Search Results (7,677)

Background: Physical activity is a well-established modifiable lifestyle factor associated with reduced cancer risk; however, the optimal weekly volume of moderate-to-vigorous physical activity (MVPA) for cancer prevention, particularly when assessed using objective measures, remains unclear. Most existing evidence relies on self-reported physical activity, which may introduce measurement bias and obscure accurate dose–response relationships. Methods: We analyzed data from UK Biobank participants with valid accelerometer measurements to quantify habitual MVPA. Observational associations between MVPA and incident cancer were evaluated using multivariable Cox proportional hazards regression and restricted cubic splines. One-sample Mendelian randomization (MR) analyses, including both linear and nonlinear approaches, were conducted to evaluate potential causal associations and explore possible dose–response patterns. Results: Higher MVPA was associated with lower total cancer risk (HR 0.971, 95% CI 0.954–0.988, p = 0.001). Consistent associations were observed for several site-specific cancers, particularly lung, colorectal, breast, kidney, and bladder cancer. MR analyses supported a directionally consistent association between genetically predicted MVPA and lower total cancer risk (HR 0.977, 95% CI 0.962–0.992, p = 0.002). Nonlinear MR analyses suggested a potential nonlinear association, with lower cancer risk observed at a model-derived exploratory point of approximately 5 h of weekly MVPA. Conclusions: These findings provide supportive evidence that higher accelerometer-measured MVPA is associated with lower total cancer risk and contribute to a better understanding of the dose–response relationship between MVPA and cancer incidence. Full article

Objective: Minimally invasive surgery in Hirschsprung disease (HSCR) management was introduced in the mid-1990s. Despite decades of clinical application of various laparoscopic approaches, there remains a paucity of high-powered prospective studies and comprehensive systematic reviews in the literature. This study aimed to systematically review and summarize published techniques and outcomes of laparoscopic- and robotic-assisted surgery in HSCR. Methods: A systematic literature review was conducted using PubMed and the Cochrane Library. Studies reporting technical and outcome data of laparoscopic- or robotic-assisted surgery for HSCR were included. Data extraction and analysis were performed in accordance with the PRISMA 2020 guidelines. Parameters of interest included surgical technique, age at primary pull-through (PT), operative time, and functional outcomes. Outcomes of laparoscopic- versus robotic-assisted Yancey–Soave PT were compared. Results: A total of 700 publications were screened, of which seven studies met the inclusion criteria. Data from 556 patients were analyzed. A total of 338 underwent laparoscopic-assisted, and 218 underwent robotic-assisted pull-through. Large variability of the reported transanal resection technique (modified Yancey–Soave PT) was reported. Four studies reported functional outcomes in patients aged over four years. Three studies directly compared laparoscopic- and robotic-assisted PT; two reported no difference in the incidence of postoperative Hirschsprung-associated enterocolitis (HAEC). Functional outcomes were assessed using the Krickenbeck classification in three studies and the bowel function score in one study, with no significant differences reported in patients aged >4 years. Conclusions: Laparoscopic- and robotic-assisted Yancey–Soave PT appears to be safe for HSCR. Large variability in the applied surgical technique—despite being commonly classified as modified Yancey–Soave PT—as well as heterogeneity in the bowel function assessment, limit direct comparability between studies. To date, no single minimally invasive approach has demonstrated clear superiority over others. Prospective, randomized controlled studies are required to enable robust comparative evaluation of techniques, overall costs, and outcomes. Full article

Wesselsbron disease remains an underrecognized mosquito-borne flaviviral disease despite long-standing evidence of ruminant reproductive loss, neonatal disease, hepatic pathology, zoonotic infection, and mosquito-associated circulation. This narrative review critically synthesizes verified evidence on Wesselsbron virus (WSLV) at the animal–human–vector–environment interface, with the specific aim of clarifying why the virus should be considered a surveillance-sensitive One Health pathogen rather than a rare veterinary curiosity. The review integrates classical veterinary pathology, experimental infection studies, human case reports, serological and molecular evidence, mosquito surveillance, ecological suitability modelling, diagnostic-development studies, and recent evidence from molecular epidemiology, camel investigations, and digital histopathology. The review uses an evidence-weighted synthesis to distinguish experimentally and pathologically supported animal disease, confirmed but poorly quantified human infection, mosquito-associated detection, ecological suitability, diagnostic under-recognition, and unresolved reservoir or transmission questions before integrating these domains into a qualitative One Health risk-assessment framework. The evidence supports WSLV as a cause of ruminant abortion, neonatal disease, and hepatic lesions, confirms zoonotic potential, and indicates repeated detection in ecologically relevant mosquito and multi-host contexts. However, current data remain insufficient for robust estimates of animal burden, human incidence, reservoir competence, natural route frequency, or climate-driven expansion. WSLV should therefore be incorporated into targeted differential diagnosis, laboratory readiness, and One Health surveillance where ruminant abortion events, unexplained neonatal disease, compatible mosquito ecology, undiagnosed febrile illness, diagnostic ambiguity, or ecological suitability indicate plausible risk. Full article

Background: The management of diabetic foot disease and knee osteoarthritis (OA) with smart orthotics holds significant importance during the early stages of these conditions, given their potential consequences, including functional impairment, chronic pain, and economic burden. Real-time monitoring of plantar foot pressure enables early detection of abnormal force distribution and gait biomechanics, allowing for the redirection of forces away from affected ulcers or arthritic joints. This is the first systematic review to synthesise clinical evidence for smart orthotics technology with real-time plantar pressure sensor biofeedback across both diabetic foot ulcer prevention and knee osteoarthritis management simultaneously. A search of the PROSPERO register confirmed no existing registration covers this specific combination. Objectives: To examine the clinical evidence for the use of standard and smart orthotics in the prevention and management of diabetic foot ulcers (DFUs) and knee OA, and to evaluate their impact on plantar pressure redistribution, ulcer recurrence, pain, biomechanics, and economic burden. Eligibility criteria: Studies published in English involving human adult participants (≥18 years) with a clinical diagnosis of diabetes mellitus (at risk of DFU or with peripheral neuropathy) or knee OA, where the intervention involved any orthotic device or smart/intelligent insole with clinical outcomes reported, were included. Studies on healthy individuals only, those not reporting participant age, and non-weight-bearing protocols not differentiated from weight-bearing were excluded. Information sources: Five databases were searched: CINAHL (EBSCO Information Services, Ipswich, MA, USA), PubMed Advanced (National Library of Medicine, Bethesda, MD, USA), Wiley Online Library (John Wiley & Sons, Hoboken, NJ, USA), Cochrane Library (Cochrane Collaboration, London, UK), and Google Scholar (Google LLC, Mountain View, CA, USA). Searches were completed in May 2026. Methods: We conducted a comprehensive literature review. This review was structured and reported with reference to the PRISMA 2020 statement (Preferred Reporting Items for Systematic Reviews and Meta-Analysis; University of Ottawa, Ottawa, ON, Canada) to guide transparency of reporting. It does not constitute a full Cochrane-style systematic review; risk of bias assessment was applied to key included studies and GRADE (Grading of Recommendations Assessment, Development and Evaluation; McMaster University, Hamilton, ON, Canada) certainty ratings were applied informally and narratively rather than as formal per-outcome evidence profiles. Five databases were searched yielding 92,637 records. After removal of 398 duplicates by Rayyan, 92,239 records remained. A subsequent automated keyword-based relevance filter applied within Rayyan (Rayyan AI, Doha, Qatar), prior to human screening, excluded 84,572 records that did not contain any terms related to orthotics, diabetic foot, or knee osteoarthritis, yielding 7667 records for human title/abstract screening. A narrative synthesis approach was adopted owing to the heterogeneity of study designs and outcome measures across included studies, which precluded meta-analysis. This review was not prospectively registered. A complete list of all 78 included studies, including those not individually discussed in the results and discussion. Results: The available clinical studies report promising findings for orthotics and smart orthotics in pain reduction, ulcer prevention, and potential reduction in economic burden, though conclusions are limited by small sample sizes, heterogeneity, and predominantly open-label designs. Recent research found that orthotics can be used to alter the gait pattern that influences knee OA by reducing excessive force on the affected joint. A randomised controlled trial demonstrated an 80% relative risk reduction in DFU recurrence (RR = 0.20; 95% CI: 0.06–0.79; p = 0.022), with absolute event rates of 6.3% in the intervention group versus 30.8% in controls (ARR = 24.5%); a second trial reported a 71% reduction in ulcer incidence over 18 months; and a third randomised controlled trial demonstrated statistically significant plantar pressure reduction (p < 0.01) in patients with diabetic neuropathy. Conclusions: The available evidence suggests that orthotics may be associated with improved pressure redistribution, reduced ulcer incidence, and benefit in the management of knee OA. Although the number of studies directly comparing smart orthotics with standard orthotics remains limited, the limited comparative studies suggested that smart orthotics showed promising results in reducing ulcer incidence, providing the patient with real-time feedback to offload via their electronic devices. These findings, while preliminary, highlight the potential of smart orthotic technology as an adjunct to standard orthotic care in reducing the overall burden of diabetic foot disease and knee osteoarthritis. Limitations: The primary methodological limitation of this review is the open-label design of all included smart orthotic trials, which precludes participant blinding and introduces performance bias. However, this limitation is structural and inherent to the wearable technology field—analogous to surgical trials—and is substantially mitigated by the use of objective primary outcome measures (plantar pressure and ulcer recurrence) across the three included RCTs, the consistency of effect direction across independent RCTs conducted in different countries, and a narrative sensitivity analysis confirming robustness of findings (Risk of Bias Across Studies Section). Formal per-outcome GRADE evidence profiles were not produced; overall certainty of evidence was assessed narratively with reference to GRADE domains and is judged to be low to moderate for smart orthotics in DFU prevention and low for knee OA management, consistent with the Level 2–3 evidence base and open-label study designs. Future adequately powered, multi-site RCTs with standardised outcome reporting, minimum 24-month follow-up, and integrated health economic modelling are the highest priority to extend these preliminary findings. Registration: This review was not prospectively registered. Full article

Background: Dupilumab, a monoclonal antibody blocking IL-4Rα, has recently demonstrated efficacy in patients with type 2 (T2)-inflamed chronic obstructive pulmonary disease (COPD) in the BOREAS and NOTUS trials. Real-world experience in older patients with predominant chronic bronchitis phenotype remains limited. Methods: We report a single-centre case series of 12 consecutive patients with T2-inflamed COPD treated with dupilumab 300 mg every two weeks under a compassionate-use programme at San Carlo di Nancy Hospital, Rome (first administration: April 2025). Eligibility required ≥2 moderate or ≥1 severe exacerbation in the prior 12 months despite triple inhaled therapy and a blood eosinophil count ≥300 cells/µL. Follow-up ranged from 3 to 12 months, with 6 months pre-specified as the primary analysis timepoint; data at 9 and 12 months are reported as descriptive observations. Endpoints included paired changes in annualised exacerbation rate (AER), CAT score and item-level CAT, and FEV₁, with exploratory univariate Spearman analyses of candidate baseline predictors of response. Results: The cohort was elderly (mean age 73.6 ± 5.2 years, range 65–82), predominantly female (8/12, 67%) and characterised by a chronic bronchitis phenotype with high symptom burden (mean baseline CAT 22.8 ± 7.5; CAT item 2 [phlegm] median 3, IQR 3–4). Severe exacerbations decreased significantly (Wilcoxon p = 0.0156; mean AER 0.75 → 0.19 events/patient-year; 6/12 improved, 0/12 worsened). The mean cumulative function showed a standardised incidence ratio of 0.46 (95% CI 0.19–0.95; p = 0.033) versus the pre-dupilumab rate. Mean FEV₁ increased by +66 mL at 1 month (n = 11, paired Wilcoxon p = 0.025), +78 mL at 3 months (n = 10, p = 0.082) and +120 mL at 6 months (n = 10, p = 0.007). Total CAT decreased from 22.9 to 12.5 at 6 months (Friedman p = 0.0007), with the largest absolute reductions in item 2 (phlegm; Δ = −2.6 at 6 months, p < 0.001) and item 3 (chest tightness; Δ = −2.5 at 6 months, p = 0.002). Higher baseline CAT was associated with greater reduction in severe AER (Spearman ρ = −0.79, p = 0.002). Conclusions: In this elderly real-world cohort with phlegm-driven T2 COPD, dupilumab was associated with a significant decrease in severe exacerbations, a clinically meaningful gain in lung function and a marked improvement in mucus-related symptoms. Further studies are warranted to confirm these findings and to clarify whether the reduction in severe exacerbations translates into a measurable mortality benefit. Full article

Background: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms, accounting for approximately 1–3% of all gastrointestinal tumors, with an annual incidence of 1–2 cases per 100,000 population worldwide. They arise from the interstitial cells of Cajal and are most commonly located in the stomach and small intestine. Methods: We report a case of a 39-year-old man admitted with a preliminary diagnosis of an appendiceal inflammatory mass with suspected abscess formation. Results: The patient presented with right iliac fossa pain, fever, signs of pronounced systemic intoxication and laboratory findings consistent with inflammatory syndrome. Abdominal computed tomography revealed a mass in the right iliac region with infiltration of the surrounding adipose tissue, suggestive of an appendiceal infiltrate. Emergency surgical exploration identified a tumor originating from the cecum. Radical resection of the ileocecal region with side-to-side ileo-ascending anastomosis was performed. Histopathological examination confirmed a spindle-cell variant of GIST. The postoperative course was uneventful. Conclusions: This case highlights the diagnostic challenges of atypically localized GISTs, which may clinically and radiologically mimic inflammatory conditions such as appendiceal infiltrate. Conventional imaging modalities may be insufficient for definitive differential diagnosis. Surgical resection remains the cornerstone of treatment, with histopathological and immunohistochemical evaluation establishing the final diagnosis. Early identification and complete tumor excision are essential for optimizing clinical outcomes and long-term prognosis. Adjuvant therapy with tyrosine kinase inhibitors should be considered based on individual recurrence risk. Full article

Background and Objectives: Developmental dysplasia of the hip (DDH) is an orthopedic condition in the pediatric population, affecting between 0.1% and 3% of infants. Chile has one of the highest incidences in South America, reaching 1 per 500 live births. Given the potential of adverse consequences of DDH on infant health, preliminary studies are needed to determine its prevalence in the population and assess its association with relevant risk factors. Materials and Methods: The study is single-center, conducted in a Chilean population. The sample size calculation determined the use of 100 pelvic radiographs, considering a 95% confidence level and a proportion of 0.5. The infants were between 90 and 150 days old. Information was collected on possible DDH-related risk factors. For the analysis, normality tests, Chi-square tests, independent samples t-tests, Mann–Whitney U tests, and multivariate analyses were applied. Results: The prevalence of DDH was determined to be 12%, affecting the left hip to a greater extent. Female infants had a higher frequency of DDH. A statistically significant association was found between the prevalence of DDH and the presence of asymmetry in the abduction of the hip joint (p = 0.023), acetabular roof obliquity (p = 0.003), left hip involvement (p = 0.002), and height at two months of age (p = 0.016). Conclusions: The prevalence of DDH in infants was higher than that reported in the literature. However, with regard to sex, the data coincide with those previously reported by other authors. Full article

Cancer incidence among adolescents is increasing, yet cancer risk reduction education remains largely absent from school-based curricula. This pilot study assessed whether a small-scale early, developmentally appropriate intervention could improve cancer literacy to support long-term risk reduction. This pilot study used a convergent parallel mixed-methods pre–post design to evaluate two separate, 45 min, school-based cancer education interventions delivered to 24 middle-school students in Pennsylvania. The intervention delivered developmentally appropriate content on cancer biology, modifiable risk factors, genetics, HPV vaccination, and self-advocacy using a low-resource, low-investment model easy for schools to implement. Pre- and post-intervention surveys assessed student knowledge, awareness, and health-related perceptions. Survey data were analyzed both descriptively using frequencies and percentages and thematically. Post-intervention results demonstrated substantial improvements across all domains. Correct definition of cancer increased from 16% to 100%. Awareness of modifiable risk factors increased to 96%, sunscreen knowledge to 90%, genetic testing awareness to 83%, and HPV vaccine understanding from 21% to 57%. Students also reported increased confidence in recognizing symptoms and engaging in health-seeking behaviors. Findings suggest that small-scale, school-based cancer education interventions are feasible and effective in improving adolescent cancer literacy. These results support the need for larger, controlled studies to evaluate long-term knowledge retention and behavioral outcomes. Full article

Human papillomavirus (HPV) infection remains the principal etiological factor in cervical cancer development worldwide, with Eastern Europe continuing to demonstrate disproportionately high cervical cancer incidence and mortality rates. Regional disparities in screening implementation, vaccination coverage, and HPV genotype distribution contribute substantially to the persistent burden of HPV-related disease. In recent years, increasing attention has focused on molecular biomarkers and the vaginal microbiome as complementary approaches for improving cervical cancer prevention strategies. This systematic review aimed to evaluate recent evidence regarding HPV genotype distribution, molecular biomarkers, vaginal microbiome composition, and their implications for cervical cancer prevention in Eastern Europe. A systematic literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, Embase, and the Cochrane Library for studies published between January 2020 and May 2026. This systematic review was conducted in accordance with the PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420261391136). Studies from Eastern European populations reporting data on HPV genotype distribution, screening strategies, vaccination, molecular biomarkers, or vaginal microbiome composition were included. HPV prevalence in screening populations ranged from approximately 12% to over 20%, with HPV16 consistently identified as the predominant genotype across all included studies. However, non-16/18 high-risk genotypes, particularly HPV31, HPV51, HPV52, HPV66, and HPV68, represented a substantial proportion of infections in several Eastern European cohorts. Studies evaluating CINtec PLUS cytology and HPV E6/E7 mRNA testing demonstrated improved specificity for identifying clinically significant cervical lesions compared with HPV DNA testing alone. Emerging evidence also suggested associations between vaginal dysbiosis, increased microbial diversity, persistent high-risk HPV infection, and progression to cervical intraepithelial neoplasia. Although the 9-valent HPV vaccine provides coverage for most circulating high-risk genotypes identified in the region, vaccination uptake remains inconsistent throughout Eastern Europe. The findings of this systematic review support the growing importance of extended HPV genotyping, molecular biomarkers, and microbiome-related approaches in cervical cancer prevention strategies in Eastern Europe. Strengthening organized screening programs, expanding vaccination coverage, and improving access to molecular diagnostic technologies remain essential priorities for reducing the regional burden of HPV-related disease. Full article

Previous research has shown that both victim intoxication and narrative framing can influence the levels of victim blame. However, far less attention has been paid to how coercive strategy and narrative framing may interact to shape victim-blaming judgements and perceptions of sexual assault. The present study addresses this gap by examining how combinations of coercive strategies (physical force versus alcohol facilitated), narrative framing (active versus passive), and rape myth acceptance (RMA) influence victim blame and the recognition of sexual assault. Participant gender and age were also assessed in relation to RMA and victim-blaming attitudes. A total of 202 participants aged 18–63 (78.7% of women, 21.3% of men, M_Age = 28.93, SD = 14.36) completed an online survey evaluating vignettes depicting a male perpetrator sexually assaulting a female victim. Age significantly predicted victim blaming, with older participants assigning greater blame to the victim. Gender predicted both RMA and victim blame, with men reporting higher RMA and greater victim blame than women. Active framing in both the physical force and alcohol-use conditions reduced participants’ recognition of the incident as sexual assault. Participants with lower RMA consistently reported lower victim blame across conditions, and were more likely to identify the incident as sexual assault in the physical force condition. These findings highlight the influence of coercive strategies and the importance of victim-centred language in policing, legal, and media contexts, where narrative framing can meaningfully shape the recognition of sexual assault. Full article

Background: Cerebrovascular accidents (CVAs) are among the most serious complications of intra-arterial chemotherapy (IAC) for retinoblastoma (RB). This study evaluated the incidence and potential risk factors of this rare event. Methods: A retrospective cohort study included RB patients who received IAC at a tertiary cancer center. Diagnosis of CVAs was based on clinical and/or neuroimaging findings. Data included demographics, tumor features, complications, and outcomes. Meta-analysis was not feasible due to heterogeneity. A systematic review following PRISMA guidelines was conducted across major databases up to December 2025, including studies reporting CVA after IAC. Results: The cohort included 33 children who underwent 104 IAC procedures (Melphalan). CVA occurred in three patients (3/33 (9%) of patients, and 3/104 (2.9%) of procedures). Two were confirmed by neuroimaging, while one was a transient ischemic attack. Two patients (67%) were girls, and 2 of 3 (67%) were younger than 1 year. All events occurred during the IAC procedure and were ipsilateral to the treated eye. Two patients had no residual neurological deficits, while one showed improvement with only a minor residual deficit. The systematic review included 14 studies with 932 patients and identified 11 CVA events (1.2%; Range 0–9.1% per patient and 0–2.2% per IAC procedure). All were ischemic with variable presentations. Younger age, repeated catheterization, vasospasm, and embolic events were common risk factors. Outcomes were generally favorable. Conclusions: CVA after IAC, though rare, may be underreported. Events are likely procedure-related and influenced by age, treatment intensity, and vascular toxicity. Careful technique, close monitoring, and standardized reporting are needed to recognize/reduce the real risk. Full article

Background and Clinical Significance: Left ventricular free-wall rupture (LVFWR) is a rare but devastating mechanical complication of acute myocardial infarction (AMI), with reported in-hospital mortality approaching 90% without surgical intervention. Although its incidence has declined in the contemporary primary percutaneous coronary intervention (PCI) era, LVFWR remains an important cause of early post-infarction death, particularly after delayed reperfusion or fibrinolytic therapy. Subacute or contained “oozing” ruptures pose a unique diagnostic challenge because hemodynamic stability and nonspecific symptoms can mask the underlying catastrophe, and standard transthoracic echocardiography may fail to visualize a sealed defect. Contrast-enhanced cardiac computed tomography (CT) has emerged as a valuable adjunct in this setting, enabling early recognition and surgical planning. Case Presentation: We report a case of a 51-year-old male, a heavy smoker, with acute lateral ST-segment elevation myocardial infarction (STEMI) treated with thrombolysis at a referring hospital, followed by percutaneous coronary intervention (PCI) to the obtuse marginal branch. Despite reperfusion, he developed persistent pleuritic chest pain and a small pericardial effusion. Cardiac computed tomography (CT) demonstrated a contained (sealed) lateral-wall oozing-type left ventricular free-wall rupture (LVFWR) with thrombus sealing the defect. A multidisciplinary heart team initially opted for diligent observation with frequent echocardiography. Within the first 24 h, the pericardial effusion increased, and echocardiography showed circumferential effusion with lateral wall thickening and hematoma, prompting emergent sternotomy. Intraoperatively, a large posterolateral infarct with an oozing-type LV free-wall rupture was identified. Surgical repair was performed using interrupted pledgeted sutures, native pericardial patch, BioGlue, and an overlying Teflon patch, with intra-aortic balloon pump (IABP) support. This case demonstrates the complementary diagnostic value of multimodality imaging—echocardiography for serial monitoring of the pericardial effusion and regional wall changes, and cardiac CT for direct characterization of the contained (sealed) defect—and the timely transition from conservative to surgical management in oozing-type rupture. The patient recovered uneventfully and was discharged in stable condition. Conclusions: This case highlights the diagnostic value of multimodality imaging—particularly cardiac CT—in detecting contained (sealed) LVFWR when echocardiography is inconclusive. Early recognition and prompt surgical intervention enabled a successful outcome in this otherwise frequently fatal complication. Full article

Background: Unhealthy alcohol use may lead to arrhythmia and cardiomyopathy, but its impact on sudden death is not well understood. Objective: To investigate the association of unhealthy alcohol use with sudden death. Methods: We conducted a case-control study in Wake County, a large (~1 million inhabitants), diverse county in North Carolina. We screened and adjudicated victims of sudden, unexpected, out-of-hospital deaths in adults aged 18–64 years reported by emergency medical services between 2013 and 2015. We randomly selected sex- and age-matched control patients from a university health system from the same county and time period. Characteristics of sudden death victims and controls were ascertained via standardized chart reviews. Unhealthy alcohol use was identified via chart review and was defined as any evidence of excessive alcohol use, such as it being stated in the social history or medical history, alcohol abuse being listed as a possible contributor to death, or alcohol-related diagnoses. We used logistic regression to estimate odds ratios (ORs) for the association of unhealthy alcohol use and sudden death, adjusting for age, sex, race, and other psychiatric diagnoses, including depression, anxiety, schizophrenia, bipolar disorder, and substance use disorders other than tobacco and alcohol. We also calculated the E-value to estimate the impact of any unmeasured confounders. Results: We identified 399 sudden death victims, of whom 374 (94%) had alcohol use data available. Among these 374 included victims, 256 (68%) were male, and 239 (62%) were White, with a median age at death of 55 years (IQR 48, 60). The demographic characteristics of the 1114 matched controls were similar to those of sudden death victims. Unhealthy alcohol use was present in 115 (31%) sudden death victims and 27 (2%) controls. In analyses adjusted for demographics only, unhealthy alcohol use was associated with a higher incidence of sudden death, with an OR of 17.5 (95% CI 11.4, 27.8). When further adjusted for other psychiatric diagnoses, the OR was 11.2 (95% CI 7.1, 18.0). The calculated E-value was 21.8, meaning an unmeasured confounder would need to be associated with both unhealthy alcohol use and sudden death by 21.8-fold to explain away the observed OR. Conclusions: Unhealthy alcohol use was strongly associated with higher sudden death risk in working-age adults. Our calculated E-value indicates it is unlikely that any unmeasured confounders alone would account for the observed association. Our findings suggest that interventions to reduce unhealthy alcohol use may be an effective strategy to prevent sudden death in working-age adults. Full article

Background: Anaplasmosis is an emerging tick-borne infection that typically presents as a non-specific febrile illness, with variable degrees of cytopenias and liver tests abnormalities. Severe complications remain atypical and uncommon. Case Report: We report a case of acute pulmonary embolism (PE) occurring during confirmed anaplasmosis in a 73-year-old male with no traditional thromboembolic risk factors. The patient presented with fever, constitutional symptoms, thrombocytopenia, leukopenia, and abnormal liver tests, raising suspicion for a tick-borne illness. Despite early clinical improvement on doxycycline, persistent tachycardia triggered further evaluation and uncovered an acute PE. Comprehensive workup at admission and repeated 14 months later excluded inherited and acquired thrombophilias, malignancies, autoimmune diseases, and alternative infectious etiologies. The patient was treated with doxycycline 100 mg orally twice daily for 10 days and anticoagulation with unfractionated heparin followed by 6 months of apixaban for a first episode of provoked PE. He attained complete clinical recovery without recurrence of thrombosis at the two-year follow-up. Discussion: Infectious diseases are increasingly recognized as contributors to thrombosis through inflammation-mediated hypercoagulability and endothelial dysfunction. Pulmonary involvement in anaplasmosis typically manifests as pneumonitis, pneumonia or acute respiratory distress syndrome, but thrombotic complications such as PE are exceedingly rare. This case highlights a rare but clinically significant vascular complication of anaplasmosis and underscores the importance of considering thromboembolic events in patients with persistent or unexplained tachycardia. Conclusions: As the incidence of anaplasmosis continues to rise, greater awareness of its potential cardiovascular manifestations is essential. Early recognition and prompt treatment with doxycycline remain critical, while further studies are needed to better define the thrombotic risk associated with this infection. Full article

Background: Creating antibiograms solely for adults may overestimate resistance of antimicrobials for certain pathogens in children. The Canadian Paediatric Society comments that areas with no cephalosporin-resistant Streptococcus pneumoniae cases should consider ceftriaxone or cefotaxime monotherapy for meningitis, despite most experts recommending adding vancomycin. The present study created age-specific antibiograms using LifeLabs data to report incidences of resistant bacterial meningitis pathogens at the regional level to determine the need for duo-coverage. Methods: Data of common bacterial meningitis pathogen susceptibility was collected from 1 January 2023 to 31 December 2024, in the LifeLabs community laboratory on Vancouver Island. Results: Most Streptococcus pneumoniae isolates (78/83) were susceptible to ceftriaxone using the meningitis breakpoint; the remaining five isolates showed intermediate susceptibility to ceftriaxone. There was a significant difference when comparing S. pneumoniae susceptibility using penicillin-meningitis and penicillin-non-meningitis breakpoints (82% vs. 99%, respectively; p < 0.05). There was a significant difference between the three age groups (<18 years, 18–50 years, >50 years) when analyzing ciprofloxacin susceptibility of isolates [82% (n = 462), 77% (n = 2452), 75% (n = 8352), respectively, p < 0.05]. Conclusions: Ceftriaxone should remain the drug of choice for community-acquired bacterial meningitis and might be sufficient as a monotherapy for pneumococcal meningitis on Vancouver Island. The age-specific differences in E. coli susceptibilities to ciprofloxacin showed the importance of age-specific antibiograms. Full article