Search Results (253)

Introduction: Vaccination against COVID-19 has been crucial in controlling the pandemic. While side effects are typically mild, rare neurological complications have been reported. This is a case series of ten patients who reported of persistent fasciculations after COVID-19 vaccination. Methods: We describe the clinical presentation and diagnostic work-up of ten patients with new-onset fasciculations in temporal proximity to COVID-19 vaccination. Patients with prior SARS-CoV-2 infection or known alternative causes of fasciculations were excluded. Routine clinical data, including neurological examination, laboratory results, and electrophysiology (electromyography and nerve conduction studies), were analyzed. Results: Ten patients (5 male, 5 female; mean age 42.4 years) reported fasciculations beginning within 6 h to 13 days post-vaccination and persisting for 2–12 months at the time of presentation. Fasciculations were accompanied by additional symptoms such as paresthesia and fatigue. Laboratory results were mostly unremarkable; two patients had positive myositis antibodies without clinical correlates. Electrophysiology was unremarkable in six patients, while fasciculation potentials were detected in four patients. Nine were diagnosed with probable benign fasciculation syndrome (BFS), and one met diagnostic criteria for amyotrophic lateral sclerosis (ALS). Discussion: In this small, retrospective case series, most cases of post-vaccination fasciculations were benign and compatible with BFS. Whether BFS onset was causally linked to vaccination or due to a nocebo effect remains unclear. One patient was diagnosed with ALS, though a causal link remains speculative given the study’s limitations and rarity of similar reports. Larger, prospective studies are needed to validate these observations and explore underlying pathophysiological mechanisms. Full article

Background and Objectives: Muscle symptoms are the most visible adverse event attributed to statins, but terminology is often imprecise. Most patients report myalgia or nonspecific aches, whereas objective myopathy, inflammatory or necrotizing myositis, rhabdomyolysis, and anti-HMGCR immune-mediated necrotizing myopathy are uncommon and clinically distinct entities. To provide a clinically oriented narrative synthesis of statin-associated muscle symptoms (SAMS) and severe statin-associated myotoxicity, and to propose a practical prevention, evaluation, and management algorithm. The classification of muscle events is used to standardize terminology and avoid diagnostic confusion, not to create a new formal taxonomy. Materials and Methods: A clinically oriented narrative review was performed using PubMed, Google Scholar, and major society documents published from January 2021 to April 2026. Eligible sources addressed SAMS, statin myopathy/myositis, rhabdomyolysis, anti-HMGCR immune-mediated necrotizing myopathy, nocebo/drucebo effects, pharmacogenetics, drug interactions, diagnosis, or management. The final evidence set comprised 55 verifiable sources, including blinded randomized or n-of-1/crossover evidence; meta-analyses; clinical statements and reviews; pharmacovigilance analyses; pharmacogenetic guidance; mechanism-focused reviews; anti-HMGCR series; and lipid-lowering guideline/treatment studies. Because the review was narrative, no pooled estimate or formal PRISMA screening log was generated. Results: Blinded evidence indicates only a small absolute excess of muscle pain with statins, concentrated mainly in the first year of therapy, and that most muscle symptoms reported during statin therapy are not pharmacologically caused by the statin. N-of-1 and crossover trials show that symptom intensity is often similar during statin and placebo periods, consistent with an important nocebo/drucebo contribution. Severe muscle toxicity can nevertheless occur, especially when systemic statin exposure is increased by a high dose, interacting drugs, frailty, renal or hepatic impairment, hypothyroidism, transporter or metabolic genotypes, or intense unaccustomed exercise. Statin choice matters chiefly through dose, pharmacokinetics, and interaction burden. Conclusions: SAMS are common as reported clinical problems, but confirmed statin-caused muscle injury is substantially less frequent than routine clinical attribution suggests. Permanent discontinuation should be reserved for carefully assessed cases. A structured approach—baseline risk assessment, selective CK measurement, exclusion of alternative causes, correction of modifiable risks, dechallenge/rechallenge, statin switching, dose reduction, and combination with non-statin therapy—preserves cardiovascular benefit while protecting the rare patient with genuine toxicity. Full article

Background: Idiopathic inflammatory myopathies (IIMs) are a heterogenous group of disorders frequently complicated by interstitial lung disease (ILD). We sought to discern phenotypic and serological differences according to the presence of ILD and initial evaluating medical specialty, i.e., rheumatology vs. pulmonology, with the goal of advancing personalized medicine. Methods: A computer-assisted search was conducted to identify patients with a diagnosis of IIM seen at Attikon University Hospital, from January 2010 to December 2025. Medical records were reviewed for clinical, laboratory and serological features. Results: We identified 140 patients with IIM; 96 (68.6%) were female with a mean age at diagnosis of 55.8 years (SD 15.7). ILD was present in 75 patients (53.6%), being more common among males (30/44, 68.2% vs. 45/96 females, 46.9%, p = 0.019). Patients in the ILD subgroup were older at diagnosis (mean age 60.2 years vs. 50.7 years, p < 0.001) and presented more often with dyspnea (41 vs. 1, p < 0.001), higher CRP (median 5.95 mg/L vs. 2.9 mg/L, p = 0.024), and lower CPK (median 103 vs. 580, p < 0.001). Patients first seen by a pulmonologist were more likely to be older (mean age 60.5 years vs. 53 years, p = 0.002) and to present with dyspnea (33 vs. 9, p < 0.001) and ILD (48 vs. 27, p < 0.001). By contrast, skin involvement (61% vs. 27%, p = 0.04), muscle weakness (53 vs. 15, p < 0.001) and elevated CPK (median 301.5 vs. 103.5, p = 0.013) were less frequent in these patients as compared to patients first evaluated by a rheumatologist. Anti-tRNA synthetase, anti-Ro52 and anti-Pm/Scl antibodies were more frequent in the ILD subgroup. Anti-tRNA antibodies were also more frequent in patients first seen by a pulmonologist. Conclusions: Patients with IIM-ILD are more likely to present without overt clinical or biochemical characteristics of muscle involvement, thereby increasing the likelihood of initial evaluation by pulmonologists. Full article

Background/Objectives: Despite advances in diagnostic, preventive, and therapeutic strategies, diabetes mellitus remains a major global medico-social challenge with a high rate of complications, including diabetic myopathy. However, structural and functional changes in the masticatory muscles and disturbances of myodynamic balance in diabetes under stress remain insufficiently studied. This research aimed to clarify the pathomorphological patterns of diabetic myopathy development under chronic immobilization stress. Methods: Twenty-eight six-month-old male albino rats were equally divided into four groups: Group 1—streptozotocin-induced diabetes mellitus (SIDM) combined with chronic immobilization stress (CIS); Group 2—SIDM; Group 3—CIS; Group 4—control. Samples were collected on day 56. Histological, electron microscopy, biochemical, and statistical methods were applied. Results: Myopathy in experimental conditions was characterized by aseptic myositis, focal fibrosis of the masticatory muscle, muscle fiber atrophy, and peripheral neuropathy. These changes developed on the background of pronounced diabetic microangiopathy, manifested by hemorheological disturbances, reduced vascular capacity of the haemomicrocirculatory bed (confirmed by an increased Vogenvort index), thickening and proliferation of the capillary basement membrane, and decreased capillary density. Degenerative muscle fiber alterations included vacuolar dystrophy, necrosis, ferroptosis, necroptosis, and autolysis. Neuropathic changes involved segmental demyelination, axonal atrophy, decreased sprouting, and extensive neuromuscular junction destruction, possibly leading to impaired neuromuscular transmission. Conclusions: Chronic immobilization stress acts as a trigger that aggravates diabetic myopathy progression by impairing microcirculation and inducing neuromuscular junction damage, resulting in subsequent muscle atrophy. Full article

Background: Autoimmune rheumatic diseases (ARDs) often present diagnostic challenges, particularly in undifferentiated disease or overlap syndromes. Autoantibodies (AABs) serve as early biomarkers, but their relationship with cardiac involvement during the prodromal phase remains unclear. We hypothesized that cardiac involvement is an early, unifying feature in AAB-seropositive patients with suspected ARD/overlap syndromes but an as-of-yet unclear diagnosis. Methods: We prospectively recruited 18 treatment-naïve patients (mean age 52 ± 17 years, 94.4% women) with suspected undifferentiated ARD/overlap syndromes who were seropositive for myositis-specific (MSAs), myositis-associated (MAAs), or scleroderma-specific autoantibodies (SScSAs). All underwent comprehensive rheumatologic, pulmonologic, and cardiac evaluations, including multiparametric cardiovascular magnetic resonance (CMR) to assess myocardial inflammation, edema, and fibrosis. Results: Despite normal echocardiograms, electrocardiograms, and inflammatory biomarkers, all patients exhibited CMR evidence of cardiac involvement. Active myocardial inflammation (revised Lake Louise criteria) was confirmed in 66.7%, while subepicardial fibrosis was universal (median 5.0% of LV mass). During the 12-month follow-up, all patients with evidence of inflammation received immunosuppressive and cardioprotective therapy, leading to symptomatic improvement in all and reduced inflammation in 75% of repeat CMRs (3/4 patients). A definitive rheumatologic diagnosis was established in all cases, with 50% classified as overlap syndromes. Conclusions: Cardiac involvement is a highly prevalent disease manifestation in AAB-seropositive patients with suspected ARD/overlap syndromes and can be detected by CMR during the prodromal phase, even before diagnostic criteria are met. These findings support early CMR integration in the workup of such patients to guide timely immunosuppressive and cardioprotective interventions. Full article

Background/Objectives: We report a case of severe dermatomyositis demonstrating characteristic widespread extraosseous uptake on ^99mTc-methylene diphosphonate (^99mTc-MDP) bone scintigraphy. This study highlights the diagnostic value of this modality in detecting active inflammatory myopathy when conventional muscle biopsy is inconclusive and introduces its novel use for intraoperative gamma-probe-guided biopsy to precisely target metabolically active muscle. This approach may help target metabolically active muscle in heterogeneous idiopathic inflammatory myopathies (IIMs). Case Presentation: A 49-year-old man developed progressive proximal muscle weakness (Medical Research Council grade 2/5 proximally, 5/5 distally) beginning in June 2025 following influenza infection, accompanied by dysphagia, classic dermatomyositis cutaneous manifestations, back pain, and difficulty standing. Laboratory evaluation revealed elevated inflammatory markers (ESR 55 mm/hr, CRP 20 mg/L), leukocytosis (16.58 × 10⁹/L), markedly raised creatine kinase (19,937 IU/L), and troponin T levels. An initial quadriceps muscle biopsy performed on 29 July 2025 was non-diagnostic. Three-phase ^99mTc-MDP scintigraphy (~1110 MBq) demonstrated intense, diffuse extraosseous uptake involving bilateral deltoids (symmetric), biceps and triceps (patchy), paraspinal muscles (longitudinal), gluteal muscles, thighs (quadriceps and hamstrings), and gastrocnemius muscles, with relative suppression of appendicular skeletal uptake on delayed images due to soft-tissue tracer dominance—findings consistent with severe inflammatory myopathy. Following reinjection (~1100 MBq), intraoperative gamma-probe-guided biopsy targeted areas of highest uptake (left quadriceps femoris and distal triceps brachii; intraoperative counts 1300–1400 versus background ~500). Histopathology revealed histiocyte-predominant inflammation with myofibre necrosis and regeneration, sparse CD4⁺ T-cell infiltrates, and absence of fibrosis, consistent with necrotising myopathy. Positive antinuclear antibodies and strong anti-Mi-2 antibodies confirmed the diagnosis of dermatomyositis. Treatment included pulse methylprednisolone followed by oral prednisone taper, methotrexate, azathioprine, intravenous immunoglobulin, and planned rituximab therapy. Discussion: Whole-body ^99mTc-MDP scintigraphy provided a complementary whole-body functional assessment of disease extent, revealing widespread muscular involvement. The novel application of intraoperative gamma-probe-guided biopsy enabled real-time targeting of metabolically active muscle, facilitating targeted sampling after an initial non-diagnostic biopsy and yielding supportive histopathological findings. This dual diagnostic and interventional role demonstrates the technical feasibility of gamma-probe guidance in a diagnostically challenging case of dermatomyositis. Conclusions: In our case, the integration of ^99mTc-MDP scintigraphy with gamma-probe-guided biopsy enabled precise targeting of metabolically active muscle following an initial non-diagnostic biopsy. This multimodal approach may be useful in selected diagnostically challenging cases of severe inflammatory myopathy. Larger studies are needed to evaluate its reproducibility and added value. Full article

Bacterial diseases cause significant losses in the aquaculture of Amazonian fishes (Arapaima gigas, Brycon amazonicus, and Colossoma macropomum). Lactococcosis-causing bacteria (LCB) have emerged as important pathogens in global aquaculture, and although they have already been isolated from these fish species, their pathogenic role remains unconfirmed. This study evaluated the susceptibility of three Amazonian fish species to Lactococcus spp. through experimental infection and performed a detailed examination of the associated pathological damage. Lactococcus formosensis, L. garvieae, and L. petauri strains were used to intracoelomically infect juvenile Amazonian fish. Following infection, the fish were monitored for 15 days to evaluate clinical signs and mortality. Clinical signs were observed in the L. garvieae-challenged A. gigas, with one fish dying at five days post-infection. The remaining experimental animals, regardless of fish species, survived the challenge. All mortalities and surviving fish at the end of the trial underwent bacteriological and histopathological examinations. Bacteriological examination confirmed bacterial re-isolation from asymptomatic animals in the L. garvieae-challenged A. gigas (2/7) and L. formosensis-challenged C. macropomum (3/7) groups using MALDI-TOF MS and multiplex qPCR analysis. No bacterial growth or histological alterations were observed in the control groups or in the groups infected with L. petauri. Microscopic examination revealed L. garvieae-induced fibrinoid-necrotic hepatitis, lymphohistiocytic myocarditis, and myositis in diseased or asymptomatic A. gigas, while L. formosensis caused lymphohistiocytic pericarditis in surviving C. macropomum. These findings provide preliminary evidence suggestive of susceptibility of A. gigas and C. macropomum to infection by L. garvieae and L. formosensis, respectively, highlighting their potential to act as asymptomatic carriers. Furthermore, the histopathological findings were suggestive of species-associated lesion patterns of piscine lactococcosis in Amazonian fish, rather than indicative of high mortality. Full article

Background/Objectives: Immune checkpoint inhibitors (ICIs) improve cancer outcomes but may induce immune-related adverse events. Myasthenia gravis (MG), myositis, and myocarditis may co-occur as an overlap syndrome (“Triple-M”), but population-level data remain limited. This study aimed to characterize the pharmacovigilance profile, overlap patterns, and reported fatality of Triple-M associated with ICIs. Methods: A FAERS pharmacovigilance analysis was conducted using OpenVigil FDA and the openFDA API. Disproportionality metrics (ROR, PRR, χ²) were used to evaluate signals for MG, myositis, and myocarditis across nine ICIs. Triple-M was defined as the co-reporting of all three events and was evaluated over the study period from August 2016 to September 2025. Results: Among 272,753 ICI reports, 1395 (0.51%) MG, 3173 (1.16%) myocarditis, and 2018 (0.74%) myositis cases were identified; all nine ICIs met signal-detection criteria for all three toxicities (χ² > 4). Pembrolizumab and nivolumab accounted for the highest absolute report counts, whereas nivolumab-relatlimab demonstrated the strongest disproportionality (ROR = 109.5 for MG, 106.4 for myocarditis, and 29.0 for myositis). Triple-M occurred in 114 unique reports (0.04% of all ICI-related adverse events), representing 8.2% of MG, 5.6% of myositis, and 3.6% of myocarditis cases. Co-reporting was common: among 5308 unique reports involving these toxicities, 1164 reports (21.9%) included at least two components of the triad. Triple-M cases were more common in men (56%), with a median age of 74 years (IQR 68–79), a median time-to-onset of 21 days (IQR 18–28), and 50% mortality among cases with available outcomes. Conclusions: Triple-M appears to be a severe overlap phenotype reported in association with immune checkpoint inhibitors, characterized by early onset, frequent co-reporting, and substantial reported fatality. Early recognition and coordinated multidisciplinary assessment may warrant further clinical evaluation and investigation of this overlap phenotype. Full article

Background/Objectives: Idiopathic inflammatory myopathies (IIMs) are chronic immune-mediated disorders, causing striated muscle weakness and extramuscular symptoms. Real-world, single-centre data are needed to interpret phenotype patterns and evolving therapies. Methods: A single-centre, retrospective cohort study was conducted at the Rheumatology Clinic of the National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland from 1 January 2022 to 31 December 2025. Data included demographics, IIM subtypes, extramuscular involvement, co-existing Sjögren disease (SD), biopsy results, autoantibodies, and treatment. Due to sample size, descriptive analysis was used. Results: The study included 35 patients (31.4% men). Mean age was 50.7 years; mean body mass index (BMI) was 26.0 kg/m². The cohort consisted of 10 dermatomyositis (DM), one polymyositis (PM), two immune-mediated necrotising myopathy (IMNM), one inclusion body myositis (IBM), 16 anti-synthetase syndrome (ASyS), four juvenile dermatomyositis (JDM), and one clinically amyopathic dermatomyositis (CADM). SD co-occurred in eight cases, including six cases of ASyS. Anti-Jo1 was observed in 13 ASyS cases and one DM. Glucocorticoids (GCSs) were administered in all patients for induction in addition to cyclophosphamide (28.6%), mycophenolate mofetil (MMF) (51.4%), and methotrexate (MTX) (17.1%). Maintenance therapy included MTX (20%), MMF (31.4%), rituximab (34.3%), azathioprine (AZA) (42.9%), and others. Two DM, two JDM, and one ASyS patient received JAK inhibitors, one DM and one JDM anifrolumab, one IBM sirolimus, and four patients with interstitial lung disease (ILD) nintedanib. Conclusions: This Polish single-centre cohort shows effective use of novel therapies for IIM. Sirolimus, JAK inhibitors, and nintedanib were effective. Co-occurrence of SD in ASyS patients requires further research. Full article

Anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibodies are critical biomarkers in myositis, associated with distinct clinical features and prognosis. This study aimed to evaluate the proportion of anti-MDA5 positivity and compare the diagnostic performance of local immunoblotting (IB) with gold-standard immunoprecipitation (IP). We performed a retrospective analysis of 3272 physician-requested anti-MDA5 IB determinations over a five-year period (2019–2023). A subsequent exploratory pilot study of ten Hungarian patients with myositis was conducted to compare IB results with radiolabeled protein IP. Confirmatory in-house enzyme-linked immunosorbent assay (ELISA) was used to distinguish between 140 kDa bands (anti-MDA5 vs. anti-NXP2). Indirect immunofluorescence (IIF) on HEp-2 cells was also evaluated. In the retrospective cohort, 3.7% (n = 121) of samples were non-negative. Among 64 borderline patients, only one (1.6%) had a definitive diagnosis of dermatomyositis (DM). Conversely, the proportion of confirmed myositis cases was notably higher among patients with strong positive IB results. In our exploratory cross-sectional pilot study, complete concordance between the two assays was observed for negative and strong positive results. Discrepancies were noted in borderline and weak positivity ranges, where anti-MDA5 was not detected by IP; instead, alternative autoantibodies were identified. The three IP-confirmed MDA5 positive samples were all validated by ELISA. The characteristic IIF cytoplasmic staining was identifiable in 2 out of 10 cases (20%). In our cohort, borderline IB cases were frequently potential false positives, highlighting the need for careful clinical evaluation. Borderline and weak results require clinical correlation or confirmatory testing to avoid misdiagnosis. Full article

Background: Idiopathic inflammatory myopathies (IIMs), characterized by muscle weakness and chronic inflammation, currently lack highly effective therapies. This study investigated the therapeutic potential and underlying mechanism of (5R)-5-hydroxytriptolide (LLDT-8), a triptolide derivative with reduced toxicity, using an experimental autoimmune myositis (EAM) mouse model and in vitro assays. Methods: Forty female BALB/c mice were randomly assigned to five groups: normal, vehicle, methylprednisolone (MP), LLDT-8 (0.0625 mg/kg), and LLDT-8 (0.125 mg/kg). EAM mice were treated with LLDT-8 (0.0625 or 0.125 mg/kg) or methylprednisolone as a positive control. Cellular experiments and molecular docking were performed to investigate potential mechanisms of LLDT-8. Results: LLDT-8 significantly attenuated clinicopathological features, including muscle weakness and pain sensitivity, while reducing serum levels of aspartate aminotransferase and lactate dehydrogenase. Histological analysis revealed that LLDT-8 reduced inflammatory cell infiltration and the presence of CD4⁺ and CD8⁺ T cells in muscle tissues. Mechanistically, LLDT-8 inhibited the expression of nucleotide-binding oligomerization domain receptor caspase recruitment domain 5 (NLRC5), a key transcriptional regulator of major histocompatibility complex-I (MHC-I). This suppression extended to downstream antigen presentation-related molecules, including the transporter associated with antigen processing and proteasome 20S subunit beta. Molecular docking further confirmed the high binding affinity of LLDT-8 to both NLRC5 and MHC-I. Conclusions: LLDT-8 alleviates inflammatory muscle injury by targeting the NLRC5/MHC-I signaling axis, suggesting it may be a promising therapeutic candidate for IIMs. Full article

Myositis ossificans (MO) is a benign, self-limiting heterotopic ossification process that typically develops within soft tissues following trauma, although non-traumatic forms have also been described. Despite its benign nature, MO frequently represents a diagnostic challenge, particularly in its early stages when imaging findings may mimic aggressive soft-tissue tumors, leading to unnecessary biopsies or surgical interventions. This narrative review provides an updated overview of the classification, pathophysiology, and imaging features of myositis ossificans, with a specific focus on the time-dependent evolution of radiologic appearances across different imaging modalities. Radiologic findings are discussed according to disease stage, highlighting key diagnostic clues such as the zonal phenomenon and peripheral maturation pattern. In addition, the main entities included in the differential diagnosis are reviewed, with particular emphasis on imaging features that help distinguish myositis ossificans from soft-tissue sarcomas and other calcified or ossified lesions. Finally, current management strategies and the role of imaging in patient follow-up are summarized. A thorough understanding of the evolving imaging spectrum of myositis ossificans is essential for radiologists and clinicians to achieve an accurate diagnosis, guide appropriate management, and avoid overtreatment. Full article

Background/Objectives: Superficial oral mucosal (SOM) lesions are prevalent among patients with Sjögren’s disease (SjD) due to mucosal dryness. Given the limited evidence on screening and referral for SOMs, and the presence of relevant information only in dental clinical notes, a natural language processing (NLP) pipeline was developed to screen for SOMs among SjD patients. This retrospective study analyzed dental clinical notes from 180 linked electronic dental and health records, including both with and without a diagnosis of SjD. Materials and Methods: An annotation schema with four classes (SOMs, signs and symptoms of dry mouth, treatment for xerostomia, referral to specialists) was inductively created using the Extensible Human Oracle Suite of Tools (eHOST) to manually annotate clinical notes. Relevant keyterms were retrieved using a rule-based approach with Python’s Natural Language Toolkit (NLTK). SjD and control groups were compared using Fisher’s Exact tests. Four annotators reviewed ninety-three records. Results: SjD patients (mean age 54.8 ± 11.7 years) had fewer total visits across 15 years but had more dental visits per year (10.2 ± 13.3) than controls. SjD patients were more likely to have oral candidiasis (p = 0.041), exhibit signs and symptoms of dry mouth (p = 0.004), receive treatments for xerostomia (p < 0.001), be treated with cholinergic agonists (p = 0.005), and be referred to a specialist (p = 0.046), but findings were not significant for all SOMs. Additionally, SjD patients had a higher proportion of sialadenitis (p = 0.045), rheumatoid arthritis (p = 0.001), systemic lupus erythematosus (p < 0.001), myalgia/myositis/fibromyalgia (p = 0.010), and anxiety/nervousness (p = 0.004). Conclusions: These findings encourage the feasibility of using text mining from dental clinical notes for screening and management of oral conditions. Full article

Background: This study aimed to evaluate the effectiveness and safety of first-line pembrolizumab monotherapy in patients with advanced non-small cell lung cancer (NSCLC) in real-world clinical practice in Vietnam. Methods: We performed a multicenter retrospective cohort study of patients with locally advanced or metastatic NSCLC who received first-line pembrolizumab monotherapy in Vietnam between January 2018 and August 2024. The primary endpoints were progression-free survival (PFS), overall survival (OS), and safety profile. Results: A total of 73 patients were included, with a median age of 69 years (range, 47–92). Most patients had good performance status (ECOG PS 0–1, 75.3%) and high PD-L1 expression (TPS ≥ 50%, 86.3%). The overall response rate was 60.3%, and the disease control rate was 79.5%. Median PFS was 11.3 months (95% CI, 6.9–15.8), and median OS was 25.4 months (95% CI, 20.8–30.0). Multivariate analysis identified never-smoking status (HR 3.14, 95% CI 1.16–8.50; p = 0.024), squamous histology (HR 4.09, 95% CI 1.18–14.17; p = 0.026), and low PD-L1 expression (TPS 1–49%) (HR 3.67, 95% CI 1.14–11.78; p = 0.029) as independent predictors of inferior overall survival. Immune-related adverse events, including pneumonitis, hepatitis, nephritis, fever, skin reactions, and myositis, were mostly mild and manageable, with grade 3 toxicity occurring in only 4.2% of patients. Better survival was observed in patients with high PD-L1 expression and non-squamous histology. However, the association with non-squamous histology should be interpreted with caution due to the very small number of squamous cases. Conclusions: First-line pembrolizumab monotherapy demonstrated favorable effectiveness and acceptable safety in patients with advanced NSCLC in real-world clinical practice in Vietnam. Clinical outcomes were particularly favorable in patients with high PD-L1 expression, non-squamous histology, and a history of smoking. Nevertheless, the survival benefit associated with non-squamous histology should be interpreted cautiously, given the limited number of patients with squamous histology. These findings support the use of pembrolizumab monotherapy in selected patient populations within resource-limited settings. Full article

Background/Objectives: This aim of this study was to describe the demographic, clinical, and laboratory characteristics of hospitalized children with benign acute childhood myositis (BACM) and to evaluate seasonal patterns, including changes observed during the COVID-19 pandemic. Methods: We conducted a retrospective single-center review of pediatric patients hospitalized with a diagnosis of BACM between January 2016 and December 2024. Clinical, laboratory, and epidemiological data were analyzed, including seasonal distribution before and after the COVID-19 pandemic. Results: We identified 47 cases of BACM, with a male predominance (66%) and a median age of 7 years. Most cases (72%) occurred during autumn and spring. The most common prodromal symptoms were fever, cough and rhinorrhea. Bilateral calf pain was the most frequent presenting symptom. The median creatine phosphokinase (CPK) level was 4986 U/L, with higher values in boys (p = 0.040). Higher CPK levels were associated with longer hospital stays in our cohort (p = 0.030). Influenza B was the most frequently identified pathogen (63%). No BACM cases were recorded during the COVID-19 pandemic period (2020–2022), followed by an increase in 2024. All patients fully recovered, with a median hospital stay of 3.2 days. Conclusions: BACM is a self-limiting condition with a characteristic clinical and laboratory profile. The absence of cases during the COVID-19 pandemic suggests a possible association between reduced viral circulation and BACM incidence. Awareness of its typical presentation may support early diagnosis, reduce unnecessary investigations, and facilitate appropriate clinical management. Full article