Background Efgartigimod is a neonatal Fc receptor (FcRn) antagonist approved for adults with generalized myasthenia gravis (gMG) who are anti-acetylcholine receptor antibody-positive, and for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). By blocking FcRn-mediated IgG recycling, efgartigimod lowers circulating IgG and reduces pathogenic autoantibodies. Clinical trials have demonstrated efficacy and an overall acceptable safety profile, but patients with low baseline IgG were generally not well represented. Objective The main objective of this study is to describe severe reductions in serum IgG observed in routine neurologic practice during efgartigimod therapy, and to explore their potential clinical implications, including infection risk and management considerations. Methods We performed a retrospective case series of 10 patients treated with efgartigimod in our practice between 2025 and 2026 for CIDP and MG. Available clinical data were reviewed, including diagnosis, prior immunotherapy exposure, baseline IgG (when available), serial IgG measurements, nadir IgG, and any documented infectious complications. Results Several patients developed marked hypogammaglobulinemia during treatment, including profound reductions to levels below 100 mg/dL in selected cases. Several patients reached IgG levels within ranges associated with increased susceptibility to infection (<500 mg/dL, particularly <400 mg/dL), although no severe infections were observed. One patient with CIDP and prior rituximab exposure had a baseline IgG of approximately 800 mg/dL, and later developed an IgG level of 66 mg/dL. Another patient without prior B-cell-depleting therapy also developed an IgG level below 100 mg/dL. No major infectious complication was documented during the observation period, but the degree of IgG suppression raised concern for clinically meaningful vulnerability to severe infection. Conclusions Efgartigimod therapy was associated with significant reductions in IgG in this real-world cohort. Because trial populations excluded or underrepresented patients with low baseline IgG, and did not meaningfully study extreme hypogammaglobulinemia, baseline and serial IgG monitoring should be strongly considered in all patients starting therapy, especially during the first six months. These findings highlight the potential for clinically meaningful IgG decline in certain patients, and support consideration of individualized monitoring strategies. These observations are hypothesis-generating and warrant further study.
Introducción Honduras reporta una de las tasas más altas de feminicidio. Este estudio analizó las tendencias de la tasa de feminicidio entre 2013 y 2022. Métodos estudio descriptivo con datos de vigilancia del feminicidio en Honduras (2013–2022). Se calculó la tasa estandarizada por 100.000 mujeres y se analizaron tendencias mediante regresión Joinpoint. Resultados se registraron 2.677 feminicidios. La tasa estandarizada por edad disminuyó de 10,1 por 100.000 mujeres en 2013 a 3,9 en 2022, con un cambio porcentual anual (APC) de −7,6% (IC 95%: −12,8 a −2,6). El feminicidio asociado al crimen organizado fue el más frecuente (49,3%) y explicó el 55% de la reducción. Conclusiones la reducción del feminicidio estuvo impulsada por la caída de los casos relacionados con el crimen organizado, lo que refuerza la necesidad de prevenir las formas persistentes de violencia no asociadas a este.
Cutaneous thermal injury and extensive soft-tissue losses impose heavy operational and economic loads onto healthcare frameworks worldwide. Traditional treatment paradigms often rely upon frequent, highly distressing dressing applications or autologous skin grafts, which may be significantly constrained by donor-site availability and associated secondary morbidity.Human amniotic membrane (HAM) has re-emerged as an accessible, cost-effective, and highly specialized biologic skin substitute. This review evaluates the structural components, immunology, processing protocols, and clinical outcomes of HAM based on the current peer-reviewed literature. Rigorous statistical findings demonstrate that HAM yields a significantly lower bacterial colonization rate, marked pain relief, compressed healing durations, and reduced metabolic resource expenditure when compared to gold-standard silver sulfadiazine or synthetic dressings. This synthesis serves as a specialized clinical and educational guide for plastic surgery residents optimizing modern wound care pathways.
The prevalence of obesity and type 2 diabetes mellitus (T2DM) in the older adult population is rising continuously worldwide, with approximately 40
BACKGROUND:Residual congestion at discharge in acute heart failure (AHF) is a primary driver of readmission and mortality. Inferior vena cava (IVC) ultrasound provides a noninvasive bedside assessment of volume status, yet its clinical impact on guiding therapy remains underdefined. This systematic review evaluated the efficacy of IVC ultrasound-guided therapy compared to standard clinical assessment in AHF decongestion. METHODS:Following PRISMA guidelines (PROSPERO: CRD420251171323), a systematic search was conducted across PubMed, EMBASE, and other major databases through October 2025. We included randomized controlled trials (RCTs) and nonrandomized studies focusing on IVC-guided management in adults with AHF. Outcomes included congestion markers, NT-proBNP levels, hospitalization duration, and mortality. RESULTS:Four studies involving 629 patients met the inclusion criteria. Most studies showed improved decongestion with IVC ultrasound guidance, evidenced by lower residual congestion and improved IVC metrics (diameter/collapsibility). While NT-proBNP levels decreased in all cohorts, between-group differences were not statistically significant. Clinical outcomes improved in 50% of studies, showing shorter hospital stays and reduced mortality. Notably, one trial reported a significant mortality benefit (3.3% vs. 33.3%; p = 0.003). Adverse events were either similar or significantly fewer (p < 0.05) in the ultrasound-guided groups. CONCLUSION:IVC ultrasound is an effective bedside tool for individualized volume management in AHF, potentially enhancing treatment precision and clinical outcomes. While current evidence is promising, larger multicenter trials are necessary to standardize its implementation in routine heart failure care.
