Complications and mortality following percutaneous and laparoscopic liver biopsy: A multicenter study in a resource‑limited healthcare system

by Nadieh Abdallah, Ahed Almahdi, Diana Shella, Rasha Al-Masri, Iyad Maqboul, Mohammad Jaber, Ramzi Shawahna

This study was conducted to assess the incidence and types of complications and mortality following liver biopsy, and to identify independently associated factors that can inform clinical practice in a resource‑limited healthcare system. A retrospective multicenter study was conducted across six major hospitals between January 2020 and December 2025. Medical records of 218 patients undergoing percutaneous and laparoscopic liver biopsies were reviewed. Demographic, clinical, laboratory, procedural, and outcome variables were extracted using a validated data collection form. Inferential analyses were conducted using chi‑square, Fisher’s exact, and Mann‑Whitney U tests, while multivariate logistic regression models were employed to identify factors independently associated with complications and mortality. The most common types of complications were infection (n = 7, 3.2%) and hemorrhage (n = 6, 2.8%), followed by pulmonary complications (n = 4, 1.8%), metabolic disturbances (n = 3, 1.4%), and acute kidney injury (n = 2, 0.9%). Mortality was recorded in 6 patients (2.8%). Higher pre-operative white blood cell count was independently associated with infections (OR: 1.28, 95% CI: 1.02–1.62, p = 0.036). Older age was independently associated with mortality (OR: 1.07 per year increase, 95% CI: 1.01–1.15, p = 0.035). Hemorrhage and pulmonary complications were more frequent after laparoscopic biopsy and under general anesthesia, although these associations did not remain significant in adjusted models. This study provides the first systematic evidence on liver biopsy safety in Palestine, a resource‑limited healthcare system, thereby filling a critical gap in the regional literature. The study identified pre-operative increases in white blood cell count as a predictor of infection and older age as a predictor of mortality. These simple, pragmatic markers can guide monitoring and risk stratification in constrained environments, offering actionable insights for clinicians and policymakers. Future studies should be conducted to evaluate whether these markers can help reduce complications and mortality.

Maternal Zika virus exposure and neurodevelopmental outcomes: A longitudinal study of preschool children in the ZIKAlliance Colombian Cohort

by Víctor Herrera, María Consuelo Miranda, Anyela Lozano-Parra, Diana Niño, Luis Ángel Villar, Rosa Margarita Gélvez Ramírez, Thomas Jaenisch, Laura Pezzi, Claudia Acevedo, Jürg Niederbacher

Background

Zika virus (ZIKV) infection has been inconsistently associated with neurodevelopmental delay (ND). We aimed to compare the incidence of ND between ZIKV-exposed and ZIKV-unexposed children within the ZIKAlliance (ZA) cohort, in Colombia, assessed 2 years after birth (2018–2021).

Methods

We performed a neurodevelopmental evaluation on normocephalic children (aged 40–72 months) from the ZIKAlliance cohort. Children were classified as ZIKV-exposed (maternal positive RT-qPCR or virus neutralization test – VNT) or unexposed (maternal negative IgG ELISA or VNT in paired antenatal samples). A trained psychologist, blinded to exposure status, administered the Denver Developmental Screening Test II (DDST-II). Children were considered at ND risk if they presented ≥1 delay or ≥2 cautions in one or more areas, within their age range in the DDST-II scale. Inconclusive initial tests were re-evaluated. Adjusted odds ratios were estimated using logistic regression.

Results

We analyzed conclusive DDST-II results from 153 children (mean age: 4.7 years; 53.8% male). Overall, 57.2% (n = 83) were classified as cases of ND. Children with ND were more likely to be male (61.4% versus 43.5%) and less likely to attend daycare or school (42.2% versus 11.3%) than children with normal development. After adjusting for child age, sex, household size, and education, the association between in utero ZIKV exposure and ND was not statistically significant (OR = 0.71; 95% CI: 0.32–1.59, p = 0.320). However, children attending daycare or school had a significantly lower risk of ND compared to those who stayed at home.

Conclusions

Prenatal ZIKV exposure was not associated with ND in this cohort of normocephalic preschool children. Instead, attending a community daycare or school emerged as a significant protective factor against developmental delays.

Mental health help-seeking among individuals with breast cancer: A qualitative exploration of women’s and healthcare practitioners’ perspectives

by Nurdiana Mohammad Hussin, Nik Ruzyanei Nik Jaafar, Idayu Badilla Idris, Azmawati Mohammed Nawi

Individuals with breast cancer (BC) experience significant psychological distress, yet their utilization of mental health services remains low. This study identified key factors influencing help-seeking behavior through integrated Theory of Planned Behavior (TPB) and Health Belief Model (HBM) frameworks. We conducted in-depth interviews (IDIs) with eight BC patients and nominal group technique (NGT) with six health professionals, followed by Fuzzy Delphi Method (FDM) to assess expert consensus. The IDIs revealed that the individuals with BC recognized the value of professional psychological support but were reluctant to engage with these services personally. The participants identified emotional thresholds for help-seeking, expressed preference for informal support networks, and demonstrated varied understanding of mental health professional roles. The FDM evaluation demonstrated strong expert consensus across all assessed elements, particularly those related to emotional support mechanisms. Three barrier categories emerged: individual factors (mental health literacy, autonomy preferences), social factors (family support, cultural stigma), and systemic factors (healthcare integration gaps). Expert consensus exceeded 80% agreement across all domains.This study identified a complex interplay between individual psychological barriers and systemic factors affecting mental health help-seeking among individuals with BC. Effective interventions must address psychological barriers and healthcare delivery factors while respecting individual autonomy in coping choices. A multi-level approach targeting individual education, family support systems, and healthcare integration is recommended to improve mental health service utilization among individuals with BC.

Co-developing SHELTER (Safe, Healthy Environments and Local Transformation for Equity and Resilience) with families with lived experience of homelessness in the New York City shelter system: A community needs assessment and data collection protocol

by Diana Margot Rosenthal, Kate Guastaferro, Jasia Kubik, Melody Goodman

In January 2025, the nightly census revealed that over 120,000 people were staying in New York City (NYC) shelters, including more than 41,000 children, of whom almost half were aged 0–5 years. Children under five years old (under-5s) experiencing homelessness are especially vulnerable because the first five years of life are a critical period for child growth, including approximately 90% of brain development. Furthermore, under-5s experiencing homelessness have a higher risk for multiple adverse childhood experiences, developing chronic health conditions, and recurrent homelessness across the life course. Data available for under-5s experiencing homelessness is generally lacking, and what is available is of notably poor quality in the United States, leaving a wide evidence gap and an inability to determine the actual needs of this population. This proposed protocol employs community-based participatory research and was co-developed with families with under-5s who have lived experience of homelessness in NYC shelters. The aim is to determine what barriers exist in the physical and social environments to optimizing health and wellbeing (e.g., milestones, child mental health, parental mental health, safety) among under-5s living in NYC shelters. Using a sequential mixed-methods design, we propose to address a gap in the current literature by conducting an assets- and deficits-based health needs assessment comprising a quantitative survey and qualitative semi-structured interviews. In the long term, our objective is to enhance the quality and quantity of data for this vulnerable population, thereby laying the groundwork for the future co-development of a comprehensive, optimized intervention addressing the needs of under-5s experiencing homelessness.

Preclinical safety and burn wound healing activity of “Novostron”, a novel topical iodine-based therapeutic

by Nailya Ibragimova, Arailym Aitynova, Seitzhan Turganbay, Marina Lyu, Alexandr Ilin, Tamari Gapurkhaeva, Galina Ponomareva, Karina Vassilyeva, Diana Issayeva, Amirkan Azembayev, Serzhan Mombekov, Aralbek Rsaliyev, Nurgul Sikhayeva, Yergali Abduraimov, Saki Raheem

Iodine-based antiseptics are essential in wound care but are often limited by cytotoxicity, instability, and rapid iodine release. Novostron is a novel polymer–iodine complex incorporating dextrin, polyvinyl alcohol, and metal ions, designed to enable controlled iodine release. Structural integrity and composition were confirmed by ¹H and ¹³C NMR spectroscopy and physicochemical analysis, indicating a molecular weight of ~9500 g/mol, a pH of 4.23, and an iodine content of 8.13%. Pharmacokinetic analysis in rabbits demonstrated that following a single dermal application, systemic iodine absorption was minimal, with peak blood iodine concentrations remaining within physiological limits and rapid elimination within 24 hours. Evaluation of thyroid function revealed no significant changes in serum T₃, T₄, or TSH levels compared with those of the controls, confirming that topical application of Novostron does not disrupt thyroid homeostasis. In compliance with OECD guidelines in rabbits, guinea pigs, and rats, Novostron showed no signs of dermal irritation, skin sensitization, or systemic toxicity (LD₅₀ > 2000 mg/kg). In a rat cotton pellet granuloma model, Novostron significantly reduced the inflammatory mass (23.65% inhibition), supporting its anti-inflammatory potential. In a murine burn model, Novostron accelerated wound contraction (25.95% at day 10), increased epidermal thickness, and enhanced collagen deposition (~44%), outperforming controls and matching or exceeding betadine. These findings suggest that Novostron promotes tissue repair by modulating inflammation. Overall, Novostron demonstrated a favourable preclinical safety and efficacy profile, and its polymer–iodine composition, which enables controlled release and localized activity highlights its potential as a promising topical therapeutic. However, the study was limited to animal models and short-term observation; further long-term and clinical investigations are needed to confirm its translational potential in human wound healing.