This study investigates the sublethal effects of a sublethal concentration (LC20) of three insecticides, thiacloprid, emamectin benzoate, and matrine, on the host-finding behavior of the parasitoid wasp Scleroderma sichuanensis Xiao. Behavioral assessments using a Y-tube olfactometer and the Ethovision 3.1 tracking system revealed that exposure to these insecticides, particularly thiacloprid and emamectin benzoate, significantly reduced the wasps’ ability to detect and respond to host-related cues, including a synthetic compound of Monochamus alternatus Hope, 1842, and host odors. The sublethal concentrations disrupted orientation, searching behavior, and overall activity, even without causing immediate mortality. The results indicate that such behavioral disruptions may reduce the effectiveness of S. sichuanensis as a biological control agent, potentially threatening integrated pest management strategies. This study highlights the importance of behavioral changes induced by insecticides when assessing the combined use of chemical and biological control agents.
In this study, we prepared a low-cost adsorbent, magnetised activated carbon (MAC), from agricultural waste (Dodonaea Viscosa tree branches) and used it to adsorb hexavalent chromium (Cr (VI)) from aqueous solutions. The study includes a framework for material characterisation by (XRD, FTIR, SEM and BET). The major operating factors were tested, such as solution pH, adsorbent dose, initial Cr (VI) concentration, contact time and temperature, using a two-factor study method to determine optimal conditions. Adsorption isotherm models, kinetic investigations, and thermodynamic analyses were used to examine the adsorption performance and the processes involved. The FTIR spectra showed the presence of hydroxyl and carboxyl groups, and the XRD confirmed the formation of Fe3O4 on the surface of the activated carbon. SEM images showed a rough heterogeneous morphology; BET analysis showed a porous structure with a surface area of 409.584 m2/g and a total pore volume of 0.55764 cc/g. The maximum removal efficiency (97.1
Abstract Background Accurate Human Immunodeficiency Virus (HIV) viral load (VL) testing is essential for monitoring antiretroviral therapy (ART) and detecting treatment failure. In resource-limited settings such as Njombe Region, Tanzania, laboratories often face prolonged turnaround times (TAT) and suboptimal sample transport and storage. While HIV Ribonucleic Acid (RNA) degradation during extended storage of VL samples is well documented, its impact on routine, high-volume VL testing remains unclear. This study quantified the association between laboratory processing delays and reported HIV VL results. Methods We conducted a cross-sectional secondary analysis of VL data from Njombe Town Council Hospital Laboratory (October 2024–March 2025, N = 18,271). After excluding 246 records with missing dates, 18,025 samples were analyzed. Three TAT intervals—collection-to-reception (clinic to lab), reception-to-registration (lab receipt to system entry), and registration-to-testing (system entry to assay performance)—were categorized into quartiles. Multivariable multinomial logistic regression with predictive margins estimated associations between specific interval TAT delays across quartiles and VL categories. Results Median TAT from sample collection to result release was 22 days (IQR 13–36), exceeding the recommended ≤ 14 days. Only the slowest registration-to-testing quartile (Q4, 21–76 days) compared to the fastest quartile (Q1, 0–1 days) showed consistently fewer detectable VL results. Adjusted probability of Target Not Detected (TND) increased from 71.2% (fastest quartile) to 85.8% (slowest quartile) (RR = 1.205; 95% CI 1.196–1.214; p < 0.001), while probabilities for all detectable VL categories declined significantly. Conclusion Prolonged registration-to-testing delays were strongly associated with lower reported HIV VL results. Consistent with time-dependent RNA degradation, this negative association demonstrates a distinct pre-analytical bias that may compromise patient care and clinical program monitoring. Therefore, interventions targeting workflow and laboratory system optimization are warranted—a conclusion likely generalizable to similar centralized HIV VL laboratories across low- and middle-income countries.
Abstract Background Hepatitis B virus (HBV) and HIV coinfection remains an important cause of liver-related morbidity and mortality in sub-Saharan Africa. Uganda carries a substantial burden of both infections, yet evidence on HBV seroprevalence, associated factors, and liver fibrosis among people living with HIV (PLHIV) has not been comprehensively synthesized. This systematic review aimed to summarize available evidence from Uganda on HBV seroprevalence, correlates of HBV infection, and liver fibrosis burden among PLHIV. Methods This systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. We searched PubMed/MEDLINE, Scopus, Web of Science, African Journals Online (AJOL), WHO Global Index Medicus, Google Scholar, and medRxiv/bioRxiv from inception to December 2025 for studies conducted in Uganda among PLHIV reporting HBsAg seroprevalence, factors associated with HBV infection, or liver fibrosis outcomes. Eligible studies included observational designs. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Joanna Briggs Institute (JBI) critical appraisal tools. Findings were synthesized narratively. Results A total of 14 studies were included. Most studies were cross-sectional and were conducted in Northern Uganda, Central Uganda, South-Western Uganda, and Lake Victoria fishing communities. Reported HBsAg seroprevalence among PLHIV varied across settings, with higher estimates generally observed in Northern Uganda and fishing communities than in some urban clinic-based populations. Frequently reported factors associated with HBV infection included male sex, older age, lower CD4 cell count, and rural or high-risk residence. Studies assessing liver fibrosis suggested a greater burden of significant fibrosis among HBV-HIV coinfected individuals compared with HIV-monoinfected populations, although fibrosis definitions and diagnostic methods varied substantially across studies. Conclusions Available evidence indicates that HBV infection remains a significant comorbidity among PLHIV in Uganda, with substantial variation in seroprevalence across geographic settings. Male sex, older age, lower CD4 cell count, and residence in higher-burden settings were among the most frequently reported associated factors. Studies also suggest a greater burden of liver fibrosis among HBV-HIV coinfected individuals than among HIV-monoinfected populations. However, interpretation of findings is limited by methodological heterogeneity and the predominance of cross-sectional studies. Systematic review registration PROSPERO CRD420261349477.
Antimicrobial resistance is one of the leading threats to global health. The inappropriate use of antibiotics is one of its strongest drivers. Large language models (LLMs) have entered clinical discussion as tools that might support diagnosis and prescribing. However, their specific role in infectious-disease (ID) care has not been mapped in a structured way. This scoping review charts the breadth, applications, performance signals, and limitations of LLMs used for clinical decision support in ID diagnosis and antimicrobial prescribing. We followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR). We searched PubMed/MEDLINE for peer-reviewed sources that described LLM-based decision support in ID diagnosis or antimicrobial use. Sources were charted by application domain, model evaluated, study design, reported outcomes, and stated limitations. Findings were summarized descriptively. Inferential statistics are reported only as stated by the primary studies. Forty-seven sources were included. They were mapped to five domains: diagnosis and clinical reasoning; antimicrobial prescribing and stewardship; resistance and mechanism prediction; consultation and disease-specific management; and mitigation, evaluation, and ethics. LLMs answered medical-knowledge and case questions at or near passing thresholds. In vignette studies, they achieved diagnostic accuracy comparable to physicians. However, prescribing performance was inconsistent. Agreement with ID specialists on antibiotic choice was often modest, accuracy fell as case complexity rose, and unsafe or guideline-discordant advice recurred. Retrieval-augmented generation and domain grounding consistently improved accuracy and reduced hallucination. Current evidence supports an assistive, human-supervised role for LLMs in ID care rather than autonomous prescribing. Standardized evaluation, prospective validation, local grounding, and explicit stewardship oversight are prerequisites for safe adoption. Not applicable. This study is a scoping review of existing literature and is not a clinical trial; therefore, no clinical trial registration number is applicable. Large language models reason over infectious-disease diagnostic knowledge at a level comparable to physicians in vignette studies. However, their antimicrobial-prescribing performance is inconsistent and degrades as cases become more complex, so they should not prescribe autonomously. Agreement with infectious-disease specialists on antibiotic choice is frequently modest, and models may recommend less-preferred agents or unnecessarily long durations; a clinician must review every recommendation. Correct answers can rest on flawed reasoning, so evaluations must assess transparency and rationale quality, not accuracy alone. Retrieval-augmented generation and grounding in local antibiograms and guidelines consistently improve accuracy and reduce hallucination, and they should be treated as prerequisites for clinical use (Giuffrè et al. 2025; Liu et al. 2025). Safe deployment requires standardized evaluation, prospective validation against real outcomes, and mandatory infectious-disease and antimicrobial-stewardship oversight. To our knowledge, this is the first scoping review to focus specifically on large language models at the intersection of infectious-disease diagnosis and antimicrobial prescribing, rather than on artificial intelligence in medicine broadly. The review charts the evidence across five application domains and contrasts diagnostic performance with prescribing performance. It makes three distinct contributions. First, it separates the comparatively encouraging diagnostic-reasoning literature from the more cautionary prescribing literature, a distinction that is often blurred in general reviews. Second, it positions retrieval-augmented generation and local data grounding as the recurring thread that turns a generic chatbot into a clinically safer decision aid. Third, it synthesizes these findings into a practical, safeguarded framework. That framework places infectious-disease and antimicrobial-stewardship oversight at the center of any deployment, and gives clinicians and informatics staff an explicit map of the opportunities and the unresolved risks.
Rapid weight loss (RWL) is a deeply ingrained practice in elite Greco-Roman wrestling, frequently leading to health risks such as Relative Energy Deficiency in Sport (RED-S) and compromised performance. This study explores the dietary habits, weight management strategies, and psychosocial experiences of elite Turkish wrestlers, focusing on the intersection of traditional sports culture and modern nutritional science. A qualitative descriptive design was employed. Semi-structured, face-to-face interviews were conducted with 20 elite male Greco-Roman wrestlers (all university graduates) from the Turkish Olympic Preparation Center. Data were analyzed using reflexive thematic analysis following Braun and Clarke’s six-phase framework. Five main themes emerged: (1) seasonal variations in eating habits, (2) RWL strategies, (3) psychosocial stressors and social influences, (4) systemic barriers in education and support, and (5) sustainability of health and performance. Results indicate that athletes frequently employ severe carbohydrate and fluid restriction, resulting in significant performance declines, fatigue, and psychological distress, including anxiety and low motivation. Systemic deficiencies, specifically limited access to sports dietitians and the dominance of traditional coaching over scientific guidance, exacerbate these unsustainable practices. Elite wrestlers’ practices are heavily influenced by a combination of competitive pressures and a lack of integrated professional support. To mitigate RED-S risks and ensure long-term athlete health, it is essential to implement personalized nutrition counseling and multidisciplinary support systems that bridge the gap between traditional practices and sports science. Not applicable; this study was not a clinical trial.
Bottom-Up Quantification (BUQ) was institutionalized in Tanzania to improve forecasting and the availability of essential medicines by anchoring demand estimates at the health facility level. However, evidence on how faithfully the BUQ has been implemented across primary healthcare facilities, particularly following system automation, remains limited. This study assessed the level of BUQ implementation fidelity and the implementation-related factors associated with fidelity variations across facilities. An explanatory sequential mixed-methods design was used. Quantitative data were collected through a structured facility-level questionnaire administered to members of the Medicines and Therapeutics Committee and other staff involved in BUQ across primary health facilities in seven regions of mainland Tanzania. Data spanned four financial years (2020/2021–2023/2024) and captured implementation experiences. A total of 258 study participants were included in the quantitative analysis. The mean overall fidelity score was 70.1 (SD = 22.1), indicating moderate implementation fidelity, with substantial variability across facilities. Fidelity was lowest among dispensaries compared to health centers and council hospitals. Organizational responsiveness was independently associated with higher fidelity (β = 0.215, p = 0.013), while dispensary-level facilities and certificate-level staff education were associated with lower fidelity. Qualitative findings indicated that gaps in training, supervision, feedback mechanisms, staff turnover, and digital system functionality contributed to lower fidelity, particularly at lower levels of care delivery. The implementation fidelity of the BUQ in Tanzania was uneven across primary healthcare facilities, with persistent challenges at the dispensary level despite national-scale-up and automation efforts. Strengthening organizational responsiveness, human resource capacity, supervision, and feedback mechanisms is critical for improving fidelity. Differentiated implementation support tailored to the facility context is needed to enhance the effectiveness of the BUQ and strengthen the availability of essential medicines.
Autonomic-somatic coordination, which reflects the dynamic interplay between autonomic regulation and physical activity, may serve as a physiological marker of fatigue and recovery. However, its temporal characteristics and sex-specific patterns remain poorly understood. This study utilized a correlation-based framework to quantify this macroscopic coupling. This study examined the correlation between high-frequency normalized units (HFnu) of heart rate variability and physical acceleration (PA) during one-hour (1-h) periods before sleep onset and after waking in 125 healthy adults (69 men and 56 women). The participants wore a wearable device for 24-h to record their triaxial acceleration and R–R intervals. Nocturnal parasympathetic nervous system activity (PSNA) was indexed using the HFnu during sleep. Before the monitoring period, subjective fatigability was assessed using the Japanese version of the Cornell Medical Index. Women showed more negative correlations between HFnu and PA after awakening than men (p < 0.01). Among women, less negative HFnu–PA correlations before sleep onset were associated with higher subjective fatigability (p < 0.01) and higher negative correlations after waking were associated with higher nocturnal HFnu (p < 0.05). In men, more negative HFnu–PA correlations before sleep onset were associated with higher nocturnal HFnu (p < 0.05), while higher fatigue was linked to stronger negative coupling, demonstrating a contrasting pattern to that observed in women. These findings revealed sex-dependent temporal patterns in autonomic-somatic coordination quantified via correlation-based indices. Before sleep onset, higher subjective fatigue is linked to reduced coordination in women, whereas men exhibit a distinct and contrasting negative correlation pattern. Wearable-based monitoring may help to capture sex-specific autonomic dynamics related to fatigue and nocturnal parasympathetic activity.
The misuse and abuse of tramadol, a synthetic opioid analgesic, has become a major public health concern in Africa. Although effective for managing moderate to severe pain, tramadol exposure has been associated with central nervous system toxicity. Hibiscus sabdariffa, commonly consumed as “Zobo,” contains bioactive substances with potent antioxidant and anti-inflammatory properties. Therefore, this study investigated the neuroprotective potential of aqueous H. sabdariffa extract (HSE) against tramadol-induced neurotoxicity in male Swiss mice. Fifty adult male mice were randomly assigned into five groups namely control (normal saline), tramadol (50 mg/kg), and three treatment groups receiving tramadol intraperitoneally plus HSE given through oral route at 50, 100, and 200 mg/kg for 21 days. Neurobehavioral tests assessed motor coordination, cognition, anxiety, and depressive-like behaviors. Brain regions, including the hippocampus, prefrontal cortex, and cerebellum, were analyzed for malondialdehyde, reduced glutathione, catalase, superoxide dismutase, glutathione-S-transferase, nitrite levels, acetylcholinesterase activity, and pro-inflammatory cytokines, including interleukin-6, and tumour necrosis factor-alpha. Histological analysis was performed using Nissl staining, while RT-PCR quantified neurotransmission- and apoptosis-related genes, including GAD2, TH, TP53, BAX, and BCL-2. Molecular docking evaluated interactions of H. sabdariffa phytocompounds with target proteins. Tramadol exposure significantly impaired behavior, increased oxidative stress and inflammation, depleted antioxidant defenses, and induced neuronal damage with altered gene expression. H. sabdariffa extract treatment dose-dependently mitigated these alterations, preserved neuronal architecture, and modulated apoptosis-related genes. Docking computation identified Quercetin-3-O-rutinoside, Baicalin, and Delphinidin-3-O-sambubioside as hit compounds with strong binding affinity to target proteins of the genes evaluated in the RT-PCR. Hibiscus sabdariffa aqueous extract activity suggests robust neuroprotective effects against tramadol-induced neurotoxicity through coordinated antioxidant, anti-inflammatory, anti-apoptotic, and neuromodulatory mechanisms. These findings position H. sabdariffa extract as a promising, accessible therapeutic candidate for managing opioid-induced CNS damage.
Abstract Background Functional gastrointestinal disorders (FGIDs), now classified as disorders of gut–brain interaction (DGBIs), are common among adolescents and significantly affect quality of life. Despite their high prevalence, the pathophysiology of these disorders remains incompletely understood, particularly regarding the role of systemic immune activation. This study aimed to evaluate the clinical, anthropometric, laboratory, and immunological characteristics of adolescents with DGBIs (FGIDs according to Rome IV criteria) and to assess the presence of systemic immune activation through the measurement of CD163 and IL-17 A. A cross-sectional case–control study was conducted involving 181 adolescents aged 10–18 years, comprising 99 patients diagnosed with FGIDs according to Rome IV criteria and 82 healthy controls. All participants underwent clinical evaluation, anthropometric assessment, and laboratory investigations. Serum CD163 and IL-17 A concentrations were measured once for each participant using enzyme-linked immunosorbent assay (ELISA). Results DGBIs/FGIDs were significantly more prevalent among female participants ( p = 0.023). Hemoglobin levels were significantly lower in the FGID group ( p = 0.037). Functional gastrointestinal symptoms, including irritable bowel syndrome and functional abdominal pain disorders, were significantly more common among patients with FGIDs ( p ≤ 0.005). No statistically significant differences were found in serum CD163 or IL-17 A levels between the two groups. Conclusion No significant differences in serum CD163 or IL-17 A levels were detected between adolescents with DGBIs/FGIDs and healthy controls in the present study population. These findings are based on single-time-point serum measurements and do not exclude localized mucosal immune alterations or subtle systemic immune changes. Further larger-scale, longitudinal, and tissue-based studies are warranted to better define the role of immune mechanisms in pediatric DGBIs/FGIDs.
Abstract Wheat production is increasingly threatened by fungal diseases that reduce yield, grain quality, and global food security. Conventional breeding has improved disease resistance but remains constrained by long breeding cycles, polyploid genome complexity, and the continual emergence of new pathogen races. CRISPR-mediated genome editing has emerged as a powerful complementary approach for developing durable and broad-spectrum disease resistance through precise modification of resistance (R) genes, susceptibility (S) genes, and immune regulatory pathways. This review critically synthesizes recent advances in CRISPR applications for major wheat fungal diseases, including powdery mildew, rusts, Fusarium head blight, and wheat blast. Emerging genome-editing technologies, such as multiplex editing, base editing, and prime editing, are discussed alongside their applications and current limitations in wheat. The review further examines biological, technical, and regulatory challenges affecting practical deployment and highlights future opportunities for integrating genome editing with modern breeding to accelerate the development of climate-resilient, disease-resistant wheat cultivars for sustainable agriculture.
Abstract Background Greywater reuse can reduce pressure on freshwater resources in dryland areas, but its suitability depends on the combined behavior of irrigation-water chemistry, amendment properties and the receiving soil material. This study examined the short-term response of three contrasting Sudanese dryland soil materials to untreated washbasin and ablution greywater with and without Moringa-derived biochar in a 45-day soil-column experiment. Results The greywater was slightly alkaline and low in salinity, with pH 7.44–7.98 and EC 0.436–0.750 dS m⁻¹, while SAR ranged from 8.45 to 16.40. The biochar aqueous extract was alkaline and sodium-rich, with pH 9.24, EC 1.706 dS m⁻¹, soluble Na⁺ of 25.00 meq L⁻¹ and SAR of 64.55. Biochar increased residual gravimetric moisture in the amended upper layer by 16.7% in Vertisol, 22.1% in Entisol and 59.3% in Aridisol. Mean SAR was higher in the amended Vertisol and Aridisol, although these contrasts were not statistically significant. Conclusions Moringa-derived biochar improved short-term moisture retention under the tested greywater irrigation regime, but its sodium-rich chemistry introduced a soil-dependent sodicity concern. Greywater–biochar reuse should therefore be considered only after joint assessment of greywater chemistry, biochar-extract chemistry and the baseline properties of the receiving soil material.
Abstract Background While Artemisia annua possesses intrinsic antimalarial activity, its increasing use as artisanal tea infusions across Africa raises critical concerns regarding the emergence of artemisinin resistance. This study evaluates the clinical efficacy, pharmacological variability, and the risk of selecting resistant strains associated with this practice. Methods Following PRISMA 2020 guidelines, a systematic review was conducted on 24 studies investigating A. annua use in Africa. A meta-analysis was performed to quantify the Day-3 parasite positivity (D3P) rate, a key indicator of partial artemisinin resistance. Study quality was assessed using the Cochrane RoB 2 tool and the Newcastle–Ottawa Scale. Findings The meta-analysis of studies providing extractable clinical data revealed a pooled D3P rate of 18.5% (95% CI: 14.2–23.1%). This result significantly exceeds the 10% alert threshold established by the World Health Organization for signaling partial artemisinin resistance. While initial symptom relief is common, recrudescence rates reach up to 72% at 28 days in several clinical trials. This therapeutic instability is directly linked to the extreme variability of artemisinin content in infusions, which fluctuates significantly (0.05 to 1.2%) depending on preparation methods. Such sub-therapeutic exposure creates a biological "selective window" that facilitates the survival and spread of pfkelch13 mutant alleles, such as R561H and A675V, which are already emerging in East African hotspots. Conclusion The non-standardized use of Artemisia annua tea as monotherapy represents a significant pharmacological risk to health security in Africa. The failure of these preparations to ensure rapid and complete parasite clearance fuels selective pressure on mutant strains. Public health policies must prioritize access to standardized, quality-assured artemisinin-based combination therapies and regulate the transition toward stable pharmaceutical forms, such as whole-plant tablets, to safeguard the long-term efficacy of artemisinin on the continent.
Abstract Background Schwannomas are benign peripheral nerve sheath tumors arising from Schwann cells. Although up to 45% occur in the head and neck region, involvement of the supraclavicular region with cutaneous ulceration is extremely uncommon. Case presentation A 32-year-old male presented with a progressively enlarging left supraclavicular swelling associated with skin thinning and serous discharge. Imaging revealed a well-defined heterogeneously enhancing multi-nodular lesion with satellite nodules. Fine-needle aspiration cytology was suggestive of a benign peripheral nerve sheath tumor/schwannoma based on spindle cell morphology and nuclear palisading. The patient underwent wide local excision with removal of involved skin followed by local advancement flap reconstruction. Histopathological examination confirmed a benign schwannoma demonstrating Antoni A and Antoni B areas with nuclear palisading. Immunohistochemistry showed strong S100 and SOX10 positivity with a low Ki-67 index (< 2%). The satellite nodules demonstrated identical benign schwannomatous morphology. Conclusion Supraclavicular schwannomas with cutaneous involvement are rare and may present diagnostic and surgical challenges. Complete surgical excision with appropriate soft tissue reconstruction remains the treatment of choice and prevents recurrence. The follow-up period of 6 months showed no evidence of recurrence.
Postoperative liver dysfunction is a recognized complication of cardiac surgery and is associated with increased morbidity and mortality. Although transient hyperbilirubinemia is common following prolonged cardiopulmonary bypass (CPB), extreme direct hyperbilirubinemia exceeding 40 mg/dL with complete recovery is rare. Congenital parachute mitral valve has no established association with hepatic dysfunction. The novelty of this report lies in the occurrence of profound postoperative hypoxic-ischemic hepatitis followed by extreme reversible post-ischemic cholestasis after technically challenging minimally invasive mitral valve replacement in an adult with this rare congenital anomaly. A 30-year-old woman with progressive exertional dyspnea secondary to severe congenital parachute mitral valve causing symptomatic mitral stenosis underwent minimally invasive mitral valve replacement through a right mini-thoracotomy using peripheral femoro-femoral cardiopulmonary bypass. The congenital anomaly had remained undiagnosed until adulthood because of delayed clinical presentation. Preoperative assessment demonstrated a small body habitus (height 151 cm, weight 56 kg, body surface area 1.53 m²), and peripheral cannulation was performed using a 15-Fr femoral arterial cannula and a 23-Fr long femoral venous cannula. Intraoperatively, small femoral vessel caliber resulted in suboptimal arterial inflow and venous drainage despite optimization of pump flow and vasopressor support, contributing to prolonged cardiopulmonary bypass (217 min), aortic cross-clamp time (161 min), and sustained low perfusion pressures. The postoperative course was complicated by profound vasoplegic shock, severe lactic acidosis (lactate > 15 mmol/L), acute kidney injury (peak creatinine 4.92 mg/dL), and hypoxic-ischemic hepatitis, with peak AST and ALT levels of 920 U/L and 2256 U/L, respectively. Despite rapid improvement in aminotransferases, total and direct bilirubin progressively increased to peaks of 40.6 mg/dL and 35.8 mg/dL, respectively, accompanied by cholestatic enzyme elevation. Comprehensive evaluation, including ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, transesophageal echocardiography, viral and autoimmune serology, and hemolysis testing, excluded biliary obstruction, prosthetic valve dysfunction, infective endocarditis, and other alternative causes of cholestasis. Conservative management, including supportive care and ursodeoxycholic acid, resulted in progressive biochemical improvement and complete clinical recovery. This case demonstrates a rare biphasic pattern of postoperative liver injury consisting of acute hypoxic-ischemic hepatitis followed by prolonged reversible post-ischemic cholestasis with extreme direct hyperbilirubinemia after technically challenging minimally invasive mitral valve replacement. Recognition of this reversible syndrome, together with careful interpretation of perioperative hemodynamic events and exclusion of structural hepatobiliary disease, may prevent unnecessary invasive investigations and support successful conservative management.
A PRISMA-guided systematic review and random-effects meta-analysis (k = 35 studies; 2000–2025) quantified adaptability of major Southern African meat goat genotypes across agro-ecological zones (AEZs) using physiological, morphological, behavioral, and production traits, with risk of bias assessed via ROBIS and heterogeneity evaluated using I2. Significant genotype-by-environment interactions were detected (p < 0.01), with high between-study heterogeneity for physiological traits (I2 = 81–92
Abstract Background Bariatric surgery is the most effective long-term intervention for severe obesity and its metabolic complications. However, the influence of chronic hypobaric hypoxia at high altitude (HA) on surgical outcomes remains inadequately characterized. This systematic review synthesizes available evidence on HA as a potential risk modifier and provides mechanistic insights and clinical management guidance. Methods A systematic search was conducted across PubMed, Embase, Cochrane Library, CNKI, and Wanfang Data from inception to October 25, 2025. Studies comparing postoperative outcomes between HA (≥ 2000 m) and low-altitude (LA, < 1000 m) patients undergoing primary bariatric surgery were included. Data were synthesized narratively by procedure type and outcome domain. Results Six studies comprising 476 patients met eligibility criteria, predominantly examining laparoscopic sleeve gastrectomy (LSG) with limited data on Roux-en-Y gastric bypass (RYGB). LSG complication rates at HA ranged from 4.35% to 15.3% across studies, consistently exceeding typical LA benchmarks. Staple-line complications and pulmonary events were most frequently reported. Early postoperative weight loss was often attenuated at HA, although medium-term outcomes at 12–24 months became comparable between groups. Evidence for RYGB remains restricted to a single small study without internal LA comparator, precluding definitive conclusions. Conclusions High-altitude residence is associated with elevated perioperative risks for LSG, supported by consistent multi-study evidence. Whether altitude independently affects RYGB outcomes cannot be reliably determined from current data. Healthcare system factors and altitude-associated comorbidities likely contribute substantially to observed differences. Procedure-specific, altitude-adapted perioperative protocols are warranted, with LSG representing the better-studied option in HA settings. Future prospective studies with concurrent low-altitude controls are urgently needed to isolate the true altitude effect.
Widespread in many tropical and subtropical regions of the world, dengue fever is currently the most serious public health problem posed by arboviruses. Data on this disease are scarce due to the similarity of its symptoms to those of malaria, which is endemic in this region. This study aimed to evaluate the epidemiological, clinical, and paraclinical aspects of dengue fever in the city of Kribi, thereby providing objective data that could characterize the circulation of this disease in this city. We conducted a cross-sectional descriptive and analytical study from November 2024 to June 2025 at the Kribi Regional Annex Hospital. We included febrile patients to whom venous blood samples were collected in EDTA tubes. The presence of IgM, NS1, and IgG anti-DENV was detected using the lateral flow immunoassay technique. Viral genome testing was performed on samples positive for Ig Met NS1 using the TrioPlex RT-qPCR DENV, ZIKV, CHICKV‘protocol, after first extracting viral RNA using the ’Daan Gene RNA/DNA purification” kit. The data obtained were analyzed using SPSS 25. Of the 277 patients recruited, 8.7
Abstract Background Antimicrobial resistance (AMR) is a major global health threat, with particularly severe consequences in Africa, where it is associated with high mortality and substantial strain on healthcare systems. Despite this burden, empirical African data on the clinical, economic, and health-system impacts of AMR remain limited, and many global estimates are derived from modeling studies rather than primary African evidence. Methods A scoping review of studies published between January 2020 and December 2025 was conducted in accordance with PRISMA-ScR guidelines and Joanna Briggs Institute recommendations. Searches were performed across PubMed, Scopus, Embase, Web of Science, the Cochrane Library, and African Index Medicus. Empirical African studies were systematically distinguished from modeled and global estimates. Data were narratively synthesized, with extraction of mortality rates, length of hospital stay, and direct healthcare costs. Results Ninety-four studies from 32 African countries were included. Empirical evidence indicates substantial AMR-associated mortality, with case fatality rates ranging from 30 to 50% overall, 35–60% in neonatal sepsis, and 45–70% in ICU multidrug-resistant Gram-negative infections. Mortality associated with carbapenem-resistant Acinetobacter baumannii reached up to 75%. AMR infections were consistently associated with prolonged hospital stays (5–20 days), treatment failure rates of 25–40%, and direct patient costs ranging from USD 300 to 3600. Modeled and global estimates suggest that AMR may be associated with over 1 million deaths in Africa and potential reductions of up to 5% in global GDP; however, these estimates are not derived from empirical African studies. Regional variation was observed, with the highest burden reported in West Africa, moderate outcomes in East and Central Africa, and comparatively lower mortality but persistent multidrug resistance in North Africa. Health systems face major challenges, including ICU overcrowding, diagnostic delays, and limited infection prevention and control (IPC) capacity. Conclusions AMR is associated with substantial clinical, economic, and health-system impacts across Africa. Strengthened surveillance, antimicrobial stewardship, improved diagnostics, enhanced IPC measures, and integrated One Health approaches are urgently needed to mitigate the growing burden of AMR on the continent.
Abstract Background Mpox, caused by the Mpox virus, is a zoonotic disease historically endemic in Central and West Africa. Despite the Democratic Republic of Congo (DRC) carrying the highest Mpox burden, the literature lacks comprehensive data on long-term trends and geographic disparities inMpox% disease severity and mortality, highlighting a significant research gap. Understanding severity and mortality trends is critical for global control efforts. Methods This systematic review and meta-analysis followed PRISMA guidelines to synthesize evidence on Mpox severity and mortality in the DRC from 1970 to 2024. We searched PubMed, ScienceDirect, Scopus, Web of Science. Random-effects models addressed high heterogeneity, and subgroup analyses examined temporal trends, regional differences, and healthcare settings. Meta-regression explored sources of heterogeneity for both severity and case fatality rate, adjusting for study year, region, and setting. Results We included a total of 19 study reports. The pooled severity rate among 3,280 confirmed cases was 39.47% (95% confidence interval [CI] 29.11–50.86). Case fatality rates (CFRs) were 1.70% (95% CI 0.72–3.95) among 3152 suspected cases and 2.46% (95% CI 0.65–8.85) for 2239 confirmed cases. Meta-regression revealed that study year, region and setting were significant sources of heterogeneity of case fatality rates among confirmed mpox cases. Conclusion Mpox continues to impose a substantial burden in the DRC, with a high severity and moderate mortality rates. Targeted interventions, including vaccination in high-risk areas, community education, and healthcare system strengthening are warranted.
