Introduction. This retrospective cohort study aimed to estimate the return‑to‑work (RTW) proportion among stroke survivors in metropolitan Shanghai, China, who were employed pre-stroke and to explore factors associated with RTW. Methods. A retrospective cohort study included stroke patients admitted to a tertiary rehabilitation center in Shanghai, China, between 2018 and 2023, with telephone follow-up conducted in 2024. Data were collected from electronic medical records and structured interviews. The primary outcome was RTW status. Eligibility required pre-stroke employment. The primary model included age group and social dysfunction, selected based on clinical plausibility and prior literature. Results. Of 79 eligible patients, 20 had returned to paid work at follow‑up (median: 12 months; IQR, 9–18 months), yielding an RTW proportion of 25.32% (20/79). In the primary Firth regression model, absence of social dysfunction was associated with higher odds of RTW (adjusted OR 10.57, 95% CI 2.38–100.76; p < 0.001), whereas age < 60 years did not reach statistical significance (adjusted OR 3.09, 95% CI 0.96–11.59; p = 0.058). In the sensitivity analysis restricted to participants aged < 60 years, absence of social dysfunction remained associated with RTW (OR = 8.66, 95% CI: 1.81–85.07; p = 0.005). Conclusions. Only a minority of participants had returned to paid work at follow-up. Absence of social dysfunction showed a notable association with RTW in this exploratory analysis. These findings suggest that vocational rehabilitation programs addressing social dysfunction merit further investigation in larger prospective studies.
Introduction. Dengue haemorrhagic fever (DHF) is characterized by plasma leakage during the critical phase of illness, typically occurring around defervescence between illness days 4 and 7. Delayed plasma leakage beyond this period is rarely described. Case Report. We report a diagnostically challenging case of dengue in a previously healthy young woman from a dengue-endemic region, in whom plasma leakage was detected on illness day 13, raising the possibility of a delayed critical phase, though a sequential febrile illness followed by dengue infection could not be excluded. The patient initially developed high-grade fever, vomiting, arthralgia, and myalgia, which resolved after three days. After a three-day period of transient clinical improvement, severe headache, abdominal pain, and recurrent vomiting developed without recurrence of fever. She was admitted on day 12 with thrombocytopenia and marked transaminitis. On day 13 of illness, ultrasonography demonstrated free fluid in the hepatorenal pouch and right pleural cavity, consistent with plasma leakage, while dengue IgM and IgG antibodies were positive. The patient was managed as DHF with careful fluid monitoring and recovered uneventfully. Conclusion. This case highlights the importance of considering dengue in patients from endemic settings even when presentation is atypical, afebrile, or temporally delayed. Although a delayed critical phase is possible, sequential febrile illnesses with subsequent dengue infection could not be excluded because early virological confirmation was unavailable. Careful monitoring for thrombocytopenia and plasma leakage remains essential even in apparently recovering patients.
Introduction. Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal neoplasm characterized by differentiated myofibroblastic spindle cells accompanied by an inflammatory infiltrate of plasma cells and lymphocytes. While typically localized in the lungs, its primary manifestation within the thyroid gland is exceptionally rare, posing significant diagnostic challenges due to its ability to mimic aggressive thyroid malignancies on clinical and radiological assessments. Case Report. A 48-year-old female healthcare professional with a history of a benign contralateral thyroid lobectomy 10 years prior presented with a painless left neck swelling. Ultrasonography revealed a 40 × 22 mm solid, hypoechoic, lobulated nodule (TI-RADS 4). Following the 5-month observation period, the lesion exhibited rapid dimensional growth to 47 × 27 mm and demonstrated severe stiffness on shear-wave elastography. Considering the American Thyroid Association guideline criteria and clinical concern, completion thyroidectomy was performed. Histopathological examination and immunohistochemical analysis revealed a neoplastic spindle cell proliferation that was diffusely positive for smooth muscle actin (SMA) but completely negative for anaplastic lymphoma kinase-1 (ALK-1) and thyroid transcription factor-1 (TTF-1), establishing a definitive diagnosis of primary thyroid IMT. No recurrence was observed during the 1-year follow-up. Conclusion. Primary thyroid IMT is a unique entity that should be considered in the differential diagnosis of rare spindle cell thyroid lesions. Definitive diagnosis relies on postoperative histopathological and immunohistochemical characterization rather than preoperative biopsy alone.
Introduction. Superior mesenteric artery syndrome (SMAS), or Wilkie’s syndrome, is a rare vascular compression disorder characterized by the compression of the third portion of the duodenum between the abdominal aorta and the superior mesenteric artery (SMA). This study aimed to describe computed tomography angiography (CTA)-derived aortomesenteric distance and angle measurements and to evaluate their associations with age and sex in surgically treated patients with Wilkie’s syndrome at a single tertiary center. Methods. We retrospectively reviewed records of 50 patients who underwent surgical treatment for SMAS between January 2015 and May 2024. Aortomesenteric measurements were performed on abdominal CTA images using TomoCon®, a Slovak DICOM viewing software. Descriptive and inferential statistics were applied to analyze the aortomesenteric distance (AMD), aortomesenteric angle (AMA), and demographic variables. Results. The median AMD was 6.55 mm [4.63 – 7.98], and the median AMA was 18.20° [13.98 – 21.38], both within the ranges commonly reported in SMAS and lower than published reference values. The median patient age was 33.95 years [23.78 – 47.83], with a pronounced female predominance (female-to-male ratio of 4.56:1). A moderate positive correlation was observed between AMD and AMA. No significant differences in AMD, AMA, or age were found between females and males. Conclusions. Surgically treated patients with Wilkie’s syndrome had lower CTA-derived AMD and AMA than those reported in published reference populations. The cohort was characterized by a predominance of younger female patients, consistent with previous reports.
Introduction. This retrospective case series aimed to investigate the clinicopathological features, immunophenotype, and differential diagnosis of paraganglioma of the urinary bladder (PUB). Methods. The clinical, pathological, immunohistochemical, and follow‑up data of 7 patients with PUB diagnosed at the First Affiliated Hospital of Jinzhou Medical University between June 2019 and December 2024 were retrospectively analyzed, and GAPP scoring was performed. Results. The 7 patients included 5 females and 2 males, with a median age of 43 years (range, 35–61 years). Clinical presentation included incidental detection in 2 cases, micturition-related symptoms in 2 cases, and intermittent painless gross hematuria in 3 cases. The maximum tumor diameter ranged from 1.0 to 3.8 cm. Microscopically, all tumors were composed of chief cells and sustentacular cells arranged in a nested or trabecular pattern, with a rich delicate vascular stroma. Immunohistochemically, the tumor cells diffusely expressed CgA, Syn, CD56, SDHB, and vimentin, and were negative for CK, EMA, CK7, CK20, CK5/6, and P63; S‑100‑positive sustentacular cells surrounding the tumor nests were identified in 6 cases (6/7), and focal weak to moderate GATA3 positivity was observed in 4 cases (4/7). The Ki‑67 proliferation index ranged from 1% to 5%. According to the GAPP score, 4 cases were well‑differentiated (score 1–2), and 3 cases were moderately differentiated (score 3). Follow‑up data were available for 5 patients (8–72 months), and no recurrences or metastases were observed. Conclusions. The definitive diagnosis of bladder paraganglioma relies on histopathological and immunohistochemical evaluation, with particular emphasis on differentiation from urothelial carcinoma and neuroendocrine tumors. All tumors carry metastatic potential, and long-term postoperative follow-up is required. Retained SDHB immunoreactivity was observed in all cases, but SDHB immunohistochemistry cannot replace genetic testing.
Introduction. Time-restricted eating (TRE) is a circadian-aligned dietary intervention for the management of metabolic disorders. However, its efficacy in non-diabetic adults with metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease, remains unclear. This study aimed to evaluate the effects of TRE on hepatic and metabolic outcomes in this population. Methods. A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted from database inception through December 2025 across PubMed, Ovid, Web of Science, and trial registries. The searches were conducted between September and December 2025. Eligible studies enrolled non-diabetic adults with MASLD (hepatic steatosis >5%) undergoing TRE for ≥4 weeks. Random-effects models were used to pool mean differences (MDs) or standardized MDs with 95% confidence intervals, and heterogeneity was assessed using the I2 statistic. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation. Primary outcomes were liver fat content, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and insulin resistance (HOMA-IR). Secondary outcomes included anthropometric indices, lipid profile, fasting glucose, inflammatory markers, adherence, adverse events, and dropout rates. Results. Five RCTs (n = 291) from China and Iran met the inclusion criteria. TRE modestly reduced serum ALT levels compared to non-TRE controls (MD = -7.28; 95% CI, -12.27 to -2.29; p = 0.004; I2 = 50%). No significant differences were observed in liver fat content, AST, or HOMA-IR. Among secondary outcomes, only body mass index demonstrated a small, but significant improvement (MD = -0.87 kg/m2; 95% CI, -1.57 to -0.18; p = 0.01; I2 = 22%). Lipid parameters, fasting glucose, and inflammatory markers showed no consistent benefit. Clinical and methodological heterogeneity was substantial. Overall certainty of evidence ranged from very low to low. Conclusions. In non-diabetic adults with MASLD, TRE yields modest improvements in ALT and BMI but does not significantly improve hepatic steatosis or core metabolic indices. Evidence remains limited because of small sample sizes, short intervention durations, and substantial heterogeneity. Future RCTs with standardized TRE protocols and longer follow-up are required to establish clinical efficacy and strengthen evidence certainty.
Introduction. To integrate the Lung Ultrasound Score (LUSS) with routine parameters to analyze the risk factors for pulmonary atelectasis in children with severe pneumonia (SP) and to construct a predictive model. Methods. A retrospective analysis was conducted on 215 children with SP who underwent lung ultrasound examination at the Sixth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China, between September 2022 and June 2025. Based on the occurrence of atelectasis during hospitalization, the patients were categorized into an atelectasis group and a non-atelectasis group. Data collected within 48 hours of admission included general information, clinical data, laboratory parameters, and imaging findings. Univariate and multivariate logistic regression analyses were employed to identify independent risk factors for the development of atelectasis. Subsequently, a nomogram was developed and validated. Results. Among the 215 children with SP, 75 (34.88%) developed atelectasis. The LUSS, alanine aminotransferase (ALT), and α-hydroxybutyrate dehydrogenase (α-HBDH) were significantly associated with the occurrence of atelectasis complicating SP (p < 0.05). Receiver operating characteristic (ROC) curve analysis of the constructed nomogram model demonstrated that the combination of these three factors for predicting atelectasis yielded a sensitivity of 84.0%, a specificity of 65.0%, and an area under the curve (AUC) of 0.790 (95% CI: 0.728~0.846; p < 0.05). The Hosmer-Lemeshow test yielded a p-value of 0.102, indicating that the model possesses strong predictive capability. Conclusions. The model established in this study can be utilized to predict the risk of pulmonary atelectasis in children with SP. When children with SP present concurrently with severe lung ultrasound findings and elevated ALT and α-HBDH levels, a high degree of vigilance for the potential development of atelectasis is warranted, necessitating early personalized intervention.
Introduction. Young adulthood is a critical period for establishing dietary habits. This study examined associations among Mediterranean diet (MD) adherence, body mass index (BMI), and quality of life (QoL) in university students. Methods. A total of 729 students aged 18–30 years were assessed for MD adherence (MEDAS), QoL (SF-36), and anthropometrics. Associations were evaluated using regression analyses and structural equation modeling (SEM). Results. Among 729 university students (mean age 21.3 ± 2.1 years; 59.1% female), females had higher MEDAS scores than males (7.2 ± 2.0 vs. 6.5 ± 2.2; p < 0.001). Higher MEDAS scores were positively associated with SF-36 physical (B = 1.85) and mental health (B = 1.47), while higher BMI was inversely associated with both domains (physical: B = −0.95; mental: B = −0.78; all p < 0.001). SEM showed acceptable model fit and explained 21% of the variance in the MEDAS, 27% in physical health, and 23% in mental health. Conclusions. Greater MD adherence is associated with better QoL and lower BMI in young adults, supporting the potential value of MD-based dietary behaviors.
Asymmetric dimethylarginine (ADMA) has been discussed as a potential biomarker of cardiovascular risk, but its interpretation in type 1 diabetes mellitus (T1DM) remains context-dependent. In commenting on the recent study by Chausheva et al., we suggest that the findings should be interpreted cautiously rather than viewed as definitively excluding clinical relevance. In addition to glycemic status, kidney function, and biological sex, ADMA concentrations may also be influenced by smoking exposure, physical inactivity, inflammatory status, and medication use. These factors may complicate its interpretation as a universal cardiovascular risk marker in heterogeneous T1DM populations. ADMA may therefore be more appropriately considered in selected phenotypes or as part of a broader multivariable framework rather than as a standalone indicator.
Introduction. Diabetes and prediabetes are major global health concerns, with rising prevalence driven by aging, urbanization, obesity, and sedentary lifestyles. Early identification of at-risk individuals is essential to prevent progression and complications. Data on the epidemiology of diabetes and prediabetes in Duhok City, Iraq, remain scarce. This study aims to determine the prevalence of diabetes and prediabetes, as well as the associated risk factors, among adults in Methods. A population-based cross-sectional study was conducted in March 2025 among 563 adults selected via multistage random sampling. Data on demographics, lifestyle, medical history, anthropometrics, and blood glucose were collected. Diabetes and prediabetes were diagnosed based on fasting blood glucose, random blood glucose, and glycated hemoglobin levels. Logistic regression was used to estimate odds ratios with 95% confidence intervals for factors associated with prediabetes and diabetes. Results. The overall prevalence of glycemic abnormalities was 18.1%, including 6.4% with prediabetes and 11.7% with diabetes; 13.6% of diabetes cases were previously undiagnosed. Factors associated with prediabetes were older age and a history of dyslipidemia, whereas factors associated with diabetes included older age, higher body mass index, a history of dyslipidemia, and a family history of diabetes. Conclusions. One in five adults in Duhok City has prediabetes or diabetes, with a substantial proportion undiagnosed. Older age, higher body mass index, a history of dyslipidemia, and a family history of diabetes are key determinants of diabetes. These findings emphasize the need for targeted screening and early interventions to prevent the progression of diabetes and its complications.
Introduction. Tuberculous (TB) lymphadenitis is the most frequent extrapulmonary manifestation of Mycobacterium tuberculosis infection, with predominant involvement of the cervical lymph nodes (LN). Bilateral LN enlargement in elderly patients, especially in the presence of a thyroid nodule, may closely mimic malignant disease. This case highlights the diagnostic challenge of distinguishing TB from metastatic thyroid carcinoma and contributes to literature by emphasizing the role of minimally invasive and molecular techniques in diagnosis. Case report. An 83-year-old female was admitted with progressive bilateral cervical swelling, pain, and systemic symptoms, including weight loss, fatigue, and night sweats. Physical examination revealed bilateral cervical lymphadenopathy and a palpable thyroid nodule. Laboratory studies showed microcytic anemia, leukopenia, and subclinical hypothyroidism. Computed tomography demonstrated bilateral cervical and mesenteric lymphadenopathy, right pleural effusion with pulmonary consolidation, and splenomegaly. Fine-needle aspiration (FNA) of a cervical LN revealed granulomatous inflammation, while polymerase chain reaction (PCR) confirmed Mycobacterium tuberculosis. Cytological evaluation of the thyroid nodule was benign. A final diagnosis of disseminated extrapulmonary TB (EPTB) with LNs, pleural, and probable thyroid involvement was established. The patient was referred to a specialized tuberculosis clinic for further management, but follow-up data were not available. Conclusion. This case illustrates the diagnostic complexity of EPTB, particularly when concurrent thyroid pathology is present. In such patients, TB may be clinically and radiologically indistinguishable from metastatic malignancy. FNA combined with molecular testing significantly enhances diagnostic accuracy, reducing the need for excisional biopsy.
Metabolic and endocrine disorders profoundly influence cardiovascular morphology through complex mechanisms that converge on endothelial dysfunction. This review synthesises current evidence on structural alterations of the endocardium and arterial system under conditions such as hypertension, diabetes mellitus, metabolic syndrome, and hypothyroidism. Particular attention is given to the endothelium as an active regulator of vascular tone, haemostasis, inflammatory balance, and extracellular matrix dynamics. Chronic metabolic stress, oxidative injury, and dysregulated hormonal signalling drive endothelial-to-mesenchymal transition, smooth muscle cell phenotypic switching, collagen accumulation, and loss of vascular compliance. These processes underlie arterial wall thickening, microvascular rarefaction, endomyocardial fibrosis, and maladaptive myocardial remodelling. Distinct morphological patterns are highlighted across metabolic and endocrine states, including myxedematous changes in hypothyroidism, interstitial fibrosis in diabetes, and hypertrophic vascular remodelling in hypertension. By integrating histological, ultrastructural, and pathogenetic data, this narrative review underscores endothelial dysfunction as a unifying mechanism linking systemic disturbances to cardiovascular pathology. Recognition of these pathways not only advances morphofunctional understanding but also identifies early diagnostic markers and therapeutic targets in cardiometabolic disease.
Introduction. Both hereditary angioedema (HAE) and acquired epidermolysis bullosa (AEB) are extremely rare disorders, and their coexistence in a single patient is unique. Awareness of this exceptional association can aid in timely diagnosis and guide safe, individualized treatment strategies. Case Report. We present a case of a 38-year-old female with co-occurring type I HAE, associated with a heterozygous SERPING1 variant c.425T>C (p.Leu142Ser) of uncertain significance previously reported in individuals with angioedema, and a rare autoimmune subepidermal blistering disorder mediated by autoantibodies against type VII collagen – AEB. Since adolescence, the patient had experienced recurrent limb edema and atypical dermatological manifestations, including macules, vesicles, and bullae, predominantly in areas exposed to mechanical stress and frequently resulting in scar formation. The disease course later progressed with an episode of acute laryngeal edema following a dental procedure. Laboratory evaluation confirmed a critically low level of C1-inhibitor and an almost complete depletion of C4 in plasma, indicating chronic activation of the classical complement pathway. Given the frequent exacerbations and severe clinical course, long-term prophylactic therapy with intravenous C1-INH (1,000 IU twice weekly) was initiated. This treatment regimen led to sustained clinical remission, resolution of angioedema episodes, notable improvement in dermatologic symptoms of AEB, and a substantial enhancement in overall quality of life. Conclusions. The coexistence of HAE and AEB is exceptionally rare, with no prior cases identified. Complement dysregulation may link these conditions, underscoring the importance of considering autoimmune blistering disorders in HAE patients with atypical skin manifestations. This case highlights a potential role for complement-targeted therapies, warranting further clinical investigation.
Background: Demographic patterns of parotid gland tumors (PGTs) vary across regions and over time, which is important for clinical practice. We aimed to characterize the epidemiology of PGTs in seven regions from northeastern and north-central Bulgaria, focusing on patient demographics, laterality, benign–malignant distribution, histologic subtypes and temporal incidence. Methods: A retrospective descriptive study was conducted at a single university maxillofacial surgery clinic in Bulgaria. Cases were reviewed over a 10-year period (1 January 2015–31 December 2024). Age, sex, histology, and benign/malignant status were recorded. Group differences were assessed with t-tests and χ² tests. Annual crude benign, malignant and total parotid tumor incidence rates of per 100,000 population were calculated (2015–2024). Results: Benign tumors constituted 86.4% (312/361) and malignant 13.6% (49/361). Patients with benign tumors were significantly younger than those with malignancy (56.5 ± 14.2 vs 65.4 ± 14.3 years; t = −4.1; p < 0.001). The proportion of malignancy increased with age (χ² = 22.965; p < 0.001). Among benign neoplasms, Warthin’s tumor (WT) was most frequent (44.9%), followed by pleomorphic adenoma (PA) (34.3%); WT predominated in men and PA in women (p < 0.001). In children, PA was the only benign entity identified. Among malignancies, salivary duct carcinoma and adenoid cystic carcinoma were most common (18.4% each), with mucoepidermoid carcinoma close behind (16.3%); when pooled, malignant tumors showed no significant associations with sex or age. Crude annual incidence rates for benign PGTs rose from 1.50 (2015) to 3.48 per 100 000 in 2023, (p=0.002). Malignant rates varied without a clear trend, (p=0.25) and total PGT incidence increased significantly from 1.79 (2015) to 3.80 per 100 000 in 2023, (p=0.001). Conclusions: In this single-center study, most PGTs were benign (86.4%); benign cases presented younger, and the likelihood of malignancy increased with age. WT predominated, especially in men, whereas PA was more common in women and was the only diagnosed pediatric tumor; malignancies were mainly salivary duct carcinoma and adenoid cystic carcinoma (with mucoepidermoid carcinoma being also common) with no sex/age associations, and crude incidence rose over time for benign and total tumors but not for malignant entities.
Introduction. Ruta graveolens L. (R. graveolens) is a rich source of biologically active compounds with antimicrobial and antibiotic-potentiating properties; however, its impact on the duration of the postantibiotic effect (PAE) remains unclear. This study aimed to evaluate, in vitro, the PAE duration of erythromycin in staphylococcal strains with different MLS (macrolides, lincosamides, and streptogramin B) resistance phenotypes and to assess the impact of 70% and 90% ethanolic R. graveolens extracts on this parameter. Methods. Three control strains of staphylococcal skin isolates with different MLS resistance phenotypes, inducible (D), constitutive (Neg), and resistant (R), were used in this study. The minimum inhibitory concentrations of erythromycin and ethanolic R. graveolens extracts (70% and 90%) were determined using the broth microdilution method. Bacterial growth was monitored spectrophotometrically in microplates, and the lag phase, log phase, and PAE values were assessed. Results. The duration of the erythromycin PAE differed among staphylococcal strains exhibiting different MLS resistance phenotypes. The most extended PAE duration was observed in the tested strain with an inducible phenotype (7.3 ± 0.75 hours). An intermediate mean PAE duration (3.76 ± 0.4 hours) was observed for the strain with complete resistance to the MLS group of antibiotics. The erythromycin PAE was not detected in the strain with the Neg phenotype. Seventy percent R. graveolens extract modified the lag phase and prolonged the erythromycin PAE duration in a phenotype-dependent manner. In contrast, 90% R. graveolens extract did not show a potentiating effect compared to 70% R. graveolens extract. Conclusions. Combinations of erythromycin with subinhibitory concentrations of 70% R. graveolens extract modified the lag phase and prolonged erythromycin PAE in a resistance phenotype-dependent manner. The most pronounced effect of 70% R. graveolens extract was observed in strains with the D and R MLS resistance phenotypes. Moreover, 90% R. graveolens extract did not potentiate erythromycin activity against MLS-resistant staphylococci.
Introduction. Acinetobacter lwoffii is a rare cause of bacterial meningitis, particularly in immunocompetent individuals without prior healthcare exposure. To date, only a very limited number of cases have been documented in the literature. Case Report. A 17-year-old male patient presented with fever, severe headache, meningeal irritation, and neurological symptoms. Cerebrospinal fluid analysis revealed neutrophilic pleocytosis and elevated inflammatory markers. Phenotypic analysis with the Vitek 2C system identified the cerebrospinal fluid isolate as A. lwoffii. Empirical antibiotic therapy was initiated and subsequently adjusted based on sensitivity testing, improving clinical and laboratory parameters. Conclusions. This case highlights the pathogenic potential of A. lwoffii to cause severe central nervous system infections in healthy individuals. It emphasizes the importance of early microbiological diagnosis and targeted antibiotic therapy. The clinical picture, diagnostic approach, treatment strategy, and outcome are discussed in relation to the existing evidence.
Metabolic syndrome (MetS) is a multifactorial condition with rising global prevalence and significant long-term health risks. In emergency contexts such as wartime, MetS management becomes increasingly complex due to disrupted healthcare access, limited drug availability, and heightened psycho-emotional stress. This narrative review synthesizes current evidence on pharmacological strategies for MetS, focusing on three widely used agents, metformin, alpha-lipoic acid (ALA), and glucagon-like peptide-1 (GLP-1) receptor agonists, and introduces a three-axis model to address treatment barriers. Seventy-eight peer-reviewed publications from 2015 to 2025 were thematically analyzed to assess the therapeutic efficacy, safety, and feasibility of metformin, ALA, and GLP-1 receptor agonists. These agents demonstrate complementary mechanisms targeting insulin resistance, oxidative stress, and cardiometabolic risk factors with favorable safety profiles and relatively high availability. In constrained settings, pharmacological management must prioritize feasibility, simplicity, and continuity of care. Strategies such as avoiding overlapping mechanisms, integrating lifestyle interventions, and leveraging telemedicine are essential. The proposed three-axis model provides a practical tool for clinicians to identify and address barriers related to physicians, drugs, and patients, thereby improving personalized therapy planning. It emphasizes the importance of tailored care, therapeutic sequencing, drug bioavailability, and patient adherence, especially in situations of social instability. This review stresses the need for multidisciplinary approaches to MetS treatment, going beyond pharmacology to include systemic resilience and patient-centered care.
Introduction. Polymyxin B (PMB) and other antibiotics in the polymyxin group are known to be nephrotoxic. In recent years, due to the increasing prevalence of antibiotic resistance, they have become a frequent treatment option for infections caused by multidrug-resistant Gram-negative bacteria. Our study aims to comprehensively examine the nephrotoxic effects and clinical characteristics of PMB in patients receiving treatment without dose reduction. Methods. This study included 176 patients, who were divided into two groups based on the presence or absence of acute kidney injury (AKI). The groups were analyzed for nephrotoxicity, associated risk factors, mortality, and other clinical characteristics. Results. Gender, pathogen, site of infection, comorbidities, additional nephrotoxic agents, duration of antibiotic use, and mechanical ventilation status were not identified as risk factors for AKI development. However, advanced age was found to be associated with nephrotoxicity (OR = 1.024, 95% CI 1.001–1.047; p = 0.037). Additionally, the mortality rate was higher in the AKI group (p = 0.001), although no significant difference was observed in the survival analysis (p = 0.189). Conclusions. PMB is commonly used in critically ill patients, and PMB-associated AKI tends to develop early during treatment. While most clinical characteristics were not independently associated with AKI, advanced age was identified as a significant risk factor. Therefore, close monitoring of renal function is recommended throughout PMB therapy.
Evaluation of peri-implant tissue health is typically based on conventional clinical parameters, including subjective and visual signs of inflammation or tissue destruction, assessment of pocket probing depth, bleeding, suppuration, and X-ray analysis of progressive bone level changes. Subsequently, the assessment of biomarkers in peri-implant crevicular fluid (PICF) has been proposed to improve the standard diagnostic protocol. PICF is a site-specific fluid that contains cells, microbes, cytokines, and other mediators. Studies have been conducted to evaluate the diagnostic significance of PICF biomarkers in the early identification of peri-implant diseases. However, this non-invasive method can be used to monitor healing processes after implant installation or soft tissue augmentation as well. Despite numerous studies, the reliability of specific biomarkers remains controversial, and their diagnostic value should be evaluated comprehensively. This narrative review aimed to compare published research on the diagnostic potential of biomarkers in PICF. After screening the scientific data, all biomarkers were grouped based on their associated biological processes. The most extensively studied categories were pro- and anti-inflammatory cytokines, tissue degradation markers, and bone remodeling factors. Despite extensive research confirming the high reliability of several cytokines, such as IL-1β, TNF-α, MMP-8, etc., many other biomarkers still require additional research to establish their specificity and sensitivity in assessing peri-implant tissues.
