Online cancer forums are often assumed to promote misinformation and unsupported treatment claims, including some non-evidence-based complementary and alternative medicine (CAM) approaches. This study examined the relationship between online cancer forum use, attitudes toward complementary and alternative medicine (CAM), and the use of non-evidence-based therapies, with a specific focus on CAM approaches prevalent in German-speaking countries. A cross-sectional anonymous online survey was conducted in June-July 2025 among adult users of the largest German cancer forum, assessing forum use, CAM-related attitudes (defined according to the German S3 guideline checklist, version 1.2), eHealth literacy, psychological distress, and sociodemographic and disease-related variables. Forum use was dichotomized by median split, and data were analyzed using non-parametric tests and multivariable regression models. Among 458 participants, high versus low forum use differed by sociodemographic and disease-related factors but was not associated with eHealth literacy or psychological distress. Among CAM users (44.3%, n = 203), CAM use intensity was moderate (median = 2, IQR 1-3) and showed no association with forum use, eHealth literacy, psychological distress, or sociodemographic variables; no independent predictors were identified. CAM-related forum discussions were rated as significantly less trustworthy than discussions on conventional cancer treatments (t(383) = 16.88, p < 0.001), independent of eHealth literacy, psychological distress, or participant role. The use of CAM approaches, including both evidence-based supportive interventions and non-evidence-based methods, was not associated with forum exposure, eHealth literacy, or psychological distress. Forum users demonstrated differentiated trust patterns, with consistently lower perceived credibility attributed to CAM-related discussions compared with discussions on conventional cancer treatments. For cancer survivors, online cancer forums appear to function primarily as contextual support resources rather than drivers of non-evidence-based treatment decisions. Clinicians should therefore address forum use openly and early, focusing on guidance and shared decision-making instead of discouragement.
Visceral myopathy (VSCM) is an ultra-rare life-threatening condition characterized by severe impairment of gastrointestinal (GI), genitourinary, and uterine smooth muscle. This disorder represents a significant clinical challenge due to variable presentation and the lack of standardized diagnostic and therapeutic protocols. To discuss advances in the field, scientists and clinicians with a special interest in VSCM met in Arenzano, Genova, Italy in October 2024 for the second International Forum on Visceral Myopathy 2024 (IFVM2024) (https://ifvm2024.ge.ibf.cnr.it/). As in the previous edition of the event (https://poic-e-dintorni.org/efvm-2022/), attendees included clinicians and researchers from around the world who study this disease, representatives from support organizations, patients affected by VSCM and their families, and companies that co-funded the event. The present manuscript aims to summarize knowledge shared during the IFVM2024 conference, thus providing an updated state-of-the-art summary of VSCM biology and disease management. Here, we pay particular attention to the epidemiology of the disease, histopathology, genetics, novel treatments, advances in molecular and cell biology, experimental models, and the lived experiences and impact of this disorder on families.
The clinical presentation of chronic pancreatitis (CP) is highly variable and determined by the presence of pancreatic and extrapancreatic complications that occur with varying prevalence and severity. The Scandinavian and Baltic Pancreatic Club (SBPC) Forum of Excellence is a forum for clinicians from the Nordic and Baltic countries with specific knowledge on pancreatic diseases. In 2016, the forum established a database for patients with CP, which became the largest database on this patient population. This paper provides an insight into the 14 studies published from the SBPC database. The cohort grew over the years, and finally, a total of 2608 patients were entered into the database. Smoking and alcohol were leading aetiologies and these are both associated with pain, pancreatic exocrine insufficiency and structural changes. Cluster analysis revealed distinct complication profiles. Imaging findings correlated with clinical outcomes, and enzyme therapy adherence was suboptimal. Chronic pancreatitis is associated with reduced quality of life compared to controls. Endoscopic procedures (EP) were common while surgery was rare and usually preceded by EPs. The SBPC's research offers valuable insights into the aetiology, treatment and complications of CP, with significant implications for patient management. Future studies should aim to expand the evidence base for acute on chronic pancreatitis and explore the long-term outcomes of pancreatic enzyme replacement therapy adherence and invasive interventions in diverse populations. To address these problems, a new prospective register was started that is fully compliant with the current European Union legislation.
The 11th Cardiovascular Outcome Trial (CVOT) Summit: Congress on Cardiovascular, Kidney, and Metabolic Outcomes was held virtually on November 20-21, 2025. The Summit provided a multidisciplinary forum to review and discuss recent outcome trials investigating emerging pharmacological therapies targeting diseases of the cardiovascular-kidney-metabolic (CKM) continuum. This report highlights the unique developments of 2025 discussed during the Summit, including the first head-to-head CVOT (SURPASS-CVOT), the growing evidence base for combination therapies across the disease spectrum, new insights into the inflammatory component of the CKM syndrome, and relevant policy developments. The first part of this report summarizes pioneering clinical trials addressing combination therapy with finerenone and empagliflozin (CONFIDENCE), the oral glucagon-like peptide-1 (GLP-1) receptor agonists orforglipron (ATTAIN-1), and the aldosterone synthase inhibitor (ASI) baxdrostat (BaxHTN). The second part presents recent guideline and policy developments discussed by experts in endocrinology, diabetology, cardiology, nephrology, hepatology, and general practice. In addition, advances in medical technology, particularly in continuous glucose and ketone monitoring, are highlighted, as well as emerging therapies for diseases of the CKM continuum. These include pharmacological agents for a broad spectrum of metabolic disorders such as metabolic liver disease and type 1 Diabetes (T1D) alongside emphasis on the importance of early detection and innovative treatment strategies. The 12th Cardiovascular Outcome Trial Summit will be held virtually on 19-20 November 2026 ( http://www.cvot.org ).
Although more women are entering gastroenterology and related fields (GI practice) in India, gender gaps remain in training, leadership and career growth. This Indian Society of Gastroenterology-Women in GI Forum (ISG-WGF) study examines the challenges women face in GI and hepatology and suggests practical steps to improve equity and inclusion. A structured, online questionnaire was disseminated to 4140 members of the ISG, including trainees and practising gastroenterologists. The questionnaire assessed six domains: socio-demographic data, GI training experiences, family support, current GI practice, work-life balance and gender-related career trajectory in men and women GI professionals. Of 185 respondents (response rate 4.5%), women represented 46.5%, although they comprised only 10.7% of ISG members. Women reported greater work-life imbalance (65.0% vs. 43.8%; p = 0.023), more family-related career disruptions (43% vs. 21%; p < 0.001) and higher perceived gender discrimination (36% vs. 11.1%; p < 0.001). Women respondents were younger than men (42.4 ± 16.7 years vs. 47.3 ± 13.4, p = 0.032) and only 24.4% of women respondents held leadership positions compared to 45.5% of men (p = 0.004). Women scientists face career barriers such as inadequate mentorship, inflexible work schedules, limited family and institutional support and ergonomic issues in endoscopy. Solutions include mandated gender equity policies, structured mentorship, leadership opportunities, innovations in endoscopy practice and inclusive institutional reforms. Addressing gaps in GI training and practice by implementing mentorship, gender-sensitive policies and workplace equity initiatives may help improve professional satisfaction, reduce career lag and increase female involvement in GI leadership roles.
Endoscopic full-thickness resection (EFTR) has emerged as a minimally invasive treatment for small gastrointestinal subepithelial neoplasms (SETs). In particular, the development of novel closure methods such as clip-line and various endoscopic suturing techniques has enabled the secure closure of any resultant defects. During the Advanced Therapeutic Endoscopy session at the Endoscopic Forum Japan 2025, we summarized the current status of EFTR for SETs and discussed future clinical applications for epithelial neoplasms from oncological and technical perspectives. Although predominantly documented in gastric subepithelial neoplasms, EFTR is also used to treat select esophageal, duodenal, and colorectal SETs. While extensively evaluated for gastric gastrointestinal stromal tumors (GISTs), relatively low R0 resection rates have limited its broader clinical adoption; however, the novel no-touch EFTR technique could overcome this challenge and facilitate the adoption of this procedure for small gastric GISTs. Applying EFTR to epithelial tumors requires strict assessment of oncological clearance, given the risks of lymph node metastasis and peritoneal seeding following full-thickness breaches. At the end of the session, we voted on the appropriateness of EFTR for epithelial neoplasms across different organs, balancing oncological risks against technical feasibility. All nine participants (100%) supported EFTR for rectal lesions, and eight (89%) supported its use for gastric lesions. Future investigations and technical innovations are required to expand the clinical indications for EFTR in epithelial neoplasms.
Africa bears a disproportionate burden of hepatitis B virus (HBV) infection, with 68 million chronically infected individuals and 65% of global new infections. However, only 18 (1%) of 1804 global HBV clinical trials have been conducted in Africa, limiting the generalisability of therapeutic findings. The HBV arm of the Forum for Collaborative Research convened a series of multistakeholder discussions between 2023 and 2024, to identify gaps in clinical research and identify solutions. This Personal View synthesises insights from these convenings, highlighting key barriers and potential solutions to the disparities in HBV clinical research. Barriers include inadequate funding, insufficient political will, low community awareness, and logistical challenges due to health-care infrastructure and regulatory systems. This Personal View emphasises the urgent need for African-led research, given region-specific factors such as diverse HBV genotypes and co-infections with HIV and hepatitis D virus. We propose solutions, including strengthening regulatory frameworks, leveraging existing research networks, establishing industry funding consortiums, and advocating for increased investment.
Ulcerative colitis (UC) and Crohn's disease (CD) are increasingly prevalent in the Asia Pacific region, necessitating updated, region-specific guidance on advanced therapies. Targeted small molecule agents, such as filgotinib, tofacitinib, upadacitinib, etrasimod, and ozanimod; and the IL-23 p19 inhibitors (guselkumab, mirikizumab, risankizumab) are the newest advanced therapies in our armamentarium for the treatment of IBD. The aim of the Asia-Pacific consensus statements is to provide context-specific recommendations integrating real-world evidence specific to our region. The Asian-Pacific Association of Gastroenterology (APAGE) Committee on Inflammatory Bowel Disease, with the participation of Asian Education Network in Inflammatory Bowel Disease (AEN-IBD), convened a forum of 34 IBD experts from 12 countries to develop consensus guidelines on the best practices on the use of these new advanced therapies using the modified Delphi method. IL-23 p19 inhibitors have shown good efficacy in biologic-naïve and experienced patients in both UC and CD, with clinical and endoscopic superiority over ustekinumab and an excellent safety profile. JAK inhibitors (tofacitinib and filgotinib) are efficacious in UC, and upadacitinib is efficacious in both UC and CD. They have a rapid time to response, and emerging data on acute severe UC appears promising. However, careful screening and monitoring is needed for known side effects, and prophylactic vaccination for herpes zoster should be considered. S1P modulators (ozanimod, etrasimod) are efficacious in UC with a favorable side effect profile.
Endoscopic ultrasound (EUS) is being increasingly used for both diagnostic and therapeutic purposes in various settings in gastroenterology and hepatology. Similarly, it has also been adopted in liver transplantation (LT), and its utilization is steadily increasing. EUS strengthens LT care in both the pre-transplant and post-transplant periods. Specifically, EUS is valuable in the evaluation of liver parenchyma, portal hypertension assessment and variceal management, tissue sampling when percutaneous or transjugular approaches are contraindicated or impractical, detection and characterization of hepatic and nodal metastases-thereby refining staging and sometimes even eligibility for LT-management of postoperative collections, and enabling biliary and pancreatic interventions in altered anatomy by creating access routes. In this review, we discuss these applications of EUS, along with its current limitations and its evolving role in the setting of LT.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and is strongly linked to metabolic comorbidities such as diabetes mellitus, hypertension, dyslipidemia, and coronary artery disease. Despite their cardiovascular benefits, statins are historically underused in patients with MASLD because of concerns regarding hepatotoxicity. This study aimed to evaluate the impact of statins on liver transaminase levels in patients with MASLD and assess whether statin type or dose influences these outcomes. We conducted a retrospective review of 104 patients with MASLD who attended outpatient clinics between January 2023 and December 2024. Patients on statins for ≥12 months were included, while those with viral hepatitis, autoimmune liver disease, or significant alcohol intake were excluded. The data collected included comorbidities, statin type/dose, and liver transaminase levels at baseline, 3, 6, and 12 months. Patients without baseline transaminase levels available at the time of statin initiation were excluded. Of the 104 patients recruited, only 21 underwent transient elastography, of which two had advanced chronic liver disease. The mean BMI was 34.26 kg/m2. Most patients had diabetes mellitus (86%), hypertension (88.5%), and dyslipidemia (98.1%). Transaminase levels remained stable over 12 months (ALT, χ2(3)=0.340, p=0.952; AST, χ2(3)=0.342, p=0.926). Statin type and dose had no significant effects on transaminase levels. Statins of different types and doses did not significantly affect transaminases in patients with MASLD, indicating that statins are safe for use in patients with MASLD who meet the criteria for lipid-lowering therapy. Further studies are warranted to explore the long-term hepatic effects of statins in patients with metabolic dysfunction-associated steatohepatitis (MASH), focusing on histological outcomes.
Cardiovascular, kidney, and metabolic (CKM) diseases and liver disease are not merely linked by shared risk factors, but also frequently coexist as comorbidities with overlapping pathophysiology. Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent in individuals with CKM disorders, and vice versa. The concomitant presence of these conditions amplifies the risk of both CKM and liver-related outcomes, raising the question of whether the CKM model should formally incorporate liver dysfunction. In this review, we detail the epidemiologic and pathophysiologic evidence that supports that expanded framework, highlighting the shared mechanisms of systemic inflammation, lipotoxicity, and fibrotic remodeling that unite these conditions. We then critically appraise the current landscape of selected heart failure, chronic kidney disease, and MASLD/metabolic dysfunction-associated steatohepatitis (MASH) trials, demonstrating how focus on single disease states with the exclusion of or insufficient data on the others has created knowledge gaps. Building on this, we provide a pragmatic outline for designing integrated multiorgan trials. We outline strategies for enriching trial populations, discuss the evidence and challenges for establishing noninvasive tests as surrogate endpoints to replace liver biopsy, and provide a framework for advanced biomarker and imaging substudies in CKM and MASLD/MASH trials. Finally, we advocate for a transition from isolated studies to patient-centered basket and platform trials that use master protocols to develop holistic therapies for these interconnected diseases.
Hepatotoxicity represents a significant adverse effect associated with cancer treatment. The present study was designed to evaluate the possible hepatoprotective effects of bevacizumab and nivolumab when administered concomitantly with cisplatin. A total of forty-two male Wistar Albino rats were randomly allocated into six groups: control, bevacizumab (10 mg/kg), nivolumab (3 mg/kg), cisplatin (12 mg/kg), cisplatin plus bevacizumab, and cisplatin plus nivolumab. Histological assessment of liver tissues was performed using hematoxylin and eosin (H&E) and Masson's trichrome staining. Immunohistochemical evaluation was conducted for inflammatory markers (TNF-α, IL-6), the angiogenic factor VEGF, and apoptotic markers (Bax, Bcl-2, Caspase-3). Administration of cisplatin resulted in hepatotoxic changes, including disruption of normal hepatic cord architecture, cytoplasmic vacuolization, hemorrhage, mononuclear cell infiltration, and enhanced collagen accumulation. Co-treatment with bevacizumab or nivolumab significantly alleviated these histopathological changes (p<0.001). In addition, levels of inflammatory and pro-apoptotic markers (TNF-α, Bax, Caspase-3) were markedly reduced, whereas expression of the anti-apoptotic protein Bcl-2 was increased in the combination treatment groups compared with the cisplatin-only group. In the cisplatin + nivolumab group, the TNF-α level was 1.0 (0.8-1.2), whereas in the cisplatin-only group it was 2.0 (1.8-2.0) (p=0.03). The Bcl-2 level in the cisplatin + nivolumab group was 1.0 (0.8-1.2), while it was 0.2 (0-0.6) in the cisplatin group (p=0.04). Bevacizumab and nivolumab exhibited hepatoprotective properties when combined with cisplatin, as demonstrated by histological improvement and regulation of inflammatory and apoptotic signaling pathways.
Enteric infectious diseases claim more than 1 million lives annually and are among the top ten causes of death in children younger than 5 years. Remarkable global investment has been dedicated to enteric infectious disease prevention and control; however, the shifting global health landscape is testing the continuance of progress. To evaluate the current status and guide future interventions, we present the latest epidemiological estimates of enteric infectious diseases from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 and assess progress towards the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) mortality target of fewer than 20 deaths per 100 000 children younger than 5 years by 2025. We quantified the incidence, mortality, and disability-adjusted life-years (DALYs) of enteric infectious diseases by age, sex, and year across 204 countries and territories from 1990 to 2023. In GBD 2023, the following were considered under the category of enteric infectious diseases: diarrhoeal diseases, enteric fever (typhoid and paratyphoid), invasive non-typhoidal Salmonella spp (iNTS) infections, and other intestinal infectious diseases. We also examined 15 aetiologies contributing to diarrhoeal diseases. Incidence and prevalence were estimated with DisMod-MR (version 2.1), a Bayesian meta-regression tool, drawing on data from systematic reviews, population-based surveys, claims data, and hospital sources. Cause-specific mortality was modelled with Cause of Death Ensemble Modelling based on data from sources including vital registration, mortality surveillance, verbal autopsy, and minimally invasive tissue sampling. Years of life lost and years lived with disability were computed and combined to derive DALYs. For aetiology-specific estimation, population-attributable fractions (PAFs) for 15 pathogens were derived with a counterfactual framework. Point estimates and 95% uncertainty intervals (UIs) were generated from 250 draws from the posterior distribution. In 2023, enteric infectious diseases resulted in an estimated 1·27 million (95% UI 0·963-1·68) deaths globally, declining from 3·69 million (3·04-4·56) in 1990. The global age-standardised mortality rate (ASMR) decreased from 74·1 (62·0-92·9) per 100 000 population to 16·4 (12·6-21·3) per 100 000 population during the same period. Diarrhoeal diseases accounted for most deaths in 2023 (1·11 million [0·811-1·54]), followed by enteric fever and iNTS. South Asia and sub-Saharan Africa remained the most affected regions in 2023, with 599 000 (441 000-882 000) and 501 000 (373 000-648 000) deaths due to enteric infectious diseases, respectively, predominantly from diarrhoeal disease. Rotavirus was the leading cause of all-age diarrhoeal disease deaths (PAF 16·3% [12·0-21·5]), followed by norovirus (10·2% [2·4-17·0]) and Shigella spp (9·3% [5·4-15·2]). Among children younger than 5 years, PAFs of deaths due to diarrhoeal diseases were 40·2% (32·5-48·5) for rotavirus, 24·0% (15·1-36·7) for Shigella spp, and 23·4% (13·7-34·3) for adenovirus. Across 204 countries and territories, 141 met the GAPPD mortality target in 2023. The driving aetiologies among countries that did not meet the target in 2023 varied slightly by GBD super-region, but the highest or second-highest number of deaths in children younger than 5 years were consistently attributed to rotavirus. Astrovirus and sapovirus, newly included in GBD 2023, were responsible for 24 600 (6290-49 000) and 18 800 (4650-44 400) deaths, respectively, in 2023, mainly in children younger than 5 years. Our findings show that mortality and ASMRs of enteric infectious diseases declined substantially between 1990 and 2023. This decline is consistent with the expansion of public health measures and broader socioeconomic development. However, the burden in 2023 remains considerably high, with the highest mortality concentrated in sub-Saharan Africa and south Asia. Considering that more than a quarter of all countries had yet to meet the GAPPD mortality target in 2023, sustained efforts are needed to address the persistent burden in affected countries and to adapt to the changing global health landscape. Gates Foundation.
Meningitis remains the leading infectious cause of neurological disabilities globally, disproportionately affecting children younger than 5 years and populations in the African meningitis belt. Whereas previous global estimates focused on ten pathogen categories, this study presents the most comprehensive analysis to date, assessing the meningitis burden attributable to 17 causative pathogens based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework. GBD is a systematic, scientific effort aimed at quantifying the comparative magnitude of health loss caused by diseases, injuries, and risk factors across age groups, sexes, and geographical locations over time. We estimated meningitis mortality using the Cause of Death Ensemble model (CODEm) and morbidity using DisMod-MR 2.1, incorporating data from vital registration, verbal autopsy, surveillance, hospital data, and systematic reviews. Aetiology-specific estimates were generated with pathogen-linked case-fatality ratios and splined binomial regression models. Risk factor attribution was based on established risk-outcome pairs and population attributable fractions. In 2023, there were 259 000 (95% uncertainty interval 202 000-335 000) global deaths and 2·54 million (2·20-2·93) incident cases of meningitis. Children younger than 5 years accounted for more than a third of deaths (86 600 [53 300-149 000]). Streptococcus pneumoniae, Neisseria meningitidis, non-polio enteroviruses, and other viruses were the leading causes of death, while non-polio enteroviruses caused the most cases. The four WHO-defined preventable meningitis pathogens of interest (S pneumoniae, N meningitidis, Haemophilus influenzae, and Group B streptococcus) contributed to 98 700 deaths (77 000-127 000) and 594 000 cases (514 000-686 000). Low birthweight, short gestation, and household air pollution were the top risk factors for meningitis-related mortality. Although mortality and incidence have declined significantly since 1990, progress is insufficient to meet WHO 2030 targets. Despite marked progress in reducing bacterial meningitis via global vaccination campaigns, a substantial meningitis burden persists, attributable both to common pathogens such as S pneumoniae and N meningitidis and to emerging non-bacterial pathogens such as Candida spp and drug-resistant fungi. Achieving WHO goals will require sustained investment in surveillance, vaccination, maternal screening, and health-system strengthening, especially in high-burden settings. Gates Foundation, Wellcome Trust, and UK Department of Health and Social Care.
To evaluate the diagnostic performance, technical feasibility, and safety of percutaneous endobiliary punch biopsy (PEPB) in patients with suspected malignant biliary strictures, particularly when endoscopic approaches are not feasible. This retrospective, single-center study included 23 patients with radiologically confirmed biliary strictures who underwent PEPB between January 2020 and January 2025. All procedures were conducted under fluoroscopic guidance following percutaneous biliary drainage. Clinical, laboratory, and procedural data were reviewed. Biopsy samples were adequate for histopathological analysis in all cases. The technical success rate was 100%. Malignancy was detected by PEPB in 17 patients, while 3 cases were confirmed as benign and 3 were false-negative results later proven malignant. PEPB demonstrated a sensitivity of 85%, specificity of 100%, and an overall accuracy of 86.96%. Fisher's exact test showed a significant association between biopsy results and final diagnosis (p=0.011). Two minor complications (8.7%)-cholangitis and hemobilia-occurred and were managed conservatively. PEPB is a safe, technically viable, and diagnostically accurate method for tissue sampling in biliary strictures. It offers a valuable alternative when endoscopic biopsy fails or is not feasible.
Occult Hepatitis B Infection (OBI) is a condition in which HBsAg tests are negative, but Hepatitis B virus (HBV) DNA is detectable in the liver, with or without low levels of HBV DNA in the blood (<200 IU/mL). The Hepatitis B surface antigen (HBsAg) negative status in OBI may result from the absence or low production of HBsAg due to immune system defense mechanisms or mutations in the S genome of HBV DNA, which make HBsAg undetectable. The gold standard for diagnosing OBI is testing for HBV DNA from liver tissue, with an alternative method being HBV DNA testing from serum. Patients with OBI may be at risk of transmitting HBV to others through blood transfusions or organ transplants. Reactivation may occur, especially in OBI patients who are immunocompromised or undergoing immunosuppressive therapy. Antiviral prophylaxis may be considered for OBI patients at risk of reactivation. Additionally, OBI patients also carry a risk of developing hepatocellular carcinoma (HCC), similar to those with non-occult hepatitis B infection. Antiviral therapy for OBI is generally not required unless the case represents false OBI due to HBsAg mutation.
Campylobacter and Salmonella are leading causes of bacterial gastroenteritis worldwide, yet their comparative impact on acute kidney injury (AKI) remains unexplored. We conducted a retrospective cohort study of adults (≥18 years) hospitalized with community-acquired bacterial gastroenteritis at a tertiary center in South Korea (2018-2025). The primary outcome was AKI incidence. Multivariable logistic regression assessed associations between pathogen type (Campylobacter, Salmonella, or Others, including Escherichia coli or Clostridium difficile) and AKI risk (reference: Campylobacter). Secondary outcomes included postdischarge kidney outcomes (acute kidney disease [AKD], incident chronic kidney disease [CKD], and CKD progression). Among 232 patients (Campylobacter n = 139, Salmonella n = 55, and Others n = 38), AKI incidence differed significantly across groups (26.6%, 70.9%, and 31.6%, respectively; P < .001), with 42% of Salmonella patients developing AKI stages 2 and 3. Salmonella enteritis was independently associated with higher AKI risk than Campylobacter (odds ratio 3.19, 95% confidence interval [CI] 1.23-8.30). Salmonella patients had 46% longer hospital stays (median 8 vs 5 days). In-hospital AKI was associated with postdischarge composite kidney outcome (hazard ratio 3.17, 95% CI 1.02-9.83), particularly during the AKD window (7-90 days postdischarge). Notably, 17% of patients who recovered from AKI before discharge subsequently developed AKD or CKD. In this retrospective study, hospitalized patients with Salmonella enteritis had a higher risk of AKI than those with Campylobacter; furthermore, those with in-hospital AKI from any cause were more likely to have adverse short-to-intermediate-term postdischarge kidney abnormalities. These findings support pathogen-specific risk stratification and the need for postdischarge monitoring of patients who develop in-hospital AKI.
While liver biopsy remains the reference standard for assessing hepatic fibrosis, the major prognostic factor in metabolic dysfunction-associated steatotic liver disease (MASLD), its inherent limitations have driven the search for innovative non-invasive diagnostic tests. In this study, we sought to evaluate the diagnostic accuracy of plasma PDGFRβ and PSD4 methylation levels, integrated within machine learning algorithms, for non-invasive staging of hepatic fibrosis in patients with MASLD, and to compare its performance against established non-invasive biomarkers. Patients with biopsy-proven MASLD and healthy controls were recruited from the three institutions. Quantitative methylation of circulating cell-free DNA was assessed using bisulfite modification and pyrosequencing. The resulting data were used to develop linear discriminant analysis, random forest, and support vector machine algorithms to identify patients at different stages of fibrosis. The study included 234 patients with histologically confirmed MASLD and 43 healthy controls. Each dataset was validated using an independent cohort. Advanced fibrosis was associated with elevated plasma PDGFRβ and PSD4 methylation levels in both the discovery and validation cohorts. The integration of plasma DNA methylation markers with clinical parameters demonstrated performance comparable to that of existing noninvasive biomarkers for detecting both significant and advanced fibrosis, achieving area under the curve scores exceeding 0.75 across all models. Supervised machine learning algorithms incorporating plasma PDGFRβ and PSD4 DNA methylation levels show promise as a non-invasive approach for assessing hepatic fibrosis in MASLD.
Liver diseases account for 1 in 25 deaths worldwide. Owing to the asymptomatic nature across the dynamic spectrum of steatotic liver disease (SLD) and the absence of targeted screening programmes, individuals at risk of progression to cirrhosis or hepatocellular carcinoma (HCC) are unlikely to pursue liver disease testing. Historically, hepatitis B and C were the leading causes of liver injury that can progress to cirrhosis or HCC. Global efforts to implement screening and vaccination programmes, expand testing and treatment, and encourage active viral hepatitis case finding followed the widespread availability of curative treatment for hepatitis C and effective suppressive therapy and vaccines for hepatitis B, further supported by changes in law, regulation and public policy. With encouraging declines in new viral hepatitis infections in many countries, greater attention should turn to SLD, now the leading global indicator for cirrhosis and HCC. Screening and active case finding for SLD lag far behind its increasing prevalence, leaving most people undiagnosed. This Expert Recommendation draws on lessons learned from legal, regulatory and policy changes required to combat the viral hepatitis public health threat. Our recommendations can contribute to a concerted shift in legal frameworks and policies to enhance screening programmes, increase testing and improve health outcomes.
Immune reconstitution inflammatory syndrome (IRIS) is a well-described complication following initiation of antiretroviral therapy (ART) in people with HIV. In this case report, we describe the complex clinical presentation of a 27-year-old ART-naïve male with advanced HIV who developed Kaposi sarcoma-associated IRIS (KS-IRIS) with visceral involvement and pericardial effusion shortly after starting ART. We review known risk factors for KS-IRIS, its clinical manifestations including rare cardiac involvement and paradoxical worsening with steroid use, as well as current evidence for chemotherapeutic and antiviral treatment strategies.