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Background. The advent of Highly Active Antiretroviral Therapy (HAART) has changed Human Immunodeficiency Virus (HIV) infection from an uncontrollable and lethal diagnosis into a manageable and controllable chronic condition. Overall, the clinical and epidemiological success of this therapeutic revolution hinges on strict patient adherence. This narrative review synthesized clinical data and public health perspectives to evaluate the critical thresholds of adherence, the biological mechanics of drug resistance, and the multi-tiered barriers that impede optimal treatment compliance across diverse global settings.
Main Text. A narrative synthesis of key literature was conducted, integrating foundational clinical trials, behavioral studies, and regional epidemiological reports detailing adherence challenges. A 95% adherence value remains the optimal benchmark for older or complex regimens, but newer agents offer slightly more pharmacokinetic flexibility to achieve good viral suppression and prevent CD4 count depletion. Drops below this benchmark trigger viral replication, creating sub-therapeutic pharmacokinetic windows that could select for drug-resistant mutant strains. This may induce cross-resistance that exhaust future line-of-defense therapies. Mechanistically, a drop in adherence could interfere with increase in drug resistance, complications, and mortality. While developed nations face barriers primarily driven by drug toxicities, psychiatric comorbidities, and lifestyle disruptions, resource-limited settings confront profound structural obstacles, including systemic supply chain failures, catastrophic out-of-pocket costs, and deep-seated psychosocial stigma.

Conclusion. Adherence is not merely an individual behavioral variable but a complex public health challenge. Maximizing the long-term durability of first-line regimens requires a paradigm shift: bridging precise clinical management with structural interventions that secure drug supply, alleviate financial burdens, and dismantle institutional stigma.

Background: Hypercalcemia of malignancy is an important metabolic complication of cancer that may produce neurologic manifestations and is associated with poor prognosis. Diagnosis and management can be particularly challenging in elderly patients with end-stage renal disease (ESRD), in whom abnormalities of calcium and parathyroid hormone homeostasis may complicate interpretation. Case Presentation: An 86-year-old man with ESRD and prostate cancer in remission presented with acute confusion, worsening left hip pain, and abnormal laboratory findings. Nephrology evaluation found a creatinine of 5.9 mg/dL and calcium of 10.8 mg/dL. Hospital studies showed anemia secondary to ESRD, elevated serum calcium at 10.8 mg/dL, ionized calcium at 1.50 mmol/L, intact parathyroid hormone (PTH) at 26.3 pg/mL, elevated parathyroid hormone-related peptide (PTHrP) at 3.0 pmol/L, and a normal PSA of 1.3 ng/mL. Radiographs and CT demonstrated a large destructive lytic lesion involving the left lesser trochanter and proximal femoral shaft, highly suspicious for malignancy of uncertain primary origin. Bone scintigraphy subsequently demonstrated intense tracer uptake spanning approximately 13 cm of the left proximal femur, further supporting an active osseous process. Despite medical management, the patient's hypercalcemia persisted, and his encephalopathy worsened. After multidisciplinary discussions, the family opted for comfort care. Discussion: Malignancy-associated hypercalcemia may result from PTHrP secretion or osteolytic bone destruction, while ESRD can complicate the interpretation and management of calcium abnormalities. This case highlights that even mild total hypercalcemia, particularly when accompanied by elevated ionized calcium, new confusion, and progressive focal bone pain, should prompt consideration of an underlying destructive osseous process.
 

Background: Pleural effusion in advanced illness presents complex challenges in balancing symptom relief with the burden of invasive interventions. Case presentation: We report a 69-year-old bedbound male with a history of cerebrovascular accident, dementia, type 2 diabetes, hypothyroidism, malnutrition, and prior candidemia, who presented with a one-month history of intermittent non-productive cough. Imaging revealed multifocal pneumonia with large left and moderate right pleural effusions. Despite antibiotic therapy with Vancomycin and Piperacillin-Tazobactam, his overall condition remained poor, with profound malnutrition (BMI 17.5 kg/m²) and limited functional capacity. Pulmonology consultation considered bilateral thoracentesis; however, given his steeply declining health, dementia, and poor nutritional status, the family declined invasive interventions and opted for comfort-focused care. His family changed his code status to Do Not Resuscitate (DNR), and the palliative care team was consulted and provided symptom management, psychosocial support, and hospice transition planning. Conclusion: This case emphasizes the importance of collaborative decision-making and involvement of palliative care to ensure that management aligns with the patient's goals and overall health. Choosing to avoid invasive procedures and instead focus on comfort care can better reflect the patient's wishes and uphold the principles of autonomy, beneficence, and quality of life.

Background: DNA methylation–based epigenetic clocks are increasingly used to estimate biological age and to track aging-related physiology in both chronic disease management and longevity-focused care. These assessment tools are heterogeneous: some models prioritize chronological-age prediction, whereas others emphasize morbidity/mortality risk, methylation variability (“biological noise”), organ-system aging patterns, or pace-of-aging metrics. In rheumatoid arthritis (RA), inflammation has been associated with epigenetic age acceleration, including findings reported using second-generation clocks such as GrimAge and GrimAge2. Multilineage-differentiating stress-enduring (MUSE) cells are endogenous, non-tumorigenic reparative stem cells with reported damage-site homing and immunomodulatory effects; contemporary reviews and clinical-trial experience describe intravenous administration of donor MUSE cells without human leukocyte antigen (HLA) matching or immunosuppression in select indications. Objective: To describe the clinical outcomes and epigenetic aging findings observed following MUSE cell and exosome therapy in two patients undergoing regenerative and longevity-focused treatment. Case presentation: We present two patients who underwent MUSE cell and exosome therapy. The first patient was a 45-year-old male with rheumatoid arthritis and chronic multisite inflammatory musculoskeletal pain. The second patient was a 52-year-old female pursuing longevity-focused care after demonstrating elevated biological age estimates and unfavorable pace-of-aging metrics. Conclusion: In this two-patient case series, following MUSE cell and exosome therapy, favorable patient-reported and epigenetic aging outcomes were reported. These outcomes included improved mobility, reduced inflammatory symptoms, decreased analgesic use, and improvements in biological aging metrics such as OrganSystemAge, OmniAge, and pace-of-aging outputs. These findings support further investigation into the relationship between regenerative therapies and biological aging metrics.

Background: Chondroid syringoma is a rare adnexal tumor that originates from sweat glands. It typically presents as a slow-growing, painless, firm, and well-circumscribed cutaneous nodule, most commonly located in the head and neck region. Dermoscopy, a non-invasive diagnostic tool, can aid in differentiating between possible diagnoses. Case presentation: In the described case of a 29-year-old man with a 1-cm asymptomatic, firm, pinkish-brown nodule on the upper lip, dermoscopic features included a peripheral erythematous rim, linear whitish streaks, white structureless areas, yellowish crust, and irregular brown blotches. Histopathological examination revealed a biphasic tumor architecture with nests of basaloid epithelial cells and myoepithelial strands embedded in a chondromyxoid stroma, confirming the diagnosis of chondroid syringoma. Conclusion: This case highlights the supportive role of dermoscopy in suggesting the diagnosis of chondroid syringoma and in excluding major differential diagnoses, particularly nodular basal cell carcinoma, although histopathological examination remains mandatory for definitive diagnosis.

Background: Intragastric balloon (IGB) therapy is a minimally invasive endoscopic intervention for weight reduction in patients with obesity. Although generally safe, rare but clinically significant complications such as acute pancreatitis have been reported. Case Presentation: A 19-year-old male presented with acute epigastric pain, nausea, and vomiting three weeks after intragastric balloon insertion. Laboratory investigations demonstrated markedly elevated serum lipase (>3× upper limit of normal) and leukocytosis. Imaging revealed peripancreatic fat stranding consistent with early acute pancreatitis. The intragastric balloon was endoscopically deflated and removed, followed by supportive management, resulting in complete clinical recovery. Conclusion: Acute pancreatitis is an uncommon but important complication of intragastric balloon therapy. Early recognition and prompt management are essential to achieve favorable outcomes.

Antimicrobial resistance (AMR) has emerged as a major global public health threat, compromising the effective treatment of infectious diseases caused by a variety of organisms. The widespread and uncontrolled use of antibiotics in human healthcare, veterinary medicine, and agriculture is a main contributor to this problem. Practices, such as improper prescribing, self-medication, and routine use in food-producing animals exert selective pressure that encourages the development and spread of resistant microorganisms. These resistant pathogens lead to treatment failures, increased morbidity and mortality, and higher healthcare costs. It is estimated that about one million people die from AMR infections every year in the world. This article highlights the role of irrational antibiotic use in the development of AMR and emphasizes the need for responsible antibiotic stewardship. Judicious use of antibiotics in clinical practice is essential. Strengthening regulatory frameworks, improving public awareness, and adopting a One Health approach are essential to curb the growing threat of antimicrobial resistance.

Introduction: In daily clinical practice, dental practitioners encounter numerous variations of normal anatomy. Two notable developmental variations are torus mandibularis and supernumerary teeth. Torus mandibularis is a benign bony exostosis arising on the lingual surface of the mandible, whereas supernumerary teeth, or hyperdontia, refer to the formation of additional teeth beyond the normal dental complement. Objective: The aim of this case report is to present a rare coexistence of torus mandibularis and supernumerary teeth. Observation: A patient presenting with mandibular tori and multiple supernumerary teeth was evaluated clinically and radiographically using panoramic imaging and cone-beam computed tomography (CBCT). The case highlights the anatomical characteristics, diagnostic considerations, and potential treatment challenges associated with the coexistence of these developmental anomalies. Conclusion: Although torus mandibularis and supernumerary teeth arise from different developmental processes, their coexistence may influence clinical decision-making. Comprehensive assessment and a multidisciplinary approach are important to ensure appropriate management and optimal patient outcomes.

Antimicrobial resistance (AMR) is a growing global health threat that jeopardizes both human and animal health, with significant economic implications. The overuse and misuse of antibiotics in human medicine, agriculture, and veterinary practices have driven the development of resistance, making infections harder to treat and increasing the risk of disease spread. In particular, the use of antibiotics in livestock and aquaculture has accelerated the emergence of resistant pathogens that can transfer to humans via the food chain. AMR is linked to an increase in morbidity and mortality rates, extended hospital stays, and higher healthcare costs. Projections suggest that AMR could lead to up to 10 million deaths annually by 2050, with devastating impacts on global economies, particularly in low- and middle-income countries. Addressing AMR requires a multi-faceted approach, including stricter antibiotic regulations, improved management practices in agriculture, and enhanced surveillance systems. This article reviews the mechanisms of AMR, its global and regional implications, and the strategies needed to mitigate its impact on public health and food security.

Albendazole is a broad-spectrum anthelmintic drug generally regarded as safe. Rarely, it may cause acute toxic hepatitis. We report a case of severe hepatotoxicity following albendazole use in a pediatric patient. Other causes of acute hepatitis were excluded, and the Roussel Uclaf Causality Assessment Method (RUCAM) score was 8, indicating a highly probable drug-induced liver injury.

Paroxetine is a selective serotonin reuptake inhibitor (SSRI). It is used to treat several diseases, including major depressive disorder, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, and premenstrual dysphoric disorder. Anaesthesia or surgery may exacerbate the cardiac effects of the drug. Its interaction with anaesthetic drugs may also have an effect on the heart rhythm. In this case report, the mechanism of such an arrhythmia is elucidated upon. We report a case of acquired QT prolongation in a patient receiving paroxetine who underwent lumbar spinal fusion surgery under general anaesthesia. The potential mechanisms, perioperative implications, and management strategies for acquired QT prolongation are discussed.

Copper deficiency is an uncommon but clinically significant etiology of cytopenias that can closely resemble myelodysplastic syndrome (MDS), particularly when ring sideroblasts and multilineage dysplasia are observed. This morphological overlap presents a diagnostic challenge and may lead to misclassification, unnecessary treatments, and delays in appropriate management. Here, we report the case of a 60-year-old woman who presented with progressive fatigue and was found to have severe neutropenia. Bone marrow examination demonstrated hypercellularity with marked multilineage dysplasia and ring sideroblasts, initially raising concern for MDS with sideroblastic features. Nevertheless, initially exhaustive molecular testing, including an MDS next-generation sequencing panel, SF3B1 mutation analysis, and standard myelodysplastic syndrome fluorescence in situ hybridization (MDS FISH) studies, all yielded negative findings, prompting further evaluation for other reversible causes of dysplasia. Following comprehensive laboratory studies, profound copper deficiency was revealed. The patient started receiving copper repletion, resulting in rapid hematologic recovery, sustained improvement in neutrophil counts, and near-complete resolution of dysplastic morphology on repeat marrow evaluation. The case emphasizes the importance of early consideration of nutritional deficiencies in diagnostic differentials, particularly copper deficiency, in the differential diagnosis of unexplained cytopenias and dysplasia. Early recognition is critical to avoid inappropriate initiation of disease-modifying therapy and to ensure timely, effective, and reversible management and treatment.

Hematopoietic stem cell transplantation (HSCT) is an essential therapy for malignant and non-malignant hematologic, autoimmune, and genetic disorders. However, post-transplant complications, particularly pulmonary infections, remain a leading cause of morbidity and mortality. Case report: We present the case of a 70-year-old male with chronic lymphocytic leukemia (CLL) who underwent allogeneic HSCT several years ago. Post-transplant, he received intravenous immunoglobulin (IVIG) every six weeks for immune support. Despite this, he developed chronic obstructive pulmonary disease (COPD) without any smoking history and has experienced recurrent pneumonia requiring frequent hospitalizations. Extensive microbiologic and imaging evaluations repeatedly failed to identify a causative organism. The patient remains on chronic antibiotic therapy, nebulized bronchodilators, and antiviral prophylaxis with valacyclovir. This case underscores the vulnerability of post-HSCT patients to recurrent, often unexplained pulmonary infections despite ongoing prophylactic and supportive measures. Management focuses on infection prevention and treatment through broad-spectrum antimicrobials, immunoglobulin replacement, and respiratory support, while addressing physical, psychological, and nutritional needs. Discussion: In patients with CLL and T-cell-depleted HSCT, persistent immunodeficiency can lead to refractory pulmonary complications, significantly reducing quality of life and survival. Early recognition, aggressive management, and multidisciplinary care are essential to improving outcomes in this high-risk population.