Search Results (966)

The soil-borne fungi, Setophoma terrestris and Fusarium spp., are often associated with pink root, although the etiology of the disease remains doubtful. While recognized as the primary inoculum, studies show conflicting views on the formation of chlamydospores and microsclerotia in Setophoma. Therefore, this study aims to clarify the etiology of the pink root of garlic and onion and the formation of chlamydospores and microsclerotia in Setophoma. The isolates were obtained from symptomatic tissues of garlic, leeks, brachiaria, onions, chives, and maize collected from seven different states in Brazil. Representative isolates were selected for pathogenicity tests. Sequence comparison of the tubulin gene showed Setophoma (n = 50) and Fusarium clades (n = 25). Garlic and onion plants inoculated with Setophoma showed pink root symptoms, while plants inoculated with different Fusarium isolates remained asymptomatic. Multigene analysis of pathogenic isolates confirms that only Setophoma terrestris causes pink root in garlic and onion. In addition, brachiaria, chives, and leeks are newly identified hosts of this pathogen in Brazil. To our knowledge, the main sources of primary inoculum of the disease are chlamydospores, pycnidia, colonized roots of garlic, onion, and plant debris of susceptible crops. The new information obtained in this study will be fundamental for researchers in the development of genotypes that are resistant to pink root and will help the efficient management of the disease. Full article

Background: Midportion Achilles tendinopathy (Mid-AT) is a complex condition that may be exacerbated by anatomical variations of the plantaris tendon. Recent anatomical studies, particularly the classification proposed by Olewnik et al., have enhanced the understanding of plantaris–Achilles interactions and their clinical implications. Objective: This review aims to assess the anatomical types of the plantaris tendon, their imaging correlates, and the impact of the Olewnik classification on diagnosis, treatment planning, and surgical outcomes in patients with Mid-AT. Methods: We present an evidence-based analysis of the six anatomical types of the plantaris tendon and their relevance to Achilles tendinopathy, with emphasis on MRI and ultrasound (USG) evaluation. A diagnostic and therapeutic algorithm is proposed, and clinical outcomes of both conservative and operative management are compared across tendon types. Results: Types I and V were most strongly associated with symptomatic conflict and showed the highest benefit from surgical resection. Endoscopic approaches were effective in Types II and III, while Type IV typically responded to conservative treatment. Type VI, often misdiagnosed as tarsal tunnel syndrome, required combined neurolysis. The classification significantly improves surgical decision-making, reduces overtreatment, and enhances diagnostic precision. Conclusions: The Olewnik classification provides a reproducible, clinically relevant framework for individualized management of Mid-AT. Its integration into imaging protocols and treatment algorithms may improve therapeutic outcomes and guide future research in orthopaedic tendon pathology. Full article

Introduction: The optimal management of hallux sesamoid fracture nonunions remains a subject of ongoing debate, particularly in the context of personalized medicine. This systematic review aimed to synthesize current evidence regarding surgical strategies for this rare but disabling condition. Methods: A comprehensive literature search was conducted in accordance with the PRISMA guidelines. Results: Six studies met the inclusion criteria, encompassing a total of 80 patients. Surgical techniques varied and included open and arthroscopic sesamoidectomy, autologous bone grafting (alone or combined with screw fixation), and percutaneous screw fixation. When reported, outcomes were generally favorable, with union rates ranging from 90.5% to 100% and with consistent postoperative improvements in clinical function. Complication and reoperation rates were both 6.5%. The most frequent reoperation was sesamoidectomy for persistent pain or nonunion, followed by hardware removal. Conclusions: Despite the limited and low-quality evidence, available data suggest that individualized surgical planning can lead to favorable outcomes with low complication rates. Sesamoidectomy remains the most reliable salvage procedure in refractory cases. These findings support a personalized, stepwise approach to treatment—prioritizing sesamoid preservation, when feasible, while reserving excision for symptomatic nonunions. Further studies are needed to validate tailored algorithms and refine patient-specific decision-making in this challenging clinical scenario. Full article

Background and Clinical Significance: Sarcina ventriculi is a rare Gram-positive coccus that thrives in acidic environments such as the human stomach. It has been increasingly identified in individuals with delayed gastric emptying and has been reported in association with various gastric disorders. However, its exact pathogenic role is not fully understood and remains controversial. Case Presentation: We present two cases of patients, one with a small bowel obstruction and the other with epigastric pain, both diagnosed with Sarcina ventriculi infection by histological examination of gastric biopsies. The patients were managed with a combination of antibiotics and a proton pump inhibitor, resulting in symptom resolution and clearance of Sarcina ventriculi upon follow-up examinations. Conclusions: This report explores the pathogenicity of Sarcina ventriculi by documenting its presence in symptomatic patients without other identifiable pathogens and demonstrating complete symptom resolution following targeted therapy. These findings raise the possibility of Sarcina ventriculi’s pathogenic potential under specific clinical conditions, suggesting it may act as more than a benign colonizer. Full article

Background: Doppler-guided haemorrhoidal artery ligation with rectoanal repair (HAL-RAR) is a minimally invasive alternative to conventional haemorrhoidectomy. While associated with reduced postoperative pain and quicker recovery, data on its safety, recurrence rates, and applicability across haemorrhoid grades remain limited, particularly in Australian settings. Methods: A retrospective review was conducted on 128 consecutive patients who underwent elective HAL-RAR at a single institution between February 2022 and December 2024. Data on demographics, operative details, postoperative outcomes, and recurrence were collected. Outcomes were stratified by haemorrhoid grade. Multivariate logistic regression was used to identify predictors of recurrence, day-case completion, and conversion to excisional surgery. Results: The median age was 49 years, and 77.3% had Grade II or III haemorrhoids. HAL-RAR was completed as a day case in 76.6% of patients. Postoperative urinary retention occurred in 3.9%, return to theatre in 0.8%, and 30-day readmission in 7.0%. The symptomatic recurrence rate was 17.6%. Grade IV haemorrhoids were independently associated with increased recurrence (aOR 3.64, 95% CI 1.03–12.84), reduced likelihood of day-case management (aOR 0.14, 95% CI 0.03–0.93), and higher conversion to excisional haemorrhoidectomy (aOR 7.23, 95% CI 1.13–46.40). Conclusions: HAL-RAR is a safe, effective, and low-morbidity option for the management of Grade II and III haemorrhoids, suitable for day-case surgery. In selected Grade IV cases, it may offer benefit, although with higher recurrence and conversion risk. Careful patient selection is essential, and longer-term prospective studies are needed to assess durability. Full article

Palliative care aims to alleviate suffering and prioritize the quality of life of patients facing serious and fatal diseases, such as cancer. Cancer patients, especially in advanced stages, often have many difficult-to-control symptoms, such as pain, fatigue, dyspnea, anxiety, and depression, requiring the attention of a multidisciplinary team highly trained in palliative care and end-of-life management. Pain, dyspnea, nausea, and vomiting are the focus of symptomatic assessment in palliative care, but patients experience other equally important symptoms that do not receive as much attention and are often overlooked, which negatively impacts the quality of life of these patients. One of the main aims of palliative care is to provide patients with the best possible quality of life through adequate symptom control, teamwork, and psychosocial support based on the principles, values, and wishes of the patient and family. In this review, the authors summarize the management of common symptoms in patients in oncology and palliative care, as well as present a brief reflection on quality of life in this context. Full article

Background: Since the COVID-19 pandemic, managing acute infections in symptomatic individuals, regardless of vaccination status, has been widely debated and extensively studied. Even more concerning, however, is the impact of COVID-19 on pregnant women—especially its effects on fetuses and newborns. Several studies have documented complications in both expectant mothers and their infants following infection. Methods: In our previous works, we provided scientific evidence of the bacteriophage behavior of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2). This demonstrated that a well-defined combination of two antibiotics, amoxicillin and rifaximin, is associated with the same statistics for subjects affected by severe cases of SARS-CoV-2, regardless of vaccination status. We considered the few cases in the literature regarding the management of pregnancies infected with SARS-CoV-2, as well as previous data published in our works. In this brief case series, we present two pregnancies from the same unvaccinated mother—one prior to the COVID-19 pandemic and the other during the spread of the Omicron variant—as well as one pregnancy from a mother vaccinated against COVID-19. We describe the management of acute maternal infection using a previously published protocol that addresses the bacteriophage and toxicological mechanisms associated with SARS-CoV-2. Results: The three pregnancies are compared based on fetal growth and ultrasound findings. This report highlights that, even in unvaccinated mothers, timely and well-guided management of symptomatic COVID-19 can result in positive outcomes. In all cases, intrauterine growth remained within excellent percentiles, and the births resulted in optimal APGAR scores. Conclusions: This demonstrates that a careful and strategic approach, guided by ultrasound controls, can support healthy pregnancies during SARS-CoV-2 infection, regardless of vaccination status. Full article

Conventional ground reaction force (GRF) and load rate (LR) analyses may overlook temporal and waveform characteristics that reflect injury status and acuity. This study used an alternative GRF processing methodology to characterize GRF waveforms among runners with symptomatic medial tibial stress fractures (MTSS) and those recovering from tibial stress fractures (TSF; both unilateral [UL] and bilateral [BL]). This cross-sectional analysis of runners (n = 66) included four groups: symptomatic MTSS, recovering from UL or BL TSF, or uninjured case-matched controls. Participants ran at self-selected speed on an instrumented treadmill. Kinematics were collected with a 3D optical motion analysis system. Double-Gaussian models described the biphasic loading pattern of running gait (initial impact, active phases). Gaussian parameters described relative differences in the GRF waveform by injury condition. LR was calculated using the central difference numerical derivative of the raw normalized net force data. During the impact phase (0–20% of stance), controls and BL TSF produced higher GRF amplitudes than UL TSF and MTSS (p < 0.05). BL TSF and controls had greater maximal positive LR and minimum LR than UL TSF and MTSS. Peak medial GRF was 18–43% higher in the BL TSF group than in MTSS and UL TSF (p < 0.05). Correlations existed between tibial pain severity and early stance net GRF (r = 0.512; p = 0.016) and between pain severity and the duration since diagnosis for LR values during the impact phase (r values = 0.389–0.522; all p < 0.05). Collectively, these data suggest that this waveform modeling approach can differentiate injury status and pain acuity in runners. Early stance GRF and LR may offer novel insight into the management of running-related injuries. Full article

Verticillium wilt is characterized by chlorosis in leaves and is a devastating disease in eggplant. Early diagnosis, prior to the manifestation of symptoms, enables targeted management of the disease. In this study, we aim to detect early leaf wilt in eggplant leaves caused by Verticillium dahliae by integrating multispectral imaging with machine learning and deep learning techniques. Multispectral and chlorophyll fluorescence images were collected from leaves of the inbred eggplant line 11-435, including data on image texture, spectral reflectance, and chlorophyll fluorescence. Subsequently, we established a multispectral data model, fusion information model, and multispectral image–information fusion model. The multispectral image–information fusion model, integrated with a two-dimensional convolutional neural network (2D-CNN), demonstrated optimal performance in classifying early-stage Verticillium wilt infection, achieving a test accuracy of 99.37%. Additionally, transfer learning enabled us to diagnose early leaf wilt in another eggplant variety, the inbred line 14-345, with an accuracy of 84.54 ± 1.82%. Compared to traditional methods that rely on visible symptom observation and typically require about 10 days to confirm infection, this study achieved early detection of Verticillium wilt as soon as the third day post-inoculation. These findings underscore the potential of the fusion model as a valuable tool for the early detection of pre-symptomatic states in infected plants, thereby offering theoretical support for in-field detection of eggplant health. Full article

Tree diseases affecting Camellia japonica have emerged as a significant threat to the health and longevity of this ornamental tree, particularly in countries where this tree species is widely distributed and cultivated. Among these, Pestalotiopsis spp. have been frequently reported and are considered one of the most impactful fungal pathogens, causing leaf blight or leaf spot, in multiple countries. Understanding the etiology and distribution of these diseases is essential for effective management and conservation of C. japonica populations. The traditional methods based on pathogen isolation and pure culture cultivation for diagnosis of tree diseases are labor intensive and time-consuming. In addition, the frequent coexistence of the major pathogens with other endophytes within a single C. japonica tree, coupled with inconsistent symptom expression and the occurrence of pathogens in asymptomatic hosts, further complicates disease diagnosis. These challenges highlight the urgent need to develop more rapid, accurate, and efficient diagnostic or monitoring tools to improve disease monitoring and management on trees, including C. japonica. To address these challenges, we applied a metagenomic approach to screen fungal communities within C. japonica trees. This method enabled comprehensive detection and characterization of fungal taxa present in symptomatic and asymptomatic tissues. By analyzing the correlation between fungal dominance and symptom expression, we identified key pathogenic taxa associated with disease manifestation. To validate the metagenomic approach, we employed a combined strategy integrating metagenomic screening and traditional fungal isolation to monitor foliar diseases in C. japonica. The correlation between dominant taxa and symptom expression was confirmed. Simultaneously, traditional isolation enabled the identification of a novel species, Pestalotiopsis, as the causal agent of leaf spot disease on C. japonica. In addition to confirming previously known pathogens, our study led to the discovery and preliminary characterization of a novel fungal taxon with pathogenic potential. Our findings provide critical insights into the fungal community of C. japonica and lay the groundwork for developing improved, rapid diagnostic tools for effective disease monitoring and management of tree diseases. Full article

Background: Recurrent apical pelvic organ prolapse (POP) presents significant management challenges, with limited evidence on optimal surgical approaches. This study evaluated the safety and long-term effectiveness of minimally invasive sacrospinous ligament (SSL) fixation using the EnPlace^® device for treating recurrent apical POP. Methods: A cohort analysis was performed on 82 consecutive patients (mean age 65.9 ± 8.6 years) with stage III or IV recurrent symptomatic apical POP. All patients underwent transvaginal SSL fixation using the EnPlace^® device between January 2021 and July 2023. Primary outcomes included anatomical cure rates, patient satisfaction, and complications. Long-term follow-up was conducted via a structured telephone survey in December 2024. Results: The mean interval between primary and recurrent repair was 3.2 ± 2.6 years. Most patients (64.6%) underwent surgery under regional anesthesia with a mean operative time of 24.1 ± 7.1 min and minimal blood loss (23.8 ± 6.5 mL). No intraoperative complications occurred, and 98.8% of patients were discharged the same day. Two early postoperative complications occurred, neither requiring surgical intervention. At six-month follow-up, significant improvements were observed in POP-Q measurements for apical prolapse, cystocele, and rectocele. Long-term follow-up (mean 31.6 ± 8.3 months) revealed that only 11 patients (13.4%) reported mild POP symptoms. Patient satisfaction scores averaged 90.8 ± 17.1, with only 8.5% reporting low satisfaction. Only two patients (2.4%) required additional intervention for recurrent apical POP. Conclusions: Minimally invasive SSL fixation using the EnPlace^® device demonstrates favorable safety and efficacy for recurrent apical POP, offering a viable alternative to more invasive procedures with high patient satisfaction and low recurrence rates. Full article

The cultivation of cowpea (Vigna unguiculata), a vital vegetable crop, faces significant threats from Fusarium spp.-induced root rot. In this study, three fungal pathogens (Fusarium falciforme HKFf, Fusarium incarnatum HKFi, and Fusarium oxysporum HKFo) were isolated from symptomatic cowpea plants, and we screened 90 rhizobacteria from healthy rhizospheres using six culture media. Among these pathogens, Priestia megaterium TSA-10E showed a notable suppression of F. oxysporum HKFo (63.21%), F. incarnatum HKFi (55.16%), and F. falciforme HKFf (50.93%). In addition, Bacillus cereus KB-6 inhibited the mycelial growth of F. incarnatum HKFi and F. oxysporum HKFo by 42.39% and 47.93%, respectively. Critically, cell-free filtrates from P. megaterium TSA-10E and B. cereus KB-6 cultures reduced conidial germination in F. oxysporum HKFo and F. incarnatum HKFi, highlighting their role in disrupting the early infection stages. In greenhouse trials, TSA-10E and KB-6 reduced disease severity by 48.7% and 40.4%, respectively, with treated plants maintaining healthy growth while untreated controls succumbed to wilting. Broad-spectrum assays revealed that B. subtilis TSA-6E and P. megaterium TSA-10E were potent antagonists against both economic and grain crop pathogens. These findings underscore the potential of rhizobacteria as sustainable biocontrol agents for managing root rot disease caused by Fusarium spp. in cowpea cultivation. Full article

Polycystic liver disease (PLD) is a rare genetic disorder characterized by the development of >10 fluid-filled cysts in the liver. While PLD can occur in isolation, it is most commonly associated with autosomal dominant polycystic kidney disease, adding complexity to its management. PLD is often asymptomatic but can lead to hepatomegaly, causing symptoms such as abdominal distension, pain and discomfort, early satiety, gastroesophageal reflux, and malnutrition, ultimately affecting patients’ quality of life. Current treatment strategies, including pharmacological and interventional approaches, focus on reducing liver volume and alleviating symptoms. However, management remains largely symptomatic, as no definitive therapies exist to halt cyst progression. Liver transplantation is the only curative option for patients with severe, progressive disease and refractory complications. The EASL guidelines recognize that PLD-related symptoms, primarily due to hepatomegaly, can contribute to involuntary weight loss and recommend assessing symptomatic patients for malnutrition and sarcopenia. Although evidence suggests that patients with PLD may be at risk of malnutrition, original data on the quality and extent of nutritional alterations remain scarce. The potential influence of nutrition on disease progression, symptom burden, and overall well-being is also largely unexplored. Given these knowledge gaps, addressing nutritional challenges, such as early satiety, is essential for optimizing symptom management and maintaining overall nutritional status. This review outlines a possible pathophysiology of malnutrition, specific dietary considerations and recommendations, and weight management in patients with PLD. Additionally, dietary complexities in patients with concurrent renal involvement are discussed, offering a practical framework for clinicians and dietitians in managing this challenging condition. Full article

Culinary melon (Cucumis melo subsp. agrestis var. conomon) is widely cultivated throughout Thailand and represents an important agricultural crop. During 2023–2024, anthracnose, charcoal rot, and fruit rot caused by fungi were observed on postharvest culinary melon fruits in northern Thailand. This study aimed to isolate and identify fungal pathogens associated with these postharvest diseases in culinary melons, as well as to assess their pathogenicity. Eight fungal strains were isolated and identified through morphological characterization and multi-gene phylogenetic analysis. Colletotrichum chlorophyti and C. siamense were identified as the causal agents of anthracnose, Fusarium sulawesiense caused fruit rot, and Macrophomina phaseolina was responsible for charcoal rot. Pathogenicity tests were conducted, and the fungi were successfully re-isolated from the symptomatic lesions. Moreover, sensitivity tests for fungicides revealed that C. siamense was completely inhibited by copper oxychloride and copper hydroxide. Colletotrichum chlorophyti was inhibited by benalaxyl-M + mancozeb, copper hydroxide, and mancozeb. In the case of M. phaseolina, complete inhibition was observed with the use of benalaxyl-M + mancozeb, mancozeb, and propineb. Copper hydroxide successfully inhibited F. sulawesiense completely. To our knowledge, this study is the first to report C. siamense and C. chlorophyti as causes of anthracnose, F. sulawesiense as a cause of fruit rot, and M. phaseolina as a cause of charcoal rot in postharvest culinary melon fruits in Thailand. It also marks the first global report of C. siamense, M. phaseolina, and F. sulawesiense as causal agents of these respective diseases in culinary melon. Furthermore, the results of the fungicide sensitivity tests provide valuable information for developing effective management strategies to control these postharvest diseases in the future. Full article

Introduction: Primary extracranial vertebral artery aneurysms are sporadic in the general population. They are uncommon in individuals with neurofibromatosis type 1. During pregnancy or in the puerperium, the risk of aneurysm rupture in individuals with neurofibromatosis type 1 and extracranial aneurysms is elevated. Rupture of a vertebral artery aneurysm is an emergency condition and can be fatal. Case presentation: We present the case of a 33-year-old woman in the puerperium with neurofibromatosis type 1 who had a vertebral symptomatic artery aneurysm. During a previous hospitalization, two months before the treatment of the vertebral aneurysm, a same-sided aneurysm of the thyrocervical trunk was successfully treated with endovascular coiling because of aneurysm rupture. In this case report, the vertebral artery aneurysm was successfully managed using a flow diverter stent graft. Conclusions: This is the first reported case of a successfully treated symptomatic vertebral artery aneurysm with a flow diverter stent graft in a patient with neurofibromatosis type 1 during the early puerperium. Endovascular treatment with a stent graft is a minimally invasive, safe, and effective treatment for patients with vertebral artery aneurysms. Early diagnosis of non-ruptured vertebral artery aneurysms is a crucial as well as appropriate treatment, which should be undertaken in a timely manner to prevent serious complications or a fatal outcome. Full article