Medicinal applications of bismuth(III): from antimicrobial to anticancer.

Adolescence is a critical phase of rapid growth with long-term health implications. We aimed to examine the trends and associated factors of malnutrition among adolescents with diarrhoea in urban Bangladesh. We conducted a retrospective cross-sectional study and analysed data from 1597 adolescents aged 10-19 years enrolled in the Diarrhoeal Disease Surveillance System at icddr,b's Dhaka Hospital between 2012 and 2023. Nutritional status was defined using WHO standards. Trends were assessed using the Jonckheere-Terpstra test. Logistic regression models were developed after variable selection with least absolute shrinkage and selection operator. The pooled prevalence of stunting, thinness, and overweight across 2012-2023 was 473/1597 (29.6%), 388/1597 (24.3%), and 106/1597 (6.6%), respectively. Stunting declined significantly from 40.8% in 2012 to 25.7% in 2023, while thinness increased from 21.8% to 24.3%. In adjusted models, stunting was positively associated with age (aOR: 1.06; 95% CI: 1.02-1.10) and negatively with maternal post-primary education (aOR: 0.71; 95% CI: 0.53-0.94) and rich households (aOR: 0.66; 95% CI: 0.46-0.96). Thinness was less likely among females (aOR: 0.46; 95% CI: 0.35-0.60), older adolescents (aOR: 0.90; 95% CI: 0.86-0.94), and the richest households (aOR: 0.52; 95% CI: 0.30-0.90). Overweight was inversely associated with age (aOR: 0.92; 95% CI: 0.86-0.99) but increased with post-primary maternal education (aOR: 3.22; 95% CI: 2.09-4.96) and richest households (aOR: 2.72; 95% CI: 1.13-6.55). Adolescent stunting decreased while thinness increased over the 12-year period, highlighting a dual burden of malnutrition. Male adolescents and those from socioeconomically disadvantaged households remain particularly vulnerable to malnutrition. These findings underscore the need for integrated adolescent nutrition strategies within diarrhoeal disease management and urban health programmes in Bangladesh.

Inborn errors of immunity (IEI) refer to a heterogeneous group of monogenic disorders caused by germline variants that disrupt immune function. Among these conditions, immunodeficiency 92 (IMD92), an extremely rare autosomal recessive disorder due to c Rel deficiency that results from pathogenic variants of the REL gene. c Rel is a key actor of the NF-κB pathway with major implications in the immune response. Up untill now, only two patients with confirmed pathogenic REL variants have been reported. Here, a third case is described of a 5-year-old Moroccan child with combined immunodeficiency presenting with chronic diarrhea and recurrent opportunistic infections, alongside newly reported features including craniosynostosis, language delay, and epilepsy. Clinical exome sequencing, confirmed by Sanger sequencing, identified a novel homozygous frameshift variant (NM_001291746.4) REL:c.24del p.(Tyr9Ilefs*2). This variant introduces a very early premature stop codon. Western blot analysis of peripheral blood mononuclear cells demonstrated a severe reduction of c Rel protein expression with preserved p65 levels, confirming its functional impact. This report expands the mutational spectrum of REL and further supports the critical, non-redundant role of c-Rel in human immune homeostasis. It also highlights the central role of next generation sequencing, particularly clinical exome approaches, in the diagnosis and evolving genetic classification of IEI, enabling earlier recognition, refined subclassification, and more personalized management of affected patients.

Cerebrotendinous xanthomatosis (CTX) is rare, autosomal recessive inborn error of metabolism caused by biallelic pathogenic variants in CYP27A1, which encodes sterile 27 hydroxylase, a key enzyme in bile acid biosynthesis. Enzyme deficiency results in reduced cholic and chenodeoxycholic acid synthesis with accumulation of cholestanol, bile acid intermediates, and bile alcohols, producing a progressive multisystem disorder characterized by chronic diarrhea, juvenile-onset cataracts, tendons xanthomas, and neurological dysfunction. Although CTX typically begins in childhood, diagnosis is frequently delayed until adulthood, limiting the benefit of effective disease modifying therapy with chenodeoxycholic acid. Since the identification of CYP27A1, more than 200 pathogenic variants have been reported, including canonical loss of function alleles and missense variants with variable residual enzyme activity. In this review, we summarize the medical genetics, population genetics and genotype phenotype relationships of CTX. We highlight insights from large population databases that refine global incidence estimates, revealing population-specific enrichment of pathogenic variants and persistent underdiagnosis. We further review functional and clinical data demonstrating that stratification of CYP27A1 variants by functional effect,complete loss of function versus hypomorph alleles,correlates with clinical severity and biochemical phenotype. Finally, we discuss emerging advances in biochemical testing and newborn screening strategies that offer the potential for presymptomatic diagnosis, enabling timely initiation of therapy and prevention of irreversible disease manifestations. Integrating molecular, functional, and population genetic data provides a framework for improved variant interpretation, earlier diagnosis, and optimized therapeutic intervention in CTX.

Pattern-based histologic approach in colitis with chronic architectural damage: GIPAD recommendations.

Identification and characterization of a novel lysin-like endopeptidase from the Vibrio cholerae predator phage ICP1.

Celiac Disease as a Rare Cause of Chronic Diarrhea in a Patient After Heart Transplantation

Comparative evaluation of four genetic markers for molecular detection of Giardia duodenalis in human fecal samples.

Community Health Practitioners [CHPs] play a critical role in Nigeria's primary healthcare system, serving as frontline workers in infectious disease prevention and control. Despite their importance, a comprehensive synthesis of their roles, the diseases they address, and the challenges they face remains limited. The aim of this review is to map and synthesize available evidence on the roles of Community Health Practitioners in infectious disease prevention and control in Nigeria. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews [PRISMA-ScR] 2020 guidelines and the Joanna Briggs Institute [JBI] methodology. The protocol was formally registered on the Open Science Framework [OSF]. A comprehensive search was conducted across PubMed/MEDLINE, Google Scholar, SciSpace, African Journals Online [AJOL], WHO reports, and Nigerian Ministry of Health publications. Studies published up to December 2025 that examined CHPs' involvement in infectious disease prevention and control in Nigeria were included. Data were extracted on CHP roles, infectious diseases addressed, challenges faced, and gaps in the literature. A total of 93 unique studies were identified and screened, with 30 studies meeting the inclusion criteria for detailed analysis. CHPs performed diverse roles, including disease surveillance and notification, case detection and diagnosis, treatment, health education and community mobilization, immunization services, outbreak response, and infection prevention and control. The most frequently addressed infectious diseases were malaria [n=15], COVID-19 [n=10], vaccine-preventable diseases including measles, polio, and meningitis [n=8], and other diseases such as Lassa fever, tuberculosis, HIV/AIDS, diarrheal diseases, and pneumonia. Major challenges included inadequate training and knowledge gaps [n=12], resource and infrastructure limitations [n=10], poor remuneration and lack of incentives [n=7], inadequate supervision and administrative support [n=6], and community acceptance issues [n=4]. Conclusively, CHPs are integral to infectious disease prevention and control in Nigeria, performing multifaceted roles across diverse disease contexts. However, significant systemic challenges, including inadequate training, resource constraints, and poor remuneration, limit their effectiveness. Strengthening CHP capacity through enhanced training, improved resource allocation, better remuneration, and robust supervision systems is essential for optimizing their contribution to infectious disease control and achieving universal health coverage in Nigeria.

Expatriate soldiers often died at high rates because of infectious diseases when deployed into the tropics during the nineteenth century. A British regiment of Black soldiers from the West Indies was specifically raised to provide soldiers less likely to die of malaria and yellow fever than their White European counterparts. Black soldiers were initially recruited from recovered slaves born in West Africa, but recruitment was from free men born in the West Indies by the middle of the century. All-cause (ranging from 1% to 6%/year) and disease-specific annual mortality rates were collected from British West Indies soldiers while stationed in the West Indies (Jamaica and the Windward Islands) and West Africa (Sierra Leone and Ghana). British West Indies Regiment soldiers died at lower rates initially in West Africa where they had been born. However, during the latter half of the nineteenth century, soldiers originating in the West Indies died at higher rates when stationed in West Africa than in the West Indies because of diseases, including malaria, tuberculosis, and diarrheal and respiratory diseases. This difference in mortality rates between the West Indies and West Africa equalized by the early twentieth century, suggesting that resistance to disease mortality depended on early life experience with infections rather than genetic factors inherited from earlier generations from West Africa.

Sudan virus disease in humans.

Paediatric acute gastroenteritis remains a major cause of morbidity in low- and middle-income countries. In India, non-rotavirus enteric viruses—particularly norovirus, enteric adenovirus, and astrovirus—are frequently under-detected despite their established role in childhood diarrhoeal disease. This narrative review synthesizes multicentre and large regional Indian studies published over the past two decades to describe prevalence patterns, age distribution, seasonality, regional variation, and co-infection profiles of these viruses in children. Evidence from hospital-based and surveillance studies indicates that Adenovirus, Norovirus, and Astrovirus together account for approximately 10–30% of viral acute gastroenteritis cases, with substantial heterogeneity across geographic regions and study settings. Indian multicentre studies report Norovirus detection rates of approximately 14–15% among hospitalised children under five years, while Adenovirus prevalence exceeds one-third of detected viral cases in some northeastern region. Globally, Norovirus has been associated with nearly one-fifth of all acute gastroenteritis cases, with Astrovirus contributing a smaller but consistent proportion

Cryptosporidiosis, a disease caused by the protozoan parasite Cryptosporidium, can lead to prolonged and chronic diarrhea in individuals with weakened immune systems. The zoonotic characteristics of this parasite may impose notable economic challenges. This study investigates the prevalence of Cryptosporidium in ornamental birds and their sellers in Isfahan, the central region of Iran.A total of 223 samples, comprising 193 bird faecal samples (86.55%) and 30 seller samples (13.45%), were collected from pet stores throughout Isfahan. The samples were microscopically examined using the modified Ziehl-Neelsen staining method. Positive samples were subsequently subjected to DNA extraction and nested PCR for Cryptosporidium species identification. Furthermore, a phylogenetic tree and a haplotype network were constructed to investigate the evolutionary relationships and haplotype network distribution patterns, respectively.The infection was detected in 4.66% (9/193) of ornamental birds and 13.33% (4/30) of bird sellers. Among the infected birds, 8 (4.15%) were identified as C. parvum and 1 (0.52%) as C. galli, while all infected sellers (4/30) harboured C. parvum. No significant correlation was observed between demographic variables and infection rates. Notably, in two pet shops, both birds and sellers were concurrently infected, indicating a potential zoonotic transmission link.This study reveals the presence of Cryptosporidium in pet birds and their sellers, emphasizing the potential for zoonotic transmission. By employing a One Health approach through phylogenetic tree construction and haplotype network analysis, the interconnectedness between human and pet bird populations is evident. As close contact between birds and their sellers may facilitate disease transmission, regular testing is highly recommended to monitor and prevent the spread of Cryptosporidium.

Roux-en-Y gastric bypass (RYGB) surgery is a highly effective technique for treating obesity. However, it may result in nutritional deficiencies. Here we report the case of a 55-year-old woman presenting with chronic diarrhea lasting 2 years, accompanied by lower limb paresthesia, macrocytic anemia, leukopenia, and thrombocytopenia. Her medical history included hypothyroidism treated with levothyroxine, and RYGB surgery performed in 2014, with intermittent micronutrient supplementation. The patient developed copper and zinc deficiencies. To our knowledge, this is the first report of a patient presenting with both deficiencies simultaneously with pancytopenia 10 years after RYGB. This case underscores the need to verify adherence to existing preoperative screening recommendations involving preoperative micronutrient measurements to assess micronutrient deficiency risks and multidisciplinary postoperative follow-up,the importance of monitoring micronutrient levels, close follow-up of both symptomatic and asymptomatic patients and evaluating adherence to supplementation regimens.

Cryptosporidium is a pathogenic intestinal parasite that causes cryptosporidiosis, a diarrheal disease common in the US. The predominant species infecting humans are C. hominis and C. parvum. These species can be further classified into families and subtypes by analyzing the sequence of the 60-kDa glycoprotein (gp60) gene. Currently, there are no data available regarding the families and subtypes of Cryptosporidium found in New York State (NYS) or their distribution within the state. To address these unknowns the gp60 gene was sequenced to identify the subtypes for C. hominis and C. parvum positive specimens submitted to the Wadsworth Center (NYS Public Health Laboratory) in 2022 and 2023. All together 634 specimens tested positive for C. hominis, and a subtype family was determined for 613. In 2022 and 2023 IdA16 and IfA12G1R5 were the most frequently identified C. hominis subtypes. Interestingly, IdA16 is typically not found in the US while subtype IfA12G1R5 is currently recognized as the dominant C. hominis subtype.When assessing C. parvum, there were 489 positive specimens over the 2-year period, and a family and subtype was identified for 466. Subtype family IIa was responsible for a majority of the infections. This family also had the greatest genetic diversity with 30 different subtypes identified throughout the surveillance period. Laboratory surveillance data such as those presented here, aid in improving outbreak detection and investigations, determine the geographic distribution of subtypes, and identify populations that may be at higher risk for becoming infected with Cryptosporidium.

Severe acute malnutrition (SAM) is a leading cause of morbidity and mortality among children under five years, accounting for over one-third of global child deaths. This study explored clinical and sociodemographic factors asociated with SAM in children aged from 2 to 23 months with diarrhoea. The "Antibiotics for Children with Diarrhoea (ABCD)" study was conducted from July 1, 2017, to July 10, 2019, with Bangladesh as one of the seven-country sites. The data were collected from the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). This secondary analysis was conducted among children who were excluded from the 35,504 children initially screened in the ABCD trial. Children were excluded if they had dysentery, suspected cholera, or had SAM, had comorbidities or had been treated with antibiotics for the last 14 days. Age and sex matched controls were randomly selected from excluded children without SAM in a 1:3 ratio of SAM children. SAM cases were compared with non-SAM controls using conditional logistic regression to identify associated factors. Of 2,640 children, 660 were cases and 1,980 controls; 57% were male with a mean age of 10 months. Admission characteristics, including dehydration, fever, vomiting and hospital stays, were higher among SAM children (cases). In conditional logistic regression, dehydration was associated with higher odds of SAM (OR: 5.89, 95% CI: 3.48-9.97; p = 0.001). Cough (OR: 2.23 95% CI: 1.36-3.66) and not being breastfed (OR: 1.64 95% CI: 1.12-2.41) were also associated with increased odds (p < 0.05). Recent antibiotic use was shown to be a protective factor (OR: 0.77, 95% CI 0.63-0.95; p < 0.05). In addition, maternal underweight increased the risk, while higher levels of parental education were protective (p < 0.001). These findings underscore the importance of early detection of dehydration, breastfeeding and targeted interventions for families with lower educational levels to reduce the risk of SAM.

Hyperactivating mutations in guanylyl cyclase C (GC-C) are monogenic causes of early-onset inflammatory bowel disease, familial diarrheal syndrome and congenital secretory diarrhea. The mechanisms linking elevated cGMP levels to immune imbalance remain poorly defined. Here, using a preclinical model of a disease-associated GC-C mutation, we observe pleiotropic alterations in the small intestinal epithelium. Transcriptomic and functional analyses revealed impaired Paneth and goblet cell differentiation, compromised barrier integrity, heightened epithelial permeability, and increased proinflammatory cytokine levels. Intestinal organoids from mutant mice exhibited amplified cGMP responses to GC-C ligands and defects in secretory lineage specification, confirming cell-autonomous mechanisms. Strikingly, oral zinc administration suppressed aberrant GC-C activity, normalized cGMP levels and restored barrier function. These findings highlight the central role of epithelial cGMP signaling in coordinating barrier integrity and immune-epithelial interactions, and identify zinc as a tractable therapeutic strategy for GC-C-mediated intestinal disorders.

Giant villous adenomas of the colon are a rare cause of chronic secretory diarrhea. These lesions can produce excessive mucus, fluid, and electrolyte loss, leading to life‐threatening hypokalemia, hyponatremia, and acute kidney injury. Chronic secretory diarrhea with electrolyte imbalance and possible acute kidney injury caused by secretory giant tubulovillous adenomas constitutes McKittrick–Wheelock syndrome, a rare condition described in 257 patients worldwide. We report two cases of McKittrick–Wheelock syndrome caused by giant tubulovillous adenomas of the rectum and rectosigmoid junction with malignant transformation. The first case, a 72‐year‐old female, presented with profound electrolyte depletion and acute renal failure, managed in the intensive care unit with supportive therapy. The second case, a 73‐year‐old male, had chronic diarrheal syndrome and marked electrolyte depletion due to three giant colonic tubulovillous adenomas with malignant transformation. After rehydration and electrolyte replacement, both patients underwent surgical resection with low anterior rectal resection and protective loop ileostomy. The male patient required reoperation with total proctocolectomy due to coloanal anastomotic dehiscence. Postoperative courses were uneventful, and both patients were discharged with normalized laboratory values and scheduled for regular follow‐up. McKittrick–Wheelock syndrome should be suspected in patients with chronic diarrhea and electrolyte disturbances. Prompt endoscopic evaluation allows accurate diagnosis, and timely fluid and electrolyte replacement combined with surgical resection of the secretory lesion is essential for effective treatment and prevention of serious complications.

Structural basis for the lack of immunogenicity of a Cryptosporidium octapeptide: anchor switching induces MHC-I groove remodeling and instability.

Cryptosporidium is a waterborne and zoonotic protozoan parasite that causes cryptosporidiosis, a diarrheal disease that disproportionately affects young children and immunocompromised individuals in low- and middle-income settings. In Southeast Asia, ecological diversity, agricultural intensification, and uneven sanitation infrastructure create overlapping transmission pathways across human, animal, and environmental domains. Despite a growing body of regional literature, the structure of the evidence base and its utility for surveillance and control have not been comprehensively evaluated using an integrated One Health lens. This protocol outlines the methodology for a scoping review mapping the published literature on Cryptosporidium in Southeast Asia, characterizing the distribution of evidence on prevalence, diagnostic methods, species and genotype diversity, and environmental, food-related, and socioeconomic determinants of transmission across human, animal, and environmental domains. The review follows the Arksey and O'Malley framework, refined by Levac and colleagues and the Joanna Briggs Institute, and is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Five databases were searched from inception through September 30, 2024: PubMed, Embase, CABI Digital Library, Cochrane Library, and Index Medicus for the South-East Asia Region (IMSEAR), supplemented by backward citation tracking and targeted searches of organizational websites. Studies were included if they reported primary data on Cryptosporidium in human, animal, or environmental samples collected from one or more of the eleven Southeast Asian countries and addressed prevalence, diagnostic methods, or transmission risk factors. Reviews, editorials, letters, conference abstracts, and non-English publications were excluded. No formal risk-of-bias assessment was conducted, consistent with scoping review methodology. Data were organized thematically and synthesized descriptively, with findings presented across One Health domains using tables, figures, and maps generated in RStudio (version 2023.09.1+494). Database searches retrieved 889 records before deduplication. After removing 177 duplicates, 711 unique records underwent title and abstract screening. Of 333 full-text articles assessed for eligibility, 176 studies were included in the final synthesis, representing nine of eleven Southeast Asian countries and spanning 1985 to 2024. Data extraction and analysis are complete. The manuscript reporting the full findings is being prepared for submission to a peer-reviewed journal. This scoping review provides a comprehensive cross-domain mapping of evidence on Cryptosporidium in Southeast Asia. The findings are expected to identify structural gaps in the regional evidence base, characterize diagnostic heterogeneity and its implications for surveillance utility, and support the development of integrated One Health surveillance strategies in the region.