Although current guidelines classify the natural history of chronic hepatitis B (CHB) into several immune phases, a substantial proportion of patients with CHB do not meet criteria for any of the defined immune phases and are considered to be in an indeterminate phase. We aim to perform a meta-analysis to systematically evaluate the prevalence, clinical presentation and outcome of indeterminate CHB patients classified according to American Association for the Study of Liver Diseases (AASLD) 2018 guidelines or European Association for the Study of the Liver (EASL) 2017 guidelines. We searched four databases from inception to Aug 21, 2024, for studies reporting the prevalence, characteristics and/or clinical outcomes of patients with indeterminate CHB classified according to AASLD 2018 guidelines or EASL 2017 guidelines. Of the 4553 studies initially identified, 50 studies met study inclusion criteria and were analysed. The prevalence of indeterminate patients was 38.90% (95% CI: 33.51-44.57) and 38.81% (95% CI: 31.22-46.99) by AASLD 2018 and EASL 2017 guidelines, respectively. Among indeterminate CHB patients, the pooled incidence rate per 1000 person-years for hepatocellular carcinoma and liver-related events was 5.36 (95% CI: 1.38-9.35) and 7.27 (95% CI: 0.00-22.21) per AASLD 2018 guidelines and 5.20 (95% CI: 1.41-8.99) and 9.79 (95% CI: 0.00-25.35) per EASL 2017 guidelines, respectively. Indeterminate phase affects nearly 40% of CHB patients who are at risk for hepatocellular carcinoma and liver-related adverse outcomes. Further research is needed to inform treatment strategies specifically tailored for the indeterminate CHB patients.

Hereditary Spastic Paraplegia (HSP) is a group of inherited neurodegenerative disorders primarily characterized by progressive lower limb spasticity and weakness. Among the various genetic causes of HSP, pathogenetic variants in SPG4/SPAST are the most frequently identified, making them the leading molecular cause of autosomal dominant HSP. The SPAST gene encodes spastin, a protein involved in microtubule dynamics. In this study, we focused on the functional characterization of two specific intronic variants in SPAST absent or present at a very low frequency in GnomAD database and with conflicting classification of pathogenicity, c.1245+5G>A and c.1493+2_1493+5del respectively. These variants were identified in two independent families, one of Brazilian origin and the other of Japanese descent. Our data shows that the splicing variants impact splicing. Furthermore, through segregation analysis and clinical assessments, we provided a detailed description of the affected individuals, emphasizing the clinical presentation associated with these genetic changes. Notably, in both families, the identified variants co-segregated symptoms consistent with anorexia nervosa, suggesting a potential, previously unrecognized association between SPAST pathogenic variants and disordered eating behaviors. Our findings contributed to the expanding clinical spectrum of SPG4-associated HSP and highlighted the importance of characterizing intronic SPAST variants. The characterization of intronic pathogenetic variants enhanced our understanding of their potential pathogenic mechanisms, which may have implications for both genetic diagnosis and the broader clinical management of HSP.

Introduction: Human adenoviral infections, though prevalent among children, are often under-reported. Although adenoviral infections are usually self-limiting, they can cause significant morbidity and hospitalisations in children. Aim: To evaluate the demographic, clinical, laboratory and radiological characteristics of paediatric patients hospitalised with Human Adenovirus (HAdV) infection. Materials and Methods: This was a hospital-based retrospective study conducted in the Paediatric Outpatient Department (OPD) and inpatient wards of Rainbow Children’s Hospital, Hyderabad, Telangana, India for a period of 11 months from February 2023 to December 2023. A total of 210 children aged one month to 16 years who tested positive for adenovirus by Polymerase Chain Reaction (PCR) on a nasopharyngeal swab were included in the study. The demographic, clinical, laboratory, and radiological profiles of these cases were analysed. The statistical analysis was performed using the IBM Statistical Package for Social Sciences (SPSS) software version 27.0 (Armonk, NY, USA). Results: Of the 210 children who tested positive for adenovirus, 126 (60%) were males and 129 (61.42%) were between one and five years of age. Notably, 141 children (67.14%) were hospitalised during the summer season. Most cases occurred during the summer months, predominantly among males aged 1-5 years. Symptoms included high-grade persistent fever in 205 cases (97.62%), cough and cold in 129 (61.42%), vomiting in 59 (28.1%) and loose stools in 27 (12.86%). Less frequent presentations were pneumonia in 12 cases (5.71%), seizures in 8 (3.81%), burning micturition in 5 (2.38%) and conjunctivitis in 4 (1.9%). Children were categorised into three groups: A, B and C- based on their clinical presentation as respiratory, gastrointestinal or mixed types, respectively. A significant difference in C-Reactive Protein (CRP) distribution was observed among the three groups (p-value <0.0001). CRP positivity (>10 mg/L) was most frequent in group A, 78/99 (78.8%), followed by group C 36/52 (69.2%), while group B showed a lower proportion 21/59 (35.6%). Group A children had significantly higher CRP levels and a longer duration of fever. Of the 210 cases, 195 children (92.86%) were treated with antibiotics. Conclusion: The HAdV infections present with high-grade fever and respiratory symptoms are their predominant manifestation. HAdV infections should be considered as a differential diagnosis in children with prolonged fever and multisystem involvement. In addition, gastrointestinal involvement was common. All children had favourable outcomes and were discharged without any complications. Early and accurate diagnosis of HAdV infection using rapid diagnostic tests prevents unnecessary antibiotic use and aids parental counselling and should be routinely employed.

Antibodies in Creutzfeldt-Jakob disease: A systematic review of patient characteristics, diagnostics, and clinical implications.

Introduction: Acute Coronary Syndrome (ACS) remains a major cause of morbidity and mortality worldwide, primarily driven by plaque rupture and thrombotic occlusion in coronary arteries. Traditional biomarkers provide limited insight into the inflammatory and lipid-driven mechanisms underlying plaque instability. Soluble Triggering Receptor Expressed on Myeloid Cells 2 (sTREM2), a shed form of a membrane-bound receptor expressed on macrophages and other myeloid cells, has been implicated in lipid metabolism, immune regulation and tissue homeostasis. Although its role in neurodegenerative and metabolic disorders has been increasingly recognised, its relevance in atherosclerosis and acute coronary events is still being elucidated. Exploring sTREM2 in this setting may offer novel perspectives on immune-metabolic activity in coronary artery disease. Aim: To investigate the association between serum sTREM2 levels and ACS, as well as disease severity. Materials and Methods: The present observational crosssectional study was conducted at the Department of Biochemistry, SRM Medical College Hospital and Research Centre, Potheri, SRM Nagar, Kattankulathur, Tamil Nadu, India, between December 2023 and August 2024. A total of 180 participants were enrolled, including 90 newly diagnosed ACS patients and 90 age- and gender-matched healthy controls. Inclusion criteria for the ACS group included adults aged over 25 years with a confirmed diagnosis of ACS {STElevation Myocardial Infarction (STEMI), Non ST-Elevation Myocardial Infarction (NSTEMI), or unstable angina} based on clinical presentation, Electrocardiographic (ECG) changes and cardiac biomarkers. Controls were healthy volunteers with no history of cardiovascular disease. Serum sTREM2 levels, lipid profile, Apolipoprotein B (ApoB) and high-sensitivity C-Reactive Protein (hs-CRP) were measured. ACS severity was assessed using the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX I) score. Demographic parameters including age, gender, Body Mass Index (BMI). Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 22.0. Data normality was assessed using the Shapiro-Wilk test. Group comparisons were conducted using the Mann-Whitney U test and Kruskal-Wallis test. Spearman’s correlation was used to evaluate relationships between variables and Receiver Operating Characteristic (ROC) curve analysis assessed the diagnostic utility of biomarkers. A p-value <0.05 was considered statistically significant. Results: Serum sTREM2 levels were significantly higher in ACS patients {115.19 (78.18-191.67) pg/mL} compared to controls {70.74 (51.16-89.03) pg/mL} (p<0.001). ACS patients also exhibited elevated hs-CRP, ApoB, Total Cholesterol (TC), LowDensity Lipoprotein (LDL) and Very Low-Density Lipoprotein (VLDL), along with reduced High-Density Lipoprotein (HDL) levels. A positive correlation was identified between sTREM2 and body weight, BMI, TC, LDL and the TC/HDL ratio, while a negative correlation was noted with HDL. sTREM2 levels increased progressively with ACS severity as determined by the SYNTAX I score. No significant correlation was found between sTREM2 and hs-CRP or ApoB. ROC analysis demonstrated moderate diagnostic accuracy for sTREM2, with an Area Under the Curve (AUC) of 0.771. Conclusion: The present study demonstrates that serum sTREM2 levels are significantly elevated in ACS patients and correlate with disease severity. These findings suggest that sTREM2 may serve as a novel biomarker for ACS stratification, providing insights into the inflammatory and lipid-related mechanisms driving disease progression. Further longitudinal studies are required to validate its prognostic and clinical utility.

Introduction: Although Renal Angiomyolipoma (AML) is a relatively rare entity, it is the most common benign mesenchymal kidney tumour, made up of varying amounts of thick-walled blood vessels, smooth muscle, and adipose tissue. AML occurs either sporadically or in association with Tuberous Sclerosis Complex (TSC). It is often detected incidentally during imaging, though it can present with flank pain, haematuria, or life-threatening haemorrhage, thereby posing diagnostic and therapeutic challenges. Aim: To analyse the clinicopathological features of surgically resected renal AMLs and evaluate the association between radiological and histopathological findings. Materials and Methods: This was a retrospective, crosssectional study conducted in the Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, in which the clinicopathological features of surgically resected renal AMLs received between January 2014 and October 2023 were studied. Data retrieval, analysis, and manuscript preparation were carried out between December 2023 and March 2024. Clinicoradiological detailsincluding age, gender, clinical presentation, tumour size, laterality, imaging features (fat-rich or fat-poor), presence of haemorrhage, association with TSC/LAM, and type of surgical procedure were retrieved from the hospital information system of the study Institute. The data were analysed using Statistical Package for the Social Sciences (SPSS), IBM Corp, Armonk, NY), version 26.0. Categorical variables are reported as frequencies and percentages, whereas the mean (standard deviations) or medians with interquartile ranges, as appropriate, were used for continuous variables; the associations between categorical variables were analysed using the Chi-square test, where p-value <0.05 was considered to indicate statistical significance. Results: The study included a total of 31 patients, with a mean age of 48.9±16.8 years, and a mean tumour size of 10.0±6.1 cm, resulting in a female-to-male ratio of 2.4:1. Twenty-seven cases were symptomatic, while four were incidental. The major subtype was classical (24), followed by leiomyoma-like (4), epithelioid (2), and lipoma-like (1). Fat-poor AML patients who underwent surgery for Renal Cell Carcinoma (RCC) on imaging were confirmed via histopathology (epithelioid-1, leiomyomalike-3). Bleeding was observed with tumour size ≥6.0 cm (n=10 cases; p-value=0.012). TSC-associated cases (n=3) were younger (mean age-30.3 years vs sporadic-50.4 years) and had a larger mean tumour size of 16.8 cm (vs sporadic-8.8 cm). One patient had concurrent RCC. Conclusion: TSC-associated cases present at a younger age when compared to sporadic AMLs. Fat-poor AMLs can typically mimic RCC on imaging. Larger tumours are known to cause haemorrhage, particularly TSC-associated, from the rupture of pseudoaneurysms. Immunohistochemistry (IHC) for Human Melanoma Black (HMB) 45 and Smooth Muscle Actin (SMA) was useful in establishing a diagnosis in atypical AMLs.

Tachycardia and Positive Amphetamine Screen are Associated With True Positive-Methamphetamine Exposures in Pediatric Patients.

Parvovirus B19 is a known cause of erythema infectiosum, aplastic crises and severe anemia, especially in patients with hemolytic anemia. The aim of this study was to investigate the clinical and diagnostic parameters of parvovirus B19 infection in children with and without hemolytic anemia and to record the course of case numbers in recent years. We retrospectively included all patients diagnosed with acute parvovirus B19 infection at the Department of Pediatrics, Jena University Hospital, Jena, Germany between 2016 and 2024. Diagnosis was confirmed by positive parvovirus B19 IgM serology and/or PCR testing. Both demographic and clinical data as well as diagnostic parameters were collected and analyzed, focusing on differences between children with and without underlying hemolytic anemia. Among the 40 pediatric patients included in this study, 14 patients were diagnosed with hemolytic anemia. Children with hemolytic anemia suffered from a significantly greater hemoglobin drop and a significantly higher need for transfusion compared to children without hemolytic anemia. A Poisson regression model, adjusted for observation time, was used to compare case rates between 2016 and 2022 and 2023-2024.The model demonstrated a more than fivefold increase in parvovirus B19 cases in 2023-2024 compared to 2016-2022. Children with hemolytic anemia, such as spherocytosis, are at higher risk of severe anemia and require more frequently transfusions during acute parvovirus B19 infection. The observed increase in cases after 2022 suggests changing epidemiological patterns and highlights the need for careful surveillance and early diagnostic and therapeutic interventions in affected children.

Early identification of invasive bacterial infections (IBI) in febrile infants under 90 days is essential, with blood biomarkers widely used for their risk evaluation. However, their diagnostic performance may vary by causative organism or type of IBI. We conducted a retrospective, multicenter study of infants ≤90 days with IBI treated in pediatric emergency departments of 18 hospitals (Spain and Latin America) from 2008 to 2022. IBI was defined by isolation or polymerase chain reaction (PCR) detection of a pathogenic bacterium in blood or cerebrospinal fluid. Sensitivity of standard biomarker cutoffs was analyzed by pathogen and IBI type, with multivariate regression adjusting for age, sex, temperature, symptom duration and clinical presentation. Of 395 infants, Escherichia coli (45.6%) and Streptococcus agalactiae (25.6%) were the most frequently isolated bacteria, and bacteremia (43.8%) and bacteremic urinary tract infection (41.3%) were the most frequent IBI. Biomarker responses varied by organism and IBI type. E. coli IBIs showed higher white blood cell (WBC) and absolute neutrophil (ANC) counts and C-reactive protein levels than S. agalactiae IBIs. Only procalcitonin had high sensitivity for S. agalactiae IBIs. Standard cutoffs for WBC and ANC showed sensitivities below 50% for all pathogens and types of IBI. Biomarker levels in young febrile infants with IBIs depend on IBI type and causing bacteria. Increases in WBC, ANC and C-reactive protein are lower in isolated bacteremias than in bacteremic urinary tract infections. Procalcitonin is the best biomarker for ruling out S. agalactiae IBIs. These distinctions are key to interpreting lab tests and preventing underdiagnosis of invasive infections.

The Impact of Sex on Atherectomy Outcomes for Different Anatomic Regions.

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is an autosomal dominant condition that may co-occur with cardiac, renal, and skeletal abnormalities. It affects females causing utero-vaginal agenesis. Radiological assessment tools such as ultrasound and Magnetic Resonance Imaging (MRI) can be utilised for the confirmation of MRKH syndrome and for planning further management. Management of MRKH syndrome includes both non-surgical and surgical approaches, depending on the clinical presentation. The current report presents a case of a 21-year-old female who presented with a complaint of primary amenorrhoea and dyspareunia. Examination of the genitalia revealed normal external urethral meatus, labia majora and minora, and pubic hair development. Speculum examination confirmed the lack of a vaginal canal. Radiological findings were suggestive of uterine agenesis. Genetic analysis showed a 46,XX karyotype, thereby ruling out the chromosomal abnormalities. Based on the above findings and clinical evaluations, a final diagnosis of MRKH syndrome was confirmed. The patient declined surgical interventions at present and was managed non-surgically. In MRKH syndrome patients, counselling is crucial attributed to the associated physical abnormalities, related queries and mental stress.

Toxocara seropositivity in patients with atopic dermatitis and chronic urticaria: Evidence from a matched case-control study.

Introduction: Presacral tumours are an extremely rare entity. Schwannomas account for only 3% of tumours in this region. Schwannomas are benign, unifocal and often asymptomatic. Presacral lesions are usually asymptomatic, although a few of these patients may present with compressive symptoms or neurogenic pain. Diagnosis and characterisation of nerve sheath tumours, of which schwannoma is a part, is usually done with Magnetic Resonance Imaging (MRI). Surgical excision is the mainstay of management, although it is associated with high morbidity. Although a few case reports are available, large datasets are sparse. Aim: To study the clinical presentation, imaging features and management of patients who underwent excision of presacral schwannomas. Materials and Methods: The present retrospective descriptive study was conducted in General Surgery Unit-IV in Christian Medical College and Hospital, Vellore, Tamil Nadu, India, from July 2013 to July 2024. All patients above 18 years of age, histopathologically confirmed presacral schwannomas, were identified and included. The demographic profile, presenting symptoms, imaging findings, preoperative assessment, surgical details, postoperative complications, and follow-up were recorded. Descriptive statistics were calculated, with mean and median serving as the measure of central tendency and the standard deviation representing the measure of dispersion. Results: A total of 20 patients were identified with a mean age of 41.3 years (±14.05), with 13 patients being male and the remaining female. Eleven patients presented with pressure symptoms due to direct compression of the pelvic organs. Imaging of choice was MRI in 19 patients. Seventeen patients had preoperative biopsy done, of which 16 were schwannoma and one was neurofibroma. Median largest diameter of these tumours at the time of presentation was 10.55 cm with a range of 6.8 to 25 cm. 19 patients underwent a laparotomy (transperitoneal approach) with intracapsular excision of the tumour. The mean operating time was 2.85 hours (±1.12), with a mean blood loss of approximately 500 mL (±240). 10% of patients developed postoperative neurological deficits. Three patients had neuropathic pain, which settled with medication in the postoperative period. Five patients developed a surgical site occurrence. The mean duration of hospitalisation for these patients was 7.7 days. The mean follow-up period was 27.8 months. 90% (18) of the patients had classical schwannoma on histopathology. Conclusion: Management of large presacral tumours is a daunting task even for the most experienced surgeons. Intracapsular excision of these tumours needs to be considered while planning these operations, based on the possible morbidity profile for these patients.

Does living in the Andes make cerebral arteriovenous malformations more dangerous? high altitude fails to predict hemorrhage in a large Ecuadorian cohort.

Typhoid fever remains a significant public health challenge in many low- and middle-income countries, including Indonesia, where inadequate sanitation, limited access to clean water, and suboptimal hygiene practices continue to facilitate disease transmission. Although typhoid fever is more commonly reported in school-aged children and adolescents, its occurrence in toddlers poses unique diagnostic and management challenges due to atypical clinical presentations and increased vulnerability to dehydration and complications. Early recognition and comprehensive management at the primary health care level are therefore critical. This study describes the holistic primary care–based management of typhoid fever in a 14-month-old boy presenting to a community health center in Bandar Lampung, Indonesia. The patient was brought with a three-day history of persistent fever and a one-week history of watery diarrhea, accompanied by decreased appetite, irritability, and generalized weakness. A holistic diagnostic approach integrating clinical symptoms, physical examination, environmental exposure, and family hygiene practices was applied. Key clinical features included a fever pattern worsening in the late afternoon to evening, prolonged diarrhea, and a coated tongue with erythematous margins, strongly suggestive of typhoid fever in the absence of other focal infections. Management combined pharmacological and non-pharmacological interventions tailored to the toddler age group and primary care setting. Pharmacological therapy consisted of first-line antibiotic treatment with cotrimoxazole, antipyretic therapy, zinc supplementation, and oral rehydration therapy to prevent dehydration. Non-pharmacological interventions emphasized continued breastfeeding, adequate fluid intake, safe food preparation, access to clean drinking water, and strict hand hygiene practices within the household. Family members were actively involved in the care process to ensure adherence to treatment and implementation of preventive measures. Clinical improvement was observed following the integrated intervention, with resolution of fever and gastrointestinal symptoms and restoration of appetite and activity levels. This approach highlights the importance of combining clinical management with family-centered hygiene education and environmental risk assessment. The findings underscore the critical role of primary health care services in early detection, effective treatment, and prevention of typhoid fever among vulnerable pediatric populations.

Doege–Potter syndrome (DPS) is a rare paraneoplastic disorder characterised by non-islet cell tumour hypoglycaemia (NICTH), resulting from ectopic secretion of insulin-like growth factor 2 (IGF-II) by solitary fibrous tumours (SFTs). We describe the case of an 85-year-old woman, presenting in October 2024, with a chronic subdural haematoma and profound intraoperative hypoglycaemia. Further investigation revealed a large pleural mass; the pathophysiological findings were consistent with DPS, and histopathology confirmed a malignant SFT. Hypoglycaemia resolved after complete tumour resection. The current case highlights the importance of considering NICTH in older patients with unexplained, treatment-resistant hypoglycaemia, especially when comorbidities (like subdural hematoma) mask the clinical picture. A focused narrative review accompanies this report, providing clinicians with practical insights into the spectrum of clinical presentations, diagnostic work-up, therapeutic modalities, and anaesthetic considerations in DPS. Early recognition is crucial to avoid serious complications. Complete surgical removal remains the cornerstone of effective management, while alternative therapies may be needed in inoperable cases.

Haemangiomas are benign vascular neoplasms typically diagnosed in infants and rarely seen in adults. Their occurrence in the medial canthal region is particularly uncommon and may clinically mimic more frequent benign lesions such as dermoid cysts. This is a rare case of an adult-onset medial canthal capillary haemangioma that was initially misdiagnosed as a dermoid cyst, emphasising the diagnostic challenge posed by such presentations. A 46-year-old female presented with a 10-year history of a painless, slowly progressive swelling over the right medial canthus. The lesion was soft, mobile, non-tender, and measured approximately 0.5×0.5 cm, without associated visual disturbances or discharge. Based on clinical examination, a provisional diagnosis of dermoid cyst was made. The lesion was surgically excised under local anaesthesia, revealing a well-circumscribed, encapsulated soft mass. Histopathological analysis demonstrated proliferation of capillary-sized blood vessels lined by flattened endothelial cells within a fibrous stroma, confirming the diagnosis of capillary haemangioma. The postoperative period was uneventful, and no recurrence was noted at three months follow-up. Adult-onset periorbital haemangiomas are extremely rare, with few cases documented in the literature. Their clinical presentation frequently overlaps with dermoid cysts due to similar location, consistency, and benign nature. Misdiagnosis is therefore common, highlighting the need for a high index of suspicion. Unlike infantile haemangiomas, adult variants do not undergo spontaneous involution and often require surgical excision for definitive management. This case underlines the importance of considering vascular tumours in the differential diagnosis of long-standing periorbital swellings in adults. Accurate diagnosis through histopathological confirmation is essential to avoid mismanagement and contributes to the limited existing literature on this rare clinical entity

Respiratory physiotherapy is a treatment option for children on paediatric intensive care units (PICUs), aiming to facilitate airway clearance and improve ventilation. Given the vulnerable nature of this patient group, safety and adverse events related to respiratory physiotherapy are important considerations. The aim of this qualitative study was to understand what physiotherapists perceive to be risk factors for instability and adverse events and how they manage these. This study involved virtual semi-structured interviews and focus groups with PICU physiotherapists. Sixteen interviews and two focus groups (n=7) were completed. These were audio-recorded and transcribed verbatim. Framework analysis was used. From the interview analysis, a framework Strategies for managing instability and adverse events was developed. Two frameworks were developed from the focus group analysis: Instability and adverse events and Managing instability and adverse events. Physiotherapists provided a comprehensive list of perceived risk factors for instability and adverse events, including clinical presentations and support required. Practical strategies were reported to promote efficiency, including readiness of equipment and two-person treatments. Physiotherapists described accepting short-term unwanted effects for longer-term improvement, discussed in terms of risk versus benefit. The patient's parents/family were involved in the sharing of responsibility for treatment decisions. Multidisciplinary team involvement included collaborative discussion with practical assistance as required. This study provides novel data about physiotherapists' management of instability and adverse events in PICUs. Preparation and planning, involving the multidisciplinary team, family inclusion, reacting and adapting, and accepting instability were important strategies. The findings from this study highlight several areas that require consideration from a workforce support and education perspective.

Candidozyma (Candida) auris has emerged over the past two decades as a formidable global health threat due to its multidrug resistance, persistence in healthcare environments, and rapid nosocomial spread. Recently reclassified into the genus Candidozyma based on phylogenomic analysis, C. auris poses major challenges for both clinical management and infection control. Its ability to tolerate heat, salinity, and disinfectants supports long-term survival on surfaces and medical devices, facilitating transmission. Biofilm formation further enhances virulence and resistance to antifungal therapy. Clinical presentations range from asymptomatic colonization to invasive infections, with mortality rates approaching 50%. Echinocandins remain an important first-line treatment option, but their fungistatic activity, limited tissue penetration, and emerging resistance contribute to suboptimal outcomes, highlighting the need for new agents and optimized dosing strategies. The role of triazoles and amphotericin B is significantly limited by resistance and associated toxicities, while newer agents such as ibrexafungerp, fosmanogepix, and rezafungin show promising invitro activity but lack substantial supporting clinical data. Combination therapy may also offer potential benefit, though supporting evidence is sparse. Infection control methods including active surveillance, contact precautions, and environmental disinfection with sporicidal agents and avoidance of ineffective quaternary ammonium compounds are key to preventing the nosocomial spread of C. auris. Despite growing awareness, effective decolonization strategies are lacking, and recurrence and transmission continue to pose challenges. Ongoing efforts to refine antifungal therapy, improve rapid diagnostics, and strengthen infection control practices are essential to mitigating the spread of this pathogen and optimizing outcomes for patients.

Neurobrucellosis (NB) and Neurotuberculosis (NT) are rare central nervous system infections, but pose significant diagnostic and therapeutic challenges. If not diagnosed and treated early, they can have high mortality. Clinical presentations for both are nonspecific, mimicking diverse pathologies. Therefore, it is crucial to identify distinguishing features to ensure timely treatment. We conducted a retrospective review of cases of NB and NT admitted to the American University of Beirut Medical Center (AUBMC) between January 1982 and December 2022, identifying 20 patients with NT, and five cases of NB. Their presentation and diagnostic work-up were compared. NT patients were mostly male and presented earlier than NB patients (median symptom duration 150 days). Patients with NT had higher rates of systemic and neurologic symptoms compared to NB. Both groups had hyponatremia. NB patients had higher cerebrospinal fluid lymphocyte counts. Imaging in NT revealed diverse brain abnormalities such as hydrocephalus and small nodules whereas mostly meningeal enhancement in NB. Despite severe presentations no 30-day mortality occurred in either group. Neurological complications were more frequent in NT. Finally, NT patients generally present earlier with more severe symptoms than NB. Due to overlapping features but differing treatments, larger scale studies are crucial to better understand and manage these infections.