Visceral leishmaniasis is a severe infectious disease caused by Leishmania spp., characterized by a strong host immune response and significant hematological abnormalities. Clinically, the disease presents with prolonged fever, splenomegaly, severe anemia, pancytopenia, and hypergammaglobulinemia, and delayed diagnosis may worsen patient outcomes. This retrospective descriptive study included 23 patients with confirmed visceral leishmaniasis admitted between January 2022 and March 2023 to the Infectious Diseases Service and the Pediatric Infectious Diseases Service at the Mother Teresa University Hospital Center in Tirana. Demographic characteristics, clinical manifestations, and laboratory parameters—including hematological indices, inflammatory markers, biochemical tests, and bone marrow examination—were collected and analyzed. The disease was more frequent in the pediatric population, with most affected children under 5 years of age, while the mean age among adults was 48 years. HIV–Leishmania coinfection was identified in three patients. Anemia was present in all cases and was frequently associated with neutropenia and thrombocytopenia. Bone marrow examination confirmed the presence of the parasite in all evaluated samples, supporting its role as the diagnostic gold standard. Additional laboratory abnormalities included changes in inflammatory markers, liver enzyme levels, and the albumin–globulin ratio. The correlation of laboratory findings with clinical manifestations may facilitate earlier suspicion and diagnosis of visceral leishmaniasis, particularly in non-specialized centers, enabling timely confirmation and management of the disease.
Background: Mixed lupus nephritis (LN), combining proliferative and membranous lesions, is frequently associated with substantial proteinuria and increased risk of kidney injury. However, the occurrence of massive nephroticrange proteinuria despite minimal histologic activity, persistently negative antidouble stranded DNA (anti-dsDNA) antibodies, and preserved serum creatinine represents an uncommon diagnostic challenge. The coexistence of systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and psoriatic arthritis (PsA) in a single patient is exceptionally rare and further complicates disease assessment and management. Case Presentation: We report a 39-year-old man with an 18-year history of triple autoimmune overlap syndrome (SLE, RA, and PsA) who presented with severe nephrotic-range proteinuria (10.7 g/24 h), urinary albumin-to-creatinine ratio (UACR) of 23,538 mg/g, hypoalbuminemia, persistent hypocomplementemia, pancytopenia, and severe obesity BMI 39.2 kg/m². Despite preserved serum creatinine (0.8 mg/dL), measured creatinine clearance was markedly elevated at 216 mL/min, consistent with extreme glomerular hyperfiltration. Serological evaluation demonstrated positive antinuclear antibodies (ANA) but persistently negative anti-dsDNA antibodies. Kidney biopsy revealed mixed lupus nephritis Class III+V according to the 2018 ISN/RPS classification, with full-house immunofluorescence, a low activity index (2/24), and minimal chronicity (0– 1). The marked discrepancy between massive proteinuria and limited histologic activity raised the possibility that obesity-related hyperfiltration contributed to urinary protein losses in addition to immune-complex-mediated renal injury. Following treatment with pulse methylprednisolone, mycophenolate mofetil, hydroxychloroquine, and supportive nephroprotective therapy, the patient achieved substantial clinical and biochemical improvement. After nine months of follow-up, proteinuria decreased to 3.8 g/24 h, UACR declined to 238 mg/g, serum albumin improved to the lower limit of normal, and complement levels normalized, while body weight remained unchanged. Conclusion: This case highlights three important clinical messages. First, active lupus nephritis may occur despite persistently negative anti-dsDNA antibodies. Second, severe nephrotic-range proteinuria may be observed in mixed Class III+V lupus nephritis even when histologic activity appears limited. Third, obesityrelated glomerular hyperfiltration may amplify proteinuria and contribute to clinicopathological discordance. The marked renal improvement despite unchanged body weight suggests that lupus nephritis represented the principal pathological process, whereas hyperfiltration acted as an important disease modifier. Kidney MEDICUS No. 10, ISSUE 1/ 2026 61 biopsy remains indispensable for diagnosis and therapeutic decision-making in complex autoimmune overlap syndromes.
The growing prevalence of sedentary lifestyles and prolonged static working positions, particularly among office workers, has contributed significantly to the development of postural dysfunctions. These dysfunctions are commonly associated MEDICUS No. 10, ISSUE 1/ 2026 129 with musculoskeletal pain, especially in the cervical region, but their influence on cardiorespiratory function remains underexplored in clinical practice. This paper aims to analyze the relationship between postural alterations, muscular activity, and respiratory mechanics, emphasizing the role of physiotherapy in optimizing cardiorespiratory function through the treatment of postural dysfunctions. A narrative and analytical review approach was adopted through the structured analysis of contemporary scientific literature indexed in PubMed, Scopus, PEDro, and Google Scholar. The review focused on studies investigating the interaction between posture, electromyographic activity, respiratory function, and neuromuscular control in sedentary populations and individuals with chronic neck pain. The analyzed evidence demonstrates that forward head posture, thoracic kyphosis, and reduced thoracic mobility negatively influence respiratory mechanics and ventilatory efficiency. Postural dysfunctions are associated with increased activation of cervical and accessory respiratory muscles, reduced diaphragmatic contribution, and decreased respiratory muscle performance. Integrated physiotherapeutic interventions combining postural correction, respiratory training, and neuromuscular re-education were shown to improve respiratory efficiency, reduce pain, and enhance functional performance. Postural dysfunctions should be considered multidimensional functional disorders that affect both musculoskeletal and cardiorespiratory systems. Physiotherapy plays a critical role in restoring the interaction between posture and respiration through integrated therapeutic approaches. Further empirical and longitudinal studies are needed to strengthen the evidence regarding the clinical effectiveness of these interventions.
Polypharmacy is an increasing challenge in modern clinical practice, particularly among older adults and patients with multimorbidity, chronic kidney disease, heart failure, diabetes, frailty, or cognitive impairment. Its clinical impact extends beyond the number of prescribed medicines and reflects the interaction between therapeutic burden, comorbidities, organ dysfunction, fragmented care, changing physiological reserve, and multiple prescribers. Traditional medication review remains essential but may be limited by incomplete medication histories, time constraints, fragmented records, and the difficulty of identifying clinically meaningful drug–drug, drug–disease, and drug–patient interactions. Artificial intelligence (AI) may support safer medication management by integrating prescribing data with diagnoses, laboratory values, clinical events, and patterns of healthcare use. Potential applications include medication reconciliation, prioritization of clinically relevant interactions, renal dose adjustment, adverse drug event prediction, recognition of prescribing cascades, and identification of patients most likely to benefit from structured medication review or deprescribing. However, the value of AI in polypharmacy management should not be measured by the number of alerts generated. Its most useful role may be to help clinicians distinguish theoretical medication-related risks from those that are likely to be clinically important for an individual patient. This requires transparent recommendations, reliable data, local validation, integration into clinical workflow, and clear professional accountability. This narrative clinical viewpoint discusses the opportunities, limitations, and ethical implications of AI in polypharmacy management. It argues that AI should function as a human-centered clinical decision-support tool that improves prioritization, supports multidisciplinary medication review, and preserves clinicianled and patient-centered prescribing decisions
Multiple myeloma (MM) is a hematologic malignancy with heterogeneous clinical presentations, often delaying diagnosis [1,3,4]. Renal impairment is one of its most frequent and severe complications, primarily due to light-chain cast nephropathy, 108 MEDICUS No. 10, ISSUE 1/ 2026 hypercalcemia-induced nephropathy, or nephrotoxic exposures [2,5,10]. We present a case of recurrent acute kidney injury (AKI), episodic hypercalcemia, progressive anemia, and disproportionately elevated inflammatory markers, including hyperferritinemia and markedly elevated D-dimer (>10,000 ng/mL),which initially suggested alternative etiologies such as infection, thromboinflammation, or macrophage activation, but may also reflect tumor activity [9,11]. Serial clinical deterioration ultimately led to a bone marrow aspirate confirming MM [8,13]. This case underscores the diagnostic challenges of MM when renal involvement and inflammatory dysregulation dominate the early clinical picture [6,12]. It highlights the importance of timely hematologic evaluation, repeated assessment of monoclonal components, and early suspicion of myeloma kidney in patients with unexplained recurrent renal dysfunction [2,5,10].
