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Distal humerus fractures can be difficult to manage in older patients with poor bone quality and those with risk factors for failure of open reduction internal fixation. When nonunion occurs, there are limited repeat fixation options and conversion to total elbow arthroplasty (TEA) can be considered. The objective of this descriptive, retrospective case series is to compare the outcomes of TEA for aseptic vs. septic nonunion of distal humerus fractures. Seven cases were identified by 2 orthopedic surgeons that specialize in TEA. The inclusion criteria were as follows: (a) adult patients (≥18 years of age), (b) underwent TEA after distal humerus open reduction internal fixation complicated by aseptic or septic nonunion, (c) had clinical follow-up data ≥1 year after TEA, and (d) completed patient-reported outcome surveys ≥1 year after TEA. Charts were reviewed to extract the relevant data, and outcomes between aseptic and septic nonunion groups compared using range of motion, grip strength, x-rays, and patient-reported outcome measures. After TEA, all average patient-reported outcome scores were better in the aseptic nonunion group compared to the septic nonunion group, indicating a more favorable recovery trajectory (Disabilities of the Arm, Shoulder and Hand score: 39.5 ± 9.3 vs. 58.4 ± 21.9; visual analog pain scale: 3.1 ± 2.1 vs. 4.4 ± 2.4). In addition, range of motion was better in the aseptic nonunion group compared to the septic nonunion group for most parameters (flexion: 127.3 ± 17.3 vs. 106.7 ± 18.8; supination: 73.3 ± 20.5 vs. 58.3 ± 28.4; pronation: 80.5 ± 9.9 vs. 69.0 ± 21.5), except elbow extension (27.5 ± 43.7 vs. -2.3 ± 8.7). Two patients in the aseptic nonunion group developed post-operative complications (ulnar neuropathy and periprosthetic fracture with osteolysis) compared to one patient in the septic nonunion group (periprosthetic infection). TEA is a viable treatment option for patients with aseptic and septic nonunion of distal humerus fractures, although patient outcomes in septic nonunion tend to be worse. Conversion to TEA is best done in 2 stages to ensure infection is identified and treated appropriately.

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Full-endoscopic spine surgery performed under local anesthesia offers clinical advantages, particularly for elderly patients. However, its reliance on fluoroscopy raises concerns about occupational radiation exposure. Although several studies have evaluated cumulative radiation dose, real-time data identifying specific high-risk phases of surgery remain limited. This study aimed to clarify phase-dependent scatter radiation patterns and identify targets for effective protection. We analyzed real-time personal dose equivalent, Hp(10), measured over the protective apron (over-apron Hp(10)) in 28 FESS cases using RaySafe i3 dosimeters across four staff roles: operator, assistant, supervisor, and scrub nurse. Surgical procedures were divided into three phases: Phase 1 (Marking), Phase 2 (Setup), and Phase 3 (Check). The operator showed the highest median total over-apron Hp(10) per case (0.244 mSv), significantly exceeding other staff (p&#x2009;<&#x2009;0.001), with an operator-to-nurse over-apron Hp(10) ratio of approximately 51.9:1. Phase-based analysis demonstrated that the operator's over-apron Hp(10) was heavily concentrated in Phase 2 (Setup) (median 0.194 mSv), significantly higher than Phase 1 and Phase 3 (p&#x2009;<&#x2009;0.001). No significant difference in total over-apron Hp(10) was found among surgical approaches. In conclusion, although FESS is minimally invasive for patients, the Setup phase represents a critical target for radiation safety. These anatomical and spatial observations suggest that further investigation into behavioral modifications, such as the use of single-shot fluoroscopy and maximizing operator distance during sheath placement, is warranted to reduce occupational radiation risk.

Personal-care-product-derived microbeads are an important source of primary microplastics (MPs), yet their environmental transformation and toxicity remain unclear. Here, facial scrub (FS) microbeads were subjected to simulated photoaging and evaluated in zebrafish larvae at an environmentally relevant concentration. Photoaging promoted the formation of environmentally persistent free radicals (EPFRs), altered FS physicochemical properties, and enhanced the release of organic additives and heavy metals. Compared to virgin FS, photoaged FS (FS-60) induced stronger neurobehavioral impairment, including reduced tail coiling, swimming activity, and inner zone duration, mainly driven by leachates and EPFR-associated reactivity. Transcriptomic and biological analyses revealed disrupted mitochondrial function and neuronal signaling. FS-60 impaired central nervous system and motor neuron development, altered neurotransmitter levels (acetylcholine, serotonin, and &#x3b3;-aminobutyric acid), and downregulated neurodevelopment-related genes. Moreover, FS-60 induced mitochondrial dysfunction, as supported by TEM-observed mitochondrial structural damage, elevated reactive oxygen species (ROS) and cytochrome c release, reduced ATP production and NAD+/NADH ratios, and suppressed electron-transport-chain-related genes. Mitoquinone mesylate (MitoQ) significantly alleviated locomotor deficits and ROS accumulation, confirming mitochondrial dysfunction as a key driver of FS-induced neurotoxicity. This study demonstrates that photoaging amplifies the neurotoxicity of cosmetic microbeads and should be considered in ecological risk assessment.

Acute febrile illness (AFI) is prevalent in tropical regions, with varying etiologies across South Asia. Limited data exists regarding its epidemiology. We aimed to determine the etiology, severity, organ dysfunction, and fatality rate of AFI. This prospective cross-sectional study was conducted at a tertiary care hospital in Southwestern India from September 2016 to August 2018. Hospitalized adults aged >18&#x2009;years with fever (3-14&#x2009;days) and no infection foci were included. Patients with co-infections, immunocompromised status, chronic kidney disease, chronic obstructive pulmonary disease, or chronic liver disease were excluded. Severity was assessed using Sequential Organ Failure Assessment (SOFA) score (&#x2265;2 indicating severe illness). Among 314 patients, 66.8% were male. Etiologies included undifferentiated fever (38.5%), dengue (33.1%), scrub typhus (10.2%), leptospirosis (7.6%), malaria (5.1%), and alternate diagnoses (6.4%), with seasonal peaks during monsoon (June to October). Severe illness (SOFA &#x2265;2) was noted in 62.4% of cases. Fatality was 3.2%, with 60% due to undifferentiated fever and 40% due to leptospirosis-associated multi-organ dysfunction. In this study of acute febrile illness (AFI), at a tertiary care hospital in Manipal, Karnataka, India, etiologies were dengue, scrub typhus, leptospirosis, and malaria. Among these, leptospirosis was associated with the highest median SOFA score, severe hepatorenal and cardiopulmonary dysfunction, required intensive support (inotropes, mechanical ventilation, and hemodialysis), and had the highest fatality rate. Limitations include serological diagnosis of some cases of AFI, lack of convalescent serology in undifferentiated cases, and potential referral bias inherent to a tertiary care hospital.

SUMMARYRickettsial diseases, encompassing scrub typhus, spotted fever group rickettsioses, and typhus group rickettsioses, represent a significant and escalating public health threat worldwide, particularly in the Asia-Pacific and sub-Saharan African regions. Despite their high morbidity and potential for fatal outcomes if left untreated, these infections remain notoriously underdiagnosed due to their nonspecific clinical presentation, which frequently overlaps with other acute undifferentiated febrile illnesses (AUFIs) such as dengue, malaria, and leptospirosis. This review evaluates the evolving diagnostic landscape, highlighting the severe limitations of conventional methods: the Weil-Felix test lacks necessary specificity, while the gold standard indirect immunofluorescence assay (IFA) is primarily retrospective due to delayed seroconversion. Molecular diagnostics, particularly multiplex polymerase chain reaction (mPCR), have emerged as a critical advancement, enabling early, species-specific identification during the acute phase of infection when doxycycline therapy is most effective. We further explore the paradigm shift toward syndromic molecular panels, such as the TaqMan Array Card (TAC), which facilitate simultaneous screening for multiple AUFI pathogens. Emerging platforms, including digital PCR (dPCR) for absolute quantification and CRISPR-Cas-based point-of-care (POC) systems (SHERLOCK and DETECTR), offer promising solutions for low-resource settings. Finally, this review underscores the necessity of integrating molecular surveillance within a One Health framework and utilizing artificial intelligence (AI) to address technical and implementation barriers. Overcoming these challenges is essential for transforming rickettsial diagnosis from a reactive to a proactive strategy, ultimately reducing the global burden of these neglected zoonoses.

To evaluate the radiation protection requirements for a UK first specimen PET-CT scanner, the AURA10 (Xeos, Ghent), as assessed through a clinical trial investigating its use for intra-operative surgical margin assessment in urology and head and neck (H&N) tumour removal. A radiation risk assessment was performed to inform radiation protection requirements and training. 0.8 MBq/kg of 18Fluorine fluorodeoxyglucose and 50 MBq of 68Gallium prostate-specific membrane antigen were administered for H&N and urology cases respectively. Whole body optically stimulated luminescence dosimeters, finger and eye ThermoLuminescent dosimeters and electronic personal dosimeters were issued to staff in theatres, recovery, and histopathology. Dose rate measurements were recorded at the position of staff members in theatres. Measured counts and dose rate from the resected specimen and swabs were obtained and contamination monitoring of the room were performed following removal of the patient. Training sessions and dry runs with surgical staff helped identify radiation risks and optimise workflow. Occupational doses from surgeons and scrub nurses were the highest for both modalities. Doses to other theatre staff were below dose limits for members of the public in the UK. Doses to staff outside theatres, including recovery and histopathology, were found to be below threshold values. Low level contamination was present in swabs (<&#x2009;6&#xa0;kBq and <&#x2009;250&#xa0;kBq for H&N and urology cases respectively). Thorough staff training, systems of work and shielding are required to ensure radiation doses to staff are minimised and contamination and radioactive waste are contained. There were difficult occasions during shift changes and untrained staff rota-ed in, but nuclear medicine supervision and then the introduction of theatre-based cascade trainers helped solidify learning and provide assurance to theatre staff and staff showed good compliance with the systems of work in place. Annual doses to theatre staff are heavily dependent on workload, with surgeons and scrub nurses closest to the patient receiving whole body doses of 39 &#xb5;Sv and 12 &#xb5;Sv, and finger doses of 88 &#xb5;Sv and 48 &#xb5;Sv respectively per case for H&N. Corresponding urology doses per case were measured as 7.2 &#xb5;Sv and 2.5 &#xb5;Sv for whole body and 16 &#xb5;Sv and below threshold values for the assisting surgeon and scrub nurse respectively. www. gov. URL trail registry record: Study Details | NCT06676943 | Investigating the Diagnostic Performance of High-resolution Specimen PET-CT in Determining Margin Status in Cancer Resection | ClinicalTrials.gov.

Conservation actions such as habitat restoration and translocation require spatially informed, quantitative decision-making. We modeled habitat suitability for nine priority landbird species of the Channel Islands to understand habitat preferences, inform conservation planning and assess future climate impacts. In the absence of recent airborne lidar, we derived vegetation structure from spaceborne lidar, radar and optical remote sensing data combined with downscaled climate observations to train machine-learning models. Models performed well (average AUC&#x2009;=&#x2009;0.84) under spatial cross-validation. Incorporating citizen science data improved Boyce Index performance for eight of the nine species, though AUC declined for 6 out of 9 species, likely reflecting spatial bias in opportunistic records. A radar-derived vegetation index was consistently influential, while maximum temperature strongly affected species restricted to Santa Cruz Island. Most species are projected to lose suitable habitat under two near-future (2040-2069) climate scenarios, except Grasshopper sparrow, Island scrub jay and Rufous-crowned sparrow. We identified climate change refugia to inform spatial conservation priorities.

Scrub typhus (ST), caused by Orientia tsutsugamushi, is an underdiagnosed cause of acute febrile illness in Southeast Asia. Acute febrile illness surveillance data from febrile patients presenting to health facilities in two Thailand border provinces (Tak [north] and Nakhon Phanom [northeast]) were analyzed to estimate ST prevalence and describe clinical and epidemiological characteristics and risk factors. Scrub typhus cases were classified as confirmed (polymerase chain reaction-positive), probable (acute-to-convalescent rise in ELISA IgM/IgG plus &#x2265;2 clinical features), or suspect (positive acute and convalescent sera results for anti-IgM/IgG or for patients with only one sera sample, positive acute or convalescent sera results for anti-IgM/IgG and &#x2265;2 of these clinical features). All others were considered non-cases. The 75 ST cases were classified as confirmed (39) or probable (36). Scrub typhus prevalence was higher in Tak (6.9%; 95% CI: 4.8-9.4) than in Nakhon Phanom (1.3%, 95% CI: 0.6-2.3). Common symptoms included headache, fatigue, myalgia, and chills. Discharge diagnosis matched ST case designation 15% of the time. Approximately one-quarter (n = 18) of patients were coinfected with another bacterium (15, 20%) or virus (3, 4%). Appropriate antibiotics were administered to 56% (n = 9) of the 21% (n = 16) of patients who received antibiotics before study specimen collections. Participants in Tak were 4.2 (95% CI: 2.2-8.2) or 4.5 (95% CI: 2.4-8.5) times as likely to test positive for ST if they visited the forest or contacted farm animals, respectively, within the past 30 days. Findings confirm the persistent burden of ST along Thailand's borders. Targeted actions are needed to strengthen clinical management, access to diagnostics, and community-based prevention.

Scrub typhus is a notable zoonosis, yet natural host-associated pathogen prevalence and genotypic diversity remain underexplored. A total of 261 small mammals comprising rodents and shrews captured in Uttar Pradesh, India, were screened for Orientia tsutsugamushi (OT) using nested PCR. The sample included Rattus rattus (n&#x202f;=&#x202f;28), Rattus norvegicus (n&#x202f;=&#x202f;42), Rattus tanezumi (n&#x202f;=&#x202f;42), Bandicota bengalensis (n&#x202f;=&#x202f;10), Mus musculus (n&#x202f;=&#x202f;15), and Suncus murinus (n&#x202f;=&#x202f;124). The overall molecular prevalence was 11.9% (95% CI: 8.2-16.4) with detection rates of 13.1% in rodents and 12.1% in shrews. Prevalence was significantly higher in rural (15.2%) than urban (1.6%) settings, and during monsoon (29.3%) and post-monsoon (11.9%) periods. Phylogenetic analysis of the partial tsa56 gene identified 4 OT strains circulating in rodent and shrew hosts, including Gilliam and TA678, along with novel JJOtsu5 and JJOtsu7. Population genetic analysis revealed substantial tsa56 nucleotide and haplotype diversity under purifying selection, while recombination analysis detected recombination in a subset of sequences, also contributing to genetic diversity. Deduced amino acid sequence analysis of the contiguous partial tsa56 gene revealed distinct mutations and structural variation in Gilliam-like and TA678-like strains, while JJOtsu5 and JJOtsu7 showed no variation relative to reference strains. In silico immunoinformatic analysis predicted 8 CD8 and 55 CD4 T-cell epitopes (TCEs) eliciting a human immune response, predominantly located within the spacer region S-VDIII/IV. The CD8 epitope AQLYKDLVKL was conserved across Gilliam, TA678-like (variant-27S), and JJOtsu7 strains; while the CD4 epitope PVKVLSDKITQIYSD was shared among Gilliam, JJOtsu5 and JJOtsu7 strains with a single S290R substitution. These strains exhibited distinct histopathological responses in OT PCR-positive animal tissues. Gilliam infections caused moderate lesions in liver, spleen, and lungs; TA678 infections exhibited mild pulmonary and renal changes; JJOtsu7 induced severe pulmonary and myocardial changes; and JJOtsu5 caused mild-to-moderate inflammation in liver, spleen, and kidneys. These findings highlight substantial genetic diversity, differential immunogenic potential and variable pathogenicity among rodent and shrew associated OT strains, underscoring the need for extended surveillance and strain-specific virulence characterization for improved control strategies.

Scrub typhus, caused by Orientia tsutsugamushi , is re-emerging as a cause of acute febrile illness (AFI) in India. Its nonspecific presentation and diagnostic challenges contribute to underdiagnosis and preventable mortality. To estimate the pooled prevalence of scrub typhus among AFI cases in India and to summarize the pooled case fatality rate (CFR). A systematic search of PubMed and Google Scholar was conducted for literature published between January 2013 and October 2023 (last search: September 15, 2023). Full search strings and filters are provided. Observational studies from India reporting laboratory-confirmed scrub typhus among patients with AFI were included. Community serosurveys were analyzed separately from hospital-based AFI cohorts. Studies using only Weil-Felix test were excluded from the main analysis; a sensitivity analysis including them is presented. Two reviewers independently extracted data. A random-effects meta-analysis model was used. Due to extreme heterogeneity (I 2 > 90%), pooled estimates are presented with caution, and medians and ranges are also reported. From 36 studies (excluding pre-2013 and Weil-Felix-only studies from main analysis), the pooled prevalence of scrub typhus among AFI cases was 26.4% (95% CI: 22.0-31.0%; I 2 = 94%; median: 24.5%, range: 8-53%). The pooled CFR among confirmed cases was 7.7% (95% CI: 4.4-11.7%; I 2 = 89%; median: 6.5%, range: 2-23%). The classic eschar was present in only 29% (95% CI: 22-37%) of patients. Community serosurveys (n=7) showed substantially lower prevalence (pooled 8.2%, 95% CI: 4.1-13.5%). Heterogeneity was high. Available hospital-based studies consistently identify scrub typhus as an important cause of acute febrile illness in several regions of India, although the magnitude of burden varies substantially between settings. The low frequency of eschar and diagnostic variability underscore the need for heightened clinical suspicion and standardized testing. Given the very high heterogeneity, pooled estimates should be interpreted cautiously, and readers are encouraged to examine the range and median values presented.

Scrub typhus is a re-emerging but often underdiagnosed tropical zoonosis in India. Its clinical heterogeneity, serological overlap with other endemic infections, and frequent absence of pathognomonic signs contribute to delayed diagnosis and high complication rates. Central nervous system, pulmonary, and renal involvement signify severe disease and are associated with considerable morbidity and mortality. We describe three cases of previously healthy young adult males (ages 24-32) who presented with severe, organ-threatening complications of scrub typhus: acute encephalitis syndrome (AES), acute respiratory distress syndrome (ARDS), and acute kidney injury (AKI). All patients had evidence of systemic inflammation, thrombocytopenia, and multiorgan dysfunction. Eschars-although present in all cases-were initially missed or overlooked, delaying causal diagnosis. Serologic cross-reactivity with dengue, chikungunya, and leptospira further complicated early recognition. Despite early initiation of doxycycline upon clinical suspicion, one patient with ARDS succumbed to progressive hypoxemia and multiorgan failure. These cases underscore the protean and fulminant nature of scrub typhus and highlight the diagnostic importance of thorough skin examination in febrile patients with unexplained CNS, pulmonary, or renal involvement. In endemic settings, empiric doxycycline should be considered early, even in the absence of classical signs. Early recognition and treatment remain the most critical determinants of survival. Our experience reinforces that scrub typhus, though elusive, is a potentially treatable cause of severe febrile illness when promptly identified.

Occupational radiation exposure remains a critical concern in modern health care due to cumulative health risks for procedural staff, stringent regulatory requirements, and the proliferation of advanced imaging technologies. This systematic review aimed to evaluate occupational radiation exposure among medical personnel during standard and complex endovascular aortic repair (EVAR) procedures, identify key determinants of radiation dose, assess the efficacy of protection strategies, and propose evidence-based recommendations to optimize staff safety in endovascular practice. A systematic review was conducted following PRISMA guidelines, searching MEDLINE, Cochrane Library, and Scopus databases from January 2019 to May 2025. Eligible studies reported quantitative dosimetric data for operating room staff during elective EVAR procedures, excluding ruptured aneurysm cases and non-English publications. Study selection and quality assessment was performed by 2 independent reviewers using ROBINS-I tool. From 942 screened studies, 18 met inclusion criteria, revealing significant occupational intraoperative radiation exposure variability. Eligible studies reported dosimetric data in terms of absorbed dose (D), effective dose (ED), personal dose equivalent Hp(10) for whole-body exposure, Hp(3) for eye lens dose, Hp(0.07) for skin and extremities dose, as well as peak skin dose (PSD). The ranges of D, ED, Hp(10), Hp(3), Hp(0.07), and PSD were 0.02 to 0.12 &#x3bc;Gy, 0.40 to 4350.00 &#x3bc;Sv, 0.00 to 6112.70 &#x3bc;Sv, 0.25 to 2500.00 &#x3bc;Sv, 0.20 to 971.00 &#x3bc;Sv, and 190.00 to 8430.00 &#x3bc;Gy, respectively. Operator exposure patterns showed consistent left-sided predominance (left eye 200.00 vs right eye 30.00 &#x3bc;Sv; left hand 76.90 vs right hand 46.70 &#x3bc;Sv). Advanced imaging technologies demonstrated substantial protective benefits: 3D image fusion reduced operator ED by approximately 55% to 66%, while dual fluoroscopy with digital zooming decreased median doses by 62%. Suspended lead shielding systems eliminated axillary exposure in some cases. Supporting staff received lower but non-negligible exposure, with scrub nurses sustaining higher doses than circulating nurses. Complex EVAR procedures continue to pose significant occupational radiation risks despite technological advancements. The findings emphasize the need for optimized protection protocols, particularly for ocular exposure, standardized dosimetric reporting practices across institutions, and continued development of low-radiation or radiation-free navigation technologies. Future research should prioritize multicenter prospective studies with standardized metrics to evaluate long-term health outcomes among surgeons performing complex EVAR operations.Clinical ImpactThis systematic review offers a comprehensive synthesis of current evidence on occupational perioperative radiation exposure during minimally invasive endovascular stent grafting, providing vascular teams with insights to enhance radiation safety protocols. By analyzing dose patterns across different procedure types and technologies, the study highlights effective protective measures, incorporating newfangled imaging systems and shielding solutions. The findings support clinical decision-making by demonstrating how specific interventions can reduce staff exposure while maintaining procedural efficiency. Using an evidence-based approach, this framework guides institutions in optimizing radiation safety programs, improving staff training, and facilitating the integration of dose-reduction technologies in contemporary endovascular practice.

Accurate wetland mapping is essential for monitoring ecosystem health and guiding conservation planning efforts. This study evaluated the effectiveness of deep learning architectures and high-resolution National Agriculture Imagery Program (NAIP) imagery for classifying diverse vegetation cover across five public land holdings in three states with significant seasonally flooded, emergent wetland habitats in the southeastern United States. We built and tested deep learning models in ArcGIS Pro using three architectural encoders (U-Net, PSPNet, and DeepLabV3) with different input combinations, including NAIP natural color (RGB), Near-Infrared bands (NIR), Normalized Difference Vegetation Index (NDVI), Digital Elevation Models (DEM), and Texture metrics derived from NAIP imagery using Gray Level Cooccurrence Matrix (GLCM) features, resulting in eight (8) input combinations and three (3) rotational augmentations (0&#xb0;, 30&#xb0;, and 60&#xb0;). Results revealed differences in classification accuracy ranging from 71 to 90% across sites, with Kappa scores from 0.54 to 0.81. We also found differences in model performance under alternating conditions and in the impact of combinations on performance metrics and computational time. Classification of the forested and scrub-shrub classes was consistent with F1 scores above 0.90 at several sites. However, distinguishing open water, aquatic beds, and emergent marshes became more difficult for some model-training architectures. At Mingo National Wildlife Refuge, clear spectral signatures and high-quality training data yielded the highest accuracy, thereby improving classification performance. In contrast, classification accuracy was lower for Red Slough and Choctaw East Wildlife Management Areas. Across all scenarios, the U-Net and DeepLabV3 models consistently outperformed the PSPNet model, achieving mean F1 scores close to 0.91, whereas PSPNet underperformed, with several configurations falling below 0.80. These results explain that while deep learning methods are effective and adaptable across different wetland types, their success depends on the ecological diversity of these environments. Overall, this research highlights the potential of deep learning for wetland monitoring and its crucial role in supporting conservation and management efforts.

Leptospirosis is a zoonotic disease prevalent in low and middle-income countries and tropical regions. It can be mimicked by endemic infectious diseases that present simultaneously, like dengue, malaria, melioidosis, or scrub typhus. However, there is a dearth of documented evidence about the frequency of coinfection, as well as related symptoms and mortality. The study aims to determine the frequency and geographical extent of coinfections in leptospirosis patients in India. We systematically searched databases, including Scopus, PubMed, Embase, and Web of Science, for articles published between January 2010 and August 2024 assessing coinfections in leptospirosis patients in India. The eligible articles were evaluated for full text data extraction using a standardized methodology. Of 804 articles screened 39 studies were included; overall these reported on 1565 leptospirosis cases with 236 (15.1%) cases with coinfections. Of these, seven observational studies assessed coinfections in 1318 leptospirosis-positive cases, identifying 113 (8.6%) coinfections: most commonly dengue (79; 69.9%), followed by hepatitis E (15; 13.2%), typhoid (9; 7.9%), and malaria (9; 7.9%). The most coinfection cases were reported from New Delhi (29.6%), followed by Kerala (21.6%), Karnataka (14.4%), Uttar Pradesh (12.2%), and Tamil Nadu (5.5%). Common symptoms included fever, vomiting, icterus, headache, thrombocytopenia, and transaminitis. Cases with coinfection had poorer outcomes with increased mortality compared to cases with isolated infection. In India, leptospirosis can present with co-infections such as dengue, hepatitis E, malaria, typhoid, and scrub typhus, complicating diagnosis due to overlapping clinical features. These coinfections are associated with unfavorable outcomes, including multi-organ dysfunction and increased mortality. Early diagnostic testing in febrile patients and timely, appropriate treatment are essential to improve patient outcomes. Clinical trial number: not applicable. Review protocol registration (Open Science Framework): DOI https://doi.org/10.17605/OSF.IO/AS9W5.

Operating room noise is a significant occupational hazard affecting healthcare professionals, but the specific consequences for scrub nurses have been largely overlooked. This study aimed to investigate the effects of operating room noise on scrub nurses across three key domains: psychological status, physiological and physical symptoms, and perceived surgical performance. A cross-sectional comparative study was conducted among 94 scrub nurses working in high-noise (orthopedic) and low-noise (ophthalmic) operating rooms. Participants completed validated psychological scales, underwent standardized physiological measurements, and reported physical symptoms and perceived noise impact on surgical performance. Between-group comparisons were performed using IBM SPSS Statistics 26.0 (P < 0.05). Psychologically, the high-noise group reported significantly higher levels of anxiety, sleep disturbances, specific burnout dimensions (exhaustion and cynicism), and perceived stress compared to the low-noise group (P < 0.05). Physiologically, nurses in the high-noise environment exhibited elevated resting heart rates (RHR) and systolic blood pressure (SBP). Furthermore, they reported a significantly higher prevalence of noise-related physical symptoms, including tinnitus and palpitations, rather than clinically diagnosed conditions. Regarding performance, the high-noise group perceived a substantially greater negative impact of noise on their task efficiency, surgical concentration, and intraoperative communication. The findings suggest that prolonged exposure to high-noise environments is associated with elevated psychological distress, physiological stress responses, and frequent somatic complaints among scrub nurses. Additionally, high noise levels are perceived to negatively interfere with surgical performance. Longitudinal studies and targeted noise-reduction interventions are recommended to safeguard occupational health and patient safety.

Vertebrate consumers are known to influence plant recruitment and community assembly based on the species they prefer to eat. The enemy release hypothesis (ERH) predicts that invasive introduced plant species may avoid consumption due to a lack of coevolved predators. Herbivores and granivores may also prefer species due to their functional traits, irrespective of species origin. We hypothesized that in a highly invaded plant community, invasive plants would benefit from enemy release and animal consumers would likely decrease plant diversity if they avoided invasive species in favor of native species (Hypothesis 1). Animals were expected to filter the species pool based on preference for palatable functional traits (Hypothesis 2). A factorial experiment combining cage and native seed addition treatments was established in the Voorhis Ecological Reserve, a California sage scrub ecosystem in Southern California. Seed and seedling preference trials were conducted to gather additional evidence of consumer preference at the study site. Although we found little influence of plant functional traits on consumer selection of species, animals created more functionally similar communities. In preference trials, native rodents and birds were found to prefer native plant species and avoid dominant invasive species, and the effects of animal preference were observed in experimental plant communities. Small vertebrates encouraged the success of invasive plants while limiting recruitment of native species, consistent with the ERH. Thus, birds and small mammals may function as an important filter in sage scrub habitat by reducing community diversity and promoting the dominance of competitively superior invasive plant species.

Orientia tsutsugamushi (OT), an obligate intracellular Gram-negative bacterium of the Rickettsiaceae family, causes scrub typhus (ST), a re-emerging vector-borne infectious disease with significant morbidity and mortality in South and Southeast Asia. Despite its widespread prevalence and mortality rates reaching up to 30% in untreated individuals, no effective vaccines or targeted therapeutics are currently available.Compounding these challenges are limitations in existing diagnostic methods, increasing antibiotic resistance, and complex interactions among host, pathogen, and vector. To address these critical gaps, this study conducted a comprehensive genome-wide comparative analysis across 23 OT strains, including UT 76, Karp, Kato, Gilliam, and Wuj/2014, using an in-house R-based computational pipeline. This analysis identified a conserved core genome of 744 genes, of which 19 are unique and pathogen- specific proteins. Subcellular localisation analyses revealed that nine of these proteins are membrane- associated, highlighting their potential accessibility to therapeutic agents. Additionally, proteins were prioritised through an integrative analysis that incorporates protein- protein interaction networks, druggability assessments, and antigenicity profiling. Six key proteins- dnaK, fusA, fabG, infB, nuoN and fabI were identified based on their essential roles in pathogen- specific pathways. These proteins are involved in membrane transport, transcription regulation, and biosynthesis, making them promising drug targets. Notably, this study employs in silico methodologies to overcome limitations inherent to traditional wet-lab approaches. Computational strategies are cost-effective for identifying conserved targets and supporting hypothesis- driven drug discovery. The findings presented here not only reveal previously uncharacterized therapeutic targets but also establish a genomic framework to improve diagnostic accuracy and guide future drug development against ST.

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