Search Results (428)

Background: Liver cirrhosis is associated with portal hypertension and its gastrointestinal complications, but non-variceal gastroduodenal mucosal injury and its relationship to Helicobacter pylori (H. pylori) infection and hepatic disease severity remain incompletely characterized. Methods: This retrospective, cross-sectional study included 162 patients undergoing first upper gastrointestinal endoscopy (61 with cirrhosis, 101 controls), assessed using a composite gastroduodenal mucosal injury score (range 0–16) across the antrum, gastric corpus, duodenal bulb, and second duodenal portion. Results: Cirrhosis was independently associated with a higher injury burden after adjusting for H. pylori status, nonsteroidal anti-inflammatory drug (NSAID), antiplatelet, anticoagulant, and proton pump inhibitor (PPI) use (adjusted count ratio [aCR] = 1.33, 95% CI: 1.09–1.63, p = 0.006); and H. pylori infection was independently and separately associated with higher injury burden (aCR = 1.25, 95% CI: 1.01–1.54, p = 0.037), while none of the four medication classes showed an independent association. This excess injury was concentrated almost exclusively in the gastric corpus (adjusted aCR = 3.04, p < 0.0001), with no significant differences at other sites. Injury severity did not correlate with Child–Pugh class or tests of the liver’s biosynthetic capacity (all p > 0.05). Only patients with concurrent cirrhosis and H. pylori infection showed significantly elevated injury relative to unexposed controls (adjusted aCR = 1.87, 95% CI: 1.38–2.53, p < 0.0001), with a significant, exploratory cirrhosis × H. pylori interaction (aCR = 1.56, p = 0.037). Conclusions: Cirrhosis is therefore associated with a corpus-predominant pattern of gastroduodenal injury, compatible with, though not proof of, a portal hypertension-related mechanism, and shows a significant positive multiplicative interaction with concurrent H. pylori infection; given the exploratory nature of this analysis, these findings are hypothesis-generating and warrant prospective confirmation before informing endoscopic screening or infection-screening practice. Full article

Diabetes-related hypoglycemia contributes substantially to increased morbidity, mortality, health-care utilization, and reduced quality of life. Older adults with diabetes represent a heterogeneous group of patients who need individualized blood glucose targets to avoid hypoglycemia. Since the elderly present with varying degrees of functional and cognitive status and individualized health needs, their management varies among individuals. Complicating this, the hypoglycemia risk in older adults treated with insulin also varies due to aging, renal dysfunction, cognitive impairment, and other comorbidities. The challenge for healthcare providers is in considering all aspects of care in order to avoid hypoglycemia in elderly individuals. In this review, we introduce a Patient and Function Centric Approach to the assessment and management of hypoglycemia in older adults. This holistic framework extends beyond blood glucose values to systematically evaluate the other domains of patients’ health that influence hypoglycemia risk, including biochemical, medication, timing, autonomic, cognitive, mood, renal, pancreatic, hepatic, social, and physical function. The management of hypoglycemia in older adults should also include strategies to address both fear of hypoglycemia and hypoglycemia unawareness. In addition to physical limitations, the psychosocial barriers to self-care in older individuals with hypoglycemia are also of paramount importance. Using tools that measure diabetes burden, diabetes distress, and fear of hypoglycemia provides valuable insights into patient wellbeing. The use of newer anti-hyperglycemic medications, sensor-augmented insulin pump therapy, intranasal glucagon, and continuous glucose monitoring (CGM) has significantly contributed to reduced hypoglycemia incidence in individuals with diabetes. Overall, successful management requires a collaborative approach that empowers patients, respects their individual needs and preferences and helps them face the challenges associated with diabetes management with confidence rather than fear or anxiety. Adopting a patient- and function-centric approach to hypoglycemia management allows clinicians to move beyond a one-size-fits-all model and adopt individualized glycemic targets that improve overall diabetes control and mental well-being. Full article

Background: Female sex is widely regarded as an independent risk factor for adverse outcomes after conventional coronary artery bypass grafting (CABG) and is incorporated as a risk variable in EuroSCORE II. Whether this disadvantage persists in the setting of minimally invasive direct coronary artery bypass (MIDCAB), in which sternotomy and cardiopulmonary bypass are avoided, remains insufficiently characterised. We assessed sex-specific short- and long-term outcomes after MIDCAB in a single-centre cohort with extended follow-up. Methods: We retrospectively analysed 350 consecutive patients who underwent MIDCAB at Hannover Medical School between July 1999 and April 2025 (follow-up to April 2025). Eligibility criteria and heart team-applied exclusion criteria (prior left thoracotomy, unfavourable LAD anatomy, prohibitive respiratory reserve, hostile chest wall, active endocarditis, or haemodynamic instability requiring on-pump revascularization) are detailed in the Methods. Females (n = 102) and males (n = 248) were compared before and after 1:1 propensity score matching using greedy nearest-neighbour matching with a caliper of 0.2 × SD of the logit propensity score. The primary endpoint was all-cause long-term mortality; secondary endpoints included perioperative complications and in-hospital outcomes. Long-term survival was assessed by Kaplan–Meier analysis and multivariable Cox proportional hazards regression performed in the full unmatched cohort. A pre-specified subgroup analysis of long-term survival by coronary disease pattern (single-vessel vs. multivessel disease) was also performed. Results: Matching produced 100 female–male pairs with excellent covariate balance (all standardized mean differences < 0.20). MIDCAB was completed without intraoperative conversion in all patients. Thirty-day mortality was 0% in both sexes; no postoperative stroke or new requirement for dialysis occurred. New-onset atrial fibrillation (3.0% vs. 1.0%, p = 0.621), length of intensive care unit stay (median 1 day in both groups), and hospital length of stay (median 8 days in both groups) were comparable between females and males. Re-exploration for bleeding was numerically more frequent in women (5.0% vs. 0.0%; Newcombe 95% CI for the risk difference +0.3 to +11.2%; Fisher’s exact p = 0.059). At a median follow-up of 19.0 years (IQR 11.8–23.9), all-cause mortality was identical (12.0% vs. 12.0%, p = 1.000; log-rank p = 0.703). In multivariable Cox regression in the full unmatched cohort, female sex was not associated with long-term mortality (adjusted HR 0.80, 95% CI 0.38–1.70, p = 0.560); only advancing age emerged as a strong independent predictor (HR 1.10 per year, 95% CI 1.05–1.15, p < 0.001), with EuroSCORE II approaching significance (HR 1.67 per unit, 95% CI 1.00–2.82, p = 0.052). Long-term survival in patients with multivessel disease (20-year Kaplan–Meier 90.9%) was equivalent to that in single-vessel disease (92.3%; log-rank p = 0.94). Conclusions: In this propensity-matched analysis with two decades of follow-up, MIDCAB conferred equivalent perioperative safety and long-term survival in women and men. Female sex was not an independent predictor of adverse outcome. These findings support MIDCAB as a sex-neutral revascularization strategy for single-vessel and LAD-predominant coronary artery disease in the very low-risk, appropriately selected population studied, and are consistent with the most recent published MIDCAB literature. Full article

Background/Objectives: Artificial intelligence tools have emerged as promising methodological support for systematic reviews and health technology assessment (HTA). Smart infusion pump interoperability represents a relevant case study due to its implications for medication safety, nursing workflow, and hospital quality improvement. The aim was to evaluate the performance of artificial intelligence as a methodological support tool across a systematic review, using the evidence synthesis on smart infusion pump–electronic health record interoperability as a case study. Methods: A systematic review following PRISMA 2020 guidelines was conducted. Searches were performed in MEDLINE, Embase, and Cochrane Library databases. AI-assisted tools (ChatGPT GPT-4 and Open Science Reviewer) were incorporated into data extraction, reporting appraisal based on STROBE criteria, and exploratory identification of methodological limitations under strict human supervision. Concordance between AI-assisted and manual extraction was evaluated descriptively. Results: Overall concordance between AI-assisted and manual data extraction was 82.5% (99/120) across assessed variables. Agreement was highest for structured variables, including study design (10/10; 100.0%), study identification variables (19/20; 95.0%), and participant characteristics (36/40; 90.0%). Agreement was lower for study content variables (18/30; 60.0%) and methodological appraisal (16/20; 80.0%). Among the 21 discrepancies, misclassification errors were most common (13/21; 61.9%), followed by omissions (3/21; 14.3%), incomplete data (3/21; 14.3%), and hallucinations (2/21; 9.5%). AI-assisted identification of methodological limitations showed substantial descriptive agreement with human assessments but demonstrated limited capacity for judgmental interpretations. Conclusions: Artificial intelligence demonstrated utility for structured review tasks such as data extraction and reporting appraisal, but showed limitations in tasks requiring interpretative and methodological judgement. Human oversight therefore remains essential throughout the review process. These findings derive from a single case study and should not be generalised beyond the evaluated context and AI tools. Full article

The hospital environment is widely recognised as a source of microorganisms that collectively constitute the so-called “hospital microbiota”. The aim of this study was to investigate this microbiota, providing as accurate a picture as possible of the actual level of environmental contamination within the hospital. We conducted a 2-year surveillance study in a large acute-care hospital to map the microbiological profiles of the various wards and identify areas requiring improvement. The analysis revealed substantial contamination of surfaces by ESKAPEE microorganisms, well-known causes of healthcare-associated infections. Near-patient surfaces and some critical items such as IV poles, medication carts, and infusion pumps, were found to be contaminated. Among wards, the highest level of contamination was found in the medical area, followed by emergency and surgical wards. A substantial amount of antibiotic-resistant microorganisms was detected, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, multidrug-resistant Acinetobacter baumannii and carbapenem-resistant Enterobacteriaceae. The presence of these microorganisms on particularly critical surfaces and in critical wards poses a serious risk. Monitoring environmental contamination could help identify critical issues and assess the necessity of improving environmental disinfection protocols in addition to the well-known procedures for preventing healthcare-associated infections. Full article

Pharmacogenomics can convert stable DNA variation into prescribing information, but its value in primary care depends on whether a result changes a decision at the right moment. This narrative review critically examines selected actionable gene–drug pairs, implementation models, conflicting evidence, and unresolved questions for family physicians managing multimorbidity and polypharmacy. A targeted search of PubMed/MEDLINE and current pharmacogenomic guideline resources was updated through 14 August 2026, prioritizing clinical guidelines, randomized and pragmatic trials, implementation studies, and primary-care evidence. Guideline actionability describes how an available result can guide treatment; it does not by itself establish that testing should be ordered. Selected examples include clopidogrel, statins, metoprolol, antidepressants, codeine and tramadol, proton-pump inhibitors, nonsteroidal anti-inflammatory drugs, and warfarin, together with shared-care medicines such as thiopurines and carbamazepine. In PREPARE, a defined 12-gene panel linked to prescribing recommendations reduced clinically relevant adverse drug reactions within a specific European workflow. Other trials showed that benefit is drug-, population-, comparator-, and workflow-dependent. Pharmacogenomics does not replace assessment of organ function, interactions, adherence, frailty, or patient preference. This review proposes selective, clinically triggered panel testing as a pragmatic model for primary care, with structured, reusable results and concise decision support. Future work should define who benefits, improve ancestry representation, account for phenoconversion, and demonstrate health-system-specific cost-effectiveness. Pharmacogenomics is best understood as an additional medication-safety input rather than a stand-alone precision-medicine solution. Full article

Background: Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular disorder that primarily affects the skin and gastrointestinal tract, driven predominantly by somatic mosaic mutations, most commonly in TEK. Here, we report a case of a child with BRBNS and autism spectrum disorder (ASD). Case presentation: A 13-year-old boy diagnosed with ASD at 3 years presented with recurrent abdominal pain, blood in the stool, and severe anemia persisting for 6 months. At admission, his hemoglobin level was 5.6 g/dL. He had received a transfusion at age 6 for unexplained anemia. On examination, he appeared pale but stable, with bluish, compressible nodules on the right index finger and great toe, typical of BRBNS. Laboratory findings were consistent with chronic bleeding-induced iron deficiency. Endoscopic findings revealed multiple vascular lesions in the stomach, duodenum, ileum, and colon. Several colonic lesions were removed and pathologically confirmed as cavernous hemangiomas. Magnetic resonance enterography revealed additional small intestinal lesions. Whole-exome sequencing performed on buccal swab-derived DNA identified a heterozygous PDGFRA variant (c.2075G>T, p.Ser692Ile) classified as a variant of uncertain significance; no variants were identified in TEK, PIK3CA, or GNAQ. The patient underwent endoscopic resection of the larger lesions and received oral iron and a proton pump inhibitor. Hemoglobin stabilized at 11–12 g/dL, and no further transfusions were required. Conclusions: This case raises, but does not confirm, the possibility that genes other than TEK may contribute to BRBNS. The coexistence of ASD may be coincidental; a mechanistic link remains unproven. Careful endoscopic therapy and medical management controlled bleeding and anemia in this child. Full article

Lasers operating in the 2 µm spectral region have significant application value and development potential in fields such as lidar, medical surgery, and mid-infrared nonlinear optics because they are located in the atmospheric absorption window and coincide with a strong absorption peak of water molecules. This article first briefly introduces the energy level characteristics and commonly used crystal matrices of Tm³⁺, Ho³⁺ and Tm³⁺/Ho³⁺ codoped systems, and then reviews the research progress of 2 µm side-pumped solid-state lasers based on these ions and matrices. This review summarizes the research progress of 2 µm side-pumped solid-state lasers, categorized by operating mode and gain medium. Particular attention is given to the mature advantages of Tm-doped garnet lasers in high average power output and the potential of Tm/Ho-codoped fluoride lasers in high-energy, high-beam-quality pulse output. Finally, this paper further reviews the development of side-pumped laser structures and offers a prospective outlook on the future development of 2 µm region side-pumped lasers. Full article

Background and Objectives: Immune checkpoint inhibitors (ICIs) improve survival in advanced non-small-cell lung cancer (NSCLC), yet treatment responses vary. The potential influence of proton pump inhibitors (PPIs), metformin, statins, and nonsteroidal anti-inflammatory drugs (NSAIDs) on immunotherapy efficacy has gained increasing attention. This study aimed to evaluate the associations of these medications with survival outcomes. Materials and Methods: This retrospective cohort study included 179 patients with advanced NSCLC who received second-line nivolumab. The use of PPIs, metformin, statins, and NSAIDs was assessed within a ±30-day exposure window around nivolumab initiation. Sensitivity analyses were performed including all four studied medications. Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan–Meier method and Cox regression models. Results: Median follow-up was 19 months, and 52.5% of patients used PPIs. In univariable analysis, PPI use was significantly associated with worse PFS (HR = 2.01; p < 0.001), while PD-L1 ≥ 50% expression was associated with improved PFS (HR = 0.57; p = 0.034). In multivariable analysis, PPI use remained independently associated with worse PFS (HR = 2.22; p < 0.001), and male sex was associated with improved PFS (HR = 0.56; p = 0.013). For OS, PPI use (HR = 1.53; p = 0.043), ECOG ≥ 2 (HR = 2.09; p = 0.001), and male sex (HR = 0.53; p = 0.008) were significant factors in univariable analysis. In multivariable analysis, PPI use (HR = 2.01; p = 0.002) and ECOG ≥ 2 (HR = 2.21; p = 0.001) were independent adverse prognostic factors, while male sex was independently associated with improved OS (HR = 0.41; p = 0.001). Median PFS was 5 months in PPI users versus 9 months in non-users (p < 0.001); median OS was 9 versus 14 months (p = 0.036). The use of metformin, statins, and NSAIDs showed no significant relationship with PFS or OS. Sensitivity analyses supported an association between PPI use and worse outcomes. Conclusions: PPI use was associated with worse PFS and OS in patients with advanced NSCLC receiving second-line nivolumab. These findings suggest that unnecessary PPI use should be carefully reassessed during immunotherapy. Full article

Background: Same-day or post-admission cancellation of elective surgery is associated with inefficient operating room utilization, patient distress, and disruption of coordinated perioperative care. Functional neurosurgery is particularly vulnerable to late-stage cancellation because procedural readiness depends on parallel clinical, anatomical, medication-related, device-related, and systemic considerations. Objective: This paper aims to describe the implementation of a structured preoperative review framework for functional neurosurgery and to evaluate its association with late-stage surgical cancellation after patient admission. Methods: We performed a retrospective single-center before-and-after study of consecutive functional neurosurgical procedures scheduled at Sheba Medical Center between January 2020 and December 2025. The ABCDE framework was introduced in 2023 as a structured workflow model organized around five domains: Anatomy, Bacteria, Clotting, Devices, and Elsewhere. Included procedures were deep brain stimulation, vagus nerve stimulation, focused ultrasound, intrathecal pump implantation or replacement, implantable pulse generator replacement, spinal cord stimulation, peripheral nerve stimulation, and other palliative neuromodulation procedures. The primary endpoint was late-stage cancellation, defined as cancellation after hospital admission and initiation of operative preparation. The primary comparison was between 2020–2022 and 2023–2025. A sensitivity analysis excluded 2020 because of pandemic-era disruption. Results: A total of 867 procedures were scheduled. Late-stage cancellation occurred in 16 of 407 pre-implementation procedures and 5 of 460 post-implementation procedures, corresponding to rates of 3.9% and 1.1%, respectively. The absolute risk difference was −2.8 percentage points (95% CI, −5.2 to −0.8), and the relative risk for cancellation after implementation was 0.28 (95% CI, 0.10 to 0.75). A two-sided Fisher’s exact test comparing cancellation versus non-cancellation across the pre-implementation and post-implementation periods was statistically significant (16/407 vs. 5/460; p = 0.0074). After excluding 2020, the direction of effect remained similar, but the difference was not statistically significant: 8 of 302 procedures in 2021–2022 were canceled compared with 5 of 460 in 2023–2025 (2.6% vs. 1.1%; p = 0.15). Detailed source-level attribution was incomplete for 10 of 21 cancellation events, and domain-level analyses should therefore be interpreted descriptively. Conclusions: Implementation of the ABCDE framework was associated with fewer late-stage surgical cancellations in this single-center before-and-after study. Because the design is observational, the number of events is small, and the study period overlaps with pandemic-era disruption and post-pandemic service stabilization, the findings should be interpreted as hypothesis-generating rather than causal. The framework may provide a practical structure for standardizing preoperative review in functional neurosurgery, but prospective studies with formal adherence tracking and procedure-specific analyses are needed. Full article

Background: Proton pump inhibitors (PPIs) are widely used for the treatment of gastrointestinal (GI) disorders. Omeprazole is one of the most commonly prescribed PPIs in Thailand. However, it is frequently overprescribed in hospital settings, increasing the risk of adverse effects. Moreover, such overuse imposes unnecessary healthcare costs. Objectives: To determine the prevalence of potentially inappropriate omeprazole prescribing and its associated factors, and to assess the financial impact of its overuse. Methods: This retrospective cross-sectional study was conducted in a general hospital in Thailand. Outpatients who received omeprazole between 1 January 2025 and 30 June 2025 were included. Descriptive statistics were used to summarize the data. The Chi-square test and Fisher’s exact test were used to compare categorical variables, as appropriate. Factors associated with inappropriate omeprazole prescribing were evaluated using logistic regression analysis. Results: A total of 229 patients receiving 347 omeprazole prescriptions were included. The mean age was 61.35 ± 17.17 years, and 59.4% were female. Inappropriate omeprazole prescribing was identified in 58.2% of prescriptions, primarily due to lack of appropriate indications (75.2%), followed by inappropriate duration. Antiplatelet use (OR 0.21, 95% CI 0.11–0.38, p < 0.001) and dual antiplatelet therapy (OR 0.05, 95% CI 0.01–0.37, p = 0.004) were significantly associated with a lower likelihood of inappropriate prescribing. Conclusions: Inappropriate omeprazole prescribing was common and largely driven by the absence of a clear indication, which was the main contributor to excess costs. Targeted interventions focusing on appropriate initiation, GI risk assessment, and regular reassessment may improve prescribing quality and reduce unnecessary healthcare expenditure. Full article

Background/Objectives: As population aging increases the prevalence of atrial fibrillation (AF), the use of direct oral anticoagulants (DOACs) has expanded for thromboembolism prevention. Although DOACs offer advantages over vitamin K antagonists (VKAs), gastrointestinal bleeding (GIB) remains the most common extracranial adverse event. Current guidelines address global bleeding risk but provide limited guidance on site-specific gastrointestinal risk assessment and prevention. This narrative review aims to summarize current evidence on the mechanisms, etiologies, and risk factors for DOAC-associated gastrointestinal bleeding and to propose a pragmatic, risk-based framework to support clinicians in individualized bleeding prevention. Methods: A narrative review of studies published between 2004 and 2025 was conducted, including randomized clinical trials, real-world evidence, meta-analyses, and major society guidelines. Evidence addressing DOAC safety profiles, gastrointestinal bleeding etiologies, patient-level risk factors, medication interactions, and preventive strategies was analyzed. Results: Gastrointestinal bleeding in patients treated with DOAC is strongly influenced by underlying gastrointestinal pathology, comorbid conditions, and concomitant medications. Established risk factors include prior gastrointestinal hemorrhage, Helicobacter pylori infection, gastrointestinal malignancy, diverticulosis, and angiodysplasia, as well as the use of nonsteroidal anti-inflammatory drugs (NSAIDs), antiplatelet therapy, or selective serotonin reuptake inhibitors (SSRIs). DOACs differ in gastrointestinal safety: apixaban consistently demonstrates the most favorable profile, whereas rivaroxaban and high-dose dabigatran show higher GIB rates. Preventive strategies such as H. pylori testing and eradication, proton pump inhibitor use in high-risk individuals, avoidance of NSAIDs and unnecessary antiplatelet therapy, and individualized DOAC selection may help reduce bleeding risk. Conclusions: Gastrointestinal bleeding risk in patients receiving DOAC therapy should be assessed using a site-specific and dynamic approach. A structured strategy integrating baseline risk evaluation, correction of modifiable factors, tailored anticoagulant selection, and risk-adapted follow-up may improve the safety of anticoagulation. The proposed framework may provide a pragmatic approach to individualized bleeding risk mitigation while preserving the benefits of DOAC therapy; however, prospective validation is required before its routine implementation can be recommended. Full article

Background/Objectives: While satisfactory glycaemic control is possible with specialist care from a diabetologist and modern therapies, women with type 1 diabetes are still subject to poorer obstetric outcomes, even with optimal management. Methods: The analysis comprised a cohort of 55 pregnant patients with type 1 diabetes who attended the Diabetology Outpatient Clinic between 2018 and 2023; all were recruited no later than the first trimester. Qualified patients underwent medical interviews and physical examinations. Insulin pump, continuous glucose monitoring (CGM) system, and postpartum data were collected. Results: The median glycated haemoglobin (HbA1c) at the beginning of pregnancy was 6.1%, with means of 5.9% and 6.0% in the following trimesters. Only 1/3 of the women achieved the recommended HbA1c value throughout pregnancy. The average/median time in range (TIR) in each trimester was ≤70%. Among the women who achieved the recommended TIR target, the infants tended to have lower birth weights but a higher likelihood of jaundice. Almost half of the newborns were large for gestational age (LGA), and a third were macrosomic. The strongest predictor of LGA was a mean blood glucose level > 124 mg/dL in the third trimester, which increased the risk of LGA by almost 12 times. Conclusions: Good diabetes control does not prevent LGA/macrosomia. TIR appears to be a better predictor of obstetric complications, including LGA. A mean glucose level ≥ 124 mg/dL in the third trimester greatly increases the risk of LGA. Full article

It is crucial to consider newer antibiotics with activity against anaerobes and Helicobacter pylori, given their healthcare importance, and the constantly growing antibiotic resistance/multidrug resistance, which complicates the therapy. The aim of this review was to emphasize certain recently approved or still-under-investigation antibiotics with potential benefits for treating Clostridioides difficile infections (CDIs), other anaerobic infections, and those caused by H. pylori, covering recent data from articles published primarily in 2020–2026. Given the limited number of antibiotics for treating CDI and fidaxomicin nonavailability in many countries, it is necessary to conduct more extensive laboratory and clinical studies of promising antibiotics such as ibezapolstat, delafloxacin, lascufloxacin, omadacycline, eravacycline, ridinilazole, and CRS3123. Against Bacteroides fragilis group species, delafloxacin and eravacycline showed good activity. Research on rifasutenizol for bacterial vaginosis, sarecycline and nadifloxacin for acne vulgaris and amixicile for periodontal diseases needs to be expanded. For H. pylori infection, delafloxacin, sitafloxacin, nemonoxacin, zoliflodacin, and rifasutenizol may improve the suboptimal success of most eradication regimens. However, more efforts, in coordination between medical, scientific, manufacturing, and government representatives, should ensure wider access to and research on the newer antibacterials. Establishing more research groups, careful examination of market issues, and additional approaches, such as nanomaterials, efflux pump inhibitors, phage therapy, and CRISPR-Cas systems, should be beneficial. Notwithstanding the difficulties, there are many opportunities to promote research on and potential use of newer antibiotics which show advantages over the older antibacterials, and to make them available to numerous countries and patients worldwide. Full article

The widespread use of proton pump inhibitors (PPIs) in clinical practice has increased the number of related hypersensitivity reactions (HSRs). The active ingredient is not always responsible for the reaction. In some cases, HSRs may be related to the excipients contained in the drug. The adverse reactions to anti-SARS-CoV-2 vaccines have drawn the scientific community’s attention to the potential roles of excipients such as polyethylene glycol (PEG) and polysorbate 80. We present a case of a patient with three anaphylactic reactions following the administration of the anti-SARS-CoV-2 vaccine and a history of HSR to omeprazole. Through an in-depth medical history and allergy testing, we found that the patient was sensitized to PEG contained in the vaccine and to the omeprazole formulation used. We also conducted a mini-review of the literature, reporting all cases of reactions to PPIs, both related to the active ingredient and to excipients. Adverse reactions to PPIs are rare but still increasing. To our knowledge, this is the first reported case of anaphylaxis to PPI-related PEG. Some excipients are widely used in commonly used products, including non-pharmaceuticals. Therefore, in patients with multiple episodes of anaphylaxis, it appears necessary to exclude a possible allergy to excipients. This could ensure a greater safety and a better quality of life. Full article