EClinicalMedicine

BackgroundMulti-system impacts of long COVID remain unknown. We compared multi-system deficits between people with long COVID and controls. MethodsA case-control study recruited from the Avon Longitudinal Study of Parents and Children and TwinsUK population cohorts. Cases (141) had long COVID (evidence of COVID-19 infection and persistent symptoms [&ge;]4 weeks post infection); controls (280) included people making a full recovery in <4 weeks, people self-reporting long COVID like symptoms but ...

BackgroundFatal insulin intoxication remains difficult to diagnose because insulin undergoes rapid degradation after death, limiting the reliability of direct biochemical measurements. This creates diagnostic uncertainty when objective molecular confirmation of insulin excess are required. We hypothesised that insulin excess induces systemic metabolic alterations that persist beyond insulin degradation and can be captured using postmortem metabolomics in a forensic setting. MethodsHigh-resoluti...

BackgroundA retrospective study in Nature recently reported improved overall survival (OS) when COVID-19 mRNA vaccination was administered around initiation of immune checkpoint inhibitor (ICI) therapy. Whether this association depends on vaccination timing relative to ICI treatment remains unclear. MethodsWe conducted a single-centre retrospective cohort study of patients receiving palliative-intent ICI therapy at a UK tertiary cancer centre (October 2014-December 2025). Two vaccination exposu...

BackgroundPlatelet count and C-reactive protein (CRP) are blood tests commonly used in primary care as part of diagnostic work up for symptomatic patients. Abnormal results of these tests can indicate an undetected cancer; however, it is not known whether the association between an abnormal test result and cancer risk varies by patient ethnicity. MethodsThis cohort study used routinely collected primary and secondary health care records in England with linkage to national cancer registry data. ...

ObjectiveTo investigate the burden of environmental enteric dysfunction (EED) and its association with water, sanitation, and hygiene (WASH) and linear growth amongst infants in rural Central Java, Indonesia. Study designA longitudinal study of 119 infants aged between 5-19 months was conducted in five villages of Wonosobo District, Central Java, Indonesia. Anthropometric measurements of infants and their mothers were performed at baseline and 5-month follow-up alongside a quantitative question...

BackgroundCardiovascular and cerebrovascular risks of SARS-CoV-2 infection and mRNA vaccination remain incompletely defined and lacking comparative outcomes such as sex-specific vulnerabilities. MethodsUsing the TriNetX Research Network (December 2020-December 2024), we identified four mutually exclusive cohorts: uninfected/unvaccinated (naive), infected/unvaccinated, vaccinated-only, and infected/vaccinated (hybrid immunity). We compared 50 prespecified cardiovascular, cerebrovascular, and mor...

Abstract This protocol is reported in accordance with the SPIRIT 2025 guidelines for clinical trial protocols. Introduction: Young children, from birth to age 5 y are particularly vulnerable to indoor air pollutants and respiratory pathogens. Portable air purifiers (or filtration) and upper-room ultraviolet germicidal irradiation (UVGI) are two widely used interventions with the potential to improve indoor air quality (IAQ) and reduce sick-related absences. However, a review of the literature re...

This study presents a theoretical and mathematical framework for understanding the dynamical behavior of infectious disease spread using a compartmental modeling approach. The proposed model incorporates memory effects to capture temporal dependencies that are not adequately represented by classical formulations. Qualitative analysis is employed to investigate the stability properties of the system and the role of key mechanisms in shaping long term dynamics. Publicly available surveillance info...

BackgroundReliable detection of latent Mycobacterium tuberculosis (Mtb) infection (LTBI) remains challenging, particularly in TB contacts and immunocompromised individuals, where interferon-{gamma} release assays (IGRAs) demonstrate variable sensitivity. IP-10, a chemokine produced at substantially higher concentrations than IFN-{gamma}, represents a promising immune marker. This study aimed to evaluate the diagnostic performance of two IP-10 based assays RIDA(R)QUICK TB (lateral flow) and RIDA...

BackgroundSevere Fever with Thrombocytopenia Syndrome (SFTS) is an acute infectious disease with high mortality. This study aimed to develop a quantitative scoring system for grading SFTS severity using dynamic clinical data. MethodsA retrospective study included 547 confirmed SFTS patients from two hospitals. Clinical data were collected over a 14-day course (divided into four phases). Patients were grouped into survivors (n=451) and non-survivors (n=96). Statistical analyses, including Kaplan...

BackgroundTuberculosis (TB) remains a major global health challenge, necessitating rapid and accurate diagnostic tools. The World Health Organization (WHO) endorses nucleic acid amplification tests (NAATs) like Truenat MTB Plus and Xpert MTB/RIF Ultra. While both are widely implemented, direct comparisons integrating diagnostic accuracy with operational and cost considerations across real-world settings are limited. This study aimed to compare the diagnostic accuracy of Truenat MTB Plus and Xper...

BackgroundAfrica continues to have a significant public health problem with mpox, where endemic transmission persists and overlaps with a high burden of other infectious diseases. Although their epidemiology and clinical impact are still poorly understood throughout the continent, coinfections with human immunodeficiency virus (HIV) and varicella-zoster virus (VZV) can affect the clinical picture, severity of the disease, and accuracy of the diagnosis. MethodsFollowing PRISMA criteria, we regis...

BackgroundMedical oxygen is an essential medicine that is often unavailable for patients when they need it. We explored if Outsourced Oxygen to the Bedside (O2B) pilots, where private providers deliver a package of services, were successful in ensuring reliable oxygen access at the patient bedside. MethodsWe conducted a sequential explanatory mixed-methods assessment of O2B pilots in Kenya, Nigeria, India, Tanzania, and Uganda from September 2024 - January 2025. A quantitative cross-sectional ...

BackgroundSex disparities in the delivery of care and in-hospital outcomes following ST-segment elevation myocardial infarction (STEMI) remain a global concern. We performed an updated global meta-analysis comparing clinical outcomes between males and females with STEMI. MethodsThis study was conducted according to PRISMA guidelines (PROSPERO CRD42024612510). We searched major electronic databases from 1st January 2000 to 7th November 2024. Pairwise meta-analysis was performed on outcomes relat...

The COVID-19 pandemic led to significantly disrupted tuberculosis case detection and management. Additionally, overlapping symptoms, radiological findings and risk factors make differentiating tuberculosis and COVID-19 disease difficult. We conducted a prospective multicentre diagnostic accuracy study to determine sensitivity, specificity and operational characteristics of the Truenat MTB Ultima/COVID-19 assay, using a combined sputum plus nasopharyngeal swab specimen, in a single multiplex mol...

Aim/backgroundEthnic inequalities in stroke incidence are well-established, but long-term trends and the impact of socioeconomic status (SES) remain understudied. We estimated incidence rates by ethnicity over 30-years, and differences by SES, using the South London Stroke Register (1995-2024). MethodsWe conducted a population-based study including all residents of a geographically defined area of South London, calculating standardised incidence rates using census-derived denominators and the 2...

BackgroundWhile accurate sleep measurement is vital for older adults, the validity of actigraphy (AG) in free-living environments remains controversial, particularly given the flexible sleep-wake schedules common in this demographic. To address this uncertainty, we assessed the accuracy of wrist AG against in-home portable electroencephalography (EEG) among community-dwelling older adults. MethodsCommunity-dwelling older adults underwent concurrent sleep monitoring using a portable EEG device a...

Embedding equity into vaccine eligibility is essential for reducing health inequalities. Yet, adult vaccine eligibility in most European countries is primarily based on fixed age thresholds, prioritising cost-effectiveness. This approach risks excluding the most vulnerable populations living in deprived communities with poorer health and shorter survival into older age. Extending eligibility based on clinical risk partially addresses this gap. Higher rates of underdiagnosis and delayed diagnosis...

ObjectiveTo assess whether focal and non-focal COVID-19 ARDS exhibit different respiratory mechanics and arterial blood gas (ABG) trajectories during the first extended prone positioning (PP) session. DesignPost-hoc analysis of a previously published retrospective monocentric cohort study. SettingA university-affiliated intensive care unit in Paris (France) between March 2020 and April 2021. PatientsSeventy-four adult patients with moderate-to-severe COVID-19 ARDS who underwent extended prone...

BackgroundVisceral leishmaniasis (VL) remains a major public health challenge in East Africa, particularly in Ethiopia. Clinical trials on VL often exclude patients with severe comorbidities or laboratory abnormalities, limiting the generalizability of evidence used to guide real-world management. We comprehensively characterised the clinical profile, treatment outcomes, and mortality of VL patients treated in a referral centre. Methododology/Principal findingsThis prospective cohort study enro...