EClinicalMedicine最新文献

Background: Cutaneous leishmaniasis (CL) is a vector-borne parasitic disease endemic in Palestine, especially in Jericho and Jenin, and remains a major public health concern. This study aimed to identify risk and protective factors for CL infection in the West Bank.

Methods: We conducted a case-control study across multiple districts of the West Bank between February 2024 and February 2025. The study included 96 patients diagnosed with CL (cases) and 96 matched controls from the same localities, matched by age and sex. Case data were retrieved from Ministry of Health records, while controls completed a self-administered questionnaire. Sociodemographic, environmental, and behavioral variables were collected. Statistical analysis was performed using Epi Info 7.2.4.0, with odds ratios (OR) and 95% confidence intervals (CI) calculated, and multivariate logistic regression. Fisher's exact test and chi-square test were applied, with P < 0.05 considered statistically significant.

Findings: A total of 192 participants were enrolled (96 cases, 96 controls), with a median age of 14 years (IQR 6-35). Children under 14 years accounted for 53% of cases. Females represented 49% of cases and 54% of controls. Most cases resided in villages (61%) compared to urban areas. Patients and their parents had significantly lower educational attainment compared to controls P < 0.001 . Environmental risk factors included the presence of rock hyrax near homes (OR = 8.56, 95% CI: 4.05-18.08), caves and crevices (OR = 8.98, 95% CI: 4.53-17.82), domestic animals (OR = 3.34, 95% CI: 1.75-6.38), and domestic dogs (OR = 2.41, 95% CI: 1.28-4.52). Protective factors included painting interior walls (OR = 0.27, 95% CI: 0.14-0.53) and pesticide spraying in households (OR = 0.13, 95% CI: 0.05-0.35). After adjusting for other covariates in the multivariate logistic regression analysis, only the father's years of education, household size, and the presence of rock hyrax in the residential area, along with stone fences around the house, remained significantly associated with CL.

Interpretation: CL remains endemic in parts of Palestine, particularly among children and rural populations. Socioeconomic and environmental factors play a critical role, highlighting the need for health education, improved housing, and vector control to reduce transmission.

Funding: This study received no funding.

Background: Studies examining machine perfusion (MP) in liver transplantation (LT) report variable post-transplant outcomes, making comparison difficult. Core outcome sets (COS) with standardized definitions and specified time points have been proposed to mitigate this variability. This study explores the quality of outcome reporting in studies with MP in LT.

Methods: We conducted a systematic review examining outcome reporting within MP LT studies. PubMed, Embase and Ovid Medline were queried for studies examining perfusion techniques from January 1st 2018 to June 1st 2025. Articles that reported clinical outcomes after LT with current perfusion techniques, i.e., normothermic (NMP), hypothermic (HMP) and normothermic regional perfusion (NRP) with >10 cases were included. Risk of bias was assessed with Rob2 and Newcastle Ottawa scores. Median number of COS were reported by perfusion technique. The percentage of studies reporting each measured outcomes was recorded and classified by perfusion technique. The study was registered on PROSPERO (ID: CRD42024590000).

Findings: 2789 records were screened, and 166 articles met inclusion criteria. HMP, including oxygen per-sufflation, was examined by 35 studies, NMP by 55 and NRP by 34 studies, respectively. Forty-two studies included a combination of perfusion techniques. The median number of COS measured was highest in studies examining HMP at 9.0 (IQR 6.0-11.0). NMP studies had the lowest median number of COS measured per article (5.0; IQR 3.0-9.5). Of the 13 COS metrics, patient and graft survival were the most frequently reported, at 88.4% and 87.1% followed by primary-non-function (72.3%), length of stay (68.4%) and non-anastomotic biliary strictures (61.3). Weighted and cumulative complications metrics, i.e., the Clavien-Dindo-Classification and Comprehensive Complication Index were poorly assessed (28.4% and 19.4%, respectively). Only 4 studies examined all 13 COS parameters (2.6%), and 24 reported >10 COS (15.5%). There was significant heterogeneity in outcome parameter definitions and time-points of assessment, especially amongst biliary complications.

Interpretation: There is significant variability in post-transplant complications reporting by LT with MP studies. Uniform definitions and standardized guidelines are critical to allow rigorous comparison of different perfusion techniques and other future innovations.

Funding: None.

Background: The neuroprotective effects of normobaric hyperoxia (NBHO) for treating acute ischemic stroke (AIS) remain unclear. This systematic review and meta-analysis evaluated the safety and functional outcomes of NBHO in AIS patients.

Methods: We searched major databases until November 13, 2025, for randomized controlled trials (RCTs) comparing NBHO (≥2 h within 24 h of onset) with room air or low-flow oxygen in adult patients with AIS. Two reviewers independently screened studies, with disagreements resolved by a third reviewer. The primary outcome was functional independence (modified Rankin Scale [mRS] scores 0-2) at three months. Secondary outcomes included reduced disability (ordinal shift across mRS grades 0-6), early neurological recovery (changes in National Institutes of Health Stroke Scale [NIHSS] within 7 days), and infarct volume changes. Safety outcomes included 90-day mortality, symptomatic intracranial hemorrhage (sICH), and pneumonia. Outcomes eligible for meta-analysis were analyzed using a random-effects model (Paule-Mandel heterogeneity estimation) with Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment for the primary analysis and without HKSJ adjustment for secondary analysis. Registration: PROSPERO (CRD42024584308).

Findings: Eight RCTs involving 804 participants were included. Six studies (n = 746) showed that NBHO improved functional independence (RR 1.28, HKSJ 95% CI 1.07-1.51; P = 0.015), reduced disability (cOR 1.72, HKSJ 95% CI 1.35-2.20; P = 0.002), and lowered mortality (RR 0.62, HKSJ 95% CI 0.39-0.99; P = 0.047) at three months. NBHO also decreased NIHSS scores at 72 h (MD -2.18, HKSJ 95% CI -3.45 to -0.90; P = 0.009) across five studies, though effects at other timepoints were significant only in secondary analysis. NBHO did not increase the risk of sICH (RR 0.79, HKSJ 95% CI 0.45-1.40; P = 0.347). Among patients receiving endovascular therapy (five studies), NBHO did not increase the risk of pneumonia (RR 0.97, HKSJ 95% CI 0.61-1.55; P = 0.863). Results for infarct volume and subgroup analyses were inconclusive due to limited data.

Interpretation: In this meta-analysis of predominantly Chinese populations, NBHO may improve functional independence, reduce disability, and lower mortality at three months, and promote early neurological recovery at 72 h without compromising safety. Generalizability to other ethnic groups requires confirmation.

Funding: This work is supported by the Cultivation Program of Clinical Research Special Project of The Second Affiliated Hospital of Army Medical University (Grant No. 2024F037).

Background: The HOST-IDEA trial demonstrated non-inferiority of 3-to-6-month dual antiplatelet therapy (DAPT) to 12-month DAPT for net adverse clinical event (NACE) at 1 year in patients undergoing percutaneous coronary intervention (PCI) with third-generation drug-eluting stents (DES). We evaluated the long-term outcomes of abbreviated antiplatelet therapy following PCI with third-generation DES.

Methods: In the open-label, adjudicator-blinded, multicentre, randomised HOST-IDEA trial, 2013 patients from 37 hospitals in South Korea were randomly allocated to 3-to-6-month (n = 1002) or 12-month (n = 1011) DAPT between January 2016 and May 2021. The primary outcome was NACE at 3 years, comprising cardiac death, target vessel myocardial infarction (TVMI), clinically driven target lesion revascularisation (CD-TLR), stent thrombosis, and major bleeding (Bleeding Academic Research Consortium type 3 or 5). Major secondary outcomes were target lesion failure (TLF)-comprising cardiac death, TVMI, and CD-TLR-and major bleeding at 3 years. To evaluate the efficacy and safety of >1-year DAPT, patients event-free at 1 year were classified into >1-year and ≤1-year DAPT groups and matched using a propensity score. These 3-year clinical outcomes were prespecified in the published protocol as mandatory clinical follow-up. HOST-IDEA is registered with ClinicalTrials.gov, NCT02601157.

Findings: At 3 years, clinical follow-up was completed in 955 patients (95.3%) and 966 patients (95.5%) in the 3-to-6-month and 12-month DAPT groups, respectively. The median follow-up duration was 1095 days (IQR 1095-1095). The primary outcome occurred in 7.7% and 8.2% of patients in the 3-to-6-month and 12-month DAPT groups, respectively (HR 0.94; 95% CI 0.69-1.29; P = 0.71). The risks of TLF (HR 0.92; 95% CI 0.62-1.36; P = 0.66) and major bleeding (HR 0.96; 95% CI 0.59-1.56; P = 0.88) were comparable between the two groups. Among patients who were event-free at 1 year, 583 remained on DAPT, while 1259 switched to single antiplatelet therapy within the 1 year. In the matched cohort, there was some evidence of a higher risk of TLF in the >1-year DAPT group (HR 2.56; 95% CI 0.99-6.60; P = 0.05), whereas major bleeding risk was significantly higher with >1-year DAPT (HR 4.44; 95% CI 1.26-15.57; P = 0.02).

Interpretation: 3-to-6-month and 12-month DAPT showed comparable 3-year clinical outcomes in patients undergoing PCI with third-generation DES. However, extending DAPT beyond 1 year was associated with increased major bleeding without additional ischemic benefits. Further studies are warranted to validate these findings and identify patient subsets who may benefit from extended DAPT.

Funding: Biotronik Korea (Seongnam si, Gyeonggi-do, South Korea) and B. Braun Korea (Seoul, South Korea).

Background: The mistreatment of women during facility-based childbirth is widespread in sub-Saharan Africa and has a negative impact on women's mental health. We aimed to examine the association between childbirth-related mistreatment and postpartum depression in Ethiopia and Guinea.

Methods: Between May 2023 and February 2024, we conducted a prospective longitudinal survey of pregnant women recruited from 22 health facilities in Addis Ababa, Ethiopia, and 20 health facilities in Conakry, Guinea. Participants were surveyed during the third trimester in health facilities and were followed up in the community for a second survey, which was conducted between 6 and 16 weeks postpartum. Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS), and mistreatment was measured across seven categories. We used multilevel mixed effects Poisson regression to assess the association between the number of mistreatment categories experienced and women's postpartum depression scores.

Findings: Of the 859 women enrolled during pregnancy, 711 women completed the postpartum survey. 87.4% of women in Addis Ababa and 71.2% in Conakry had experienced at least one category of mistreatment. Symptoms suggestive of postpartum depression (EPDS ≥11) were reported by 20.9% of women in Addis Ababa and 31.0% in Conakry. After adjusting for antepartum depression, intimate partner violence, and other sociodemographic, obstetric, and health service-related characteristics, experience of each additional mistreatment category was associated with a 5% increase in women's postpartum depression scores (adjusted incidence rate ratio [AIRR] = 1.05, 95% CI: 1.01-1.09). Among women without symptoms suggestive of antepartum depression (EPDS <11), the effect was even greater, with an 11% increase in postpartum depression scores (AIRR = 1.11; 95% CI: 1.06-1.17).

Interpretation: The strong association between mistreatment and postpartum depression, particularly among women without antenatal depressive symptoms, highlights the potential causal role of mistreatment and underscores the urgent need for coordinated, evidence-informed, and context-appropriate strategies to promote respectful maternity care and safeguard women's mental health.

Funding: Research Foundation Flanders (FWO file number 1261923N) and the Institute of Tropical Medicine (ITM), Antwerp, Belgium, with support from the Flemish Government Department of Economy, Science and Innovation (EWI) and the Belgian Federal Directorate-General for Development Cooperation and Humanitarian Aid (DGD).

Background: Low birth weight, defined as less than 2.5 kg (5.5 lbs) at birth, remains a critical global public health challenge. It significantly increases the risk of neonatal mortality and immediate complications such as sepsis and hypothermia, along with lifelong consequences including childhood disabilities and adult-onset chronic diseases. However, there was a limited study that described the spatial distribution and predictors of low birth weight in sub-Saharan Africa. The study aimed to assess geospatial variations and predictors of low birth weight in sub-Saharan Africa.

Methods: A community-based cross-sectional study design based on Demographic and Health Survey (2015-2024) data, comprising a weighted sample of 138,164 women aged 15-49 years with live births among 28 sub-Saharan African countries, was included in the study. Global Moran's I was calculated to determine overall clustering of low birth weight. Statistically significant hot spot and cold spot areas of low birth weight were determined by Getis-Ord G∗ statistics. Ordinary least squares, spatial lag, spatial error, geographically weighted regression, and multiscale geographically weighted regressions were utilized to determine predictors of low birth weight. The best-fitting models were determined by the highest R² and the lowest corrected Akaike Information Criterion values. Finally, the statistically significant predictors from the final model were displayed on a map.

Findings: Low birth weight was clustered (Moran's I 0.23, z-score 50.2, p-value <0.01) in the study area. Significant hotspot areas were depicted in Mauritania, Mali, Senegal, Burkina Faso, Nigeria, Gabon, Angola, Madagascar, South Africa, Lesotho, Malawi, and Ethiopia. Conversely, low-risk cold spots were observed in Uganda, Kenya, Rwanda, Burundi, Tanzania, Zambia, Zimbabwe, Cameroon, and Sierra Leone. Short birth interval, no visit to a health facility in the last year, twin birth, no media exposure, and unemployed women were significant predictors of low birth weight.

Interpretation: There is spatial variation of low birth weight across different regions in sub-Saharan Africa. Significant hotspot and cold spot areas along with significant predictors were identified, which is a priority for policy makers. Targeted maternal health interventions, improved healthcare access, health education using mass media, and economic empowerment for women are recommended to reduce low birth weight.

Funding: None.

Background: People with disabilities frequently experience poorer health than others in the population, yet the extent of this health gap is unknown. We undertook an umbrella review of meta-analyses to assess the amount, strength and quality of the evidence of the association between disability and a broad range of health outcomes.

Methods: We searched Cochrane Library, EMBASE, Medline, PsycINFO and Health Evidence to identify meta-analyses of quantitative studies, published January 1, 2000 to February 3, 2025, in any language. We included systematic reviews with meta-analyses that compared health outcomes between people with and without disabilities, across all study settings and geographical locations. Two reviewers assessed study eligibility and extracted data. We assessed risk of bias using the AMSTAR2 tool and evaluated the strength of evidence for each meta-analysis according to the Fusar-Poli and Radua criteria. We narratively described the association between disability and health outcomes, categorised according to ICD-11 categories. This study is registered with PROSPERO, CRD42025645729.

Findings: The search generated 11,221 unique records, of which 58 systematic reviews that included meta-analyses were included. Together, these reviews drew on 1409 primary studies from 77 countries and produced 132 separate meta-analyses that evaluated 16 health outcomes. Overall, most systematic reviews were of moderate to low quality. Intellectual and developmental disabilities accounted for the largest share of the meta-analyses (n = 60, 45%). One-third of associations (n = 45, 34%) showed convincing or highly suggestive evidence linking disability to adverse health outcomes. The majority of meta-analyses (n = 113, 86%) found statistically significant and positive associations. No studies that examined disability in relation to diseases of the blood, diseases of the immune system, diseases of the musculoskeletal system or conditions related to sexual health were identified.

Interpretation: People with disabilities are a diverse group, yet share the common experience of markedly worse health than their peers without disabilities. The evidence base is constrained by limited measurement of subjective health outcomes and definitions of disability that may not capture contextual factors. Consequently, the true association of disability and poor health outcomes may be underestimated. Health inequities experienced by people with disabilities necessitate health system reforms with efforts to embed inclusion and address social determinants of health.

Funding: The National Institute for Health and Care Research, the Programme for Evidence to Inform Disability Action grant from the Foreign, Commonwealth and Development Office, the Conrad N. Hilton Foundation.