ObjectiveUltrasound-guided percutaneous renal biopsy is a common diagnostic tool for renal disease. This study investigated the safety and efficiency of free-hand and puncture attachment approaches for ultrasound-guided percutaneous renal biopsy.MethodsThis retrospective, single-center study included 110 patients who underwent ultrasound-guided percutaneous renal biopsy. The patients were divided into the free-hand or puncture attachment group, depending on whether a puncture attachment was used.ResultsThe number of glomeruli obtained in the free-hand group was similar to that in the puncture attachment group. Two patients had no glomeruli visible under the microscope and could not be diagnosed. The most common etiologies were immunoglobulin A nephropathy (42 patients; 38.2%) and hypertensive nephropathy (27 patients; 24.5%). Most participants received individual antihemorrhagic treatments. Only three patients had postoperative complications, including gross hematuria, perinephric hematoma, and transient fever, with no significant difference between the free-hand and puncture attachment groups. After biopsy, the number of urinary red blood cells rapidly increased during the first micturition and then decreased during the third micturition.ConclusionsThe rates of hematuria and glomerular yield after renal biopsy were similar between the free-hand and puncture attachment groups. The free-hand approach could be a safe and efficient technique for patients undergoing ultrasound-guided percutaneous renal biopsy without puncture attachment.

Variants in TPMT and NUDT15 genes that affect thiopurine metabolism can guide personalized dosing to minimize toxicity. Decreased or no appreciable NUDT15 activity demonstrates impaired breakdown of active thiopurine metabolites which can lead to severe adverse events including potentially life-threatening myelosuppression. Recently, the NUDT15*6 allele was re-classified from having uncertain function to no function by the Clinical Pharmacogenetics Implementation Consortium. Here, we present a pediatric patient with a NUDT15*1/*6 genotype who experienced significant thiopurine-induced myelosuppression. The patient is a 4-year-old female with standard risk-average precursor B-cell acute lymphoblastic leukemia treated per AALL1731. Exome sequencing determined TPMT*1/*1 (normal metabolizer) and NUDT15*1/*6 (indeterminate metabolizer). After 75 mg/m2/day mercaptopurine, myelosuppression necessitated a three-week delay prior to the next phase of therapy. With 60 mg/m2/day thioguanine in a subsequent phase of therapy, she was admitted twice for fever and neutropenia. In the final phase of therapy, mercaptopurine at standard dosing of 75 mg/m2/day caused severe neutropenia and thrombocytopenia with elevated metabolite levels that required stopping mercaptopurine. After neutrophil recovery, a trial of 50% standard dosing was not tolerated and her dose was reduced to 27%, which was tolerated. Among 339 patients with cancer, sequencing revealed an allele frequency of 0.88% for NUDT15*6. In a larger cohort sequenced for suspicion of rare genetic disease, the frequency of NUDT15*6 was 0.15% among 1011 unrelated individuals. This brief report supports the recent update that patients with the NUDT15*1/*6 genotype should be classified as intermediate metabolizers.

Climate change can intensify mosquito-borne disease risks through rising temperatures and more frequent extreme weather events. To mitigate effects of climate change, cities are adopting nature-based solutions, such as urban greening and rainwater management, yet their implications for vector-borne diseases and host community composition remain poorly understood. West Nile virus (WNV), an emerging mosquito-borne human pathogen in Europe, is primarily transmitted between birds and mosquitoes. Using mosquito sampling at five sites within a one-square-kilometre area in Berlin, Germany, we examined how urban land cover, including climate-resilient infrastructure, influences local WNV amplification over two mosquito seasons in 2023 and 2024. We found seasonal WNV infection rates of up to 4.8% in mosquitoes and identified fine-scale heterogeneity in infection risk. Residential areas and cemeteries exhibited the highest minimum infection rates per month (up to 15 and 21, respectively), whereas natural conversation and sponge city sites showed significantly lower rates (up to 4 and 13, respectively). These patterns were not explained by mosquito abundance or species composition but by habitat characteristics and avian host community structure. Our findings reveal that urban land cover shapes WNV infection risk and suggest that incorporating biodiversity restoration into nature-based solutions may serve as strategy for sustainable climate-resilient urban planning.

Dengue fever is a rapidly spreading mosquito-borne disease, particularly in tropical countries like Thailand, However, limited research has examined the role of household-level environmental health factors in dengue transmission, especially through spatial multi-criteria decision analysis. This study aimed to apply the Analytic Hierarchy Process (AHP) within a Geographic Information System (GIS) environment to assess dengue risk areas based on environmental health factors in Nakhon Nayok Province, Thailand. A literature review was conducted to identify key environmental health risk factors, which informed questionnaire development and guided field data collection. These included presence of plastic or natural containers, lack of door/window screens, drainage systems, private trash bins, waste burning, agricultural and forested areas, small household size, and housing type. AHP was used to assign relative weights to environmental health factors and spatial units (districts) criteria. The weighted criteria were incorporated into spatial analysis to generate a dengue risk map, which classified areas into five risk levels. The most influential environmental health risk factors were inadequate drainage, absence of door/window screens, and poor waste management practices. High-risk zones were concentrated in Mueang Nakhon Nayok and parts of Pak Phli District, whereas Ban Na and Ongkharak Districts were predominantly low risk. The integration of AHP and GIS in this study demonstrates a conceptual framework for identifying localized dengue risk zones under data-limited conditions. The resulting risk map functions as an illustrative decision-support layer for preliminary prioritization, rather than a predictive epidemiological model.

Group testing protocols physically combine biomaterial from multiple individuals into a single 'pooled' specimen, which is then tested for markers of infection. Group testing offers a cost-effective approach for surveillance of low-prevalence infections because it greatly reduces the number of tests required relative to individual testing protocols. However, group testing poses challenges for detecting spatial clusters of disease because only pooled test results are observed. This article introduces a spatial scan statistic tailored to group testing data with variable pool sizes, using a likelihood ratio test to compare homogeneous and heterogeneous infection probability models across candidate zones. A simulation study is performed to evaluate the power and type I error rate of the spatial scan statistic test across multiple sample sizes, pooling strategies, and infection prevalences. The results demonstrate that geographically homogeneous pooling improves power relative to heterogeneous pooling. After validating the method, we apply the spatial scan statistic test to pooled testing data from ticks collected across South Carolina as part of spotted fever group Rickettsia surveillance. We detect a cluster of Rickettsia infection in Amblyomma americanum ticks along the southeast coast of South Carolina.

Event-Based Surveillance (EBS) systems play an important role in the early detection of disease outbreaks by monitoring unstructured data sources. However, they face key challenges, including handling the overwhelming volume of collected articles, detecting false positives, and the lack of explainability in detected events. To address these limitations, we previously developed EpiDCA, an unsupervised model that integrates epidemiological and environmental data, as well as expert-defined parameters, into the classification process. Its initial application to avian influenza (AI) in Asia demonstrated very promising results, comparable to well-known supervised baseline methods. In this paper, we assess the robustness and genericity of EpiDCA by applying it to three different case studies: AI in France, African swine fever (ASF) in Europe, and West Nile virus disease (WND) in Europe. Results showed that EpiDCA effectively distinguishes relevant from irrelevant events, achieving weighted F-scores between 0.64-0.85 across all case studies. Sensitivity analysis demonstrated model robustness, with most parameters showing minimal influence on results. Notably, the incorporation of environmental data and finer spatial granularity significantly improved classification precision. Overall, EpiDCA remains robust and adaptable across diverse epidemiological contexts, further validating its effectiveness as a valuable tool for event-based surveillance, with improved interpretability and real-time classification.

Lassa virus (LASV) is a hemorrhagic fever arenavirus of significant public health concern, infecting millions of people per year in Africa. Here, we developed a computational strategy to identify specific inhibitors of LASV glycoprotein-mediated virus cell entry, leveraging a previous screen of 297,156 small molecules from the MLPCN library, with the results deposited in the PubChem database. Data mining methods were developed to efficiently select small molecules prioritized for both potency and specificity in inhibiting Lassa virus infection. Cheminformatics classification then identified diverse chemical scaffolds that had not been previously reported. Representatives were evaluated against authentic LASV infection, yielding potencies as low as 10 nM. Investigation of the target mechanism compared vesicular stomatitis virus bearing the GPs of LASV, the distantly related Junín virus, and unrelated Ebola virus. The results identified 3 distinct chemical scaffolds that demonstrated strong LASV selectivity, each acting at the membrane fusion stage of virus cell entry. Sensitivity was mapped to regions of GP2 known to coordinate pH-triggered conformational rearrangements needed for membrane fusion. Time-of-addition experiments demonstrated loss of activity coincident with endosomal escape, and cell-cell fusion assays confirmed direct inhibition of GP-mediated syncytia formation. Together, these findings characterize each scaffold as an effective LASV fusion inhibitor and highlight the effectiveness of our combined computational and experimental approaches in identifying mechanistically informative antiviral scaffolds.

Timely and accurate imaging diagnosis is critical in cases of fever, altered sensorium, seizures, or headaches that do not respond to conventional clinical management. This pictorial essay aims to highlight, through case illustrations, the critical role of imaging in identifying Burkholderia pseudomallei-a rare but significant infectious agent responsible for a characteristic pattern of brain and spinal cord involvement. The condition, known as neuromelioidosis, is endemic in the tropical regions of Southeast Asia and Northern Australia including coastal regions of Tamil Nadu and Karnataka in South India. This review underscores the importance of recognising patterns associated with this disease, with emphasis on the characteristic and specific feature of corticospinal tract involvement. Correct diagnosis is necessary to guide the initiation of targeted antibiotic therapy, which is a critical step in initiating the urgent management required to improve survival outcomes. Furthermore, we provide a discussion of differential diagnoses associated with similar imaging findings, emphasising the need for a nuanced approach to diagnosis and management in such complex cases. By raising awareness of the geographical prevalence and imaging hallmarks of neuromelioidosis, this study aims to enhance clinical decision-making and improve outcomes in affected patients.

The mpox outbreaks observed in 2025 highlighted significant shifts in transmission dynamics, viral clades, and public health responses, particularly in Africa. In contrast, Sierra Leone experienced its largest mpox outbreak that year-Africa's first major Clade IIb epidemic-which ran from 10 January to 17 December 2025. It involved 5,442 confirmed cases among 7,110 suspected cases, a case fatality rate of 1.1%, and 22,536 contacts identified. A public health emergency was declared on 13 January 2025. Transmission peaked in epidemiological week 20 (May 2025) with 654 confirmed cases. The burden was highest in Western Area Urban (55.4%, 3,014 cases), Western Area Rural (19.9%), and Bombali (6.1%). Cases predominantly affected young adults aged 20-39 years (median age 26) and males (52.5%). Key affected groups included sex workers, children under 15 years (6.5%), and pregnant women (1.6%). High population density in Freetown, limited resources, weak coordination, misinformation, and surveillance gaps facilitated spread. Genomic evidence revealed undetected Clade IIb (hMPXV-1 lineage, including G.1) circulating for ~3 months from Nigeria. Environmental contamination affected 13.5% of healthcare surfaces. Symptoms included rash, fever, headache, lymphadenopathy, sore throat, and pain; 28.9% of cases were hospitalized, often delayed by stigma and fear. Among those screened for HIV co-infection (23.6%), 82% of deaths occurred in co-infected individuals. The National Public Health Agency (NPHA) implemented seven response pillars: case management and isolation, infection prevention and control (IPC), risk communication, targeted vaccination (186,470 doses administered from 267,000 received), coordination, surveillance, and research. The outbreak ended after 42 consecutive case-free days, underscoring the importance of early surveillance and genomic monitoring to prevent sustained urban transmission.