Vanishing bile duct syndrome (VBDS) is a rare condition, representing approximately 0.5% of small bile duct diseases, characterized by progressive destruction of intrahepatic bile ducts, leading to ductopenia. This condition encompasses various etiologies, with drug-induced VBDS (D-VBDS) accounting for 7% of VBDS cases. D-VBDS arises from liver injury due to chemical drugs, traditional medicines, and dietary supplements, often resulting in inflammatory responses and necrosis of bile duct epithelium. Recent years have seen a rise in reported cases, making drug-related injuries a leading cause of acute liver failure in Western countries. This review provides a comprehensive analysis of VBDS, focusing on the histopathological features of acute and chronic D-VBDS, alongside exploring its clinical presentation, prognostic implications, and future research directions. Understanding the diverse etiologies, clinical manifestations, and biochemical parameters associated with D-VBDS is essential for improving diagnosis, treatment strategies, and patient outcomes.

The global epidemic of hypertension remains largely uncontrolled and is a leading contributor to noncommunicable disease deaths worldwide. Failure to detect and to adequately treat hypertension is the largest contributor to uncontrolled hypertension. Yet, suboptimal adherence, which includes failure to initiate a prescription for antihypertensive pharmacotherapy, to take medications as often as prescribed, and to persist on pharmacotherapy long-term, is a well-recognized factor contributing to uncontrolled hypertension. A large body of research has identified several variables including patient, sociodemographic, comorbid medical and behavioral conditions, therapy-related, healthcare team, and are associated with nonadherence. Unfortunately, these factors individually and even in combination are typically only weakly related to adherence of individual patients. A two-fold strategy can be efficiently applied in the clinical setting to improve adherence. First, address major categories of adherence throughout the therapeutic journey for all patients from initiation of pharmacotherapy to titration, and maintenance. Efficient, scalable strategies in this category include teach back, clarity on treatment goals including the blood pressure range required to attain consistent control, initiation, and titration of single-pill antihypertensive combinations, limiting out-of-pocket expense, and refill consolidation. Second, objectively assess adherence when treatment goals are not attained with effective pharmacotherapy. Then, identify and address patient-specific barriers for individuals with suboptimal adherence. Given the multiple competing priorities and resultant time demands on clinicians and healthcare teams, effective, replicable, and scalable strategies to optimize adherence are important in attaining the evidence-based benefits of antihypertensive pharmacotherapy.

The advent of immunotherapy has revolutionized the therapeutic landscape of breast cancer. The immune checkpoint inhibitor drug, pembrolizumab, a monoclonal antibody targeting programmed cell death protein 1 (PD-1), was recently approved by the Food and Drug Administration (FDA) as a neoadjuvant treatment in combination with traditional chemotherapy in locally advanced triple-negative breast cancer (LA-TNBC). This manuscript aims to highlight an uncommon adverse event of immune checkpoint inhibitors (ICIs): hypereosinophilia (HE). Herein, we report the case of AW, a 49-year-old female patient, who was treated for triple-negative breast cancer (TNBC) with pembrolizumab, achieving a complete response. After undergoing surgery, pembrolizumab was reintroduced as adjuvant therapy, at which point an abnormal increase in eosinophil count was observed. Hence, treatment was interrupted, and after glucocorticoid administration, the eosinophil count reverted to normality. Our findings underscore the necessity for vigilant monitoring of blood eosinophil levels during pembrolizumab therapy and provide insights into the management of such immunotherapy-related adverse events.

Cervical cancer is the fourth leading cause of cancer-related deaths among women worldwide, causing over 660,000 new cases and 350,000 deaths in 2022, with a disproportionately high burden in low-resource countries where access to treatment is limited. Human papillomavirus (HPV) is a common sexually transmitted infection that accounts for approximately 95% of cervical cancer cases. Persistent HPV infection can progress to cervical dysplasia, categorized into varying severities (CIN1, CIN2, and CIN3), which significantly increases cancer risk. The mechanism of HPV-induced malignancy involves the disruption of cellular apoptosis by integrating viral genetic material into cervical cells, particularly within the transformation zone. The viral proteins E6 and E7 play pivotal roles in cervical carcinogenesis by inhibiting tumor suppressor proteins, promoting uncontrolled cell proliferation, and evading immune responses, ultimately driving progression toward malignancy. Timely detection and intervention are essential for managing HPV-related cervical cancers. Preventative measures such as HPV vaccination have demonstrated substantial efficacy. Six vaccines targeting high-risk (HR) HPV strains are recommended before sexual activity or exposure. Despite these advancements, barriers, such as misinformation, logistical challenges, and limited healthcare infrastructure, persist, particularly in underserved regions. Advances in diagnostic and therapeutic technologies have offered new avenues for addressing these challenges. Next-generation sequencing and CRISPR gene editing are emerging as promising tools for HPV-related cancer treatment that enable precise and targeted interventions. Furthermore, artificial intelligence (AI) and imaging innovations have significantly enhanced diagnostic accuracy and personalized care. Pap smears and HPV DNA testing are indispensable tools for early detection. To tackle HPV-related cervical cancer globally, a multifaceted approach is required. Public health education, vaccination programs, research, and international collaboration are crucial. Public health campaigns should combat misinformation, strengthen vaccination programs, and focus on novel therapies, screening technologies, and next-generation sequencing.

Esketamine, the S-enantiomer of ketamine, has gained prominence as an adjunct in pain management during general anesthesia due to its higher potency and ability to achieve therapeutic effects at lower doses than ketamine. While its benefits for pain relief and mental health are well-established, the specific effects of esketamine on cardiac function during anesthesia remain under investigation. Anesthesia itself induces physiological changes in the cardiovascular system, and esketamine can exacerbate these effects by increasing sympathetic activity, heart rate, blood pressure, and cardiac output. Additionally, it can induce peripheral vasoconstriction, raising systemic vascular resistance. These cardiovascular effects are particularly concerning in patients with pre-existing heart conditions, underscoring the importance of preoperative assessment, continuous monitoring, and potential dose adjustments. This review examined the hemodynamic effects of esketamine, the associated cardiovascular risks, and the clinical implications for patients with cardiac conditions, offering recommendations for its safe use in anesthesia.

This review explored the physiological mechanisms underlying arginine vasopressin deficiency (AVP-D, formerly central diabetes insipidus) and AVP resistance (AVP-R, formerly nephrogenic diabetes insipidus), with a focus on water balance regulation. Vital components include the hypothalamic-pituitary-AVP axis, renal AVP responsiveness, and neural mechanisms of thirst regulation. Recent insights on thirst generation within circumventricular brain nuclei (subfornical organ, median preoptic nucleus, and organum vasculosum of the lamina terminalis) are discussed, along with the diagnostic utility of copeptin in polyuric states. This review highlighted the critical role of hypothalamic-pituitary integrity and renal AVP responsiveness in maintaining water-electrolyte homeostasis. Understanding these mechanisms provided the foundation for optimizing therapeutic strategies and advancing research on AVP-related disorders.

Team-based care is a patient management strategy involving a team of at least two healthcare professionals working collaboratively toward a shared clinical goal. This approach is now increasingly recommended by international hypertension guidelines mainly to improve medication adherence and hence, blood pressure control. The goal of this paper was to review the most recent evidence on the benefits of a team-based care approach in the management of hypertension. The results show that in recent years, numerous controlled clinical trials have demonstrated the efficacy of this strategy to lower blood pressure, achieve blood pressure targets more rapidly, and obtain more hypertensive patients under control. These improvements are due essentially to two factors: improved drug adherence/persistence and a reduction of therapeutic inertia. Best results are obtained when physicians collaborate with pharmacists and/or nurses, but other healthcare professionals may be involved successfully as well. Recent data have also demonstrated that the team-based care approach is cost-effective. These observations should be a strong incentive for hypertension centers to engage in the development of a team-based care strategy.