Journal of Infection and Public Health

Introduction Aspiration events in hospitalized adults are common and linked to substantial morbidity, mortality, and healthcare burden. While antiemetics have been studied for aspiration prevention in specific settings, evidence for their broader preventive use in hospitalized adults is limited. We conducted a systematic review and meta-analysis to evaluate the effect of prophylactic scheduled antiemetics on aspiration events in adult inpatients. Methods: Ovid MEDLINE, Ovid Embase, CINAHL, and Cochrane Library (via Wiley) were searched in May 2025. We included randomized controlled trials (RCTs) and observational studies assessing prophylactic scheduled antiemetic use in hospitalized adults, with aspiration events as the primary outcome. Secondary outcomes were aspiration pneumonia, hospital length of stay, increased oxygen requirement, ICU admission, and mortality. Two investigators screened and independently extracted data in duplicate using standardized data collection forms. Extracted information included study characteristics, patient demographics and clinical characteristics, interventions, and outcomes. Results: Three RCTs met inclusion criteria (n = 515 patients; 237 antiemetic, 278 placebo). Pooled analysis of two RCTs demonstrated an 88% relative risk [RR] reduction of aspiration events; (2.8% [3/106] prophylactic antiemetic vs 27.9% [29/104] placebo; RR = 0.12, 95% confidence intervals [CI]: 0.02-0.73, p <0.0001, low certainty) in the antiemetic group. Pneumonia rates were also lower in the antiemetic group although they did not reach statistical significance (16.5% vs 32.4%; RR 0.44, 95% CI 0.15-1.28, P = 0.13, low certainty). ICU admission rates were lower in the antiemetic group (2.6% [2/76]) vs. placebo (23% [17/74]); RR = 0.11, 95% CI: 0.03-0.48, p=0.003, very low certainty). Mortality was similar between groups (35.0% vs 38.1%; RR 1.02, 95% CI: 0.84-1.24, P = 0.85, low certainty). No adverse events were reported among all studies. Conclusion: Prophylactic scheduled antiemetics were associated with a significant reduction in aspiration and ICU admission. There was a non-significant but favorable trend towards reduction of pneumonia among hospitalized adults. Larger, high-quality trials are needed to clarify their role in aspiration prevention.

Cancer is a serious public health problem, and is becoming more common, with a projected increase in deaths and more than 25 million new cases in coming decades. A number of molecular mechanisms are involved in the tumoral process, with one of them, never in mitosis A-related kinase 2 (NEK2), a serine/threonine protein kinase, being a frequent target of amplification in various malignancies that is responsible for chromosomal instability, aneuploidy and activation of several oncogenic pathways. Available kinase inhibitors are not yet optimized in terms of their pharmacokinetic properties for clinical use, and current therapies, such as chemotherapeutic agents or immunotherapies are often limited by their resistance. In silico methods represent an effective tool to search for novel potent inhibitors, before testing in animals, with time constraints and limited resources. To find new inhibitors of NEK2, we used E pharmacophore-based modeling and structure based virtual screening in this study. NEK2 was chosen as the target for therapeutic intervention and an energy optimized pharmacophore model was employed to screen the Enamine REAL library of millions of compounds. Pharmacodynamic and Pharmacokinetic properties of the Top hits were tested using ADMET profiling. These were further screened using molecular docking (standard precision and extra precision) and virtual screening to obtain three lead compounds 1, 2, and 3 which have docking score of -7.414, -8.037 and -7.562 respectively. MM-GBSA calculations were used to estimate the binding free energies for these complexes, which were determined to be -54.92, -54.18 and -49.23 kcal/mol. Lastly, 100 ns molecular dynamics simulations have been run to evaluate complex stability in dynamic situations. The overall results of the MD showed the overall stability of the NEK2-ligand complexes, and thus these three compounds are promising NEK2 inhibitor candidates and could be further validated in vitro and in vivo for clinical application. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=133 SRC="FIGDIR/small/742111v1_ufig1.gif" ALT="Figure 1"> View larger version (70K): org.highwire.dtl.DTLVardef@14e9cfeorg.highwire.dtl.DTLVardef@24ec78org.highwire.dtl.DTLVardef@20be75org.highwire.dtl.DTLVardef@1b80c02_HPS_FORMAT_FIGEXP M_FIG C_FIG

Background: Critical illness is a major contributor to morbidity and mortality in low-resource settings, yet data on its prevalence, location, management, and contextual barriers to care outside intensive care units remain limited in Ethiopia. This study aimed to determine the burden of critical illness, patient outcomes, Essential Emergency and Critical Care (EECC) provision, and barriers to implementation. Methods: This prospective mixed-methods multicenter study was conducted across 12 public hospitals in Ethiopia. A quantitative point prevalence survey assessed all adult inpatients ([&ge;]18 years) on a single census day per site using standardized vital sign criteria for critical illness. Patients were followed for 7-day in-hospital mortality, and hospital EECC resource availability was evaluated. A complementary qualitative component consisting of five key informant interviews and one focus group discussion was conducted with healthcare professionals to explore barriers to EECC implementation. Thematic analysis was used for qualitative data. Results: Of 1,077 hospitalized patients, 221 (20.5%) were critically ill. Most critically ill patients (62.0%) were managed in general wards. The 7-day in-hospital mortality was 14.0% among critically ill patients compared to 2.8% in non-critically ill patients. Only 1.8% of critically ill patients received all indicated EECC treatments. Median hospital EECC resource availability was 70.9% (IQR 41.4-79.1%), with no hospital fully equipped across all domains. Qualitative analysis identified seven major themes: challenges in early identification, resource constraints, knowledge gaps, attitudes toward EECC, organizational barriers, staff motivation issues, and delays in timely care delivery. Independent predictors of mortality included male sex, hypertension, cancer, HIV/AIDS, other comorbidities, and presence of critical illness. Conclusion: This critical illness outcome study in Ethiopia demonstrates that one in five hospitalized patients is critically ill, predominantly managed in general wards, with high short-term mortality and profound gaps in basic EECC delivery. Qualitative findings highlight multiple interconnected barriers to effective EECC implementation. Strengthening decentralized EECC through training, resource provision, ward-level protocols, and addressing systemic barriers is urgently needed to improve outcomes in resource-limited settings. Keywords: Essential Emergency Critical Care (EECC), Critical illness, Point prevalence, Mortality, Ethiopia.

Background. The clinical course of coronavirus disease 2019 (COVID-19), and the ability to anticipate which patients will require intensive care, were poorly characterized in Central Asia during the first pandemic wave. We aimed to describe the clinical features of hospitalized COVID-19 patients at the Tashkent State Medical University, Uzbekistan, and to identify risk factors for intensive care unit (ICU) admission. Methods. In this single-centre cross-sectional study, we reviewed the records of 2500 consecutive patients hospitalized between 11 April and 8 August 2020. Patients were grouped as asymptomatic or symptomatic, and symptomatic patients were compared by ICU versus non-ICU status. Groups were compared with chi-square or Fisher's exact and Mann-Whitney U tests. Univariable and multivariable logistic regression identified risk factors for ICU admission. Results. Of 2500 patients (median age 36 years; 60.9% male), 989 (39.6%) were asymptomatic and 1511 (60.4%) symptomatic. In total, 129 (5.2%) were admitted to the ICU and 38 (1.5%) died. ICU patients were older (median 56 vs 40.5 years) and more often had bilateral pneumonia, oxygen desaturation and cardiometabolic comorbidity. In the multivariable model (AUC 0.82), the independent predictors of ICU admission were ischemic heart disease (aOR 4.20), shortness of breath (aOR 3.22), hypertensive heart disease (aOR 2.93) and male sex (aOR 2.00). Conclusions. Older age, cardiometabolic comorbidity and respiratory compromise identified patients at high ICU risk. As one of the first clinical COVID-19 descriptions from Uzbekistan, these data provide a baseline for preparedness in Central Asia.

Use of fungal mycelia, which has antiviral properties, constitutes a novel strategy for addressing existing and newly emerging viral diseases. We evaluated safety and feasibility of fungal mycelia (Fomitopsis officinalis and Trametes versicolor, FoTv) for treatment of COVID-19 and assessed its antiviral effects and potential to reduce symptoms. In a randomized, double-blind, placebo-controlled, dual site (UCSD/UCLA medical centers) clinical trial we examined non-hospitalized patients who contracted mild-to-moderate COVID-19 [&le;] 96 hours, and experienced symptom onset [&le;] nine days, before enrollment. FoTv was safe, well-tolerated, and feasible for COVID-19 treatment. Minor differences in biochemical markers were observed between groups (26 FoTv, 24 Placebo). FoTv significantly reduced the number and severity of symptoms, particularly sore throat/cough, and in vitro SARS-CoV-2 (pseudovirus) cellular infection. In conclusion, FoTv was safe and reduced COVID-19 symptoms and cellular viral infection. Future studies should investigate therapeutic benefits of fungal mycelia for SARS-CoV-2 and other viruses. Clinicaltrials.gov registration:NCT04667247.

Background: Drug-resistant tuberculosis (DR-TB) remains a major challenge to tuberculosis control in sub-Saharan Africa. Cameroon faces substantial challenges in managing DR-TB; however, national evidence on treatment outcomes remains unsynthesized. This systematic review and meta-analysis aimed to estimate pooled treatment outcomes, adverse drug events (ADEs), and predictors of unfavorable outcomes among patients with DR-TB in Cameroon. Methods: This systematic review and meta-analysis followed the PRISMA 2020 guidelines. PubMed, Scopus, Embase, Web of Science, the Cochrane Library, African Journals Online. Google Scholar and reference lists were also searched. Studies reporting World Health Organization-defined treatment outcomes among patients with DR-TB were included. Random-effects meta-analyses using generalized linear mixed models with logit transformation were performed. Heterogeneity was assessed using the I2 statistic, and publication bias and sensitivity analyses were conducted. Results: Fifteen studies conducted between 1998 and 2022 were included. The pooled mortality rate was 6.8% (95% CI: 4.7-9.7; 14 reports; n = 2,351 participants), loss to follow-up was 4.1% (95% CI: 2.8-6.1; 12 studies; n = 2,244 participants), and treatment failure was 5.0% (95% CI: 1.1-19.8; 12 studies; n = 2,050 participants). The pooled treatment success rate was 74.2% (95% CI: 60.4-84.4; 13 reports; n = 2,146 participants). Treatment success improved over time and was higher with modified regimens (87.2%; 95% CI: 83.8-89.9; 3 studies; n = 460 participants) than with standard regimens (68.8%; 95% CI: 52.2-81.6; 10 studies; n = 1,686 participants). Among patients with multidrug-resistant-TB, the pooled prevalence of adverse drug events was 70.8% (95% CI: 40.2-89.7; 3 studies; n = 251 participants), with ototoxicity (41.9%; 95% CI: 23.7-62.6; 3 studies; n = 251 participants) and gastrointestinal disorders (40.9%; 95% CI: 25.5-58.2; 2 studies; n = 172 participants) being the most common events. HIV co-infection was significantly associated with unfavorable treatment outcomes (pooled OR = 2.76; 95% CI: 1.95-3.93; 6 studies), and male gender was also associated with increased odds of unfavorable outcomes (OR = 1.73; 95% CI: 1.25-2.40; 5 studies). Conclusions: Approximately three-quarters of patients with DR-TB in Cameroon achieved successful treatment, although mortality, treatment failure, and adverse drug events remain important concerns. Strengthening pharmacovigilance, integrated TB/HIV care, and the implementation of effective all-oral regimens are essential to improve treatment outcomes. Systematic review registration number: CRD420261404490.

Seasonal influenza remains a major cause of morbidity and mortality worldwide. Although neuraminidase inhibitors improve outcomes, influenza-related deaths persist. We evaluated the impact of early aspirin (ASA) and non-aspirin nonsteroidal anti-inflammatory drug (NSAID) use on outcomes in adults hospitalized with influenza. This retrospective study included adults admitted to the University of Minnesota Medical Center from 2016 to 2018. Continuous variables were summarized as medians with interquartile ranges (IQRs) and categorical variables as counts and percentages. Group comparisons used Wilcoxon rank-sum, Chi-square, or Fishers exact tests. Analyses included case-control comparisons, assessments by vaccination status, and subgroup analyses by early ASA or NSAID use. Among 2,816 patients, 320 had laboratory-confirmed influenza, with vaccination less common among cases. Unvaccinated patients had higher rates of intensive care unit (ICU) admission (23.6% vs. 11.1%; P = 0.003) and ventilatory support (15.0% vs. 6.1%; P = 0.009). In vaccinated patients, early ASA use was associated with older age and higher in-hospital mortality, whereas early NSAID use was associated with no in-hospital deaths, better one- and three-year survival (P < 0.001), and fewer, though not statistically significant, cardiovascular complications. In unvaccinated patients, ASA use was associated with lower three-year survival (59.1% vs. 79.2%; P = 0.013), while NSAID use was associated with fewer ICU admissions and no cardiovascular or renal complications. In both vaccinated and unvaccinated adults hospitalized with influenza, early NSAID use was associated with improved survival and fewer complications, whereas ASA use was associated with worse outcomes.

Background: Refractory and macrolide-resistant Mycoplasma pneumoniae pneumonia (MPP) has emerged as a major challenge in pediatric respiratory medicine, amplified by the post-2023 resurgence. However, a systematic overview of the research landscape specific to treatment-refractory and drugresistant disease in children remains lacking. Methods: Research articles and reviews on pediatric refractory or macrolide-resistant MPP published between 2000 and 2025 were retrieved from OpenAlex using Boolean searches. After screening, 2,286 records were quantitatively analyzed for annual output, contributing countries/institutions, thematic clusters, and citation-burst dynamics using Python. Results: Annual publications grew exponentially, with a pronounced surge after 2023 (n=378 in 2025). China produced the highest volume (45.1%) but recorded fewer citations per publication than the US, Japan, and Canada. The literature resolved into four clusters: macrolide resistance/molecular basis, epidemiology, etiology/co-infection, and refractory disease management. Burst analysis showed an evolution from earlier fronts like 23S rRNA mutations and azithromycin to recent emerging trends like pandemic-related co-circulation, genotype surveillance, and co-infection. Conclusions: Research on pediatric refractory and resistant MPP is expanding rapidly, shifting in emphasis from etiologic descriptions toward resistance mechanisms and clinical management. Standardizing the treatment of macrolide-unresponsive disease and post-pandemic epidemiological surveillance represent the principal directions for future work. Keywords: Mycoplasma pneumoniae; children; macrolide resistance; refractory pneumonia; bibliometric analysis; research trends

Excessive osteoclast activity contributes to pathological bone loss in osteoporosis, rheumatoid arthritis, and osteolytic malignancies. The effects of small catechol derivatives on receptor activator of nuclear factor-{kappa}B ligand (RANKL)-induced osteoclastogenesis remain poorly understood. This study investigated the effects of 4-methylcatechol (4-MC) on RANKL-induced NF-{kappa}B activation and osteoclast differentiation. 4-MC reduced RANKL-induced NF-{kappa}B luciferase activity in HEK-293T/RANK cells. 4-MC also suppressed RANKL-induced TRAP activity in RAW264.7 cells in a concentration-dependent manner and reduced the number of TRAP-positive multinucleated osteoclasts, without affecting cell viability. Molecular docking predicted non-covalent binding of 4-MC within the ATP-binding hinge region of IKK{beta} (PDB: 4KIK), forming a close polar contact with Glu97, predicted hydrogen bonds with Cys99, and a hydrophobic contact with Ile165, within the pocket occupied by the co-crystallized inhibitor K252a. Covalent docking predicted that the oxidized quinone form of 4-MC engages Cys179 in the IKK{beta} activation loop. Quantum chemical calculations confirmed a markedly higher electrophilicity index for the oxidized quinone than for the parent catechol, supporting this mechanism. In silico ADMET profiling indicated favorable drug-likeness and safety. These findings identify IKK{beta} as a plausible molecular target of 4-MC through both non-covalent and covalent mechanisms. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=108 SRC="FIGDIR/small/741661v1_ufig1.gif" ALT="Figure 1"> View larger version (40K): org.highwire.dtl.DTLVardef@35a0d3org.highwire.dtl.DTLVardef@d19458org.highwire.dtl.DTLVardef@1623fadorg.highwire.dtl.DTLVardef@1429e8b_HPS_FORMAT_FIGEXP M_FIG C_FIG

Plant-derived small molecules possess highly diverse physicochemical properties, and the computational design of their protein recognition elements depends not only on the global structural quality of candidate backbones, but also on whether the local binding pocket, ligand-contact pattern, and predefined recognition conformation can be consistently retained after sequence design and structural back-prediction. To explore pocket-design strategies for different types of natural-product small molecules, this study selected capsaicin, (4R)-limonene, and quercetin as model ligands, representing a flexible amphipathic molecule, a compact hydrophobic monoterpene, and a rigid polyphenolic flavonoid scaffold, respectively, and covering the dimensions of pungent sensory flavor, volatile aroma, and flavonoid functional constituents. A ligand- physicochemical-property-guided computational design and multi-stage prioritization framework was established for candidate protein binders. The results showed that candidates with favorable initial global structural scores did not necessarily form reasonable local small-molecule binding pockets, indicating that evaluation of the local ligand environment is essential for candidate prioritization. After screening, 31 partial- pocket candidate backbones for capsaicin, 75 buried hydrophobic-pocket candidate backbones for (4R)-limonene, and 56 pocket-qualified candidate backbones for quercetin were obtained. Further sequence design and structural back-prediction analyses indicated that a subset of candidates could maintain the original pocket geometry and major ligand-contact patterns after sequence realization. Overall, these results suggest that the physicochemical properties of different plant-derived small molecules substantially influence the efficiency of de novo protein pocket formation, with compact hydrophobic ligands being more compatible with buried hydrophobic- pocket strategies, whereas flexible or multipolar ligands require a more refined balance between hydrophobic burial and polar exposure. This study provides a pre- experimental computational prioritization framework for natural-product small- molecule-recognizing proteins and offers candidate resources for subsequent protein expression, in vitro binding validation, active-constituent enrichment, and development of small-molecule biorecognition tools. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=107 SRC="FIGDIR/small/743643v1_ufig1.gif" ALT="Figure 1"> View larger version (50K): org.highwire.dtl.DTLVardef@8fe6c2org.highwire.dtl.DTLVardef@176cef2org.highwire.dtl.DTLVardef@10c8201org.highwire.dtl.DTLVardef@2b28cf_HPS_FORMAT_FIGEXP M_FIG C_FIG

Background: Multidrug-resistant tuberculosis (MDR-TB) remains a significant public health threat in low- and middle-income countries, including Cameroon. This systematic review and meta-analysis aimed to determine the pooled prevalence of MDR-TB and other specific anti-tuberculosis drug resistance patterns, as well as to identify factors associated with drug-resistant tuberculosis in Cameroon. Methods: A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, Embase, Cochrane Library, and African Journals Online. Additional studies were identified through Google Scholar and reference list screening. Observational studies (cross-sectional, cohort, and case-control) reporting drug resistance among bacteriologically confirmed tuberculosis patients in Cameroon were eligible. Joanna Briggs Institute critical appraisal tools were used to critically assessed the study quality. Pooled prevalence estimates were calculated using random-effects meta-analysis. Subgroup analyses and meta-regression explored sources of heterogeneity. A p-value 0.05 was considered statistically significant. Results: Twenty-eight studies conducted between 1995 and 2022 were included. The pooled prevalence of MDR-TB was 5.2% (95% CI: 2.7-9.6; 21 studies; n = 7,515), with significantly higher acquired resistance (11.6%; 95% CI: 6.3-20.3) than initial resistance (2.0%; 95% CI: 1.1-3.5). The highest pooled MDR-TB prevalence was observed in the most recent studies (38.8%; 95% CI: 33.7-44.2), and the lowest in 2015-2019 (2.7%; 95% CI: 0.4-15.2). Any resistance to anti-tuberculosis drugs was 16.0% (95% CI: 10.3-23.9; 28 studies; n = 9,931), and rifampicin resistance was 4.6% (95% CI: 2.4-8.6; 25 studies; n = 8,728). Monoresistance was highest for streptomycin (6.4%; 95% CI: 3.7-10.8) and isoniazid (4.7%; 95% CI: 3.0-7.4). Previous tuberculosis infection was the strongest predictor of drug resistance (OR = 3.9; 95% CI: 1.8-8.4), followed by alcohol consumption (OR = 1.8; 95% CI: 1.2-2.7) and history of incarceration (OR = 1.7; 95% CI: 1.1-2.6). High heterogeneity was observed across most of the pooled estimates. Conclusions: Drug-resistant tuberculosis, particularly MDR-TB, poses a substantial burden in Cameroon, with acquired resistance significantly exceeding initial resistance. Previous tuberculosis infection, alcohol use, and incarceration are key modifiable risk factors. These findings underscore the urgent need to strengthen routine drug susceptibility testing, scale up rapid molecular diagnostics, enhance treatment adherence strategies, and implement targeted interventions for high-risk populations.

Background: Seasonal influenza, commonly known as flu, is an acute respiratory, highly contagious illness caused by influenza viruses. A clear understanding of influenza seasonality is crucial for guiding prevention and treatment strategies, including decisions on vaccination timing to prevent outbreaks. While well documented in temperate regions, data on influenza epidemiology in tropical areas, particularly sub-Saharan Africa, remain limited. We described the types, subtypes and positivity rate of seasonal influenza in Uganda during 2019-2023. Methods: We abstracted data from the National Influenza database on positive seasonal influenza cases confirmed by Polymerase Chain Reaction. The cases were disaggregated by age group, sex, region, month and year of reporting. Using Microsoft excel, we calculated the influenza positivity rate and disaggregated it by strain, sex, age, region and time. Test positivity rate was computed as the number of positive cases as a percentage of the total samples tested. Results: Among 17,957 individuals tested, the overall positivity rate for seasonal influenza was 5% (936 cases). Positivity was higher among males compared to females (7% vs. 4%), with children aged 5-9 years having the highest positivity rate (16%), while individuals aged 50-54 years had the lowest (1%). The median positivity rate was 4%, with a range of 1-16%. Regionally, the central region reported a positivity rate of 5%, with rates across all regions ranging from 5% to 8%. Over time, there was a gradual decline in positivity rates, decreasing from 16.5% in 2019 to 5.3% in 2023. Seasonal influenza exhibited bimodal peaks, with the primary peak occurring between March and May and a secondary peak from October to December. Influenza A was the predominant strain, accounting for 70% of seasonal influenza cases (669/936). Among the Influenza A subtypes, H3N2 was most common, representing 63% of cases (425/669). Conclusions: The declining seasonal influenza positivity rates from 2019 to 2023 and the predominance of Influenza A and H3N2 highlight the need for sustained surveillance in Uganda. Given Influenza A's high genetic variability and potential for novel strain emergence, monitoring circulating strains, informing vaccine development, and implementing targeted interventions for high-risk groups and regions are critical to controlling and preventing outbreaks.

Background: COVID-19 has been associated with persistent neuropsychiatric symptoms after recovery, including sleep disturbance and depressive symptoms. Patients who required hospitalization may be particularly vulnerable to post-acute psychological complications. This study aimed to determine the prevalence of insomnia and its association with depression among patients who had recovered from COVID-19 after hospitalization. Methods: This analytical cross-sectional study was conducted in 2023 at Shahid Beheshti Hospital, Zanjan, Iran. A total of 70 patients who had been hospitalized with PCR-confirmed COVID-19 and had recovered for at least 6 months were included. Data were collected from medical records and telephone interviews. Insomnia severity was assessed using the Insomnia Severity Index. Descriptive statistics, univariable and multivariable linear regression were used to analyze factors associated with insomnia severity. Results: The mean ISI score was 8.06 + 6.57. Overall, 40.0% of participants had at least subthreshold insomnia, and 17.1% had moderate to severe clinical insomnia. 30.0% of participants had some degree of depressive symptoms. In univariable analysis, higher depression score and lower educational level were associated with greater insomnia severity. In the multivariable regression model, depressive symptom severity remained independently associated with insomnia severity; each one-point increase in BDI-II score was associated with a 0.50-point increase in ISI score (adjusted {beta} = 0.50; 95% CI: 0.34-0.66; p < 0.001). Conclusion: Insomnia and depressive symptoms were common among patients who had recovered from COVID-19 after hospitalization. Depressive symptom severity was independently associated with greater insomnia severity. Routine screening for sleep disturbance and depressive symptoms may be beneficial in post-COVID follow-up care, particularly among previously hospitalized patients.

Introduction: Hantavirus disease is an emerging and potentially severe zoonosis of global distribution. In Uruguay, it is transmitted by rodents inhabiting peridomestic, suburban, and rural areas. Global incidence is estimated at 150,000 to 200,000 cases per year, with up to 300 annual cases in the Americas. Since 1997, Uruguay's Ministry of Public Health (MPH) has monitored Hantavirus cardiopulmonary syndrome (HCPS), the most common clinical presentation in the region. By 2019, a total of 271 cases had been identified in the country, with an estimated mortality rate of nearly 50%. Objectives: To describe the clinical, epidemiological, and occupational characteristics of patients with Hantavirus disease in Uruguay during the pre-pandemic (2018-2019) and pandemic (2020-2021) periods. Methods: A descriptive, cross-sectional, observational study was conducted, including all serologically confirmed cases of Hantavirus infection reported to the MPH between 2018 and 2021. Clinical and demographic data were extracted from the mandatory reporting form for zoonotic diseases. Incidence and case fatality rates were calculated, and factors associated with fatal outcomes were analyzed. Results: A total of 58 confirmed cases were identified between 2018 and 2021. Most patients were male (62%), with a mean age of 36.5 years (SD 16). A decline in incidence was observed during 2020-2021, with no significant change in case fatality. Direct rodent exposure was the most frequently associated risk factor. Montevideo and Canelones were the most affected departments. Renal and pulmonary involvement were significantly associated with mortality. Conclusion: Hantavirus remains a relevant public health concern in Uruguay. Although a decrease in incidence was observed during the COVID-19 pandemic years, case fatality rates remained high. The findings underscore the need for sustained surveillance and early recognition, particularly in urbanizing regions.

Background: Patients with chronic hepatitis B (CHB) may have an increased risk of severe COVID-19. Tenofovir has been hypothesized to confer protection against severe disease, but evidence is inconclusive. We evaluated the risk of severe COVID-19 among CHB patients treated with tenofovir compared with other nucleos(t)ide analogues (NAs). Methods and findings: In this nationwide, registry-based cohort study, we included all adults with CHB and laboratory-confirmed COVID-19 in Sweden between February 2020 and July 2022. Data from national health and socioeconomic registers were linked using unique personal identification numbers (PINs). Patients with HIV, hepatitis C, or hepatitis D coinfection were excluded. Exposure was defined as tenofovir versus other NA therapy. The primary outcome was severe COVID-19, defined as hospitalization >2 days or death within 30 days of diagnosis. Logistic regression was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI), controlling for age, sex, comorbidities, vaccination, socioeconomic status, and region of birth. Among 5,877 CHB patients with COVID-19, 672 were receiving NA therapy (437 tenofovir, 235 other NAs). Severe COVID-19 occurred in 8.0% of tenofovir-treated patients and 14.5% of those receiving other NAs (unadjusted OR 0.52; 95% CI, 0.31-0.85). After adjustment, the association was attenuated and no longer significant (aOR 0.72; 95% CI, 0.39-1.31). Older age, comorbidities, and unvaccinated status were strongly associated with severe disease. Conclusions: The apparent protective effect of tenofovir against severe COVID-19 in unadjusted analyses was largely explained by confounding factors. The risk of severe disease was primarily driven by age, comorbidities, and vaccination status. Prevention of severe COVID-19 in patients with CHB should instead focus on vaccination and management of comorbidities.

Considering the fact of growing elderly population in Bangladesh and breaking of the cultural tradition of family taking care of the elder generation, institutionalization has become popular. This cross-sectional study was designed to evaluate the level of depression, anxiety and stress among the elderly people living in OAHs and impact of sociodemographic, anthropometric, clinical characteristics and satisfaction levels about the institutional facilities on their depression, anxiety, stress levels. Three old age homes were selected by purposive sampling- Probin Nibash (Agargaon), Priyojon Nibash (Darus Salam Road) and Old Rehabilitation Center (Gazipur). A total of 175 participants were selected from these institutions, who met inclusion criteria. They were interviewed face- to- face with a semi- structured questionnaire. DASS-21 was used to evaluate their level of depression, anxiety and stress level. SPSS version 26 was used for statistical analysis. Most prevalent age group was found to be 66-70 years with a mean age of 75.31{+/-}7.72. Female participants (52%) were more than male respondents (48%). Most of the participants was graduates (38.3%). Most of the participants (90.3%) were widowed with 1- 2 children (80%). Half of the participants (50.3%) had non- government jobs previously, whereas 40% were housewives. Regarding communication, 68% never communicate with their family and most of them (80.6%) had no one to take care at their homes. More than half of the respondents (58.3%) had chronic diseases like hypertension (16.67%), diabetes (47.06%), heart disease (7.84%) etc. Majority of the participants were satisfied with the facilities like food (61.14%), recreation (83.43%), medical care (80.0%), caregiver services (96.57%), safety (98.86%), physical exercise (93.43%), social activities within the institution (99.43%) and funeral system (83.43%) provided by the institutions. Among all the participants, 80.57% had mild to extreme severe level depression, 68% had anxiety and 70.29% had stress. Depression was found to be associated significantly with female gender, less communication with family, 1-5 years of staying at OAHs (p<0.001). Anxiety was significantly associated with female gender and less communication with family (p<0.05). Stress was significantly associated with less communication with family, and 1-5 years of staying at OAHs (p<0.001).

Background: Childhood adversity (CA) has been identified as one of the most robust risk factors for psychotic disorders; several treatable mediating mechanisms have been proposed. Aims: To conduct a systematic review and meta-analysis examining mediating pathways linking CA and psychosis. Method: This PRISMA-compliant systematic review (PROSPERO: CRD42024542972). consisted of a search conducted in January 2026 on Ovid (PsycINFO, Medline, and Embase) using search terms related to psychosis, CA, and mediation analyses. Evidence was appraised by calculating the percentage of the total effect mediated in each study, grouping mediators into meaningful groups. When possible, meta-analyses using two-stage meta-analytic structural equation modelling (METASEM) were conducted. Results: 117 studies were included (54 in clinical samples, 59 in non-clinical samples, and four studies in both clinical and non-clinical samples). 107 studies examined psychological mediators and 12 examined biological. The median percentages of total effect mediated across all analyses per mediator family were: 49% for dissociation (k = 24), 45% for psychosocial stressors (k = 6), 37.9% for negative schemas (k = 23), 35.2% for post-traumatic symptoms (k = 10), 31.5% for depressive symptoms (k = 14), 27.8% for anxiety (k = 11), 27.1% for attachment styles (k = 12), and 8.7% for mentalization domains (k = 5). Meta-analyses confirmed a robust mediating effect of dissociation (k = 7; N = 2143; indirect effect (I.E) =0.42 [0.17, 0.66] on psychosis; 50.49%), on delusions (k =7; N = 1053; I.E = 0.36, [0.27, 0.46]; 46.44%]) and on hallucinations (k =10; N = 5705; I.E = 0.28 [0.20, 0.36]; 57.59%). Robust mediation via depression (k =5; N= 5028; indirect effect= 0.33 [0.31, 0.35]; 31.05%) and negative schemas of the association between trauma and psychosis broadly defined (k = 7; N=10791; I.E= 0.26 [0.17, 0.35]; 26.36%) was also observed. High heterogeneity was observed across all meta-analyses. Fewer studies examined biological mediators, preventing quantitative synthesis. Conclusions: Childhood adversity impacts psychosis through psychosocial mediators, particularly dissociation. Further work is required to on the potential role of biological mechanisms and its interplay with psychological mechanisms.

Cross-reactive antibodies against dengue virus are known to cause antibody-dependent enhancement (ADE) of infection or disease severity under specific conditions. In our previous study, we showed that primary immunization with the COVID-19 vaccine induces induces cross-reactive IgG causing ADE against dengue. In the present study, we investigated the influence of IgG Fc-glycosylation (analyzed by LC-MS/MS) on ADE mediated by cross-reactive IgG against dengue from IgG against SARS-CoV-2. We found a clear correlation between anti-DENV2 E IgG2 galactosylation and the ADE capacity of cross-reactive IgG against dengue in individuals vaccinated against COVID-19. IgG2 sialylation increased over time; however, it was not correlated with ADE capacity. This phenomenon was restricted to IgG2, whereas anti-DENV2 E IgG1 Fc-glycosylation remained stable after COVID-19 vaccination.

Background: Localized skin and soft tissue infections may need systemic antibacterials, but local inflammation can delay symptom recovery. We evaluated whether topical fresh Taraxacum mongolicum wet dressing added to ceftriaxone was associated with short-term benefit in selected clinically stable adults. Methods: In this single-center, assessor-blinded, three-arm randomized trial, 180 adults aged 18-74 years were randomized 1:1:1 to topical T. mongolicum plus intravenous ceftriaxone, topical T. mongolicum alone, or ceftriaxone alone for 7 days. The primary outcome was day-7 clinical response assessed by blinded independent assessors using prespecified global clinical improvement criteria. Analyses followed the intention-to-treat principle; sensitivity analyses assessed robustness. Results: Day-7 clinical response rates were 91.67% (55/60), 76.67% (46/60), and 68.33% (41/60) in the combined, T. mongolicum, and ceftriaxone groups, respectively (overall P = 0.006). Compared with ceftriaxone alone, combined therapy had a higher response rate (risk difference, 23.3 percentage points; 95% CI, 9.6 to 37.0; risk ratio, 1.34; 95% CI, 1.11 to 1.62). Sensitivity analyses were directionally consistent. Secondary outcomes and bacterial clearance favored the combined group. No serious adverse events were reported. Conclusions: In selected clinically stable adults with localized skin and soft tissue infections, adjunctive topical fresh T. mongolicum plus ceftriaxone was associated with improved short-term outcomes compared with ceftriaxone alone. Findings require cautious interpretation because this was a single-center, partially blinded trial without a placebo dressing control. The dressing should not replace antibiotics, drainage, or urgent care when indicated. Trial registration: International Traditional Medicine Clinical Trial Registry, ITMCTR2026000549.

Background: Retail red meat may act as a source of foodborne pathogens, antimicrobial resistant bacteria, and antibiotic residues, posing a significant public health concern in Bangladesh. Objectives: This study aimed to isolate and identify major bacterial pathogens from retail red meat, determine their antimicrobial susceptibility patterns, assess the prevalence of antibiotic resistant bacteria, and detect antibiotic residues in meat samples. Methods: A cross-sectional study was conducted from January to June 2019 using 60 retail red meat samples (20 cattle, 20 goat, and 20 buffalo) collected from Rajshahi and Naogaon districts. Bacterial isolates were identified using standard cultural, morphological, staining, and biochemical techniques. Antimicrobial susceptibility was evaluated by the Kirby Bauer disc diffusion method according to CLSI guidelines. Antibiotic residues were screened in 15 representative samples using thin layer chromatography (TLC). Results: Overall prevalence of Escherichia coli, Salmonella spp., and Staphylococcus aureus was 10.0%, 13.3%, and 28.3%, respectively. E. coli showed complete resistance to penicillin (100%) and high resistance to amoxicillin (83.3%), while remaining highly susceptible to ciprofloxacin (83.3%) and gentamicin (66.7%). Salmonella spp. exhibited highest resistance to penicillin (87.5%) and tetracycline (75.0%), whereas gentamicin (87.5%) and ciprofloxacin (75.0%) remained the most effective agents. S. aureus demonstrated marked resistance to penicillin (94.1%), ampicillin (58.8%), tetracycline (47.1%), and amoxicillin (47.1%), but high susceptibility to gentamicin (88.2%) and ceftriaxone (70.6%). TLC detected ciprofloxacin and oxytetracycline residues in one cattle meat sample each (6.7%). Conclusions: Retail red meat marketed in the study areas harbored multidrug-resistant bacterial pathogens and detectable antibiotic residues, highlighting potential risks to food safety and public health. Continuous surveillance, prudent antimicrobial use, improved slaughterhouse hygiene, and strict compliance with antibiotic withdrawal periods are essential to minimize antimicrobial resistance and residue contamination.