Introduction:Infectious diseases exert systemic effects beyond localized inflammation, yet selective disruption of host metabolic pathways remains incompletely characterized. Carnitine-dependent fatty-acid transport is essential for mitochondrial energy production, and acquired deficiencies are rarely attributed to infection. Chronic bacteremia has not been clearly linked to functional impairment of this pathway. Case Presentation:A 34-year-old man with no prior metabolic or neuromuscular disease presented with subacute proximal muscle weakness, fasting intolerance, and episodic confusion following several weeks of constitutional symptoms. Evaluation demonstrated hypoketotic hypoglycemia (plasma glucose 46-54 mg/dL with β-hydroxybutyrate <0.3 mmol/L), elevated creatine kinase (peak 2,140 U/L), and reduced plasma free carnitine (12 μmol/L; reference 25-50 μmol/L), indicating impaired mitochondrial fatty-acid transport. Serial blood cultures isolated Achromobacter xylosoxidans, confirming persistent bacteremia. Alternative endocrine, metabolic, and immunologic causes were excluded. Discussion:Resolution of metabolic abnormalities following targeted antimicrobial therapy supports an acquired and reversible disruption of fatty-acid transport. Potential mechanisms include inflammation-mediated renal carnitine loss and host-pathogen metabolic competition during prolonged bacteremia. Conclusion:Chronic Achromobacter xylosoxidans bacteremia may be associated with reversible secondary carnitine deficiency and selective impairment of fatty-acid transport. Plasma free carnitine normalized after antimicrobial therapy and short-term L-carnitine supplementation, with no recurrence during six months of follow-up. Metabolic evaluation should be considered in patients with unexplained hypoketotic hypoglycemia and persistent bloodstream infection.

The 2026 cruise-linked Andes virus (ANDV) outbreak represents a rare but high-consequence travel-associated zoonotic event, combining likely land-based acquisition before embarkation, limited onboard human-to-human transmission, delayed clinical recognition, and multinational public health coordination. This narrative review synthesizes current evidence on the outbreak, ANDV biology, transmission dynamics, clinical presentation, diagnostics, management, and implications for maritime and expedition travel medicine. As of 2 July 2026, the World Health Organization (WHO) had reported 13 cases linked to the motor vessel (M/V) Hondius outbreak, including 12 laboratory-confirmed infections, one probable case, and three deaths. Following completion of the 42-day follow-up period for all identified contacts without additional secondary cases, WHO considered transmission interrupted and the outbreak contained. Available evidence supports likely land-based acquisition before embarkation followed by limited onboard human-to-human transmission, without sustained spread. Severe hantavirus cardiopulmonary syndrome may begin with nonspecific fever, malaise, myalgia, gastrointestinal symptoms, or respiratory complaints, then progress abruptly to pulmonary oedema, shock, and fatal cardiopulmonary collapse. Because no licensed antiviral therapy or vaccine is available, early recognition, cautious fluid management, intensive supportive care, ventilatory support, and timely transfer to intensive care or extracorporeal membrane oxygenation-capable centres remain central. The outbreak highlights critical preparedness gaps in shipboard triage, contact tracing, specimen transport, genomic surveillance, risk communication, and cross-border follow-up. Strengthening One Health-informed pre-travel counseling, post-travel symptom surveillance, and maritime outbreak protocols is essential for future expedition-associated zoonotic threats.

Introduction: Pseudomonas aeruginosa is a frequent cause of healthcare-associated infections and is increasingly encountered in extensively drug-resistant (XDR) or pan-drug-resistant (PDR) forms. Such strains leave clinicians with virtually no therapeutic options and carry high mortality. Case Presentation: We describe a 66-year-old man with chronic hypoxic respiratory failure, chronic kidney disease, and recurrent infections who was admitted with septic shock. Initial broad-spectrum antibiotics were ineffective, and cultures yielded PDR Pseudomonas aeruginosa , resistant to cefiderocol and with borderline colistin susceptibility (MIC 2 µg/mL). Antimicrobial susceptibility testing was performed by broth microdilution on a Thermo Fisher Sensititre™ GNX3F panel, with colistin MIC confirmed by reference broth microdilution; results were interpreted per EUCAST v13.0 (2025) and CLSI M100 (2025). Despite high-dose intravenous colistin, cefiderocol, and adjunctive amikacin, the infection persisted, leading to progressive multi-organ dysfunction. Colistin dosing was adjusted for renal insufficiency and subsequently for continuous renal replacement therapy (CRRT). Meropenem (MIC 8 µg/mL; resistant) was trialed in combination with colistin for potential pharmacodynamic synergy. After 12 days of intensive care, and following discussion with family, care was redirected to comfort measures, and the patient died. The cause of death was refractory septic shock due to PDR Pseudomonas aeruginosa with multi-organ failure. Discussion: This case illustrates the therapeutic futility posed by pan-drug-resistant (PDR) Pseudomonas aeruginosa . Colistin’s limited efficacy at borderline MICs, compounded by renal impairment, constrained dosing. Even newer agents such as cefiderocol proved ineffective. Experimental therapies, including bacteriophages, novel β-lactamase inhibitors, and antimicrobial peptides, remain unavailable in most clinical settings. Conclusion: PDR Pseudomonas aeruginosa represents an urgent global threat. Until novel therapies become accessible, stringent stewardship, infection control, and preventive strategies remain the most effective defenses.

Widespread affection for urban stray animals in India, fueled by viral social media trends, is inadvertently escalating the risk of zoonotic viral transmission. Close, unregulated human contact with stray dogs, pigeons, cats, and urban macaques often lacking systematic health monitoring creates potent spillover pathways for rabies virus, pigeon paramyxovirus, feline coronaviruses, and Cercopithecine herpesvirus 1. Feeding hotspots and informal rescue efforts bypass public health safeguards and veterinary oversight, while algorithm-driven digital content normalizes high-risk behaviors without accountability. In densely populated cities lacking effective surveillance or enforcement of animal control laws, such interactions reshape urban epidemiology by promoting unmonitored viral corridors. Public sentiment, though rooted in empathy, increasingly impedes evidence-based policies and sterilization programs. The convergence of digital romanticization, administrative gaps, and cultural permissiveness fosters a climate in which emotional engagement overshadows viral threat recognition. A recalibration of this trend through integrated One Health interventions is urgently needed to prevent emotional goodwill from enabling viral harm.

Introduction:Pseudomonas aeruginosa is a frequent cause of healthcare-associated infections and is increasingly encountered in extensively drug-resistant (XDR) or pan-drug-resistant (PDR) forms. Such strains leave clinicians with virtually no therapeutic options and carry high mortality. Case Presentation:We describe a 66-year-old man with chronic hypoxic respiratory failure, chronic kidney disease, and recurrent infections who was admitted with septic shock. Initial broad-spectrum antibiotics were ineffective, and cultures yielded PDR Pseudomonas aeruginosa, resistant to cefiderocol and with borderline colistin susceptibility (MIC 2 µg/mL). Antimicrobial susceptibility testing was performed by broth microdilution on a Thermo Fisher Sensititre™ GNX3F panel, with colistin MIC confirmed by reference broth microdilution; results were interpreted per EUCAST v13.0 (2025) and CLSI M100 (2025). Despite high-dose intravenous colistin, cefiderocol, and adjunctive amikacin, the infection persisted, leading to progressive multi-organ dysfunction. Colistin dosing was adjusted for renal insufficiency and subsequently for continuous renal replacement therapy (CRRT). Meropenem (MIC 8 µg/mL; resistant) was trialed in combination with colistin for potential pharmacodynamic synergy. After 12 days of intensive care, and following discussion with family, care was redirected to comfort measures, and the patient died. The cause of death was refractory septic shock due to PDR Pseudomonas aeruginosa with multi-organ failure. Discussion:This case illustrates the therapeutic futility posed by pan-drug-resistant (PDR) Pseudomonas aeruginosa. Colistin's limited efficacy at borderline MICs, compounded by renal impairment, constrained dosing. Even newer agents such as cefiderocol proved ineffective. Experimental therapies, including bacteriophages, novel β-lactamase inhibitors, and antimicrobial peptides, remain unavailable in most clinical settings. Conclusion:PDR Pseudomonas aeruginosa represents an urgent global threat. Until novel therapies become accessible, stringent stewardship, infection control, and preventive strategies remain the most effective defenses.

Introduction: Extraskeletal Ewing’s sarcoma (EES) of diaphragmatic origin is exceptionally rare, with few cases documented. Preoperative diagnosis is challenging due to overlapping clinical and radiologic features with more common hepatic and retroperitoneal pathologies. Case presentation: A 17-year-old male presented with dyspnea, abdominal distension, and subacute intestinal obstruction. Imaging suggested a large cystic hepatic lesion. Exploratory laparotomy revealed a vascular diaphragmatic tumor with metastatic seedlings. Definitive resection via right posterolateral thoracotomy included partial diaphragm and rib excision with polypropylene mesh reconstruction. Histopathology and immunohistochemistry confirmed EES. Molecular confirmation using fluorescence in situ hybridization (FISH) demonstrated EWSR1 gene rearrangement. Adjuvant multi-agent chemotherapy and radiotherapy were administered, following the vincristine-doxorubicin-cyclophosphamide alternating with ifosfamide-etoposide (VDC/IE) regimen and conformal intensity-modulated radiotherapy (IMRT) to 45 Gray. At 10-month follow-up, the patient remained in complete remission. Discussion: Diaphragmatic EES presents unique diagnostic and surgical challenges due to its location and proximity to vital structures. Complete surgical excision with functional reconstruction, combined with multimodal adjuvant therapy, offers the best potential for local control and long-term survival. Vigilant surveillance is necessary given the early recurrence risk. Conclusion: EES should be considered in the differential diagnosis of large diaphragmatic masses. Coordinated multidisciplinary management enables effective treatment, and detailed reporting of such presentations enhances the collective understanding of rare tumor sites.

This review explores the bidirectional relationship between mental health disorders and cardiovascular disease (CVD), highlighting the potential of integrated healthcare models to improve outcomes. While CVD remains the leading cause of global mortality, traditionally linked to risk factors like hypertension and diabetes, emerging evidence shows that mental health conditions, especially depression and anxiety, significantly increase CVD risk through mechanisms such as chronic stress, inflammation, and neuroendocrine dysregulation. Activation of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system exacerbates inflammation, elevates blood pressure, and contributes to cardiovascular risk factors. Moreover, the psychological burden of CVD often worsens mental health, creating a vicious cycle that complicates treatment adherence and patient management. Integrated care models offer a holistic approach to address these interconnected issues, potentially improving clinical outcomes, reducing healthcare costs, and enhancing patient adherence. This review also explores the role of telehealth and digital health interventions in overcoming accessibility barriers, particularly for underserved populations. Finally, policy recommendations emphasize the need for increased funding, professional training in interdisciplinary care, and targeted outreach to ensure equitable access to integrated care. By addressing both CVD and mental health challenges, these models could improve quality of life and reduce the global burden of these intertwined diseases.

Modern studies have linked gut microbiota to metabolic syndrome - a condition linked to obesity, characterized by insulin resistance, dyslipidemia, hyperglycemia, and hyperlipidemia. The gut microbiota, influenced by diet, plays a pivotal role in metabolic syndrome, affecting energy absorption, metabolism, and immune responses. Dysbiosis disrupts energy metabolism and immune responses contributing to metabolic endotoxemia, leading to insulin resistance and systemic inflammation. Key metabolites like short-chain fatty acids and bile acids, modulate insulin sensitivity and metabolic pathways. Therapeutic strategies involving probiotics and prebiotics show potential in managing diabetes and cardiovascular diseases by targeting lipid metabolism, inflammation, and atherosclerosis. However, challenges in therapy standardization and regulatory approval remain. Continued research on gut microbiota's role in metabolic syndrome could lead to innovative, personalized treatment and prevention strategies based on individual metabolic profiles. The review aims to elucidate the underlying mechanisms that influence metabolic health and cardiovascular function. It seeks to synthesize current research findings, highlighting the role of microbial composition, diversity, and metabolic byproducts in the modulation of host metabolism and cardiovascular outcomes.

Background: Several studies have reported a reduced risk of COVID-19-related mortality in patients taking antidiabetic medications. This is an umbrella review, meta-analysis, and Bayesian sensitivity assessment of SGLT2 inhibitors (SGLT2is) in COVID-19 patients with type 2 diabetes mellitus (T2DM). Methods: A search was conducted on the MEDLINE (PubMed), EMBASE, Cochrane, and ClinicalTrials.gov databases on 5/12/2023. We performed an umbrella review of systematic reviews and meta-analyses on the effects of SGLT2is in T2DM patients with COVID-19 and critically appraised them using AMSTAR 2.0. Trials investigating SGLT2i use in COVID-19 patients post-hospitalisation and observational studies on prior SGLT2i use among COVID-19 patients were included in the meta-analysis, adhering to the PRISMA guidelines. Results: SGLT2is exhibited significantly lower odds of mortality (OR 0.67, 95% CI 0.53–0.84) and hospitalisation (OR 0.84, 0.75–0.94) in COVID-19 patients with T2DM. Bayesian sensitivity analyses corroborated most of the findings, with differences observed in hospitalisation and mortality outcomes. SGLT-2 inhibitors showed an OR of 1.20 (95% CI 0.64–2.27) for diabetic ketoacidosis. Publication bias was observed for hospitalisation, but not for mortality. The GRADE assessment indicated a low to very low quality of evidence because of the observational studies included. Conclusions: The prophylactic use of SGLT2is reduces mortality and hospitalisation among COVID-19 patients, particularly in patients with diabetes. The utility of SGLT2is after hospitalisation is uncertain and warrants further investigation. A limited efficacy has been observed under critical conditions. Individualised assessment is crucial before integration into COVID-19 management.

Vitamin D deficiency is a significant public health concern that affects bone health and muscle function in children, especially in developing countries. The COVID-19 pandemic has intensified this issue because lockdowns have reduced sunlight exposure. We report a rare case of a 13-year-old Indian boy who developed severe proximal myopathy induced by vitamin D deficiency during the pandemic. The patient presented with generalized body aches, progressive lower limb weakness, difficulty walking, waddling gait, and a positive Gower’s sign. Laboratory tests revealed severe hypovitaminosis D (25[OH]D level, 3.8 ng/ml), hypocalcemia, hypophosphatemia, elevated parathyroid hormone, and elevated alkaline phosphatase levels. Electromyography and nerve conduction study results were normal. The patient was diagnosed with vitamin D deficiency-induced proximal myopathy and osteomalacia, likely due to reduced sunlight exposure, inadequate dietary intake, and obesity. The treatment involved high-dose vitamin D supplementation, oral calcium, lifestyle modifications, and a structured physiotherapy program focusing on resistance training and functional mobility exercises. Despite biochemical normalization after 2 months, significant symptomatic improvement was achieved only after intensifying physiotherapy. By 7 months, the patient had fully recovered muscle strength, achieved normal gait, and maintained normal follow-up laboratory values. This case emphasizes the importance of considering vitamin D deficiency in children with muscle weakness during periods of limited sunlight exposure, and highlights the need for a multidisciplinary approach for effective management and full functional recovery.

Introduction:Zinner Syndrome is a rare congenital anomaly involving unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ejaculatory duct obstruction. We report a symptomatic case managed conservatively. Case Presentation:A 19-year-old male presented with 6 months of intermittent pelvic pain, dysuria, and ejaculatory discomfort. Examination was unremarkable. Ultrasonography showed right renal agenesis and a pelvic cyst. MRI confirmed a 2.8 cm cystic dilatation of the right seminal vesicle with vas deferens dilatation and absent right kidney. No ectopic renal tissue was seen. Semen analysis revealed oligospermia. Given mild symptoms and fertility concerns, he was treated conservatively with NSAIDs and antibiotics, resulting in symptom improvement within 4 weeks. Surveillance was planned. Conclusion:Zinner Syndrome should be considered in young males with unexplained pelvic or ejaculatory symptoms. MRI is essential for accurate diagnosis. Conservative treatment is suitable for mild cases, reserving surgery for progressive symptoms or fertility issues.

Listeria monocytogenes remains a major public health concern due to its ability to survive in diverse environments, including under refrigerated conditions, and cause severe illness in vulnerable populations. In July 2024, a Listeria outbreak linked to deli-sliced meats in the United States resulted in 61 confirmed cases, 60 hospitalizations, and 10 deaths across 19 states, underscoring persistent challenges in food safety. Historical outbreaks involving dairy, produce, and processed meats highlight the complexity of contamination routes and the importance of comprehensive preventive measures. As an intracellular pathogen, Listeria requires prompt diagnosis and targeted antibiotic therapy, typically involving ampicillin and gentamicin. Control efforts are complicated by the bacterium’s propensity for biofilm formation and its resilience under cold storage. Advances in sanitation protocols, whole-genome sequencing, and public health initiatives are key to reducing the incidence of listeriosis. Nevertheless, continued outbreaks emphasize the need for rigorous food safety practices, high-risk population awareness, and ongoing surveillance.