University of Health Sciences (Antigua)

Background: The COVID-19 pandemic severely disrupted routine pediatric immunization networks and altered population exposure to endemic respiratory pathogens. This study evaluates post-pandemic shifts in vaccine-preventable disease (VPD) mortality and the clinical severity of influenza and pneumonia complications among school-aged children (7-8 years old). Methods: Public health surveillance records and hospital registry datasets spanning the pre-pandemic (2017-2019), pandemic (2020-2022), and post-pandemic (2023-2025) eras were analyzed. Temporal variations in mortality rates were calculated alongside a specialized J-Point Matching Statistical Protocol to control for systemic healthcare utilization volatility. Clinical and laboratory parameters, including C-reactive protein (CRP), procalcitonin (PCT), and absolute neutrophil counts, were cross-referenced to evaluate disease severity. Results: Vaccine coverage for measles, mumps, and rubella (MMR) and diphtheria, tetanus, and pertussis (DTaP) dropped significantly during the pandemic, showing incomplete recovery by 2025. In the 7-8 year age bracket, post-pandemic crude mortality rates for pertussis and measles increased compared to pre-pandemic baselines. Concurrently, influenza-related complications occurred in 64.3% of hospitalized patients post-pandemic, up from 52.9% pre-pandemic (p = 0.02).

Pulmonary hypertension (PH) is a progressive disease in which the pulmonary arteries thicken and narrow, raising pulmonary vascular resistance (PVR) and eventually straining the right ventricle. Known gene mutations explain only a minority of cases and often do not account for why the disease starts, worsens, or varies so widely between patients. Growing evidence suggests that epigenetic changes, chemical marks on DNA and its packaging that alter how genes are used without changing the DNA sequence, help explain this gap. These changes, including DNA methylation, histone modification, and non-coding RNAs, can be triggered by common exposures and disease states, and they can produce lasting shifts in vascular, immune, and metabolic pathways. This narrative review synthesizes current data showing how intrinsic stresses (mitochondrial dysfunction, oxidative stress, and cancer-like metabolic reprogramming) interact with extrinsic and often modifiable factors. Obesity, cigarette smoke, asbestos exposure, chronic hypoxia, and systemic inflammation drive PH through epigenetic reprogramming. We highlight major molecular hubs implicated across studies, including bone morphogenetic factor receptor 2 (BMPR2), NOTCH3, endothelin-1 (ET-1), transforming growth factor‑β (TGF-β), interleukin‑6 (IL-6), and CCL5, and we summarize emerging therapeutic approaches aimed at epigenetic regulators and microRNA networks. This narrative review was not conducted under Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and does not constitute a formal systematic review. The information in this review provides a practical framework for clinicians and researchers to improve risk assessments, to employ biomarkers, and to develop therapies that go beyond vasodilation to address upstream drivers of pulmonary arterial remodeling. This framework may also serve as a model for other difficult-to-treat diseases in which incomplete genetic explanations and limited attention to environmental exposures have slowed progress in prevention, early detection, and personalized treatment.

Objectives: Obesity induced by a high-fat diet (HFD) is closely associated with impaired male fertility, primarily through oxidative stress, inflammation, and testicular dysfunction. Natural compounds with antioxidant and anti-inflammatory properties have gained increasing attention for their potential therapeutic effects. Bromelain, a proteolytic enzyme complex derived from Ananas comosus, exhibits antioxidant, anti-inflammatory, and antifibrotic activities, suggesting potential protective effects against obesity-related reproductive impairments. Methods: Male Wistar rats were randomly assigned to four groups (n=9 per group). Animals were fed an HFD for 12 weeks to induce obesity, followed by one month of bromelain supplementation. Testicular tissues were histologically assessed using hematoxylin & eosin (H&E) and Masson’s trichrome staining. Serum and testicular samples were analyzed for antioxidant and oxidative stress markers, including paraoxonase-1 (PON1), arylesterase (ARE), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI). Results: The HFD group showed significant testicular alterations, including thickening of the tunica albuginea, perivascular collagen accumulation, germ cell loss, and disrupted seminiferous tubule architecture (P<0.0001). Biochemically, TAS (P<0.0001) and PON1 (P=0.0041) levels were significantly decreased, whereas TOS (P<0.0001) and OSI (P<0.0001) levels were elevated. Bromelain supplementation mitigated histopathological changes, reducing collagen deposition and tunica albuginea thickness. Moreover, Bromelain significantly restored TAS and PON1 levels while decreasing TOS and OSI. No significant differences were observed in ARE (P=0.0002) activity between the groups. Conclusions: Bromelain supplementation attenuated HFD-induced oxidative stress and fibrotic alterations in testicular tissue, improving both histological and biochemical parameters. These findings suggest that Br may be a potentially beneficial natural supplement for alleviating obesity-induced impairments in male reproductive functions and associated metabolic dysfunctions.

Objectives: Contrast media can cause adverse reactions ranging from mild skin symptoms to anaphylaxis. Although the pathophysiology is not fully understood, various risk factors have been reported. This study aimed to evaluate the risk factors and skin tests in patients experiencing hypersensitivity reactions to contrast media. Methods: A total of 52 patients were included in the study. Patients experiencing contrast media-induced hypersensitivity reactions were evaluated for demographic and clinical characteristics, the type of contrast media used, and skin tests. They were compared with patients without a history of reactions. The patient group experiencing reactions was further divided into two groups: those with and without atopic disease. Results: The patient group experiencing reactions was older. Comorbidity was high, and cardiovascular disease was the most common. Reactions were most frequently immediate and grade 1 and 2 in severity. The skin was most commonly affected, and anaphylaxis was detected in 28.6%. Approximately one-third had comorbid atopic disease, and respiratory system diseases and Hashimoto's thyroiditis were significantly more common in this group. In the group without comorbid atopic disease, malignancy and psychiatric disorders were more common, but not significantly so. Skin tests were negative in all groups. Conclusions: Hypersensitivity reactions related to contrast medium use are increasing. Unnecessary examinations and tests cause delays in patient follow-up and treatment. All physicians must recognize and appropriately manage patients and reactions at high risk for contrast medium-related hypersensitivity reactions. We believe our study will contribute to the literature in managing and raising awareness of these reactions.

Objectives: Syncope is a common cause of emergency department admissions and poses challenges in patient management due to its broad etiology and risk of short-term adverse events. This study aimed to comparatively evaluate the ability of the San Francisco Syncope Rule, Canadian Syncope Risk Score and Anatolian Syncope Rule to predict short-term (1-week and 1-month) adverse events in patients presenting to the emergency department with syncope. Methods: This multicenter, prospective, observational study included 108 patients who presented to the emergency departments of two tertiary-level hospitals with syncope. Patients aged <18 years, pregnant women, those with non-syncopal causes of transient loss of consciousness, and those requiring hospitalization at presentation were excluded. Patients were contacted by phone on the 7th and 30th days after discharge to assess adverse events, including death, life-threatening arrhythmias, myocardial infarction, aortic dissection, pulmonary embolism, major bleeding, and subarachnoid hemorrhage. Results: The mean age was 45.9±18.9 years, and 57.4% were female. The most common comorbidity was hypertension (34.3%), and vasovagal syncope (47.2%) was the leading etiology. Within 1 week, 8 (7.4%) patients experienced adverse events; none occurred at 1 month. Median scores were 0 for the San Francisco Syncope Rule, 1 for the Anatolian Syncope Rule, and 0 for the Canadian Syncope Risk Score; among those with events: 0.5, 2, 3, respectively. Conclusions: The San Francisco Syncope Rule showed limited early discrimination, the Canadian Syncope Risk Score identified high-risk patients, and the Anatolian Syncope Rule better stratified low–moderate risk groups. Risk scores should complement, not replace, clinical judgment.