{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T23:34:15Z","timestamp":1790811255540,"version":"4.1.0"},"reference-count":36,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T00:00:00Z","timestamp":1743033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the World Health Organization through the USAID-funded Mpox Award","award":["# 7705"],"award-info":[{"award-number":["# 7705"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>(1) Objectives: Studies on mpox patterns, severity predictors, and public health impacts in Burundi remain limited. Therefore, we aimed to identify the clinical predictors and determinants of mpox complications among hospitalized patients in Bujumbura, Burundi, during an active outbreak. (2) Methods: We conducted a prospective cohort study of laboratory-confirmed mpox cases across three treatment centers (July\u2013October 2024). Clinical characteristics and outcomes were assessed through a systematic review of medical and laboratory records supplemented by structured interviews with patients or caregivers. Risk factors for disease complications were evaluated using multivariate Firth penalized logistic regression. (3) Results: Complications developed in 3.1% of 850 patients (54.4% male; median age, 20.3 years). Conjunctivitis (odds ratio [OR]: 27.30; 95% confidence interval [CI], 7.67\u2013122.23) and sore throat (OR: 12.63; 95% CI, 5.78\u201330.21) were significant predictors of severe disease progression. Conversely, generalized rash (OR, 0.10; 95% CI, 0.04\u20130.24) and lymphadenopathy (OR, 0.24; 95% CI, 0.08\u20130.62) were associated with a mild disease course. Sexual transmission was the predominant route of infection (58.6%). (4) Conclusions: Noncutaneous manifestations, particularly conjunctivitis and sore throat, are early indicators of mpox severity. These findings inform clinical risk stratification in resource-limited settings and highlight the need for further investigation of pathophysiological mechanisms.<\/jats:p>","DOI":"10.3390\/v17040480","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T06:06:35Z","timestamp":1743141995000},"page":"480","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Clinical Predictors and Determinants of Mpox Complications in Hospitalized Patients: A Prospective Cohort Study from Burundi"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7765-6753","authenticated-orcid":false,"given":"Liliane","family":"Nkengurutse","sequence":"first","affiliation":[{"name":"Centre des Op\u00e9rations d\u2019Urgence de Sant\u00e9 Publique (COUSP\/PHEOC Burundi), Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9946-7951","authenticated-orcid":false,"given":"John O.","family":"Otshudiema","sequence":"additional","affiliation":[{"name":"World Health Organization, WHO Burundi, 4 Avenue Muramwya, Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"},{"name":"African Region Mpox Incident Management Support Team, World Health Organization Regional Office for Africa, Cit\u00e9 du Djou\u00e9 OMS, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Godefroid","family":"Kamwenubusa","sequence":"additional","affiliation":[{"name":"Centre des Op\u00e9rations d\u2019Urgence de Sant\u00e9 Publique (COUSP\/PHEOC Burundi), Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Issa","family":"Diallo","sequence":"additional","affiliation":[{"name":"World Health Organization, WHO Burundi, 4 Avenue Muramwya, Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Odette","family":"Nsavyimana","sequence":"additional","affiliation":[{"name":"Mpox Treatment Center, Centre Hospitalo-Universitaire de Kamenge (CHUK), Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Claude","family":"Mbonicura","sequence":"additional","affiliation":[{"name":"Mpox Treatment Center, Centre Hospitalo-Universitaire de Kamenge (CHUK), Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Claude","family":"Nkurunziza","sequence":"additional","affiliation":[{"name":"Mpox Treatment Center, Centre Hospitalo-Universitaire de Kamenge (CHUK), Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fid\u00e8le","family":"Cishahayo","sequence":"additional","affiliation":[{"name":"Mpox Treatment Center, Clinique Prince Louis Rwagasore (CPLR), Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dieudonn\u00e9","family":"Niyongere","sequence":"additional","affiliation":[{"name":"Mpox Treatment Center, Clinique Prince Louis Rwagasore (CPLR), Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonite","family":"Havyarimana","sequence":"additional","affiliation":[{"name":"Mpox Treatment Center, Clinique Prince Louis Rwagasore (CPLR), Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D\u00e9o","family":"Simbarariye","sequence":"additional","affiliation":[{"name":"Mpox Treatment Center, H\u00f4pital Militaire de Kamenge (HMK), Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Nimburanira","sequence":"additional","affiliation":[{"name":"Mpox Treatment Center, H\u00f4pital Militaire de Kamenge (HMK), Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bosco","family":"Ntiranyibagira","sequence":"additional","affiliation":[{"name":"Mpox Treatment Center, H\u00f4pital Militaire de Kamenge (HMK), Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Senya Diane","family":"Nzeyimana","sequence":"additional","affiliation":[{"name":"World Health Organization, WHO Burundi, 4 Avenue Muramwya, Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brigitte","family":"Ndelema","sequence":"additional","affiliation":[{"name":"World Health Organization, WHO Burundi, 4 Avenue Muramwya, Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Nkezimana","sequence":"additional","affiliation":[{"name":"World Health Organization, WHO Burundi, 4 Avenue Muramwya, Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parfait","family":"Shingiro","sequence":"additional","affiliation":[{"name":"Centre des 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Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Niyomwungere","sequence":"additional","affiliation":[{"name":"World Health Organization, WHO Burundi, 4 Avenue Muramwya, Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamadou","family":"Zongo","sequence":"additional","affiliation":[{"name":"World Health Organization, WHO Burundi, 4 Avenue Muramwya, Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"},{"name":"African Region Mpox Incident Management Support Team, World Health Organization Regional Office for Africa, Cit\u00e9 du Djou\u00e9 OMS, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdoulaye","family":"Bousso","sequence":"additional","affiliation":[{"name":"World Health Organization, WHO Burundi, 4 Avenue Muramwya, Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"},{"name":"African Region Mpox Incident Management Support Team, World Health Organization Regional Office for Africa, Cit\u00e9 du Djou\u00e9 OMS, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Boland","sequence":"additional","affiliation":[{"name":"African Region Mpox Incident Management Support Team, World Health Organization Regional Office for Africa, Cit\u00e9 du Djou\u00e9 OMS, Brazzaville P.O. Box 06, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanine","family":"Ndayisenga","sequence":"additional","affiliation":[{"name":"Institut National de Sant\u00e9 Publique (INSP), Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dionis","family":"Nizigiyimana","sequence":"additional","affiliation":[{"name":"Institut National de Sant\u00e9 Publique (INSP), Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Nyandwi","sequence":"additional","affiliation":[{"name":"Institut National de Sant\u00e9 Publique (INSP), Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alimuddin","family":"Zumla","sequence":"additional","affiliation":[{"name":"Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London NW1 2PG, UK"},{"name":"National Institutes of Healthcare Research (NIHR), Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London NW1 2PG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7227-2545","authenticated-orcid":false,"given":"Rosamund F.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Health Emergencies Programme, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanislas","family":"Harakandi","sequence":"additional","affiliation":[{"name":"Mpox Treatment Center, Centre Hospitalo-Universitaire de Kamenge (CHUK), Rohero I, Bujumbura Mairie, Bujumbura J978+9V4, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,27]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2025, March 01). Mpox, Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/mpox."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Alakunle, E., Moens, U., Nchinda, G., and Okeke, M.I. (2020). Monkeypox Virus in Nigeria: Infection Biology, Epidemiology, and Evolution. Viruses, 12.","DOI":"10.3390\/v12111257"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Ogoina, D., Izibewule, J.H., Ogunleye, A., Ederiane, E., Anebonam, U., Neni, A., Oyeyemi, A., Etebu, E.N., and Ihekweazu, C. (2019). The 2017 human monkeypox outbreak in Nigeria: Report of outbreak experience and response in the Niger Delta University Teaching Hospital, Bayelsa State, Nigeria. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0214229"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Africa Centers for Disease Control and Prevention (2024, November 26). Africa CDC Declares Mpox a Public Health Emergency of Continental Security, Mobilizing Resources Across the Continent [Internet]. Available online: https:\/\/africacdc.org\/news-item\/africa-cdc-declares-mpox-a-public-health-emergency-of-continental-security-mobilizing-resources-across-the-continent\/.","DOI":"10.1038\/d44148-024-00244-1"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2791","DOI":"10.1038\/s41591-024-03130-3","article-title":"Sustained human outbreak of a new MPXV clade I lineage in eastern Democratic Republic of the Congo","volume":"30","author":"Vakaniaki","year":"2024","journal-title":"Nat. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e210","DOI":"10.1093\/cid\/ciaa143","article-title":"Clinical course and outcome of human monkeypox in Nigeria","volume":"71","author":"Ogoina","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1016\/S1473-3099(22)00228-6","article-title":"Clinical features and management of human monkeypox: A retrospective observational study in the UK","volume":"22","author":"Adler","year":"2022","journal-title":"Lancet Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1056\/NEJMoa2207323","article-title":"Monkeypox virus infection in humans across 16 countries\u2014April\u2013June 2022","volume":"387","author":"Thornhill","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S229","DOI":"10.1093\/infdis\/jiad492","article-title":"Development and Pilot of an Mpox Severity Scoring System","volume":"229","author":"Zucker","year":"2024","journal-title":"J. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.jviromet.2010.07.012","article-title":"Real-time PCR assays for the specific detection of monkeypox virus West African and Congo Basin strain DNA","volume":"169","author":"Li","year":"2010","journal-title":"J. Virol. Methods"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2400486","DOI":"10.2807\/1560-7917.ES.2024.29.32.2400486","article-title":"Real-time PCR assay to detect the novel Clade Ib monkeypox virus, September 2023 to May 2024","volume":"29","author":"Schuele","year":"2024","journal-title":"Euro Surveill."},{"key":"ref_12","first-page":"851","article-title":"Monkeypox: A systematic review of epidemiology, pathogenesis, manifestations, and outcomes","volume":"13","author":"Afsahi","year":"2023","journal-title":"Russ. J. Infect. Immun."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1080\/23744235.2023.2214609","article-title":"Comparative evaluation of the clinical presentation and epidemiology of the 2022 and previous mpox outbreaks: A rapid review and meta-analysis","volume":"55","author":"Okoli","year":"2023","journal-title":"Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1093\/infdis\/jiad034","article-title":"Clinical features, antiviral treatment and patient outcomes: A systematic review and comparative analysis of the previous and the 2022 mpox outbreaks","volume":"228","author":"Li","year":"2023","journal-title":"J. Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e2446","DOI":"10.1002\/rmv.2446","article-title":"Clinical manifestations of human mpox infection: A systematic review and meta-analysis","volume":"33","author":"Yon","year":"2023","journal-title":"Rev. Med. Virol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Dom\u00ednguez Garc\u00eda, L., Gutierrez-Arroyo, A., Miguel-Buckley, R., Sanchez-Vicente, J.L., Mu\u00f1oz-Sanz, A., and Cordero Coma, M. (Cornea, 2024). Persistent and Severe Mpox Keratitis Despite Systemic and Topical Treatment, Cornea, in press.","DOI":"10.1097\/ICO.0000000000003485"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1016\/j.jaad.2022.12.035","article-title":"A dermatologic assessment of 101 mpox cases from 13 countries during the 2022 outbreak: Skin lesion morphology, clinical course, and scarring","volume":"88","author":"Prasad","year":"2023","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"De la Herr\u00e1n-Arita, A.K., Gonz\u00e1lez-Galindo, C., Inzunza-Leyva, G.K., Valdez-Flores, M.A., Norzagaray-Valenzuela, C.D., Camacho-Zamora, A., Batiz-Beltr\u00e1n, J.C., Urrea-Ram\u00edrez, F.J., Romero-Utrilla, A., and Angulo-Rojo, C. (2023). Clinical Predictors of Monkeypox Diagnosis: A Case-Control Study in a Nonendemic Region during the 2022 Outbreak. Microorganisms, 11.","DOI":"10.3390\/microorganisms11092287"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"102594","DOI":"10.1016\/j.tmaid.2023.102594","article-title":"Clinical and epidemiological characteristics of mpox: A descriptive cases series in Colombia","volume":"53","author":"Mantilla","year":"2023","journal-title":"Travel. Med. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e2508","DOI":"10.1002\/rmv.2508","article-title":"Clinical characteristics and outcomes of patients with mpox during the 2022 mpox outbreak compared with those before the outbreak: A systematic review and meta-analysis","volume":"34","author":"Cho","year":"2024","journal-title":"Rev. Med. Virol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1016\/S1473-3099(23)00427-9","article-title":"Clinical characteristics and predictors of human mpox outcome during the 2022 outbreak in Nigeria: A cohort study","volume":"23","author":"Ogoina","year":"2023","journal-title":"Lancet Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"197","DOI":"10.12788\/cutis.0745","article-title":"Mpox Update: Clinical Presentation, Vaccination Guidance, and Management","volume":"111","author":"Cices","year":"2023","journal-title":"Cutis"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e2400189","DOI":"10.1056\/EVIDoa2400189","article-title":"Tecovirimat Use under Expanded Access to Treat Mpox in the United States, 2022\u20132023","volume":"3","author":"Yu","year":"2024","journal-title":"NEJM Evid."},{"key":"ref_24","unstructured":"National Institutes of Health (2025, March 12). The Antiviral Tecovirimat Is Safe but Did Not Improve Clade I Mpox Resolution in Democratic Republic of the Congo, Available online: https:\/\/www.nih.gov\/news-events\/news-releases\/antiviral-tecovirimat-safe-did-not-improve-clade-i-mpox-resolution-democratic-republic-congo."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1093\/infdis\/jiad165","article-title":"APOBEC3F Is a Mutational Driver of the Human Monkeypox Virus Identified in the 2022 Outbreak","volume":"228","author":"Raymond","year":"2023","journal-title":"J. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Kumar, A., Jhanwar, P., Roohani, B., Gulati, A., and Tatu, U. (2024). Genomic analyses of recently emerging clades of mpox virus reveal gene deletion and single nucleotide polymorphisms that correlate with altered virulence and transmission. bioRxiv.","DOI":"10.1101\/2024.09.24.614696"},{"key":"ref_27","first-page":"834","article-title":"Clade I mpox virus genomic diversity in the Democratic Republic of the Congo, 2018\u20132024: Predominance of zoonotic transmission","volume":"189","author":"Pratt","year":"2024","journal-title":"Cell"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1002\/jmv.70023","article-title":"Comparative Analysis of 2022 Outbreak MPXV and Previous Clade II MPXV","volume":"96","author":"McGrail","year":"2024","journal-title":"J. Med. Virol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2400647","DOI":"10.2807\/1560-7917.ES.2024.29.42.2400647","article-title":"Epidemiological analysis of confirmed mpox cases, Burundi, 3 July to 9 September 2024","volume":"29","author":"Nizigiyimana","year":"2024","journal-title":"Euro Surveill."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e1012","DOI":"10.1016\/S2214-109X(23)00198-5","article-title":"Description of the First Global Outbreak of Mpox: An Analysis of Global Surveillance Data","volume":"11","author":"Hoxha","year":"2023","journal-title":"Lancet Glob. Health"},{"key":"ref_31","unstructured":"World Health Organization (2025, March 19). Multi-Country Outbreak of Mpox, External Situation Report #48, Available online: https:\/\/www.who.int\/publications\/m\/item\/multi-country-outbreak-of-mpox--external-situation-report--48---10-march-2025."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"101487","DOI":"10.1016\/j.nmni.2024.101487","article-title":"The Resurgence of Monkeypox: Epidemiology, Clinical Features, and Public Health Implications in the Post-Smallpox Eradication Era","volume":"62","author":"Singh","year":"2024","journal-title":"New Microbes New Infect."},{"key":"ref_33","first-page":"e1243","article-title":"A Position Statement on Mpox as a Sexually Transmitted Disease","volume":"75","author":"Gandhi","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_34","unstructured":"Centers for Disease Control and Prevention (2025, March 19). How it Spreads|Mpox|Poxvirus, Available online: https:\/\/www.cdc.gov\/mpox\/causes\/index.html."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1652","DOI":"10.1001\/jama.2024.21091","article-title":"Mpox Clinical Presentation, Diagnostic Approaches, and Treatment Strategies: A Review","volume":"332","author":"Titanji","year":"2024","journal-title":"JAMA"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/S0140-6736(22)01436-2","article-title":"Clinical Presentation and Virological Assessment of Confirmed Human Monkeypox Virus Cases in Spain","volume":"400","author":"Alemany","year":"2022","journal-title":"Lancet"}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/4\/480\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:03:02Z","timestamp":1760029382000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/17\/4\/480"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,27]]},"references-count":36,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["v17040480"],"URL":"https:\/\/doi.org\/10.3390\/v17040480","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,27]]}}}