Search Results (1,047)

Tuberculosis (TB) is an ancient and re-emerging granulomatous infectious disease that continues to challenge public health. Early diagnosis and prompt effective treatment are crucial for preventing disease progression and reducing both morbidity and mortality. These steps play a vital role in infection control and in lowering death rates at both individual and population levels. Although diagnostic methods have improved sufficiently in recent decades, TB can still present with ambiguous laboratory and imaging features. This ambiguity can lead to diagnostic pitfalls and potentially disastrous outcomes due to delayed diagnosis. In this article, we present a case of TB that was difficult to diagnose. The disease had invaded the mediastinum, right atrium, right coronary artery, and inferior vena cava (IVC), resulting in Budd–Chiari syndrome. This rare presentation created clinical, laboratory, and radiological confusion, resulting in a diagnostic dilemma that ultimately led to open cardiac surgery. The patient initially presented with progressive shortness of breath on exertion and fatigue, which suggested possible heart disease. This suspicion was reinforced by computed tomography (CT) imaging, which showed infiltrative mass lesions predominantly in the right side of the heart, invading the right coronary artery and IVC, with imaging features mimicking angiosarcoma. Although laboratory findings revealed an exudative effusion with lymphocyte predominance and elevated adenosine deaminase (ADA), the Gram stain was negative for bacteria, and an acid-fast bacilli (AFB) smear was also negative. These findings contributed to diagnostic uncertainty and delayed the confirmation of TB. Open surgery with excisional biopsy and histopathological analysis ultimately confirmed TB. We conclude that TB should not be ruled out solely based on negative Mycobacterium bacteria in pericardial effusion or AFB smear. TB can mimic aggressive tumors such as angiosarcoma or lymphoma with invasion of the surrounding tissues and blood vessels. Awareness of the clinical presentation, imaging findings, and potential diagnostic pitfalls of TB is essential, especially in endemic regions. Full article

Small rodents are known hosts of various pathogens, including Hepatozoon, but until now, in Brazil, only Hepatozoon milleri has been described in these animals. In this study, liver samples and blood smears were obtained from 289 rodents belonging to 14 Cricetidae and two Muridae species that had been captured in municipalities of the states of Paraná and Rio de Janeiro. Smears were stained with Giemsa, and gametocytes were detected via microscopy in 10.72% (n = 31/289) of samples, with these individuals representing three rodent species. Significant morphometric differences were observed in gametocyte measurements in Akodon rodents. Using conventional PCR, Hepatozoon spp. 18S rDNA fragments were amplified in 24.91% (n = 72/289) of samples, with those individuals representing seven rodent species. Phylogenetic analyses clustered 41 sequences from this study into a subclade with other sequences from small mammals in Brazil, identifying four distinct haplotypes, and, for the first time, a relationship between Hepatozoon haplotype and gametocyte length was observed. Based on phylogenetic analysis, this study reinforces the trophic relationship between rodents and reptiles as a possible link in the Hepatozoon transmission cycle in South America. Furthermore, our findings expand knowledge on Hepatozoon spp. hosts, describing Oxymycterus nasutus and Oxymycterus quaestor as new host species and identifying two novel circulating haplotypes in rodents from Paraná State, southern Brazil. Full article

Background/Objectives: Romania remains a tuberculosis (TB) hotspot in the European Union, yet host-derived factors of poor outcomes are poorly characterised. We quantified circulating pro-inflammatory cytokines and examined their interplay with behavioural risk factors, the nutritional status, and the clinical course in adults hospitalised with pulmonary TB. We analysed 80 adults with microbiologically confirmed pulmonary TB and 40 respiratory symptom controls; four TB patients (5%) died during hospitalisation, all within 10 days of admission. Methods: A retrospective analytical case–control study was conducted at the Constanța regional TB referral centre (October 2020—October 2023). Patients with smear- or culture-confirmed TB were frequency-matched by sex, 10-year age band, and BMI class to culture-negative respiratory controls at a 2:1 ratio. The patients’ serum interferon-γ (IFN-γ), interleukin-1α (IL-1α), interleukin-1β (IL-1β), and tumour-necrosis-factor-α (TNF-α) were quantified within 24 h of admission; the neutrophil/lymphocyte ratio (NLR) was extracted from full blood counts. Independent predictors of in-hospital mortality were identified by multivariable logistic regression; factors associated with the length of stay (LOS) were modelled with quasi-Poisson regression. Results: The median TNF-α (24.1 pg mL⁻¹ vs. 16.2 pg mL⁻¹; p = 0.009) and IL-1β (5.34 pg mL⁻¹ vs. 3.67 pg mL⁻¹; p = 0.008) were significantly higher in the TB cases than in controls. TNF-α was strongly correlated with IL-1β (ρ = 0.80; p < 0.001), while NLR showed weak concordance with multiplex cytokine patterns. Among the patients with TB, four early deaths (5%) exhibited a tripling of TNF-α (71.4 pg mL⁻¹) and a doubling of NLR (7.8) compared with the survivors. Each 10 pg mL⁻¹ rise in TNF-α independently increased the odds of in-hospital death by 1.8-fold (95% CI 1.1–3.0; p = 0.02). The LOS (median 29 days) was unrelated to the smoking, alcohol, or comorbidity load, but varied across BMI strata: underweight, 27 days; normal weight, 30 days; overweight, 23 days (Kruskal–Wallis p = 0.03). In a multivariable analysis, under-nutrition (BMI < 18.5 kg m⁻²) prolonged the LOS by 19% (IRR 1.19; 95% CI 1.05–1.34; p = 0.004) independently of the disease severity. Conclusions: A hyper-TNF-α/IL-1β systemic signature correlates with early mortality in Romanian pulmonary TB, while under-nutrition is the dominant modifiable determinant of prolonged hospitalisation. Admission algorithms that pair rapid TNF-α testing with systematic nutritional assessment could enable targeted host-directed therapy trials and optimise bed utilisation in high-burden settings. Full article

Plasmodium falciparum malaria remains a major cause of morbidity and mortality, particularly in endemic regions. We report the case of a 21-year-old male with recent travel to an endemic area (Guapi, Colombia), who presented with febrile symptoms, severe respiratory distress, and oxygen saturation below 75%, necessitating orotracheal intubation. During the procedure, he developed pulseless electrical activity cardiac arrest, achieving return of spontaneous circulation after advanced resuscitation. Diagnosis was confirmed by thick blood smear, demonstrating P. falciparum infection. The patient progressed to multiorgan failure, including acute respiratory distress syndrome with capillary leak pulmonary edema, refractory distributive shock, acute kidney injury with severe hyperkalemia, and consumptive thrombocytopenia. Management included invasive mechanical ventilation, vasopressor support, sedation-analgesia, neuromuscular blockade, methylene blue, unsuccessful hemodialysis due to hemorrhagic complications, and platelet transfusions. Despite these interventions, the patient experienced a second cardiac arrest and died. This case highlights the severity and rapid progression of severe malaria with multisystem involvement, underscoring the critical importance of early diagnosis and intensive multidisciplinary management. It also emphasizes the need for preventive strategies for travelers to endemic areas and the development of clinical protocols to improve outcomes in complicated malaria. Full article

Soil-transmitted helminths (STHs) present a significant global health challenge, particularly in tropical and subtropical regions. The current diagnostic standard involves the microscopic examination of a stool smear but it lacks sensitivity to detect infections of low intensity. Innovative solutions like lab-on-a-disk (LoD) technologies are emerging, showing promise in detecting low-intensity infections. Field tests conducted using our SIMPAQ (single-image parasite quantification) LoD device have demonstrated its potential as a diagnostic tool, especially for such low-intensity infections. Nevertheless, the device’s efficiency has been limited by significant egg loss during sample preparation, low capture efficiency of eggs within the Field of View (FOV), and the presence of larger fecal debris that obstructs effective egg trapping and imaging. In this study, we conducted a set of laboratory experiments using model polystyrene particles and purified STH eggs to improve the sample preparation protocol. These experiments include the entire SIMPAQ procedure starting from sample preparation, infusing it into the LoD device, centrifugation, delivering the (model) eggs to the FOV, capturing an image, and analyzing it. We analyzed egg losses at each step of the procedure following the “standard” protocol, then elaborated and tested alternative, more efficient procedures. The resulting modified protocol significantly minimized particle and egg loss and reduced the amount of debris in the disk, thus enabling effective egg capture and clear images in the FOV, increasing the reliability of the diagnostic results. Full article

This paper presents a novel cochlear implant (CI) sound coding strategy called Spectral Feature Extraction (SFE). The SFE is a novel Fast Fourier Transform (FFT)-based Continuous Interleaved Sampling (CIS) strategy that provides less-smeared spectral cues to CI patients compared to Crystalis, a predecessor strategy used in Oticon Medical devices. The study also explores how the SFE can be enhanced into a Temporal Fine Structure (TFS)-based strategy named Spectral Event Extraction (SEE), combining spectral sharpness with temporal cues. Background/Objectives: Many CI recipients understand speech in quiet settings but struggle with music and complex environments, increasing cognitive effort. De-smearing the power spectrum and extracting spectral peak features can reduce this load. The SFE targets feature extraction from spectral peaks, while the SEE enhances TFS-based coding by tracking these features across frames. Methods: The SFE strategy extracts spectral peaks and models them with synthetic pure tone spectra characterized by instantaneous frequency, phase, energy, and peak resemblance. This deblurs input peaks by estimating their center frequency. In SEE, synthetic peaks are tracked across frames to yield reliable temporal cues (e.g., zero-crossings) aligned with stimulation pulses. Strategy characteristics are analyzed using electrodograms. Results: A flexible Frequency Allocation Map (FAM) can be applied to both SFE and SEE strategies without being limited by FFT bandwidth constraints. Electrodograms of Crystalis and SFE strategies showed that SFE reduces spectral blurring and provides detailed temporal information of harmonics in speech and music. Conclusions: SFE and SEE are expected to enhance speech understanding, lower listening effort, and improve temporal feature coding. These strategies could benefit CI users, especially in challenging acoustic environments. Full article

Tuberculosis (TB) is a global public health issue requiring early and accurate diagnosis. The loop-mediated isothermal amplification (LAMP) assay is a promising alternative recommended by the WHO for the initial diagnosis of pulmonary TB, particularly in resource-limited settings. This study evaluated the sensitivity and specificity of a commercial LAMP assay for TB detection using 198 samples from different countries including Mexico. The LAMP assay results were compared to the results of standard tests: AFB smear microscopy, cell culture, and Xpert PCR. Across all samples, LAMP showed a sensitivity of 96.20% and a specificity of 84.61%. When compared specifically to “true positives” and “true negatives” (defined by the consistency across the standard tests), LAMP demonstrated 100% sensitivity and 92.30% specificity. For context, the sensitivity of AFB smear microscopy against the culture and Xpert tests was 79.04%. A significant finding was that the LAMP test detected a high percentage (92.5%) of samples found positive by the culture and Xpert tests but negative by the AFB smear, highlighting its ability to identify cases missed by traditional microscopy. This study concluded that the LAMP assay is a sensitive and specific tool for TB diagnosis with potential for rapid and accurate diagnosis, especially in resource-limited areas. Full article

Background: The number of women veterans has been rising steadily since the Gulf War and many assume the functions of their male counterparts. Women face unique obstacles in their service, and it is imperative that differences in physiology not be overlooked so as to provide better and appropriate care to our women in uniform. Despite this influx and incorporation of female talent, dedicated reports contrasting female and male veterans are rare, outside of specific psychological studies. We therefore attempt to contrast gut constituents, absorption, innate immune system, and nutritional differences to provide a comprehensive account of similarities and differences between female and male veterans, from our single-center perspective, as this has not been carried out previously. Herein, we obtained a detailed roster of commonly used biomedical tests and some novel entities to detect differences between female and male veterans. The objective of this study was to detect differences in the innate immune system and other ancillary test results to seek differences that may impact the health of female and male veterans differently. Methods: To contrast biochemical and sociomedical parameters in female and male veterans, we studied the data collected on 450 female veterans and contrasted them to a group of approximately 1642 males, sequentially from 1995 to 2022, all selected because of above-average risk for CRC. As part of this colorectal cancer (CRC) screening cross-sectional and longitudinal study, we also collected stool, urine, saliva, and serum specimens. We used ELISA testing to detect stool p87 shedding by the Adnab-9 monoclonal and urinary organ-specific antigen using the BAC18.1 monoclonal. We used the FERAD ratio (blood ferritin/fecal p87), a measure of the innate immune system to gauge the activity of the innate immune system (InImS) by dividing the denominator p87 (10% N-linked glycoprotein detected by ELISA) into the ferritin level (the enumerator, a common lab test to assess anemia). FERAD ratios have not been performed elsewhere despite past Adnab-9 commercial availability so we have had to auto-cite our published data where appropriate. Results: Many differences between female and males were detected. The most impressive differences were those of the InImS where males clearly had the higher numbers (54,957 ± 120,095) in contrast to a much lower level in females (28,621 ± 66,869), which was highly significantly different (p < 0.004). Mortality was higher in males than females (49.4% vs. 24.1%; OR 3.08 [2.40–3.94]; p < 0.0001). Stool p87, which is secreted by Paneth cells and may have a protective function, was lower in males (0.044 ± 0.083) but higher in females (0.063 ± 0.116; p < 0.031). Immunohistochemistry of the Paneth cell-fixed p87 antigen was also higher in females (in the descending colon and rectum). In contrast, male ferritin levels were significantly higher (206.3 ± 255.9 vs. 141.1 ± 211.00 ng/mL; p < 0.0006). Females were less likely to be diabetic (29.4 vs. 37.3%; OR 0.7 [0.55–0.90]; p < 0.006). Females were also more likely to use NSAIDs (14.7 vs. 10.7%, OR 1.08 [1.08–2.00]; p < 0.015). Females also had borderline less GI bleeding by fecal immune tests (FITs), with 13.2% as opposed to 18.2% in males (OR 0.68 [0.46–1.01]; p = 0.057), but were less inclined to have available flexible sigmoidoscopy (OR 0.68 [0.53–0.89]; p < 0.004). Females also had more GI symptomatology, a higher rate of smoking, and were significantly younger than their male counterparts. Conclusions: This study shows significant differences with multiple parameters in female and male veterans. Full article

Anemia due to acquired copper deficiency is most commonly the result of malabsorption or dietary deficiency. However, it can occasionally be due to excess zinc intake, which impairs the absorption of copper. Copper deficiency may result in vacuolated erythroid and myeloid precursors in the bone marrow, and sometimes features resembling myelodysplasia that, although not specific, may be an important clue to the diagnosis. Background and Clinical Significance: We report bone marrow findings in a child with anemia due to zinc-induced copper deficiency. Case Presentation: An 18-year-old female with cerebral palsy admitted for respiratory failure was found to have anemia and leukopenia with absolute neutropenia. A bone marrow smear showed occasional ring sideroblasts. Additional testing revealed reduced serum copper and elevated serum zinc. Further inquiry uncovered a several-year history of high-dose zinc supplementation. Conclusions: It is important to consider copper deficiency as a potential etiology in patients with anemia and neutropenia, as it may otherwise be mistaken for vitamin B12 deficiency or myelodysplasia. The presence of small vacuoles in hematopoietic precursors is an important clue to the diagnosis and may help avoid ineffective interventions. Full article

Malaria remains a major public health issue, especially near hydroelectric dams that often promote mosquito breeding. This study aimed to establish baseline epidemiological data during the construction of the Singrobo–Ahouaty dam to support assessment and decision-making for short- and long-term health impacts on surrounding communities. A cross-sectional survey was carried out in randomly selected households. Blood samples were analyzed using thick/thin smears and rapid diagnostic tests, while sociodemographic and behavioral data were collected via questionnaires. Statistical analyses included chi-square, Mann–Whitney, Kruskal–Wallis tests, and logistic regression. The malaria prevalence was 43.1% (394/915). The parasite density averaged 405.7 parasites/µL. School-age children (6–13 years) showed the highest prevalence (74.3%, p < 0.0001), while younger children (0–5 years) had the highest parasite density (1218.0 parasites/µL, p < 0.0001). Highly elevated infection rates (>51%) occurred in Sokrogbo, N’Dènou, and Amani-Menou, with the highest density in Ahérémou 1 (5663.9 parasites/µL). Risk factors included being an informal worker (ORa = 1.5), working in the raw material sector (ORa = 1.4) or market gardening/rice farming (ORa = 0.9; p = 0.043), and frequent mosquito bites (OR = 0.4; p = 0.017). These results underscore the need for stronger vector control strategies, improved bed net distribution and follow-up, and enhanced intersectoral collaboration in dam-influenced areas to reduce malaria transmission. Full article

Objectives: Persistent Human Papillomavirus (HPV) infection in the cervix and the preinvasive lesions it causes are significant risk factors for cervical cancer. Therefore, a treatment strategy is necessary to facilitate the clearance of HPV and prevent the progression of preinvasive lesions without causing cervical tissue destruction. This study aimed to evaluate the effectiveness of a vaginal adsorbent gel composed of a hydroxyethyl cellulose matrix formulation containing dispersed silicon dioxide, antioxidant sodium selenite, deflamin, and citric acid in patients with HPV infection. Methods: The study was designed as a retrospective cohort study and involved 449 women infected with HPV. For the purposes of the study, the patients were divided into two groups: the treatment group (TG) comprised 207 patients who used the vaginal gel daily for a period of three months, while the control group (CG), consisting of 242 patients, received no treatment under an “active surveillance” protocol. The study’s endpoints encompassed the domains of cytology, histology, and HPV clearance. Results: The regression rate of smear pathologies was 24.8% in the control group and 29.0% in the group using the vaginal adsorbent gel. In the first year, the histological regression rate in cervical biopsies was 49.3% in the treatment group and 19.4% in the control group, with a significant difference between groups (p < 0.001). Moreover, the clearance rate of HPV types was found to be significantly higher in the group using the vaginal adsorbent gel. Conclusions: The findings of this study suggest that the outpatient treatment approach can effectively prevent the oncogenic progression of cervical dysplasia. This alternative method has been shown to be efficacious in preventing the progression of cervical dysplasia and promoting regression. Furthermore, the efficacy of this gel in eradicating HPV has been demonstrated within a 12-month period. Full article

Equine piroplasmosis (EP), caused by Theileria equi and Babesia caballi, is a worldwide tick-borne disease with severe economic, commercial, and sanitary implications for equids. Although diagnosis is based on direct (blood smear or PCR) or indirect (serology) methods, these techniques are expensive, laborious, and false-negative and false-positive results can be yielded. Biochemistry blood profiles are routinely performed in horses. Biochemical parameters and ratios could be a reliable complementary diagnostic tool to assist clinicians in EP diagnosis, mainly in endemic areas, or for discarding similar disorders (piro-like diseases) and prioritizing specific diagnostic testing. This study describes the changes induced by EP infection in blood biochemical parameters and common and novel biochemical ratios in horses. EP-infected horses showed increased serum total and indirect bilirubin, triglycerides, and GLDH concentrations and decreased sodium concentrations compared to non-infected animals. These findings could be linked to hemolysis, diminution of athletic performance, and liver inflammation due to oxidative stress damage. While molecular methods remain the gold standard for EP diagnosis, a complete biochemical profile and ratios could provide valuable complementary information to enhance the diagnostic accuracy of piroplasmosis in horses. Full article

Objectives: The present study aimed to determine the reference intervals for complete blood count and total protein parameters in Greek indigenous Capra prisca goats and to evaluate their associations with parasitic burden, age and reproductive stage. Methods: Two-hundred clinically health goats were grouped by parasite status (gastrointestinal nematodes, Eimeria spp., and lungworm infection), age (3–6-month-old growing kids; lactating non-pregnant goats ≤ 3 or >3 years old) and reproductive stage (non-lactating pregnant goats; lactating non-pregnant goats). Blood samples were analyzed for erythrogram, leukogram and megakaryocytic parameters using an automated analyzer and manual blood smears. Total plasma proteins were measured using refractometry. Results: Gastrointestinal nematode-infected animals (>300 eggs per gram of feces) were associated with a significant reduction in red blood cell counts and hematocrit estimation, and an increase in mean corpuscular hemoglobin and mean corpuscular hemoglobin concentrations, while lungworm-infected animals were associated with decreased red blood cells, red cell distribution width and neutrophils, and increased lymphocytes compared to non-infected animals. Eimeria spp. affected only basophils in growing kids. Age influenced all erythrocytic and leukocytic parameters (apart from neutrophils and monocytes), as well as all megakaryocytic parameters and total proteins, with younger animals showing higher red and white blood cell counts and platelets compared to adults. Pregnant does had elevated hemoglobin, hematocrit, neutrophils and monocytes compared with lactating non-pregnant does. Conclusions: The calculated 95% reference intervals for our demographic groups of animals provide a useful diagnostic framework for assessing Capra prisca health in Greek goat farming. Full article

Surgical Site Infection (SSI) can be a devastating complication, leading to increased morbidity, mortality, and healthcare costs. Pre-surgical hand preparation is an effective strategy to prevent SSI. The two most common pre-surgical hand preparation methods are antimicrobial soap for surgical hand scrub and alcohol-based surgical hand rub. The antimicrobial soap hand scrub remains more commonly used among operating theater staff. However, several studies showed that alcohol-based hand rubs are much more effective than antiseptic soap hand scrubs. Objective: This study aimed to compare the effect of the two methods of surgical hand preparation on the number of bacterial colonies. Methods: The design of this study was a comparative study with a pre-test and post-test approach in two groups (a surgical hand scrub using 4% chlorhexidine soap group and a surgical hand rub using 70% ethyl alcohol and 2.5% chlorhexidine group). Hand smear sampling was performed before surgical hand preparation (pre-test), immediately after surgical hand preparation (post-test 1), and after the surgery was completed (post-test 2). Seventy-one hand smear samples (35 samples applied the surgical hand rub, and 36 samples applied the surgical hand scrub) were divided into two groups and examined for colony counts in Colony Forming Units (CFU) using the total plate count method. Descriptive and comparative analysis were applied. Results: The surgical hand-scrub group had average pre-test, post-test 1, and post-test 2 colony counts of 0.202 CFU/cm², 0.007 CFU/cm², and 0.016 CFU/cm², respectively, while the surgical hand-rub group had average pre-test, post-test 1, and post-test 2 colony counts of 0.163 CFU/cm², 0.001 CFU/cm², and 0.001 CFU/cm² respectively. Statistical analysis using the Friedman test showed that both methods significantly reduced the number of colonies (p < 0.01). Based on the Mann–Whitney test, there was no significant difference between the two groups regarding the number of colonies (p > 0.05). Conclusions: Surgical hand-scrub and hand-rub have similar effectiveness in reducing and maintaining the number of colonies on hands during surgery, both gram-positive and gram-negative bacteria. Full article

Background/Objectives: Tuberculosis (TB) and HIV co-infection pose significant challenges in resource-limited settings, contributing to multi-drug-resistant TB when treatment fails. This study aimed to identify determinants of TB treatment outcomes among HIV/TB co-infected patients in Lusaka, Zambia. Methods: A retrospective cohort study was conducted at Chilenje, Chipata, and Chawama level one hospitals, using systematic sampling to select 586 patient files. Data were analyzed with SPSS version 23, employing descriptive statistics, chi-square tests, and hierarchical logistic regression. Results: Among the study population (n = 586), consisting predominantly of working-age adults (25–44 years: 61.6%) and males (56.5%), treatment success was 81.3%, with a 12.5% mortality rate across treatment phases. Baseline smear-negative TB, viral load (100,000–199,999 copies/mL), diabetes without hypertension, and negative smear at follow-up independently predicted treatment outcomes. Higher treatment failure odds were linked to smear-negative TB, high viral load, and hypertension–diabetes comorbidity, while CD4 count and HIV treatment status showed no independent effects. Conclusions: These findings underscore the influence of viral load, TB type, comorbidities, and sputum conversion on treatment success, emphasizing the need for targeted monitoring and integrated care, particularly in the continuation phase, to enhance outcomes in this vulnerable population. Full article