Drugs in Context最新文献

Cutaneous pseudolymphomas (CPLs) comprise a heterogeneous group of benign lymphoid proliferations that simulate cutaneous lymphomas both clinically and histologically. Numerous causes have been identified, including infections, arthropod bites, tattoos and drugs. With the expanding use of biologic therapies for chronic inflammatory dermatoses, a growing number of drug-related CPLs have been reported. Although tumour necrosis factor inhibitors are most frequently implicated, emerging evidence suggests that other biologic therapy classes may also trigger lymphoid hyperplasia through immune dysregulation. We provide a concise narrative review of biologics-induced CPLs and illustrate the topic with the first reported case of brodalumab-induced pseudolymphoma in a patient with psoriasis. Understanding this rare adverse event is crucial for early recognition, correct histopathological interpretation and appropriate management.

Background: Neonatal sepsis is a serious and life-threatening condition with high morbidity and mortality, especially in preterm neonates in a Neonatal Intensive Care Unit (NICU). This article provides an updated review on the aetiology and diagnosis of neonatal sepsis, antibiotic management and antibiotic stewardship.

Methods: A literature search was conducted in PubMed, Embase, Cochrane Library and Scopus in January 2025, using the following MeSH terms: "sepsis", "neonate" and "antibiotic". Meta-analyses, randomized controlled trials, clinical trials and reviews published in the English language from 2005 to 2025 with patients in the neonatal age group were included. A total of 715 articles were identified and screened, and 85 studies were included in the final review.

Results: Neonatal sepsis remains a leading cause of mortality, with distinct pathogens identified in early-onset and late-onset sepsis, ventilator-associated pneumonia, urinary tract infection and fungal infections. Early recognition, accurate diagnosis and timely commencement of empirical antibiotics are paramount for improved outcomes. Fungal prophylaxis is considered for at-risk neonates in some NICUs with a high incidence of fungal infection. Universal group B Streptococcus screening decreased the incidence of early onset sepsis, but the emergence of resistant strains of certain organisms present new challenges. Evidence-based antibiotic prescription guidelines, antibiotic stewardship programmes and quality improvement projects are essential for the prevention of antimicrobial resistance in the NICU.

Conclusion: Effective management of neonatal sepsis relies on early pathogen identification, judicious use of antibiotics and good antimicrobial stewardship. Future research directions include development of evidence-based protocols and improvement of rapid diagnostic techniques, combined with close monitoring and individualized care.

Background: Chronic venous disease and lymphoedema frequently coexist, leading to significant symptom burden and impaired quality of life (QoL). Phlebotonic agents, such as diosmin, Ruscus aculeatus, Melilotus officinalis and Vitis vinifera, have demonstrated complementary anti-inflammatory, venotonic and lymphokinetic effects. However, real-world evidence on their combined use remains limited.

Methods: The VIVEMA Stasis study was a retrospective observational analysis conducted in a real-world clinical setting. Adult patients with lower limb venous and/or lymphatic oedema received a 30-day treatment with a standardized formulation containing diosmin, R. aculeatus, M. officinalis and V. vinifera extracts, in addition to compression therapy. The primary endpoint was improvement in health-related QoL, assessed using the CIVIQ-14 questionnaire. Secondary endpoints included changes in symptom burden and limb circumference measurements.

Results: Fifty-one patients (mean age 54.0 years; 84.3% female) were included. After 30 days, significant improvements were observed in QoL (global CIVIQ-14 score: p<0.001), with reductions in pain, sleep disturbance and functional limitations. Objective measurements showed significant reductions in both ankle and calf circumferences (median reduction: 0.40 cm and 0.50 cm, respectively; p<0.001). Symptom burden scores improved significantly (median increase from 19.0 to 25.0; p=0.002), especially for swelling, heaviness and fatigue. No adverse events were reported.

Conclusion: In this real-world setting, a short-term integrative treatment with a phlebotonic formulation combining diosmin, R. aculeatus, M. officinalis and V. vinifera significantly improved QoL, symptom burden and oedema in patients with chronic venous and lymphatic disease. These findings support the therapeutic potential of combined phlebotonic therapy alongside standard care.

The persistent global burden of HIV and the need for more flexible, durable prevention strategies have accelerated the development of long-acting pre-exposure prophylaxis (PrEP) options. Lenacapavir (LEN), a first-in-class capsid inhibitor, is approved as a twice-yearly subcutaneous injection for HIV prevention and represents a major advance beyond oral injectable PrEP regimens administered daily or every 2 months. Data from phase III trials demonstrate high efficacy, sustained drug levels and strong adherence potential, positioning LEN as a transformative option for individuals seeking long-acting protection. Its unique mechanism of action and extended dosing interval can address key barriers to PrEP uptake and persistence, particularly amongst populations disproportionately at risk for HIV. LEN may play a central role in expanding choice and improving the real-world effectiveness of PrEP. Ongoing considerations include implementation logistics, equitable access, potential drug resistance and integration into existing prevention frameworks. Twice-yearly LEN is a critical addition to the evolution of HIV prevention strategies.

Ustekinumab, an IL-12/IL-23 inhibitor with an established safety profile, has recently been associated with paradoxical cutaneous immune reactions. Amongst these, morphoea developing during therapy represents a rare but mechanistically relevant phenomenon that highlights cytokine imbalance in skin homeostasis. We performed a systematic review of published cases of morphoea occurring in patients treated with ustekinumab to better define their clinical and therapeutic patterns, and coupled it to the description of a new case of morphoea in a patient receiving ustekinumab for Behçet disease. A search of PubMed, Web of Science and SciELO through October 2025 identified six eligible reports. Patients (median age 55.5 years) received ustekinumab for psoriasis, psoriatic arthritis or inflammatory bowel disease. Morphoea developed after 6-64 months of treatment and presented exclusively as plaque-type lesions with one showing overlap with lichen sclerosus. Discontinuation of ustekinumab led to improvement or remission in most patients, whilst continued therapy was associated with progression in one case. The temporal pattern, morphology and response to withdrawal support a drug-related effect, potentially reflecting a shift from a T helper 1 (T_H1)/T_H17 pathway towards profibrotic T_H2 and TGFβ pathways. Interpretation is limited by the very small number of published cases, heterogeneity of clinical descriptions, and lack of standardized diagnostic or therapeutic criteria, restricting firm causal inference. Despite these limitations, awareness of this paradoxical reaction is important for timely recognition and management. Further mechanistic investigation and pharmacovigilance are needed.

[This corrects the article DOI: 10.7573/dic.2025-8-3.].

[This corrects the article DOI: 10.7573/dic.2025-3-2.].

The management of chronic obstructive lung diseases, particularly severe asthma, chronic obstructive pulmonary disease (COPD) and non-cystic fibrosis bronchiectasis, is complicated by frequent overlap syndromes such as asthma-bronchiectasis overlap and bronchiectasis-COPD overlap syndrome. These overlapping phenotypes are characterized by severe symptoms, frequent exacerbations, accelerated lung function decline and increased mortality, driven by a common, destructive endotype: persistent, neutrophil-dominant airway inflammation. This inflammation is fuelled by the overactivity of neutrophil serine proteases, notably neutrophil elastase, which drives the self-perpetuating 'vicious vortex' of structural damage and infection. Traditional therapies, including inhaled corticosteroids and type 2 (T2) inflammation-targeted biologics, are often ineffective against this non-T2, neutrophilic inflammation. Brensocatib, a first-in-class, oral, reversible inhibitor of dipeptidyl peptidase 1 (DPP1), offers a novel, targeted strategy. By inhibiting DPP1 - the master activator of neutrophil serine proteases in the bone marrow - brensocatib effectively 'disarms' neutrophils before they reach the lungs. The phase III ASPEN trial in non-cystic fibrosis bronchiectasis demonstrated its disease-modifying potential, showing a significant reduction in the annualized rate of exacerbations and, critically, a statistically significant slowing of the decline in forced expiratory volume in 1 second in the 25 mg arm (a benefit not observed with the 10 mg dose). Subgroup analysis confirmed consistent efficacy in the high-risk bronchiectasis-COPD overlap syndrome population. These findings validate DPP1 inhibition as a first potential disease-modifying therapy. This strategy is poised to fundamentally shift clinical focus from symptom control to the preservation of lung function for patients with severe, neutrophilic-driven neutrophilic overlap syndromes.

Background: Acute ischaemic heart disease (AIHD) and atherothrombotic stroke are amongst the leading causes of mortality and disability worldwide, sharing pathogenic mechanisms. Quality indicators (QIs) are essential tools for evaluating and optimizing clinical management. The aim of this article is to develop an integrated organizational model for the care of AIHD and atherothrombotic stroke, incorporating validated and measurable QIs to improve patient outcomes and care coordination.

Methods: A multidisciplinary panel of cardiologists, neurologists, internists, primary care physicians and nursing staff reached a consensus through structured meetings. After reviewing the literature and scientific recommendations, the most relevant QIs were selected. When clear standards were lacking, the panel established criteria by consensus. The selected QIs were integrated into a care pathway covering the pre-hospital phase through long-term follow-up.

Results: Sixteen key QIs were identified for each process, covering intervention times, secondary prevention, patient satisfaction, rehabilitation, follow-up and clinical outcomes. The model highlights the importance of rapid diagnosis, timely interventions and coordinated discharge planning. Early initiation of intensive lipid-lowering therapy and systematic monitoring of targets such as LDL-c and mortality are emphasized.

Conclusion: The proposed QIs and organizational model can be valuable tools for optimizing care and coordination for patients with AIHD and atherothrombotic stroke. They enable the monitoring and improvement of critical aspects of the care process.

Moist wound healing, an established paradigm in the management of wounds, accelerates healing by maintaining an optimal microenvironment. Hydrogels, such as the Dermatix^® Wound Care (DWC) gel, possess fluid-retentive and absorptive properties and provide a moist environment for wound healing. We examined the effectiveness of DWC gel in acute and chronic wounds across various aetiologies, alone and in combination with other modalities, through a series of case studies. DWC gel promoted granulation, epithelialization, pain relief and patient adherence due to its ease of application. It is an effective and safe treatment for acute and chronic wounds; further comparative trials and research on its anti-infective and anti-inflammatory properties are warranted.