Molecular and Cellular Neuroscience

Purpose: This study examined longitudinal trajectories of adaptive functioning in 331 individuals with Angelman syndrome (AS) using the Vineland Adaptive Behavior Scales, Third Edition (Vineland-3) and examined differences by molecular subtype. Methods: A total of 331 individuals (156 females, 47%) with genetically confirmed AS (ages 6 months to 52 years) were assessed between 2018 and 2025, including 207 with a deletion subtype, 63 with uniparental disomy or imprinting defect, and 61 with a UBE3A point mutation. Growth scale values were analyzed using linear mixed-effects models with log2-transformed age. Results: Individuals with deletion subtypes demonstrated significantly lower adaptive functioning across domains compared to those with non-deletion subtypes. Adaptive skills across all Vineland-3 subdomains increased nonlinearly with age, showing faster growth early in life that slowed over time, with largely parallel trajectories across subtypes. Conclusion: Individuals with AS demonstrate slow but steady growth in adaptive functioning that continues into adulthood, with progress varying by molecular subtype. These findings provide updated natural history benchmarks and demonstrate the utility of the Vineland-3 for clinical trials.

Introduction: GCH1 has been implicated in Parkinson's disease (PD), but its risks variants and associations are not well defined. Objectives: To investigate the clinical relevance and PD risk associated with the GCH1 p.Ser80Asn variant. Methods: We first identified a segregating GCH1 p.Ser80Asn variant in a Malaysian Chinese PD family via whole genome sequencing (WGS). We assessed its risk association using multi-ancestry WGS data from the Global Parkinson's Genetics Program (GP2) (n=22,372PD vs n=8,826Controls) and meta-analysis of East Asian (EAS) cohorts (n=4,712PD vs 38,733Controls). Clinico-demographic details of affected variant carriers were collated. Results: The GCH1 p.Ser80Asn variant was enriched in GP2 EAS PD populations (n=9/2,757; 0.33%) but not detected in other ancestries. Meta-analysis revealed increased PD risk in EAS populations (odds ratio:5.1; 95%CI:2.3-10.7; p=2.89x10-5). Affected carriers (mean age at onset:56.3+-12.5 years) had additional occurrence of dystonia, while dementia was rare. Conclusions: The GCH1 p.Ser80Asn variant is a rare, EAS-enriched risk variant for PD.

Purpose: Genetic discoveries have provided etiological insight into autism spectrum disorder (ASD) such that genetic testing has become standard of care. To date, consensus about which genes are robustly associated with autism liability, and which are not, is inconsistent. Consequently, different curated ASD gene lists are applied in diagnostic testing, pre-clinical model development, and the design of precision therapeutics. Methods: We address this issue using the Evaluation of Autism Gene Link Evidence (EAGLE) framework, which allows for a protocolized and replicable curation of genes. Additionally, we compared the functional- and expression- characteristics of EAGLE-curated genes. Results: We curated 222 genes and found 78 genes with definitive EAGLE-evidence for association with autism: 43 with moderate evidence, and 99 with limited evidence for a role in ASD (noting all 222 genes are associated with the broader category of neurodevelopmental disorders (NDDs)). The top 10 EAGLE-scoring genes are NRXN1-SCN2A-MECP2-CHD8-RNU4-2-DDX3X-SHANK3-PTEN-FOXP1, and MBD5. Conclusion: EAGLE allows curation of evidence for association of genes with autism, as opposed to with NDDs broadly. Our analysis also revealed differential patterns of enrichment and expression profiles at the brain and cellular level, suggesting the biological relevance of differentiating ASD and the broader NDD-phenotype.

Summary Background Metronidazole (MET) resistance in Helicobacter pylori (H. pylori) exceeds 50-60% globally, yet MET-containing bismuth quadruple therapy (BQT) achieves &gt90% eradication in MET-resistant infections. We hypothesise this discordance stems from a structural limitation of two-fold dilution: a pharmacometric grey zone between the 128 and 256 &microg/mL breakpoints where treatable isolates are systematically misclassified as high-level resistance. Methods In a real-world cohort of 4610 treatment-na&iumlve children (2019-2024), checkerboard assays determined the bismuth-MET synergy factor (SF). Population PK/PD modelling simulated gastric MET exposure (AUC<sub&gt0-24</sub&gt/MIC &ge 70) at 1 g, 1&middot5 g and 2 g daily doses, incorporated bismuth SF, and estimated MIC coverage against the European Committee on Antimicrobial Susceptibility Testing (EUCAST) population distribution. Findings were validated against published adult trials. Findings 56&middot4% (485/860) of isolates were MET-resistant (MIC &gt 8 &microg/mL). At [&le;] 1 g/day MET, BQT offered no advantage over triple therapy for resistant infections. At 1&middot5 g/day, the synergy threshold was surpassed, achieving &gt90% eradication in MET-resistant infections, with efficacy independent of baseline susceptibility status. PK/PD modelling showed 1&middot5 g/day MET plus bismuth (median SF = 8) extended coverage to ~180 &microg/mL. To align modelled coverage with the &gt90% eradication rate, the dominant subpopulation of nominally high-resistant isolates must have a geometric mean MIC well below 256 &microg/mL (centred near 150 &microg/mL), consistent with a mixture of two log-normal subpopulations and confirming systematic upward misclassification by two-fold dilution in the grey zone. Interpretation This grey zone is a structural blind spot of two-fold dilution, not random measurement error. The &plusmn1-dilution reproducibility limit renders the interval inherently unresolvable. We propose a three-tier strategy: omit routine MET susceptibility testing for treatment-na&iumlve patients on optimised BQT; reserve categorical testing for BQT failures; and explore genomic/metabolomic biomarkers beyond MIC paradigms in this enriched population. Funding None. Keywords: Helicobacter pylori; Metronidazole resistance; Bismuth quadruple therapy; Antimicrobial susceptibility testing; Pharmacokinetic/pharmacodynamic modelling; Pharmacometric grey zone

Background: Left ventricular diastolic dysfunction (LVDD) is a major determinant of heart failure (HF), yet its assessment relies on multiparametric echocardiography, limiting scalability. We previously demonstrated that generative artificial intelligence (AI) can synthesize tissue Doppler imaging (TDI) waveforms from the 12-lead ECG. The growing complexity of candidate architecture creates a need for automated model-discovery frameworks. Objectives: To evaluate agentic AI-based auto-discovery for ECG-based LVDD assessment using either raw ECG or synthetic TDI waveforms. Methods: Two attention-based agentic AI architectures were developed using an automated large language model-driven refinement framework that optimized transfer-learning and multimodal architectures through autonomous proposal, validation, and selection of candidate model configurations. Development was performed in 1,011 paired ECG-echocardiography studies and externally validated in 983 patients using two reference frameworks: (i) data-driven phenogroups and (ii) the 2025 ASE Diastolic Function Guidelines. External validation was performed in CODE-15% (n=219,567) for HF-related mortality and EchoNext (n=35,718) for structural heart disease associations. Results: Despite the modest cohort size, the ECG-based agentic search achieved area under the receiver operating characteristic curve (AUCs) of 0.87 (95% CI: 0.85-0.89) and 0.83 (95% CI: 0.80-0.86) for phenogroup and guideline-based LVDD severity classification. Corresponding AUCs for the synthetic TDI-based model were 0.82 (95% CI: 0.80-0.85) and 0.80 (95% CI: 0.77-0.84), respectively. In large-scale external validation, both models stratified incident HF mortality with subdistribution hazard ratios ranging 5.5 to 9.5 (Gray's p<0.001 for all). Time-dependent discrimination for incident HF mortality exceeded a publicly available convolutional neural network model (ECG2HF) ({Delta}AUC range: +0.14 to +0.20). Both models demonstrated consistent associations with structural heart disease outcomes. Conclusions: Agentic auto-discovery enabled data-efficient assessment of LVDD from surface ECG by combining physiologically informed transfer learning with autonomous architecture optimization, achieving robust external generalizability. This approach may facilitate broader access to diastolic function assessment beyond conventional echocardiography.

Background Heart failure in hypertensive patients is heterogeneous and poorly captured by traditional left ventricular ejection fraction (LVEF) based classification. Multivariate echocardiographic data combined with unsupervised machine learning may provide a more precise phenotypic characterization. This pilot study evaluated the feasibility of unsupervised clustering of routine transthoracic echocardiographic data to identify phenotypic subgroups of hypertensive heart failure. Methods This retrospective pilot study analyzed transthoracic echocardiography reports from hypertensive patients with clinical heart failure. After data cleaning and exclusion of incomplete records, 102 patients with 11 echocardiographic variables were included. Variables describing left ventricular geometry, systolic function, and diastolic performance were standardized and subjected to K-means clustering. Optimal cluster number was determined using the elbow method and silhouette analysis. Cluster characteristics were assessed using descriptive statistics and Kruskal Wallis testing. Concordance with LVEF based heart failure categories was evaluated. Results Three distinct echocardiographic phenotypes were identified. Cluster 0 (n = 50) demonstrated preserved LVEF with concentric remodeling, consistent with heart failure with preserved ejection fraction (HFpEF) phenotype. Cluster 1 (n = 37) showed marked ventricular dilation and reduced systolic function, consistent with heart failure with reduced ejection fraction (HFrEF). Cluster 2 (n = 15) exhibited concentric hypertrophy with intermediate LVEF, consistent with heart failure with mildly reduced ejection fraction (HFmrEF) like phenotype. All echocardiographic variables differed significantly across clusters (p < 0.001). While Cluster 0 showed strong concordance with HFpEF (96%), Clusters 1 and 2 demonstrated substantial overlap across LVEF categories, indicating partial discordance between structural phenotypes and LVEF based classification. Conclusion Application of unsupervised machine learning to routine echocardiographic data identifies distinct heart failure phenotypes in hypertensive patients. These phenotypes demonstrate significant structural heterogeneity beyond LVEF based classification, supporting the utility of data-driven approaches for refined cardiac phenotyping. This pilot study provides a foundation for larger prospective studies.

Background: Non-monogenic arteriopathies are often classified as distinct entities according to the arterial territory involved, yet they share clinical features and may co-occur in the same individual. This pattern suggests shared susceptibility across anatomically distinct arteriopathies, potentially driven by common biological and genetic mechanisms. Methods: We investigated the shared genetic architecture of five arteriopathies (cervical artery dissection (CeAD), intracranial aneurysm (IA), spontaneous coronary artery dissection (SCAD), aortic aneurysm and dissection (AAD), and fibromuscular dysplasia (FMD)) using LD score regression, Association analysis based on SubSETs (ASSET), pairwise Multi-Trait Analysis of Genome-wide association summary statistics (MTAG), pleiotropy mapping and Mendelian randomization (MR) to identify shared loci and prioritise candidate causal genes. Results: LD score regression identified significant positive genetic correlations between CeAD-SCAD (rg = 0.64), IA-AAD (rg = 0.33), IA-SCAD (rg = 0.37), CeAD-AAD (rg = 0.56) and SCAD-AAD (rg = 0.20). ASSET identified 37 shared independent loci, and in MTAG analyses, one novel locus was identified for CeAD and SCAD (SLC39A8) and one for IA (FGF5). 13 loci showed strong cross-trait colocalization, including PHACTR1, LRP1, and CDKN2B-AS1. Using the Genotype-Phenotype Map, we found that arteriopathy-associated variants colocalized with blood pressure- and migraine-related traits, while many showed effect directions opposite to those observed for coronary artery disease. Proteome-wide MR identified 67 circulating proteins associated with at least one trait, including ECM1 and SHISA5 for CeAD and FGF5 for IA, with 17 supported by colocalization. Transcriptome-wide MR identified 204 colocalized tissue?specific signals, of which, 14 were shared across multiple traits. Enrichment analyses implicated pathways related to vascular development, smooth muscle cell function, extracellular matrix organization, and TGF-? signaling. Conclusions: These findings support shared genetic architecture across anatomically distinct arteriopathies, implicating pathways involved in vascular structure and prioritising therapeutic targets for future mechanistic investigation.

Nasopharyngeal colonisation with Streptococcus pneumoniae is a prerequisite for transmission and disease and represents an important immunising event. While colonisation induces serotype-specific immunity, the mechanisms underlying heterologous protection remain unclear. We developed a controlled human infection model using pneumococcal serotype 15B and investigated colonisation dynamics, immunogenicity, and cross-protection against subsequent heterologous challenge with serotype 6B. Fifty-four healthy adults were intranasally inoculated with 15B at escalating doses. Colonisation rates peaked at 31.4% with 8 x 10 CFU per naris, lower than those historically observed with 6B and 3 strains. Density was also lower than previously observed with other strains. In vitro assays demonstrated that 15B adhered more readily to epithelial cells than 6B, but was less efficiently internalised, potentially reducing attack rates and colonisation density. Colonisation with 15B induced capsular polysaccharide-specific serum IgG, but baseline humoral immune measures did not predict protection from acquisition. Prior colonisation with 15B did not reduce acquisition of 6B upon re-challenge. Analysis of nasal microbiopsy samples revealed distinct innate activation signatures. Resistance to colonisation was associated with elevated baseline MIP-1 and MIP-1{beta} responses upon in vitro stimulation, whereas carriage was associated with enhanced chemokine and IL-6 responses. Local innate immune activation, rather than circulating antibody responses alone, may therefore contribute to colonisation control. We demonstrate that experimental colonisation with 15B does not confer heterologous protection against 6B and highlight the importance of mucosal innate immune conditioning in serotype-independent defence. Strategies enhancing nasal innate immune recruitment and activation may be required for broader protection against pneumococcal colonisation.

Vaccination can be a useful intervention for reducing infectious disease burden. Estimating numbers of vaccine-prevented health outcomes is one approach to quantifying the benefits of vaccination. Here we improve a method described by Foppa et al. (1) that assumes vaccination has only direct effects, that is, it cannot prevent infection or onward transmission of the disease. We rederive this method and derive an improved method that increases estimation accuracy with minimal additional analytical complexity. To evaluate the improved method, we simulated disease outbreaks and compared the accuracy of the two methods for estimating prevented disease outcomes. In 84% of simulations performed over a wide parameter space, the improved method had an equal or smaller estimation error compared to the original Foppa method, with 7.9-fold smaller mean error and 44-fold smaller standard deviation of errors. Our study improves a method for estimating prevented burden when assuming vaccination has only direct effects.

The emergence of the novel monkeypox virus (MPXV) clade Ib in the Democratic Republic of the Congo (DRC) and neighboring countries in late 2023 highlighted the need for rapid, scalable surveillance approaches to support outbreak detection and response. As part of the ODIN-Mpox project, wastewater surveillance (WWS) systems were established as an emergency public health measure in three Sub-Saharan African countries (DRC, Tanzania, and Burkina Faso) to evaluate the feasibility of wastewater-based monitoring for mpox and strengthen local surveillance capacity. Between January 2025 and April 2026, 117 wastewater samples were collected from selected sites and analyzed for MPXV DNA using targeted qPCR assays. Clinical mpox data were obtained from national surveillance systems and WHO reports to assess epidemiological linkages between wastewater detections and reported infections. Six wastewater samples tested positive for MPXV DNA. During the study period, DRC experienced the highest disease burden, with weekly reported cases peaking at about 3,000 in January 2025, while Tanzania reported a peak of 20 weekly cases in March 2025. No confirmed clinical cases were reported in Burkina Faso. No clear relationship was observed between reported case numbers and qPCR Ct values in positive wastewater samples. Despite the low detection frequency, the project demonstrated the operational feasibility of implementing MPXV wastewater surveillance in resource-limited settings and established laboratory capacity for environmental monitoring of emerging infectious diseases. Given the early stage of WWS implementation in the region, the study identified opportunities for further system strengthening, including optimization of sample processing and reporting workflows, improved access to laboratory supplies, and enhanced integration of environmental and clinical surveillance data streams. These findings highlight the value of WWS as a complementary component of integrated public health surveillance systems and emphasize the need for continued investment in laboratory capacity, harmonized methodologies, governance frameworks, and knowledge exchange to enhance outbreak preparedness and response in low-resource settings.

Purpose Postprandial sedentary behavior is associated with negative health effects and constitutes a large part of daily life in modern society. This study investigated how the timing of physical activity after eating influences glucose levels, cerebral and muscle oxygenation, cognitive performance, and well-being during subsequent sitting. Methods In a four-armed randomized crossover trial, healthy adults consumed four standardized meals separated by 48-hour washout periods. Each meal was followed by 2 hours of sitting combined, in random order, with one of four interventions: (1) sitting only, (2) 15 minutes of moderate intensity cycling immediately after eating, (3) 15 minutes of cycling 20 minutes after eating, or (4) three workload-matched five-minute cycling bouts during sitting. Interstitial glucose (continuous glucose monitoring), cerebral and muscle oxygenation (Functional near infrared spectroscopy), cognitive performance (Stroop test), heart rate, blood pressure, and subjective ratings were assessed every 30 minutes. Data were analyzed using repeated-measures ANOVA. Results Twenty participants (mean age 27.1{+/-}10.3 years, 12 females) completed the study. Cycling immediately after eating reduced mean glucose levels during postprandial sitting, while both 15-minute cycling bouts increased cerebral oxygenation. All active conditions enhanced muscle oxygenation. Heart rate and arousal increased with delayed cycling and active breaks. No effects were observed for blood pressure, cognitive performance, focus, or well-being. Conclusion A short bout of physical activity immediately after eating reduces postprandial hyperglycemia and improves brain oxygenation during sitting, whereas delayed activity and brief breaks increase physiological activation without cognitive or perceptual benefits.

Acute ischemic stroke (AIS) is a leading cause of disability and death while effective treatment requires quick and accurate diagnosis. Non-contrast CT (NCCT) is widely used in the initial screening of AIS, but stroke detection is challenging because early changes on NCCT are subtle or indistinguishable. Using hyperacute NCCTs as inputs and diffusion-weighted MRI as ground truth, we trained a deep learning algorithm to classify patients with AIS and segment the stroke lesions. We hypothesized that this approach would accurately detect hyperacute tissue density changes on NCCT. For the classification task, our ResNet50 model delivered the best performance (with 98.5% accuracy, 97.4% precision, and 100% recall on an evaluation set). Classification performance remained strong when restricted to lesions smaller than 5 mL, which constituted the majority of our evaluation cases. For the segmentation task accomplished using a range of U-Net architectures, performance was acceptable for large lesions and declined sharply for smaller lesions. Together, these findings demonstrate the feasibility of deep learning for AIS detection and represent a step towards faster triage and treatment for stroke patients.

Background: Prematurity is the leading cause of child deaths worldwide, with the highest neonatal mortality in sub Saharan Africa. Respiratory distress syndrome (RDS) is the leading mortality pathway in preterm neonates, but continuous positive airway pressure (CPAP) has high impact. This analysis reports CPAP coverage and quality of care for preterm neonates admitted to 66 neonatal units in Kenya, Malawi, Nigeria and Tanzania. Methods: Analyses used individually linked neonatal inpatient data and cross-sectional health systems data. All admitted neonates were eligible for inclusion (January 2021 through December 2024). Service readiness for CPAP delivery and mean CPAP coverage were described for CPAP eligible newborns (weighing <1500g and symptomatic newborns >1500g). Quality of care cascades were constructed to illustrate key indicators. Survival among CPAP eligible neonates was analysed using regression models, stratified by clinical severity scores. Results: 375,255 newborn admissions were analysed in 66 neonatal units. Functional CPAP availability varied with median 16% of days (IQR: 4 to 47%) classified as high demand (>1.5 eligible newborns per CPAP). Of 64,761 CPAP eligible neonates, 22,006 (34%, 95% CI 33 to 34%) received CPAP. All countries showed improvement in CPAP coverage, with Tanzanian hospitals recording 63% increase in mean coverage (p-value=0.001) over time. Quality of care cascades showed treatment was initiated <24 hours after birth and continued for >1 day for 42% (95% CI 41 to 43%) of eligible neonates receiving CPAP. Only 10% of neonates <1500g started CPAP within the first hour of life. Among newborns on CPAP, 55% also received KMC (from 48% in Tanzania to 88% in Nigeria). Among newborns with high clinical severity, those treated with CPAP had a higher probability of survival (32%, 95% CI 29 to 36%) than those who were not (23%, 95% CI 21 to 26%). Odds of survival were higher for CPAP eligible newborns whose mothers received antenatal corticosteroids (aOR 1.07, p=0.001). Lower aOR of survival was associated with hypoglycaemia (aOR 0.71, p<0.001), respiratory distress (aOR 0.91, p<0.001), and outborn newborns (aOR 0.72, p<0.001). Conclusion: CPAP coverage and quality are critical for premature neonates. Clinical cascades highlight quality gaps, particularly in timely prophylactic CPAP initiation and appropriate duration. Improving comprehensive care quality for newborns on CPAP, including provision of co-interventions and maternal antenatal corticosteroids, can improve survival for preterm neonates.

Background: Longer follow-up periods in clinical trials for S. aureus bacteremia (SAB) may capture unrelated deaths, adding random noise that risks biasing trial results towards the null. Objective: To evaluate the timing and infection-relatedness of deaths within a large SAB clinical trial platform. Design: Blinded duplicate adjudication of trial deaths using a modified 7-point Likert-Scale. A third reviewer settled disagreements. Setting: 37 Canadian hospitals participating in the S. aureus Network Adaptive Platform (SNAP) Trial. Participants: 1515 adult patients recruited to SNAP between February 2022 and May 2026. Measurements: Timing and relatedness of 90-day deaths categorized as at least possibly SAB-related not likely to be SAB-related. Optimal follow-up cut-off was determined using Youden's index and graphically. Results: 247 deaths occurred; 97 (39.3%) were adjudicated as at least possibly SAB-related and 150 (60.7%) as not likely related. For probably/definitely related deaths, interrater agreement was 85.0% (Gwet's AC 0.73, substantial); for at least possibly related, it was 77.3% (Gwet's AC 0.55, moderate). Median survival was significantly shorter for SAB-related deaths (12 vs. 30.5 days; difference: 19 days earlier, 95% CI: 12-26, p<0.0001). Nearly 80% of SAB-related deaths occurred by day 30, whereas 50% of unrelated deaths occurred between days 30 and 90. Youden's index optimized follow-up at 20.5 days. Limitations: Potential for cause of death misclassification and data limited to Canadian sites. Conclusion: Deaths considered attributable to SAB cluster rapidly within the first month, while later deaths are predominantly unrelated. A 30-day all-cause mortality window may be more appropriate than 90 days for primary mortality outcomes in trials evaluating acute SAB therapies with longer follow up reserved for metastatic infection and recurrence.

Abstract Background Despite high vaccination coverage, pertussis has resurged globally. Whole-cell (wP) and acellular (aP) pertussis vaccines induce distinct immune profiles, yet immune correlates of protection against infection and symptomatic disease remain incompletely defined. We leveraged a controlled human infection model (CHIM) to identify systemic and mucosal humoral signatures associated with resistance to Bordetella pertussis. Methods Adults with documented history of vaccination had previously been enrolled in a CHIM study and challenged intranasally with B. pertussis D420. For the present work, longitudinal serum and nasal wash samples were analyzed using systems serology to comprehensively profile antibody features. Multivariate modeling and network analyses were performed to define discriminatory immune features. Findings Baseline aP vaccine antigen-specific antibodies did not distinguish infection outcomes. In wP-primed individuals, protection from B. pertussis infection was associated with broad, high-magnitude, polyfunctional antibody responses targeting non-canonical antigens, including BrkA, TcfA, OmpP, OmlA, FauA, and Pal. Protective signatures associated with resistance to symptomatic disease in both vaccine groups were characterized by enhanced Fc-receptor-engaging antibody profiles with distinct antigenic patterns shaped by vaccine history. Importantly, while conventional aP vaccine antigens failed to reliably distinguish individuals susceptible to infection or symptom development, correlates generated by integrated serum and mucosal models based on select non-canonical antigens achieved near-perfect discrimination of infection and symptom outcomes, outperforming models restricted to aP-vaccine. antigens only. Interpretation Resistance to infection was largely restricted to wP-primed individuals and was associated with integrated systemic and mucosal antibody responses directed against antigens beyond those included in acellular vaccines. Protection from symptomatic disease in both vaccine groups was linked to distinct antibody response signatures, shaped by prior vaccination history. These findings indicate that immune mechanisms preventing infection differ from those limiting clinical disease and provide a framework for redesign of next-generation pertussis vaccines aimed at blocking infection and symptomatic disease.

Background: Urethritis in women of childbearing age constitutes a significant but underreported burden of reproductive morbidity in Sub-Saharan Africa, where diagnostic constraints often necessitate suboptimal syndromic management. Methods: To identify the localized etiological profile, mid-stream urine and urethral swab specimens were prospectively collected from symptomatic women attending local clinics, subjected to standard microbiological culture, and characterized using rigorous phenotypic and biochemical diagnostic protocols. Results: Microbiological analysis successfully isolated a high prevalence of both Gram-negative and Gram-positive uropathogens, predominantly Escherichia coli, Staphylococcus aureus, and Klebsiella pneumoniae, demonstrating distinct phenotypic traits characteristic of the regional microbial ecology. Conclusion: The pronounced isolation of these specific bacterial agents highlights the critical inadequacy of generalized empirical treatments and underscores the urgent need for tailored diagnostic criteria in resource-limited African healthcare settings.

Background: ChAdOx1 nCoV-19 remains a cornerstone COVID-19 vaccine in sub-Saharan Africa, yet population-specific molecular responses are understudied. We examined peripheral blood ACE2 and TMPRSS2 expression, total RNA concentration, and coagulation indices in Nigerians >=6 months post-vaccination. Methods: In a case-control study in Port Harcourt, Nigeria, 51 ChAdOx1-vaccinated adults and 51 age/sex-matched unvaccinated controls provided venous blood for RNA extraction, qRT-PCR, and coagulation assays. Multivariable linear models assessed effects of vaccination, sex, and age on molecular parameters. Results: Vaccinated participants had 37% lower total RNA concentration than controls (4.02 +/- 0.09 vs 6.38 +/- 0.14 ng/uL, p<0.0001). ACE2 and TMPRSS2 expression did not differ by vaccination status overall. However, TMPRSS2 showed a significant sex-by-treatment interaction (p=0.011): vaccinated females had higher expression than vaccinated males. GAPDH expression varied by vaccination status and showed a three-way interaction with sex and age (p=0.027). Coagulation indices were unchanged. Conclusions: At >=6 months post-ChAdOx1, Nigerians show reduced peripheral blood RNA without sustained ACE2/TMPRSS2 upregulation. The sex-specific TMPRSS2 pattern suggests hormone and vaccine interactions previously unreported in African cohorts and highlights the need for sex-disaggregated molecular surveillance. Region-specific reference gene validation is recommended for Nigerian transcriptomic studies.

Background: In malaria-endemic tropical regions, the overlapping coagulopathy in COVID-19 and malaria poses diagnostic and prognostic challenges, particularly with potential sex differences. This study evaluated sex-specific variations in platelet indices and fibrinolytic markers and assessed the utility of Platelet Distribution Width (PDW) and D-dimer in mild/asymptomatic cases. Methods: A case-control study was conducted with 220 participants (55 each in healthy controls, malaria-positive, COVID-19-positive, and COVID-19+malaria co-infected groups), aged 20-65 years, in Port Harcourt, Nigeria. Platelet indices were analysed using Sysmex XP-300 haematology analyser, while D-dimer and fibrinogen were measured by ELISA. Data were analysed using SAS 9.4 with ANOVA, Tukey's HSD, Pearson correlation, and sex-stratified comparisons. Results: PDW was significantly elevated in all infected groups compared to controls (malaria: 15.21 +/- 0.22 fL; COVID-19: 15.21 +/- 0.22 fL; co-infection: 15.61 +/- 0.21 fL vs. control: 13.26 +/- 0.17 fL; F=25.850, p < 0.001). D-dimer levels were highest in the co-infected group (553.42 +/- 59.74 ng/ml, F=2.816, p = 0.040). No significant changes were observed in other platelet indices or fibrinogen across groups. No significant correlation existed between platelet indices and the fibrinolytic markers. Males exhibited significantly higher D-dimer levels across all infected groups (p < 0.05) and higher fibrinogen in COVID-19 subjects (p = 0.036). Sex exerted a stronger influence on parameters than age. Conclusion: Males show heightened fibrinolytic activation in COVID-19 and malaria co-infection. PDW and D-dimer are promising, cost-effective biomarkers for screening mild infections in resource-limited tropical settings.

Objective: This study aimed to identify the types of social networks present among older adults in a rural, low-income country setting and describe their association with quality of life (QoL). Methods: A population-representative, cross-sectional survey was conducted in 60 villages around Nouna in Burkina Faso from July to August 2021. Data were collected from resident adults aged 40 years and older. Variables captured were sociodemographic status; social network characteristics (using the Practitioner Assessment of Network Typology (PANT)); quality of life (using the EuroHIS-8 tool); presence of non-communicable diseases, mental health conditions, and disability. Additionally, social networks were broadly categorised as aggregated integrated and aggregated less-integrated groups. Social network types and the groups were described separately, and a multivariable linear regression model was used to understand the association between social network types and QoL, adjusted for sociodemographic and morbidity factors. Results: Among the 2390 respondents, median age was 55 yrs (IQR: 47-64 yrs) and 55.8% were female. Locally Integrated (35.4%) or Family Dependent (30.3%) were the most common PANT social network types, followed by a mixed group (having characteristics of two or more social network types) (30.5%). Private Restricted (2.1%), Locally Self-Contained (1.2%), and Wider Community-Focussed (0.4%) types were uncommon. Adults with aggregated integrated network groups (36.1%) and aggregated less-integrated group (36.0%) were near equal, while others were non-aggregable. Although Wider Community-Focused type showed a significantly better QoL ({beta}= 8.69, 95%CI: 4.10 to 13.27), the association between social networks and QoL were subdued when controlled for morbidity factors, and hence no significant associations were observed between other types or the aggregated groups. Conclusion: Although having integrated social networks lead to a better QoL, morbidity has a greater effect on the QoL among older adults in Nouna and hence, investing more on improving the physical and mental health needs appears more beneficial.

Motivational changes are determinants of healthy aging, social engagement, and functional independence, and may signal early neurodegenerative risk. Existing assessment approaches in aging typically treat motivation as a unitary construct. Here, we introduce MotDem, an age-appropriate measure of motivation co-designed with people living with dementia, carers, and clinicians. Across a broad adult lifespan sample (18-80 years), MotDem revealed a robust three-domain motivational architecture encompassing goal-directed behaviour, social reward, and pleasure, with a fourth satiety factor retained as exploratory. This structure was replicated in an independent older cohort (45-80 years) from a different national context. MotDem showed strong convergence with established measures of apathy and anhedonia, alongside more modest associations with depressive symptomatology. Together, these findings show that motivational aging is multifaceted and poorly captured by traditional unitary assessment. MotDem provides a multidimensional framework for measuring distinct motivational drivers of heterogeneous aging trajectories, with implications for resilience, wellbeing, and neurodegenerative risk.