Tracheobronchial injuries (TBI) are rare but potentially life-threatening complications of esophagectomy, with significant morbidity and mortality. This narrative review examined the incidence, risk factors, diagnostic methods, and management strategies for TBI following esophagectomy. A PubMed search was conducted for relevant studies published between 1978 and 2024 using terms related to tracheal injury and esophagectomy. Forty-five articles met the inclusion criteria. The incidence of TBI ranged from 0.4 to 3.5% in transhiatal esophagectomy (THE) and 0 to 2.67% in transthoracic esophagectomy (TTE). Identified risk factors included dense tumor adhesions, neoadjuvant chemoradiation, blunt esophageal dissection, and double-lumen endotracheal tube use. Diagnosis was primarily via bronchoscopy and imaging. Small, stable injuries were managed conservatively, while larger defects required surgical repair, often with muscle flap or synthetic reinforcement. Early intraoperative recognition and repair are key to improving outcomes, but mortality is high in cases of delayed diagnosis. This review emphasizes the importance of meticulous surgical technique, vigilant intraoperative monitoring, and individualized treatment strategies to minimize complications in high-risk patients.

Dengue fever is a mosquito-borne viral illness caused by the dengue virus, primarily transmitted by Aedes aegypti mosquitoes. It remains a major public health concern in tropical and subtropical regions worldwide. Clinical presentations range from mild febrile illness to severe complications such as Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). In recent years, atypical manifestations, including cardiac involvement, have been recognised. The present case report focuses on a nine-year-old male child from a dengue-endemic area who presented with a high-grade fever, myalgia, abdominal pain, and vomiting. Laboratory findings revealed thrombocytopenia and elevated haematocrit levels, meeting the criteria for dengue with warning signs. During the course of the illness, the child was found to have Mobitz type 1 Atrioventricular (AV) block (Wenckebach phenomenon) on an Electrocardiogram (ECG). This cardiac conduction abnormality, though rare in the paediatric population, was transient and resolved spontaneously without the need for intervention. The patient was managed conservatively with close monitoring, fluid management, and supportive care, ultimately making a full recovery. A repeat ECG showed normalisation of the cardiac rhythm. The present case underscores the importance of recognising cardiac complications in dengue fever, even in children, as they may be self-limiting yet clinically significant. Early detection and vigilant monitoring of warning signs, including electrocardiographic changes, can aid in preventing potential morbidity. Clinicians should maintain a high index of suspicion for such atypical manifestations in dengue cases, especially during outbreaks.

Background and objective: Widespread self-medication for minor pain has led to extensive use of nonsteroidal anti-inflammatory drugs (NSAIDs), sometimes for inappropriate indications, potentially increasing the risk of hypersensitivity reactions (HSRs). Real-world data on the incidence and clinical characteristics of NSAID-induced HSRs remain limited. This study aimed to estimate the incidence and characterize the clinical patterns of NSAID-induced HSRs at Srinagarind Hospital. Methods: A retrospective cross-sectional study was conducted using electronic medical records from January 1, 2021, to December 31, 2023. Patients with documented immediate HSRs following NSAID exposure were identified. Causality was assessed using the Naranjo algorithm. Descriptive and inferential analyses were performed to estimate incidence and evaluate associations between NSAID type and reaction severity. Results: Total of 1,349 patients with NSAID-associated HSRs were included; 70.5% were female, with a mean age of 51.96 ± 16.32 years. Ibuprofen accounted for the largest proportion of reactions (491, 36.40%), followed by diclofenac (254, 18.83%), naproxen (119, 8.82%), aspirin (97, 7.19%), and celecoxib (90, 6.67%). Most reactions were moderate (1,213, 89.90%), with severe events in 82 cases (6.07%). The majority were non-serious (1,232, 91.33%), with hospitalization in 70 cases (5.19%) and life-threatening reactions in 2 (0.14%). Causality was mainly classified as probable (685, 50.78%) or possible (649, 48.11%), while definite reactions were rare (14, 1.04%) and only one case (0.07%) was classified as doubtful. Cutaneous manifestations predominated, particularly rash and itching (24.54%) and angioedema (24.46%); anaphylaxis occurred in 82 cases (6.07%). Severe cutaneous adverse reactions were uncommon (SJS 0.44%, DRESS 0.29%, AGEP 0.29%). No significant associations were observed between NSAID type and reaction severity (p > 0.05). Conclusions: NSAID-induced HSRs were predominantly moderate and non-serious. Ibuprofen was the most frequently implicated drug, followed by diclofenac and naproxen, underscoring the importance of vigilant monitoring and preventive strategies to reduce NSAID-related hypersensitivity.

Introduction: Impending eclampsia represents a medical emergency requiring immediate maternal delivery to prevent progression to seizures and maternal-fetal compromise. The selection of an appropriate anesthetic technique for emergency cesarean section in severely preeclamptic patients remains clinically challenging, balancing the risks and benefits of regional versus general anesthesia. Case presentation: A 19-year-old primigravida at 35 weeks and 6 days of gestation presented with frontal headache, blurred vision, and nausea. Clinical evaluation revealed new-onset hypertension (131/81 mmHg), proteinuria (+2), and mild hypokalemia (3.4 mmol/L), consistent with impending eclampsia. Emergency cesarean section was performed under subarachnoid block utilizing heavy bupivacaine 15 mg with fentanyl 25 micrograms intrathecally. Hemodynamics remained stable throughout the operative period without vasopressor requirement. A male neonate was delivered with Apgar scores of 7-8-9 and a birth weight of 1825 grams. Both mother and infant had favorable postoperative outcomes with resolution of hypertensive crisis and normal neonatal transition. Conclusion: This case demonstrates the efficacy and safety of regional anesthesia in eclamptic parturients undergoing emergency cesarean delivery. Careful patient selection, appropriate drug dosing, and vigilant hemodynamic monitoring enable successful outcomes even in this high-risk scenario.

Upper tract urothelial carcinoma (UTUC) is a rare and aggressive malignancy, accounting for only 5-10% of all urothelial carcinomas (UCs). Lung, bone, liver, and distant lymph nodes are common sites of metastasis, while gastrointestinal metastasis is extremely rare. We present a case of a 63-year-old female who developed a descending colon lesion 19 months after left radical nephroureterectomy for high-grade ureteral UC. The diagnosis was established by computed tomography (CT), magnetic resonance imaging (MRI), colonoscopy, and biopsy, which excluded primary colorectal malignancy. First-line therapy consisted of six 21-day cycles of gemcitabine plus cisplatin, followed by two cycles of tislelizumab maintenance immunotherapy. Restaging with contrast-enhanced CT and positron emission tomography/computed tomography (PET/CT) demonstrated disease progression. Despite switching to second-line nab-paclitaxel, the patient rapidly deteriorated from tumor cachexia and ultimately succumbed to septic shock secondary to severe pulmonary infection. This represents the first reported case of descending colon metastasis from primary ureteral UC. It highlights the colon as a potential metastatic site where biopsy is essential for definitive diagnosis. Notably, although the patient initially responded to platinum-based therapy, the subsequent rapid progression underscores the need for vigilant monitoring and timely adjustment of therapeutic strategies in managing such high-risk presentations.

Extravasation of gadolinium-based contrast agents (GBCAs) during magnetic resonance imaging is a rare adverse event, with most cases resolving without significant complications. However, severe tissue injury following GBCA extravasation remains extremely rare and incompletely characterized in the existing literature. A 58-year-old female (Chinese, Asian) with hepatocellular carcinoma and ongoing chemotherapy experienced gadopentetate dimeglumine extravasation during an abdominal magnetic resonance imaging (MRI) examination. Despite standard initial management-including immediate catheter removal, ice application, limb elevation, and topical heparinoid cream administration-the patient developed a tension blister within four hours, followed by progressive tissue necrosis and a deep cutaneous ulcer. The ulceration was further complicated by secondary infection, likely secondary to inappropriate self-management of the blister. The patient underwent a prolonged wound care regimen, culminating in complete re-epithelialization after four weeks, with no residual functional impairment. This case underscores the potential severity of cutaneous complications resulting from GBCA extravasation, especially in high-risk patients with chemotherapy-induced vascular vulnerability or diminished tissue integrity. It emphasizes the critical importance of vigilant post-extravasation monitoring, proactive patient education to prevent inappropriate self-management of the injury, and the implementation of structured wound care protocols. Future studies are warranted to establish evidence-based preventive strategies and therapeutic guidelines for GBCA-related extravasation injuries.

Purpose: To report a case of recurrent hypotony and exudative choroidal detachment in a patient with pseudoexfoliation glaucoma following the use of a topical preservative-free prostaglandin–timolol fixed combination eye drop.Case summary: A 74-year-old diabetic patient with a history of trabeculectomy for pseudoexfoliation glaucoma presented with conjunctival hyperemia, ocular pain, and blurred vision 3 months after using a preservative free prostaglandin-timolol fixed combination. Intraocular pressure (IOP) was markedly reduced to 6 mmHg and fundus examination revealed severe exudative choroidal detachment involving three quadrants. Treatment with oral and topical corticosteroids, cycloplegics, and non-steroidal anti-inflammatory drugs normalized his IOP to 15 mmHg and resolved the detachment within 3 weeks. Two weeks later, the patient inadvertently reused the same medication mistaking it for artificial tears. Symptoms recurred the following day with his IOP dropping to 2 mmHg and choroidal detachment affecting all four quadrants. Re-treatment led to full recovery within 3 weeks.Conclusions: Choroidal detachment following use of combination therapy with a prostaglandin analog and an aqueous suppressant is a rare complication. Patients with pseudoexfoliation syndrome and diabetes may be particularly susceptible. Vigilant monitoring of IOP and fundus status is recommended when prescribing these agents to individuals with multiple risk factors.

Spinal cord infarction is an uncommon but devastating complication of vascular and endovascular procedures and is rarely reported after iliac artery interventions. We present a 53-year-old woman with severe bilateral common iliac artery stenoses (>90%) who underwent endovascular revascularization via bilateral femoral access with deployment of a terminal aortic covered stent-graft and bilateral "kissing" covered common iliac artery stents. The procedure was angiographically successful with restoration of inline aortoiliac flow. Within the first few postoperative hours, the patient developed acute bilateral lower-extremity weakness progressing rapidly to complete paraplegia. Spinal MRI demonstrated long-segment acute ischemia/infarction at the thoracolumbar level (T11-L2) with diffusion restriction and low ADC values. Despite supportive management, there was no neurological recovery during hospitalization, and the patient remained paraplegic at discharge. This case underscores that spinal cord infarction, although exceedingly rare, can occur after aortoiliac stenting, likely related to procedure-associated microembolization and/or compromise of pelvic-paraspinal collateral pathways, and highlights the need for careful pre-procedural risk assessment and vigilant post-procedural neurological monitoring in high-risk patients.

The freeze-dried rabies vaccine (Vero-cells) is generally safe. We present a rare case of a 44-year-old man who developed spontaneous intraperitoneal hemorrhage from a giant gastric gastrointestinal stromal tumor (GIST) shortly after receiving this vaccine. Emergency surgery was performed, and postoperative pathological and immunohistochemical analysis confirmed the diagnosis of a high−risk gastric GIST. The patient declined postoperative adjuvant therapy with imatinib. Follow-up evaluations at one year postoperatively indicated stable disease, and he has remained progression-free for 16 months to date, underscoring the indolent biology of gastric GISTs even in high-risk cases. This case serves as an important reminder for clinicians to consider underlying occult GISTs when evaluating acute abdominal symptoms after vaccination. Through this patient’s journey, we emphasize the significance of performing comprehensive computed tomography (CT) examinations in patients with giant GISTs prior to rabies vaccination, and underscore the crucial need for heightened vigilance and close monitoring following administration of the freeze-dried rabies vaccine (Vero cells). Potential mechanisms that have been hypothesized to explain spontaneous tumor hemorrhage in this context include vaccine−induced inflammatory cytokine surges and hemodynamic changes. Although a rare case of rabies vaccine-associated thrombocytopenia has been reported, evidence for this mechanism remains limited. Further studies are warranted to clarify the relationship between vaccination and tumor rupture.

Thyroid surgery remains one of the most frequently performed endocrine procedures worldwide, offering definitive management for benign multinodular goiter, toxic thyroid disorders, and differentiated thyroid malignancies. Despite advances in surgical techniques, anesthesia, and perioperative care, post-operative complications continue to influence patient recovery, length of hospital stay, and long-term functional outcomes. The present prospective study was conducted in a tertiary care hospital to systematically evaluate the incidence, pattern, and determinants of post-operative complications following thyroidectomy and to identify modifiable risk factors that may improve surgical safety and patient prognosis. Over a defined study period, patients undergoing total, subtotal, or hemithyroidectomy were enrolled and followed from the immediate post-operative phase through subsequent outpatient visits. Detailed demographic, clinical, biochemical, and intraoperative parameters were recorded, including age, gender, indication for surgery, gland size, duration of operation, and intraoperative blood loss. Post-operative monitoring focused on early and late complications such as hypocalcemia, recurrent laryngeal nerve palsy, hematoma formation, surgical site infection, seroma, and hypothyroidism. Standardized clinical assessment protocols and biochemical testing were utilized to ensure consistent detection of complications. The analysis revealed that transient hypocalcemia was the most common early complication, particularly among patients undergoing total thyroidectomy and those with extensive gland dissection. Most cases were biochemical and resolved with calcium supplementation within a few weeks. Transient voice changes attributable to neuropraxia of the recurrent laryngeal nerve were observed in a smaller subset of patients, while permanent nerve injury was rare. Post-operative hematoma occurred infrequently but required prompt recognition and intervention due to the risk of airway compromise. Surgical site infections and seroma formation were uncommon, reflecting adherence to sterile protocols and meticulous hemostasis. Statistical evaluation demonstrated significant associations between complication rates and factors such as extent of surgery, underlying pathology, and operative duration. Larger gland size and malignancy-related procedures were linked to increased risk of hypocalcemia and nerve-related complications. However, no significant correlation was observed between patient age or gender and major adverse outcomes. Importantly, structured perioperative planning and careful identification of parathyroid glands and recurrent laryngeal nerves contributed to favorable surgical outcomes. This prospective analysis underscores that thyroid surgery, when performed in a tertiary care setting with experienced surgical teams, is generally safe and associated with low rates of permanent morbidity. Early detection and timely management of complications remain critical to optimizing recovery. The findings emphasize the importance of standardized operative techniques, vigilant monitoring, and patient education to minimize preventable adverse events. Future multi-center studies with longer follow-up may further refine risk stratification models and enhance evidence-based perioperative protocols.

Jervell and Lange-Nielsen syndrome (JLNS) is a rare autosomal recessive disorder characterised by congenital sensorineural hearing loss and prolonged QT interval, predisposing to ventricular arrhythmia and sudden cardiac death. We report a 32-year-old woman with congenital deafness and recurrent syncope since childhood, diagnosed with JLNS due to a homozygous KCNQ1 exon 14 (c.1716-1719del) variant. She had an implantable cardioverter-defibrillator and was maintained on propranolol. During pregnancy, she developed fetal growth restriction and delivered a healthy neonate vaginally under continuous cardiac monitoring. Both mother and baby recovered uneventfully. This case emphasises the importance of genetic confirmation, multidisciplinary care, and vigilant peripartum monitoring in optimising outcomes for pregnancies complicated by JLNS.

Recurrent outbreaks of the highly pathogenic avian influenza (HPAI) A (H5N1) virus in farmed poultry, and reports of infections in dairy cattle herds in the United States since March 2024, have triggered concerns about the spillover threat to human populations and a subsequent influenza pandemic. The increasing threat that H5N1 poses to human health has led to more vigilant public health monitoring of these developments. In addition to intensifying surveillance, preventative strategies-like vaccinating those at higher risk-are being evaluated to help minimize infection and spread. Efforts to mitigate and respond to such an event will entail broad public health interventions including vaccination. However, analysis of the COVID-19 pandemic suggests that information quality can significantly impact the effectiveness of such measures by influencing public understanding and trust. Misinformation about H5N1 and other viruses circulating online often includes inaccurate information about transmission, prevention, and the severity of the viruses. By systematically analyzing these false narratives, public health authorities can better tailor their pandemic prevention, preparedness, and response strategies. In light of the emerging threat of H5N1, we analyzed the content of social media posts from Facebook (approximately 350,000) and Instagram (n=69,551) related to HPAI. Using 40 keywords associated with misinformation, we identified over 500 posts explicitly mentioning H5N1 and related terms for further systematic analysis. Posts were coded to identify targets and topics in the social media narratives. The "target" refers to the organization or person mentioned in the post, while the "topic" refers to the primary issue or subject being addressed. Our content analysis identifies 7 main targets of misinformation, including government (149/544, 27%), health authorities (108/544, 20%), and international organizations (74/544, 14%). Also, from the 6 topics that have been identified, we found that the most widespread one was that authority figures purposefully engineer pandemics to achieve multiple political, economic, and other objectives (362/544, 67%) followed by societal destruction (121/544, 22%), and anti-vaccination (84/544, 15%). Other themes include societal destruction and religious allusions and prophecies. Our analysis of online content showed that H5N1 misinformation was primarily aimed at individuals or groups with differing degrees of political or institutional authority, such as government leaders and public health officials. These figures were often the focus due to their involvement in making health policy decisions and implementing public health measures. Decision-making entities and individuals were the target of various misinformation narratives. Results demonstrate the ongoing need for monitoring health misinformation to inform evolving public health responses to HPAI.

Chryseobacterium sp., belonging to the family Weeksellaceae, is an emerging fish pathogen that is opportunistic in nature. In this study, we investigated a clinically infected goldfish Carassius auratus from a fish farm during a disease outbreak. The bacterial colonies were isolated from the kidneys of infected goldfish. Following a 24 h incubation at 28°C, the colonies on nutrient agar exhibited yellow pigmentation and were identified as Gram-negative, rod-shaped, catalase-positive, and oxidase-positive. A total of 35 antibiotics belonging to different classes were used to determine the antibiotic susceptibility pattern of the isolated bacteria. Amplification and sequence analysis of the 16S rRNA gene identified the microorganism as Chryseobacterium sp., sharing 99.3% sequence similarity. The pathogenicity of this bacterial pathogen was experimentally confirmed in goldfish by a challenge experiment, and LD50 was determined as 7.46 × 107 CFU ml-1. Histopathological analysis of the infected fish revealed degeneration of renal tubule epithelium and melano-macrophagic aggregates with hyperaemic condition in the kidney. Similarly, infected gills exhibit primary and secondary lamellar hyperplasia, with lamellar oedema, necrosis and fusion of secondary lamella. This study underscores the virulence of Chryseobacterium sp. as a significant opportunistic pathogen in goldfish, highlighting the need for vigilant monitoring and intervention strategies to prevent outbreaks.

Total thyroidectomy is a common surgical procedure, with postoperative anxiety and depression being recognized complications. However, the development of acute psychosis is a rare and severe manifestation. The etiology of such presentations is often complex, involving metabolic derangements that directly impact central nervous system function. We report a case of severe psychosis with convulsive features precipitated by the synergistic effects of two distinct postoperative complications: iatrogenic hypothyroidism and hypoparathyroidism-induced hypocalcemia. The unique monthly cyclical pattern of symptoms followed by postictal somnolence highlights a novel clinical presentation. A 59-year-old Arab male with no prior psychiatric history underwent a total thyroidectomy for a large goiter causing airway compression. One month postoperatively, he presented with a dramatic onset of severe agitation, confusion, bizarre behaviors, and convulsive episodes. These episodes were uniquely cyclical, occurring monthly and followed by prolonged periods of sleep and amnesia. Laboratory investigations confirmed the presence of two concurrent metabolic insults: severe hypothyroidism, evidenced by a markedly elevated thyroid-stimulating hormone (TSH) level, and significant hypocalcemia secondary to iatrogenic hypoparathyroidism. A diagnosis of Psychotic Disorder Due to Another Medical Condition was made. The patient was managed with a multidisciplinary approach, including thyroid hormone replacement, calcium and vitamin D supplementation, and a short-term regimen of antipsychotic medications (olanzapine and aripiprazole) for acute behavioral control. His symptoms resolved completely within two months, and he returned to his premorbid level of functioning. This case illustrates a "perfect storm" scenario where concurrent hypothyroidism and hypocalcemia created a state of profound neuropsychiatric decompensation. The hypothyroidism likely contributed to cerebral metabolic depression and neurotransmitter dysregulation, while the hypocalcemia induced a state of neuronal hyperexcitability, precipitating the convulsive episodes. The distinct cyclical pattern of psychosis with convulsions and postictal features suggests a potential epileptiform process masquerading as pure psychosis. This report underscores the absolute necessity for vigilant postoperative monitoring of both thyroid function and calcium homeostasis following total thyroidectomy. A high index of suspicion for these dual metabolic insults is critical for prompt diagnosis and effective, multidisciplinary management to prevent severe morbidity.

Current management strategies for Hyper-triglyceridemic acute pancreatitis (HTGP) predominantly rely on lipid-lowering agents and sequential insulin-mediated triglyceride reduction. However, the comparative efficacy of these interventions remains incompletely elucidated. A retrospective cohort study was conducted on 193 HTGP patients admitted to Nanfang Hospital, Southern Medical University, from January 1, 2018, to September 30, 2023. Patients were stratified into two arms: one receiving lipid-lowering drug and the other undergoing sequential insulin therapy for lipid reduction. Propensity score matching (PSM) was employed to mitigate baseline confounding variables, facilitating a comparative analysis of the clinical outcomes between the two groups. Furthermore, univariate and multivariate logistic regression models were utilized to ascertain predictors of ICU admission in the HTGP cohort. Irrespective of PSM status, the sequential insulin group demonstrated a statistically significant earlier initiation of open diet time (P<0.05) compared to the lipid-lowering drug group, albeit with a concurrent significant increase in the incidence of hypoglycemic (P<0.05). Post-PSM analysis revealed superior cost-effectiveness in the sequential insulin group (P=0.019). APACHE II score and CRP emerged as independent risk factors for ICU admission, while HDL conferred independent protection(P<0.05 for all). Sequential insulin therapy for HTGP offers advantages over lipid-lowering drugs in terms of earlier open diet time and reduced hospitalization costs. Nevertheless, the heightened risk of hypoglycemia necessitates vigilant monitoring for this potential adverse event.

Immune checkpoint inhibitor-related myocarditis (ICI-M) is increasingly recognized, but real-world data in thymic epithelial tumors (TET) remain limited. To evaluate the clinical outcomes, focusing on ICI-M, in patients with TET receiving immune checkpoint inhibitors (ICI). This retrospective study examined patients with TET at Guangdong Provincial People's Hospital in China from January 2018 to March 2024. We assessed the biomarker changes by comparing the baseline values to peak levels during ICI therapy. Clinical characteristics, disease progression, and outcomes of patients with ICI-M were also analyzed. To investigate the relationships between clinical factors or biomarkers and all-cause mortality, we performed univariable Cox regression analysis. Among 31 patients, 7 developed ICI-M, all in the thymoma subgroup (7/12, 58.3%). During a median follow-up of 494days (262-858), 13 patients died (13/31,41.9%), including 6 cardiovascular deaths (46.2% of deaths). N-terminal pro B-type natriuretic peptide (NT-proBNP) and Creatine kinase (CK) increased significantly during ICI therapy. In univariable Cox analysis, each doubling of CK was associated with higher all-cause mortality (HR 1.22 per doubling, 95% CI 1.01-1.47; P = 0.038). In this cohort of TET patients receiving ICI therapy, myocarditis occurred frequently in thymoma patients. Overall mortality was substantial in TET patients, with nearly half of the deaths attributable to cardiovascular causes. These findings highlight the need for vigilant cardiovascular monitoring in all TET patients undergoing ICI therapy and warrant confirmation in larger multicenter studies.

Adenotonsillectomy is one of the most common elective pediatric surgeries. However, its routine occurrence can mask substantial preventable risks arising from practitioner inexperience, underappreciated comorbidities, airway proximity to the surgical field, and challenging postoperative pain management. This review highlights common "error traps" that contribute to perioperative adverse events and outlines evidence-based mitigation strategies. Key preoperative challenges include unrecognized moderate-to-severe obstructive sleep apnea (OSA) and recent upper respiratory infections (URIs), both of which markedly increase perioperative respiratory adverse events (PRAEs). Intraoperative hazards include challenging airway management at induction and emergence, risk of airway fire, and excessive opioid administration. Postoperatively, inadequate analgesia and inappropriate disposition planning remain major preventable causes of morbidity. Perioperative management of the child with post-tonsillectomy hemorrhage is uniquely challenging. Structured OSA and URI screening and mitigation strategies, multimodal opioid-sparing analgesia, and institution-specific discharge algorithms are strongly recommended. A systematic, team-based approach emphasizing awareness of cognitive biases, vigilance, protocolized management, and hospital outcome monitoring can significantly reduce preventable complications and improve safety in pediatric adenotonsillectomy.

ABSTRACTBackground and AimTetracyclines continue to serve as a cost‐effective and essential treatment for common infections, particularly in resource‐limited regions such as lymphatic filariasis (LF)‐hyperendemic communities. The growing use of tetracycline‐based antibiotics by symptomatic filarial lymphedema patients, likely influenced by the demonstrated benefits of anti‐Wolbachia therapy, especially following doxycycline trials, underlines the necessity for vigilant monitoring of tetracycline resistance patterns. This study evaluated patients' antibiotic knowledge, attitude and practice in LF‐endemic communities, and the resistance profiles of tetracycline‐class antibiotics to assess the clinical impact of resistance on current anti‐Wolbachia treatments.MethodsThis cross‐sectional study in Ghana's Ahanta West District enrolled 71 filarial lymphedema patients from four LF‐hyperendemic communities. Structured questionnaires evaluated KAP on antibiotic use and resistance, complemented by microbiological analysis of wound swabs from 28 patients to profile the wound microbiome and assess tetracycline resistance.ResultsMean antibiotic knowledge (1.8 ± 1.0), attitude (1.4 ± 1.1), and practice (1.9 ± 1.1) scores were low, yielding a combined KAP score of 5.0 ± 1.9 (31.2% ± 11.9%) with no significant correlation to the educational level of patients. the facilities survey, the primary healthcare facilities in the area stocked at least one tetracycline‐class antibiotic (specifically tetracycline and/or doxycycline). Microbiological testing identified 68 distinct bacterial isolates (20 genera, 36 species; dominated by S. sciuri, S. aureus). Varied tetracycline resistance observed: doxycycline (35.3%), tetracycline (26.5%), and minocycline (17.6%), with nine (13.2%) isolates resistant to all three. High‐resolution melting analysis detected tet(M) gene in 34.1% (14) of isolates with Tm variation (69.27°C–73.06°C), suggesting variants.ConclusionMultifaceted strategies are essential to curb tetracycline resistance and overuse. These include culturally adapted education to enhance antibiotic stewardship among patients and providers, optimized wound care protocols addressing polymicrobial infections through improved hygiene and tailored regimens, and ongoing resistance surveillance to track trends while promoting therapeutic alternatives.

Antimicrobial resistance remains a leading global health threat, often exacerbated by inappropriate antibiotic use, particularly among the growing population of older adults. This commentary highlights the urgent need for geriatric-focused antimicrobial stewardship programs that balance efficacy, safety, and resistance mitigation. Age-related physiological changes, multimorbidity, and polypharmacy significantly increase the risk of antibiotic-associated adverse effects and drug interactions in older adults. Key challenges include inaccurate estimation of renal function and hypoalbuminemia, which alter antibiotic pharmacokinetics, as well as inappropriate treatment of asymptomatic bacteriuria and increased susceptibility to Clostridioides difficile infection. Clinical complexities such as prosthetic joint infections and antibiotic-induced neurotoxicity further underscore the need for individualized dosing regimens and vigilant monitoring. Certain antimicrobial classes, including fluoroquinolones, and specific agents such as trimethoprim/sulfamethoxazole and rifampin, require particular caution because of their potential for serious toxicities and drug interactions in this population. Pharmacists play a central role in optimizing antibiotic selection, dosing, and monitoring across care settings. Expanding their leadership in antimicrobial stewardship programs is critical to improving outcomes and minimizing preventable harm. Strengthening antimicrobial stewardship requires targeted policies and outcomes-driven research to identify best practices that effectively reduce adverse events. As the aging population continues to grow, it is imperative that pharmacists in geriatric and long-term care settings develop and implement robust antimicrobial stewardship programs that prioritize safety across the continuum of geriatric care.

Abstract Fournier’s gangrene is a life-threatening necrotizing fasciitis of the genitoperineal region with 20%–40% mortality despite aggressive treatment. While SGLT2 inhibitors are associated with this condition, extensive scrotal involvement developing rapidly remains uncommonly reported. We present a 52-year-old male with longstanding type 2 diabetes who developed fulminant Fournier’s gangrene 6 weeks after initiating canagliflozin. His severe diabetic neuropathy masked early symptoms, causing delayed presentation and catastrophic tissue loss requiring complete scrotal excision of approximately 450 square centimeters. This case highlights the heightened vulnerability of neuropathic patients to SGLT2 inhibitor-associated necrotizing fasciitis. Although absolute risk remains extremely low, clinicians should recognize neuropathic patients as high-risk and emphasize daily perineal visual inspection when prescribing SGLT2 inhibitors. Appropriate patient selection, comprehensive education, and vigilant monitoring are essential to minimize this rare complication while preserving substantial cardiovascular and renal benefits.