Background: Amiodarone is a widely used antiarrhythmic agent, but its long-term use is associated with various pulmonary toxicities, including pulmonary fibrosis. Objective: To assess the clinicopathological patterns of pulmonary fibrosis in patients receiving long-term amiodarone therapy. Methods: A retrospective observational study was conducted on 89 patients who had received amiodarone for more than six months and presented with respiratory symptoms suggestive of pulmonary toxicity. Clinical data, HRCT scan findings, and histopathological reports were analyzed. The radiological patterns were classified according to the ATS/ERS criteria, and tissue samples from lung biopsies (where available) were reviewed by two independent pathologists. Results: The mean age of the patients was 66.2 ± 8.5 years, with a male predominance (67.4%). HRCT revealed diffuse interstitial infiltrates in 52.8% of patients, ground-glass opacities in 39.3%, and honeycombing in 7.9%. Histologically, 61.8% showed fibrotic interstitial pneumonia, 24.7% had organizing pneumonia, and 13.5% had nonspecific interstitial pneumonitis. Foamy macrophages were present in 76.4% of lung biopsy specimens. Pulmonary fibrosis severity correlated significantly with cumulative amiodarone dose and treatment duration (p < 0.05). Conclusion: Amiodarone-induced pulmonary fibrosis exhibits a range of radiological and histopathological features, predominantly interstitial infiltrates and fibrotic patterns. Early detection through imaging and clinical monitoring is essential to minimize irreversible lung damage.

Background: Total knee arthroplasty (TKA) is associated with significant postoperative pain, which can affect early mobilization and patient satisfaction. Regional anesthesia techniques, including spinal, epidural, and peripheral nerve blocks, have been increasingly used to improve pain control, reduce opioid use, and enhance recovery. Objective: To compare the effectiveness of different regional anesthesia techniques on postoperative pain control and opioid requirement in patients undergoing total knee arthroplasty. Methods: A comparative analytical study, enrolling 126 patients undergoing total knee arthroplasty to evaluate postoperative pain control with regional anesthesia, using non-probability consecutive sampling. Results: A total of 126 patients undergoing total knee arthroplasty were included and divided equally among three regional anesthesia groups: spinal, epidural, and femoral nerve block (42 patients each). Spinal anesthesia resulted in the lowest mean pain scores at 6 hours (3.2 ± 1.1) and 12 hours (3.8 ± 1.4) postoperatively (p = 0.01 and p = 0.03, respectively). Total opioid use was also significantly lower in the spinal group (28.6 ± 5.4 mg) compared to the epidural (35.2 ± 7.3 mg) and femoral nerve block groups (32.4 ± 6.1 mg; p = 0.01). Time to first analgesic request was longest with spinal anesthesia (7.8 ± 1.9 hours; p = 0.04). Spinal anesthesia also had the lowest incidence of nausea (11.9%) and hypotension (7.1%). Patient satisfaction was highest in the spinal group with a mean score of 8.7 ± 1.2 and 81% of patients reporting high satisfaction (p = 0.02). These results support spinal anesthesia as the most effective and well-tolerated technique among the three evaluated. Conclusion: Spinal anesthesia provided superior postoperative pain control and reduced opioid consumption compared to epidural and femoral nerve block techniques in TKA patients. These findings support the preferential use of spinal anesthesia for enhanced recovery in lower limb arthroplasty.

Acute Respiratory Distress Syndrome (ARDS) is a life-threatening condition in pediatric intensive care unit (PICU) patients, with high morbidity and mortality. Early identification of at-risk patients can improve outcomes, but there is no validated pediatric-specific ARDS risk assessment tool. Objective: To develop and validate a risk assessment tool for predicting the development of ARDS in paediatric ICU patients. Methods: A prospective cohort study was conducted in a tertiary care PICU. Data from 500 patients were used to develop the tool, and an independent cohort of 300 patients was used for validation. Predictors included clinical, laboratory, and respiratory parameters. The tool was developed using logistic regression and validated using area under the receiver operating characteristic curve (AUC). Results: The tool included six predictors: hypoxia index, presence of pneumonia, sepsis, immunocompromised status, history of aspiration, and elevated lactate levels. The tool demonstrated excellent discrimination in the development cohort (AUC=0.92) and good discrimination in the validation cohort (AUC=0.88). Sensitivity and specificity were 85% and 89%, respectively, at the optimal cutoff. Conclusion: The Paediatric ARDS Risk Assessment Tool (PARRT) is a valid and reliable tool for predicting ARDS in PICU patients. Its use may facilitate early intervention and improve outcomes.

Middle East respiratory syndrome (MERS) is a viral respiratory disease caused by a coronavirus (MERS‐CoV) which was first isolated in Saudi Arabia in 2012.1 Since then, 1,365 confirmed cases of MERS-CoV, including almost 490 associated deaths (case fatality rate - 36%) have been reported in 26 different nations across Middle East (9), Europe (8), Africa (3), Asia (5), and United States of America.1 However, the maximum number of cases (>85%) has been isolated from Saudi Arabia alone.1 Although a major proportion of these cases have been attributed to human-to-human transmission (close contact, non-adherence to standard infection prevention guidelines while providing care to an infected patient, especially among healthcare staff and family members), nevertheless, the possibility of non-human to human transmission through camels (reservoir host) cannot be ruled out.1,2

Background Bone mineral density (BMD) is known to fluctuate with age, hormonal profile, or presence of comorbidities. Bone evaluation in HIV positive patients is mandatory, particularly in those who acquired infection early in childhood, when bone turnover is high. Data in field literature on the prevalence of osteopenia or osteoporosis in HIV infection are heterogeneous, and the studies performed are not comparable due to essential differences in the followed cohorts. To address this issue we have performed a literature review to gather data on BMD in HIV infection. Review methodology We searched PubMed for the following key terms: "HIV”, "osteopenia”, "osteoporosis”, "bone”, "BMD”. All identified studies relevant to this topic were included in the analysis. The following parameters were collected for each study: number of participants, country of participants, prevalence of lumbar and femoral osteopenia and osteoporosis, mean or median age, mean or median duration of HIV infection, nadir CD4 cell count, and any particular comments. Literature review and Conclusion Data reported in field literature regarding osteopenia and osteoporosis are extremely heterogeneous in nature. This is in part due to the profound differences in the cohorts of patients, i.e., recently diagnosed patients vs. long-term survivors, but also due to the different definitions used for describing low BMD. Caution is warranted when comparing results of different studies.

The exact incidence of chronic kidney disease (CKD) in HIV-positive patients is still up for debate, and a large spectrum of risk factors have been described in field literature. CKD also associates metabolic and hormonal abnormalities that may lead to an impairment of bone turnover, mineralization and volume, the so called chronic kidney disease-mineral and bone disorder (CKD-MBD). In addition, HIV-positive patients are considered to have a higher risk of bone demineralization and osteopenia. Methods Two categories of HIV-positive patients, with different epidemiological features, were screened for renal impairment and for osteopenia/osteoporosis. Multivariate regression models were used to investigate traditional risk factors for bone demineralization and kidney impairment. Differences between the two groups were also evaluated. Results The clinical team screened a cohort of 125 patients who were divided into two groups: group A included 64 patients in whom HIV infection had occurred in early childhood and who had received long-term treatment, group B included 61 patients in whom HIV infection had occurred during teenage years or in adulthood. Interestingly, no significant differences were identified in albuminuria, renal function, and the presence of osteopenia or osteoporosis. In patients from the Romanian HIV cohort we identified higher current or nadir CD4 cell counts (p=0.031 and p=0.041, respectively), a more frequent medical history of over three antiretroviral regimens (p=0.000), a higher rate of HBV coinfection (p=0.0002), and a lower proportion of hyperparathyroidism (p=0.011). Conclusion Traditional risk factors such as BMI, presence of comorbidities such as diabetes mellitus or hypertension, smoking status and vitamin D deficiency or insufficiency, were similar in the studied groups. Overall, the rate of renal and bone impairment was low in the studied groups.

Background Cases of typhoid, a disease caused by Salmonella typhi, have been on the increase in the City of Harare in Zimbabwe. However, factors associated with typhoid infection are not clear. The study investigated factors associated with typhoid infection during an outbreak in Harare, Zimbabwe Methods This was a case control study based on quantitative and qualitative analyses of interviewer-administered semi-structured questionnaires on selected cases and controls. Sanitation facilities of the affected households were assessed using a checklist prepared by the researchers. Results Out of 240 study participants, 80 (33.3%) were cases and 160 (66.7%) were controls. Among the 80 cases only 21 (26.2%) were men. The attack rate of the disease was 136 cases per 100,000 population. The main treatment given to the cases at the health facility included ciprofloxacin (78/80, 98%) and oral rehydration solution (53/80, 66%). Out of 80 cases, only 2 (3%) were admitted to the hospital. No fatalities were recorded. Investigations associated the outbreak to drinking contaminated borehole water. Conclusion Urgent continued health education on importance of boiling or treating drinking water and practicing good personal hygienic behaviors is necessary. Environmental health officers should ensure that borehole water must be regularly monitored for coliforms.

Hemolytic-uremic syndrome (HUS) consists of microangiopathic hemolytic anemia, thrombocytopenia and acute, potentially fatal, kidney failure. As the name suggests, this is a ­syndrome and not a disease, meaning that its etiology is diverse, and causes of HUS can include post-medication reactions, pregnancy, antiphospholipid syndrome, systemic lupus erythematosus, genetic factors such as complement genes mutation, antibodies to complement factor H, or infection with HIV or bacteria such as Escherichia coli, Shigella dysenteriae orStreptococcus pneumoniae. In an important number of cases, however, particular strains of E. coli appear to be the causative agents of HUS, especially in children. HUS develops in association or not with a previous bloody diarrhea syndrome.