Treatment outcomes among young persons living with HIV who transitioned to adult care in southern Nigeria: A retrospective cohort study

BACKGROUND

In October 2019, a peer-based transition preparedness model was introduced as part of peer club activities to prepare young persons living with HIV (YLHIV) for adult care. This study compared the 12 and 24 months treatment outcomes of YLHIV who transitioned to adult care in primary, secondary and tertiary health facilities in Southern Nigeria, following the introduction of this model.

MATERIALS AND METHODS

This was a retrospective cohort study using data extracted from the medical records of YLHIV who transitioned to adult care at 25 years in 2018 and in 2021 across 155 healthcare facilities in southern Nigeria. Baseline data at transition, as well as 12 and 24 months post-transition data were extracted for comparison between those who were transitioned before (2018 cohort) and after (2021 cohort) the transition preparedness model was introduced. Logistics regression analysis was used to compare client continuity on treatment and undetectable viral load between the two groups at 12 and 24 months after transitioning to adult care.

RESULTS

Most of the1,555 YLHIV who transitioned to adult care in 2018 (n = 343, 22.1%) and 2021 (n = 1,212, 77.9%) were females (91.0% in 2018 v.82.6% in 2021) and initiated ART at 20 years or older (92.7% v. 95.7%). A higher proportion of those in the 2021 cohort were continuously retained both at 12 months and 24 months post-transitioning compared to those in the 2018 cohort (12 months: 96.7% vs 80.2%, p < 0.001; 24 months: 92.7% vs 77.6% p < 0.001). Similarly, the proportion of YLHIV with undetectable viral load in the 2021 cohort was significantly higher than those in the 2018 cohort at both 12 months (96.1% vs 60.1%, p < 0.001) and 24 months (93.3% vs 80.6%, p < 0.001), respectively.

CONCLUSION

Peer-based transition preparedness model improved treatment outcomes of YLHIV who transition to adult care. Programs should implement tailored, peer-based interventions to address gaps in service delivery.

SARS-CoV-2 damages cardiomyocyte mitochondria and implicates long COVID-associated cardiovascular manifestations

INTRODUCTION

With the COVID-19 pandemic becoming endemic, vigilance for Long COVID-related cardiovascular issues remains essential, though their specific pathophysiology is largely unexplored.

OBJECTIVES

Our study investigates the persistent cardiovascular symptoms observed in individuals long after contracting SARS-CoV-2, a condition commonly referred to as "Long COVID", which has significantly affected millions globally.

METHODS

We meticulously describe the cardiovascular outcomes in five patients, encompassing a range of severe conditions such as sudden cardiac death during exercise, coronary atherosclerotic heart disease, palpitation, chest tightness, and acute myocarditis.

RESULTS

All five patients were diagnosed with myocarditis, confirmed through endomyocardial biopsy and histochemical staining, which identified inflammatory cell infiltration in their heart tissue. Crucially, electron microscopy revealed widespread mitochondrial vacuolations and the presence of myofilament degradation within the cardiomyocytes of these patients. These findings were mirrored in SARS-CoV-2-infected mice, suggesting a potential underlying cellular mechanism for the cardiac effects associated with Long COVID.

CONCLUSION

Our findings demonstrate a profound impact of SARS-CoV-2 on mitochondrial integrity, shedding light on the cardiovascular implications of Long COVID.

Signature Gene Mutations in Colorectal Cancer: Potential Neoantigens for Cancer Vaccines

Colorectal cancer (CRC), the third most common cancer worldwide, is one of the deadliest cancers. CRC is known as a cold tumor, characterized by a low immune response that makes it difficult for immune cells to infiltrate and exhibits strong resistance to immunotherapy with checkpoint inhibition. This restricted response is largely attributed to signature gene mutations including mismatch repair (MMR) genes, KRAS, BRAF, APC, and TP53, which are also the main oncogenes in CRC. Mutated signature genes continuously upregulate abnormal signaling pathways, leading to excessive proliferation, cancer progression, and metastasis. Furthermore, it reorganizes the tumor microenvironment (TME) by recruiting immunosuppressive cells. However, the mutation can produce neoantigens that can provoke an immune response, making it a potential target for immunotherapy. In particular, cancer vaccines that leverage the strong neoantigenic properties of these mutations are considered promising for overcoming immune resistance and eliciting anti-tumor responses. In this review, we will describe signature gene mutations in CRC and focus on cancer vaccines targeting these mutations as potential therapies for CRC.

Is the repeat worth it? Optimizing syndromic panel pathogen detection protocols

OBJECTIVE

The aim of the study was to compare the cost and clinical impact of repeating BioFire FilmArray gastrointestinal (GI) and respiratory (RP) panel assays with 3 vs 4 pathogen targets positive.

METHOD

We analyzed 12,027 GI and RP panels to evaluate our retesting policy, which retested panels with 3 or more detected pathogens (3-pathogen protocol) compared with the manufacturer's 4-pathogen (4-pathogen protocol) recommendation. We compared the retesting results, calculated the cost implications, and reviewed the clinical impact on antibiotic prescriptions and patient outcomes.

RESULTS

Retesting with our 3-pathogen protocol revealed that 81% (39/48) of GI and 76% (26/34) of RP panels had identical results, whereas 19% (9/48) of GI and 24% (8/34) of RP panels showed discrepancies on retesting. The additional cost incurred by our protocol compared with the manufacturer's protocol was $9820.32. There was no evidence that our more stringent policy affected antibiotic prescription or clinical outcomes.

CONCLUSION

Our more stringent 3-pathogen protocol for retesting panels did not improve patient management compared with the manufacturer's 4-pathogen protocol but resulted in unnecessary costs and increased the risk of depleting testing kits during supply shortages. Consequently, we adopted the manufacturer's suggestions, highlighting the need to balance clinical rigor with cost-effectiveness in laboratory testing protocols.

Development of a novel amplicon based whole-genome sequencing framework for improved surveillance of Toscana virus

Toscana virus (TOSV), a Phlebovirus transmitted by sandflies, is a leading cause of aseptic meningitis in the Mediterranean region. Despite its clinical significance, underreporting and limited availability of complete genomic data hinder a thorough understanding of its genetic diversity and evolution. This study presents a novel amplicon-based whole-genome sequencing (WGS) method using Illumina library preparation kits and proprietary software to optimize workflows and enhance bioinformatic analyses. Primers targeting TOSV lineage A genomes were designed with PrimalScheme to generate 400 bp amplicons, incorporating degenerate bases to improve coverage. Library preparation utilized Illumina Microbial Amplicon Prep (iMAP) kits, followed by de novo assembly using BaseSpace DRAGEN Targeted Microbial software. The method's sensitivity was tested on viral propagates at various RNA concentrations (104 to 10 copies/μL), demonstrating robust performance at concentrations above 102 copies/μL. Validation on high-titre viral propagates (n = 7), low-titre clinical samples (n = 15), and phlebotomine pools (n = 5) confirmed its reproducibility and ability to comprehensively cover coding regions. Cerebrospinal fluid samples yielded the most consistent results compared to urine and sandfly pools. This innovative WGS approach represents a significant advancement in TOSV genomic surveillance, enabling large-scale studies of its genetic diversity and evolutionary dynamics, which are critical for improving diagnostics and public health strategies.

Advances in cancer immunotherapy: historical perspectives, current developments, and future directions

Cancer immunotherapy, encompassing both experimental and standard-of-care therapies, has emerged as a promising approach to harnessing the immune system for tumor suppression. Experimental strategies, including novel immunotherapies and preclinical models, are actively being explored, while established treatments, such as immune checkpoint inhibitors (ICIs), are widely implemented in clinical settings. This comprehensive review examines the historical evolution, underlying mechanisms, and diverse strategies of cancer immunotherapy, highlighting both its clinical applications and ongoing preclinical advancements. The review delves into the essential components of anticancer immunity, including dendritic cell activation, T cell priming, and immune surveillance, while addressing the challenges posed by immune evasion mechanisms. Key immunotherapeutic strategies, such as cancer vaccines, oncolytic viruses, adoptive cell transfer, and ICIs, are discussed in detail. Additionally, the role of nanotechnology, cytokines, chemokines, and adjuvants in enhancing the precision and efficacy of immunotherapies were explored. Combination therapies, particularly those integrating immunotherapy with radiotherapy or chemotherapy, exhibit synergistic potential but necessitate careful management to reduce side effects. Emerging factors influencing immunotherapy outcomes, including tumor heterogeneity, gut microbiota composition, and genomic and epigenetic modifications, are also examined. Furthermore, the molecular mechanisms underlying immune evasion and therapeutic resistance are analyzed, with a focus on the contributions of noncoding RNAs and epigenetic alterations, along with innovative intervention strategies. This review emphasizes recent preclinical and clinical advancements, with particular attention to biomarker-driven approaches aimed at optimizing patient prognosis. Challenges such as immunotherapy-related toxicity, limited efficacy in solid tumors, and production constraints are highlighted as critical areas for future research. Advancements in personalized therapies and novel delivery systems are proposed as avenues to enhance treatment effectiveness and accessibility. By incorporating insights from multiple disciplines, this review aims to deepen the understanding and application of cancer immunotherapy, ultimately fostering more effective and widely accessible therapeutic solutions.

A full-length S1 gene sequencing of a novel emerged GI-19 and GI-23 lineages of Infectious bronchitis virus currently circulating in chicken flocks in upper Egypt reveals marked genetic diversity and recombination events

BACKGROUND

Infectious bronchitis virus (IBV) is a highly contagious evolving pathogen that causes respiratory, urinary and reproductive symptoms; threatening the poultry industry globally.

METHODS

During this study, 90 tissue specimens were collected from various poultry flocks of seven Upper Egypt governorates from 2023 to 2024 for genetic characterization.

RESULT

Typical IBV lesions of the inoculated embryos in the specific-pathogen-free-embryonated chicken eggs (SPF-ECE) were observed. Using real-time reverse transcriptase polymerase chain reaction (rRT-PCR) assay targeting the conserved N gene, only 60 samples were considered positive with 66.6%. Collectively, 23 tissue specimens were examined through a one-step PCR assay. Sequencing is targeting the S1 gene, and the phylogenetic analysis was conducted based on partial sequencing showed that Avian coronavirus (ACoV) isolates belong to GI-23 (n = 18), GI-12 (n = 2), GI-1 (n = 1), and GI-19 (n = 2). Genotyping of the S1 gene indicates that GI-23 shows a genetic similarity to Egyptian isolates, and Israeli variants with nucleotide identity percentages (95-97%) and, (88-92%); respectively. Concerning full sequencing, five ACoV isolates were clustered as GI-23 (n = 3), and GI-19 (n = 2). Currently, QX-strains showed low genomic relatedness with Egyptian strains, and vaccinal strains with nucleotide (78-79%), and amino acid (77-80%), and (75-77%) identities, respectively. This is the first detailed study that recorded various IBV isolates, especially the novel emerged QX strain circulating in chicken flocks in Egypt. The recombination event within the Assuit-1-QX-EGYIBV-2024 isolate was detected as a result of recombination between the major (GI-19) and minor (GI-22) putative parents. Importantly, the G1-19 and G1-23 shared multiple amino acids mutations at S1 gene.

CONCLUSIONS

This study provides empirical evidence for the ACoV circulating in Egypt in vaccinated and non-vaccinated poultry flocks despite the excessive vaccination schemes.

Molecular detection of SARS-CoV-2 and medically important respiratory and gastrointestinal virus pathogens on Thai currency

Fomite-mediated viral transmission through using cash might be a potential risk to human health. Persistence of SARS-CoV-2, and other medically important viruses was investigated. A total of 300 samples (i.e., 150 banknotes and 150 coins) were randomly collected from nineteen fresh markets distributed across seventeen districts of Bangkok, Thailand. Every banknote or coin was entirely swabbed and generated a total of 100 pool samples. Total viral nucleic acid was extracted and subjected for multiplex real-time qRT-PCR using Allplex™ SARS-CoV-2/FluA/FluB/RSV assay and Allplex™ GI-virus assay. The results revealed detection rate of 4% (4/100), and they were only detected in banknote pooled samples. Two samples collected from fish shops tested positive for SARS-CoV-2 (2%, 2/100); meanwhile, two samples (2%, 2/100) from pork and chicken shops tested positive for rotavirus A. None of pool samples were detected for influenza A and B viruses, respiratory syncytial virus, norovirus genogroup I and II, adenovirus, astrovirus, and sapovirus. Phylogenetic analysis demonstrated that rotavirus A belonged to genotype G8; meanwhile, SARS-CoV-2 resembled omicron GRA JN.1 sub variant. Our finding is the first report for demonstrating the presence of SARS-CoV-2 and rotavirus A in Thai banknotes on real-world situation, implying the potential risk to human health and safety.

Impairment of Esophageal Barrier Integrity: New Insights into Esophageal Symptoms in Post-COVID-19

BACKGROUND

The COVID-19 pandemic, caused by SARS-CoV-2, has unveiled a range of symptoms beyond the respiratory system, including significant gastrointestinal manifestations.

AIMS

This study explores the prevalence and intensity of gastroesophageal symptoms in post-COVID-19 patients and the integrity of the esophageal epithelial barrier.

METHODS

We conducted a prospective longitudinal cohort study with 55 patients hospitalized due to COVID-19 at a University Hospital. Patients were evaluated during hospitalization and between 3 and 6 months post-discharge, using validated questionnaires for gastrointestinal and gastroesophageal reflux symptoms. Additionally, 25 of these patients underwent upper digestive endoscopy, with esophageal mucosal biopsies analyzed for transepithelial electrical resistance (TER), permeability, and expression of inflammatory cytokines and cell junction proteins. Data expressed as mean EPM, inference by two-way ANOVA.

RESULTS

Results were considered statistically significant at p < 0.05. There were significant increases in heartburn and acid reflux symptoms in post-COVID-19 patients, as measured by the GSRS questionnaire. Biopsies from post-COVID patients revealed increased esophageal permeability when compared to non-COVID patients in acidic media (pH 2: non-COVID-19: 717.8 ± 168.2 vs. post-COVID-19: 1377.6 ± 316.4), suggesting compromised mucosal barrier. Furthermore, IL-8 levels and expression of Claudin-2 were elevated in these patients.

CONCLUSIONS

The data suggested that COVID-19 infection may cause lasting damage to the esophageal epithelial barrier, increasing its permeability and provoking an exacerbated inflammatory response. These changes may explain the prevalence of post-infection gastroesophageal symptoms. Our findings underscored the importance of continuous monitoring and the development of therapeutic strategies to mitigate gastroesophageal effects in patients recovering from COVID-19.

The evolving landscape of oncolytic virus immunotherapy: combinatorial strategies and novel engineering approaches

Oncolytic viruses (OVs) are a promising class of cancer therapy, exploiting their abilities to selectively infect and kill cancer cells while stimulating antitumor immune responses. The current assessment explores the changing horizons of OV immunotherapy, focusing on recent advances in technology plans to improve OV projects and combined approaches to improve curative efficacy. We discuss how OVs induce direct oncolysis and promote the release of tumor-associated antigens, leading to the activation of both innate and adaptive immunity. Special attention shall be given to programs for arm OVs to express curative genes, modify the tumor microenvironment and overcome immunosuppression. Moreover, we assess the synergies of uniting OVs with other immunotherapeutic techniques, such as immune checkpoint inhibitors and cell therapy, to improve tolerant outcomes. The present assessment provides an understanding of the relevant declaration of the OV analysis, highlighting the main obstacles and the future directions for the development of other capable and targeted cancer immunotherapy.

The global prevalence and impact of steatotic liver disease and viral infections: A systematic review and meta-analysis

BACKGROUND

Steatotic liver disease (SLD) affects ~30% of adults worldwide. The global population is continuously threatened by epidemic and endemic viral diseases. This study aims to thoroughly examine the interaction between SLD and major viral diseases.

METHODS

We systematically searched databases from inception to April 2, 2024, for observational studies recording viral-infected adult patients with eligible data on the presence of hepatic steatosis.

RESULTS

Six hundred thirty-six eligible studies were included in the analysis of SLD prevalence. Among patients with monoinfections, the highest SLD prevalence was observed in those infected with HCV at 49% (95% CI: 47%-51%), followed by SARS-CoV-2 (39%, 95% CI [34%-44%]), HIV (39%, 95% CI [33%-44%]), and HBV (36%, 95% CI [32%-40%]). Additionally, co-infections, such as HCV-HIV and HBV-HCV, exhibit even higher SLD prevalence. The prevalence of steatohepatitis is particularly high in HIV-infected (24%, 95% CI: 17%-30%) and HCV-infected (18%, 95% CI: 13%-24%) populations. The co-existence of SLD with viral infections was associated not only with the progression of liver disease but also with more severe outcomes of the infections and poorer responses to antiviral treatment. The combination of cardiometabolic risk factors and viral-associated and host factors contributes to the higher risk of SLD in viral-infected populations.

CONCLUSIONS

SLD is highly prevalent in viral-infected populations, and the reciprocal interactions between SLD and viral diseases exacerbate both conditions, leading to poorer patient outcomes in general.

Prevalence and Risk Factors of Transfusion-Transmissible Infections Among Voluntary Blood Donors in North Shoa, Amhara Region, Ethiopia: A Cross-Sectional Study

Background and Aim

Transfusion-transmissible infections (TTIs) pose a significant threat to patients requiring blood transfusion. The prevalence of TTIs among blood donors reflects the broader burden of infections within populations. Therefore, assessing the prevalence of TTIs among voluntary blood donors is crucial for informing effective prevention and control strategies in the community.

Study Design and Methods

A cross-sectional study was conducted from April 2022 to July 2022. Sociodemographic and related data were collected using a pre-tested structured questionnaire. A venous blood sample (5 mL) was drawn from each blood donor into sterile test tubes, and serum was separated through centrifugation. The serum samples were tested using enzyme-linked immunosorbent assays (ELISA) to detect hepatitis B Virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis. Data analysis was performed using SPSS version 25 and summarized in tables and figures.

Results

A total of 538 participants were enrolled in the study, with an overall prevalence of transfusion-transmissible infections (TTIs) at 7.4% (n = 40). Syphilis exhibited the highest prevalence at 3% (n = 16), followed by HBV at 2% (n = 11). The prevalence of HCV and HIV was 1.3% (n = 7) and 1.1% (n = 6), respectively. Significant factors associated with HBV seroprevalence included the donation site at Debre Berhan [AOR = 24.18, 95% CI: 1.98-295.14, p = 0.01] and the presence of body tattoos [AOR = 19.1, 95% CI: 4.0-89.8, p ≤ 0.01]. Male sex was significantly associated with syphilis infections [AOR = 3.78, 95% CI: 1.23-11.61, p = 0.03].

Conclusions

This study highlighted the high prevalence of TTIs among blood donors. To prevent and control the transmission of TTIs within the population, strict donor screening protocols, improved diagnostic methods, and enhanced awareness about infection transmission should be implemented.

Recommendations to Advance Social Connectedness in End Stage Kidney Disease Care in a Post-COVID-19 Era

Social connectedness, defined as a sense of belonging and inclusion among individuals and groups, is crucial for the well-being of end-stage kidney disease (ESKD) patients. This Perspective employs a hypothetical case study to highlight the risks of social isolation and loneliness faced by ESKD patients. It offers guidance on how the ESKD community can effectively address these challenges. Although in-center hemodialysis provides an inherent environment for fostering social connections, the COVID-19 pandemic has intensified the risk of social disconnection. We delineate 5 key recommendations to mitigate this risk: (1) improve detection of loneliness and social isolation; (2) implement evidence-based social support interventions; (3) revitalize the in-center experience; (4) engage family caregivers; and (5) leverage technology for social connectedness. Neglecting opportunities to bolster social connections among ESKD patients would represent a significant interdisciplinary lapse. The proposed recommendations are feasible due to the integral role of interdisciplinary care within dialysis centers.

A hepatitis B virus-free cccDNA-producing stable cell for antiviral screening

The covalently closed circular DNA (cccDNA) of the Hepatitis B virus (HBV) serves as a template for producing progeny viruses in virally infected hepatocytes. Promising cccDNA-targeting antiviral agents remain unavailable and unpredictable in the research and development pipelines, making sterile HBV elimination challenging at the current stage. The major challenge of discriminating trace amounts of cccDNA from the abundant HBV relaxed circular DNA (rcDNA), which is nearly identical to cccDNA in sequence, substantially discourages efforts to discover and directly screen cccDNA-targeting drugs. Therefore, an easy cccDNA cell culture system is required for high-throughput drug screening. In this study, we designed an HBV cccDNA self-generating stable cell culture system using a functional complementary concept and successfully generated an HBV cccDNA Gaussia luciferase reporter cell line in HepG2 and Huh7 cells. This design ensures that the Gluc signal is exclusively expressed upon cccDNA formation, allowing for the accurate and easy measurement of cccDNA levels via luminescent signals. Using this system, in conjunction with a firefly luciferase reporter to monitor cell activity, we screened 2074 drugs in the HepG2-HBV-cccDNA/Firefly cell line. Four compounds were selected for further experimentation and their anti-HBV effects were confirmed. Thus, this virus-free hepatitis B cccDNA cell culture system provides a valuable and convenient platform for the high-throughput screening of anti-HBV drugs.

Vaccine Hesitancy: Where Are We Now?

Vaccine hesitancy is the delay in acceptance or outright refusal of immunizations, which has evolved into a growing public health threat. In this article, we explore recent trends in vaccine hesitancy in the setting of the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic, vaccine-specific variations, social media influence, and sociodemographic factors. During the coronavirus disease 2019 pandemic, the antivaccine movement gained increasing support and generated widespread conspiracy theories and mistrust. This highlighted the importance of enhancing communication between the health care field and general public. While the impact of antivaccine social media is widespread, physicians have also begun to use technology to spread factual information and increase vaccination uptake. There is a growing body of evidence regarding sociodemographic data, including the pervasive impact of medical racism on vaccine hesitancy, with additional studies on age, education, income, and more. Providers must serve as communicators and focus on presumptive language, strong recommendations, and tailored conversations with families who are hesitant about vaccines. [Pediatr Ann. 2025;54(5):e154-e159.].

Ocular manifestations of West Nile virus infection: A case report and systematic review of the literature

PurposeTo report the case of a patient with ocular West Nile virus infection (WNVI) and to describe the demographics, eye characteristics, and treatment of patients with WNVI reported in the literature.MethodsSystematic literature search using the PubMed MEDLINE database searching for all cases of ocular WNVI published from inception until October 14, 2023. Inclusion criteria were patients with serologic and/or cerebrospinal fluid diagnosis of WNVI with ocular involvement.ResultsA total of 60 patients (111 eyes), including the present case, were included. Most patients were males (57%), diagnosed in the United States (77%), and with a mean age at presentation of 54 years. The median time elapsed between the viral prodrome, and eye symptoms was 7 days. Neurologic involvement was present in 47 (78%) patients. Diabetes mellitus was the most frequent systemic comorbidity (45%). Posterior segment findings were present in 107 (96%) eyes. Multifocal chorioretinal lesions (86%), vitreous inflammation (51%), intraretinal hemorrhages (43%), and retinal vasculitis (21%) were the most frequent findings. Fluorescein angiography was performed in 88 (79%) eyes. Fifty-seven (51%) eyes did not receive treatment. Topical and systemic steroids were prescribed to 35% and 28% of eyes, respectively.ConclusionWNVI should be considered as a potential diagnosis in older patients who exhibit posterior uveitis, especially if they have recently experienced flu-like symptoms and have been exposed to mosquitoes. A comprehensive ocular assessment, which includes a dilated fundus examination and ocular imaging studies, can help raise suspicion for this condition even before serological confirmation is obtained.

COVID-19 infection in patients with end-stage kidney disease undergoing renal replacement therapies in Korea

BACKGROUND

The global coronavirus disease 2019 (COVID-19) pandemic has placed patients with end-stage kidney disease (ESKD) at heightened risk owing to their vulnerability to infections. Our study focused on patients with ESKD, examining COVID-19 incidence, hospitalization, and mortality in relation to their renal replacement therapy (RRT) type and identifying factors influencing COVID-19 hospitalization.

METHODS

We conducted a retrospective cohort study using health insurance claims data from the Health Insurance Review and Assessment Service for patients with ESKD between July 2017 and June 2022. COVID-19 data for the general population were sourced from the Korea Disease Control and Prevention Agency.

RESULTS

Patients undergoing hemodialysis (HD) constituted 90.7% of the cohort, followed by kidney transplantation (KT) recipients and peritoneal dialysis (PD). After adjusting for every 10,000 individuals, KT recipients exhibited the highest COVID-19 incidence, followed by those undergoing HD and PD, whereas the general population showed a higher infection rate of 43.64. Patients undergoing HD had the highest hospitalization rates, followed by KT recipients and those undergoing PD. The mortality rate per 10,000 individuals was highest in HD, followed by PD, the general population, and KT. Multivariate analysis indicated that age, RRT duration, residence in a nursing hospital, and comorbidities were associated with COVID-19 hospitalization.

CONCLUSION

Among RRT modalities, KT recipients displayed the highest COVID-19 incidence, whereas those undergoing HD exhibited the highest hospitalization and mortality rates. This study contributes to our understanding of infectious diseases in patients on RRT and aids in preparedness for future infectious disease outbreaks.

Drug Induced Liver Injury: Highlights and Controversies in the 2023 Literature

Drug-induced liver injury (DILI) remains an active field of clinical research and investigation with more than 4700 publications appearing in 2023 relating to hepatotoxicity of all causes and injury patterns. As in years past, we have attempted to identify and summarize highlights and controversies from the past year's literature. Several new and novel therapeutic agents were approved by the US Food and Drug Administration (FDA) in 2023, a number of which were associated with significant hepatotoxicity. Updates in the diagnosis and management of DILI using causality scores as well as newer artificial intelligence-based methods were published. Details of newly established hepatotoxins as well as updated information on previously documented hepatotoxic drugs is presented. Significant updates in treatment of DILI were also included as well as reports related to global DILI registries.

Susceptibility of diverse sand fly species to Toscana virus

Toscana virus (TOSV) is an emerging but neglected human pathogen currently circulating around the Mediterranean basin including North Africa. Human illness ranges from asymptomatic or mild flu-like syndromes to severe neurological diseases such as meningitis or meningoencephalitis. Despite its significant impact, understanding of TOSV transmission and epidemiology remains limited. Sand flies (Diptera: Phlebotominae), specifically Phlebotomus perniciosus and Phlebotomus perfiliewi, are believed to be the primary vectors of TOSV. However, the spread of TOSV to new geographical areas and its detection in other sand fly species suggest that additional species play a role in the circulation and transmission of this virus. This study investigated the vector competence of four sand fly species - P. tobbi, P. sergenti, P. papatasi, and Sergentomyia schwetzi - for two TOSV strains: 1500590 (TOSV A lineage) and MRS20104319501 (TOSV B lineage). Sand flies were orally challenged with TOSV via bloodmeals. None of the tested species showed susceptibility to the TOSV A strain. However, for TOSV B strain, P. tobbi demonstrated a high potential as a new vector, exhibiting high infection and dissemination rates. P. sergenti also showed some susceptibility to TOSV B, with the virus dissemination observed in all infected females. These finding suggests that P. tobbi and P. sergenti are new potential vectors for TOSV B. Given that P. tobbi and P. sergenti are the primary vectors of human leishmaniases in the Balkans, Turkey and Middle East, their susceptibility to TOSV could have significant epidemiological consequences. On the other hand, P. papatasi and S. schwetzi appeared refractory to TOSV B infection. Refractoriness of P. papatasi, a highly anthropophilic species distributed from the Mediterranean to the Middle East and India, suggests that this species does not contribute to TOSV circulation.

Adapted hepatitis C virus clone infects innate immunity-deficient mouse hepatocytes with minimal human HCV entry factors

Background & Aims

Hepatitis C virus (HCV) has a narrow species tropism and cannot infect mice. To understand HCV species tropism and to develop better animal models, we adapted HCV to infect mouse cells deficient in innate immunity and with minimal human HCV host factors.

Methods

HCV was adapted via passaging an HCV infectious virus clone several times in human hepatoma cells, mouse liver cells, and eventually primary mouse hepatocytes deficient in innate immunity and ectopically expressing human occludin and human CD81. Using RNAseq the sequence of the adapted virus was analyzed, and several clones were generated to study replication and infection kinetics as well as neutralization assays in several human/mouse cell lines and primary hepatocytes from human, mouse, and macaques.

Results

Accumulation of 35 non-synonymous and 66 synonymous mutations correlated with >1,000-fold enhanced production of infectious progeny from primary mouse hepatocytes. These mutations did not confer drug resistance or evasion from innate immunity. They did not enhance fitness in human or macaque hepatocytes. We show that non-synonymous mutations are necessary and sufficient for adaptation, and that changes to the glycoproteins are not essential. Mutations outside of viral envelope proteins enhanced specific infectivity and facilitated viral spread in murine cells.

Conclusions

This study reveals key viral factors governing HCV species tropism. The mouse-adapted HCV opens up possibilities for the development of animal models to analyze HCV pathogenesis, immune control, and vaccine development.

Impact and implications

This work demonstrates the feasibility in principle of HCV adaptation to replication in and infection of non-human cells. This is made possible by a manageable number of non-synonymous mutations and opens up new ways to elucidate the principles of HCV species tropism and to develop important animal models for HCV research in the long term.

Acute Epstein Barr Virus is a risk factor for severe malaria in infants under 24 months

Background

Primary Epstein Barr Virus (EBV) infection occurs during late adolescence and is characterized by the symptomatic manifestation of infectious mononucleosis (IM). Primary EBV infection in malaria-endemic areas often occurs in young children by the age of 2 and is generally asymptomatic. Acute EBV infection in children of this age results in humoral immune suppression to unrelated antigenic challenges for approximately 4 weeks. Whether acute EBV in infants similarly suppresses the development of antibody responses against Plasmodium falciparum (Pf) predisposing infants to severe malaria is unknown.

Methods

We undertook a cross-sectional study of 195 infants aged 6-24 months in Cameroon. Infants were determined to be parasitaemic by microscopy or RDT, and their disease severity classified based on WHO criteria. The EBV infection status of each child was determined using a standard serological classification system, and the magnitude, breadth, and invasion blocking capacity of the anti- Pf antibody response were quantified.

Results

26.7% of children were serologically positive for acute EBV infection, and the highest proportion of severe malaria cases was in children with primary acute EBV. An elevated magnitude and breadth of the antibody response with increased in vitro invasion-blocking capacity was observed in children with acute EBV but circulating parasitaemia in vivo was similar.

Conclusion

Acute EBV infection is a risk factor for developing severe malaria in children 6-24 months. Targeting EBV infection in young children may be beneficial in protecting against the development of severe falciparum malaria in children living in malaria-endemic areas.

Key points

Acute EBV infection in infants increases the risk of severe falciparum malaria. This does not appear to be due to an EBV-induced impairment of the anti- Plasmodium humoral immune response which is elevated in magnitude, breadth and function.

Predictive Biomarkers of Acute Kidney Injury in COVID-19: Distinct Inflammatory Pathways in Patients with and Without Pre-Existing Chronic Kidney Disease

BACKGROUND

Acute kidney injury (AKI) has emerged as a significant complication in patients with coronavirus disease 2019 (COVID-19). The pathophysiology of COVID-19-associated AKI is multifactorial, involving both direct viral effects on renal cells and indirect mechanisms such as systemic inflammation and cytokine storms. This highlights the critical need for early detection and effective management strategies to mitigate kidney injury and improve patient outcomes. The aim of our study is to assess the potential predictive role of inflammatory biomarkers in determining the risk of developing COVID-19-associated AKI in patients with and without pre-existing CKD.

METHODS

This study included 84 patients stratified by pre-existing chronic kidney disease (CKD) status. Demographic, clinical, and laboratory data were collected, including vital signs, hematological profiles, renal function markers, inflammatory biomarkers, coagulation parameters, and treatments. Outcomes such as acute kidney injury (AKI) and in-hospital mortality were documented.

RESULTS

In patients with pre-existing CKD, IL-6 and NLR demonstrated high predictive accuracy for AKI onset. In patients without pre-existing CKD, white blood cell (WBC) count emerged as a significant predictor of AKI onset.

CONCLUSIONS

The differential roles of IL-6, NLR, and WBC in predicting AKI onset highlight distinct physiopathological pathways influenced by COVID-19. In CKD+ patients, chronic inflammation and immune dysregulation are key drivers of AKI, with IL-6 and NLR serving as robust markers of this inflammatory state. In contrast, in CKD- patients, AKI may be more influenced by acute inflammatory responses and infectious factors, as reflected by WBC count.

Advances and challenges in cancer immunotherapy: Strategies for personalized treatment

Cancer immunotherapy has transformed oncology by harnessing the immune system to specifically target cancer cells, offering reduced systemic toxicity compared to traditional therapies. This review highlights key strategies, including adoptive cell transfer (ACT), immune checkpoint inhibitors, oncolytic viral (OV) therapy, monoclonal antibodies (mAbs), and mRNA-based vaccines. ACT reinfuses enhanced immune cells like tumor-infiltrating lymphocytes (TILs) to combat refractory cancers, while checkpoint inhibitors (eg, PD-1 and CTLA-4 blockers) restore T-cell activity. OV therapy uses engineered viruses (eg, T-VEC) to selectively lyse cancer cells, and advanced mAbs improve targeting precision. mRNA vaccines introduce tumor-specific antigens to trigger robust immune responses. Despite significant progress, challenges like immune-related side effects, high costs, and immunosuppressive tumor microenvironments persist. This review underscores the need for combination strategies and precision medicine to overcome these barriers and maximize the potential of immunotherapy in personalized cancer treatment.

Current status of next-generation vaccines against mpox virus: a scoping review

Introduction

The mpox disease, caused by the mpox virus (MPXV), has become a rising public health issue due to its potential to cause outbreaks. Consistently, this investigation aims to evaluate the current advances in the development of novel immunotherapeutic approaches against MPXV, which are crucial for preventing and controlling mpox spread.

Methods

This scoping review was performed by analyzing the content of English-language articles published between 2018 and 2024, which reported the development of next-generation vaccines against MPXV and their assessment in animal models. Patents within the scope of this research were also included. Contrarywise, studies based solely on immunoinformatic methods, reviews, book chapters, news, and others were excluded. The literature search was executed in 11 databases, such as Scopus, MEDLINE, and PubMed.

Results

A total of 36 records (32 studies and 4 patents) were included in this review. All 32 articles contain preclinical studies with varied group sizes (4-16) in which the main animal models were BALB/c mice. Less commonly used models included CAST/Ei mice and cynomolgus macaques. Moreover, most vaccines targeted one or more MPXV antigens, such as A29L, A35R, B6R, and M1R, through active immunization (via mRNAs or recombinant antigens) or passive immunization (antibody delivery).

Conclusion

Overall, new generation vaccines might represent prospective candidates to combat the mpox health concern. Nonetheless, several of the analyzed studies possess drawbacks, including animal models with limited similarity to humans, small group sizes, and brief follow-up durations. Consequently, additional research is required to ascertain the long-term protection, efficacy, and safety of these immunotherapeutic approaches.

Association Between Nursing Diagnoses and Mortality in Hospitalized Patients with COVID-19: A Retrospective Cohort Study

Previous studies suggest that nursing diagnoses (NDs) could predict clinical outcomes, such as mortality, among patients with non-communicable diseases. However, evidence in patients with COVID-19 is still scarce. Objective: To evaluate the association between NDs and COVID-19 mortality among hospitalized patients. Methods: A retrospective cohort study was conducted on 498 paper clinical records of patients hospitalized for at least 72 h in the internal medicine unit for COVID-19 from June to December 2020. The interest association was assessed using logistic regression models. Results: NDs focused on COVID-19 pulmonary responses, such as impaired gas exchange (OR = 3.04; 95% CI = 1.87, 4.95), impaired spontaneous ventilation (OR = 3.67; 95% CI = 2.17, 6.21), or ineffective airway clearance (OR = 2.47; 95% CI = 1.48, 4.12), were significant predictors of mortality. NDs on COVID-19 extrapulmonary responses, such as risk for unstable blood glucose level (OR = 2.45; 95% CI = 1.45, 4,15), risk for impaired liver function (OR = 2.02; 95% CI = 1.11, 3.63), hyperthermia (OR = 2.08; 95% CI = 1.29, 3.35), decreased cardiac output (OR = 2.95; 95% CI = 1.42, 6.11), or risk for shock (OR = 3.03; 95% CI = 1.28, 7.13), were associated with a higher risk of in-hospital mortality. Conversely, patients with NDs of fear (OR = 0.56; 95% CI = 0.35, 0.89) and anxiety (OR = 0.44; 95% CI = 0.26, 0.77) had a lower risk of death. Conclusions: NDs on pulmonary and extrapulmonary responses to COVID-19 were associated with in-hospital mortality, suggesting that they are indicators of the severity of these patients. Therefore, NDs may help nursing staff identify individuals who require closer monitoring and guide early interventions for their recovery.

The epidemiology of Lassa fever in Ghana: a study on the 2023 Lassa fever outbreak in Ghana

Background

Viral disease outbreak remains a key public health concern given its impact on life and livelihood. Historical data suggests Lassa fever is endemic in several West African countries with sporadic cases occurring elsewhere in the region. In February 2023, Ghana recorded its second outbreak of Lassa fever following that of 2011. The present study sought to document the epidemiology of the recent outbreak in Ghana.

Methods

The study used data from the case investigation forms accompanying samples submitted to Noguchi Memorial Institute for Medical Research between February and March 2023 for Lassa fever testing. Descriptive analysis was used to analyse and report the demographic characteristics. Inferential statistics was used to determine associations between the study variables.

Results

The overall positivity rate was 5.19% out of the 539 samples received. Most cases were confirmed in the Month of February. Positivity rate was higher among females (5.65%). Over 90% of all confirmed cases were from the Greater Accra Region. Case burden for LF was highest among healthcare professionals and also adults aged 25-35 years. The commonly reported symptoms among confirmed cases included headache, intense fatigue, fever, and muscle/joint pain.

Conclusion

Lassa fever was confirmed among 5.19% of the suspected cases. Transmission was largely through contact with the highest burden among healthcare workers which is suggestive of poor infection control procedures. There is a need to build and sustain fundamental public health capacities to recognise, diagnose, report, and respond to risks of public health concern and interest.

Emerging Immunotherapies in Lung Cancer: The Latest Advances and the Future of mRNA Vaccines

Lung cancer is the most lethal malignancy worldwide, having the highest incidence rate. This is a heterogeneous disease classified according to its histological and molecular characteristics. Depending on these, different therapeutic approaches have already been approved for lung cancer treatment targeting genetic alterations or even the immune system. Nonetheless, other therapies are being studied to continuously improve the care and survival of lung cancer patients. Among them, immunotherapies are one of the main targets of investigation to try and combat the ability of some malignant cells to evade anti-tumor responses mediated by the immune system. Cancer vaccine development has emerged as a promising approach to strengthen the patient's immune system and combat the disease, especially mRNA vaccines. Currently, there are several ongoing studies investigating the therapeutic efficacy of mRNA vaccines in lung cancer treatment alone or combined with other therapeutic drugs. This review aims to highlight the importance of immunotherapy in lung cancer treatment, presenting the most recent advances particularly in mRNA-based vaccines as well as the challenges and future perspectives.

BioCurve Analyzer: a web-based shiny app for analyzing biological response curves

BACKGROUND

Dose-response and time-to-event data are common in enzymology, pharmacology, and agronomy studies. Diverse biological response curves can be generated from such data. The features of these curves can be elucidated through parameters such as ED50 (the effective dose that gives 50% of the maximum response) and T50 (the time required to reach 50% of the maximum response). Properly estimating these parameters is crucial for inferring the potency of compounds or the relative timings of biological processes.

RESULTS

We present an open-source Shiny application, BioCurve Analyzer, that simplifies the process of inferring ED50 and T50 parameters from response curves exhibiting various patterns, including classic monotonic sigmoidal curves and more complicated biphasic curves. BioCurve Analyzer provides access to several packages and commonly used models for characterizing response patterns, assists users in identifying the models that best describe their data, and includes options for inferring ED50 values on both sides of biphasic curves. BioCurve Analyzer also facilitates the visualization of response patterns and allows users to customize their final graphical representation to deliver publication-quality graphs of the data.

CONCLUSION

BioCurve Analyzer integrates multiple R packages in an easy-to-use web-based interface to facilitate dose-response and time-to-event analyses.

Pathophysiological Mechanisms Linking COVID-19 and Acute Surgical Abdomen: A Literature Review

Acute surgical abdomen is characterized by intense, sudden abdominal pain due to intra-abdominal conditions requiring prompt surgical intervention. The coronavirus disease 2019 (COVID-19) pandemic has led to various complications related to the disease's complex pathophysiological mechanisms, hence the hypothesis of COVID-19-induced acute abdominal surgical pathologies. The connection between acute surgical abdomen and COVID-19 involves two primary mechanisms. First, there is the presence of angiotensin-converting enzyme 2 (ACE2) receptors in multiple abdominal organs. This facilitates the cytokine storm through direct viral injury and inflammation. Second, the hypercoagulable state induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) increases the thrombotic risk within abdominal vessels, which can subsequently lead to ischemia. ACE2 receptors are notably expressed in the gastric, duodenal, and rectal epithelium, with SARS-CoV-2 viral RNA and nucleocapsid proteins detected in these tissues. The inflammatory response results in significant endothelial damage, activating coagulation pathways that cause monocellular infiltration, lymphocytic inflammation, and uncontrolled coagulation. These findings highlight the need for further research to clarify how COVID-19 leads to acute abdominal pathologies. Understanding these mechanisms is vital for improving clinical management and patient outcomes during future health crises and in the aftermath of the pandemic.

Important issues on the prevention of surgical site infections and the management of prophylactic antibiotics

In this article, we have addressed the recent published article by Wang et al which examines risk factors associated with surgical site infections (SSIs) and evaluates the effectiveness of prophylactic antibiotics in their prevention. Wang et al identified several significant risk factors of SSIs, including age ≥ 60 years, diabetes mellitus, and surgical complications such as insufficient cystic duct stump closure, gallbladder perforation, empyema, and postoperative hematoma. Their findings suggest that prophylactic antibiotics can serve as a protective factor against SSIs. However, other reported risk factors and preventive strategies warrant consideration to further reduce the incidence of SSIs, lower healthcare costs, and enhance patient outcomes. Additionally, the judicious use of prophylactic antibiotics is crucial in light of the growing global challenge of antibiotic resistance caused by the misuse and overuse of antibiotics. Effective management strategies for prophylactic antibiotic use should be prioritized to balance infection control with the need to combat antimicrobial resistance.

Targeted protein degraders of SARS-CoV-2 Mpro are more active than enzymatic inhibition alone with activity against nirmatrelvir resistant virus

BACKGROUND

Effective antiviral therapy is lacking for most viral infections, and when available, is frequently compromised by the selection of resistance. Targeted protein degraders could provide an avenue to more effective antivirals, able to overcome the selection of resistance. The aim of this study was to determine whether adaptation of SARS-CoV-2 main protease (Mpro, also described as chymotrypsin-like protease (3CLpro) or non-structural protein 5 (Nsp5)) inhibitors into degraders leads to increased antiviral activity, including activity against resistant virus.

METHODS

We adapted the clinically approved Mpro inhibitor nirmatrelvir into a panel of degraders. Size-matched non-degrading controls were also synthesised to discriminate degradation activity from inhibition activity. Degrader activity was confirmed using an inducible Mpro-HiBiT tag expressing cell line. Antiviral activity against both wildtype and nirmatrelvir-resistant virus was performed using infection of susceptible cell lines.

RESULTS

Here we show three compounds, derived from nirmatrelvir and utilising VHL or IAP ubiquitin ligase recruiters, capable of degrading Mpro protein in a concentration, time and proteasome dependent fashion. These compounds also degrade nirmatrelvir-resistant mutant Mpro. The most potent of these compounds possesses enhanced antiviral activity against multiple wildtype SARS-CoV-2 strains and nirmatrelvir-resistant strains compared to non-degrading controls.

CONCLUSIONS

This work demonstrates the feasibility of generating degraders from viral protein inhibitors, and confirms that degraders possess higher antiviral potency and activity against resistant virus, compared to size matched non-degrading enzymatic inhibitors. These findings further support the development of targeted viral protein degraders as antiviral drugs, which may lead to more effective antiviral therapies for the future.

Exploring quercetin based nano formulation in combating human Metapneumovirus infections

Human Metapneumovirus (hMPV) is a significant respiratory pathogen, particularly affecting children, the elderly, and immunocompromised individuals. Despite its clinical impact, there are currently no approved vaccines or specific antiviral treatments for hMPV, necessitating the exploration of novel therapeutic strategies. Quercetin, a naturally occurring flavonoid with well-documented antioxidant, anti-inflammatory, and antiviral properties, has shown promising potential in combating hMPV infections. However, its poor bioavailability limits its therapeutic efficacy. Recent advancements in nanotechnology offer a solution through quercetin-based nanoformulations, which enhance its solubility, stability, and bioavailability, thereby improving its antiviral potency. Molecular docking studies have demonstrated strong interactions between quercetin and the hMPV matrix protein, suggesting its role in inhibiting viral replication. Additionally, quercetin modulates oxidative stress and inflammatory responses by suppressing key pathways such as NF-κB and IRF-3, reducing lung damage associated with hMPV infections. In vitro and in vivo studies indicate that quercetin-loaded nanoparticles effectively decrease viral titers and inflammatory markers. Given its natural origin, safety profile, and therapeutic potential, quercetin-based nanoformulations emerge as a promising candidate for hMPV treatment. Further clinical trials are required to validate their efficacy and optimize formulations for potential clinical application.

A Standardised Method to Quantify the Infectious Titre of Rabbit Haemorrhagic Disease Virus

Quantifying the infectious titre of preparations containing rabbit haemorrhagic disease virus (RHDV) is an essential virological technique during RHDV research. The infectious titre of an RHDV preparation is determined using a bioassay to identify the endpoint dilution at which 50% of rabbits become infected (RID50). Previous publications have briefly described the method for estimating the infectious titre of RHDV preparations by challenging rabbits with 10-fold serial dilutions. However, these descriptions lack the critical considerations for a standardised method to estimate RID50. These details are presented here, along with a comparison between the Reed-Muench, Dragstedt-Behrens, Spearman-Kärber, and probit regression methods for calculating the RID50. All the statistical approaches demonstrated a high level of agreement in calculating the RID50. To help assess the precision of the estimated infectious titre, the improved Spearman-Kärber and probit regression methods provide the 95% confidence intervals. The method outlined improves the accuracy of results when undertaking studies of pathogenicity, host resistance, and the production of vaccines against RHDV.

Evaluating HIV drug resistance in the middle East and North Africa and its associated factors: a systematic review

OBJECTIVE

One of the obstacles to achieving successful treatment of HIV infections is the development and spread of mutations linked to resistance. Thus, it is important to monitor the prevalence and occurrence of drug resistance in HIV consistently. This study aimed to investigate how drug resistance affects the effectiveness of ART.

METHODS

This systematic review focused on surveying ART resistance in both treatment-naïve and treatment-experienced PWH from 2004 to 2024.

RESULTS

Out of 101 potential publications, 41 studies were included in this review. ART-experienced PWH in MENA countries commonly receive a regimen consisting of two NRTI drugs in combination with one NNRTI drug. The most frequent mutations were found in NRTIs (M184V, D67N, V75M, M41L, and T69N), NNRTIs (K103N, K101E, V106A, and G190S), and PIs (M36I and H69K). The ART-experienced groups in Israel and Iran presented the highest rates of resistance, reaching 52.78% and 43.03%, respectively, whereas the ART-naïve group in Turkey presented a resistance rate of 53.57%. The most prevalent HIV-1 subtypes in the region were B, CRF35-AD, CRF01-AE, A1, CR02-AG, C, and D. A high frequency of drug resistance mutations, such as M184V and K103N/S, was observed in the CRF35-AD, A, and C subtypes.

CONCLUSION

This is the first report to provide deep insight into ART resistance patterns in the MENA region among both ART-naïve and ART-experienced PWH. The results revealed a significant occurrence of drug resistance to RTIs, PIs, and INSTIs among both groups. This finding highlights the importance of prescribing the INTIs in native and PWH with resistance to RTIs and/or PIs to increase the chance of response to ART as well as regular monitoring of resistance to ART in MENA countries. This also involves identifying the key factors contributing to drug resistance, including inadequate adherence to ART and a lack of adequate monitoring systems to prevent treatment failure. Since the MENA region is significant as an economic challenge, PWH with poor adherence to ART medication and insufficient monitoring systems may hinder successful infection control; therefore, HIV control strategies may prevent viruses from spreading in other countries.

CLINICAL TRIAL NUMBER

Not applicable.

Advances in the Drug Development and Quality Evaluation Principles of Oncolytic Herpes Simplex Virus

Oncolytic herpes simplex virus (oHSV) represents a promising therapeutic approach to treating cancers by virtue of its selective replication in and lysis of tumor cells, with stimulation of host antitumor immunity. At present, four OV drugs have been approved for the treatment of cancers worldwide, two of which are oHSV drugs that have received extensive attention, known as T-VEC and Delytact. This review discusses the history, mechanism of action, clinical development, quality control, and evaluation principles of oHSV products, including viral species and genetic modifications that have improved these products' therapeutic potential, limitations, and future directions. Integration of oHSVs with immunotherapeutic agents and conventional therapies has a promising future in the field of treatment of malignant tumors. Although much progress has been achieved, there is still much work to be done regarding the optimization of treatment protocols and the quality control of oncolytic virus drugs. The approval of various oncolytic virus therapies underlines their clinical relevance, safety, and efficacy, thereby paving the way for further research aimed at overcoming the existing limitations and enhancing patient responses.

The Effect of a Brief Video-Based Intervention to Improve AIDS Prevention in Older Men: Randomized Controlled Trial

Background

The AIDS epidemic among older people is becoming more serious. Evidence-based, acceptable, and effective preventive interventions are urgently needed. Video-based interventions have become an innovative way to change behaviors, and we have developed a brief video-based intervention named Sunset Without AIDS.

Objective

In this study, we tested the effectiveness of a brief video-based intervention targeting older men's understanding of AIDS prevention.

Methods

A randomized controlled trial was conducted from June 20 to July 3, 2023. In total, 100 older men were randomly divided into the intervention group (n=50) and the control group (n=50) using the envelope extraction method. The intervention group was shown the Sunset Without AIDS video; the control group viewed a standard AIDS education video. A questionnaire was used to measure the effect of Sunset Without AIDS after 2 interventions. AIDS-related high-risk behaviors were followed up 1 and 3 months after the intervention. The difference was statistically significant at P≤.05.

Results

After 2 interventions, the total awareness rates (%) of AIDS-related knowledge in the intervention and control groups were 84% (42/50) and 66% (33/50), respectively (P=.04). The mean stigma attitude scores of the 2 groups were 2.53 (SD 0.45) and 2.58 (SD 0.49), respectively (P=.55), but there was a statistically significant difference in the first dimension (fear of infection) between the 2 groups (P<.001). The mean positive scores of attitudes of AIDS-related high-risk behaviors of the 2 groups were 83.33 (SD 21.56) and 75.67 (SD 26.77), respectively (P=.58). In addition, 82% reported that they were satisfied with the educational content within the Sunset Without AIDS video. At 1- and 3-month follow-ups conducted after the intervention, participants in the 2 groups did not report AIDS-related high-risk behaviors. After watching the 2 videos, more people accepted and were satisfied with Sunset Without AIDS.

Conclusions

Sunset Without AIDS could improve the ability of older men in China to follow best practices for AIDS prevention and provide a certain basis for the innovation of AIDS education in the older adult population.

The structural protein VP3 of enterovirus D68 interacts with MAVS to inhibit the NF-κB signaling pathway

Enterovirus D68 (EV-D68) is an emerging pathogen causing severe respiratory infections, and the immune evasion mediated by EV-D68 structural protein has been under discussion for several years. Our early research has identified that EV-D68 structural protein VP3 targets specifically the interferon regulatory factor 7 to inhibit type I interferon signaling, but not interferon regulatory factor 3, which is indispensable for mitochondrial antiviral signaling protein (MAVS)-activated type I interferon signaling. Interestingly, in this study, we found that VP3 co-localizes and interacts with MAVS. Furthermore, VP3 acts as a negative regulator of MAVS/Sendai virus-activated NF-κB signaling pathway. Overexpression of VP3 can promote EV-D68 replication and reverse MAVS-mediated inhibition of virus replication. The mechanism of the interaction between VP3 and MAVS may be that VP3 not only disrupts the mitochondrial membrane potential but also leads to the release of MAVS from mitochondria. Moreover, VP3 binds to the transmembrane domain of MAVS with mitochondrial membrane localization function, which provides support for the mechanism of action. Finally, in our study, we found that VP3 interaction with MAVS to inhibit NF-κB activation is a mechanism that is prevalent in enteroviruses. Overall, our data demonstrate that the interaction between VP3 and MAVS can be used by enteroviruses to evade host innate immunity as a broad-spectrum strategy.IMPORTANCEEnterovirus D68 (EV-D68), as an emerging pathogen, has resulted in a rising number of pediatric infections worldwide since its initial outbreak in the United States in 2014. This virus can cause severe respiratory illnesses and is linked to acute flaccid myelitis. In this article, we report that the structural protein VP3 of EV-D68 inhibits the activation of the NF-κB signaling pathway by targeting mitochondrial antiviral signaling protein (MAVS). Further studies demonstrate that VP3 can induce mitochondrial damage, resulting in the loss of MAVS localization in mitochondria. These findings suggest that the interaction between VP3 and MAVS may represent a mechanism by which EV-D68 suppresses the activation of the NF-κB signaling pathway, facilitating immune evasion and promoting viral replication. Our study suggests potential therapeutic strategies for enterovirus-related viral diseases and the development of novel antiviral drugs.

Prediction and Evaluation of Coronavirus and Human Protein-Protein Interactions Integrating Five Different Computational Methods

The high lethality and infectiousness of coronaviruses, particularly SARS-Cov-2, pose a significant threat to human society. Understanding coronaviruses, especially the interactions between these viruses and humans, is crucial for mitigating the coronavirus pandemic. In this study, we conducted a comprehensive comparison and evaluation of five prevalent computational methods: interolog mapping, domain-domain interaction methodology, domain-motif interaction methodology, structure-based approaches, and machine learning techniques. These methods were assessed using unbiased datasets that include C1, C2h, C2v, and C3 test sets. Ultimately, we integrated these five methodologies into a unified model for predicting protein-protein interactions (PPIs) between coronaviruses and human proteins. Our final model demonstrates relatively better performance, particularly with the C2v and C3 test sets, which are frequently used datasets in practical applications. Based on this model, we further established a high-confidence PPI network between coronaviruses and humans, consisting of 18,012 interactions between 3843 human proteins and 129 coronavirus proteins. The reliability of our predictions was further validated through the current knowledge framework and network analysis. This study is anticipated to enhance mechanistic understanding of the coronavirus-human relationship a while facilitating the rediscovery of antiviral drug targets. The source codes and datasets are accessible at https://github.com/covhppilab/CoVHPPI.

Natural pyrrolo[1,2-a]quinazolinone derivatives: Design, synthesis, characterization, and bio-evaluation as novel antiviral agents

As viral infectious diseases increasingly threaten global health, antiviral drug research has become a focus in the medicinal chemistry. Enterovirus has always been an important virus causing infections disease with a high incidence in summer and autumn, such as Enterovirus 71 (EV71) and Coxsackievirus B3 (CVB3). Currently, no specific antiviral drugs are available for EV71 and CVB3. So, we designed and synthesized a novel series of quinazolinone derivatives based on the natural pyrrolo[1,2-a]quinazolinone scaffold, which were fully characterized and identified as potential anti-enterovirus agents. Among them, compound B9 exhibited potent anti-CVB3 activity with an EC50 value of 17.4 ± 3.62 μM, and compound B5 exhibited potent anti-EV71 activity with an EC50 value of 14.8 ± 2.18 μM as confirmed by determining the cytopathic effects, progeny virus titers, viral nucleic acid and protein levels. The potential antiviral mechanisms of compound B5 were also explored. The compound B5 exhibited a powerful therapeutic effect primarily by blocking the post-attachment stage of viral infection. Further experiments demonstrated that compound B5 didn't inhibit the activities of the EV71 2Apro and 3Dpol. Modelling of the molecular binding of the 3Cpro-compound complex revealed that the compound B5 could insert into the substrate-binding pocket of EV71 3Cpro, blocking substrate recognition and possibly inhibiting EV71 3Cpro activity. These researches may provide evidence for the development of these novel pyrrolo[1,2-a]quinazolinone derivatives derived from natural products as potential antiviral agents.

Diabetes and natural and man-made disasters: prevention, preparation, response and recovery

Both the global prevalence of diabetes and the frequency of natural and man-made disasters are increasing. Of all chronic diseases, the consequences of sudden loss of medical supplies are most serious for those with diabetes, with people living with type 1 diabetes being at risk of death within a few days without insulin. This review considers how to prepare for and respond to sudden reductions in medical supplies to those with diabetes. Recent experiences with the COVID-19 pandemic in India, the war in Ukraine and the war/blockade in the Tigray region of Ethiopia are described, and the importance of prevention, preparedness, response and recovery are discussed. It is hoped that lessons from these and other disasters and ongoing advocacy and other actions may help to mitigate the risks of significant morbidity and mortality for people with diabetes in disaster-impacted regions across the world.

Scalable Production of Recombinant Adeno-Associated Virus Vectors Expressing Soluble Viral Receptors for Broad-Spectrum Inhibition of Porcine Reproductive and Respiratory Syndrome Virus Type 2

Porcine reproductive and respiratory syndrome virus (PRRSV) continues to be a major threat to the global swine industry, causing significant economic losses. To address this, we developed a scalable recombinant adeno-associated virus (rAAV)-based strategy for the delivery of soluble viral receptors (SVRs) to treat and potentially eliminate PRRSV infections. This strategy involves fusing the virus-binding domains of two key cellular receptors, sialoadhesin (Sn4D) and CD163 (SRCR5-9), with an Fc fragment. We then used an insect cell-baculovirus expression vector system to produce the rAAV-SRCR59-Fc/Sn4D-Fc vector. Through a series of optimizations, we determined the best conditions for rAAV production, including a baculovirus co-infection ratio of 0.5:1.0, an initial insect cell density of 2.0 × 106 cells/mL, a fetal bovine serum concentration of 2%, and a culture temperature of 30 °C. Under these optimized conditions, we achieved a high titer of rAAV-SRCR59-Fc/Sn4D-Fc in a 2 L bioreactor, reaching 5.4 ± 0.9 × 109 infectious viral particles (IVPs)/mL. Notably, in vitro neutralization assays using a Transwell co-culture system demonstrated a 4.3 log reduction in viral titers across genetically diverse PRRSV-2 strains, including VR2332, JXA1, JS07, and SH1705. Collectively, this study provides a robust platform for large-scale rAAV production and highlights the potential of SVR-based gene therapy to address the antigenic diversity of PRRSV-2.

Understanding local determinants of dengue: a geographically weighted panel regression approach in Yogyakarta, Indonesia

BACKGROUND

Dengue remains a major public health concern in tropical regions, including Yogyakarta, Indonesia. Understanding its spatiotemporal patterns and determinants is crucial for effective prevention strategies. This study explores the spatiotemporal determinants of dengue incidence and evaluates the spatial variability of predictors using a geographically weighted panel regression (GWPR) approach.

METHODS

This ecological study applied a spatiotemporal approach, analyzing dengue incidence across 78 sub-districts in Yogyakarta from 2017 to 2022. The dataset included meteorological variables (rainfall, temperature, humidity, wind speed, and atmospheric pressure), sociodemographic data (population density), and land-use characteristics (built-up areas, crops, trees, water bodies, and flooded vegetation). A GWPR model with a Fixed Exponential kernel was used to assess local variations in predictor influence.

RESULTS

The Fixed Exponential Kernel GWPR model showed strong explanatory power (Adjusted R2 = 0.516, RSS = 43,097.96, AIC = 28,447.38). Local R-Square values ranged from 0.25 (low-performing sub-districts) to 0.75 (high-performing sub-districts), indicating significant spatial heterogeneity. Sub-districts such as Pakem, Cangkringan, and Girimulyo exhibited high local R2 values (>0.75), indicating robust model performance, whereas Kalibawang showed lower values (<0.25), suggesting weaker predictive power. High-dengue-burden sub-districts, including Kasihan (0.743), Banguntapan (0.731), Sewon (0.716), Wonosari (0.623), and Wates (0.540), demonstrated stronger associations between dengue incidence and key predictors. In Wonosari, the most influential predictors were Rainfall Lag 1, Rainfall Lag 3, temperature, humidity, wind speed, atmospheric pressure, and land-use variables, while in Wates, significant predictors included Rainfall Lag 1, Rainfall Lag 3, atmospheric pressure, and land-use factors. Lower model performance in Sedayu and Kalibawang suggests the necessity of incorporating additional predictors such as sanitation conditions and vector control activities.

CONCLUSIONS

The GWPR model provides valuable insights into the spatiotemporal dynamics of dengue incidence, emphasizing the role of localized predictors. Spatially adaptive prevention strategies focusing on high-risk areas are essential for effective dengue control in Yogyakarta and similar tropical regions.

Characteristics of the pseudorabies virus strain GDWS2 with severe neurological signs and high viral shedding capacity in pigs

Pseudorabies virus (PRV) poses a serious threat to the global swine industry, as PRV infection can lead to reproductive disorders in sows and high mortality in newborn piglets. Although pigs typically exhibit age-related resistance to PRV, with older pigs exhibiting milder symptoms upon infection, the recent isolation of multiple highly pathogenic PRV variants and reports of severe symptoms and even death in older pigs have garnered much attention. The GDWS2 strain isolated in this study exhibits characteristics similar to those of highly pathogenic strains. GDWS2 was isolated from the brain tissue of a 90-day-old diseased pig that exhibited severe respiratory and neurological symptoms. The pig originated from a farm that had been previously vaccinated with the Bartha-k61 strain. In vitro experiments demonstrated that GDWS2 induces substantial cytopathic effects in PK-15, VERO, BHK cells, and PAM. Moreover, GDWS2 formed larger plaques and exhibited higher early replication titers in PK-15 cells compared to the highly pathogenic variant strain JM isolated in China. Phylogenetic analysis revealed that GDWS2 belongs to PRV genotype II, with gD, gE, and TK genes showing high homology to those of highly pathogenic PRV variants. Additionally, GDWS2 harbors unique insertions or mutations in the US1, UL36, and UL5 gene regions, and its genome contains recombination events with PRV variants, Bartha, or genotype I strains. In vivo experiments further confirmed the high pathogenicity of GDWS2. In rabbit and 90-day-old pig models, GDWS2, compared with the JM strain, caused high mortality rates, accompanied by severe pathological damage. Notably, in the 90-day-old pig model, the GDWS2 challenge group exhibited more severe respiratory and neurological symptoms, and enhanced neurotropism and shedding capacity. The data from this study may indicate the emergence of a naturally recombined and highly pathogenic PRV variant in China once again.

Gastrointestinal cytomegalovirus infection in persons with HIV: a retrospective case series study

BACKGROUND

Gastrointestinal (GI) cytomegalovirus (CMV) infection remains an important cause of morbidity among persons with HIV (PWH), even in the late antiretroviral therapy (ART) era. However, its varied clinical presentations and outcomes are not fully understood.

METHODS

We conducted a retrospective review of 21 PWH with histologically confirmed GI-CMV infections admitted to a tertiary hospital in Nanjing, China, between September 2018 and September 2023. Clinical features, endoscopic findings, histology, treatment responses, and outcomes were examined.

RESULTS

Patients were predominantly male (95.2%) with a median age of 42 years. Over 80% had CD4 cell counts below 50 cells/µL; at admission, they were not on effective ART or had only recently initiated it, with a median HIV viral load of 5.2 log copies/mL (IQR: 4.9-5.7). Diarrhea (71.4%) was the most common presentation, followed by fever (52.4%), abdominal pain (47.6%), and GI bleeding (38.1%). The median symptom duration was 2.0 months (IQR: 1.0-5.0). Nearly half the patients had concurrent CMV end-organ disease-most commonly CMV retinitis-and 95.2% had at least one AIDS-defining illness; GI mycobacterial co-infection was found in three patients. The colon was the most frequently affected GI site, followed by the stomach and esophagus. Endoscopic findings included ulcers, erosions, proliferative lesions, and diffuse mucosal hemorrhage. All patients initially received intravenous ganciclovir and/or foscarnet for a median of 30 days (IQR: 20-39). The 9 patients with CMV retinitis were given oral ganciclovir maintenance. Gastrointestinal surgery was needed in 9.5% of cases. The 6-month mortality rate was 4.8%.

CONCLUSION

GI-CMV infection primarily affects PWH with profound immunosuppression (CD4 < 50 cells/µL) and inadequate or absent ART. These patients frequently have other AIDS-defining illnesses and CMV end-organ diseases, complicating their management. For PWH with GI-CMV infection, clinicians should address not only CMV itself but also coexisting conditions arising from advanced immunodeficiency to improve outcomes.

Determinants of Foot and Mouth Virus in Eastern Algeria

Foot and mouth disease (FMD) is a highly contagious viral disease affecting cattle with significant economic impact. This cross-sectional field study aims to determine the current serological status of FMD in Algerian cattle herds. The objectives were: to evaluate post-vaccination antibody responses to non-structural proteins (NSPs) in vaccinated cattle under the Algerian FMD control program, and to identify circulating Foot and Mouth Disease Virus (FMDV) strains while assessing vaccine efficacy. From September to November 2019, we collected 573 blood samples from clinically healthy, vaccinated cattle four weeks post-vaccination. Differentiation between infected and vaccinated animals was accomplished through detection of antibodies against NSPs using the FMDV 3ABC-AB ELISA assay for serotype determination. Results revealed that 112 samples (19.55%) tested positive for FMDV NSP antibodies, while 461 samples (80.45%) were negative. Only serotype O was identified among the positive samples. Sex (OR = 12.01; 95% CI: [5.60-25.75]) and age (OR = 9.38; 95% CI: [5.72-15.39]) were identified as significant risk factors for infection susceptibility. This study provides the first data on FMD prevalence and highlights the current serological status in Algeria. Our findings suggest the existing vaccination scheme requires optimization based on regional risk assessment and serological monitoring. We recommend implementing animal identification for traceability, cross-border surveillance, and molecular-spatial modeling to target interventions in high-risk areas.

Variability of Clinical Metrics in Small Population Communities Drive Perceived Wastewater and Environmental Surveillance Data Quality: Ontario, Canada-Wide Study

The emergence of COVID-19 in Canada has led to over 4.9 million cases and 59,000 deaths by May 2024. Traditional clinical surveillance metrics (hospital admissions and clinical laboratory-positive cases) were complemented with wastewater and environmental monitoring (WEM) to monitor SARS-CoV-2 incidence. However, challenges in public health integration of WEM persist due to perceived limitations of WEM data quality, potentially driving inconsistent correlations variability and lead times. This study investigates how factors like population size, WEM measurement magnitude, site isolation status, hospital admissions, and clinical laboratory-positive cases affect WEM data correlations and variability in Ontario. The analysis uncovers a direct relationship between clinical surveillance data and the population size of the surveyed sewersheds, while WEM measurement magnitude was not directly impacted by population size. Higher variability in clinical surveillance data was observed in smaller sewersheds, likely reducing correlation strength for inferring COVID-19 incidence. Population size significantly influenced correlation quality, with thresholds identified at ∼66,000 inhabitants for strong WEM-hospital admissions correlations and ∼68,000 inhabitants for WEM-laboratory-positive cases during waned vaccination periods in Ontario (the Omicron BA.1 wave). During significant vaccination immunization (the Omicron BA.2 wave), these thresholds increased to ∼187,000 and 238,000, respectively. These findings highlight the benefit of WEM for strategic public health monitoring and interventions, especially in smaller communities. This study provides insights for enhancing public health decision making and disease monitoring through WEM, applicable to COVID-19 and potentially other diseases.

Development of a ROS-responsive, glutathione-functionalized injectable hydrogel system for controlled drug release

Oxidative stress arises from an imbalance between excessive production of reactive oxygen species (ROS) and the body's antioxidant defenses. In neurodegenerative diseases, this imbalance leads to ROS accumulation, causing neuronal dysfunction and cell death. Traditional drug therapies often fail to address the dynamic nature of neuroinflammation, limiting their therapeutic efficacy. To overcome this challenge, we have developed an innovative ROS-responsive injectable hydrogel. This hydrogel is designed to detect oxidative stress sensitively and release glutathione in a controlled manner, thereby modulating inflammation and restoring the damaged immune microenvironment to facilitate tissue repair. The hydrogel was synthesized by crosslinking polyvinyl alcohol (PVA) with sodium alginate modified with 3-aminophenylboronic acid (Alg-PBA). We investigated the hydrogel's formation mechanism and analyzed how component variations affect its morphological and rheological properties. Our findings demonstrate that an optimal Alg-PBA to PVA weight ratio of 2:1 yields a hydrogel with superior mechanical strength. Glutathione (GSH) release studies confirmed the hydrogel's pronounced ROS-responsive drug release behavior. Furthermore, biocompatibility assessments revealed that the hydrogel loaded with 100 μg/mL GSH exhibited excellent compatibility and significantly inhibited neuronal apoptosis under oxygen-glucose deprivation (OGD) conditions. This work presents a promising strategy for treating inflammation-related diseases and provides valuable insights for designing next-generation hydrogels that adapt to injury-responsive microenvironments.

Passage-attenuated Powassan virus LI9P protects mice from lethal LI9 challenge and links envelope residue D308 to neurovirulence

Powassan virus (POWV) is an emergent tick-borne flavivirus that causes lethal encephalitic disease and chronic neurologic deficits in surviving patients. POWV-LI9 is a tick-derived isolate that causes neurovirulent disease and age-dependent lethality in mice. Serial passage of VeroE6 cells infected with LI9 resulted in eight amino acid changes in a POWV strain LI9P. LI9P fails to cause neurological sequelae, or lethality in C57BL/6 mice yet elicits neutralizing POWV antibody responses and protects mice from lethal LI9 challenge. Analysis revealed that LI9, but not LI9P, is present at high levels in the CNS, suggesting that LI9P is restricted from neuroinvasion or CNS replication. LI9 and LI9P are distinguished by a D308N envelope change within a domain associated with cell attachment. We evaluated the roles of Env-Domain III residue changes in LI9 virulence and LI9P attenuation using recombinant POWVs (recPOWVs) generated by reverse genetics. Remarkably, mutating D308N in LI9 completely abolished viral lethality and neuroinvasion in 50-week-old mice, reflecting the avirulent phenotype of LI9P. Analysis of the reciprocal N308D change in LI9P only partially restored neuroinvasion and lethality to the LI9P-N308D mutant, indicating that further LI9P residue changes contribute to LI9P attenuation. Consistent with differences in neuroinvasion, we found that rapid LI9P RNA synthesis and corresponding early IFN induction may contribute to LI9P clearance. Collectively, these findings define D308 as a determinant of POWV neuroinvasion and lethality, suggest potential mechanisms for restricted LI9P CNS entry, and reveal passage-attenuated LI9P as a candidate POWV vaccine platform.

IMPORTANCE

Powassan virus (POWV) infection causes a 10% lethal encephalitis, resulting in chronic neurological symptoms in half of survivors. POWV is transmitted in as short as 15 min following tick attachment, demonstrating the need for the development of POWV vaccines and therapeutics. Mechanisms of POWV neurovirulence remain to be defined to inform vaccine and therapeutic design. Cell culture passage has successfully been used to generate live-attenuated flavivirus vaccines. Accordingly, we serially passaged POWV LI9-infected VeroE6 cells and isolated an attenuated POWV strain, LI9P, that fails to cause neurologic sequelae or murine lethality. LI9P elicits neutralizing antibody responses, protects mice from a lethal WT POWV challenge, and is a potential POWV vaccine. Analysis of attenuating mutations in LI9P revealed that changing envelope residue D308N alone in LI9 prevents POWV neurovirulence and lethality in immunocompetent mice. Altogether, this study defines viral determinants of POWV pathogenesis and attenuating mutations that inform the development of live-attenuated POWV vaccines.

Emergence and Characterization of Three Pseudorabies Variants with Moderate Pathogenicity in Growing Pigs

Pseudorabies virus (PRV) remains a critical threat for the global swine industry, with heightened attention due to the emergence of variant strains since late 2011 in China. Emergent viral variants generally undergo three to four years of adaptation to present new phenotypes. However, limited investigations have been performed on the evolution and pathogenicity of variant PRV strains in growing pigs after 2015. In this study, three PRV field strains, named SD1501, SD1701, and SD1801, were isolated and their genetic characteristics and pathogenicity on 9-week-old pigs were analyzed. Nucleotide identity and phylogenetic analyses based on the complete genome sequence, as well as major immunogenic and virulence-related genes revealed that all three isolates clustered closely with genotype II variant strains prevalent in China. The pathogenicity analysis demonstrated that the three isolates exhibited moderate pathogenicity in growing pigs with a TCID50 of 107. Infected pigs displayed transient fever and reduced appetite, with only one pig in each challenge group showing typical neurological symptoms and succumbing within 6 days post infection. These findings enrich the epidemiological data of PRV and provide direct evidence for the phenotypic variations caused by PRV infection, which enhances our understanding of PRV evolution in China and contributes to PRV control in the field.

Charting the course of depression care: a meta-analysis of reliability generalization of the patient health questionnaire (PHQ- 9) as the measure

BACKGROUND

Depression is a leading cause of disability worldwide, requiring reliable and adaptable screening tools. The Patient Health Questionnaire- 9 (PHQ- 9) is widely used, yet its reliability across diverse populations and cultural adaptations remains unclear.

OBJECTIVE

This meta-analysis assessed the reliability generalization of the PHQ- 9 across different populations, settings, and cultural contexts to determine its applicability in global mental health assessments.

METHODS

A reliability generalization (RG) meta-analysis was conducted on 60 studies with 232,147 participants. A random-effects model was used to estimate pooled internal consistency (Cronbach's α) and test-retest reliability. Subgroup analyses examined the effects of administration modes, cultural adaptations, and study settings.

RESULTS

The pooled Cronbach's α was 0.86 (95% CI [0.85, 0.87]), indicating high internal consistency. Test-retest reliability, based on eight studies, was 0.82 (95% CI [0.74, 0.90]). Self-administered formats had the highest reliability (α = 0.87), while face-to-face interviews were lower (α = 0.80). Substantial heterogeneity (I2 = 99.3%) was observed.

CONCLUSIONS

The PHQ- 9 is a reliable depression screening tool globally, but significant heterogeneity highlights the need for continued cultural adaptation and validation to enhance its applicability across diverse contexts.