Abstract: Nontuberculous mycobacteria (NTM) is a general term for mycobacteria other than the Mycobacterium tuberculosis complex and Mycobacterium leprae. There are over 150 species of NTM, which are widely distributed not only in natural environments such as water systems and soil, but also in residential environments such as bathrooms. Inhalation exposure from these environments can lead to pulmonary NTM disease, a respiratory infection. In Japan, 90% of pulmonary NTM disease cases are caused by two species, Mycobacterium avium and M. intracellulare. Because the two species are biochemically similar, they are collectively referred to as Mycobacterium avium complex (MAC). Pulmonary MAC disease is broadly divided into two types: the fibrocavitary type and the nodular/bronchectamic type, each with its own characteristics. The two cases reported here were both elderly women with refractory MAC pulmonary disease, with different phenotypes: a fibrocavitary type and a long-standing, progressive nodular and bronchiectatic type. Treatment was performed with a regimen using liposomal amikacin (ALIS). ALIS is an aminoglycoside antibiotic that works by binding to bacterial liposomes and inhibiting protein synthesis. Using amikacin liposomal technology and a specialized inhaler, ALIS efficiently reaches alveolar macrophages, directly killing MAC bacteria within. However, the unique administration method, which requires inhaler cleaning, makes continued use difficult given the characteristics of patients with refractory MAC pulmonary disease. Even when treatment is possible, frequent side effects, such as hoarseness and dysphonia, while not severe, further contribute to the difficulty of initiating treatment. In both of these cases, treatment was made possible with the cooperation of the patient's family, and no adverse effects were observed. This is the first report in the world to show that the therapeutic effect was confirmed even when the number of treatments was less than half the standard number, and that thanks to the new drug delivery method of inhalation, it can become a new treatment option when existing drugs cannot be used or are ineffective for some reason, and that it may be safe to use even in elderly patients.

Abstract:

Background: Robotic-assisted surgery (RAS) is increasingly used for colorectal cancer (CRC), but its clinical and oncologic advantages over conventional laparoscopy (LS) remain uncertain. Prior meta-analyses have included overlapping RCTs but vary in methodology, scope, and analytical transparency. This review aims to provide an updated, independently re-analyzed synthesis of RCTs published from 2015–2025, with full PRISMA compliance, explicit analytic reproducibility, and expanded evaluation of bias and evidence certainty. Methods: A systematic review and meta-analysis was conducted according to PRISMA guidelines. The protocol was retrospectively registered in PROSPERO (Registration ID: CRD420251237158). PubMed, Embase, and Cochrane CENTRAL were searched (January 1, 2015–January 31, 2025). Full reproducible search strings, PICOS criteria, and inclusion/exclusion rules were predefined. Only RCTs comparing RAS vs LS for malignant colorectal disease were included. Data extraction was performed independently by two reviewers. Meta-analyses used DerSimonian–Laird random-effects models; standardized procedures were applied for converting medians/IQRs into means/SDs and for continuity corrections in zero-event trials. Risk of bias was assessed using Cochrane RoB 2.0, and evidence certainty was graded using GRADE. Results: A total of 12 RCTs encompassing 3,107 patients met the inclusion criteria. RAS resulted in significantly lower conversion-to-open rates (OR 0.42; 95% CI 0.28–0.63; I²=18%) compared with LS. Operative time was consistently longer with RAS (MD +23.8 minutes; 95% CI 14.2–33.4; I²=67%). Overall postoperative complications (Clavien–Dindo ≥II) were comparable (OR 0.91; 95% CI 0.76–1.13; I²=22%). Length of stay showed a small but significant reduction with RAS (MD −0.8 days; 95% CI −1.3 to −0.2; I²=49%). Pathologic outcomes showed lower circumferential resection margin (CRM) positivity with RAS (OR 0.59; 95% CI 0.41–0.85). Lymph node retrieval was slightly higher with RAS (MD +0.71 nodes; 95% CI 0.25–1.18). Distal margins and TME completeness were equivalent. No RCT reported mature long-term oncologic outcomes; evidence remains limited to short-term surrogates. Conclusions: In contemporary RCTs, RAS provides fewer conversions and slightly better pathologic surrogates, while maintaining similar morbidity compared to LS. The main trade-off remains longer operative time and higher resource use. True oncologic equivalence cannot be confirmed until long-term RCT data mature. Advanced imaging (e.g., SOMATOM Force CT), age-specific MIS evidence, and the emergence of endoluminal robotic systems are likely to shape future refinements in technique and patient selection.

Abstract: Anderson–Fabry disease (FD) is an X-linked lysosomal storage disorder caused by pathogenic variants in the GLA gene, resulting in deficient α-galactosidase A activity and progressive accu-mulation of globotriaosylceramide (Gb3) and its derivative lyso-Gb3 within lysosomes. Beyond substrate storage, FD involves a complex interplay of molecular, metabolic, and inflammatory disturbances that collectively drive multisystemic damage. It seems that Gb3 accumulation im-pairs autophagic flux, promotes mitochondrial dysfunction, and triggers endoplasmic reticulum stress, leading to oxidative imbalance and bioenergetic failure. Concurrently, activation of innate immune pathways, particularly the TLR4/NF-κB axis, induces pro-inflammatory cytokine release and endothelial dysfunction, while complement activation and adaptive immune responses con-tribute to chronic inflammation and fibrosis. These mechanisms define a sustained state of “met-aflammation,” linking lysosomal dysfunction to systemic inflammation. Understanding this molecular cross-talk provides a rationale for identifying novel biomarkers and designing thera-pies that go beyond enzymatic correction, including chaperone therapy, substrate reduction, and gene-based or anti-inflammatory approaches. A deeper comprehension of these interconnected patterns may guide the development of precision medicine strategies aimed at improving long-term outcomes in Fabry disease.

Abstract: Silent gastroesophageal reflux disease (GERD) may present without classic symptoms and instead manifest through respiratory and laryngeal signs. We report the case of a 27-year-old Middle Eastern Arab male with acute dry cough and hoarseness, unresponsive to antitussive therapy, ultimately diagnosed with silent GERD after significant improvement with proton pump inhibitor (PPI) therapy.

Abstract: Background: The comparative effects of pharmacological treatment, bariatric surgery, and diet on insulin resistance (IR) remain unclear. Aim: To study the comparative effects of the methods on IR: pharmacologic, bariatric surgery, and very-low-calorie diet (VLCD) in patients with type 2 diabetes mellitus (T2DM) and hypertension. Methods. Design: a 90-day prospective, multicenter, comparative clinical trial including 130 adult patients divided in three groups: Drug, Surgical, and VLCD groups. Endpoints: HOMA-IR; weight loss; HbA1c, systolic/diastolic blood pressure (SBP/DBP). Results. At 90 days, weight lost in Surgery (-19.8%) and VLCD groups (-17.4%) (P< 0.0001), while in Drug group the loss was unsignificant (-6.5%; P=0.06). SBP/DBP in Drug group decreased by -9.5% (P=0.0002) and -4.1% (P=0.09), respectively. SBP/DBP in: Surgical group decreased by -13.6% and -10.6%, respectively (P< 0.001); VLCD group -23.3% and 21.3%, respectively (P< 0.0001). HOMA-IR in Drug, Surgery and VLCD groups decreased by -42.2% (P=0.004), -87.6% (P< 0.0001), and -88.7% (P< 0.0001), respectively. In Drug group HOMA-IR did not reach normal level. Correlation-regression-analysis revealed a direct correlation between weight-loss and a decrease in HOMA-IR (r=0.526; F=33.2, P< 0.0001). HOMA-IR decreases by 65% if weight decreases by 10%; if weight decreases by 25%, then HOMA-IR decreases by 83%. Conclusions. HOMA-IR was associated with weight loss: the greater the weight loss, the lower HOMA-IR. Weight loss leads to reduce the need for antidiabetic/antihypertensive drugs in the patients.

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.