Abstract: Introduction: Sequencing therapy in CD is currently intensively discussed due to the development of novel drugs and lack of standardized criteria for drug positioning in first and further treatment lines. The aim of this study was to compare the efficacy of a second line advanced therapy in Romanian patients with CD who have failed an anti-TNF agent. Methods: We performed a multicenter retrospective study that included adult patients with CD who had secondary loss of response after an initial response with an an-ti-TNF drug. The main outcome was clinical remission at 12 weeks of second-line treatment (CDAI < 150). Secondary outcomes included clinical response (decrease of CDAI ≥ 25%), persistence of therapy at 1 year and rates of adverse events. Results: From 2008 to 2024, 216 patients were either switched to another anti-TNF or swapped to another therapeutic class due to failure of a first anti-TNF drug. Secondary lines of treatment in-cluded infliximab (IFX), adalimumab (ADA), vedolizumab (VDZ), ustekinumab (UST). The highest rate of clinical remission (81%) was obtained with the sequence ADA-IFX in 26/32(81%) patients and ADA-UST in 62/82(76%) patients, followed by IFX-UST in 22/33(67%) and IFX-ADA 34/51(67%). Persistence on therapy at 1 year was better for the sequence ADA-UST(73%) and IFX-UST(67%) and ADA-IFX(63%) compared to IFX-ADA(59%) and IFX-VDZ(44%)(p< 0.001). Conclusions: In patients with CD who have failed a first anti-TNF, the highest rate of clinical re-mission at 12 weeks was obtained with second line IFX and UST whilst vedolizumab showed lower efficacy. UST demonstrated the most favorable long-term treatment persistence at 1 year.

Abstract: Background Pellagra, a disease caused by niacin (vitamin B3) deficiency, is characterized by the "3 Ds": dermatitis, diarrhea, and dementia. While rare in industrialized nations, it persists in at-risk populations, particularly those with alcohol use disorder, malabsorption, or post-bariatric surgery. Case presentation This case presents a 64-year-old woman with chronic alcohol dependence and a history of sleeve gastrectomy, who developed advanced pellagra. Her clinical symptoms included a diffuse pruritic rash, diarrhea, cognitive decline, and severe leg pain. Clinical exams was notable for a symmetric hyperpigmented rash on both forearms, the neck and the upper back. Laboratory tests confirmed a significantly low serum niacin level (< 20). Initial diagnoses, such as toxic shock syndrome or Stevens-Johnson syndrome, were ruled out after a skin biopsy showed nonspecific spongiotic dermatitis. After starting oral niacin supplementation, gastrointestinal and dermatologic symptoms improved, though her cognitive impairment persisted. The patient’s condition was complicated by sepsis, acute kidney injury, and multi-organ failure, leading to eventual brain death. Discussion This case highlights the challenges of diagnosing pellagra in a modern clinical setting, especially when compounded by other medical conditions. Despite early treatment, delayed recognition and aggressive systemic complications contributed to a fatal outcome. It underscores the importance of considering secondary pellagra in patients with risk factors and the need for early diagnosis and niacin replacement to prevent severe outcomes.

Abstract: The aim of our research was to monitor smoking habits at patients requesting medical assistance of an emergency department and to identify any connections with the health status of patients during the year 2018, in Romania. The survey included 431 patients who came to the hospital, out of which 49.88% were women and 50.12% were men. Their ages varied between 18 and 93 years, women’s mean age was of 66.46 years and standard deviation (SD) of ±12.157, and of 62.10 years and SD of ±14.164 in the case of men, respectively. Our working method was the cross-sectional population study. The study revealed that 14.6% of the patients smoke less than 20 cigarettes per day, while 17.4% smoke more than 20 cigarettes per day. A higher number of smoked cigarettes can be found in the case of men, with an impact of 17.4%, as well as in the case of younger people. There is a significant association between the diagnosis of acute psychiatric pathology and tobacco consumption, as this diagnosis occurs 3.57 times more frequently in the case of people who smoke more than 20 cigarettes per day, compared with non-smokers. Tobacco consumption is a risk factor for the ingravescence of digestive pathology, as digestive pathology occurs 2.3 times more frequent at people who smoke more than 20 cigarettes per day, compared with non-smokers.

Abstract: Background: Engaging diverse populations including Muslims in research activities is important to support patient-centered research and improve health equity. Objectives: To describe the community engagement steps that informed conducting research with five distinctively diverse U.S. Muslim communities. Methods: Researchers engaged with leaders, advisory members, and people from five diverse communities. Strategies to support sampling, recruitment, multi-language interpretation methods, and how to support closed communities and address their concerns are discussed. Lessons Learned: Researchers interested in working with Muslim communities should be aware of principles of seclusion when interacting with sex-discordant participants. Including language concordant researchers demonstrated effectiveness and efficiency in the process. Researchers should be open to rejections from communities and accept stepping back to give community members the space needed to decide whether to participate in research. Conclusion: Flexibility and adaptability are integral in recruitment and data collection as diverse communities may respond differently to methods successfully used elsewhere.

Abstract: Dental anxiety is a common experience and can be considered a public health issue. This qualitative evidence synthesis used a thematic synthesis approach, to identify and synthesise findings of qualitative studies exploring adults’ lived experiences of dental anxiety.Systematic searches of Embase, Medline, Scopus, PsycINFO, Web of Science, ProQuest, CINAHL and the Cochrane Library identified eleven qualitative studies (total N = 308; age range 18–75 years; 62% female) exploring adults’ dental anxiety experiences Data were extracted and critically appraised using the Critical Appraisal Skills Programme (CASP, 2018) checklist for qualitative research, then synthesised with confidence in synthesised findings assessed using GRADE‑CERQual criteria.Eleven qualitative studies (308 adult participants) yielded 18 review findings, which were organised into nine descriptive themes and synthesised into four analytical themes. The constructed themes captured dental anxiety as a convergence of past and present experiences, shaped by the patient-clinician relationships and systemic factors in dental care. The role of shame contributed to avoidance behaviours, and the use of personal coping strategies was linked to regaining a sense of control which was perceived to be minimal whilst in the dental chair. Findings highlight the benefits of qualitative research methods for understanding the complexity of dental anxiety.

Abstract: Introduction: Healthcare workers experience high rates of job-related stress and burnout, contributing to a substantial burden of mental and emotional health conditions. Exposure to natural environments is associated with improved mental health outcomes. However, for healthcare workers, the effects of nature in the workplace have been underexplored. This analysis reports the health effects of gaining a window view of nature among a sample of healthcare workers.Methods: In November 2023, a rehabilitation hospital moved its primary location from a midsize [redacted for anonymous review] city to a nearby area surrounded by woodlands. Employees completed surveys on work environment, job satisfaction and burnout, and health-related outcomes prior to the move, four weeks after the move, and one year after the move.Results: In difference-in-differences models controlling for gender, age, and change in job category, participants who gained a window view of a natural environment had greater odds of experiencing improvements in their reported satisfaction of their window view (OR=8.05, p=0.02). However, no statistically-significant improvements were reported for outcomes relating to job satisfaction, stress, burnout, or mental health associated with the change in window view. Conclusions: Although participants gaining window views of nature reported increases in window view satisfaction, we found no changes to job-related or health-related outcomes either at the first followup or one year after the move associated with gaining a window view of nature. Greater doses of nature in workplace environments, or different kinds of strategies, may be necessary to promote mental health among healthcare workers.

Abstract: Lead is a toxic heavy metal associated with significant health risks, particularly in children, due to its neurotoxic effects and lack of a safe exposure threshold. This study presents a comprehensive analysis of blood lead levels (BLLs) in children under 18 years, utilizing data from Georgia's national early disease detection program collected between 2020 and 2023. The dataset includes over 32,000 children, providing a robust foundation for evaluating temporal trends and regional disparities in lead exposure. A nationwide decline in elevated BLLs was observed during the study period, with an overall mean BLL of 3.56 µg/dL; however, substantial regional variations persist, with Adjara (mean BLL 5.27 µg/dL, 11.7% with BLL ≥10 µg/dL) and Guria (mean BLL 5.01 µg/dL, 8.3% with BLL ≥10 µg/dL) reporting the highest levels. These findings under-score the critical need for targeted, region-specific environmental health interventions and policies to address persistent lead exposure risks. This analysis contributes valua-ble epidemiological insights into childhood lead exposure in Georgia, informing future public health strategies and resource allocation.

Abstract: Early childhood caries (ECC) is routinely described as a complex, multifactorial disease shaped by biofilm ecology, host susceptibility, diet, behavior, and social context. Yet, a growing strand of public-health messaging and implementation practice increasingly treats ECC as a one-step problem solvable by a topical “magic paint” (most prominently silver diamine fluoride, SDF) and deliverable by non-dental or minimally trained providers. This commentary argues that the core contradiction—declaring ECC polycausal while operationalizing it as monocausal—drives a harmful evidence-to-policy drift: research designs favor short-term, easily marketable surrogate endpoints (e.g., “arrest” defined partly by SDF-induced black staining) and implementation strategies shift diagnosis and management to underprepared personnel without robust guardrails.Using a journal-style critical lens anchored in ROB-2, CONSORT, and STROBE principles, I examine recent Canadian work frequently cited to justify “paint-and-go” approaches, including open-label randomized trials of SDF application intervals and microbiome-focused substudies, and I integrate the delegation axis through the Canadian Caries Risk Assessment Tool (CCRAT) and its embedding into primary care workflows. While SDF and non-dental screening can be valuable adjuncts in a continuum of care, overselling them as substitutes for dentist-led diagnosis, pulpal assessment, and definitive rehabilitation risks institutionalizing a two-tier standard for children—especially for Indigenous and remote communities. I conclude with concrete research and policy guardrails: comparator-driven trials, multilevel modeling, lesion-specific sampling where mechanistic claims are made, patient-centered outcomes, defined referral timelines, and a dental-home–anchored pathway that treats SDF as a bridge—not a destination.

Abstract: Light exposure is a primary zeitgeber for the human circadian system and plays a key role in shaping sleep–wake patterns during adolescence, a period marked by biological sensitivity and social constraints. How the temporal organization and spectral composition of daily light exposure differ between weekdays and weekends remains poorly un-derstood. Eighteen adolescents (15–17 years) were monitored for seven days using wrist actigraphy with integrated light sensors. Sleep parameters, nonparametric circadian rhythm indices, and time-resolved profiles of ambient and spectral (blue, green, and red) light exposure were analyzed. Repeated-measures ANOVA tested the effects of time of day and day type. Total sleep time and time in bed were longer on weekdays than on weekends (p < 0.05), while sleep latency and WASO did not differ. Circadian indices indicated preserved rhythmic organization. Light exposure showed a robust diurnal profile, with higher spectral irradiance on weekends (p < 0.001), especially in the morning and early afternoon. Significant time × day-type interactions were observed across all spectral bands (p < 0.001), indicating systematic reshaping of daily light profiles. Ado-lescents exhibit weekday–weekend differences in the temporal and spectral organization of light exposure, affecting the amplitude and shape of overall daily profiles.

Abstract: Background: Population aging poses a growing public health challenge in low- and middle-income countries, including Indonesia. Functional independence is a key determinant of older adults’ quality of life, yet integrated community-based health promotion models addressing this issue remain limited. Objective: This study developed and empirically validated an Integrated 5I Health Promotion Model (Identify, Inspire, Initiate, Integrate, and Impact) to enhance independence and quality of life among pre-older adults and older adults in an urban Indonesian setting. Methods: A community-based cross-sectional survey was conducted among 240 pre-older adults and older adults in Surakarta, Indonesia, using proportional cluster sampling from community activity groups. The Integrated 5I Model was constructed based on the Health Belief Model, the Logic Model, and a pentahelix approach. Data were collected using a structured questionnaire and analyzed using path analysis to examine direct and indirect relationships among internal and external factors, perceptions, participation, independence, and quality of life. Results: The model demonstrated good structural fit and explained a substantial proportion of variance in independence and quality of life. Perception and participation played significant mediating roles between internal and external factors and independence. Increased independence was significantly associated with improved quality of life among older adults. Participation showed the strongest direct effect on physical independence (β = 3.018, p < 0.001), while independence significantly predicted quality of life (β = 0.599, p < 0.001). The model demonstrated excellent fit (CFI = 1.000; RMSEA = 0.000; SRMR = 0.012). Conclusions: The Integrated 5I Health Promotion Model provides a pragmatic and scalable framework for community-based interventions designed to promote independence and quality of life among aging populations in urban low- and middle-income settings. This model has important implications for public health programs and policies targeting healthy and active aging.

Abstract: The oral-gut microbiome axis represents a critical, interdependent ecosystem whose stability is essential for systemic immune homeostasis and barrier defense. In the intensive care unit (ICU), this axis undergoes a profound and targeted assault from life-sustaining interventions. Mechanical ventilation, broad-spectrum antibiotics, and proton pump inhibitors (PPIs) act synergistically to dismantle the physiological barriers separating the oral and gut microbiomes, driving dysbiosis at both sites and facilitating the ectopic translocation and colonization of oral pathobionts in the gastrointestinal tract. This process transcends passive microbial spillover, actively fueling intestinal inflammation, compromising epithelial integrity, and exacerbating systemic immune dysregulation—key pathways in the pathogenesis of ventilator-associated pneumonia (VAP), enterogenic sepsis, and multiple organ dysfunction. This review synthesizes contemporary evidence to posit that the integrity of the oral-gut axis is a modifiable determinant of outcome in critical illness. Consequently, we advocate for a paradigm shift in infection prevention from external disinfection towards the active stewardship of endogenous microbial ecology. We critically evaluate evolving oral care strategies, deconstruct the limitations of non-selective antiseptics like chlorhexidine, and highlight the evidence supporting ecological approaches such as mechanical hygiene, physiological irrigation, and selective oropharyngeal decontamination. Future research must prioritize the standardization of axis-preserving protocols and rigorously evaluate microbiome-targeted interventions, including the refinement of selective decontamination strategies for targeted populations, to restore ecological resilience and improve patient survival.

Abstract: Congenital cytomegalovirus (CMV) infection is the most common congenital viral infection worldwide and a leading cause of neurodevelopmental abnormalities, including sensorineural hearing loss, microcephaly, and developmental delay in neonates. Transmission occurs primarily through vertical maternal–fetal infection during early pregnancy. Although most infected neonates are asymptomatic at birth, a significant proportion develop long-term neurological sequelae. In low- and middle-income countries, including Nigeria, routine screening for congenital CMV is rarely performed, and molecular epidemiological data remain limited. This study aimed to determine the molecular prevalence and characterize congenital CMV infection among neonates attending tertiary health institutions in Jos, Nigeria. A cross-sectional molecular study was conducted among neonates aged ≤21 days recruited from three tertiary hospitals in Jos between January 2021 and December 2022. Buccal swab samples were collected and tested for CMV DNA using standardized in-house polymerase chain reaction (PCR). Positive samples were subjected to Sanger sequencing, and phylogenetic analysis was performed. Data were analyzed descriptively, and molecular prevalence was reported with exact 95% confidence intervals. Out of 180 neonates enrolled, one tested positive for CMV DNA, giving a molecular prevalence of 0.6% (95% CI: 0.02–3.1%). BLAST analysis revealed 98.9% nucleotide sequence similarity to Human herpesvirus 5 strain HAN22, and the sequence was assigned the GenBank accession number PV668598. Phylogenetic analysis showed clustering with previously reported African isolates. The CMV-positive neonate presented with microcephaly and small-for-gestational-age status. Although congenital CMV infection was rare in this cohort, molecular detection and genomic characterization provide valuable baseline data on CMV epidemiology in Nigeria and underscore the importance of continued surveillance and early diagnosis.

Abstract: Background/Objectives: Anxiety and suicidal ideation are major mental health concerns during the perinatal period, impacting both mothers and newborns. While studies from South America address this issue, no prior systematic reviews have synthesized the findings. This review and meta-analysis aimed to explore the relationship between anxiety and suicidal ideation in perinatal women in South American countries. Methods: A systematic review and meta-analysis were registered in PROSPERO (CRD42025631849). Database searches were conducted in PubMed, Scopus, Web of Science, SciELO, and LILACS, including studies published up to December 2024, with no restrictions on year of publication. Study quality was evaluated using Joanna Briggs Institute tools. A random-effects model was used for the meta-analysis, following PRISMA guidelines. Results: Suicidal ideation was linked to 23 variables, such as age, race, depression, mother-infant bonding, violence, marital status, drug use, planned pregnancy, anxiety, low birth weight, and preterm birth. Anxiety was associated with 10 variables, including age, race, marital status, hyperglycemia, disabilities, eating habits, and mother-child relationship. The meta-analysis revealed a strong, significant association between suicidal ideation and violence, with affected women being 2.84 times more likely to report ideation. Conclusions: Violence and marital status emerged as key factors, reinforcing the need for screening and maternal mental health policies.

Abstract: Low back pain (LBP) represents an immense economic burden, with a lifetime prevalence of up to 84 %. However, conventional diagnostic methods such as MRI or X-rays provide only limited information about the pathogenesis and specific pain-related functional limitations. Wearable inertial sensors (IMU) and electromyography sensors (EMG) offer an expanded spectrum for the targeted identification and diagnosis of LBP. The aim of the study is to evaluate a selective diagnostic series for the subcategorization of functional deficits and their precise assignment to specific functional deficits. Based on a systematic literature review, an objectively measurable functional LBP assessment was defined that tests fatigue resistance, neuromuscular control, lumbopelvic stability, and global trunk musculature. Subsequently, 38 individuals were recruited in a prospective cross-sectional study and divided into three groups: “healthy,” “mild pain,” and “severe pain.” These individuals underwent an assessment. The two pain groups differed significantly from the symptom-free individuals in all previously defined functional levels. In addition, the two pain groups also differed significantly from each other. The functional assessment, which incorporates IMUs and EMG sensors as a central diagnostic element, is so valuable because it can identify causal relationships between mechanical dysfunctions and the underlying neuromuscular cause, thus enabling individualized therapy.

Abstract: Background/Objectives: Functional decline and depression often coexist in older adults, yet local Singapore-based research often lacks detailed temporal resolution due to heterogeneity in ageing. This study employs non-parametric, data-driven longitudinal clustering to analyse functional trajectories and their association with depression, using high-frequency data to pinpoint key intervention periods. Methods: Data were drawn from 4,273 older adults from Singapore Life Panel® (2020–2024). Participants completed quarterly self-reported assessments of ADL, IADL and depressive symptoms (8-item CES-D). We employed k-means longitudinal clustering (kml) to identify functional trajectory groups and Cox regression to evaluate the hazard of worsening depression (≥5-point increase in CES-D). Results: Three trajectories emerged: Stable, Medium (gradual increase in functional difficulty), and High (rapid increase in functional difficulty). The High cluster, comprising older and socioeconomically disadvantaged individuals, exhibited worse baseline health and psychosocial factor scores. Depression scores escalated in the Medium and High groups. Kaplan-Meier analysis revealed a faster rate of symptom worsening in these groups than in the Stable group. The High ADL trajectory predicted a 1.65-fold increased hazard of depression worsening after adjusting for sociodemographic and psychosocial confounders. Conclusions: Rapid functional decline acts as a precursor to worsening depressive symptoms. Routine monitoring of functional trajectories offers a strategic window for proactive mental health interventions in at-risk older adults.