Annals of Medicine and Surgery最新文献

The respiratory syncytial virus (RSV) remains the primary cause of acute lower respiratory tract infections and mortality among infants worldwide, with disproportionate deaths in low- and middle-income countries due to limited access to supportive care. The U.S. Food and Drug Administration recently approved clesrovimab, a single-dose monoclonal antibody aimed at protecting infants during their first RSV season. Key phase 2b/3 clinical trials demonstrated clesrovimab's significant efficacy in reducing RSV-associated hospitalizations by 84.3% and medically attended lower respiratory infections by 60.5%, with a safety profile comparable to existing prophylactic treatments in high-risk pediatric populations. The approval marks a significant advancement for infant RSV prevention in high-income settings, but to effectively reduce the global burden, particularly in resource-limited environments, equitable access and affordability must be prioritized. This intervention offers a vital opportunity to decrease RSV-related morbidity and mortality among vulnerable infants worldwide.

Neutrophil extracellular traps (NETs) represent a critical defensive mechanism against pathogens. However, dysregulated NETs have been implicated in a range of pathological conditions. More recently, increasing attention has been given to its implications in perioperative settings. This has led to increasing interest in how common anesthetics would modulate the neutrophil ability to form NETs. Although their ability to modulate the immune system has long been recognized, a better understanding of the impact of common anesthetics on NETs release is still needed. This may reveal considerations for optimizing immune function and personalizing anesthetic techniques, especially for vulnerable perioperative and intensive care unit patients. In this review, we comprehensively discuss recent advancements in understanding the role of common anesthetics in modulating the capacity of neutrophils to form NETs and the related mechanisms. Gaining insights into the effects of anesthetics on NETs may guide new strategies to reduce complications and improve the recovery and survival of perioperative and ICU patients.

Introduction and importance: Kartagener syndrome, or primary ciliary dyskinesia (PCD), is a rare inherited disorder marked by situs inversus, bronchiectasis, and chronic sinusitis due to impaired motile cilia. Systemic lupus erythematosus (SLE) is an autoimmune condition characterized by multisystem inflammation, most commonly affecting skin, joints, kidneys, and other systems. To date, the association between PCD and SLE has not been described. Recognizing this overlap in understanding the interaction between the genetic and autoimmune pathways, ultimately informing tailored diagnostic and therapeutic strategies.

Case presentation: A 49-year-old male with a history of Kartagener syndrome, SLE, and visceral inversion presented with multi-system complaints: significant weight loss, fatigue, grade IV dyspnea, diarrhea, vomiting, and fever. Clinical evaluation revealed bilateral pulmonary infiltrates, pleural effusion, and severe renal dysfunction. Laboratory findings showed anemia, electrolyte imbalances, and elevated inflammatory markers. Treatment included IV fluids with electrolyte correction, broad-spectrum antibiotics, and immunosuppressive agents, alongside oral supplements.

Clinical discussion: This case spotlights the delicate balance between infection control in PCD and immunosuppression for SLE. Chronic mucociliary clearance defects may perpetuate antigenic stimulation, potentially exacerbating autoimmunity, whereas aggressive immunomodulation can heighten infection risk. No mechanistic link has been established, but our experience underscores the need for integrated multidisciplinary care. Future studies should explore immune profiling in PCD to identify predisposition toward autoimmune disorders.

Conclusion: This first-reported concurrence of Kartagener syndrome and SLE emphasizes the importance of holistic evaluation in patients with complex genetic and autoimmune conditions. Awareness of potential cross-talk between ciliary dysfunction and systemic autoimmunity may enhance diagnostic precision and guide individualized management.

Background and objective: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that predisposes individuals to multiple organ involvement, with renal complications, particularly lupus nephritis (LN), which is common and clinically significant. The classification and prognosis of LN largely depend on renal biopsy findings, including histopathology, direct immunofluorescence (IF), and electron microscopy. This study aimed to correlate clinicopathological features of SLE patients with LN classes according to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification.

Methods: This retrospective cohort study was conducted over 5 years and included 65 patients with biopsy-proven LN. Patients were categorized into six histological classes based on the ISN/RPS 2003 classification. Demographic, clinical, laboratory, histopathological, and IF data were collected and correlated. Statistical analysis was performed, and a P-value < 0.05 was considered significant.

Results: Anemia was the most frequent hematological abnormality. Class IV LN was the predominant histologic subtype in 56.92% of the cases. Statistically significant associations were found between LN class and serum creatinine level, estimated glomerular filtration rate, proteinuria, and activity index. Interstitial fibrosis and tubular atrophy significantly correlated with elevated serum creatinine levels.

Conclusion: This study highlights strong clinicopathological correlations in LN, especially between renal function parameters and histological indices. The integration of routine renal profiles, urine analysis, and histological scoring can guide clinical decision-making and underscore the utility of repeat biopsies during follow-up.

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have shown promise in treating heart failure (HF), but the best choice among these drugs remains unclear. This study aims to compare the effectiveness and safety of different SGLT2is in HF patients.

Methods: We conducted a comprehensive search of 5 databases (PubMed, Scopus, Web of Science, Embase, and ClinicalTrials.gov) for randomized controlled trials (RCTs) conducted up until March 2023. These trials had to compare SGLT2i medications to a placebo in patients with HF. The main outcomes were all-cause mortality, cardiovascular mortality, hospitalization due to HF, and myocardial infarction (MI). Furthermore, we calculated the risk ratio (RR) with a 95% confidence interval (CI) using the random-effects model and inverse variance statistics.

Results: We included 16 RCTs involving 80 666 patients (43 743 on SGLT2 inhibitors, 36 923 on placebo). No SGLT2 inhibitor demonstrated a significant difference in all-cause mortality and MI compared to others. However, empagliflozin significantly reduced the risk of cardiovascular mortality by 20% (RR: 0.80, 95% CI 0.69-0.93), including in patients with diabetes. All SGLT2 inhibitors lowered the risk of hospitalization for HF compared to placebo, except for canagliflozin. Sotagliflozin had the greatest reduction in hospitalizations (RR: 0.66, 95% CI 0.57-0.76), followed by empagliflozin (RR 0.73, 95% CI 0.66-0.81). There were no significant differences among SGLT2 inhibitors for stroke or drug discontinuation due to side effects. Notably, empagliflozin had a 13% lower risk of serious adverse events (RR 0.87, 95% CI 0.76-0.99).

Conclusion: Empagliflozin was associated with the lowest risk of both cardiovascular mortality and serious side effects. While all SGLT2 inhibitors reduced the likelihood of hospitalizations for HF, canagliflozin did not show a significant benefit in this area. There were no significant differences between the SGLT2 inhibitors in terms of all-cause mortality, MI, stroke, or side effects leading to treatment discontinuation.

Background: Colorectal cancer (CRC) ranks as the third most prevalent malignancy worldwide, yet early detection rates remain suboptimal. Diagnostic biomarkers hold significant promise for improving early CRC detection. This study conducts a bibliometric and visualization analysis to elucidate global research trends in diagnostic biomarkers for CRC.

Methods: A dataset of 255 publications was extracted from the Web of Science Core Collection (WoSCC) spanning from 1 January 2014 to 10 September 2024. CiteSpace, VOSviewer, and Excel were employed for comprehensive analysis of authorship patterns, journal distribution, institutional contributions, geographic focus, keyword co-occurrence, and citation networks.

Results: Publication volumes demonstrated an initial upward trajectory, peaking in 2021 before a slight decline. China emerged as the leading contributor, followed by Egypt, Iran, and the United States, with the Egyptian Knowledge Bank identified as the most prolific institution. Keyword analysis revealed concentrated research interests in Colorectal Cancer, Genetic Markers, Long Non-Coding RNAs (lncRNAs), Proteins, DNA Methylation, and MicroRNAs.

Conclusion: Genomic, proteomic, and non-coding RNA biomarkers represent the primary research frontiers in CRC diagnostics. Future investigations should prioritize multi-institutional cohort studies and integrated multi-omics approaches to validate and refine biomarkers for clinical implementation in early CRC screening programs.

Introduction and importance: Kounis syndrome (KS), a rare allergic reaction-induced myocardial injury, can be triggered by various allergens, such as antibiotics (including ceftriaxone). Ceftriaxone carries a higher risk of anaphylactoid reactions compared to other antibiotics.

Presentation of case: A 65-year-old female from Ethiopia presented with 3 days of nausea, diarrhea, vomiting, abdominal pain, fever, and fatigue. Examination revealed tachycardia and fever. Initial tests, including electrocardiography (ECG), were normal, except for leukocytosis. Sepsis from a gastrointestinal source was suspected, and she was started on intravenous fluids, metronidazole, and ceftriaxone. Immediately after the first dose of ceftriaxone, she developed signs of anaphylaxis. Repeat ECG revealed diffuse ST-segment elevation and atrial fibrillation. Ceftriaxone-induced KS was suspected. Anti-ischemic treatment and supportive care were initiated with discontinuation of ceftriaxone. After 2 hours, her ECG normalized. Troponin and echo were normal. She improved and was discharged after 5 days.

Clinical discussion: Ceftriaxone-induced KS is a rare, potentially fatal manifestation of allergic reactions to ceftriaxone, affecting about 1.1%-3.4% of all allergic reactions. Although the exact mechanism is unknown, this immune-mediated reaction results in significant effects on the cardiovascular system. KS is classified into three types based on the underlying cause and is typically managed by immediate discontinuation of the triggering agent, but it still carries a high in-hospital mortality rate of approximately 7%. Suspicion should be high in allergic drug reactions.

Conclusion: Ceftriaxone-induced KS is a rare but dangerous complication of ceftriaxone allergy. Improving outcomes requires a focus on prevention through detailed allergy histories, prompt diagnosis, and better healthcare resources.

In June 2025, the FDA approved Lenacapavir, a twice-yearly injectable for HIV pre-exposure prophylaxis (PrEP), following striking trial results showing near-perfect efficacy. This long-acting injectable represents a game-changing innovation, promising to transform HIV prevention by reducing pill burden, stigma, and adherence challenges for individuals at high risk of infection. However, despite its potential, Lenacapavir is being launched into a system where access to life-saving treatments remains deeply unequal. Currently priced at over $28 000 annually in the United States, Lenacapavir may remain out of reach for millions in low- and middle-income countries (LMICs) unless global action is taken. Although, Gilead Sciences has entered voluntary licensing agreements, historical patterns suggest that production, registration, and distribution delays may once again exclude the most vulnerable. Without enforceable commitments, voluntary mechanisms risk perpetuating the same global health divides that once delayed antiretroviral access across sub-Saharan Africa. This perspective argues that Lenacapavir's success must not be judged by regulatory approval alone, but by the speed and scale of equitable implementation. Unless governments, funders, and civil society act now, this biomedical triumph could widen the very disparities it seeks to overcome. The breakthrough and advancement is real but so is the risk of leaving millions behind.

Cannabidiol (CBD) has gained significant attention for its potential therapeutic benefits, but its safety profile in healthy populations remains underexplored. This systematic review and meta-analysis aim to evaluate the safety of CBD compared to placebo in healthy adults. A comprehensive search of PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov identified four randomized controlled trials (RCTs) involving 269 healthy adults. The primary outcome was headache, with secondary outcomes including fatigue, abdominal pain, diarrhea, upper respiratory tract infection (URTI), and dizziness. The results revealed that CBD use was associated with a significantly higher risk of diarrhea (RR = 5.85; 95% CI = 1.14-30.02; P = 0.03). While there was a trend toward increased abdominal pain and headache, these results were not statistically significant. Fatigue, dizziness, and URTI showed no significant differences between the CBD and placebo groups. These findings suggest that while CBD appears safe for short-term use in healthy adults, gastrointestinal side effects, particularly diarrhea, should be monitored. Further large-scale studies with longer follow-up periods are warranted to confirm these results and explore long-term safety.