi-square tests, logistic regression for hospitalization probability, and Cox proportional hazards models for mortality risk. Results: Of the patients analyzed, 31.45% had received at least one vaccine dose. Fever, headache, cough, and anosmia were more frequent among vaccinated individuals (p < 0.001). Prostration and chest pain were strongly associated with hospitalization in both groups. In unvaccinated patients, smoking (OR = 4.75), obesity (OR = 3.85), and hypertension (OR = 2.94) increased hospitalization risk. Among vaccinated patients, diabetes mellitus (OR = 3.62) and hypertension (OR = 2.88) were key predictors. Vaccination was significantly associated with lower odds of hospitalization (OR = 0.38; 95% CI: 0.26–0.55) and reduced mortality risk (HR = 0.24; 95% CI: 0.08–0.71). Conclusions: Vaccination status was a significant protective factor for both hospitalization and mortality; however, clinical symptoms and comorbidity-related risks varied, highlighting the need for individualized patient management strategies. Full article
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