The International Journal of Frontier Sciences

Background: Infective endocarditis (IE) is a life-threatening condition associated with high morbidity and mortality, particularly when complicated by neurological events. Ischemic stroke occurs in up to 30% of IE cases and poses a major challenge regarding the timing of cardiac surgery due to the risk of hemorrhagic transformation. Case Presentation: We present the case of a 31-year-old Caucasian non-working female featuring progressive dyspnea, orthopnea, palpitations and retrosternal chest discomfort for the last two months. She had no cardiovascular or chronic medical disease before admission. One month prior, she developed sudden right-sided hemiparesis. Neuroimaging showed ischemic stroke with hemorrhagic transformation. Blood cultures grew Streptococcus viridans and transthoracic echocardiography showed a large, mobile vegetation (app. 13 mm) on the mitral valve. Due to high embolic risk, surgical treatment was undertaken following multidisciplinary decision with consideration by cardiology, neurology, neurosurgery, and cardiac surgery teams. After stabilization the patient required urgent mitral valve replacement with a mechanical prosthesis. Postoperatively, the patient was neurologically and hemodynamically intact, with no progression of hemorrhagic transformation. She received a 6-week course of targeted intravenous antibiotic therapy. At 3-month follow-up, she noted marked neurological recovery with motor strength up to approximately 4 out of 5 with independent ambulation and no cardiac complications. Conclusions: This case study suggests that early surgical management is safely available for several patients with ischemic and hemorrhagic transformation complications of IE only when considering carefully tailored patient multidisciplinary evaluation and close perioperative monitoring. Full article

Background: Digital transformation has become essential for strengthening health systems in low- and middle-income countries (LMICs), which often experience workforce shortages, fragmented governance, inadequate infrastructure, and ongoing health inequities. Advances in artificial intelligence (AI), big data analytics, interoperability frameworks, precision medicine (PM), and connected health technologies present opportunities to improve access, quality, efficiency, and resilience within these systems. However, the implementation of these technologies remains inconsistent due to structural, regulatory, financial, and capacity-related barriers. This narrative review synthesizes current evidence on digital health transformation in LMICs, focusing on emerging technologies, system-level challenges, and future directions. Methods: A narrative literature review of peer-reviewed articles and grey literature published between 2015 and 2025 was conducted to examine digital health initiatives across health system functions. Results: LMICs have significant opportunities to utilize digital health to drive transformative reforms in their health systems. However, they face challenges stemming from a persistent “triple divide” that includes gaps in infrastructure, limitations in digital literacy, and disparities in data access. Additional barriers to progress include fragmented, non-interoperable systems; weak regulatory frameworks; deficiencies in data governance; infrastructure limitations; workforce shortages; algorithmic bias; and unequal access to resources. Promising solutions highlight the importance of developing interoperable digital public infrastructure (DPI), utilizing AI-enabled data harmonization, implementing federated learning, adapting governance models, and designing people-centered systems. Conclusions: Digital health has the potential to significantly enhance the resilience, equity, and sustainability of health systems in LMICs. This transformation can be achieved through coordinated national strategies, strong governance, inclusive and interoperable digital architectures, and consistent investment in workforce and institutional capacity. Future initiatives should prioritize ethical, context-sensitive AI, interoperability, and locally driven innovation to ensure lasting improvements in population health. Full article

Nipah virus (NiV) is a highly pathogenic zoonotic henipavirus that causes severe respiratory and neurological disease with case-fatality rates of 40–75%. Despite its epidemic potential, no licensed vaccines or specific antiviral therapies are currently available. Consequently, the World Health Organization (WHO) has prioritized NiV and established a research and development roadmap to accelerate the development of diagnostics, therapeutics, and vaccines. Since its emergence during outbreaks in Malaysia and Singapore in 1998–1999, NiV has caused recurrent outbreaks in South and Southeast Asia, including multiple events in West Bengal, India, with the most recent cases reported in January 2026. NiV transmission occurs through direct contact with infected animals, consumption of contaminated food products, or human-to-human transmission, with fruit bats (Pteropus spp.) serving as natural reservoirs. Clinical manifestations range from mild illness to severe acute respiratory disease and fatal encephalitis, with rapid neurological deterioration. Laboratory diagnosis relies primarily on molecular detection by RT–PCR and serological assays, such as ELISA. However, diagnostic development is limited by the scarcity of well-characterized clinical specimens, gaps in external quality assessment, and insufficient surveillance data. This article reviews current laboratory diagnostic strategies and outlines WHO research priorities for 2024–2029, emphasizing rapid point-of-care diagnostics, strengthened laboratory capacity, particularly in low- and middle-income countries, and integration within One Health surveillance frameworks to improve outbreak preparedness and response. Full article