BACKGROUND: Myasthenia gravis (MG) is a rare autoimmune neuromuscular disorder with significant unmet needs despite conventional therapies. Novel FcRn and complement inhibitors have transformed the treatment paradigm for...BACKGROUND: Myasthenia gravis (MG) is a rare autoimmune neuromuscular disorder with significant unmet needs despite conventional therapies. Novel FcRn and complement inhibitors have transformed the treatment paradigm for generalized MG. METHODS: This commentary reviews the clinical efficacy, safety, and practical implications of FDA-approved FcRn inhibitors (efgartigimod, rozanolixizumab, nipocalimab) and complements inhibitors (eculizumab, ravulizumab, zilucoplan), drawing on clinical trial data and literature from 2013 to 2025. RESULTS: FcRn inhibitors significantly improve MG-ADL scores in anti-AChR and MuSK antibody-positive patients, with rozanolixizumab and nipocalimab uniquely approved for MuSK-MG. Complement inhibitors show rapid efficacy in refractory anti-AChR MG, with zilucoplan enabling self-administration. Adverse events include infections and hypersensitivity reactions. These medications require vaccination and close monitoring. CONCLUSIONS: These therapies offer personalized, effective options for MG management, though challenges in cost and access remain. Future research should address long-term outcomes and biomarkers.
BACKGROUND: Approximately 10% of adults and 7.6% of children in the United States have food allergies. Allergic reactions to foods can be life threatening, which requires patients and caregivers to be constantly diligent...BACKGROUND: Approximately 10% of adults and 7.6% of children in the United States have food allergies. Allergic reactions to foods can be life threatening, which requires patients and caregivers to be constantly diligent in avoiding foods that may trigger an immune-mediated event. Until recently, the only FDA-approved treatment for food allergy was oral immunotherapy (OIT), which involves daily ingestion of small doses of antigen to gradually build up a patient's tolerance. This therapy can be burdensome, requiring multiple office visits, and it is not without serious risk, including anaphylaxis. Anti-IgE therapy with omalizumab has recently been approved as an alternative to OIT to reduce the risk of allergic reaction associated with IgE-mediated food allergy. PHARMACOLOGY: Omalizumab is an anti-IgE monoclonal antibody that has recently shown promising results for treating multiple food allergies in the first phase of the OUtMATCH clinical trial. This drug is administered by subcutaneous injection every 2-4 weeks based on a patient's weight and serum IgE levels. By binding and neutralizing serum IgE antibodies, omalizumab reduces the body's sensitivity to allergen exposure, allowing for an increased threshold dose of antigen exposure before an allergic reaction ensues. CLINICAL TRIALS: Small clinical trials of anti-IgE therapy for the management of food allergies have been reported since 2003. Monotherapy with omalizumab has been reported to increase the tolerance threshold to various foods, including peanut, cow's milk, egg, and wheat. When combined with OIT, small trials have demonstrated that omalizumab facilitated the speed of desensitization and reduced the risk of adverse allergic reactions compared with OIT alone. The OUtMATCH trial is the largest trial to date, and it has demonstrated that omalizumab significantly increases the threshold dose for experiencing an adverse allergic reaction among subjects with allergies to multiple foods, including peanuts, cashew, milk, egg, walnut, wheat, or hazelnut. THERAPEUTIC ADVANCE: Omalizumab is a novel treatment strategy for multiple food allergies. By increasing the tolerance to foods that induce allergies, patients may experience a reduced risk of immune-mediated reactions on accidental allergen exposure. Uncertainty remains about the ideal candidates for omalizumab, its comparative effectiveness, practical implementation, and long-term outcomes. Ongoing trials and future real-world data are expected to clarify these issues, including its impact on reducing anaphylaxis, ED visits, and hospitalizations. Patient-specific factors and available options should be discussed with the patient in the shared decision process as an essential component in choosing the therapeutic strategy.
Covaciu A, Bobescu E, Benza V
… +10 more, Pepine EL, Ivascu M, Tomulescu AA, Cojocariu E, Mahjoub LA, Cojocaru N, Rogozea L, Dima L, Strempel CG, Rus H
BACKGROUND: Infective endocarditis is a severe cardiac infection disease with high morbidity and mortality, remained largely unchanged over the past 2 decades with an increased incidence in the last years. STUDY QUESTION...BACKGROUND: Infective endocarditis is a severe cardiac infection disease with high morbidity and mortality, remained largely unchanged over the past 2 decades with an increased incidence in the last years. STUDY QUESTION: Was to evaluate the main causes of increased incidence and antibiotic resistance and the role of biomarkers in infective endocarditis. STUDY DESIGN: Patients with infective endocarditis admitted in Cardiology Department were evaluated regarding the annual incidence and characteristics in the last 8 years, to identify the causes of the increased incidence of this disease. MEASURES AND OUTCOMES: We enrolled 178 patients diagnosed with infective endocarditis admitted in hospital in the last 8 years. The data included patient's demographic data, medical history, presence of preexisting risk, or associated systemic diseases. RESULTS AND DISCUSSION: Infective endocarditis was diagnosed twice as frequently in urban areas with two-thirds of patients being male and 4 of 5 patients being older than 60 years. The most common disease associated was previous valvopathies and the most affected aortic native valve in 1 of 5 cases. Inflammation markers were predictive for diagnosis, complication, and prognosis in patients with IE. The highest frequencies pathogens were Staphylococcus spp., Enterococcus spp., and Streptococcus spp. Two-thirds of patients needed reserve antibiotics such as glycopeptides and/or carbapenems because of antibiotic resistance. The predictors for in-hospital mortality were the following: old age, heart and renal failure, markers of organ dysfunction, persistence of infection, and high inflammatory markers. CONCLUSIONS: Infective endocarditis was diagnosed more frequently in urban areas, in male, and those aged older than 60 years. Previous valvopathies was most common associated disease, and aortic native valve was the most affected. Persistent infection and inflammation were predictors for bad prognosis in patients with infective endocarditis. The top 3 highest frequencies pathogens were Staphylococcus spp., Enterococcus spp., and Streptococcus spp., and an increase in antibiotic resistance has been recorded.
BACKGROUND: Scorpion envenomation is a significant public health concern in specific regions and can have severe consequences in pediatric patients. The efficacy of antivenom treatment remains controversial. OBJECTIVE: T...BACKGROUND: Scorpion envenomation is a significant public health concern in specific regions and can have severe consequences in pediatric patients. The efficacy of antivenom treatment remains controversial. OBJECTIVE: To compare the clinical course and outcomes of pediatric scorpion envenomation in patients receiving SCORPIFAV antivenom versus supportive care alone. METHODS: We conducted a retrospective study of children aged 0-18 years presenting with grade ≥2 scorpion envenomation to the pediatric emergency department at Soroka University Medical Center, Israel, between 2014 and 2020. Clinical outcomes were compared between patients who received SCORPIFAV and those treated with supportive care alone. RESULTS: A total of 194 children were included (median age: 3 years, interquartile range: 2-8 years); 125 received SCORPIFAV and 69 received supportive care only. Patients treated with SCORPIFAV required less sedation (10.3% vs. 23.4%, P = 0.02), less analgesia (53.3% vs. 81.3%, P < 0.001), and fewer antihypertensive medications (0% vs. 17.2%, P < 0.001). SCORPIFAV administration was associated with higher odds of requiring minimal additional treatment (OR = 2.568, 95% CI, 1.168-5.646, P = 0.019). No significant differences were found in pediatric intensive care unit admission rates or length of stay. CONCLUSIONS: In pediatric patients with grade ≥2 scorpion envenomation, SCORPIFAV use was associated with reduced need for sedatives, analgesics, and antihypertensive medications. These findings suggest that early administration of SCORPIFAV in the emergency setting may help attenuate the sympathetic response and reduce overall treatment intensity.
BACKGROUND: Pain management remains a critical challenge in medical practice. There is a complex interplay between chronic pain and opioid use disorder, 2 prevalent problems of significant public health concern. Research...BACKGROUND: Pain management remains a critical challenge in medical practice. There is a complex interplay between chronic pain and opioid use disorder, 2 prevalent problems of significant public health concern. Research into new treatment strategies is increasingly important. STUDY QUESTION: This study aims to highlight the analgesic effect of morphine through its exclusive action on peripheral opioid receptors in carrageenan-induced inflammatory pain. STUDY DESIGN: The first experiment aimed to establish a dose-effect relationship for intraplantar morphine administration in a rat model of carrageenan-induced inflammation by testing successive doses after carrageenan injection. The second experiment assessed whether a 5-mg/kg dose of intraplantar morphine has only local, not central nervous system, analgesic effects by comparing it with 5- and 10-mg/kg doses given intraperitoneally. MEASURES AND OUTCOMES: For each rat, paw pain sensitivity was measured using the Ugo Basile Plantar Test-Hargreaves Apparatus. RESULTS: In the first part, lower doses (2.5 mg/kg) did not significantly affect paw withdrawal latency, whereas higher doses (5 and 10 mg/kg) increased it significantly, suggesting maximum receptor activation at 5 mg/kg intraplantarly. The 20-mg/kg intraplantar dose caused central nervous system effects, indicating systemic absorption. The second part compared intraplantar versus intraperitoneal morphine, finding that the 5-mg/kg intraplantar dose produced significant local analgesia, whereas the same intraperitoneal dose did not-supporting peripheral receptor involvement. CONCLUSIONS: Our findings suggest that morphine administered locally in experimentally inflamed tissue acts predominantly via peripheral opioid receptors. This opens the possibility for developing localized opioid delivery systems offering safer, more selective pain management.
Mohammed C, Qamar MW, Pathak B
… +11 more, Shareef M, Ahmed RS, Shihab A, Khalid U, Singh G, Masood AZ, Shahjehan RD, MacKenzie Picker S, Ahmed R, Ahmed M, Ehsan M