Severe Health Research Articles

Long-term mental health impairments in survivors of critical illness

Abstract Background Survivors of critical illness frequently suffer from long-term disabilities, including physical, cognitive, and mental impairments (post-intensive care syndrome). However, long-term studies are scarce and healthcare services for critical illness survivors are limited, not only in Germany. Therefore, we followed-up on anxiety, depression, and post-traumatic stress disorder (PTSD) during post-intensive care unit (ICU) rehabilitation and up to 1 year after critical illness onset. Methods Patients at Schoen Clinic Bad Aibling in Germany were eligible for this prospective cohort study after receiving ≥5 days of mechanical ventilation. The Hospital Anxiety and Depression Scale (HADS; subcategory score ≥8) was conducted after ICU discharge (V1), at discharge from inpatient rehabilitation (V2) and 1 year after critical illness onset (V3). The Impact of Event Scale-6 (score ≥1.75) was conducted to assess PTSD at V3. Multiple logistic regressions were performed. Results We included 250 patients (62±14 years, 34% female, median stay on ICU 55 days, median duration of rehabilitation 65 days). 10% died before V3. Anxiety decreased during rehabilitation (effect size r = 0.35, p<.001), but increased again until V3 (r = 0.42, p<.001). At V3, 54% suffered from anxiety. Depression also decreased during rehabilitation (r = 0.46, p<.001), and increased again until V3 (r = 0.39, p<.001). At V3, 44% showed depressive symptoms and 38% suffered from PTSD. COVID-19 diagnosis was associated with increased anxiety (p<.001), depression (p=.068), and PTSD at V3 (p=.028), compared to non-COVID-19 patients. Furthermore, longer duration of mechanical ventilation was associated with increased anxiety (p=.041) and depression (p=.019) at V3. Conclusions Mental health impairments frequently occur in critical illness survivors, and they seem to worsen after rehabilitation. As these impairments can significantly impact daily functioning and quality of life, tailored healthcare services are urgently needed. Key messages • Anxiety, depression, and PTSD are frequent in critical illness survivors, even 1 year after critical disease onset. This calls for tailored healthcare services. • Patients with COVID-19 and longer mechanical ventilation suffer from more severe mental health impairments.

Flooding and Mental Health interventions for vulnerable groups

Abstract Issue/Problem The UK is increasingly vulnerable to flooding due to climate change, which significantly affects mental health. Vulnerable populations are disproportionately impacted, experiencing stress, anxiety, and other severe mental health issues, requiring effective intervention strategies. Description of the problem The UK’s third Climate Change Risk Assessment (CCRA) highlights flooding as a key challenge, with mental health impacts representing a major health burden. Effective interventions are crucial for these communities. Results UKHSA’s flooding and mental health guidance is incorporated into flooding and health advice documents for the public and frontline responders. It includes assessment and support strategies for health and social care staff, emergency responders, and local authorities. It focuses on those most at risk and promotes a phased approach to care-from immediate safety and shelter to long-term psychological support. This strategy accommodates the prolonged nature of mental health recovery, requiring adaptable and sustained interventions. Lessons Addressing the mental health impacts of flooding demands a comprehensive, multi-phase strategy that adapts to the evolving needs of affected populations. Early intervention and long-term support are vital to mitigate the extensive psychosocial damage. Key messages • Flooding severely affects mental health, necessitating structured, long-term interventions. • Flexible support strategies that evolve over time are crucial for effective recovery, ensuring that interventions meet the changing needs of those impacted by flooding.

Psychosomatic complaints at age 15-16 and subsequent depression and anxiety disorders

Abstract Background In recent years, the prevalence of self-reported mental health issues such as psychosomatic complaints has risen among adolescents in several countries, including Sweden. Despite this trend, a gap in the understanding remains regarding the implications of these complaints, including their ability to predict more severe mental health conditions. Depression and anxiety represent common mental health disorders among youth today, significantly affecting daily functioning. In light of this, the current study aims to investigate the association between self-reported psychosomatic complaints at age 15-16 and the likelihood of being diagnosed with depression or anxiety by age 20. Methods Data was drawn from Futura01, a cohort study of Swedish adolescents who attended grade 9 in 2017 (n = 5,225). Information on psychiatric diagnoses was obtained from the Swedish National Patient Register. Psychosomatic complaints were captured through self-reported frequencies of headache, stomach ache, and difficulties falling asleep, which were aggregated into an index (ranging from 3-15). Covariates included sex, parental education, parental country of birth, family type, and prior diagnoses of ADHD, depression, and anxiety. Binary logistic regression analyses were performed. Results The findings show that higher levels of psychosomatic complaints at age 15-16 were prospectively associated with increased odds of being diagnosed with depression (OR = 1.28, 95% CI 1.22-1.34) as well as anxiety (OR = 1.30, 95% CI 1.25-1.35) by age 20, even after adjusting for prior diagnoses and other covariates. Conclusions This study highlights the potential for psychosomatic complaints during adolescence to act as early indicators of future mental health disorders. Recognising the importance of these complaints and implementing public health interventions targeting mental health issues among youth could help improve mental health outcomes in late adolescence and young adulthood. Key messages • Adolescents reporting frequent psychosomatic complaints at age 15-16 were more likely to receive subsequent specialised care due to a depression or anxiety diagnosis in a Swedish sample. • Interventions directed at youth experiencing frequent psychosomatic complaints may have a beneficial impact on their future mental health outcomes.

Refugee mental health - systematic review and meta-analysis

Abstract Background Mental health conditions of forcibly displaced persons are unknown as the characteristics of the population change over the years. This study aims to estimate the prevalence rates of mental health conditions among refugees (depression, anxiety and posttraumatic stress). Methods We conducted a systematic review using MEDLINE (Ovid), Embase, Web of Science Core Collection (Clarivate), PsycINFO (EBSCO), Sociological Abstracts (ProQuest), and PTSDPubs (ProQuest) published between 1994-2022. We set up clear eligibility criteria and developed a data extraction sheet. The risk of bias of the included studies was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies. Heterogeneity was assessed using I² statistics. Results The search yielded 4,381 records, of which 171 were included in the full-text review. 54 studies were included in the final review. These 54 studies comprised of 62,522 forcibly displaced populations (49.22% males, 50.78% females). Pooled prevalence rates for anxiety, depression, and PTSD were 36.3% (95% CI 30.0-43.2), 35.9% (95% CI 31.9-41.3), and 35.4% (95% CI 29.0-42.4) respectively. Conclusions The prevalence of PTSD, depression and anxiety is significant among forcibly displaced persons. Screening for mental health conditions among these populations might prove beneficial to prevent more severe mental health conditions through the implementation of early intervention strategies.

Risk of long COVID in migrants and the contribution of vaccinations, disease severity, social inequalities and preexisting health: A nationwide register study in Sweden

Abstract Background and aim A number of studies have found higher COVID-19 infection rates, hospitalizations and deaths in migrants and ethnic minorities throughout the Corona Pandemic. Some recent evidence also suggests higher risk of long COVID in migrants although less is known about the risk factors for long COVID in this population. The objective of our study is to examine the risk of long COVID in migrants and to examine whether preexisting health conditions, disease severity, social inequalities and vaccinations contribute to the association. Methods We used linked Swedish administrative registers to estimate the risk of a long COVID diagnosis in the population that had a confirmed COVID-19 infection. Poisson regressions were used to calculate incidence rate ratios between the Swedish born and migrant groups. Adjustments for preexisting health conditions, disease severity, vaccinations and social inequalities were separately introduced. Results Higher risks of long COVID were found among migrants from Africa, Asia, Eastern Europe, Finland, Middle-East and South America. While the contribution of vaccinations and social inequalities were modest, we found that disease severity (i.e. whether the person was hospitalized or treated in an intensive care unit) primarily contributed to the higher risk of long COVID found in migrants. Conclusions The greater exposure and impact of the COVID-19 virus among migrants during the pandemic also affected the longer-term consequences of infection in this at-risk population.

JA ImpleMENTAL Implementing the Belgian Best Practice on Community Mental Health system Reform

Abstract Mental health challenges affect more than one in six people across the EU. In order to support Member States to proceed with mental health care system transformation and suicide prevention JA ImpleMENTAL, was initiated on the request of Member States, on October 2021 under the European Union 3rd Health Program. The JA consists of 39 organizations from 21 countries, more than 180 persons are working. Two advisory bodies support the consortium and provide their insights and expertise, a stakeholder forum with 10 key European Organizations in Mental Health including EUPHA Mental Health Section and WHO Europe and OECD, and the Member State Policy Committee which ensures the involvement of ministries and enables the practices to be embedded in health systems. Within the 11 countries implementing pilots under the Belgium model using a common Implementation Strategy, a total 163 activities are implemented under the 5 following key areas: 62 on structural measures needed for the establishment of local networks promoting a user’s centered, human’s right based recovery approach, 43 for the development and/or transformation of mental health services, 22 on training & capacity building in support of the reform and cultural change, 22 on continuous communication, information and awareness raising, and 13 on data collection, monitoring and evaluation. An analysis of MS pilot action plans shows that most service transformation efforts have concentrated on: defining care pathways for people at risk and for those with mild to severe mental health conditions including smooth transition from child and adolescent to Adult Mental Health services, as well as from inpatient to community services, the nomination of case managers for assisting individuals to their recovery process the development of individual service plans, the Involvement of users in various layers of service delivery including peer support and the provision of assertive treatment through mobile units.

Psychiatric comorbidity and hospitalization outcomes for AMI in portuguese public hospitals

Abstract Background Severe mental health disorders directly affect quality of life but may also indirectly relate to physical diseases and their prognosis. We test this hypothesis for the specific case of acute myocardial infarction (AMI), postulating a longer in-patient stay and an excess in-hospital mortality among patients suffering psychiatric comorbidities (PC). Methods A retrospective observational study was conducted using secondary data from public Portuguese hospitals, for all patients with a primary diagnosis of AMI (12,213 patients aged 18-80, for the years 2017-18). We used linear and logistic regression to model length of stay (LoS) and in-hospital mortality, respectively. Having at least one psychiatric comorbidity was the explanatory variable, and models were adjusted for age, sex, and the Charlson Comorbidity Index. Results The prevalence of PC was 12.95%. The in-hospital mortality rate was significantly higher in the group with PC (4.43%, OR = 1.372, 95%CI=1.041-1.784), than in the group without PC (3,38%). Stays were significantly longer among those with PC (mean=7.69 days), compared to those without PC (mean=6.87 days; adjusted β-coefficient=0.098, 95%CI=0.056-0.141). Conclusions Patients with AMI and comorbid mental disorders have poorer hospitalization outcomes than those without PC. This emphasizes the importance of promoting effective management strategies for comorbid psychiatric disorder, for instance, by improving the integration of mental health care in general hospitals, and empowering healthcare professionals to recognize and manage patients with PC. Key messages • Psychiatric comorbidity is related to longer inpatient stays and higher mortality risk among patients with AMI. • Efforts to integrate mental health care in general hospitals should be maintained.

Designing 1,2,3‐Triazole Derivatives for Targeted Inhibition of Proteolytic and Coagulant Activities in Bothrops Jararaca and Bothrops neuwiedi Snake Venoms

AbstractSnakebites inflict significant injuries on humans and animals, posing a severe global public health challenge due to high mortality and morbidity rates. This study presents results against the venoms of Bothrops jararaca and Bothrops neuwiedi using sixteen synthetic hybrid molecules containing thiophene and triazoles, designated as 6a–h and 7a–h. The compounds were assessed for their ability to inhibit proteolytic and plasma coagulant activities induced by the snake venoms, and their toxicity was analyzed. Most derivatives demonstrated nontoxicity through in silico analysis with the Osiris Property Explorer tool and in vitro cytotoxic hemocompatibility on red blood cells. Notably, only derivative 6e exhibited toxicity to erythrocytes, while 6b, 6d, 7c, and 7f displayed mutagenic, tumorigenic, or adverse effects on the reproductive system. Derivatives 6a, 6c–h, 7c–e, 7g, or 7h effectively inhibited the coagulating activity of B. jararaca venom, while 6a–b, 6d–e, 6h, or 7a–f inhibited coagulation induced by B. neuwiedi venom. All derivatives demonstrated inhibition of the proteolytic activity caused by B. jararaca venom, and derivatives 6a–d and 7e–f inhibited the activity of B. neuwiedi venom. Consequently, these derivatives exhibited varying degrees of efficacy in countering two crucial toxic effects of B. jararaca or B. neuwiedi venoms, suggesting their potential as antivenoms against both species.

Detection and molecular characterization of avian polyomavirus in budgerigar and non-budgerigar psittacine species in bird markets of Pakistan

Avian Polyomaviruses are imposing severe health problems in budgerigars, non-budgerigar Psittacine species, and non-psittacine species all over the world, including Pakistan. It marks future challenges for aviculturists and pet store owners, causing significant financial losses. This study emphasizes the occurrence and molecular characterization of polyomaviruses in budgerigars and non-budgerigar Psittacine species. Thirty-five feather Samples of adult birds and 15 tissue samples of deceased birds were collected for the detection of Avian polyomavirus based on the VP1 gene. Screening of samples by PCR revealed the presence of 550 bp VP1 gene in deceased nestlings of two lovebirds and four budgerigars, while the feather samples of adult birds were all negative for VP1 gene. The overall positive rate of APV in Psittacine birds was 6/50 (12 %), and the distribution frequency of virus among species was 4/19 (20 %) in Budgerigars and 2/31 (6.4 %) in non-budgerigar. Positive samples were subjected to partial sequencing which showed a nucleotide similarity index of VP1 gene between 97.46 % & 99.6 % with reference sequences in GenBank. The main problem that researchers are dealing with is the scarcity of data on the prevalence and identification of APV in Pakistan. This study is a milestone for further research on APV for the diagnosis and development of vaccines.

Effects of a Six-Month Physical Activity Program on Health Risk Factors and Body Composition Among Overweight and Obese Middle-Aged Adults.

Introduction. Physical activity is vital for preventing and managing lifestyle-related diseases, which pose significant health and socio-economic challenges. This study aimed to evaluate the effects of a six-month supervised physical activity program on health risk factors and body composition in middle-aged individuals with overweight or obesity. Methods. The study involved 166 men and women aged 30 to 65 years, with a body mass index (BMI) ranging from 26 to 35 and moderate to severe health risks. Participants of the study were engaged in a six-month physical activity training program designed in accordance with World Health Organization guidelines. Comprehensive assessments were performed at baseline and after the intervention, including measurements of various anthropometric and body composition parameters, as well as evaluations of functional performance. Fitness tests were also conducted to assess participants' physical capacity and to monitor improvements throughout the training period. Results. Baseline measures of body mass composition and age demonstrated a strong positive correlation with visceral fat rating (VFR) in both men (r = 0.364, p < 0.001) and women (r = 0.420, p = 0.002). Following the six-month training program, participants exhibited an average improvement of 30% (p < 0.001) in their Cooper endurance test results. The physical activity intervention positively impacted body mass index (BMI) and various body composition metrics, including fat mass, VFR, and muscle mass, across all participants and most subgroups (gender, BMI, and age). In males, training at higher maximum heart rate (HRmax) zones significantly contributed to a reduction in the percentage of fat mass (80-89% HRmax) and an increase in the percentage of muscle mass (70-79% and 80-89% HRmax). Conclusions. The study indicates that a six-month supervised physical activity program significantly improves health risk factors and body composition (visceral fat reduction and improvement in percent of fat and muscle mass) among middle-aged individuals with overweight or obesity. Therefore, we advocate for the integration of structured physical activity interventions into healthcare practices to effectively enhance health outcomes in this population.

High rates of Treponema pallidum, Neisseria gonorrhoeae, Chlamydia trachomatis, or Trichomonas vaginalis co-infection in people with HIV: a systematic review and meta-analysis.

People living with HIV (PWH) experience a disproportionate burden of sexually transmitted infections (STIs), leading to more severe health outcomes and increasing the risk of HIV transmission. The presence of untreated STIs can accelerate HIV disease progression, while HIV infection can complicate STI diagnosis and treatment. Despite this interconnectedness, comprehensive data on the global prevalence of specific STIs among PWH remain limited. This systematic review aims to synthesize existing data to provide a more accurate picture of the prevalence of co-infection with Treponema pallidum, Neisseria gonorrhoeae, Chlamydia trachomatis or Trichomonas vaginalis in PWH, while also identifying critical knowledge gaps and informing future research priorities. We searched databases for eligible studies reporting the prevalence of Treponema pallidum, Neisseria gonorrhoeae, Chlamydia trachomatis, or Trichomonas vaginalis among PWH, published from January 1, 2000, to February 1, 2023. From 22,290 identified articles, 127 independent studies meeting the inclusion criteria were included in this meta-analysis. The overall global co-infection prevalence of Treponema pallidum, Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis in PWH, was 4.8% (95%CI: 4.7-5.0%), 0.8% (95%CI: 0.6-0.9%), 2.5% (95%CI: 2.2-2.7%), and 3.0% (95%CI: 2.7-3.3%), respectively. The global prevalence of these four STIs in PWH is high, especially in Africa and Southeast Asia and in MSM and TGW populations. Based on the subgroup analyses, we further found that there was a high prevalence of Treponema pallidum and Chlamydia trachomatis in Southeast Asia and a high infection of Trichomonas vaginalis in the whole of Africa. Treponema pallidum infection was more common in males than females, and Chlamydia trachomatis and Trichomonas vaginalis infections were more common in females than males. Besides, high infection rates of Treponema pallidum, Neisseria gonorrhoeae, and Chlamydia trachomatis were detected in men who have sex with men (MSM) + transgender women (TGW), while high infection rates of Trichomonas vaginalis were found in sex workers and pregnant women. The study confirmed high prevalence of four sexually transmitted pathogens in PWH, noting regional, gender, and subpopulation-specific differences. It offered insights for targeted interventions and healthcare strategies. The research underscored the necessity for enhanced data collection and expanded screening/treatment for vulnerable populations and regions.

Estimated number of COVID-19 deaths averted by vaccination in Belgium

Abstract Background Vaccination campaigns have been rolled out globally to limit the impact of COVID-19 on severe health outcomes, including mortality. We aimed to estimate the number of averted deaths by COVID-19 vaccination in the Belgian population aged ≥65 years, between January 2021 and January 2023. Methods Nationwide data on COVID-19 infections, vaccinations and all-cause mortality were individually linked. We estimated Vaccine Effectiveness against COVID-19 mortality (VE) in persons having received a vaccine dose in the last 6 months using a Cox proportional hazards model adjusted for age, sex, time since vaccination, previous infection, comorbidities, province and income. COVID-19 death was defined as a death within 1-7 weeks after a positive SARS-CoV-2 laboratory-test. Based on obtained VE estimates, vaccine coverage and national COVID-19 mortality data, we estimated the number of averted deaths (expected deaths without vaccinating minus the reported deaths). Results By January 31st 2023, 11,033 COVID-19 deaths have been reported in Belgium. The average vaccine coverage was 48% during alpha, 85% during delta and 63% during omicron dominance. VE was estimated at 0-59 days after vaccination, for 65-79 year and ≥80 year-olds respectively, at 65% (58%-60%) and 35% (28%-41%) during Alpha, at 84% (82%-87%) and 79% (77%-81%) during Delta and at 83% (80%-85%) and 71% (68%-73%) during Omicron dominance. We estimated 10,042 deaths averted (range: 8,917-11,188) among the Belgian population aged ≥65 years, representing a 48% reduction (range 45%-50%) in the expected deaths. Out of 10,042 averted deaths, the majority was averted during Delta (47%; 4,670) or Omicron dominance (43%; 4,366), compared to during Alpha dominance (10%; 1,006). Conclusions Vaccinating against COVID-19 led to an important reduction in COVID-19-related mortality among the Belgian population ≥65 years, in particular during Delta and Omicron dominance, underscoring the effectiveness of vaccines against mortality. Key messages • Vaccinating against COVID-19 led to an important reduction of 48% in COVID-19-related mortality among the Belgian population ≥65 years, in particular during Delta and Omicron dominance. • Vaccine effectiveness against COVID-19 mortality was estimated as high in the Belgian population ≥65 years (range: 71-84%) during Delta and Omicron dominance, also among elderly over 80 years.

Influence of postpartum depression on maternal-infant bonding and breastfeeding practices among mothers in Abeokuta, Ogun state

BackgroundPostpartum Depression (PPD) is a severe mental health condition that adversely affects mothers and their infants. The influence of PPD on maternal-infant bonding and breastfeeding practices has been scarcely reported in Nigeria. Therefore, we examined the prevalence of PPD, the associated factors, and the relationship with maternal-infant bonding and breastfeeding practices in Abeokuta, Nigeria.MethodA descriptive cross-sectional survey was conducted among 600 mothers within the extended postpartum period (≤ 1 year) from three government-owned immunisation clinics at primary, secondary, and tertiary health facilities in Abeokuta, Ogun State. PPD was assessed using the Edinburgh postnatal depression Scale (EPDS ≥ 13), and maternal-infant bonding was evaluated using the Postpartum Bonding Questionnaire (PBQ ≥ 50). We also examined breastfeeding practices (i.e. the time to initiation by 30 min, exclusive breastfeeding for 6 months and early commencement of complementary feeding by 2 months). Data was analysed using chi-square and logistics regression models at a 5% significance level.ResultsThe prevalence of PPD was 21.8%, 95% CI (18.7–25.3). Factors associated with PPD were maternal age: 25–34 years [AOR = 0.52; 95% CI (0.29–0.90)]; ≥ 35 years [AOR = 0.44; 95% CI (0.20–0.96)], being married [AOR = 0.43; 95% CI (0.21–0.85)], perceived stress increased the odds of PPD: moderate stress level [AOR = 8.38; 95% CI (3.50–19.9)]; high-stress level [AOR = 47.8; 95% CI (8.65–263.7)] and self-reported history of emotional problems [AOR = 3.25; 95% CI (1.43–7.38)]. There was a significant direct association between PPD and poor maternal-infant bonding [AOR = 3.91; 95% CI (1.04–4.60)]. PPD reduces the odds of early breastfeeding initiation [AOR = 0.43; 95% CI (0.28–0.68)], but no association was found between PPD and exclusive breastfeeding [AOR = 1.07; 95% CI (0.07–1.67)].ConclusionThe prevalence of PPD was high in our study population and associated with poor maternal-infant bonding and late breastfeeding initiation but not with exclusive breastfeeding. Promoting maternal mental health to foster stronger mother-infant relationships and better breastfeeding practices has become crucial.

Risk factors of obstructive sleep apnea syndrome in the developmental age

Background: Obstructive Sleep Apnea Syndrome (OSAS) is a prevalent respiratory sleep disorder in children, associated with severe health consequences, including hypertension, cardiac dysfunction, and neurocognitive impairment. Despite extensive research on OSAS in adults, the risk factors for pediatric OSAS remain underexplored. Objective: This literature review aims to identify and present the key risk factors associated with pediatric OSAS based on contemporary studies. Methods: A systematic search of the PubMed and Scopus databases was conducted for literature published between 2016 and 2024. Search terms included “obstructive sleep apnea,” “children,” and “risk factors.” A total of 93 relevant studies were reviewed after excluding non-pediatric and irrelevant papers from an initial pool of 283. Results: The most commonly identified risk factors for pediatric OSAS include adenoid and tonsillar hypertrophy, obesity, craniofacial abnormalities, and asthma. Additional risk factors such as allergic rhinitis, recurrent upper respiratory infections, nasal stenosis, congenital diseases, low vitamin D levels, and preterm birth were also noted. Conclusion: Pediatric OSAS is influenced by multiple factors, including anatomical, physiological, and genetic components. Further research is required to explore emerging risk factors, such as role of vitamin D deficiency and microbiota, and to clarify the impact of variables like ethnicity and breastfeeding.

Atypical Foreign Body Ingestion for Suicide

The ingestion of foreign bodies can cause severe health issues such as bleeding, perforations, and obstructions. The majority of gastrointestinal foreign bodies discovered in adults result from intentional ingestion, often found in patients with preexisting psychiatric conditions. In the literature, there are few similar cases of voluntary ingestion of a fork that has passed through the esophagus to the duodenum. We present a case of a 33-year-old man with a psychiatric disorder who presented to the emergency room five months after ingesting a fork, which was discovered incidentally during imaging evaluations. He had complained of epigastric pain lasting for a month, leading to the search for a cause. An abdominopelvic CT scan revealed a linear structure in the D2 and D3 segments, creating a metallic artifact, obstructing wall exploration, and measuring 9x136 mm. The patient underwent surgical extraction via laparotomy under general anesthesia, and the postoperative course was uneventful.

Hepatitis B Virus-Associated Liver Carcinoma: The Role of Iron Metabolism and Its Modulation.

Hepatitis B virus (HBV) infection is a significant contributor to the development of hepatocellular carcinoma (HCC), a leading cause of cancer-related mortality worldwide. Iron, a central co-factor in various metabolic pathways, plays an essential role in liver function, but its dysregulation can lead to severe health consequences. Accumulation of iron within hepatic cells over time is linked to increased liver injury and is strongly associated with sensitive exposure to a range of conditions, including cirrhosis, fibrosis and ultimately, HCC. This review explores the intricate interplay between iron metabolism and HCC within the context of HBV infection. Hepatic iron overload can arise from liver injury and disruptions in iron homeostasis, causing hepatic necrosis, inflammation, and fibrosis, ultimately culminating in carcinogenesis. Moreover, alterations in serum iron components in HBV-related scenarios have been observed to impact the persistence of HBV infection. Notably, the progression of HBV-associated liver damage exhibits distinct characteristics at various stages of liver disease. In addition to elucidating the complex relationship between iron metabolism and HCC in the context of HBV infection, this review also investigates the prognostic implications of systemic iron levels for HCC. Furthermore, it aims to provide a comprehensive understanding of the intricate interplay between iron metabolism and HCC, extending the discussion to the context of hepatitis C virus (HCV) infection. By shedding light on these multifaceted connections, this review aims to contribute to our understanding of the pathogenesis of HBV-associated HCC and potentially identify novel therapeutic avenues for intervention.

Examining the measurement of severity of intimate partner violence and its association to mental health outcomes: a narrative synthesis.

The aims of this synthesis were to investigate the relationship between IPV severity and mental health outcomes and shed light to gaps and limitations in existing methodologies used to assess IPV severity and its association with mental health outcomes. We conducted a two-stage narrative synthesis of 76 studies. First, we identified IPV measures used in at least five studies, focusing on their variations and severity score calculation. Then, we analyzed findings of studies correlating IPV severity with mental health outcomes, identifying features of measures and statistical methods influencing result consistency. Measures of intimate partner violence were often modified from their original, potentially impact on the reliability and validity of these measures. The operationalization of violence severity varied across studies, leading to inconsistencies in scoring whereby compromising the consistency of severity levels across studies. We found lack of consistency in applying validated methods for scoring instruments to determine abuse severity. In this review, we consistently found that the severity of IPV and its various subtypes were linked to different mental health outcomes across multiple studies. We discovered evidence suggesting that experiencing more types of IPV was associated with worse mental health outcomes. Generally, higher levels of overall IPV severity and its specific subtypes were correlated with poorer mental health outcomes. However, our analyses did not reveal consistent patterns that would allow for a definitive determination of how individual IPV subtypes differently affect mental health outcomes. Nevertheless, we observed that increasing severity of physical IPV tended to have a notable impact on post-traumatic stress disorder (PTSD). Conversely, increasing severity of psychological IPV was consistently associated with depression. While sexual IPV severity was explored in fewer studies, the evidence regarding its impact on various mental health outcomes was less conclusive. To achieve a comprehensive understanding of the mechanism by which IPV severity is related to mental health it may be time to take an alternative approach to measuring IPV severity. No IPV measures assessed the acceptability of the content to people who have experienced IPV. This is an important omission with significant consequences for the validity of the evidence base.

An Uncommon Case of Plasmodium vivax Malaria with Disseminated Intravascular Coagulation: Rare Case Report with Review of Literature.

Malaria is a severe health issue in India despite government efforts. Malaria has many complications, some of which can be life-threatening. Disseminated intravascular coagulation (DIC) is a prominent malaria complication, besides renal failure, cerebral malaria, pulmonary edema, and anemia. We report a young man with Plasmodium vivax malaria who developed septic shock due to DIC. A 25-year-old male had a fever, abdominal pain, vomiting, and nausea for 5 days. On clinical examination, the patient was in distress and had a fever of 102.6°F with a blood pressure of 86/46 mmHg. A complete blood count revealed anemia, leukocytopenia, and severe thrombocytopenia. Peripheral blood smear findings showed a P. vivax parasite in red blood cells with the presence of a few schistocytes. Further coagulation tests showed raised prothrombin, partial thromboplastin time, and d-dimer. DIC and septic shock required critical care unit admission. Conservative treatment with artesunate and lumefantrine completely cured him. This unusual case shows that P. vivax causes severe malaria and its morbid consequences. It stresses early diagnosis and treatment to prevent mortality and morbidity.

Biofabricated silver nanoparticles from Calotropis procera: A potential antimicrobial solution against pathogenic bacteria

Calotropis procera has the potential as a traditional medicinal plant that offers a diverse array of healing treatments. It was used in conventional medicine to remedy several ailments, including diarrhea and snakebites. This study examines the antibacterial properties of silver nanoparticles derived from the floral and latex components of C. procera. The nanoparticles were tested for their effectiveness against Gram-negative and Gram-positive bacterial strains. For characterization, the synthesized nanoparticles underwent thorough analysis using UV spectroscopy, fourier-transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and scanning electron microscopy (SEM). After the reduction process, the FTIR analysis revealed that some functional biomolecules found in plants form a coating on the nanoparticles, serving as organic agents that stabilize the nanoparticles. The size of nanoparticles analyzed with SEM falls in the 30 to 130 nm range. Furthermore, the synthesized silver nanoparticles were tested as antimicrobial agents against Escherichia coli, Bacillus subtilis, Staphylococcus aureus, and Pseudomonas aeruginosa, well-known microorganisms that can produce ulceration phases and severe health consequences. After a comprehensive examination, it was found that the silver nanoparticles have significant antibacterial effectiveness, particularly against S. aureus, a primary bacterium responsible for causing different ailments. The remarkable antibacterial efficacy of the silver nanoparticles synthesized in an environment-friendly manner underscores its potential applications in combating the evolution of antibiotic-resistant strains.

Evaluation of the Epitogen Lyme Detect IgG ELISA: a novel peptide multiplexing approach.

Lyme Borreliosis (LB), or Lyme disease, is a growing health concern caused by Borrelia burgdorferi sensu lato (Bbsl) bacteria transmitted through tick bites, and untreated cases can lead to severe health complications. Existing serology tests, while valuable, have low sensitivity in early infection stages where diagnosis is vital, interpretation variability, and false positives from cross-reactivity, while direct detection methods also suffer from low sensitivity, due to the inconsistent presence of Bbsl components in clinical samples. This study validated the diagnostic performance of the novel Epitogen Lyme Detect IgG enzyme-linked immunosorbent assay (ELISA) based on scaffold-displayed peptide antigens, using 120 specific immunodominant epitopes selected from 37 antigenic bacterial proteins corresponding to the main pathogenic Bbsl genospecies. Using 220 serum samples from Scottish patients with early, late, and disseminated LB, the assay's sensitivity was compared with that of the LIAISON Borrelia IgG CLIA, while specificity was assessed with 198 control samples, including healthy individuals and patients with diseases that are humorally similar. The Epitogen Lyme Detect IgG assay demonstrated comparable performance to the LIAISON Borrelia IgG in disseminated and late LB (Lyme neuroborreliosis, acrodermatitis chronica atrophicans, and Lyme arthritis). Notably, the Epitogen Lyme Detect IgG showed significantly higher sensitivity in patients with suspected erythema migrans, while maintaining high specificity. The Epitogen Lyme Detect IgG ELISA offers a promising advancement in LB diagnostics, demonstrating its potential for more accurate and timely diagnosis, particularly in the early stages of LB infection.IMPORTANCELyme Borreliosis (LB), caused by Borrelia burgdorferi sensu lato bacteria, poses significant health risks if undiagnosed or diagnosed late. Current diagnostic tests have limitations, especially in early-stage detection. This study validates the Epitogen Lyme Detect IgG enzyme-linked immunosorbent assay, demonstrating superior sensitivity in early LB detection while maintaining high specificity. The Epitogen Lyme Detect IgG comprises a suite of 120 immunodominant IgG epitopes/peptides from 37 bacterial antigens, covering the main LB-causing species: Borrelia burgdorferi sensu stricto, Borrelia afzelii, Borrelia garinii, and Borrelia mayonii. The novel design of multiplexing peptide antigens onto a scaffold to facilitate expression, correct folding, and orientation of the relevant peptides offers a promising advancement, potentially leading to more accurate and timely LB diagnoses and improving patient outcomes.