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    Characterizing Aeromonas spp. as a Potential Sentinel Organism for Antimicrobial Resistance Dissemination in Wastewater and Drinking Water Treatment Systems: A Case Study in the Barcelona Metropolitan Area, Spain
    (MDPI, 2026-03-01) Mondéjar, Laura; Gabasa, Yaiza; Castellsagués, Laura; Vilaró, Carles; Galofre, Belén; González-Díaz, Aida; Martí Martí, Sara; Sanz, Sergi; Soto González, Sara M.; Ballén, Victoria; Pinar-Méndez, Anna
    Background: Wastewater treatment plants (WWTPs) are hotspots of antimicrobial resistance (AMR) due to inputs from diverse anthropogenic sources. Aeromonas spp., ubiquitous in aquatic environments, often carry clinically relevant antibiotic resistance genes (ARGs) and can persist beyond fecal contamination indicators, making them promising sentinel organisms for AMR dissemination. The aim of this study was to assess the suitability of Aeromonas spp. in this role by characterizing resistance profiles, associated virulence factor genes (VFGs), genetic mobility, and persistence across wastewater and drinking water treatment processes in the Barcelona metropolitan area, Spain. Methods: Isolates were phenotypically characterized and screened for ARGs, VFGs, integrons, and heavy metal tolerance genes, followed by whole-genome sequencing (WGS). Biofilm formation was assessed in vitro. Conjugation assays with Escherichia coli evaluated horizontal gene transfer (HGT) potential. Results: A total of 428 antibiotic-resistant Aeromonas spp., the most abundant antibiotic-resistant bacteria isolated during the 2023 sampling campaigns from two WWTPs and one drinking water treatment plant (DWTP), were characterized. Trimethoprim/sulfamethoxazole (SXT) non-susceptibility was most frequent (72%), followed by cefoxitin resistance (65.4%). The sul1 (57.5%) and blaMOX (78.6%) genes predominated among SXT- and β-lactam-resistant isolates. The merA gene was detected in 23.6%; 97.9% harbored at least one VFG (aerA, act, fla, alt, or hlyA), and 70.3% carried intI1. Half formed biofilm. Conjugation confirmed bi-directional HGT, and WGS revealed persistent ST3458 clones across treatment stages. Conclusions: WWTPs and DWTPs act as reservoirs of antibiotic-resistant Aeromonas spp., demonstrating persistence and HGT potential. Findings support their use as sentinel organisms for AMR surveillance in aquatic environments and for assessing treatment efficacy, highlighting variability across treatment types and locations, and reinforcing their relevance for urban water reclamation monitoring. Keywords: Aeromonas spp.; antimicrobial resistance; antibiotic resistance genes; wastewater treatment plants; drinking water treatment; horizontal gene transfer; biofilms; environmental surveillance
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    Time to positivity as a diagnostic tool for catheter-related candidemia: a species-specific analysis
    (Elsevier B.V., 2026-09) Albanell Fernández, Marta; Vergara Gómez, Andrea; Cardozo Espinola, Celia; Herrera, Sabina; Verdejo, Miguel Ángel; Malano-Barletta, Daniel; Pitart, Cristina; Hernández Meneses, Marta; Cuervo Requena, Guillermo; García Vidal, Carolina; López, Néstor; Rio, Ana del; Espasa, Mateu; Casals Pascual, Climent; Morales, Javier; Juan, Paula; García Alcaide, Felipe; Mensa Pueyo, Josep; Morata Ruiz, Laura; Tuset Creus, Montserrat; Bodro, Marta; Soriano Viladomiu, Alex
    Objectives: Early identification of the source of candidemia is critical for catheter management. Time to positivity (TTP) is an accessible marker of catheter-related bloodstream infection in bacteremia, but its role in candidemia remains unclear. We evaluated the ability of TTP to predict catheter-related can- didemia across major species and compared its performance with differential time to positivity (DTP). Methods: Single-center retrospective study assessing the diagnostic utility and optimal TTP cut-offs for catheter-related candidemia. Predictors of catheter-related source were analyzed using multivariable lo- gistic regression. Results: Among 544 episodes, 407 were analyzed. In C. albicans (n = 133) and C. parapsilosis (n = 100), TTP differed significantly by source. In C. albicans , TTP ≤27 h predicted catheter-related candidemia (sen- sitivity 71.8%, specificity 70.2%, Positive Predictive Value (PPV) 50.0%, Negative Predictive Value (NPV) 85.7%) and was the only independent predictor (OR 5.1 [2.1-12.1], P < 0.001). In C. parapsilosis , TTP ≤35 h showed sensitivity 77.5%, specificity 51.7%, PPV 51.7%, NPV 77.5%, and remained independently associated (OR 3.1 [1.2-8.0], P = 0.017). Although DTP ≥2 h was more frequent in catheter-related candidemia by C. parapsilosis , the TTP ≤35 h was the strongest predictor. Conclusion: TTP outperformed DTP in identifying catheter-related sources in C. albicans and C. parapsilosis candidemia and may support timely catheter management.
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    Operational performance of a programmatic mass drug administration campaign for malaria in southern Mozambique: a comprehensive mixed-methods evaluation of implementation outcomes
    (BioMed Central, 2026-04-07) Fuente Soro, Laura; Tusell Rabassa, Maria; Vecchio, Jacopo; Nhangave, Amancio; Bapu, Khalid; Riley, Christina; Materrula, Felisbela; Dimene, Mércia; Sibindy, Samira; Candrinho, Baltazar; Aide, Pedro Carlos Paulino; Guinovart, Caterina
    BACKGROUND: The World Health Organization (WHO) recommends Mass Drug Administration (MDA) to reduce malaria transmission in low-transmission settings, with a target coverage of at least 80%. To maximize impact, the development of effective and sustainable programmatic implementation strategies is essential. Between December 2022 and February 2023, two rounds of programmatic MDA (pMDA) were implemented in Chidenguele, in Gaza province, Mozambique. The target population was approximately 59,271 individuals. Door-to-door drug distribution, using dihydroartemisinin-piperaquine, was guided by satellite imagery-based mapping. METHODS: A mixed-methods evaluation was conducted to assess operational performance —including acceptability, appropriateness, coverage, feasibility, fidelity, and adoption— using a community household survey (n = 770), a health staff survey (n = 28), and field observations (n = 149). RESULTS: Among household survey participants eligible for medication during round 2, 96,2% (607/631) accepted to participate in the pMDA. All health staff survey participants and 91,3% (703/770) of household survey participants considered taking antimalarials while asymptomatic to be an acceptable preventive measure. All health staff survey participants (28/28) and 84,1% (648/770) of household survey participants felt the intervention was appropriate for reducing malaria transmission in the community. Programmatic or contact coverage (proportion of survey participants that received pMDA treatment) reached 73,9% (569/770), while operational coverage (proportion of those present at the time of the intervention that received pMDA treatment) was 90,2% (569/631). All health staff survey participants (28/28) considered the pMDA implementation strategy feasible to implement. In terms of fidelity, direct observations of pMDA household visits showed that pMDA distribution teams correctly explained the purpose of the visit in 74,5% (111/149) of interactions, requested verbal consent in 86,6% (129/149), and emphasized the importance of completing the treatment in 60,4% (90/149). Health staff survey participants showed strong willingness to adopt the procedures, with 86.0% (24/28) and 96.0% (27/28) expressing high commitment in rounds 1 and 2, respectively. CONCLUSIONS: Despite the pMDA delivery strategy being implemented with good operational performance and being well accepted by the community and health staff, reaching the 80% coverage target remains challenging. Sustained collaboration and active engagement from communities, partners, and policymakers, and enhancement of some key outcomes, such as the fidelity of the implementation, are critical to improving coverage and ensuring the success of pMDA campaigns.
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    HPV Vaccination in Women with Cervical Intraepithelial Neoplasia Undergoing Excisional Treatment: Insights into Unsolved Questions.
    (MDPI, 2022-06-01) Henere, Carla; Torné Bladé, Aureli; Llupià Garcia, Anna; Aldea, Marta; Martí Delgado, Cristina; Glickman, Ariel; Saco, Adela; Marimon, Lorena; Manzotti, Carolina; Rakislova, Natalia; Ordi Maja, Jaume; Pino Saladrigues, Marta del
    Several questions regarding the role of vaccination in women treated for high-grade cervical intraepithelial lesion (HSIL) have not been clarified. One of the main queries is whether the time at which the vaccine is administered (before or after treatment) influences the protection against post-treatment HSIL. A second unanswered question is whether the vaccine has any effect in women with persistent HPV after treatment. We aimed to address these questions in a study of 398 women undergoing excisional treatment from July 2016 to December 2019. Vaccination was funded and offered to all women undergoing treatment. A total of 306 women (76.9%) accepted HPV vaccination (vaccinated group): 113 (36.9%) received the first dose before excision and 193 (63.1%) after the procedure. A total of 92 women (23.1%) refused the vaccine (non-vaccinated group). Women vaccinated before treatment showed a lower rate of post-treatment HSIL compared with non-vaccinated women (0.9% vs. 6.5%; p = 0.047). Among women with persistent HPV infection after treatment, those who had received the vaccine showed a lower prevalence of post-treatment HSIL than non-vaccinated women (2.6% vs. 10.5%; p = 0.043). In conclusion, this study shows that HPV vaccination before treatment reduces the prevalence of post-treatment HSIL and suggests that vaccination might even benefit women with persistent HPV after treatment.
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    A sustainable development goal framework to guide multisectoral action on NAFLD through a societal approach
    (John Wiley & Sons, 2021-12-05) Lazarus, Jeffrey V.; Mark, Henry E.; Colombo, Massimo; Demaio, Sandro; Dillon, John F.; George, Jacob; Hagström, Hannes; Hocking, Samantha; Lee, Nancy; Nieuwenhuijsen, Mark J.; Rinella, Mary E.; Schattenberg, Jörn M.; Romero-Gomez, Manuel; Soriano, Joan B.; Tacke, Frank; Tsochatzis, Emmanuel A.; Valenti, Luca; Zelber-Sagi, Shira; Dirac, M. Ashworth; Huang, Terry T-K.
    Background: Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent condition that requires a comprehensive and coordinated response across sectors and disciplines. Aims: In the absence of a multisectoral framework to tackle this condition, we developed one using the sustainable development goals (SDGs) as the basis for converging thinking about the design and delivery of public health responses. Methods: A multidisciplinary group identified the SDG targets and indicators for inclusion in the new framework through a two-stage process. Firstly, a core team of three researchers independently reviewed the 169 targets and 231 indicators of the SDGs to select a shortlist. Over two Delphi rounds, a multidisciplinary group of 12 experts selected which of the shortlisted targets and indicators to include. Respondents also provided written feedback on their selection. Targets and indicators with 75% or greater agreement were included in the final framework. Results: The final framework comprises 16 targets—representing 9% of all targets and 62% (16/26) of the shortlisted targets—and seven indicators, accounting for 50% (7/14) of the shortlisted indicators and 3% of all indicators. The selected targets and indicators cover a broad range of factors, from health, food and nutrition to education, the economy, and the built environment. Conclusions: Addressing the challenge of NAFLD will require a re-envisioning of the liver health landscape, with greater focus on joined-up systems thinking and action. This new framework can help guide this process, including by outlining the stakeholders with whom the liver health community needs to engage.
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    POCUS Examination of the Mediastinum in Children: A Simplified and Standardized Protocol for Pulmonary Tuberculosis
    (2025-11-17) Munyangaju, Isabelle; Carratalà Castro, Lucía; Acácio, Sozinho; Escudero Fernández, José Miguel; Soriano Arandes, Antoni; Espiau, María; Santiago Garcia, Begoña; Hernanz Lobo, Alicia; Lancharro Zapata, Ángel M.; Soler García, Aleix; Ladera, Enrique; Noguera Julian, Antoni; Manzanares, Ángela; Blazquez, Daniel; Aguirre Pascual, Elisa; Massingue, José; Dalsuco, Jessica; Bramugy, Justina; Thierry-Chef, Isabelle; Bassat Orellana, Quique; Buonsenso, Danilo; López Varela, Elisa; Serres Créixams, Xavier
    Background: Point of care ultrasound (POCUS) is increasingly recognized as a valuable tool for mediastinal assessment in children, particularly in resource-limited settings where advanced radiological options such as computed tomography (CT) scans are often unavailable. In high-income countries, POCUS is gaining traction as a complementary imaging method, offering a safer, radiation-free alternative. Methods: To overcome the operator-dependent nature of mediastinal POCUS, a standardized protocol was developed. The protocol includes clear techniques and detailed descriptions of normal and pathological findings, aiming to enhance consistency and diagnostic accuracy. Results: The standardized protocol improved reliability in mediastinal POCUS assessments, especially in the context of paediatric pulmonary tuberculosis, a condition often marked by lymph node involvement. Given the challenges of obtaining respiratory samples in children and their typically low diagnostic yield, POCUS emerged as a particularly suitable diagnostic modality. Conclusions: Mediastinal POCUS, guided by a standardized protocol, represents a safe, affordable, point-of-care, and non-ionizing option for identifying mediastinal lymphadenopathy. Its application holds promise for improving the diagnosis of paediatric tuberculosis, especially in settings with limited access to advanced radiological imaging.
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    Contextual dimensions of pediatric tuberculosis imaging: radiation exposure, access, and system capacity in high- and low-resource settings
    (Springer Verlag, 2026-04-01) Munyangaju, Isabelle; Jahnen, Andreas; Esmail, Ridwaan; José, Benedita; Adrigwe, Jacinta; Mutemba, Criménia; Pérez, Patricia; Escudero Fernández, José Miguel; Soriano Arandes, Antoni; Espiau, María; Santiago Garcia, Begoña; Hernanz Lobo, Alicia; Lancharro Zapata, Ángel M.; Soler García, Aleix; Ladera, Enrique; Noguera Julian, Antoni; Manzanares, Ángela; Blazquez, Daniel; Aguirre Pascual, Elisa; Bassat Orellana, Quique; López Varela, Elisa; Thierry-Chef, Isabelle
    Background: Pediatric tuberculosis diagnosis relies heavily on imaging, yet access, equipment standards, and dose monitoring differ widely across health systems. Evidence describing how these contextual factors influence imaging use and radiation exposure in children remains scarce. Objective: To describe pediatric tuberculosis imaging practices and estimated radiation doses across two distinct resource settings, Spain (hospital-based, high-resource) and Mozambique (primary care-based, low-resource), to inform strategies for safe, equitable, and context-appropriate imaging. Methods and materials: A descriptive mixed-methods study combined retrospective data of children (<16 years) diagnosed with tuberculosis (Spain 2015-2021; Mozambique 2018-2021) with complementary surveys of imaging providers. In Spain, chest X-ray and computed tomography parameters were extracted from digital imaging and communications in medicine files to estimate organ-specific doses using the National Cancer Institute dosimetry systems for radiography and computed tomography. In Mozambique, dose estimates were based on standardized pediatric protocols and site survey parameters due to limited digital data. Surveys captured information on imaging access, guideline use, and professional training. Results: Imaging data were available for 84 Spanish and 83 Mozambican children. In Spain, children underwent multiple chest X-rays (mean four per child) and computed tomographies (mean three per child), resulting in cumulative lung doses up to ~20 mGy cm2, remaining below diagnostic reference levels. In Mozambique, most children had one or two chest X-rays, with cumulative lung doses <0.05 mGy cm2. Survey findings indicated structured dose optimization and quality assurance practices in Spain, versus limited equipment and predominantly non-physician interpretation in Mozambique. Conclusion: Context-appropriate improvements in pediatric imaging such as strengthened infrastructure, training, dose monitoring, and quality assurance are essential to ensure safe exposure and equitable, reliable tuberculosis diagnosis for children.
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    Diagnostic Performance of Comprehensive Point-of-Care Ultrasound for Pediatric Tuberculosis in Spain: A Prospective Observational Study
    (Wiley, 2026-03-15) Munyangaju, Isabelle; Noguera Julian, Antoni; Soler García, Aleix; Soriano Arandes, Antoni; Escudero Fernández, José Miguel; Espiau, María; Santiago Garcia, Begoña; Hernanz Lobo, Alicia; Lancharro Zapata, Ángel M.; Ladera, Enrique; Manzanares, Ángela; Blazquez, Daniel; Aguirre Pascual, Elisa; Thierry-Chef, Isabelle; Buonsenso, Danilo; Serres Créixams, Xavier; Bassat Orellana, Quique; López Varela, Elisa
    Background: Diagnosing tuberculosis (TB) in children is challenging because of nonspecific symptoms, low microbiological yield, and imaging limitations. Comprehensive point-of-care ultrasound (cPOCUS) may detect mediastinal lymphadenopathy, but evidence remains limited. Methods: We conducted a prospective observational study in four tertiary hospitals in Spain (May 2023-June 2024) enrolling children (0-18 years) with presumptive TB. All participants underwent chest X-ray (CXR) and cPOCUS; chest CT was performed when clinically indicated. cPOCUS assessed lung, mediastinal, and abdominal compartments using a standardized protocol. Images were independently reviewed by expert readers blinded to clinical data. Diagnostic performance was evaluated against a final TB classification based on clinical, immunological, microbiological, and conventional radiological findings, excluding cPOCUS. Results: Twenty-seven children were included (median age 9.0 years), of whom 12 (44.4%) had TB disease. CT was performed in 14 (51.9%). Only 22.2% of cPOCUS examinations were complete. Mediastinal lymphadenopathy was the most frequent abnormality. cPOCUS detected abnormalities in 58.3%-63.6% of TB cases, particularly aortopulmonary window lymph nodes and small subpleural consolidations, with moderate sensitivity and high specificity (80.0%-86.7%). Inter-reader agreement was high (κ = 0.92). Conclusions: In this pilot prospective study, cPOCUS demonstrated limited diagnostic performance but high inter-reader reliability. These exploratory findings suggest that cPOCUS may complement standard imaging for selected abnormalities (particularly aortopulmonary window lymphadenopathy), but larger studies with optimized protocols are needed before broader clinical implementation.
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    Gulf Cooperation Council states: On the brink of HBV elimination
    (John Wiley & Sons, 2021-12-01) Lazarus, Jeffrey V.; Mark, Henry E.; Sanai, F.M.; Hashim, Almoutaz; Farghaly, Mohamed; Alqahtani, Saleh A.; Al-Awadhi, Sameer
    The global health sector strategy (GHSS) on viral hepatitis 2016-20211 set the stage for bold action to eliminate the hepatitis B virus (HBV) and hepatitis C virus (HCV) as public health threats by 2030. The strategy provided a roadmap setting out tangible targets on diagnosis, prevention and treatment. Recently, the World Health Assembly approved the development of a new global health sector strategy on viral hepatitis for 2022-2030. The new strategy comes at a critical time as countries need to make a strong push to eliminate HBV and HBC by 2030. Despite substantial progress, numerous challenges remain to HBV elimination across policy and practice.2 Here, we reflect on the successes and challenges towards HBV elimination in the six Gulf Cooperation Council (GCC) states: Bahrain, Kuwait, Oman, Qatar, the Kingdom of Saudi Arabia (KSA) and the United Arab Emirates (UAE). We also set out how the new health sector strategy can drive the field towards achieving the 2030 targets.
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    Incorporating social vulnerability in infectious disease mathematical modelling: a scoping review
    (BioMed Central, 2024-03-18) Naidoo, Megan; Shephard, Whitney; Kambewe, Innocensia; Mtshali, Nokuthula; Cope, Sky; Alves Rubio, Felipe; Rasella, Davide
    Background: Highlighted by the rise of COVID-19, climate change, and conflict, socially vulnerable populations are least resilient to disaster. In infectious disease management, mathematical models are a commonly used tool. Researchers should include social vulnerability in models to strengthen their utility in reflecting real-world dynamics. We conducted a scoping review to evaluate how researchers have incorporated social vulnerability into infectious disease mathematical models. Methods: The methodology followed the Joanna Briggs Institute and updated Arksey and O'Malley frameworks, verified by the PRISMA-ScR checklist. PubMed, Clarivate Web of Science, Scopus, EBSCO Africa Wide Information, and Cochrane Library were systematically searched for peer-reviewed published articles. Screening and extracting data were done by two independent researchers. Results: Of 4075 results, 89 articles were identified. Two-thirds of articles used a compartmental model (n = 58, 65.2%), with a quarter using agent-based models (n = 24, 27.0%). Overall, routine indicators, namely age and sex, were among the most frequently used measures (n = 42, 12.3%; n = 22, 6.4%, respectively). Only one measure related to culture and social behaviour (0.3%). For compartmental models, researchers commonly constructed distinct models for each level of a social vulnerability measure and included new parameters or influenced standard parameters in model equations (n = 30, 51.7%). For all agent-based models, characteristics were assigned to hosts (n = 24, 100.0%), with most models including age, contact behaviour, and/or sex (n = 18, 75.0%; n = 14, 53.3%; n = 10, 41.7%, respectively). Conclusions: Given the importance of equitable and effective infectious disease management, there is potential to further the field. Our findings demonstrate that social vulnerability is not considered holistically. There is a focus on incorporating routine demographic indicators but important cultural and social behaviours that impact health outcomes are excluded. It is crucial to develop models that foreground social vulnerability to not only design more equitable interventions, but also to develop more effective infectious disease control and elimination strategies. Furthermore, this study revealed the lack of transparency around data sources, inconsistent reporting, lack of collaboration with local experts, and limited studies focused on modelling cultural indicators. These challenges are priorities for future research.
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    How to incorporate social vulnerability into epidemic mathematical modelling: recommendations from an international Delphi
    (Elsevier Ltd., 2025-10-01) Naidoo, Megan; Shephard, Whitney; Mtshali, Nokuthula; Kambewe, Innocensia; Muthien, Bernedette; Abuelezam, Nadia N.; Ponce de Leon, Miguel; Villela, Daniel A. M.; Paes Sousa, Romulo; Pan Ngum, Wirichada; Dowdy, David; Morse, Stephen S.; Pena, Daiana; Barberia, Lorena G.; Houben, Rein M. G. J.; Arcos González, Pedro; Robertson, Jamela E.; Muleia, Rachid; Lawal, Olanrewaju; Rasella, Davide
    Epidemic mathematical modelling plays a crucial role in understanding and responding to infectious disease epidemics. However, these models often neglect social vulnerability (SV): the social, economic, political, and health system inequalities that inform disease dynamics. Despite its importance in health outcomes, SV is not routinely included in epidemic modelling. Given the critical need to include SV but limited direction, this paper aimed to develop research recommendations to incorporate SV in epidemic mathematical modelling. Using the Delphi technique, 22 interdisciplinary experts from 12 countries were surveyed to reach consensus on research recommendations. Three rounds of online surveys were completed, consisting of free-text and seven-point Likert scale questions. Descriptive statistics and inductive qualitative analyses were conducted. Consensus was reached on 27 recommendations across seven themes: collaboration, design, data selection, data sources, relationship dynamics, reporting, and calibration and sensitivity. Experts also identified 92 indicators of SV with access to sanitation (n = 14, 6.1 %), access to healthcare (n = 12, 5.3 %), and household density and composition (n = 12, 5.3 %) as the most frequently cited. Given the recent focus on the social determinants of pandemic resilience, this study provides both process and technical recommendations to incorporate SV into epidemic modelling. SV's inclusion provides a more holistic view of the real world and calls attention to communities at risk. This supports forecasting accuracy and the success of policy and programmatic interventions.
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    A systematic review and meta-analysis of the diagnostic accuracy of ultrasound in the diagnosis of paediatric tuberculosis
    (Oxford University Press, 2026-02-09) Munyangaju, Isabelle; Carratalà Castro, Lucía; Osório, Dulce; Bigio, Jacob; Mateyo, Kondwelani John; Vonasek, Bryan J.; Buonsenso, Danilo; Bassat Orellana, Quique; Serres Créixams, Xavier; Thierry-Chef, Isabelle; Garcia Basteiro, Alberto; Pai, Madhukar; López Varela, Elisa
    Diagnosing tuberculosis (TB) in children is challenging due to non-specific symptoms, paucibacillary disease, and difficulty producing sputum. Chest X-rays (CXRs), though widely used, are often inaccessible in low-resource settings and involve radiation. Ultrasound (US) is a radiation-free, portable, and potentially low-cost alternative that can detect pulmonary and extrapulmonary TB features. However, its diagnostic accuracy in paediatric TB remains unclear. This systematic review and meta-analysis assessed US diagnostic performance for paediatric TB across anatomical sites. Following PRISMA-DTA guidelines, we searched five databases through May 2025. Studies were included if they involved children under 15 with presumptive TB and reported US diagnostic accuracy data. Data extraction, quality assessment (QUADAS-2), and meta-analyses using a bivariate random-effects model were conducted. Graham’s TB classification served as the reference standard. CXR was used as a comparator where available, with agreement assessed via Cohen’s kappa. Of 17 019 records, 7 studies involving 945 children met inclusion criteria. Pooled US sensitivity was 52% (95% CI: 46–58%), and specificity was 76% (95% CI: 67–83%). US showed high specificity but low sensitivity across most features, including abdominal lymphadenopathy and pericardial effusion; pleural effusion had slightly higher sensitivity (18%). Agreement with CXR was moderate (kappa 0.24–0.42). Variability in US protocols, operator skills, and reference standards limited generalizability. Only one study had low risk of bias across all QUADAS-2 domains. US is a promising adjunct for paediatric TB diagnosis in resource-limited settings, but standardization and validation are needed to improve its standalone utility.
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    Towards a point of care approach for intra-amniotic infection or early delivery using minimally invasive prediction models in women with preterm labor.
    (Elsevier Inc., 2026-03-27) Cobo, Teresa; Boada, David; Burgos Artizzu, Xavier P. ; Goya, María; Vergara Gómez, Andrea; Kacerovsky, Marian; Ferrero Martinez, Sílvia ; Filella Pla, Xavier; Sellarés, Anna; González, Bernardino; Mouriz, Natalia; Mohedano, Noah; Ampurdanes, Queralt; Roldán, Eva; Barco, Ester del; Murillo Bravo, Clara; Hidalgo, Judit; Garbí, Sandra; Musilova, Ivana; Fabregat Bolufer, Aleix B. ; Palacio, Montse; Gratacós Solsona, Eduard
    Among women with preterm labor and intact membranes, those with intra-amniotic infection or inflammation represent the highest risk group of spontaneous delivery and worse adverse outcome. Identification of this group requires amniocentesis, which is perceived as too invasive by both patients and physicians. This study aimed to develop a minimally invasive prediction model for intra-amniotic infection or early delivery, thereby better stratifying patients (low or high-risk) and rationalizing the use of amniocentesis limiting the indications to the highest-risk group of spontaneous preterm delivery. We performed external validation of 4 prediction models using data from 2022-2024 of women diagnosed with preterm labor below 34 weeks admitted to the Hospital Clinic, Hospital Sant Joan de Déu, and the Hospital Vall Hebron in Barcelona (Spain), and the Hradec Kralove University Hospital, in Kradec Kralove (Czech Republic), who underwent amniocentesis to rule in/out intra-amniotic infection or inflammation. Different prediction models, including ultrasound (US) transvaginal cervical length, serum C-reactive protein (CRP), vaginal IL-6, vaginal pH, vaginal lactic acid, and vaginal Lactobacillus genus, were validated in these patients. Diagnostic performance was done in 114 women with PTL below 34 weeks, 42 (36.8%) of whom had intra-amniotic infection or spontaneous delivery within 7 days. The areas under the curve (AUC) of the different models ranged from ranging from 84 (95% confidence interval (CI) 78.8-89.2%) to 89.9% (88.4-91.4%), sensitivities ranging from 78.6 (33/42) to 90.5% (38/42). and specificities from 70.8% (51/72) to 84.7% (61/72). The most feasible and efficient model was formed by combining US cervical length, serum CRP and vaginal IL-6, showing an AUC of 84% with a sensitivity of 78.6% (33/42), specificity of 84.7% (61/72), positive predictive value of 75% (33/44), and negative predictive value of 87.1% (61/70). We developed minimally invasive models to screen women at high risk of intra-amniotic infection or early delivery and guide the selective use of amniocentesis, thereby improving both antenatal counseling and the clinical management of high-risk patients.
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    The mitigating effect of social protection on undernourishment during economic downturns: A longitudinal study of 46 low- and middle-income countries over the last two decades
    (Elsevier Ltd., 2024-11-01) Barreix Sibils, Gonzalo; Brachowicz Quintanilla, Nicolai; Silva, Natanael de Jesus; Landin, Elisa; Macicame, I.; Naidoo, M.; Morais, G. de Sampaio; Rasella, Davide
    Background Low- and middle-income countries (LMICs) are particularly vulnerable to the adverse effects of economic downturns on the Prevalence of Undernourishment (PoU). Our study aimed to evaluate the impact of Social Protection and Labor Programs (SPL) on PoU in 46 LMICs from 2001 to 2019, and to estimate SPL mitigating effects during economic downturns. Methods This cohort study used a multi-country ecological design with two-ways fixed effects multivariable linear regression models, adjusted for relevant demographic, socioeconomic, and contextual variables. Interaction terms between economic downturns and SPL were used to evaluate SPL mitigating effects. Findings Our study cohort displayed an average 15.30% PoU and 34.34% SPL coverage in the initial year, contrasting with 8.58% PoU and 43.81% SPL coverage in the final year. A 10% SPL coverage was associated with a 0.51% PoU reduction (95%CI: 0.04–0.99) across all countries and 0.78% reduction within the poorest subgroup. SPL have been able to prevent an estimated 1.01 billion (95% UI: 0.16–1.86) cases of undernourishment over the study period in the 46 LMICs. Economic downturns were associated with a 4.55% PoU increase (95% CI: 1.28–7.81) in all countries, and a 6.06% PoU increase in the poorest subgroup. High SPL coverage during the downturns had significant mitigating effects, reducing an overall 1.17% PoU for every 10% SPL coverage in all countries, and 1.81% PoU in the poorest nations.
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    In vitro activity of amoxicillin combined with oral cephalosporins against endocarditis-associated E. faecalis clinical isolates
    (Oxford University Press, 2026-04-03) Luque Paz, David; Cañas, María Alexandra; Cuervo Requena, Guillermo; Espasa, Mateu; Hernández Meneses, Marta; Quintana, Eduard; Falces Salvador, Carles; Tolosana, José M. (José María); Vidal, Bàrbara; Perissinotti, Andrés; Llopis Pérez, Jaime; Moreno Camacho, Ma. Asunción; García de la Mària, Cristina; Miró Meda, José M. (José María), 1956-
    Objectives: Aminopenicillin associated with parenteral cephalosporins provides synergistic activity against Enterococcus faecalis. Oral consolidation treatment is an option for infective endocarditis E. faecalis (EFIE), but optimal oral regimen remains under debate. We aimed to assess the in vitro activity of combinations based on amoxicillin plus an oral cephalosporin, namely, cephalexin or cefixime, against E. faecalis strains. Methods: MIC and MBC values were determined against 6 clinical isolates of endocarditis-associated E. faecalis. Time-kill (TK) experiments were performed using amoxicillin (½MIC) plus cephalexin or cefixime at different concentrations (Cmax, ½Cmax and Cmin). Comparator regimens were amoxicillin/cefazolin and amoxicillin/ceftriaxone. TK experiments were carried out at standard (∼5 × 105 cfu/mL) and high inoculum (∼108 cfu/mL). Results: Using amoxicillin combined with Cmax, ½Cmax or Cmin of oral cephalosporin at standard inoculum, synergy or additivity was observed in 66, 33 and 0% of E. faecalis isolates with adjunctive cephalexin; and in 83, 50 and 33% of isolates with adjunctive cefixime, respectively. In comparator regimens, synergy was found in all isolates at standard inoculum. At high inoculum, amoxicillin/cefixime at Cmax had similar efficacy to amoxicillin/ceftriaxone, showing synergy in 50% of E. faecalis isolates, while amoxicillin/cephalexin at Cmax and amoxicillin/cefazolin only achieved synergy in 17% of isolates. Conclusions: The combination of amoxicillin/cefixime exhibits synergy in most E. faecalis strains at standard inoculum. Cefixime could represent an interesting adjunctive therapy to amoxicillin for oral consolidation treatment of EFIE.
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    Dynamic biomarkers in hormone receptor-positive/HER2-negative breast cancer trials: a new hope for precision oncology
    (Springer Nature, 2026-01-28) Grazia, Giuseppe Di; Schettini, Francesco; Sánchez Bayona, Rodrigo; Casals Pascual, Climent; Pascual, Tomás; Generali, Daniele; Gennari, Alessandra; Vigneri, Paolo; Harbeck, Nadia; Cortés, Javier; Prat Aparicio, Aleix
    Hormone receptor-positive/HER2-negative breast cancer evolves in response to therapy, demanding smarter, adaptive biomarker-based treatment strategies. We review emerging dynamic biomarkers to guide therapeutic decision-making, spanning tissue and liquid biopsies, metabolic imaging, and microbiome profiling, that capture tumor or host-related changes over time. By contrasting Academic and Industry approaches, we advocate for a cultural shift in clinical trial design and implementation, aiming to move from reactive to proactive Oncology.
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    Emerging global patterns of COVID-19 vaccine information fatigue in 23 countries in 2023
    (Elsevier B.V., 2024-12-02) White, Trenton M.; Lazarus, Jeffrey V.; Rabin, Kenneth; Ratzan, Scott; El-Mohandes, Ayman
    Vaccine information fatigue, exacerbated by the infodemic, misinformation, and cultural influences, hampers public responsiveness to the uptake of vaccines for COVID-19 and other vaccine-preventable diseases. This cross-sectional study of 23,000 respondents surveyed in 23 countries in October 2023 analyzed trust in information sources, perceptions of the pandemic's conclusion, and confidence in one's ability to discern false information from true and the association of these factors with willingness to pay attention to COVID-19 vaccine information, adjusting for sociodemographic characteristics. Results revealed that satisfaction with health authority communication was positively associated with individuals' willingness to pay attention to COVID-19 vaccine information in all 23 countries. Confidence in one's own capacity to distinguish true information from false was associated with willingness in 20 countries. Belief that the pandemic is over was associated with unwillingness to pay attention to COVID-19 vaccine information in 14 countries. These findings underscore the need for tailored communication strategies that build trust in information sources, combat complacency, and enhance discernment skills to address vaccine and pandemic fatigue, aiming to sustain public engagement with vaccine information and, ultimately, support vaccination efforts.
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    High-resolution kinetics and cellular determinants of SARS-CoV-2 antibody response over two years after COVID-19 vaccination
    (Elsevier Masson SAS, 2025-02-01) Rubio Bodí, Rocío; Macià Bros, Dídac; Barrios, Diana; Vidal, Marta; Jiménez, Alfons; Molinos Albert, Luis M.; Díaz Garrido, Natalia; Canyelles, Mar; Lara Escandell, Maria; Planchais, Cyril; Santamaria, Pere; Carolis, Carlo; Izquierdo, Luis; Aguilar, Ruth; Moncunill Piñas, Gemma; Dobaño, Carlota, 1969-
    Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) studies usually rely on cross-sectional data of large cohorts but limited repeated samples, overlooking significant inter-individual antibody kinetic differences. By combining Luminex, activation-induced marker (AIM) and IFN-γ/IL-2 Fluorospot assays, we characterized the IgM, IgA, and IgG antibody kinetics using 610 samples from 31 healthy adults over two years after COVID-19 vaccination, and the T-cell responses six months post-booster. Antibody trajectories varied among isotypes: IgG decayed slowly, IgA exhibited an initial sharp decline, which gradually slowed down and stabilized above the seropositivity threshold. Contrarily, IgM rapidly dropped to undetectable levels after primary vaccination. Importantly, three vaccine doses induced higher and more durable anti-spike IgG and IgA levels compared to two doses, whereas infection led to the highest antibody peak and slowest antibody decay rate compared to vaccination. Comparing with ancestral virus, antibody levels recognizing Omicron subvariants had a faster antibody decay. Finally, polyfunctional T cells were positively associated with subsequent IgA responses. These results revealed distinctive antibody patterns by isotype and highlight the benefits of booster doses in enhancing and sustaining antibody responses.
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    Not all severe malaria cases are severe: Is it time to redefine severity criteria for malaria in non-endemic regions?
    (Elsevier, 2024-07-01) Balerdi Sarasola, Leire; Muñoz Gutiérrez, José; Fleitas, Pedro E.; Rodriguez Valero, Natalia; Almuedo Riera, Alex; Antequera, Alba; Subirà, Carme; Grafia, Ignacio; Ortiz Fernández, Maria; Alba, Tessa de; Álvarez Martínez, Míriam; Valls Lolla, Ma. Eugenia; Parolo, Claudio; Castro Rebollo, Pedro; Camprubí Ferrer, Daniel
    Background: The current definition of severe malaria in non-endemic areas follows WHO criteria, which mainly target children in malaria-endemic areas, potentially misclassifying cases in non-endemic regions. We assessed the performance of a modified severe malaria classification criteria within our patient cohort. Methods: A cohort study of patients managed for malaria in a non-endemic setting (2005-2023) was analyzed. We classified patients into severe malaria (SM) using WHO 2013 criteria except for hyperparasitemia, where 2 % threshold was applied. Patients with SM were distinguished as very severe malaria (VSM) when presenting at least one of the following conditions: parasitemia >10 %, pulmonary edema, impaired consciousness, seizures, renal failure, metabolic acidosis or hyperlactatemia, shock or hypoglycemia. In patients with SM and no criteria for VSM, less severe malaria (LSM) was defined by: 2-10 % parasitemia, hyperbilirubinemia, prostration, anemia or minor bleeding. The primary composite outcome was death or the need for a life-saving intervention, as analyzed in the three comparative groups. Secondary outcome was the prevalence of co-infections. Results: Among 506 patients with malaria, 176 (34.8 %) presented with SM. A total of 37 (7.3 %) patients developed a life-threatening condition, namely death (n = 4) and/or the need for life-saving interventions (n = 34). All fatalities and 33 out of the 34 life-saving interventions occurred in the VSM group. Patients in LSM group did not develop any life-threatening conditions. As to co-infections, 28 (5.5 %) patients had a community-acquired co-infection, with no differences between groups (p = 0.763). Conclusions: Severity criteria definitions would benefit from a review when assessing patients with malaria in non-endemic areas. Within the spectrum of SM, patients reclassified as LSM have a low risk of developing a life-threatening condition and present low co-infection incidence and could benefit from management out of intensive care units and a restrictive use of empirical antibiotics.
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    Reactivation of Trypanosoma cruzi infection in immunosuppressed patients: a systematic review and meta-analysis
    (European Society of Clinical Microbiology and Infectious Diseases, 2024-08-01) Antequera, Alba; Molin Veglia, Agustina dal; López Alcalde, Jesús; Álvarez Díaz, Noelia; Muriel García, Alfonso; Muñoz Gutiérrez, José
    Background: The risk of Trypanosoma cruzi reactivation is poorly understood. Previous studies evaluating the risk of reactivation report imprecise findings, and recommendations for monitoring and management from clinical guidelines rely on consensus opinion. Objectives: We conducted a systematic review and meta-analysis to estimate the cumulative T. cruzi reactivation incidence in immunosuppressed adults, summarize the available evidence on prognostic factors for reactivation, and examine its prognostic effect on mortality. Data sources: MEDLINE, Embase, LILACS, Clinical Trials, and CENTRAL from inception to 4 July 2022. Study eligibility criteria: Studies reporting the incidence of T. cruzi reactivation. Participants: Immunosuppressed adults chronically infected by T. cruzi. Methods: Two authors independently extracted data (including, but not limited to, incidence data, reactivation definition, follow-up, treatment, monitoring schedule, examined prognostic factors) and evaluated the risk of bias. We pooled cumulative incidence using a random-effects model. Results: Twenty-two studies (806 participants) were included. The overall pooled incidence of T. cruzi reactivation was 27% (95% CI, 19-36), with the highest pooled proportion in the sub-group of transplant recipients (36%; 95% CI, 25-48). The highest risk period was in the first 6 months after transplant (32%; 95% CI, 17-58), decreasing drastically the number of new cases later. People living with HIV and patients with autoimmune diseases experienced significantly lower cumulative reactivation incidences (17%; 95% CI, 8-29 and 18%; 95% CI, 9-29, respectively). A single study explored the independent effect of benznidazole and found benefits for preventing reactivations. No studies evaluated the independent association between reactivation and mortality, while sensitivity analysis results using unadjusted estimates were inconclusive. The heterogeneity of diagnostic algorithms was substantial. Conclusions: Reactivation occurs in three out of ten T. cruzi-seropositive immunosuppressed adults. These findings can assist clinicians and panel guidelines in tailoring monitoring schedules. There is a great need for an accurate definition of reactivation and targeted monitoring.