This report describes a case of bilateral linezolid-associated optic neuropathy in a 65-year-old woman treated for Mycobacterium abscessus infection and highlights the importance of early recognition and intervention. The patient developed progressive, painless bilateral visual decline after more than six months of linezolid therapy. Ophthalmic examination revealed optic disc edema (left greater than right), impaired color vision, and prolonged visual evoked potential latencies. Neuroimaging excluded compressive or inflammatory etiologies, while optical coherence tomography demonstrated bilateral retinal nerve fiber layer thickening, with subsequent imaging showing optic atrophy in the left eye. Linezolid was discontinued, and a short empirical course of corticosteroids was administered. Visual function partially improved in the left eye following cataract extraction; however, residual optic atrophy and dyschromatopsia persisted. This case reinforces that linezolid-associated optic neuropathy is a potentially reversible yet under-recognized complication of prolonged therapy and emphasizes the need for routine ophthalmologic surveillance in patients receiving linezolid beyond recommended durations. A high index of suspicion is essential, as progressive bilateral visual loss may be misattributed to common ocular comorbidities such as cataracts, leading to delayed diagnosis and irreversible visual impairment.
Extended postoperative antibiotic regimens remain widely prescribed in reduction mammaplasty, despite variability in practice and insufficient evidence to support their superiority over single-dose preoperative prophylaxis. This divergence in clinical practice carries significant implications for antimicrobial stewardship, healthcare costs, and patient safety. We aimed to synthesize contemporary evidence comparing single-dose preoperative versus extended postoperative antibiotic prophylaxis in reducing surgical site infection (SSI) and postoperative morbidity in reduction mammaplasty. PubMed, Embase, Scopus, Web of Science, Medline (EBSCO), CENTRAL, and Google Scholar were searched from database inception through December 2025. Studies comparing single-dose preoperative versus extended-dose postoperative antibiotic (≥24 hours) prophylaxis in adult females undergoing reduction mammaplasty were included. The primary outcome was SSI, and secondary outcomes included wound complications and operative time. Random-effects models were employed, and risk of bias was assessed with RoB 2.0 and ROBINS-I. Six studies (3 RCTs; 3 observational), including 5,020 patients (2,496 extended-dose; 2,524 single-dose), found no significant difference in SSI rates (OR = 0.66; 95% CI [0.28, 1.60]; p = 0.36). Similarly, secondary outcomes showed no difference in operative time (SMD = 0.19; 95% CI [-0.04, 0.41]; p = 0.11), wound dehiscence (OR = 0.29; 95% CI [0.06, 1.49]; p = 0.14), or delayed wound healing (OR = 2.00; 95% CI [0.65, 6.15]; p = 0.23). This study provides evidence that single-dose preoperative antibiotic prophylaxis is equivalent to extended postoperative courses in preventing infectious and wound-related complications. These findings support antimicrobial stewardship principles and may inform the development of standardized prophylaxis protocols for reduction mammaplasty.
Radial head dislocation after both bone forearm fractures (BBFF) fixation is rare. The management of BBFF involves open reduction and internal fixation (ORIF) to restore anatomy and function. Anatomic reduction of the radius and ulna is required to restore the unique geometric relationship of the forearm and allow normal rotation. Nonanatomic reduction of the radius can result in postoperative radial head dislocation, disrupting forearm function and stability.
Emergency medicine has evolved from an emerging discipline to a formally recognised specialty across much of Asia over the past four decades. Adoption has been staggered, from early pioneers such as Singapore, the Philippines and Hong Kong, to more recent recognition in India, Brunei, Myanmar, Laos and several Middle Eastern countries. This broad but uneven maturation has not eliminated substantial workforce and systems gaps. Challenges include shortages of trained emergency medicine specialists, variable training quality and persistent brain drain towards higher-income health systems. At the plenary session “Leading Change Together: Regional Collaboration for Emergency Medicine in Asia” during the Asian Conference on Emergency Medicine 2025 in Dubai, regional society leaders and international federation representatives examined three interlinked domains: workforce growth and retention, regional collaboration and standard-setting, and the implications of digital innovation and artificial intelligence for emergency care. In this communication, we synthesise the panel and audience discourse to argue that the next phase of emergency medicine development in Asia depends on three domains. We urge stakeholders to establish a coherent training and leadership pipeline supporting both undergraduate and postgraduate development; to foster purposeful cross-border collaboration led by professional societies to harmonise standards and share expertise; and to implement digital transformation strategies that maximise integration, promote equity, and maintain a strong focus on human-centred care. By committing to practical actions across each domain, we can collectively shift the region from fragmented growth to a more resilient, equitable, and future-ready emergency care ecosystem, positioning Asia as a global reference for emergency medicine development in diverse, resource-variable settings.
The risk of cardiovascular disease is significantly increased by both type 2 diabetes mellitus (T2DM) and obesity through overlapping pathways involving insulin resistance, dyslipidemia, systemic inflammation, and endothelial dysfunction. Tirzepatide, the first dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, has shown significant glycemic and weight-reducing effects and is increasingly recognized as a cardiometabolic therapy that extends beyond glucose control. This narrative review summarizes clinical and translational evidence about the cardiovascular and metabolic benefits of tirzepatide and the biologic mechanisms that may underpin its effects. Tirzepatide has consistently shown high improvements in key indicators of glycemic control and body weight across the SURPASS program in patients with T2DM and the SURMOUNT program in patients with obesity. Benefits include marked reduction in glycated hemoglobin and cardiovascular risk factors, such as systolic and diastolic blood pressure, atherogenic lipid parameters, visceral adiposity, and several inflammatory biomarkers. Dual incretin signaling seems to increase endothelial function by enhancing the bioavailability of nitric oxide, reducing oxidative stress, inhibiting pro-inflammatory pathways such as nuclear factor kappa B, and favorably modulating adipokine profiles, collectively supporting cardiovascular protection. Promising data suggest symptomatic and functional improvements in obesity-related heart failure with preserved ejection fraction. Reductions in major adverse cardiovascular events are currently under investigation in dedicated outcome trials, including the SURPASS Cardiovascular Outcomes Trial. Overall, tirzepatide provides broad cardiometabolic benefits, making it a promising treatment in the changing landscape of cardiometabolic disease management.
