Abstract: Accumulating evidence suggests that exposure to pollution from environmental cadmium (Cd) contributes to diabetic kidney disease as indicated by albuminuria and a progressive decrease in the estimated glomerular filtration rate (eGFR). This study examined the effects of Cd exposure on eGFR and the excretion rates of albumin (Ealb) and β2-microglobulin (Eβ2M) in 65 diabetics and 72 controls. Excretion of Cd (ECd) was a measure of exposure, while excretion of N-acetylglucosaminidase (ENAG) reflected the extent of kidney tubular cell injury. In participants with an elevated excretion of Eβ2M, the prevalence odds ratios (POR) for a reduced eGFR rose 6.4-fold, whereas the POR for albuminuria rose 4.3-fold, 4.1-fold, and 2.8-fold in those with a reduced eGFR, diabetes, and hypertension, respectively. By using covariance analysis, which adjusted for the interactions, 43% of the variation in Ealb among diabetics could be explained by female gender (η2 = 0.176), ENAG (η2 = 0.162), hypertension (η2 = 0.146), smoking (η2 = 0.107) and body mass index (η2 = 0.097), while the direct contribution of ECd to Ealb variability was minimal (η2 = 0.005). Results from a mediation analysis inferred that Cd could indirectly contribute to albuminuria and a falling eGFR through inducing additional tubular cell injury, leading to reduced reabsorption of filtered protein, albumin and β2M included.

Abstract:

Background: Fluid resuscitation is a cornerstone in the management of sepsis and septic shock, yet the optimal strategy remains controversial. Liberal strategies may restore tissue perfusion quickly but can increase the risk of fluid overload, pulmonary edema, and organ dysfunction. Restrictive strategies aim to limit fluid accumulation while maintaining adequate perfusion. Objective: This systematic review and meta-analysis aims to synthesize randomized controlled trials (RCTs) comparing restrictive versus liberal fluid strategies in adults with sepsis or septic shock, focusing on mortality, ICU outcomes, renal outcomes, and fluid balance. Methods: A comprehensive search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library up to October 2025. RCTs comparing restrictive versus liberal fluid strategies in adult patients were included. Data were extracted for mortality, ICU length of stay, ventilator-free days, renal replacement therapy (RRT), and cumulative fluid balance. Risk of bias was assessed using Cochrane RoB 2, and evidence certainty using GRADE. Meta-analysis was performed using random-effects models. Results: Twelve RCTs comprising 8,743 patients were included. Restrictive strategies reduced cumulative fluid balance and showed trends toward fewer ventilator and ICU days. Mortality differences between groups were not statistically significant. Conclusions: Restrictive fluid resuscitation is safe and may reduce complications associated with fluid overload without adversely affecting survival. Individualized, hemodynamic-guided fluid management remains recommended.

Abstract:

Background/Objectives: Metabolic dysfunction–associated steatotic liver disease (MASLD) is now the leading cause of chronic liver disease globally, mirroring the increasing prevalence of obesity, insulin resistance, and type 2 diabetes. Early detection of hepatic steatosis is vital for cardiometabolic risk assessment; however, conventional imaging is costly and impractical for population screening. This study aimed to develop interpretable machine-learning models to predict ultrasound-detected MASLD using routinely available clinical and biochemical data. Methods: We analyzed data from 644 adults (50% with MASLD on ultrasonography). Preprocessing, imputation, and feature selection were implemented within a single scikit-learn pipeline to avoid information leakage. An Elastic Net–regularized logistic regression identified the top 20 predictors, which were subsequently used across nine supervised machine learning (ML) classifiers. Model performance was evaluated via repeated stratified 5-fold cross-validation (25 resamples) using accuracy, F1 score, sensitivity, specificity, Youden’s J, balanced accuracy, and Area Under the Receiver Operating Characteristic Curve (AUROC). Interpretability was assessed using SHapley Additive exPlanations (SHAP). Results: Participants with MASLD exhibited greater adiposity, insulin resistance, and dyslipidemia compared with controls [p < 0.05 for body mass index (BMI), waist circumference, glucose, HbA1c, triglycerides). Elastic Net selection highlighted Weight, Ponderal Index, Fibrosis-4 Index (FIB-4), blood urea nitrogen (BUN)/Creatinine ratio, Aspartate Aminotransferase to Platelet Ratio Index (APRI), and Visceral Adiposity Index as the strongest predictors. Logistic Regression and Gradient Boosting achieved the best performance (accuracy = 0.65 ± 0.03; AUROC = 0.71 ± 0.04; balanced accuracy = 0.66 ± 0.06), outperforming rule-based indices such as Fatty Liver Index (FLI) and Hepatic Steatosis Index (HSI) reported in the literature. SHAP analysis confirmed clinically coherent feature effects, with higher anthropometric and hepatic injury indices increasing predicted MASLD probability. Conclusions: Routinely available clinical and biochemical parameters can predict hepatic steatosis with moderate accuracy using transparent, interpretable ML models. Logistic Regression and Gradient Boosting provided the best discrimination and generalizability, offering a pragmatic, low-cost approach for early MASLD screening in primary and metabolic care settings.

Abstract: Background The relative merits of the Henderson–Hasselbalch (HH) versus Stewart frameworks for interpreting dialysis-associated acid–base shifts remain debated. Dialysis alters systemic pH through exogenous bicarbonate delivery, chloride displacement, and removal of organic anions. We compared these approaches across hemodialysis (HD) and peritoneal dialysis (PD). Methods We studied 53 HD patients with paired pre/post HD blood gas and chemistry (106 observations) and 41 PD patients cross-sectionally, totaling 147 datasets. Derived variables followed the Figge/Stewart implementation [apparent SID (SIDa), effective SID (SIDe), strong ion gap (SIG), albumin-corrected anion gap (AGc)]. For HD, changes in pH (ΔpH) were modeled using HH predictors (ΔHCO₃⁻, ΔPCO₂) and Stewart predictors (ΔSIDa, ΔATOT, ΔPCO₂). For cross-sectional data (HD-pre, HD-post, and PD), HH- and Stewart-based level-models were fitted. Stewart-predicted pH was also computed using the Figge and the simplified Constable electroneutrality equation. Results HD increased pH by 0.11, driven by ΔHCO₃⁻ = +5.7 mΕq/L, ΔCl⁻ = −2.3 mEq/L, and declines in unmeasured anions (ΔSIG = −3.9; ΔAGc = −3.3). SIDa increased only marginally (+1.3 mEq/L), whereas SIDe rose by +5.3 mEq/L and fully tracked the alkalinization. In Δ-models, HH explained 90% of variance in ΔpH (R² = 0.903) compared with 51% for Stewart (R² = 0.514). In level-models, HH explained 96% of pH variance versus 36% for Stewart. Bland–Altman analysis showed systematic overestimation of pH by the Figge and Constable approach (bias +0.111), most pronounced pre-HD. PD patients had consistently higher AGc and SIG values than HD patients, indicating a greater burden of unmeasured anions. Conclusions Alkalinization during HD is primarily attributable to bicarbonate gain, chloride displacement, and organic-anion clearance. The HH framework provides superior predictive performance for ΔpH, while closed-system Stewart formulations based on SIDa underestimate alkalinization. However, a broader physicochemical interpretation using SIDe and SIG, which incorporate bicarbonate and unmeasured anions, coherently describes the observed physiology. Future applications of the Stewart approach in dialysis should emphasize SIDe and SIG to better reflect the open-system physiology of both HD and PD.

Abstract: The 2024 Japanese diagnostic criteria for primary sclerosing cholangitis (PSC) introduce a paradigm shift in recognizing small-duct PSC (sdPSC), particularly within ulcerative colitis (UC) cohorts. By integrating high-resolution magnetic resonance cholangiopancreatography (MRCP) and mandatory histopathology for normal cholangiograms, these updates address prior underdiagnosis and variability in sdPSC detection. Japanese cohort studies reveal sdPSC prevalence between 5–15%, with up to 55% progressing to large-duct disease. Earlier detection, facilitated by the 2024 criteria’s 86% MRCP sensitivity and clarified histologic thresholds, may halve diagnostic delays, curbing cirrhosis and malignancy risks. In UC patients, these refinements enhance colorectal neoplasia surveillance and enable preemptive management through unified gut–liver assessment. Yet, challenges persist, including biopsy hesitancy, donor shortages, and evolving genetic insights. Overall, the updated criteria mark a decisive move toward precision hepatology, aligning Japan’s PSC-UC strategy with proactive, spectrum-based detection and management for improved long-term outcomes.

Abstract: Background and Clinical Significance: Collagenous colitis is an uncommon form of microscopic colitis characterized by chronic watery diarrhea and thickening of the subepithelial collagen layer. While various medications have been implicated in its pathogenesis, paclitaxel-associated collagenous colitis remains exceptionally rare in the literature. Recognition of this adverse event is crucial for appropriate management, particularly in patients receiving dose-modified chemotherapy regimens. This case highlights the importance of considering drug-induced collagenous colitis in cancer patients presenting with severe diarrhea during chemotherapy. Case Presentation: We report a 71-year-old Japanese male with metastatic breast cancer who developed acute-onset collagenous colitis during paclitaxel treatment. His primary tumor was invasive ductal carcinoma with hormone receptor-positive, HER2-negative disease (ER+, PgR+, HER2-, Ki-67 46%) and progressive metastatic dis-ease. Given pre-existing renal dysfunction, paclitaxel was initiated at 60% dose reduc-tion. Sixteen days after treatment initiation, the patient experienced abrupt onset of profuse watery diarrhea with approximately 10 bowel movements daily, necessitating hospital admission. Colonoscopic evaluation demonstrated increased vascular per-meability and superficial mucosal erosions. Histopathological analysis revealed diag-nostic features of collagenous colitis with a markedly thickened subepithelial collagen band measuring 23 μm. Following immediate cessation of paclitaxel, the patient expe-rienced complete resolution of diarrheal symptoms without subsequent relapse. Conclusions: This case represents a rare manifestation of paclitaxel-induced colla-genous colitis. Clinicians should maintain heightened awareness of this potential com-plication in patients receiving taxane-based chemotherapy who develop significant diarrhea. Prompt recognition and immediate drug discontinuation are essential for favorable outcomes and symptom resolution.

Abstract: Background: Pulmonary involvement in systemic sclerosis (SSc) is typically assessed using pulmonary function tests (PFTs), high-resolution CT (HRCT), and composite indices. Patient-reported outcomes (PRO), including ScleroID, provide insight into quality of life, but their relationship with clinical measures and role in overall disease assessment remain unclear. Objective: To assess the correlation between ScleroID scores and both lung involvement and disease activity/damage in a cohort of SSc-ILD patients from a large tertiary care center. Methods: Disease activity [European Scleroderma Study Group Activity Index (EScSG-AI), Scleroderma Clinical Trials Consortium Activity Index (SCTC-AI)], disease severity [Medsger severity scale (MSS)], and PRO measure ScleroID were assessed for associations with the extent and severity of SSc-ILD. Results: : Eighty-two SSc patients (mean age 56.0 ± 10.8 years; median disease duration 4.2 ± 4.7 years) were included. Baseline lung function was moderately impaired (FVC 76.8%, DLCO 54.3%), with mean ESsSG-AI 6.1 ± 1.7, SCTC-AI 34.5 ± 14.8, Medsger severity 9.6 ± 3.8, and ScleroID total 4.1 ± 2.4. Diffuse cutaneous SSc, ATA positivity, NYHA class > III dyspnea, FVC < 80% predicted, HRCT fibrosis >20%, and pulmonary hypertension were associated with higher disease activity and severity scores. Patients with ≥20% fibrosis reported worse ScleroID scores for fatigue, social life, mobility, and breathlessness compared with those with 10–20% fibrosis (p = 0.001–0.02). Higher ScleroID scores correlated with lower FVC%, shorter 6-MWD, and greater ILD extent on HRCT. ScleroID domains were strongly interrelated in both fibrosis subgroups. In patients with >20% fibrosis, fatigue, mobility, and social impact correlated with clinical activity and severity scores (r = 0.373–0.635, all p < 0.05), while correlations were weak or absent in the 10–20% group. Breathlessness showed minimal associations in both subgroups. Overall, ScleroID captured patient-perceived disease burden—including fatigue, mobility, and social limitations—more closely reflecting functional impact than objective measures in patients with less extensive fibrosis. Conclusions: SSc-ILD patients experience a higher disease burden, with breathlessness as a key feature. ScleroID captured disease impact mainly in those with advanced fibrosis (≥20% lung involvement), suggesting it may underestimate impact in patients with milder ILD.

Abstract: Large-volume paracentesis (LVP) of the peritoneal and pleural cavities is a common therapeutic and diagnostic intervention in patients with liver cirrhosis or advanced heart failure, which are often complicated by ascites or pleural effusion. Although generally considered low-risk, the potential complications of LVP include intrapleural or abdominal hemorrhage or, more commonly, intraabdominal wall hemorrhage, organ puncture, and infection. Performing paracentesis in patients with coagulopathy or bleeding disorders, whether due to underlying disease or resulting from anticoagulant therapy, presents a major clinical dilemma. The safety thresholds for conducting the procedure in such patients vary, and the strategies for mitigating the bleeding risk remain debated, with no consensus reached across different professional societies. Based on our institutional experience and the current international literature, we herein present comprehensive recommendations for the safe and effective execution of LVP, based on evidence synthesis and expert consensus. This review may serve as a practical guide for clinicians performing LVP in high-risk patients.

Abstract: Diabetic kidney disease and hypertension are the leading causes of kidney failure. The reduction in an estimated glomerular filtration rate (eGFR) in response to chronic exposure to low levels of cadmium (Cd) has been causally linked, however, the exact mechanism is poorly understood. We postulate that the toxicity of Cd and lead (Pb) towards kidney tubular cells impairs their function, particularly their ability to clear filtered proteins, notably β2-microglobulin (β2M). As proteins in the glomerular filtrate is concentrated, it becomes toxic to cells, and thus a further reduction in eGFR. In this study we analyzed data from a Thai cohort of 137 persons of which 72 were diagnosed with diabetes. Blood Cd, blood Pb and urinary excretion of Cd (ECd) were measured to obtain an indication of exposure to these metals. Tubular cell injury and tubular cell function were assessed by measurement of urinary N-acetylglucosaminidase (ENAG) and fractional tubular degradation of β2M (FrTDβ2M), respectively. FrTDβ2M was more strongly associated with eGFR in those with diabetes (β = 0.476) than those without (β = 0.360). Intriguingly, only in those with diabetes, FrTDβ2M was inversely associated with ECd (β = −0.295) as was an association of ENAG with ECd (R2 = 0.071). The mediation analysis infers that a falling eGFR was partially linked to a diminished tubular degradation of β2M, caused by Cd-induced tubular cell injury. In conclusion, individuals with diabetes were especially susceptible to tubular cell injury, reductions in both eGFR and the degradation of filtered proteins following Cd/Pb exposure.

Abstract: Background and Clinical Significance: Coronavirus disease 2019 (COVID-19) has been associated with myopathies that may arise from immune dysregulation, autoimmunity, or possible direct viral injury, though the exact mechanisms remain unclear. Recognizing these cases is clinically important, as they can resemble primary autoimmune myopathies but may follow a different course and prognosis. Case Presentation: We report a 59-year-old previously healthy woman who developed acute myopathy shortly after COVID-19. She presented with diffuse myalgia, fatigue, exertional dyspnea, dizziness, fine motor difficulties, and urinary incontinence. Neurological examination showed preserved reflexes, no sensory deficits, and normal cerebrospinal fluid, excluding GuillainBarré syndrome and transverse myelitis. Laboratory tests revealed elevated lactate dehydrogenase (616 U/L; ref. 105–205), alanine aminotransferase (239 U/L; ref. <70), and plasma myoglobin (60–74 µg/L; ref. <45). The myositis antibody panel was negative except for isolated CHD4 (anti-Mi-2) positivity, deemed non-specific. She was treated with intravenous fluids, paracetamol, ibuprofen, and physiotherapy. Symptoms resolved within one week, and she was discharged on day 10. At sixmonth follow-up, she remained fully recovered without recurrence. Conclusion: This case illustrates that COVID-19 can cause acute, self-limiting viral myopathy in otherwise healthy individuals, emphasizing the need for clinical awareness and supportive management.

Abstract:

Background: Cognitive impairment is a frequent complication of cirrhosis, and its relationship with hepatic functional reserve remains incompletely understood. The Albumin-Bilirubin (ALBI) score provides an objective measure of liver dysfunction, but its association with cognitive outcomes in cirrhosis requires clarification. Methods: This retrospective secondary analysis utilized a publicly available cohort of 268 patients with cirrhosis. Demographic, clinical, and laboratory parameters were extracted, including ALBI, Model for End-Stage Liver Disease (MELD), and Child-Pugh classification. Cognitive function was measured with the Animal Naming Test (ANT), with scores <20 indicating impairment. Associations between ALBI and clinical outcomes were evaluated. Results: The mean age was 59.1±10.6 years, 58.6% were male, and 47.4% exhibited cognitive impairment. ALBI correlated significantly with MELD (ρ=0.67, p<0.0001), Child-Pugh class (ρ=0.60, p<0.0001), history of ascites (ρ=0.40, p<0.0001), and minimal hepatic encephalopathy (ρ=0.16, p=0.007), but not with ANT performance. Linear regression showed no significant association between ALBI and ANT scores (β=−0.48, p=0.374). Logistic regression confirmed minimal hepatic encephalopathy (OR=4.46, 95% CI:2.39–8.56, p<0.0001) and lower education (OR=0.82, 95% CI:0.69–0.97, p=0.022) as independent predictors of cognitive impairment, whereas ALBI was not significant in any model. Model performance improved with additional covariates. Conclusion: While the ALBI score correlated with established indices of liver disease severity, it was not independently associated with cognitive impairment. Instead, minimal hepatic encephalopathy and lower education emerged as the strongest predictors. These findings suggest that cognitive decline in cirrhosis may be more strongly driven by neurocognitive and socioeconomic factors than by hepatic synthetic reserve alone.

Abstract: Background/Objectives: In staphylococcal implant infections, there is often discussion about the optimal postoperative timing of the introduction of rifampicin in the postoperative period with open wounds. Methods: We reviewed all adult patients with residual staphylococcal implant infections between January 2014 and May 2024. We analyzed the delay to rifampicin use in relation to therapeutic failures, infection recurrences and development of ultimate rifampicin resistance. The “last Staphylococcus” represented any clinical sample at the end of the individual period. Results: Among 103 independent infection episodes, the pathogens were S. aureus in 47 episodes (46%) and the remainder were different coagulase-negative staphylococci. The median number of surgical interventions was 1 and the median duration of postsurgical systemic antibiotic treatment was 84 days (interquartile range (IQR), 42-84 d). The median daily dose of oral rifampicin was 900 mg, the median delay of its introduction 5 days (IQR, 3-8 d). Overall, 13% experienced an adverse event related to rifampicin (mostly gastrointestinal), requiring its stopping. The incidences of Clinical Failures and of Microbiologically identical Recurrences were 27% and 10%, respectively. The risk of rifampin-resistance among the “last Staphylococcus” isolates was 1%. This single case occurred in an infected knee to which rifampicin was introduced after a delay of eight days. In multivariate Cox regression analysis, the delay of rifampicin administration, its dose or its duration all failed to alter outcomes. Conclusions: In our retrospective cohort of staphylococcal orthopedic implant infections, the timing of rifampicin introduction failed to alter clinical and microbiological outcomes.

Abstract: Abstract Background: Streptococcus pneumoniae is a well-known pathogen responsible for respiratory and invasive diseases; however, central nervous system (CNS) involvement in the form of bacterial myelitis is exceedingly rare, particularly in immunocompetent adults. Moreover, the association between pneumococcal infections and reactive arthritis is scarcely documented. We report an unusual case of pneumococcal myelitis complicated by reactive arthritis in an elderly patient with no evident immunosuppression. Case Presentation: A 68-year-old man with a medical history of hypertension, benign prostatic hyperplasia, multiple disc herniations, and a resected pancreatic neuroendocrine tumour presented to the emergency department with acute urinary retention and fever (38.5 °C). The neurological examination revealed lower limb weakness and decreased deep tendon reflexes. Spinal magnetic resonance demonstrated T2 hyperintense lesions suggestive of longitudinally transverse myelitis. Cerebrospinal fluid (CSF) analysis showed pleocytosis with elevated protein levels; the polymerase chain reaction (PCR) test resulted positive for Streptococcus pneumoniae. The patient received intravenous antimicrobial and corticosteroid therapy with partial neurological improvement. Within days, he developed acute monoarthritis of the right ankle. Joint aspiration revealed sterile inflammatory fluid, negative for crystals and cultures, supporting a diagnosis of reactive arthritis. The articular symptoms resolved with the use of prednisone. An extensive immunological work-up was negative, and no other infectious or autoimmune triggers were identified. The patient underwent a structured rehabilitation program with gradual improvement in motor function over the following weeks. Conclusions: This case illustrates a rare clinical scenario of pneumococcal myelitis associated with reactive arthritis in a patient without overt immunosuppression. It highlights the importance of considering bacterial etiologies in cases of acute transverse myelitis and the potential for unusual systemic immune responses such as reactive arthritis. Early recognition and the administration of appropriate antimicrobial and supportive therapies are crucial for improving neurological and systemic outcomes. To our knowledge, this is one of the first reported cases describing the co-occurrence of these two conditions in the context of S. pneumoniae infection.

Abstract:

Background: Hydroxychloroquine (HCQ) is a disease-modifying antirheumatic drug used in rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and other autoimmune diseases. Although HCQ reduces SARS-CoV-2 replication in vitro at high doses, its prophylactic role in COVID-19 remains unproven. This study evaluated SARS-CoV-2 incidence in patients with rheumatic diseases on therapeutic HCQ versus healthy controls taking HCQ prophylactically. Materials and Methods: In this prospective case-control study, 145 patients with autoimmune diseases (RA, SLE, Sjogren’s syndrome, MCTD) taking HCQ (200–400 mg/day) were compared with 77 healthy volunteers on prophylactic HCQ (400 mg/week). Participants underwent SARS-CoV-2 PCR and serology testing over one year (Feb 2020–Mar 2021). Results: SARS-CoV-2 positivity was observed in 24/145 (16.6%) patients versus 4/77 (5.2%) controls (χ² = 4.90, p = 0.027; Fisher’s exact p = 0.018; OR ≈ 3.62). All positive cases in both groups experienced mild disease without hospitalization. Conclusions: Therapeutic HCQ in patients with autoimmune diseases did not prevent SARS-CoV-2 infection as effectively as low-dose prophylactic HCQ in healthy controls. Nevertheless, disease severity was mild in all cases, supporting the overall safety of HCQ. Larger, randomized studies are needed to clarify HCQ’s prophylactic potential.

Abstract: Background/Objectives: Occlusion of the subclavian artery, often associated with subclavian steal syndrome (SSS), presents significant diagnostic and therapeutic challenges. This occlusion typically results in retrograde blood flow from the vertebral artery, manifesting clinically as ischemia in various regions supplied by branches of the affected artery. High-grade stenosis (≥75%) or complete occlusion usually precedes symptoms, where inadequate collateral circulation leads to significant hemodynamic disturbances. Case presentation: This case report delves into the case of an 87-year-old woman with a significant medical history, including universal atherosclerosis, dementia, a surgically treated uterine adenocarcinoma, hypertension, and glenohumeral arthritis with a history of several hospitalisations over the past decade due to ISMN-related collapses. Omarthrosis played a key role and posed a diagnostic challenge in masking a severe vascular issue. Results: Due to comprehensive diagnostic efforts, the contributing aetiology was identified – subclavian steal syndrome resulting from the severe stenosis of the right subclavian artery. This case highlights the importance of a thorough investigation and differential diagnosis in older patients. Conclusions: In the geriatric population, it is essential to consider not only common causes of weakness, such as age-related sarcopenia or overweight/obesity, known cardiovascular issues, and neurodegenerative disorders, but also less frequent conditions that might overlap.

Abstract:

Introduction: Vaccine is the most widely used public health measure to control the global COVID-19 pandemic. Most of the vaccines used in Europe and North America are mRNA-based vaccine A mass vaccination campaign was carried out between 2021 and 2024. Some adverse events have been reported. We question the role of vaccines in the pathogenesis of rheumatological manifestations observed following one or more injections. Material and methods: A prospective observational study involving two cohorts was initiated, with the first cohort observed from 13th September 2021 to 30th September 2022, and the second cohort from 1st October 2022 to 30th September 2023. The study also focused on the interval between the last vaccine injection and the onset of rheumatic symptoms. None of the patients had a history of rheumatic or inflammatory diseases. We compare both cohorts and ankle arthritis case series to analyze the differences between early and late onset adverse events patients. Results: In both cohorts and case series, the majority of patients are women. The most common symptoms include diffuse muscle pain, which mimics polymyalgia rheumatica and ankle arthritis. Very high levels of anti-Spike antibodies (> 2080 BAU/ml) were generally detected. Pearson correlation coefficient between both cohorts and case series is very high, confirming the reproducibility of post-vaccine clinical and biological features. Conclusion: These rheumatological manifestations might be triggered by inappropriate individual immune responses to the vaccine's Spike protein and/or the overproduction of Spike protein, which can mediate a pro-inflammatory reaction explaining early and late-onset effects.

Abstract: Type 2 diabetes mellitus (T2D) is a chronic metabolic disease associated with macro and microvascular complications. Premature death, a worse quality of life, and a persistent need for medical care are the results of this disease. A key component of its pathophysiology is inflammation. This study aimed to evaluate the association between specific inflammatory biomarkers (IL-6, IL-8, IL-1β, IL-18, TNF-α, miR-155, and miR-146a) and the progression of T2D in Ecuadorian patients. Following the inclusion criteria, 198 patients were selected for a biomarker study out of the initial 598 participants. Patients were classified into four groups, based on disease stage in non-diabetic controls (NDC), controlled diabetic patients (CT2D), uncontrolled diabetic patients (NC-T2D), and diabetic patients with kidney disease (DKD). The results showed that IL8, IL-6, Leptin, and Adiponectin in-creased according to disease stage. We also observed a downregulation of miRNA-146a in T2D (NDC = 1, C-T2D = 0.44, NC-T2D = 0.26, DKD = 0.40). Using binary logistic regression, we determined the association between T2DM and the inflammatory biomarkers, considering their cut-off points IL-8 (OR = 6.733), IL-6 (OR = 4.436), Leptin (OR = 13.765), and miR-146a (OR = 4.062). The association between DKD and adiponectin was also deter-mined (OR = 4.154). This study highlights a clear association between the stage of Type 2 diabetes mellitus and chronic inflammation, reflected in altered levels of specific inflammatory biomarkers.

Abstract: Idiopathic edema is a disease of unknown etiology in women characterized by swelling of hands and face followed by increasing abdominal and truncal girth, bloating, edema, > 1.4 kg weight gain when in upright posture and nocturia that eliminates the retained fluid to become edema-free on awakening. We review how a capillary leak was determined as the primary pathophysiologic abnormality that induces different clinical presentations. We eliminated weight gains and nocturia in 4 cases of IE by sodium restriction with or without diuretic therapy. We present a case of hyponatremia-induced seizure and coma due to undiagnosed IE from ages 18 to 81. It took nearly 2 years to convince her that she will never have a seizure or suffer from IE if she drank small amounts of water every 3 hours and reduced sodium intake with or without diuretics, respectively. We present a 42-year-old woman with an 8-year history of postural hypotension, dizziness and fainting that led to many bone fractures and dislocated joints. She was home-bound and mentioning nocturia led to a diagnosis of IE where the capillary leak was of such magnitude that she became severely intravascularly volume depleted when standing. Wearing support stockings eliminated the postural hypotension, dizziness and fainting and symptoms of IE with no weight gain or nocturia. Increased capillary leak induces diverse pathophysiologic changes that cause seemingly disparate clinical manifestations. IE is probably much more common than it is perceived to be with many remaining undiagnosed for many years.

Abstract: Background: Telemedicine has emerged as a pivotal innovation in contemporary healthcare, providing solutions for bridging spatial barriers and enhancing accessibility to medical services. Azerbaijan has progressively embraced digital health initiatives, particularly telemedicine, in its efforts to modernize the national healthcare system. Objective: This study aims to examine the development and implementation of telemedicine and digital health technologies in Azerbaijan within the framework of international experiences. The objective is to identify current achievements, challenges, and potential strategies for future enhancement of the country’s e-health ecosystem. Methods: A comparative analytical approach was adopted, drawing upon academic literature, policy papers, national healthcare strategies, and international benchmarks. The study includes qualitative analysis of telemedicine infrastructure, regulatory frameworks, and technological applications in Azerbaijan, contrasted with global and regional practices. Results: Azerbaijan has initiated various telemedicine projects, including remote consultations, tele-education, and telemonitoring, in alignment with global digital health trends. Nevertheless, systemic challenges persist, including infrastructural constraints, regulatory fragmentation, and digital literacy gaps. The findings suggest that effective implementation requires cohesive policy action, investment in ICT infrastructure, and capacity building among healthcare professionals. Conclusion: Telemedicine holds substantial potential for transforming healthcare delivery in Azerbaijan. By aligning national strategies with global standards and addressing existing implementation gaps, Azerbaijan can leverage digital health tools to improve access, reduce healthcare costs, and enhance service quality, particularly in underserved regions.

Abstract: Media reporting on scientific studies influences how adults who smoke perceive the risks of combusted cigarettes vs. non-combusting nicotine products. The U.S. FDA has indicated that adults who switch away from smoking cigarettes to FDA-authorized alternative nicotine products can reduce their health risks. Despite this guidance, a growing proportion of adults who smoke in both the US and England believe the opposite, that combusted cigarettes are safer. Cross-sectional studies represent an important source of information on the health impact of nicotine products, but can require evaluation of the precision of the study design and results to avoid inaccurate conclusions. An analysis of news coverage surrounding a recent cross-sectional observational study on dual-use highlights how misinterpretations of underlying data can originate and then spread. This case study identified key issues, including significant omissions and unsupported claims during press release development and subsequent media reporting. Understanding these problems can guide more precise designs of cross-sectional studies, and highlights the imperative for precise and accurate press release generation and media reporting.