Epidemiological Studies Research Articles

ASD: Interaction and socialisation through an adapted social network

Epidemiological studies have demonstrated a significant increase in the incidence of Autism Spectrum Disorder (ASD) in the population over the years. Estimates indicate that approximately 1% of children worldwide are diagnosed with autism, while in the United States, this ratio is 1 in every 36 children. Additionally, research suggests a growing interest in technology among autistic children, with the use of computing devices showing potential for the development of social and emotional skills. Digital technology is widely recognized for playing a crucial role in promoting social inclusion and improving the quality of life for people with disabilities. In this context, social networks offer a virtual environment for entertainment and interaction among various groups of individuals. This project aims to present a social network platform specifically developed for adolescents with Autism Spectrum Disorder. The project incorporates various accessibility concepts and strategies to promote interaction and socialisation among community members. Usability and accessibility evaluations were conducted in different ways. First, an initial usability test, conducted within the scope of the tool's development, involved two students and a professor in the field of HCI. Subsequently, the usability of the social network was evaluated by three specialists using Nielsen's heuristic evaluation technique, revealing few usability issues, as presented in this article. Furthermore, usability inspections were conducted using automated tools, identifying x issues, as described in the text. Finally, a test with an ASD specialist was conducted, whose considerations indicate good clinical use prospects for the tool, which are detailed in this article.

Characterising "obesogenic" versus "protective" food consumption, and their value chain among Ghanaian households.

This paper explores the characteristics of Ghanaian households' consumption of obesogenic versus protective foods, including their retail, distribution, and origin. A household food consumption survey was conducted using an adapted Prospective Urban and Rural Epidemiology study Food Frequency Questionnaire. Product pathways for selected obesogenic (processed meat, Sugar-Sweetened Beverages, and biscuits) and protective (cooked vegetables, legumes, and fish) foods were traced from retailers through distributors/wholesalers to producers. Rural and urban communities in the Ashanti Region and selected retail/wholesale/producers nationwide. 612 households, 209 retailers and 185 wholesalers/distributors. About 20% of households consume Sugar-Sweetened Beverages (SSB) and confectionery weekly, and just 2% consumed processed meat. Of the protective foods, fish had the highest proportion of households consuming weekly (74.5%), followed by cooked vegetables (53.1%) and legumes (22.8%). Frequent SSB consumption is higher in younger (p<0.001), male (p=0.010), urban (p<0.001), and more educated (p<0.001) food purchaser households. Below 10% of households followed the healthiest dietary pattern (high-protective-and-low-obesogenic) but higher in older and more educated food purchaser households. In contrast, most households (about 80%) consumption patterns did not discriminate between obesogenic and protective foods. Generally, characteristics of purchasers from retail/wholesale outlets agree with those of households, where obesogenic foods were retailed to younger, less educated buyers than older, more educated ones. While the protective foods had a strong local producer presence, the obesogenic foods were predominantly imported. Household consumption and retail/distribution of obesogenic foods are associated with socio-demographic characteristics, but obesogenic foods are almost entirely produced outside Ghana. Policies that regulate importation on health grounds can promote a healthier food environment.

How do large scale population studies inform vaccine evaluations in England?

Large scale population studies are important to monitor and evaluate aspects of a vaccination programme including vaccine coverage, real-world effectiveness, and post-licensure vaccine safety. These types of epidemiological studies often come under the remit of public health agencies, such as the UK Health Security Agency (UKHSA) in England, who are required to undertake surveillance of vaccine preventable diseases, including via seroepidemiological studies and data linkage studies using national level electronic healthcare data. An individual level national vaccine register with an accurate denominator can be the key to gaining insights into vaccine coverage, effectiveness and safety. During the COVID-19 pandemic, England's first vaccine register was developed. This enabled timely estimates of real-world vaccine effectiveness in the whole population of England, as well as enabling epidemiological investigations of rare potential risks from vaccines in specific populations. Population-based research studies, including prospective cohort studies are complementary to surveillance, and combined, enable more comprehensive assessments. As there was unprecedented investment into research studies and infrastructure during the pandemic, the scale of these studies meant they were able to contribute to vaccine programme evaluations in a way that had not been possible for previous vaccine programmes. In this review, we summarise the different large scale surveillance and research studies that have been used to evaluate and inform vaccine policy from the time of the first data linkage studies undertaken in England in the 1990s to the present day post-COVID-19 pandemic.

Accessory Infraorbital Foramen: Prevalence in the Mexican Population by Tomographic Study

Objective: The accessory infraorbital foramen (AIOF) has been reported to have a prevalence of up to 47.6% in the global population. Cadaveric studies have observed that components of the infraorbital neurovascular bundle may emerge through the AIOF. The objective of this study was to determine the prevalence of the AIOF in the Mexican population. Methods: A cross-sectional, observational, descriptive epidemiological study was conducted, analyzing skull computed tomography (CT) scans with three-dimensional reconstruction from 345 randomly selected Mexican patients performed between 2015 and 2022. The presence of the AIOF was assessed, including its area, location, laterality, and number. Descriptive statistical analysis was performed using IBM SPSS Statistics version 25.0. Results: The presence of the AIOF was found in 17.8% (58 cases), with 11% in men and 6.8% in women. The majority of cases (73.9%) had a superomedial location. The AIOF was found bilaterally at 48.3%, on the left side at 41.4%, and on the right side at 10.3%. Of these, 96.6% were single, and 3.4% were double; no triple or quadruple AIOFs were observed. The average area of the AIOF was 2.9 mm². Conclusions: Awareness of the presence of the AIOF is crucial for preventing inadvertent injuries to the infraorbital neurovascular bundle during procedures involving the infraorbital area, both medical and surgical, thereby reducing the risk of complications. The use of three-dimensional tomographic reconstruction offers more accurate and precise knowledge when planning these procedures.

Associations of four obesity indices with diabetes mellitus in Korean middle-aged and older adults using the Korean Genome and Epidemiology Study (KoGES)

BackgroundObesity is associated with a high risk of diabetes mellitus (DM); therefore, obesity-related indices are strongly associated with DM. This study evaluated the association of obesity indices, including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and a body shape index (ABSI), with DM in Korean middle-aged and older adults.MethodsData from three population-based cohorts (Ansan and Ansung, Health Examinee, and Cardiovascular Disease Association Study, derived from the Korean Genome and Epidemiology Study) were analyzed. Logistic analysis was used to evaluate the association of BMI, WC, WHR, and ABSI with DM, after adjusting for covariates according to sex and age. The integrated discrimination index (IDI) and category-free net reclassification improvement (cfNRI) and area under the curve (AUC) of the receiver operating characteristic (ROC) curve were analyzed by age group to investigate index-specific model performance.ResultsAmong the 160,585 participants, 13,846 had DM (6,837; men [11.86%] and 7,009 women [6.81%]). Age increase was associated with an increased prevalence of DM: 2,339 (4.01%), 5,313 (8.74%), and 6,194 (14.93%) in the 40–49, 50–59, and ≥ 60 years age groups. After adjusting for covariates, the odds ratios (OR) for DM of WHR and WC were higher than those of the other indices in every age group. However, the OR for WHR, WC, and BMI decreased with age in both sexes. ABSI showed steady and slightly increasing ORs with increasing age although the ORs in both sexes were generally low for DM. For IDI and cfNRI, WHR had the highest values among all age groups. The AUC of the ROC curve showed that the WHR had the highest value in all age groups.ConclusionThe WHR had the strongest association with DM, but was not a good DM index in older people. Therefore, age-related index criteria for DM, especially in women, were needed for the effective prevention and management of DM.

The prevalence of thromboembolic events among COVID-19 patients admitted to a single centre intensive care unit (ICU): an epidemiological study from a Malaysian population

The prevalence of thromboembolic events among COVID-19 patients admitted to a single centre intensive care unit (ICU): an epidemiological study from a Malaysian population

Effect of Feeding Human Milk on Development of the Infant Immune System and Allergic Outcomes-An Area of Research Challenge and Need.

Surprisingly little is known about the effect of breastfeeding on the infant's immune system development. Systematic reviews have suggested the role of breastfeeding in the prevention against asthma, autoimmune diseases, inflammatory bowel disease, and childhood leukemia. However, studies on atopic disease suffer from reverse causation, small size, and those assessing food allergy (FA) have often relied on parent-reported outcomes. Randomized controlled trials (RCTs) are not possible for ethical reasons. In addition, epidemiological studies have not considered that there is a large interindividual variation in human milk (HM) composition and feeding at the breast versus pumped HM potentially impacting the effect of breastfeeding between mothers. While prevention strategies such as early introduction of highly allergenic food are impactful in preventing peanut and egg allergies, implementation of early introduction guidelines has been slow, and many infants are already sensitized by 4-6 months of age. To be more effective, primary prevention strategies must commence much earlier, during breastfeeding. There are studies that imply a definitive effect of breastfeeding on the gut microbiome and regulatory T cells (Tregs) as well as a higher rate of FA in populations with historically low rates of breastfeeding. These provide a strong rationale for assessing the effect of feeding HM in the context of HM composition and mode of feeding on immune development. The lack of well-conducted, large studies assessing the role of breastfeeding and HM composition in the development of immune system development is a significant gap when designing prevention strategies.

Low dose deltamethrin exposure affects gene expression in rat frontal cortex

Pyrethroids are a class of commonly used synthetic insecticides, widely used in agricultural and residential settings due to their efficacy and relatively low environmental impact. Nonetheless, epidemiological studies have found that exposure to pyrethroids during developmental stages is linked to risk for neurodevelopmental disorders. However, the molecular mechanisms behind these neurotoxic effects remain unclear. Our study investigates the impact of oral exposure to deltamethrin, a widely used Type II pyrethroid pesticide, on gene expression in the frontal cortex of rats. We used differential gene expression data from frontal cortex dissections from male Long-Evans rats exposed to a 3 mg/kg oral dose of deltamethrin (or vehicle) to perform a 3Pod analysis in R Studio, which included GSEA, Enrichr, and iLINCS analyses. We found that rats who were exposed to deltamethrin had significant changes in gene expression in cortex in pathways related to inflammation, apoptosis, cellular energy metabolism, and synapses. Our study provides important insight on the effects of pesticide exposure on the brain and possible treatments and preventions. This study also emphasizes the need for further research on pyrethroid pesticides and their relationship to neurodevelopmental disorders.

Differential protection against SARS-CoV-2 reinfection pre- and post-Omicron

Abstract The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly evolved over short timescales, leading to the emergence of more transmissible variants such as Alpha and Delta1–3. The arrival of the Omicron variant marked a major shift, introducing numerous extra mutations in the spike gene compared with earlier variants1,2. These evolutionary changes have raised concerns regarding their potential impact on immune evasion, disease severity and the effectiveness of vaccines and treatments1,3. In this epidemiological study, we identified two distinct patterns in the protective effect of natural infection against reinfection in the Omicron versus pre-Omicron eras. Before Omicron, natural infection provided strong and durable protection against reinfection, with minimal waning over time. However, during the Omicron era, protection was robust only for those recently infected, declining rapidly over time and diminishing within a year. These results demonstrate that SARS-CoV-2 immune protection is shaped by a dynamic interaction between host immunity and viral evolution, leading to contrasting reinfection patterns before and after Omicron’s first wave. This shift in patterns suggests a change in evolutionary pressures, with intrinsic transmissibility driving adaptation pre-Omicron and immune escape becoming dominant post-Omicron, underscoring the need for periodic vaccine updates to sustain immunity.

Epidemiological Investigation of Unplanned Intensive Care Unit Admissions From the Operating Room After Elective Surgery: A Nationwide Observational Study in Japan.

Over 75% of surgeries worldwide are elective and unplanned ICU admissions after these surgeries pose a major-albeit rare-challenge. However, few epidemiological studies have focused on patients requiring unplanned ICU admission directly from the operating room after elective surgeries are lacking. This study uses the Japanese Intensive Care Patient Database (JIPAD) to describe unplanned ICU admissions after elective surgeries. We conducted a multicenter retrospective cohort study using data from the JIPAD from April 2015 to March 2022, focusing on patients with unplanned ICU admissions after elective surgery. Collected variables included patient characteristics, treatments, outcomes, reasons for ICU admission, and type of surgery. We categorized the reasons for ICU admission into 9 types: anaphylaxis, hemorrhage, anesthesia-related complications, respiratory-related complications, cardiovascular-related complications, neurological-related complications, surgical-related complications, electrolyte/acid-base abnormalities, and unknown causes. The type of surgery was classified using JIPAD definitions. Among 141,969 patients in the JIPAD who underwent elective surgery, 2666 patients (1.9%) required an unplanned ICU admission. Cardiac arrest before ICU admission occurred in 52 patients (2.0%), the median APACHE III score was 51, and 1218 patients (45.7%) required postoperative mechanical ventilation. The median hospital stay for patients with unplanned ICU admission was 21 days and in-hospital mortality was 3.3% (88/2666). The most common reason for ICU admission was respiratory complications (n = 440, 16.5%), followed by hemorrhage (n = 377, 14.1%). Cardiovascular-related complications had the highest in-hospital mortality at 6.8% (20/294). Hospital mortality exceeded ICU mortality, suggesting that patients expected to derive limited benefit from intensive care may have been transitioned out of the ICU to accommodate other patients with greater need. The most frequent surgeries requiring unplanned ICU admission were for gastrointestinal neoplasms (n = 464, 17.4%), followed by orthopedic surgeries (n = 303, 11.4%). Anaphylaxis occurred across a broad spectrum of surgeries. Respiratory-related complications were common in patients with other respiratory diseases and accounted for over half of the total number of cases according to surgery type. Neurological-related complications were most frequent in craniotomies for neoplasms. In our review of a nationwide ICU database from 2015 to 2022 we identified a 1.9% rate of unplanned ICU admission and found that mortality varied according to the reasons for ICU admission. Respiratory-related complications were most common, and cardiovascular complications were most associated with in-hospital mortality. Further research may help us to better understand the epidemiology of unplanned ICU admission after surgery.

Health effects of indium compounds in animal experiments.

Before 2000, very little attention had been paid to the health effects of indium, a rare metal, because there was very little information in the literature on its toxicity. A fatal case of indium-tin oxide (ITO) inhalation occurred in 2001, followed by concerns regarding occupational exposure to indium compounds and their health effects. Epidemiological studies and case reports have established a causal relationship between the inhalation of insoluble indium compounds, mainly ITO and the development of lung damage. This review has focused on the results of animal studies of ITO and other insoluble indium compounds. Available data indicate that insoluble indium compounds such as ITO, indium arsenide (InAs), indium phosphide (InP), copper indium gallium, and diselenium (CIGS) solar cell materials are toxic to the lungs of animals. In addition to lung damage, ITO nanoparticles have been found to cause kidney damage, while InAs, InP, and ITO cause testicular damage. Furthermore, InP has demonstrated compelling evidence of its carcinogenic potential in long-term inhalation studies using rats and mice, which was evident in rats exposed to ITO. Based on the results of these animal experiments, the International Agency for Research on Cancer evaluated InP as probably carcinogenic to humans (Group 2A) and ITO as possibly carcinogenic to humans (Group 2 B). Hence, occupational exposure of humans to insoluble indium compounds not only causes lung damage, but also lung carcinogenesis and kidney or testicular damage. Greater attention should be directed towards human occupational exposure to insoluble indium compounds.

Modelling extensions for multi-location studies in environmental epidemiology.

Multi-location studies are increasingly used in environmental epidemiology. Their application is supported by designs and statistical techniques developed in the last decades, which however have known limitations. In this contribution, we propose an improved modelling framework that addresses these issues. Specifically, this flexible framework allows the direct modelling of demographic differences across locations, defining geographical variations linked to multiple vulnerability factors, capturing spatial heterogeneity and predicting risks to new locations, and improving the assessment of uncertainty. We illustrate these new developments in an analysis of temperature-mortality associations in Italian cities, providing fully reproducible R code and data.

Primary Sites and Clinicopathological Features of Corneal Melanoma: A Surveillance, Epidemiology, and End Results (SEER) Population-based Study of 29 Cases

Purpose: Corneal melanoma (CM) is a rare malignancy that develops from melanocytes within the cornea, constituting a minority of all ocular tumors. In this study, we sought to investigate the clinicopathological characteristics correlated with the prognosis of CM patients.Methods: We collected patients with CM between 1983 and 2018 from the Surveillance, Epidemiology, and End Results (SEER) database. Cox proportional hazards regression was used for univariate analysis to value hazard ratio of malignant CM versus spindle cell melanoma and nodular melanoma subgroups. Kaplan-Meier survival analysis and log-rank test were also performed to identify additional prognostic markers and confirm the findings of the Cox hazard ratio.Results: A total of 29 eligible patients were collected in our study. Age at diagnosis, laterality, primary site, tumor size, the extent of disease, marital status, income, residential area, and treatment showed no significant prognostic factors for CM patients (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). However, when concerned with the primary site of malignant melanoma, spindle cell melanoma and nodular melanoma were found to show significantly poorer prognosis in CM patients (both &lt;i&gt;p&lt;/i&gt; &lt; 0.05).Conclusions: Age at diagnosis, laterality, primary site, tumor size, the extent of disease, and treatment were not significant prognostic indicators for CM patients. Spindle cell melanoma and nodular melanoma were notable for showing worse survival outcomes than malignant melanoma. Although the sample size in the SEER database was limited, our findings may provide motivation for tailoring individualized treatments for patients with CM with different primary sites.

Association Between Biomass Fuel Use and Depression Symptoms in the Adult Population of Oaxaca, Mexico

Background: The impact of biomass fuel exposure on mental health, along with the associated gender disparities, remains largely unexplored. This study aimed to examine the association between biomass fuel use and depressive symptoms in the population of Oaxaca, Mexico, while also identifying gender differences in this relationship. Methods: This study used data from the 2022 National Health and Nutrition Survey (ENSANUT). Depressive symptoms, the outcome variable, were assessed using the Center for Epidemiologic Studies Depression Scale (CESD). The primary predictor variable was biomass fuel use, with gender, age, and residency stratum included as covariates. First, a binary logistic regression model was developed to estimate the dichotomous variable “depression symptoms”. Subsequently, a second binary logistic regression model was constructed to evaluate potential interactions between the covariates and the predictor variable. Findings: The sample included 1.4 million adults from Oaxaca, with a prevalence of depressive symptoms of 15%. Biomass fuel was used by 15.4% of the population. The first logistic regression model showed that women (Odds Ratio (OR): 1.249; 95% CI: 1.235–1.263; p &lt; 0.001), individuals aged 60 years and older compared to the younger population group (OR: 12.192; 95% CI: 12.064–12.321; p &lt; 0.001), those residing in rural areas (OR: 1.245; 95% CI: 1.232–1.259; p &lt; 0.001), and individuals using firewood or charcoal for cooking (OR: 1.674; 95% CI: 1.651–1.697; p &lt; 0.001) had higher odds of depressive symptoms. In the second binary logistic regression model, all associations and OR coefficients retained their direction, although the coefficients underwent a slight adjustment following the introduction of the interaction term, indicating the presence of an interaction. Conclusions: The study findings suggest a gendered association between biomass fuel exposure and depressive symptoms in the adult population of Oaxaca, with older women and women dwelling in rural areas being the most vulnerable. Interventions aimed at reducing biomass air pollution exposure and strengthening mental health support for women are strongly recommended.

Predictors of depression among Chinese college students: a machine learning approach

BackgroundDepression is highly prevalent among college students, posing a significant public health challenge. Identifying key predictors of depression is essential for developing effective interventions. This study aimed to analyze potential depression risk factors among Chinese college students using the Random Forest Algorithm (RFA) and to explore gender differences in risk patterns.MethodsA cross-sectional study was conducted with 10,043 undergraduate students from Guizhou Normal University. Thirty-three variables were analyzed using RFA. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D), with a score of ≥ 16 indicating depression risk. The variables included sociodemographic characteristics, physical and psychological health indicators, behavioral and lifestyle factors, socioeconomic conditions, and family mental health history.ResultsThe RFA identified several factors associated with depression risk, with suicidal ideation, anxiety, and sleep quality exhibiting the strongest associations. Other significant predictors included academic stress, BMI, vital capacity, psychological resilience, physical fitness test scores, major satisfaction, and social network use. The model achieved an accuracy of 87.5% and an AUC of 0.927. Gender-stratified analysis suggested different patterns: physical fitness indicators showed stronger associations with depression risk among male students, while BMI was more strongly associated with depression risk among female students.ConclusionsThis cross-sectional study identified factors associated with depression risk among Chinese college students, with psychological factors showing the strongest associations. Gender-specific patterns were observed, suggesting the importance of considering gender differences when developing mental health interventions. However, longitudinal studies are required to establish causal relationships and validate these findings through intervention trials.

Smartwatches in the assessment of heart failure patients in epidemiology and pathophysiology studies: A scoping review.

A limited number of studies with smartwatches (SWs) investigated their potential in the field of heart failure (HF). The aim of this scoping review is to understand the extent of current literature on SWs in the HF population and the device's potential to improve disease management. The literature search was performed on PubMed and Embase in March 2024. Inclusion criteria included the use of commercialized SWs, HF diagnosis and peer-reviewed publications. Articles were excluded if the SW was not the study intervention or was part of a broader intervention programme. Reviews, case reports and study protocols were excluded. Of 1200 identified articles, 13 were included in the scoping review, encompassing 1171 patients with HF, and findings were presented in a descriptive summary table. Validity of several SW-collected physiological metrics was assessed against established technologies. Heart rate and step count measures were deemed moderately accurate in the HF population with Fitbit trackers (n=5 patients, r=0.54) and Garmin watches [n=15 patients (mean age: 65.5±12.6years), concordance correlation coefficient (CCC)=0.89 for Vivofit 1 and CCC=0.92 for Vivofit 3], respectively, while calorimetry was the least reliable measurement [n=19 patients (mean age: 65.1±6.6years), mean difference to indirect calorimeter: P=0.01 for Fitbit Charge 2, P=0.02 for Mio Slice]. Wrist-worn activity trackers were positively received by patients with HF [91.3% of adherence in research setting (n=70 patients, median age (IQR): 79years (76-82)), and 64% in real-world environment (n=14 patients)]and their health-care providers (six cardiologists out of six acknowledged the data's usefulness), although device ownership ranged from 10 to 50% among the HF population. Physical activity information collected from SWs was found to be valuable in assisting cardiologists with their New York Heart Association (NYHA) functional class assessment, which is known for its limited objectivity and reproducibility. Multiple studies found that SWs, especially Fitbit devices, successfully identified a pattern where the degree of exercise intolerance increased with higher NYHA classes. These findings suggested that activity trackers can objectively evaluate the severity of physical activity limitations. As the functional classification of patients influences treatment strategies, SWs could serve as a valuable tool to facilitate and optimize outpatient disease management. SWs could be used as a complement to standard monitoring in HF. With continuous technological advances, it will be valuable to follow the deployment of SWs and to investigate their contribution to increased patient safety and consequently to health care cost reductions.

Unveiling the Functional Component in Post-Concussive Cognitive Impairment: A Novel Modelling Approach

&lt;p dir="ltr"&gt;&lt;span&gt;Mild traumatic brain injury (mTBI) is a common public health problem that significantly affects millions of people, especially people in high-risk occupations. Post-concussive cognitive impairment (PCCI) is a prevalent and debilitating outcome of mTBI that has a major impact on cognitive function as well as quality of life, thus affecting long-term health outcomes. Of all traumatic brain injuries, mTBI accounts for 58-88%, according to epidemiological studies. However, mTBI sufferers report a multitude of cognitive and emotional symptoms that constitute post-concussive syndrome (PCS). The most reported symptoms include fatigue, headaches, sensitivity to noise, anxiety, and depression. Although there is progress in understanding biochemical and structural changes after mTBI, memory, attention, and processing speed in PCCI remain poorly understood. This study aims to develop a regression model based on the modified version of Brown's disease cognition model. This model describes both cognitive and behavioural responses as indicators of functional aspects in PCS. In this study, data from 45 patients were analysed to reveal the functional nature of cognitive impairment in PCS, to open the way for more precise interventions. In addition to investigating the physiological aspects of PCS, we aim to recognise the inherent social dimension of the experiences of individuals affected by PCS. Additionally, the often subtle and non-observable nature of symptoms can bring challenges in interpersonal relationships, emphasising the need to enhance awareness among family, colleagues, and employers of the cognitive and behavioural aspects of PCS.&lt;/span&gt;&lt;/p&gt;&lt;div&gt;&lt;span&gt;&lt;br /&gt;&lt;/span&gt;&lt;/div&gt;

Independent introductions and nosocomial transmission of Candida auris in Saudi Arabia ─ a genomic epidemiological study of an outbreak from a hospital in Riyadh.

Candida auris, a pathogenic yeast responsible for global healthcare-associated outbreaks, was involved in a significant outbreak at King Fahad Medical City (KFMC) in Riyadh, affecting 20 patients from August 2018 to May 2019. Our study analyzed 23 C. auris isolates from these patients, utilizing whole genome sequencing, single-nucleotide polymorphism (SNP) analysis, phylogenetic analysis, and transmission network construction. We identified four phylogeographic clades in Saudi Arabia, with two present among the KFMC isolates. The transmission network predominantly displayed two star-like patterns, indicative of super-spreader events. Resistance to various azoles was common, and one isolate was resistant to 5-flucytosine, linked to specific mutations in the ERG11 and CIT1 genes. High genetic similarity of the isolates suggested a nosocomial origin of the KFMC outbreak. The distribution of phylogeographic clades suggests at least four separate introductions into Saudi Arabia from 2017 to 2019 and two into KFMC, underscoring both direct and nosocomial transmission pathways within the hospital.IMPORTANCECandida auris is an emerging multidrug-resistant yeast that poses a significant threat in healthcare settings worldwide. This study is one of the largest genomic investigations of a Candida auris outbreak in the Middle East, focusing on a hospital in Riyadh, Saudi Arabia. By analyzing the genomes of isolates from 20 patients, we uncovered multiple independent introductions of C. auris into the region, as well as its subsequent spread within a hospital. The findings highlight the complex transmission dynamics and the challenges in controlling this pathogenic yeast in healthcare environments. This research underscores the critical need for robust genomic surveillance and accurate identification methods to prevent and manage C. auris outbreaks, which are increasingly linked to high mortality rates and limited treatment options. The insights gained from this study contribute to our understanding of C. auris transmission and resistance, offering valuable guidance for public health strategies.

The impact of uric acid on musculoskeletal diseases: clinical associations and underlying mechanisms

Serum urate (SU) levels are significantly elevated in conditions such as gout, type 2 diabetes (T2D), obesity, and other metabolic syndromes. Recently, due to the high prevalence of hyperuricemia (HUA), numerous clinical connections between SU and musculoskeletal disorders like sarcopenia, osteoarthritis (OA), rheumatoid arthritis (RA), intervertebral disc degeneration (IDD), and osteoporosis (OP) have been identified. This review discusses the mechanisms linking SU to musculoskeletal disorders, as well as the clinical associations of SU with conditions such as sarcopenia, T2D with sarcopenia, McArdle disease, heart failure, gout, OA, IDD, OP and exercise-induced acute kidney injury (EIAKI), offering valuable insights for improved prevention and treatment strategies. Mechanisms linking SU to musculoskeletal disorders include oxidative stress, MSU (monosodium urate) crystal deposition, inflammation, and other factors. In adults, both age and SU levels should be considered for preventing sarcopenia, while gender and SU may directly impact muscle mass in children and adolescents. HUA and gout may be risk factors for OA progression, although some reports suggest otherwise. A U-shaped relationship between SU and IDD has been reported, particularly in Chinese men, indicating lower or higher SU level may be risk factors for IDD. Maintaining SU levels within a certain range may help prevent OP and fractures. Future research, including epidemiological studies and new pathogenesis findings, will further clarify the relationship between musculoskeletal diseases and SU.

Review on Exploring Role of Vitamin D on Alzheimer’s Disease: Mechanistic Insights and Implications

Background Alzheimer’s disease (AD) is a complex neurological disorder characterized by neuronal loss and progressive cognitive decline. The disease progression is influenced by both environmental and genetic factors. Recent research highlights the significant role of vitamin D in the pathological progression of AD. Purpose This review aims to comprehensively analyze the interplay between vitamin D and Alzheimer’s disease, focusing on its molecular mechanisms, epidemiological evidence, and therapeutic implications. Methods An extensive literature review was conducted to explore the molecular pathways by which vitamin D affects key pathological processes in AD, including amyloid-beta deposition, oxidative stress, neuronal inflammation, and tau phosphorylation. Epidemiological studies linking vitamin D status with AD prevalence and clinical outcomes were also analyzed, along with data from research trials investigating the efficacy of vitamin D supplementation in AD prevention and management. Results Vitamin D deficiency is associated with increased cognitive decline and heightened risk of developing AD. The review highlights the therapeutic potential of vitamin D supplementation in mitigating AD progression through its effects on pathological processes. However, challenges and controversies remain regarding the efficacy, optimal dosing regimens, and therapeutic strategies of vitamin D intake. Conclusion This review underscores the role of vitamin D as a modifiable factor and therapeutic target in Alzheimer’s disease. Further research is required to establish definitive dosing regimens and strategies to optimize the use of vitamin D in preventing and managing this debilitating neurological disorder.