Lung cancer is one of the leading causes of cancer-related deaths worldwide, with non-small cell lung cancer (NSCLC) accounting for 84% of cases. Traditional treatments like surgery and chemotherapy have limited effectiveness and significant side effects. Despite combination chemotherapy being the preferred first-line therapy, the prognosis for advanced NSCLC remains poor, with a median survival of 8-11 months and a 1-year survival rate of 30%. There is a critical need for new treatments targeting the molecular mechanisms of NSCLC. Precision medicine, or targeted therapy, has emerged as a promising approach, focusing on genetic and epigenetic alterations. This method is more effective for advanced NSCLC. It involves drugs targeting specific genetic abnormalities such as ROS proto-oncogene 1 (ROS1), EGFR (Epidermal growth factor receptor), ALK (Anaplastic lymphoma kinase), BRAF (v-Raf murine sarcoma viral oncogene homolog B1, MET (Mesenchymal epithelial transcription factor), and RET (Rearranged during transfection) mutations, which are vital driver genes for lung cancer development and progression. With up to twenty treatments approved by the FDA, targeted medicines are still being developed, and targeted therapy and chemotherapy have dramatically improved patient outcomes. Despite progress, treating metastatic NSCLC remains challenging due to resistance to genetic changes. This narrative review provides a detailed description of the various classifications of molecular targeted therapeutic approaches employed in lung cancer management and its mechanisms of action in cancer prevention and its advantages and disadvantages.
One of the major hallmarks of Alzheimer’s disease (AD), deposition of amyloid plaques in the brain, arises from the proteolytic processing of the amyloid precursor protein (APP), a process in which the rate-limiting step is carried by β-secretase (BACE1). Due to this essential role in the development of AD, BACE1 has become a widely studied drug target for the development of new drugs aimed at blocking amyloid β peptide formation and aggregation through inhibition of BACE1 activity. The development of the first BACE1 inhibitors allowed the determination of its crystal structure and description of its active site, confirming the existence of eleven well-defined subsites able to accommodate a range of substrates, which enabled BACE1 to participate in a number of biological processes. For this reason, the study of BACE1 structure and determination of specific structural motifs responsible for the accommodation of known substrates could enable defining drugs with very specific targets, as well as provide insight into the mode of action of BACE1 itself. This review will focus on the overall structure of BACE1 and its active site, as well as on the effect of genetic polymorphisms and isoforms on its activity.
Ovarian cancer is one of the most common and deadliest tumors among women. Despite recent clinical advances, the combination of platinum-based chemotherapy and surgery remains the first-line therapeutic option. Due to frequent detection at an advanced stage and development of therapy resistance, the disease prognosis is often poor, and mortality rates remain high. Therefore, it is necessary to investigate new therapeutic approaches that would contribute to increased survival and higher life quality of ovarian cancer patients. One of these approaches is the use of the pro-oxidant effect of certain drugs that can disrupt the redox balance in tumor cells and lead to their death. Vitamin C (ascorbic acid or ascorbate) used in high concentrations suppresses cancer cell growth and metastasis. There are several mechanisms by which vitamin C exerts its antitumor function including pro-oxidant activity, epigenetic reprogramming and tumor environment oxygen sensing. The potential use of vitamin C in combinatorial therapies (as a support to standard therapies) should be reconsidered through more detailed mechanistic and clinical studies. Finding new therapeutic approaches would augment the available mechanisms in the fight against cancer leading to the increase in patient welfare and overall survival of cancer patients.
Aquaculture stands out as a highly promising practice within sustainable agriculture, especially when compared to other livestock production sectors. However, it faces significant challenges, including water pollution, fluctuations in dissolved oxygen levels, and the prevalence of both chronic and acute diseases. To address these issues, researchers in the aquaculture sector have been exploring and implementing innovative solutions. One of the most notable advancements is the use of nanobubble technology, which has already been applied in numerous aquaculture farms to mitigate these challenges. Nanobubbles (NBs) with a diameter of less than 200 nm have shown promising results in improving water quality in aquaculture systems, increasing dissolved oxygen availability, and improving the overall health of cultured organisms. This review will emphasize various practical applications of nanobubble technology in different areas of aquaculture, including their properties and characterization methods, and discuss the hotspots of current research to help shape the future of intensive aquaculture. It will also uncover the nanobubble technology application in water and wastewater treatment processes, such as disinfection, sterilization, and detoxification. Additionally, the review will discuss the application of nanobubble technology in improving the growth performance and health of aquatic organisms, including its roles in aeration, water quality management, nutrient, drug delivery, monitoring, algae control, and functional feeding strategies. However, extensive research and standardization to be optimized for the application of nanobubbles in culture systems to understand their chronic effects on growth and overall production of fishes.
Background and purpose: Clarias magur (Hamilton, 1822), the Asian or walking catfish, is a high-value fish species in India and Southeast Asia for its taste and nutritional value. The combined effect of ammonia and bacterial infection on C. magur has not been studied so far. Moreover, the mechanism of ammonia-induced toxicity and their adaptability in C. magur is poorly understood. Given this context, a systematic study was devised to examine the individual and combined exposure effect of unionized ammonia and Aeromonas caviae on haemato-biochemical and histopathological changes of different tissues of C. magur. Materials and methods: A 14-day experiment was conducted to expose the fish to sublethal doses of UIA, A. caviae, and a combination of both. Initially, we have determined the 96-hr LC50 value for UIA in C. magur. During the experimental period, various hematological parameters were tested, such as total erythrocyte count, hemoglobin, packed cell volume, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration. Different biochemical parameters like blood glucose, serum, and tissue urea, serum glutamate pyruvate transaminase, and serum glutamate oxaloacetate transaminase levels and histopathological examination were performed. Results: The 96-hr LC50 value for UIA in C. magur was 7.21 mgL–1. The 14th day exposure of UIA (2.4 mgL–1), A. caviae (1.53 × 105 CFU mL–1), and their combination resulted in significant decreases in various hematological parameters such as total erythrocyte count, hemoglobin, packed cell volume, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration. Additionally, there were notable increases in blood glucose, serum and tissue urea, serum glutamate pyruvate transaminase, and serum glutamate oxaloacetate transaminase levels in all treatment groups compared to the control. Histological examination revealed significant changes in gill, kidney, and liver tissues, including lamellar fusion, edema, nodular enlargement of lamellar tips, lamellar congestion and curling in gill tissues, cytoplasmic vacuolation, pyknosis, karyorrhexis, karyolysis, and degeneration of renal tubule cells in kidney tissues, and increased vacuolation in hepatocytes, disorganization of hepatic cords, and increased hemorrhage in liver tissues. Interestingly, the combined exposure to UIA and A. caviae resulted in fewer histological alterations than individual exposures. Furthermore, after the 14th day, the group exposed only to bacteria exhibited the lowest relative percent survival compared to those exposed to only UIA and the combination. Conclusions: This study signifies that there was a negative synergistic or antagonism effect in the fish after exposureto ammonia and bacteria in combination. This discrepancy indicates that elevated ammonia concentrations might haverestricted the survival of A. caviae or disrupted the infection process. The present study's findings open a new avenue for further understanding the mechanism of ammonia exposure in the direction of an alternative method to combat bacterial infections.
Background and purpose: Epithelial tissue, functioning as a protective barrier, has mechanisms to recognize an array of external disturbances and threats and to send signals to the immune system. Here we report the uncovering of the selective expression of CD123 on epithelial cells lining distinct surfaces of the digestive system and lungs. Materials and methods: The expression level of CD123, the α chain of the heterodimeric receptor for Interleukin-3, was detected by immunohistochemical staining. Results: We found high expression of CD123 on pancreas duct cells, intrahepatic bile ducts epithelial cells, and alveolar epithelium, but not on hepatocytes, gastric mucosa, duodenal, and colon mucosa. The CD123 expression on carcinoma specimens showed the same pattern as the tissue of origin. Conclusions: We postulated that CD123 expression is characteristic of the epithelium of normally germ-free compartments that is, in steady state, quiescent, in terms of low turnover and low cytokine production. Upon infection and subsequent inflammation, IL-3 produced by activated immune cells may contribute to the restoration of the epithelial barrier by enhancing epithelial cell proliferation and cytokine production.
Background and purpose: Three genera and eleven species of Glossosomatidae family have been confirmed in Bosnia and Herzegovina. However, there is limited research on the biodiversity of this family in the region, especially on molecular data. With this paper, we contribute to the knowledge on the Glossosomatidae family with the first molecular records for two species for Bosnia and Herzegovina. Materials and methods: Larval samples of caddisflies were collected in April 2019 and 2021 at the area of the Natural Monument the Spring of Bosna River followed by morphological identification. Molecular confirmation of species was done using DNA barcoding, targeting the cytochrome c oxidase subunit I (COI) region using Folmer’s primers and degenerated primers LCO1490-JJ and HCO2198-JJ. All obtained PCR products were bidirectionally sequenced using the same primers as in PCR. Results: Out of 52 specimens, 18 were morphologically determined to species level. A DNA barcode was successfully generated for 16 specimens. Eight sequences were generated for Synagapetus krawanyi, revealing three haplotypes previously absent from the BOLD database. Four sequences were obtained for S. iridipennis, with one new haplotype for BOLD database. Conclusions: We present new data on species distribution and genetic diversity of S. krawanyi and S. iridipennis from Bosnia and Herzegovina. This study contributes to the knowledge of caddisfly biodiversity and the Global Trichoptera Barcode Initiative by adding new records from two underrepresented species in the BOLD database.
Background and purpose: Root Knot Nematodes (RKN) hamper plant growth and productivity. They are basically managed by chemicals arising environmental and health concerns. Material and methods: Pots and greenhouse experiments were conducted to test the bio-control effect of Trivago SC20 (based on abamectin derived from Streptomyces avermitilis) and Myco-up attack (based on Glomus iranicum var tenuihypharum mycorrhizae compared with the two nematicides [Vydate® (oxamyl) for pot assay and Mocap® (ethoprophos) for greenhouse assay] in controlling Meloidogyne javanica infesting tomato. Gall index, gall number /g root, egg-masses /g root, RKN /g root, multiplication rate, M. javanica density, nematodes groups frequency, hatched eggs/ egg masses, agronomic and production traits were studied to determine the efficiency of arbuscular mycorrhizal fungi (AMF) and abamectin compared with the fungicide application. Results: The first experimental results showed that high nematode suppression was provided by G. iranicum and abamectin treatments. Both bio-nematicides were also effective in the control of M. javanica naturally infested tomato plants under greenhouse conditions. Besides, the G. iranicum and abamectin had a positive effect on plant growth because of stimulation of plant vegetation parameters, such as the shoot weight and root length. Furthermore, the AMF satisfactorily colonized the tomato roots. Conclusions: Hence, tested abamectin and mycorrhizae-based products may be used for M. javanica management programs as an alternative and eco-friendly approach to fungicides, while preserving the environment.
Background and purpose: Benign prostatic hypertrophy (BPH) is one of the most common pathologies affecting the urogenital system of the elderly man. Urtica dioica, a plant rich in antioxidants, is used in traditional medicine to treat BPH urinary symptoms. This study aims to evaluate the effects of hydroalcoholic extract from Urtica dioica roots on benign prostatic hyperplasia (BPH) induced by testosterone and a high-calorie diet. Material and methods: Antioxidant activity of plant root extract and polyphenol assay were performed. In vivo experiments included serum biochemical assays and histological analysis of the murine prostate tissue. A population of 16 male mice divided into 4 groups; a control group (group 1), a group 2 receiving an intraperitoneal injection of testosterone (0.5 mL / week) and a high calorie diet (HCD), group 3 received testosterone, HCD and 0.2 mL of the Urtica dioica root hydroalcoholic extract (14.8 mg / mL) and a group 4 received HCD and the extract. Results: The inhibition rate and the polyphenol content were respectively 21.3 % and 60.3 μg / mL gallic acid. The body weight of the mice (group 2) was 41.15 ± 1.62 g, in contrast to the group 3 which weighed 36.64 ± 1.38 g. A decrease in blood glucose in group 3 (0.84 ± 0.13 g / L) was observed compared to group 2 (1.09 ± 0.32 g / L). Prostate-specific antigen (PSA) was increased in group 2 (0.25 ng / mL) and decreased in group 3 (0.18 ng / mL). In group 2, prostatic glands and fibro-muscular tissue exhibited an enlarged appearance whereas animals treated with Urtica dioica extract had narrower glands and acini of regular shape. Conclusion: Urtica dioica root hydroalcoholic extract demonstrated a beneficial effect on testosterone and high-calorie diet-induced BPH in mice. The treatment reduced prostate enlargement, improved blood glucose levels, and decreased PSA levels, suggesting potential anti-inflammatory or metabolic regulatory properties. However, the exact mechanisms underlying these effects remain unclear and require further investigation.
Background and purpose: Autism, a prevalent developmental disorder, has been linked to genetic factors that regulate critical brain functions, such as neuropilins (NRPs). This study aimed to examine the NRP2 rs849563 polymorphism for its association with autism risk and its relationship with specific autism spectrum disorder (ASD) clinical variables in the Azerbaijani population. Materials and methods: The study included 48 ASD patients and 42 controls from the same population. Diagnoses followed DSM-5 criteria, with DNA extracted from buccal samples and genotyped for the NRP2 rs849563 polymorphism via PCR-RFLP. Statistical analyses using MedCalc assessed genotype frequencies and their associations with clinical variables, with significance set at p ≤ 0.05. Results: PCR-RFLP genotyping revealed 75% TT and 25% TG in autistic children, compared to 66.67% TT and 33.33% TG in controls, with the GG genotype absent. Statistical analysis showed no significant association of genotype (OR = 0.667, 95% CI = 0.267 - 1.666, p = 0.385) or allele frequencies (OR = 0.714, 95% CI = 0.31 – 1.64, p = 0.429) with ASD. However, a significant association was found between the NRP2 rs849563 polymorphism and rocking and swaying behavior (p = 0.029), highlighting its potential role in ASD symptomatology. Conclusions: Our study provides pioneering insights into the potential role of the NRP2 gene in autism susceptibility among Azerbaijani children. The results, including a significant association, lay the groundwork for future research with larger cohorts and more comprehensive phenotypic evaluations.
Background and purpose: This study investigates the protective effects of sirt1 on albumin-induced podocyte damage, focusing on the regulatory role of HIF-1a. Podocyte injury contributes significantly to proteinuria, a marker of chronic kidney disease (CKD) progression. Understanding the sirt1/HIF-1a pathway may provide insights into novel therapeutic strategies for CKD. Materials and methods: Cultured mouse podocytes were divided into control, albumin-induced, sirt1 agonist, and sirt1 inhibitor groups. RTqPCR was used to evaluate the expression of sirt1 and HIF-1a mRNA. Protein levels of Nephrin, podocalyxin, and TRPC6 were assessed through Western blot and immunofluorescence techniques to determine podocyte damage. Results: The albumin-induced group showed decreased Sirt1 and increased HIF-1a levels, while sirt1 agonists reversed these changes, indicating that the kidney protective effect. In contrast, sirt1 inhibitors worsened podocyte injury. Western blot and immunofluorescence confirmed a significant reduction in Nephrin and podocalyxin and an increase in TRPC6 protein expression in albumin-treated groups, which was mitigated by sirt1 activation. Conclusions: Sirt1 protects against albumin-induced podocyte damage by modulating HIF-1a, suggesting its potential as a therapeutic target for proteinuria and CKD management. This study provides a foundational understanding of sirt1's role in podocyte protection and highlights the need for further research to explore its clinical applications in preventing CKD progression.
Background and purpose: Thyroidectomies are one of the most common elective surgical procedures in modern medicine. Performed under general anesthesia, thyroidectomies are associated with a high incidence of postoperative nausea and vomiting. Other common complications that increase anxiety among the surgical population are pain, postoperative voice dysfunction, and hypocalcemia. Dexamethasone, as a common adjuvant in anesthesia, is recommended as standard of care for prophylaxis of postoperative nausea and vomiting, as well as in the management of postoperative pain. Recent studies recommended the prophylactic use of dexamethasone in order to prevent hypocalcemia, and voice changes after thyroid surgery. Materials and methods: A literature review with 35 studies included was done to investigate and evaluate the effect of dexamethasone on the postoperative nausea and vomiting, pain, and voice dysfunction in patients undergoing thyroid surgery. Results: Dexamethasone seems to be effective for postoperative nausea and vomiting prophylaxis in patients undergoing thyroid surgery in a preoperative single dose of 8-10 mg intravenously. Dexamethasone may have potential in alleviating pain, but the correct dose needs to be determined. Studies supported the prophylaxis with dexamethasone for voice changes and hypocalcemia, but further research is required. Conclusion: A preoperative single intravenous dose of dexamethasone is a safe and effective method for preventing postoperative nausea and vomiting. Further meta-analyses and high-quality trials are needed to determine the optimal dose for pain relief and to assess its impact on voice changes and hypocalcemia.
Background and purpose: Respiratory tract infections (RTIs) are a global public health issue and one of the major causes of morbidity and mortality worldwide, especially in immune sensitive or compromised population. It is particularly challenging to distinguish viral from bacterial RTI based only on the symptoms presentations. Bacterial cultures are the gold standard in detecting the causative pathogens. However, they have several shortcomings such as variable diagnostic sensitivity, a relatively long turnaround time and the fact that not all possible pathogens can be detected using one culture. In such case, tests detecting host-response blood-based biomarkers are a valuable contribution in diagnosis making and patient management. Materials and methods: A literature search was conducted in the PubMed electronic database from January 1st 2005 to March 31st 2025 using the following search terms “Clinical Laboratory Techniques” AND “Serum” AND “Infections” AND “Respiratory tract diseases” AND “Diagnosis” AND “Prognosis”. Randomized,non-randomized studies as well as reviews were taken into consideration. Results: C-reactive protein and procalcitonin are at the present the most robust and widely used biomarkers; however newer biomarkers such as serum calprotectin, pentraxin 3 and presepsin, as well as combinations of different biomarkers with high potential for clinical utility are emerging. Conclusions: Host-response biomarkers of inflammation are useful tools in RTIs management when used together in conjunction with clinical symptoms. Depending on the kinetics of their release into the circulation and their elimination, they can be used as either early markers of inflammation or as a prognostic marker for disease severity and mortality.
Background and purpose: Extubation in patients with cervical spine injury (CSI) is a high-stakes clinical intervention, requiring a nuanced understanding of spinal pathophysiology, respiratory mechanics, and risk mitigation strategies. This review synthesizes the current evidence on the demographics, injury mechanisms, and extubation risks associated with CSI, highlighting the complexities that arise from associated spinal cord injuries, diaphragmatic dysfunction, and airway instability. Results: Epidemiological data reveal a bimodal age distribution and an increasing incidence of CSI due to falls, especially among the elderly. The anatomical vulnerability of the cervical spine and the two-phase pathophysiology of spinal cord injury—primary mechanical insult and secondary inflammatory cascades—complicate respiratory management and timing of extubation. Patients with CSI often face unique extubation challenges, including impaired airway reflexes, agitation, and upper airway edema. Existing guidelines, such as those from the Difficult Airway Society, underscore the need for high-risk extubation protocols, emphasizing preparedness, appropriate sedation, and airway reflex control strategies like remifentanil infusion or delayed extubation in select cases. Several predictors of extubation failure in patients with CSI have been investigated, such as prolonged surgery, vertebral level involvement and blood loss. For ventilator-dependent tetraplegic patients, individualized weaning strategies based on neurological and diaphragmatic function are crucial. The use of adjuncts like cough-assist devices post-extubation is essential for airway secretion clearance. Conclusion: Safe extubation in CSI patients demands a multidisciplinary, protocol-driven approach tailored to individual pathophysiological and surgical risk profiles.
Background and purpose: Operating rooms (ORs) and intensive care units (ICUs) are two most common medical environments where endotracheal extubation is conducted. The goal of this publication is to investigate the prevalence, causes, and risk factors of endotracheal extubation and to present current guidelines and protocols for performing safe endotracheal extubation of patients. Materials and methods: A narrative review of guidelines related to endotracheal extubation of patients. Results: Coughing and temporary hypertension are minor side effects of endotracheal extubation. With a mortality rate of about 5%, significant complications, such as extubation failure requiring reintubation, pose serious dangers. Inadequate communication between medical personnel, a lack of backup plans, and certain surgical procedures, especially those involving head and neck surgery, are factors that contribute to extubation failure. Reintubation occurs in 0.1% to 25.7% of cases. Patient features that may impact the outcome of extubation and additional extubation issues include obesity, obstructive sleep apnea, and other comorbidities. The endotracheal extubation method can be improved, and the incidence of post-extubation complications can be minimised to the greatest extent possible by implementing thorough standards and protocols to ensure safe extubation practices, especially for patients undergoing complex surgical operations. Conclusion: the approach to each endotracheal extubation should be carefully planned and personalised. Many measures can help avoid complications from endotracheal extubation. As advances in airway management continue to evolve, future research and guideline development should prioritise the integration of new technologies in medicine.
Background and purpose: Pregnant individuals exhibit a lower tolerance for apnea due to heightened metabolic oxygen consumption coupled with a gradual reduction in functional residual capacity (FRC). In obstetric patients, anesthesia-related mortality is frequently attributed to respiratory complications. It is advisable to assess the airway of each patient upon their admission to the labor floor. Should we anticipate challenges in airway management, it is prudent to implement neuraxial analgesia, such as an epidural catheter, as early as possible to mitigate the necessity for general anesthesia and airway management during cesarean delivery if required. Neuraxial anesthesia is predominantly utilized for cesarean deliveries, even in emergency situations, rendering the need for airway management infrequent, with difficulties arising even more rarely. Supraglottic airway devices are reserved for a carefully chosen subset of parturient and are only employed during the first and second trimesters for non-abdominal and non-obstetric procedures. Endotracheal intubation remains the primary and preferred method for securing the airway during cesarean deliveries when neuraxial anesthesia is not feasible due to significant concerns. The use of video laryngoscopy enhances glottic visualization and may improve the success rate of first-pass intubation. Conclusion: The anesthesia team should engage in discussions with the surgical and/or obstetric teams regarding the risks and benefits of proceeding with the procedure once ventilation attempts are successful. When considering extubation, it is essential that pregnant patients are extubated while fully awake at the conclusion of surgery to ensure the preservation of protective airway reflexes.
Background and purpose: Retrosternal goiter refers to thyroid enlargement in which the lower pole of the thyroid is not palpable with the neck in a hyperextended position. The presence of a mass in the anterior mediastinum and displacement of the trachea are the risk factors for a difficult airway. The aim of this study was to present our experience with airway management in patients with retrosternal goiter. Materials and methods: We conducted a retrospective observational study of patients undergoing elective retrosternal goiter surgery in a tertiary center over one year. We analyzed the preoperative evaluation data and the planning, techniques and outcome of airway management. Results: From January 1st to December 31st, 2024, a total of 349 patients underwent thyroid surgery at our center. Among 72 patients admitted for goiter surgery, 26 patients were diagnosed with retrosternal goiter. A preoperative computerized tomography scan was performed in most patients and revealed 11 patients with massive retrosternal goiter. Intravenous induction to anesthesia with direct or video laryngoscopy was the preferred method of intubation. No significant complications were recorded. Conclusion: If there are no additional risk factors, intravenous induction of anesthesia and intubation with direct or video laryngoscopy are acceptable methods of airway management in patients with retrosternal goiter. Flexible nasendoscopy and virtual bronchoscopy are valuable methods for airway assessment and may reduce the need for awake fiberoptic intubation in complex cases. However, multicentric studies with larger sample sizes are needed to confirm our findings.
Background and purpose: Community-acquired pneumonia (CAP) represents a major global health concern due to its high morbidity and mortality. Severe community-acquired pneumonia (sCAP) is characterized by respiratory failure requiring invasive mechanical ventilation and/or septic shock. This narrative review outlines current diagnostic and therapeutic strategies for sCAP. Materials and methods: A review of the bibliographic database PubMed was made. Results: The primary bacterial pathogens include Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila. In recent years, respiratory viruses, particularly influenza and SARS-CoV-2, have become increasingly recognized as significant etiological agents. This narrative review outlines current diagnostic and therapeutic strategies for sCAP. Diagnostic evaluation for hospitalized patients typically includes blood cultures, sputum Gram stain and culture, urinary antigen testing for S. Pneumoniae and Legionella, and screening for respiratory viruses. Multiplex polymerase chain reaction (PCR) assays capable of detecting a wide range of viral and bacterial pathogens are increasingly used. Management of sCAP involves immediate empirical antibiotic therapy, typically combining a β-lactam with a macrolide or a fluoroquinolone. Adjunctive therapies such as corticosteroids and antiviral medications may be considered in specific cases. Despite therapeutic advancements, sCAP remains associated with high mortality rates, reaching up to 35% in intensive care unit patients. Preventive measures including pneumococcal and influenza vaccination, smoking cessation, and timely medical intervention play a crucial role in reducing disease burden. Conclusions: Continued research and clinical innovation are essential to improving outcomes and minimizing the global impact of sCAP.
Background and purpose: The selection of anaesthetics and their correct dosage when securing the airway by endotracheal intubation are crucial for patient safety. In this context, different classes of drugs play an essential role. Intravenous anaesthetics, such as propofol, are often used to induce anaesthesia. Knowledge of the pharmacokinetic and pharmacodynamic characteristics of intravenous anaesthetics is extremely important due to the possibility of adequate drug selection in relation to the patient's condition and the side effects produced by these drugs. Ketamine is an anaesthetic that provides dissociative anaesthesia, analgesia and amnesia, and is often used in emergency situations because of its favourable hemodynamic effects. In recent years, the use of ketamine has undergone significant expansion, as has the study of its anaesthetic effects. Muscle relaxants that facilitate intubation and ventilation during anaesthesia are an essential part of the complex process of establishing the airway. These drugs, in combination with hypnotics and opioid analgesics, facilitate endotracheal intubation. Opioid analgesics, such as fentanyl, are necessary drugs to establish an airway, given that endotracheal intubation is one of the most painful interventions in anaesthesia. for analgesia during procedures and immediate postoperative treatment of acute pain. Benzodiazepines are used in elective airway management with the aim of sedation and anxiety reduction. Conclusions: The correct application of drugs and intubation techniques is directly related to the safety and efficiency of establishing the airway; thus, the quality of healthcare is significantly improved.
Background and purpose: Airway management remains one of anesthesiology’s most unpredictable challenges. The prediction of a difficult airway extends beyond the scope of standard bedside tests and anthropometric measurements, therefore patients classified as low risk may present with unanticipated challenges in ventilation or tracheal intubation. This review explores the limitations of current predictive tools and provides an overview of the leading national guidelines for unanticipated difficult airway management. Materials and methods: A detailed guideline analysis was performed covering definitions, incidence, risk factors, and recommendations issued by major national and professional societies in the field of airway management. Results: Findings confirm that bedside predictive tests lack accuracy, and most difficult airways are unanticipated. The incidence of the difficult airway varies greatly in the literature, by setting and surgical specialties. Guidelines, though varied in structure, consistently emphasize first-pass success, limited attempts, early alternative device use, and the need for backup strategies and documentation. Conclusions: Airway difficulty is an essential part of pre-operative evaluation but remains largely unpredictable. Although technological innovations improve management, neither history, clinical examination nor widely used bedside tests are consistently reliable predictors. Effective clinical judgment, individualized planning with a ready back-up strategy for a possible failed airway management, together with structured, evidence based guidelines still remain essential. Documentation, teamwork, and adaptable algorithms tailored to environment and clinician preference are key to enhancing patient safety and reducing airway-related adverse events.
