Search Results (103)

Background: Sepsis constitutes a major healthcare burden worldwide, with an estimated 48.9 million incident cases and 11.0 million deaths in 2017, accounting for nearly one-fifth of all global deaths. Even with advances in definitions and guidelines, significant inequalities persist in awareness, early treatment, and health system readiness. Methods: We performed a structured narrative review of epidemiology studies, clinical case definitions, diagnostic approaches, stewardship interventions, and health system reports. Both electronic sources (PubMed, Web of Science, Embase, Scopus) and grey literature (World Health Organization [WHO], National Institute for Health and Care Excellence [NICE], Society Critical Care [SSC]) were explored. Evidence incorporated themes were organized across recognition, diagnostics, antimicrobial therapy, organ support, guidelines, and health system determinants. Results: Measurement tools, including quick Sequential Organ Failure Assessment (qSOFA) and Sequential Organ Failure Assessment (SOFA), exhibited suboptimal sensitivity and utility in varied clinical environments. Biomarkers (procalcitonin, presepsin, CD64) and rapid molecular diagnostics, including metagenomic next-generation sequencing (mNGS) and AI-based devices, enhance detection but are limited by cost and infrastructure constraints. Each hour of delay in antibiotic therapy is associated with a 6–10% increased risk of mortality, underscoring the importance of stewardship, including the incorporation of empiric regimens with rapid de-escalation. Health system bottlenecks—human resources, funding, infrastructure—continue to be a significant determinant of outcomes, especially in low- and middle-income countries. Conclusions: Attaining the 2030 WHO targets for sepsis involves precision diagnostics, adaptable guidelines, stewardship frameworks, and resilient health systems. Fair application and resource allocation are crucial to lower the incidence and mortality worldwide. Full article

Background/Objectives: With the rising incidence of obesity-related endometrial cancer, there is renewed interest in physiologic, low-cost approaches to identify women with hormonally active endometrium who may benefit from early preventive interventions. The progesterone challenge test (PCT), an established clinical tool for evaluating amenorrhea, has been previously proposed as a method to detect endometrial pathology. This study systematically evaluated the diagnostic accuracy of the PCT for detecting endometrial hyperplasia, intraepithelial neoplasia, and carcinoma in asymptomatic postmenopausal women to determine its potential role as a physiologic marker of endometrial cancer risk. Methods: A systematic review and meta-analysis were conducted following PRISMA-DTA guidelines. MEDLINE, EMBASE, EBM Reviews, and CINAHL were searched from inception to 20 January 2025, along with ClinicalTrials.gov and grey literature. Eligible studies prospectively evaluated the PCT with endometrial biopsy as the reference standard. Data extraction and risk-of-bias assessment were performed in duplicate. Risk of bias was assessed using QUADAS-2. Pooled sensitivity, specificity, and predictive values were estimated using hierarchical summary receiver operating characteristic models. Results: Nineteen studies (n = 3902) met the inclusion criteria. The pooled sensitivity and specificity of the PCT for detecting endometrial pathology were 95% (95% CI 86–100%) and 87% (76–96%), respectively. The positive predictive value was 32% (95% CI, 16–50%) and the negative predictive value was 100% (100–100%). When endometrial proliferation was included in the target condition, sensitivity decreased to 82%, but positive predictive value increased to 70%. Conclusions: The PCT shows high diagnostic accuracy for identifying estrogen-driven endometrial pathology in asymptomatic postmenopausal women. Re-evaluating this simple, physiologic test as a functional risk-stratification tool could inform precision prevention strategies for endometrial cancer. Full article

In recent years, there has been rapid growth in aesthetic medicine and an increase in the number of minimally invasive procedures aimed at improving appearance. With the increasing number of procedures performed, the incidence of post-operative complications is also rising, and high-frequency ultrasound (HFUS) is increasingly being used to assess these complications. The article presents the case of a 52-year-old woman who reported for an HFUS examination several months after non-surgical nose correction with hyaluronic acid (HA) and implantation of polydioxanone (PDO) lifting threads. The patient experienced post-treatment complications in the form of erythema, oedema and pain, followed by blanching and bruising of the skin. Hyaluronidase and prednisone were used for treatment. Four months after the procedure, the patient returned for another HFUS examination because, despite the disappearance of most symptoms, uneven purple-blue discoloration of the skin on the nose and a subjective feeling of cold persisted. At the time of the HFUS examination, the discoloration was barely visible. The grey-scale HFUS examination revealed foci corresponding to HA deposits and PDO threads located in close proximity to the dorsal artery of the nose. A Doppler examination revealed blood flow disturbances in this artery, which may indicate compression by the threads and be the likely cause of the patient’s complaints. High-frequency ultrasound has proven to be a useful diagnostic method for assessing such complications. Due to its safety, non-invasiveness and high reliability, HFUS has the potential to become a common diagnostic tool in aesthetic medicine practice. Full article

Botrytis cinerea Pers., the causal agent of grey mould, causes major economic losses in viticulture by reducing grape and wine quality and yield. Antagonistic yeasts that release bioactive volatile organic compounds (VOCs) represent a sustainable alternative to synthetic fungicides. Here, VOCs produced by Pichia guilliermondii strain ZIM624 were identified and assessed for antifungal activity against B. cinerea. 65 VOCs—including higher alcohols, volatile phenols, esters, and terpenes—were detected using two newly developed and validated analytical methods combining automated headspace solid-phase microextraction with gas chromatography–mass spectrometry. A total of 13 VOCs were selected for the bioassays. Fumigation assays demonstrated that terpenes (citronellol, geraniol, nerol, α-terpineol, and linalool) were the most effective inhibitors of B. cinerea mycelial growth (EC₅₀ = 6.3–33.9 μL/L). Strong inhibition was also observed for 4-vinylphenol and isoamyl acetate. In vivo assays confirmed that exposing infected grape berries to P. guilliermondii VOCs significantly reduced grey mould incidence. These results highlight the potential of P. guilliermondii ZIM624 volatiles as natural biofumigants for the eco-friendly management of B. cinerea in grapes. Future research should focus on optimising VOC production, evaluating efficacy under field conditions, and developing formulations for practical application in vineyards and post-harvest storage. Additionally, investigating potential synergistic effects of VOC combinations could lead to more effective biocontrol strategies. Full article

There is little research exploring the grey area of sexual violence (SV), considered in the literature as being a more subtle manifestation of SV, and therefore tending to be trivialized, legitimized, and normalized by society. This study aimed to compare students’ perceptions of the grey area of SV based on the gender of those involved, in a cis-hetero context, as well as potential sex differences in these perceptions. A vignette methodology was employed to gain valuable insights into the topic. The sample consisted of 164 university students living in Portugal, 71.3% (n = 117) female, with an average age of 23 (SD = 5.84). The thematic analysis revealed a central theme, Severity, reflecting participants’ perceptions of the seriousness of sexual violence within the “grey area”. This theme is expressed through four sub-themes: Attribution of severity, referring to how seriousness is assigned depending on context and beliefs; Identifying sexual violence, highlighting difficulties in recognizing certain behaviors as abusive; Frequency, capturing perceptions of how often such situations occur; and Report, addressing the barriers and facilitators to formal reporting. Our results indicated that while some participants minimized the scenario, the majority of the sample considered the situation as somewhat or very serious. Only few participants trivialized subtle forms of SV, perceiving incidents without overt physical force as less severe. Notably, sex differences emerged, despite being in the minority of the sample, female participants were more inclined to recognize these behaviors as abusive and to view the allegations as credible, whereas male participants tended to downplay the severity. Full article

The formation of strategies and tactics of destructive impact (DI) at the stages of complex computer attacks (CCAs) largely depends on the content of intelligence data obtained by the intruder about the attacked elements of distributed information systems (DISs). This study analyzes scientific papers, methodologies and standards in the field of assessing the indicators of awareness of the intruder about the objects of DI and symmetrical indicators of intelligence security of the elements of the DIS. It was revealed that the aspects of changing the quantitative and qualitative characteristics of intelligence data (ID) at the stages of CCA, as well as their impact on the possibilities of using certain types of simple computer attacks (SKAs), are poorly studied and insufficiently systematized. This paper uses technologies for modeling the process of an intruder obtaining ID based on the application of the methodology of black, grey and white boxes and the theory of fuzzy sets. This allowed us to identify the relationship between certain arrays of ID and the possibilities of applying certain types of SCA end-structure arrays of ID according to the levels of identifying objects of DI, and to create a scale of intruder awareness symmetrical to the scale of intelligence protection of the elements of the DIS. Experiments were conducted to verify the practical applicability of the developed models and techniques, showing positive results that make it possible to identify vulnerable objects, tactics and techniques of the intruder in advance. The result of this study is the development of an intruder awareness scale, which includes five levels of his knowledge about the attacked system, estimated by numerical intervals and characterized by linguistic terms. Each awareness level corresponds to one CCA stage: primary ID collection, penetration and legalization, privilege escalation, distribution and DI. Awareness levels have corresponding typical ID lists that can be potentially available after conducting the corresponding type of SCA. Typical ID lists are classified according to the following DI levels: network, hardware, system, application and user level. For each awareness level, the method of obtaining the ID by the intruder is specified. These research results represent a scientific contribution. The practical contribution is the application of the developed scale for information security (IS) incident management. It allows for a proactive assessment of DIS security against CCAs—modeling the real DIS structure and various CCA scenarios. During an incident, upon detection of a certain CCA stage, it allows for identifying data on DIS elements potentially known by the intruder and eliminating further development of the incident. The results of this study can also be used for training IS specialists in network security, risk assessment and IS incident management. Full article

Postharvest fungal infections, particularly by Botrytis cinerea, can cause up to 50% losses in fruits and vegetables, and the overuse of synthetic fungicides has led to resistant pathogen strains. We hypothesized that hexane (Hex) and methanolic (MeOH) extracts from peanut (P) and pecan nut (PN) shells possess antifungal properties effective against B. cinerea in strawberries. To test this, we conducted both in vitro and ex vivo assays using strawberries inoculated with B. cinerea, comparing two controls (T0: water; T1: commercial synthetic fungicide) with four treatments—Hex-P, MeOH-P, Hex-PN, and MeOH-PN—at 1000 and 2000 ppm (in vitro) and 4000 ppm (ex vivo). Total phenolic content (TPC) and antioxidant activity (AA) were also measured. MeOH-P and Hex-PN extracts at 2000 ppm significantly inhibited fungal mycelial growth in vitro. In ex vivo assays, MeOH-P reduced both disease incidence and severity comparably to the synthetic fungicide. MeOH-PN exhibited the highest TPC and AA. These findings support the potential use of MeOH-P extract as a natural alternative to synthetic fungicides for controlling B. cinerea in strawberries during postharvest storage. Full article

Background/Objectives: The correlation between cardiovascular diseases, particularly infective endocarditis, and oral disorders such as periodontitis and dental caries has been widely discussed in the scientific literature. In this mapping review, we aim to examine the available evidence on the link between these conditions, focusing on the pathogenetic mechanisms that underlie the development of endocarditis in patients with oral diseases. Methods: A systematic search was conducted across three major databases—PubMed, Scopus, and ScienceDirect—as well as grey literature in Google Scholar. Relevant articles were selected based on inclusion and exclusion criteria, focusing primarily on systematic reviews. The data extracted included study characteristics, main outcomes, and risk-of-bias evaluations. Results: A total of 13 systematic reviews were included in this mapping review. The findings suggest there is a significant connection between periodontal disease, dental caries, and the incidence of infective endocarditis. The evidence highlights that oral bacteria, particularly Streptococcus species, can enter the bloodstream during daily activities and invasive dental procedures, contributing to the development of endocarditis in susceptible individuals. However, the role of antibiotic prophylaxis in preventing endocarditis following dental procedures remains controversial. Conclusions: This review reinforces the importance of oral health in preventing cardiovascular complications, especially infective endocarditis. Although antibiotic prophylaxis may reduce the risk in high-risk individuals, further research is needed to clarify its effectiveness. Enhanced awareness of and education on the shared risks between oral and cardiovascular health could improve prevention strategies and patient outcomes. Full article

According to the WHO, echinococcosis is a neglected tropical disease of global importance. The Russian Federation (R.F.) is traditionally considered an endemic area of echinococcosis. This study aims to analyze the state of human infection in the R.F. in the 2000–2021 period, for which there is not enough consolidated data. Epidemiological data on human echinococcosis in the R.F. from 1 January 2000 to 31 December 2021 were collected through literature research (both published and grey literature) and official reports. From the 2022 selected records, 12 full-text articles, three doctoral dissertations, and 17 official reports were analyzed, all of which met the criteria for inclusion in the study. In the R.F., in the period from 2000 to 2021, echinococcosis (cystic (C.E.) and alveolar (A.E.) echinococcosis) has been continuously registered in humans (0.4–0.22 cases/100,000 inhabitants). Until 2013, the incidence of echinococcosis did not change (Pearson’s r (N = 13) = 0.288, p = 0.340), but in the period 2013–2021 it decreased significantly (Pearson’s r (N = 9) = −0.709, p = 0.032). In that period, the incidence of C.E. decreased significantly (Pearson’s r (N = 9) = −0.717, p = 0.035), while the incidence of A.E. did not change (Pearson’s r (N = 9) = −0.518, p = 0.154). The infection is registered annually in 30 out of 86 federal units. The C.E. infection rate was significantly higher in the European part (0.46/100,000 population) (2 = 33,783. r < 0.00001) than in the Asian part of the R.F. (0.32/100,000 population), where A.E. was more widespread. Within the European part, the frequency of C.E. infection was significantly higher in the southern (0.70/100,000 inhabitants) (χ² = 806.67, p < 00001) than in the central and northern parts (0.25/100,000 inhabitants). The incidence of C.E. per federal district was positively correlated with rural population representation (Pearson’s r (N = 8) = 0.866, p = 0.005). Every year, although in small numbers, deaths caused by echinococcosis (in the period 2009–2020—66 deaths) were registered in the R.F., significantly more often caused by A.E. than C.E. (χ² = 39.4401, p < 0.00001). Our results indicate that, between 2000 and 2021, echinococcosis was still generally endemic in the R.F. The incidence of C.E. has demonstrated a decreasing trend, especially after 2014, while the rate of A.E. remained unchanged. Full article

Near-surface floating kelp farms constitute a Nature-Based Solution (NBS) capable of damping incident wind-generated waves, which might be beneficial to reduce wave overtopping on maritime structures. As the global mean sea level rises, the mean wave overtopping discharge is expected to increase. The incorporation of this NBS, as a green–grey solution, might be beneficial to mitigate this effect. Physical modelling experiments with random waves have been conducted to assess the ability of this NBS to reduce the mean wave overtopping discharge on a rubble mound breakwater. Results show that while the mean wave overtopping discharge was reduced by 47% with a kelp farm length of 50 m (prototype scale), a kelp farm of 200 m achieved a reduction of 93% for the tested conditions. This reduction is mainly a function of the ratio between floating kelp farm length and incident wavelength. An idealized case study at the Port of Leixões breakwater suggests that, under storm wave conditions with return period of 2 and 5 years, floating kelp farms could maintain mean wave overtopping discharges below present levels until 2070. Thus, this study highlights the relevance of incorporating NBS with existing coastal and port defence structures as an adaptation measure to mitigate climate change effects. Full article

Objectives: This study aims to review the scientific literature on the prevention of white spot lesions (WSLs) associated with fixed orthodontic treatment. WSLs result from enamel demineralization and pose aesthetic and functional challenges. The study evaluates the effectiveness of various preventive interventions to reduce the risk of WSLs during orthodontic care. Methods: A comprehensive literature search was conducted using MeSH terms such as “white spot”, “fixed orthodontic treatment”, “CPP-ACP”, “topical fluoride”, and “demineralized lesion”, combined with the Boolean operator ‘AND’. Databases searched included PubMed, EMBASE, Scopus, and OpenGrey, focusing on studies published between January 2014 and September 2024. The inclusion criteria required studies to evaluate interventions aimed at reducing WSL risk in patients undergoing fixed orthodontic treatment. A total of 41 articles were screened, with 17 selected based on relevance and methodological rigor. Results: The review identified several effective strategies for preventing WSLs. Topical fluoride applications, particularly high-concentration varnishes, significantly reduced WSL prevalence, with some studies favoring fluoride varnish over other interventions. CPP-ACP and CPP-ACPF formulations demonstrated potential for remineralizing demineralized enamel, especially when combined with fluoride toothpaste. High-fluoride toothpaste and acidulated phosphate fluoride mouthwash were effective in reducing lesion incidence, emphasizing the importance of patient compliance in daily oral hygiene routines. Professional interventions, such as fluoride varnish applications, showed enhanced outcomes when re-applied periodically. Conclusions: Preventing WSLs during orthodontic treatment is crucial for ensuring the aesthetic and functional success of therapy. Strategies combining fluoride-based interventions with casein phosphopeptide formulations offer significant benefits. However, patient education and adherence to recommended oral hygiene practices remain critical. Further research is needed to compare the long-term effectiveness of these interventions and to explore new technologies for WSL prevention. Full article

Camellias are evergreen shrubs native to the eastern and southern regions of Asia. In Romania, camellias are popular ornamental plants grown in pots. Pestalotiopsis species have a worldwide distribution and are pathogenic to a wide range of hosts. They also represent an important group of endophytes capable of producing a variety of bioactive secondary metabolites. This paper reports the occurrence of grey blight and twig or branch dieback caused by Pestalotiopsis sp. on Camellia japonica L. grown in pots and used in the landscaping of a public garden located in Iasi city, Romania (GPS coordinates: 47°09′24.0″ N 27°35′15.6″ E). Pestalotiopsis species were identified based on morphological characteristics and Sanger sequencing. Genomic analysis of the fungal isolate coded P_CJ_24, obtained from living plants, was based on ribosomal internal transcribed spacer region amplification using the LSU primers. This first report of Pestalotiopsis species infection of ornamental plants in Romania suggests that new plant pathogens can be introduced in new environmental conditions through plant pods and their incidence increases with the widespread of plant material among gardens. Full article

Due to the increasing number of people working at computers in professional settings, the incidence of lumbar disc herniation is increasing. Background/Objectives: The early diagnosis and treatment of lumbar disc herniation is much more likely to yield favorable results, allowing the hernia to be treated before it develops further. The aim of this study was to classify lumbar disc herniations in a computer-aided, fully automated manner using magnetic resonance images (MRIs). Methods: This study presents a hybrid method integrating residual network (ResNet50), grey wolf optimization (GWO), and machine learning classifiers such as multi-layer perceptron (MLP) and support vector machine (SVM) to improve classification performance. The proposed approach begins with feature extraction using ResNet50, a deep convolutional neural network known for its robust feature representation capabilities. ResNet50’s residual connections allow for effective training and high-quality feature extraction from input images. Following feature extraction, the GWO algorithm, inspired by the social hierarchy and hunting behavior of grey wolves, is employed to optimize the feature set by selecting the most relevant features. Finally, the optimized feature set is fed into machine learning classifiers (MLP and SVM) for classification. The use of various activation functions (e.g., ReLU, identity, logistic, and tanh) in MLP and various kernel functions (e.g., linear, rbf, sigmoid, and polynomial) in SVM allows for a thorough evaluation of the classifiers’ performance. Results: The proposed methodology demonstrates significant improvements in metrics such as accuracy, precision, recall, and F1 score, outperforming traditional approaches in several cases. These results highlight the effectiveness of combining deep learning-based feature extraction with optimization and machine learning classifiers. Conclusions: Compared to other methods, such as capsule networks (CapsNet), EfficientNetB6, and DenseNet169, the proposed ResNet50-GWO-SVM approach achieved superior performance across all metrics, including accuracy, precision, recall, and F1 score, demonstrating its robustness and effectiveness in classification tasks. Full article

Fresh produce prone to microbial contamination is a potential reservoir for antimicrobial-resistant bacteria (ARB) and antimicrobial resistance genes (ARGs), posing challenges to food safety and public health. This systematic review aims to comprehensively assess the prevalence of bacterial pathogens and the incidence of ARB/ARGs in fresh produce and agro-ecosystems across South Asia. Twenty-two relevant studies published between 2012 and 2022 from three major scientific databases and the grey literature were identified. The results revealed a wide occurrence of microbial contamination in various types of fresh produce across South Asia, with a predominance of E. coli (16/22), Salmonella spp. (13/22), Staphylococcus spp. (5/22), and Klebsiella spp. (4/22). The agro-ecosystem serves as a complex interface for microbial interactions; studies have reported the prevalence of E. coli (1/4), Salmonella spp. (1/4) and Listeria monocytogenes (1/4) in farm environment samples. A concerning prevalence of ARB has been reported, with resistance to multiple classes of antibiotics. The presence of ARGs in fresh produce underscores the potential for gene transfer and the emergence of resistant pathogens. To conclude, our review provides insights into the requirements of enhanced surveillance, collaborative efforts, implementation of good agricultural practices, and public awareness for food safety and safeguarding public health in the region. Full article

In the extreme polar marine environment, safety risks pose a significant threat to drilling vessels. By conducting a safety risk assessment, potential hazards can be predicted and identified, thereby significantly reducing the frequency of accidents and promoting the sustained stability of economic activities. This paper investigates a Bayesian-network-based risk assessment model for polar drilling operations. Grey relational analysis was employed to identify the main risk factors. The model is trained using 525 valid incident sample data and is combined with expert knowledge. The accuracy rate is above 88%. Additionally, corresponding decision-making recommendations are provided through sensitivity analysis. The three most sensitive elements to fire nodes are human error, other causes, and equipment damage, with sensitivity coefficients of 0.046, 0.042, and 0.022, respectively. In terms of deck/handrail collision nodes, the highly sensitive elements are related to lifting (totally more than 0.1). For the events that have already transpired, the probabilities of most related nodes are 0.73 and 0.74, both of which are above 0.5, thereby validating the accuracy of forward and backward reasoning. Risk assessments based on Bayesian networks can offer pertinent decision-making recommendations and preventive measures. Full article