ObjectiveTo evaluate the clinical utility of the admission albumin-to-globulin ratio for assessing disease severity and predicting prognosis in patients with wasp stings.MethodsThis retrospective cohort study enrolled 161 hospitalized patients categorized into mild, moderate, and severe groups according to the 2018 Chinese Expert Consensus Criteria. Baseline characteristics, admission albumin-to-globulin ratio, and inflammatory markers were compared among the severity groups. Spearman correlation analysis was used to assess associations between the albumin-to-globulin ratio and clinical parameters. Multivariable logistic regression was performed to identify independent risk factors for poor prognosis, multiple organ dysfunction syndrome, and acute kidney injury. Receiver operating characteristic curve analysis was used to evaluate the predictive performance of admission albumin-to-globulin ratio and its coefficient of variation.ResultsAdmission albumin-to-globulin ratio was significantly lower in the severe group (p < 0.05) and negatively correlated with white blood cell count, C-reactive protein, procalcitonin, and serum amyloid A. Decreased albumin-to-globulin ratio and elevated coefficient of variation of the albumin-to-globulin ratio were independent risk factors for multiple organ dysfunction syndrome and acute kidney injury. Admission albumin-to-globulin ratio demonstrated strong diagnostic efficacy, with areas under the curve of 0.822 for multiple organ dysfunction syndrome and 0.860 for acute kidney injury. The combination of albumin-to-globulin ratio with coefficient of variation of the albumin-to-globulin ratio significantly improved the areas under the curve for multiple organ dysfunction syndrome prediction to 0.934 (95% confidence interval: 0.854-0.978), yielding 89.29% sensitivity and 82.00% specificity. Admission albumin-to-globulin ratio provides early risk stratification tool, whereas coefficient of variation of the albumin-to-globulin ratio reflects dynamic changes during hospitalization and provides complementary prognostic information. Furthermore, patients with an admission albumin-to-globulin ratio ≤1.1 exhibited significantly higher incidences of acute kidney injury, multiple organ dysfunction syndrome, hepatic dysfunction, and coagulopathy (p < 0.001).ConclusionsAdmission albumin-to-globulin ratio is a simple, effective biomarker for risk stratification in patients with wasp sting. Integrating static admission albumin-to-globulin ratio with dynamic coefficient of variation of the albumin-to-globulin ratio enhances predictive accuracy and may support incorporation of these measures into routine clinical protocols to facilitate early identification of high-risk individuals and guide intensive interventions.

Managing thrombosis in patients with bleeding disorders requires careful assessment of thromboembolic and bleeding risks, tailoring antithrombotic treatment in terms of type, dose, and duration, and considering the need for replacement therapy based on individual factor levels and bleeding history.

A little-known arm of the immune system respond to lipids, with a protein called CD1 driving reactions to bee stings, bacteria, and possibly poison ivy.

Intranasal adrenaline has recently become available in Australia as a needle-free alternative to adrenaline autoinjectors for anaphylaxis management. Intranasal adrenaline may be particularly suitable for patients with barriers to adrenaline autoinjector usage, such as needle aversion or poor compliance with autoinjector carriage. However, although the data supporting real-world efficacy of intranasal adrenaline for anaphylaxis are growing, there is no published evidence confirming its efficacy in insect venom anaphylaxis. We report three cases of intranasal adrenaline (neffy, CSL Seqirus, Victoria, Australia) used to treat insect venom-induced anaphylaxis. Clinicians should be aware of the availability and current level of evidence for intranasal adrenaline for anaphylaxis management.

Topical repellents are considered as valuable supplementary tools for reducing vector-borne disease transmission risk by preventing mosquito bites. Plant-based formulations have attracted growing interest as safer, more acceptable alternatives to synthetic repellents, yet evidence for their real-world effectiveness remains limited. This study evaluated the protective efficacy of two topical repellents, DEET and Vetiver essential oil (Vetiver E.O.) against Anopheles dirus Peyton & Harrison, a main malaria vector species, through semi-field system (SFS) trials. These tests were followed by a nine-month community-level randomized trial in Khun Han District, Sisaket Province, with concurrent social science evaluation. In the SFS trials, DEET reduced mosquito landing by 95.75% over 6 h, while Vetiver E.O. conferred moderate protection at 51.9%. Both products also reduced the percentage of blood-feeding, suggesting additional transmission-reducing potential beyond simple landing deterrence. At the community level, 457 participants were randomized into DEET, Vetiver E.O., and placebo groups. DEET participants demonstrated substantially higher product collection adherence and frequency of use than Vetiver E.O. or placebo participants. Participant-reported efficacy and acceptability ratings for Vetiver E.O. were comparable to the placebo group, suggesting that its biological activity was insufficient to generate a perceptible benefit under field conditions. Across all groups, participants predominantly applied repellents to clothing rather than exposed skin, likely attenuating real-world protective efficacy. These findings support the establishment of a minimum efficacy threshold under semi-field conditions before proceeding to community trials with candidate repellents and underscore the need to implement personal protection strategies that minimize the need for regular application by each individual.

American Cutaneous Leishmaniasis (ACL) is a multi-host vector-borne disease with complex transmission dynamics involving sand fly vectors, reservoirs, and incidental hosts. In this study, we develop and analyze two delay differential equation (DDE) models to explore the role of biological time delays in ACL transmission dynamics. The first model incorporates a delay in the parasite clearance term of the incidental host, reflecting the minimum parasite clearance time between infection and recovery. The second model introduces a delay that represents delays in skin lesion development following exposure to infective sand fly bites. For both models, we derived the basic reproduction number R 0 and performed an elasticity analysis which revealed that vector-reservoir transmission and vector mortality are key drivers of outbreak potential. For both models we studied the stability of the disease-free and endemic equilibria. Using linearization, we identified critical delay thresholds that generate Hopf bifurcations. We show that time delays can destabilize the endemic equilibrium and induce periodic oscillations. Despite having the same R 0 , the two models exhibit distinct qualitative behaviors due to differences in the delay structure. Simulations support the analytical findings, illustrating how increasing delays can lead to oscillations in transmission. These findings highlight the importance of incorporating biologically inspired delays when modeling ACL transmission.

Botanical repellents provide a traditional means of personal protection, yet optimizing their formulations is increasingly required to address shifting mosquito feeding behaviors and mitigate disease transmission. The current study aimed to evaluate the repellent efficacy of essential oils and their binary combinations as complex matrices against Anopheles arabiensis bites, the major malaria vector in Ethiopia. Essential oils were extracted from fresh parts of four ethnobotanically investigated medicinal plants in the Ghibe Valley, Ethiopia, namely Croton macrostachyus, Echinops kebericho, Eucalyptus globulus, and Juniperus procera using hydrodistillation. The chemical composition of the essential oils was analyzed by Gas Chromatography-Mass Spectrometry (GC-MS). Arm-in-cage bioassays using laboratory-reared mosquitoes and human volunteers determined the effective dosage and complete protection time of the essential oils at 10% and 20% concentrations. A total of 131 chemical constituents were identified across the four analyzed essential oils. The C. macrostachyus leaf and seed oils provided a significantly longer protection time (p < 0.001), reaching 180 minutes with a mean percentage repellency of 85% to 100%. The essential oil of J. procera blended with C. macrostachyus or E. kebericho exhibited significant synergistic repellency (p < 0.001). The protection duration demonstrating by C. macrostachyus oil underscores their potential to meet the regulatory performance standards for natural insect repellents. Future investigations should include larger sample sizes, dermal toxicity assessments and field validation to fully support the commercialization of these essential oils.

Lymphadenopathy, also referred to as adenopathy, represents a common finding during physical examinations in general medical practice. The discovery of enlarged lymph nodes can generate varying levels of concern among patients and clinicians because a small proportion of cases may result from clinically significant infections or neoplasms, including HIV, tuberculosis, or malignancy. However, most cases of localized and generalized lymphadenopathy, particularly among pediatric patients, have benign and self-limited etiologies. A comprehensive understanding of lymph node function, anatomical distribution, clinical characteristics, and causes of enlargement supports appropriate clinical decision-making by helping clinicians determine which patients require urgent and extensive evaluation and which patients can be safely monitored. The lymph node serves as an antigen-filtering component of the body’s reticuloendothelial system. Each lymph node contains a complex, multilayered sinus system that sequentially exposes B-cell lymphocytes, T-cell lymphocytes, and macrophages to afferent extracellular fluid. This process allows the immune system to identify foreign proteins, initiate an immune response, or sequester antigens as appropriate. During immune activation, proliferation of antigen-specific cell lines leads to increased lymph node size. Although lymph nodes larger than 1 cm are commonly considered enlarged, normal versus abnormal size criteria vary according to anatomical location and patient age. Children younger than 10 years often have more active immune systems, and lymph nodes measuring up to 2 cm may represent a normal finding in selected clinical situations. Conversely, an epitrochlear lymph node larger than 0.5 cm in an adult generally indicates pathological enlargement. The pattern, distribution, and physical characteristics of lymphadenopathy provide important diagnostic information. Lymphadenopathy generally presents in 2 patterns: localized and generalized, with localized lymphadenopathy occurring more frequently. Generalized lymphadenopathy involves enlargement of lymph nodes in 2 or more non-contiguous anatomical regions, whereas localized adenopathy occurs within contiguous lymph node groups. Because lymph nodes correspond to specific lymphatic drainage regions, enlargement often reflects pathology originating within the associated anatomical area, with the head and neck region representing a common location in both adults and children. Lymph nodes may present as tender or nontender, fixed or mobile, discrete or “matted” together. Associated symptoms, particularly systemic findings, eg, fever, weight loss, fatigue, and night sweats, along with patient-specific epidemiologic factors, provide additional diagnostic guidance. A detailed history addressing preceding illness, chills, constitutional symptoms, localizing symptoms, age, gender, infectious exposures, toxin exposure, medication use, and lifestyle factors can provide critical diagnostic clues. A careful history and focused physical examination represent the cornerstone of lymphadenopathy evaluation. The extent of the clinical assessment should be guided by the patient’s presentation and the level of diagnostic uncertainty. For example, a patient presenting with posterior cervical adenopathy, sore throat, and significant fatigue may require only a targeted history, focused examination, and a monospot test for Epstein-Barr virus (EBV). In contrast, a patient with generalized lymphadenopathy and fatigue requires a broader evaluation to identify potential systemic, infectious, autoimmune, or malignant causes. Generalized lymphadenopathy generally warrants clinical investigation, and the presence of “matted lymphadenopathy” may indicate significant underlying pathology. Integration of the patient’s history, physical examination findings, and demographic risk factors allows clinicians to categorize patients using established diagnostic algorithms for lymphadenopathy evaluation. Applying these clinical indicators and selecting the appropriate diagnostic pathway supports timely, cost-effective evaluation while helping determine when observation remains appropriate. This structured approach improves diagnostic accuracy, facilitates recognition of concerning presentations, and guides appropriate escalation of care when necessary. Algorithmic Analysis of Lymphadenopathy After a history and physical examination are completed, lymphadenopathy can be placed into 1 of 3 general categories: 1. "Diagnostic", eg, strep pharyngitis or upper respiratory tract disease, in which case the course of action is to treat the condition. 2. "Suggestive" (eg, mononucleosis, lymphoma, or HIV), wherein the history and physical are strongly suggestive for diagnosis-specific testing, and if positive, the action is to treat the condition. 3. "Unexplained" where the lymphadenopathy is divided into generalized lymphadenopathy and localized lymphadenopathy. For unexplained localized lymphadenopathy, a review of history, a regional exam, and epidemiological clues are used to separate patients into lower (no risk of malignancy or serious disease) versus higher risk for serious disease or malignancy categories. As an example, if the patient is at no risk for malignancy or serious illness, a reasonable course may be to observe the patient for 3 to 4 weeks to see if the lymphadenopathy resolves or improves. If the lymphadenopathy does not resolve or improve, the next step is to obtain a biopsy. If the patient is judged to have a risk for malignancy or serious illness, the procedure is to proceed immediately to biopsy. For unexplained generalized lymphadenopathy, the key to diagnosis is a history to evaluate for suspected causes. The initial search would be historical questions for a mononucleosis-type syndrome evidenced by fever, atypical lymphocytosis, and malaise. Included in the differential would be Epstein-Barr virus, cytomegalovirus, toxoplasmosis, and (especially in the case of a flu-like illness and rash) the initial stages of an HIV infection. The second step in evaluating unexplained generalized lymphadenopathy involves carefully reviewing epidemiological cues. Included in the epidemiological cues would be the following: Infectious disease exposure. Animal exposure. Insect bites. Recent travel. Complete medication history. Personal habits: smoking, consumption of alcohol, consumption of drugs (pay special attention to a history of intravenous drug use, high-risk sexual behavior). Consumption of undercooked food/untreated water . Although there is no "cookbook" for the laboratory evaluation of generalized unexplained lymphadenopathy, the initial steps are to obtain a complete blood count (CBC) with a manual differential and EBV serology. If nondiagnostic, the next steps would be PPD placement/IGRA, RPR, chest x-ray, ANA, hepatitis B surface antigen, and HIV test (see Image. Mediastinal Adenopathy). Again, if any of the above are positive, appropriate treatment can be initiated. In the presence of negative serological examination, radiological examination, and/or significant symptomology, a biopsy of the abnormal node is the gold standard for diagnosis. Statistics concerning lymphadenopathy are inaccurate as the great majority of lymphadenopathy is caused by a nonreportable illness and thus not reported or taken into account. This results in a statistical bias, or skew, toward the reportable causes of lymphadenopathy: malignancies, HIV, tuberculosis, and sexually transmitted infections. Citations in the recent literature for general medical practice indicate that less than 1% of people with lymphadenopathy have malignant disease, most often due to leukemia in younger children, Hodgkin lymphoma in adolescence, non-Hodgkin disease, and chronic lymphocytic leukemia in adults. It has been reported that the general prevalence of malignancy is 0.4% in patients under 40 years and around 4% in those older than 40 years of age seen in a primary care setting. The prevalence rate of neoplastic disease is reported to rise to nearly 20% in referral centers and rises to 50% or more in patients with initial risk factors.

Malaria transmission exhibits significant heterogeneity within communities, with small proportions of individuals experiencing disproportionate mosquito exposure.

The patient, John, is a 94-year-old man with mild mobility issues but is otherwise fit and active. He developed a trauma-related ulcer, likely originating from an insect bite, that is now almost fully closed following treatment with compression hosiery. This case study discusses the symptoms, assessment, diagnosis, treatment plan and the outcomes resulting from timely and appropriate nursing interventions.

Bluetongue is an insect-borne disease of ruminants caused by the Bluetongue virus (BTV). It is primarily transmitted through the bites of Culicoides midges and is widely distributed in tropical, subtropical, and temperate regions around the world. Due to its favorable geographical location and abundant population of BTV vector midges, Yunnan Province, China, has become a key region for research on BTV diversity. However, there are gaps in research on the genetic evolution of BTV in this region. Between January 2024 and December 2025, Culicoides midges were collected from three border counties in Yunnan Province. Researchers isolated BTV strains and sequenced the full-length segment 2 (Seg-2) gene. Subsequently, phylogenetic analysis, Bayesian evolutionary rate analysis, population dynamics analysis, and phylogeographic analysis were performed utilizing Seg-2 sequence data sourced from the NCBI database. Four BTV serotypes (BTV-1, BTV-4, BTV-5, and BTV-16) were identified. The estimated average evolutionary rate varied from 2.88 × 10[-4] to 4.26 × 10[-3] substitutions per site per year, with ancestral origins dating back to the period between 1872 and 1988. The effective population size displayed significant fluctuations over time. Phylogeographic reconstructions indicated that the pathogen entered Yunnan through various transcontinental transmission pathways, originating from Europe, South Asia, Oceania, and East Asia, with evidence of reciprocal transmission between Africa, Europe, and West Asia. The BTV serotypes circulating in Yunnan Province are highly diverse, and the population dynamics of different serotypes exhibit significant heterogeneity. Yunnan is simultaneously exposed to BTV introductions from multiple directions, including Europe, South Asia, Oceania, and East Asia.

Background and Objectives: Hymenoptera venom allergy (HVA) represents one of the most frequent causes of anaphylaxis in adults. Venom immunotherapy (VIT) remains the only causal intervention that effectively reduces the risk of systemic reactions following subsequent stings. Accelerated-induction protocols enable rapid attainment of the maintenance dose; however, data on their safety with depot preparations are still limited. To evaluate the safety of accelerated-induction VIT using a depot preparation in a real-world clinical setting. Materials and Methods: A retrospective, single-center study was conducted between 2022 and 2024; accelerated-induction VIT with a depot preparation was initiated in 54 consecutive patients at a tertiary referral center. All patients had a documented history of systemic allergic reactions after Hymenoptera stings. A three-day accelerated-induction protocol was applied. Safety outcomes and adverse events occurring during the induction phase were systematically recorded and analyzed. Results: All 54 patients successfully achieved the maintenance dose. Adverse reactions were observed only in five patients (9.3%) and were restricted to mild local reactions at the injection site, including erythema and localized swelling. No systemic reactions or cases of anaphylaxis were reported. None of the patients required permanent discontinuation of VIT. Conclusions: Accelerated-induction VIT using a depot preparation demonstrated a favorable safety profile. When performed in an experienced tertiary care setting, this approach allows for rapid attainment of the maintenance dose while maintaining excellent tolerability.