aging

Background: Effective medication to manage diabetes mellitus-related organ complications with minimal adverse drug toxicity is still in pursuit by scientists worldwide. This study investigated the cardio-protective of Rida herbal bitter (RHB) in a high-fat diet/streptozotocin (STZ)-induced diabetic rats.Methods: Thirty-two matured male Wistar rats (250 ± 20g) were used. The animals were fed with high-fat diet (HFD) for 6 weeks before diabetes induction. A single dose of (35 mg/kgb.wt) freshly prepared STZ was injected intraperitoneally to induce diabetes. The animals were allocated into four groups, 8rats/group. Group I: control; Group II: HFD/STZ-induced diabetic rats; Groups III & IV: HFD/STZ-induced diabetic rats treated with 0.3 ml RHB & 200 mg/kgb.wt metformin respectively. At the end of the experiment, the animals were sacrificed, blood was sample collected via cardiac puncture and the heart was excised and homogenized. The blood samples and cardiac homogenates tissue were centrifuged to retrieve clear supernatant plasma for biochemical assay.Results: Diabetic rats exhibited significant (p < 0.05) elevated blood glucose, insulin, glycated hemoglobin (HbA1c), cardiac biomarkers, lipid profile, malondialdehyde (MDA), pro-inflammatory cytokines, food, and water intake levels with a reduction in body weight, cardiac antioxidant activity, and total protein. RHB administration significantly (p < 0.05) diminished the blood glucose, insulin, HbA1c, cardiac biomarkers, MDA, pro-inflammatory cytokines, lipid profile, food, and water intake, and improved the body weight cardiac antioxidant activity, and total protein.Conclusion: Rida herbal bitter possesses a cardio-protective effect from this study and could be a better alternative medication for managing diabetes and its related cardiovascular complications.

The authors are searchers in psychopathology and communicate here about the dead wishes in relation to euthanasia. In Europe, the question comes regularly up to know if the law should be changed concerning the prohibition of euthanasia. The health system obeys progressively a modern idea of comfort and the “good life”. The authors are psychotherapists and their methodology is based mainly on phenomenological psychology, psychoanalysis, and psychopathology. Statistics of the French Ministry of Health will support their statements. Different clinical experiences with young patients, aging patients, or near-to-death patients are crossed and compared to those marked by heavy experiences like rape or amputation. The unbearable nature of their suffering makes them ask frequently to stop the pain. They would prefer being dead. This contribution examinates this kind of demand to find a helpful position for the caregiver and the patient. We should consider that near-death patients may often be at the climax of anxiety and depression is likely to switch over to dementia. In asking to finish with life, this purpose may change one day to another – sometimes it just highlights the wish to see things changed. The position of society and the medical staff has a high influence as well. Asking for euthanasia shows the variety of the same words that have different meanings from a medical, psychological, or psychopathological viewpoint. The purpose is to consider these aspects with the patient’s demand.

Forensic laboratories face a backlog of case files, affecting service delivery, causing delays. The backlog points to underfunding, poor planning, and inadequate support, hindering deoxyribonucleic acid (DNA) analysis. Resolving casework backlogs may initially seem like a straightforward and attainable measure to improve the arrest of offenders and promote justice. Longer turnaround times impede investigative leads, emphasising the need for efficient strategies and a comprehensive approach to address and prevent backlogs in forensic laboratories. No study has been published on the forensic DNA backlogs in South Africa. The article explicitly addresses one aspect of a Doctor of Philosophy study and aims to ascertain the impact of backlogs in forensic DNA case entries. The study article’s research questions included the following: “What cases are considered as backlog?”; “What is the current backlog in forensic DNA case entries in South Africa?” and “What are the main reasons for the backlog of cases involving forensic DNA?” The prompt processing of DNA evidence is vital not only for safeguarding individuals falsely accused of crimes based on circumstantial evidence but also for aiding prosecutors and providing justice for crime victims.

The aging global population requires a new social model to meet the growing social, economic, and physical needs of seniors. Western social models need to be reconsidered in light of examples that support communal ways of living, which are sustainable through smart city design for more supportive geriatric care systems. To address the complex problems of geriatric care in this growing aging population with specific needs related to increased lifespan and limited financial resources, the use of emerging technologies, such as artificial intelligence (AI) and the Internet of Things (IoT), should be considered. As retirement ages rise and funds for retirement continue to decrease automated and sustainable solutions need to be sought. The ethical need to consider citizens not as customers but as decision-makers and to validate the ethical nature of medical decisions made for and by individuals should also be prioritized. This study provides recommendations for a smart city design and highlights the need for reflection on the ethics, modernization, and management of geriatric care. It suggests that technological devices can benefit health system reform by facilitating problem-solving. Overall, this new model integrates communal living and non-Western values with emerging technologies to address the growing need for geriatric care and the well-being of seniors.

Science is the art of systematic and reproducible measurements, ultimately leading to knowledge supported by a holistic logic. Besides serendipity, there are 6 ways in general to obtain knowledge: authoritarianism; mysticism; rationalism, empiricism; pragmatism; and scepticism. Over the last 100 years, a canonical mythology – cortical spreading depression (CSD) – has prevailed in migraine pathophysiology. Conversely, a well-defined adaptive/protective role has evolved for CSD in locusts, Drosophila, and mammals. Additionally, an elaborate but entirely symptomatic nosologic system has arbitrarily evolved in migraine / primary headache. While the so-called systematic but symptomatic classification system of migraine / primary headache keeps on advancing the data-bank exponentially, the cause-effect nexus continues to obscure the most important systematic and insightful components of the knowledge of primary headache. The first step in advancing the cause-effect mystery of migraine / primary headache is to create a conceptual, consistent, and important adaptive-pathogenetic divide in the massive and disparate data-linked pathophysiology of the disorder. Once certain definitive principles (not laboratory/neuroimaging / genetic/epidemiologic data) emerge in the science of migraine / primary headache, we become empowered to understand the complex but key phenotypic blueprint as well as the neuro-pathophysiology / neuropsychiatry of the entity, including the visual (nasal visual-field sparing digitally-displaceable and eyeball-movement-synchronous scintillating scotomata), the lateralizing fronto-temporal-nuchal headache exclusively involving the ophthalmic division of the trigeminal nerve, and the associated features such as ‘stress’, ‘post-stress’, ‘autonomic storm’, ‘protean’ and ‘spontaneous’ onset and offset, and headache-aborting nausea-vomiting. In this manner, we have also evolved principles to begin to understand the most complex female predominance of migraine patients in adults [F:M=3:1] as well as the decline of prevalence in migraine attacks following menopause and advancing age. The Laws of the Pathophysiology of Migraine encompass the invaluable neurological / neuro-ophthalmological shift in pathophysiology from the brain to the eye.

In this case report a 64-year-old male patient with recent past medical history of head injury complicated by zygomatic arc fracture and mild subarachnoid hemorrhage is studied. He had been presented to the Emergency Department because of progressive neurological symptoms and neurological deficits in the physical examination that could have been indicating subcacute subdural hemorrhage. However, the patient was reluctant to undergo diagnostic imaging due to concerns about radiation exposure. After several explanations, a CT scan was done, which revealed a bilateral subacute subdural hematoma. Neurosurgical management was initiated and intravenous corticosteroid therapy was administered to reduce local edema. The challenge of this case is based on the subtlety of symptoms that might cause patients to delay seeking medical attention. Additionally, patient reluctance to undergo diagnostic tests can complicate management, emphasizing the importance of patient education and therapeutic alliance. Multidisciplinary management involving Neurology and Neurosurgery is crucial for optimal patient care in such cases. This report underscores the significance of effective communication and collaborative decision-making between healthcare providers and patients to ensure timely and appropriate management of complex medical conditions.

Objective: This study aimed to evaluate the clinical characteristics and diagnostic challenges associated with osteomyelitis in patients presenting with persistent lumbar pain and fever.Methods: We conducted a descriptive observational study, reviewing four cases of osteomyelitis diagnosed at our hospital’s Emergency Department in 2022. Data on patient demographics, medical history, clinical presentation, diagnostic methods, and treatment outcomes were analyzed.Findings: The cases included middle-aged to elderly men, with predisposing factors such as urological interventions and immunodeficiency. Imaging studies, particularly CT-scan and MRI, were instrumental in diagnosing lumbar spondylodiscitis. Biopsies revealed lymphoplasmacytic infiltrates and treatment responses were positive in all cases after eight months of follow-up. The study highlights the importance of considering osteomyelitis in the differential diagnosis of lumbar pain and fever, necessitating multidisciplinary collaboration for timely management.

Peripartum cardiomyopathy is a rare case of heart failure with reduced ejection fraction and is considered a diagnosis of exclusion. The symptoms of heart failure in patients with peripartum cardiomyopathy can mimic the physiologic conditions of normal pregnancy. In an acute decompensated state, PPCM can present with acute severe upper abdominal or epigastric pain. We are presenting a 24-year-old female with no personal or family history of heart disease and no identifiable risk factor for PPCM. Based on her initial presentation in the emergency department, a diagnosis of acute severe pancreatitis was sought, and she was referred to the Intensive Care Unit. After further evaluation of the serological tests and imaging, she was eventually diagnosed as a case of PPCM. We emphasize the rare nature of the disease with a diverse presentation which poses a diagnostic challenge, especially in a resource-limited setting where advanced diagnostic tools may be restricted and socioeconomic condition poses a barrier to further patient evaluation. This case exemplifies the infrequent occurrence and atypical manifestation, presenting a learning opportunity for future clinicians.

Background: This case study explores an integrated approach to managing a complex cardiac condition, presenting a comprehensive single-session intervention. This includes balloon valvuloplasty using a Nucleus 18 mm balloon, complex angioplasty with rotational atherectomy (rotablator) targeting calcified lesions in the left main and left anterior descending artery, and Transcatheter Aortic Valve Implantation (TAVI) with a 23 mm Sapien 3 valve, all performed on an 81-year-old woman. Furthermore, this report underscores the strategic left atrial appendage closure conducted three months post-procedure due to the patient’s elevated hemorrhagic risk.Case presentation: Facing critical coronary and valvular pathologies, the patient underwent a meticulously planned, single-session intervention. The process began with a balloon valvuloplasty using a Nucleus 18 mm balloon to address the aortic stenosis. This was followed by a high-risk angioplasty, during which the Impella CP device provided hemodynamic support and rotational atherectomy was employed to address the calcified coronary artery disease effectively. The same session saw the successful execution of TAVI using a 23 mm Sapien 3 valve. The comprehensive approach notably diminished procedural complications, illustrating the benefits of an integrated treatment pathway in managing high-risk patients. Three months later, the patient underwent a left atrial appendage closure, a critical move considering her high risk of hemorrhage. This procedure also provided an opportunity to assess the favorable outcomes of the previous angioplasty.Conclusion: This case validates the feasibility and efficacy of performing multiple advanced percutaneous interventions in a single session for high-risk cardiac patients. It underscores the crucial role of innovative and personalized treatment strategies in improving patient outcomes, particularly in complex clinical scenarios. Moreover, the case exemplifies the essential relationship between immediate, comprehensive intervention and subsequent follow-up procedures in ensuring optimal long-term patient care.

Susceptibility-weighted imaging (SWI) is based on a 3D high-spatial-resolution, velocity-corrected gradient-echo MRI sequence that uses magnitude and filtered-phase information to create images. It SWI uses tissue magnetic susceptibility differences to generate signal contrast that may arise from paramagnetic (hemosiderin), diamagnetic (minerals and calcifications) and ferromagnetic (metal) molecules. Distinguishing between calcification and blood products is possible through the filtered phase images, helping to visualize osteoblastic and osteolytic bone metastases or demonstrating calcifications and osteoid production in liposarcoma and osteosarcoma. When acquired in combination with the injection of an exogenous contrast agent, contrast-enhanced SWI (CE-SWI) can simultaneously detect the T2* susceptibility effect, T2 signal difference, contrast-induced T1 shortening, and out-of-phase fat and water chemical shift effect. Bone and soft tissue lesion SWI features have been described, including giant cell tumors in bone and synovial sarcomas in soft tissues. We expand on the appearance of benign soft-tissue lesions such as hemangioma, neurofibroma, pigmented villonodular synovitis, abscess, and hematoma. Most myxoid sarcomas demonstrate absent or just low-grade intra-tumoral hemorrhage at the baseline. CE-SWI shows superior differentiation between mature fibrotic T2* dark components and active enhancing T1 shortening components in desmoid fibromatosis. SWI has gained popularity in oncologic MSK imaging because of its sensitivity for displaying hemorrhage in soft tissue lesions, thereby helping to differentiate benign versus malignant soft tissue tumors. The ability to show the viable, enhancing portions of a soft tissue sarcoma separately from hemorrhagic/necrotic components also suggests its utility as a biomarker of tumor treatment response. It is essential to understand and appreciate the differences between spontaneous hemorrhage patterns in high-grade sarcomas and those occurring in the therapy-induced necrosis process in responding tumors. Ring-like hemosiderin SWI pattern is observed in successfully treated sarcomas. CE-SWI also demonstrates early promising results in separating the T2* blooming of healthy iron-loaded bone marrow from the T1-shortened enhancement in bone marrow that is displaced by the tumor.SWI and CE-SWI in MSK oncology learning objectives: SWI and CE-SWI can be used to identify calcifications on MRI.Certain SWI and CE-SWI patterns can correlate with tumor histologic type.CE-SWI can discriminate mature from immature components of desmoid tumors.CE-SWI patterns can help to assess treatment response in soft tissue sarcomas.Understanding CE-SWI patterns in post-surgical changes can also be useful in discriminating between residual and recurrent tumors with overlapping imaging features.

The rising prevalence of chronic diseases and the aging population globally are diminishing the overall quality of life, especially for those with demanding daily routines. As medical advancements extend lifespans, the proportion of individuals over 60 is set to double by 2050, necessitating societal shifts toward health-responsible citizenship. Despite longer lifespans, evidence suggests that older age often accompanies mental health challenges such as anxiety, depression, and substance misuse. Social isolation and loneliness further compound these issues, affecting both physical and mental well-being. Digital wellness empowers individuals to take charge of their health, promoting proactive care and literacy to foster health-conscious citizenship. This paper explores the intersection of mental health, aging populations, preventive wellness initiatives, and health literacy, emphasizing their significance within the Health 5.0 framework, especially for older adults. Traditionally, health regulators offer static workflows for adopting standard procedures in health and well-being, reflecting a reactive approach. However, the evolving landscape of wearable and mobile devices connecting to healthcare IT systems through secure online networks necessitates a shift. Technology now facilitates remote patient monitoring and telemedicine service subscriptions and empowers individuals to manage their health proactively.The BE4YOU project, conducted in Portugal, serves as a case study, facilitating individual maintenance of health and well-being through intelligent and dynamic workflows, which are defined based on analytical models considering each person’s risk profile. By facilitating data sharing, promoting healthy lifestyles, and enabling early detection of mental health issues, the project leverages technology to support personalized monitoring and enhance overall health outcomes. Through technology-driven empowerment, individuals and healthcare professionals are better equipped to assess risks and ensure ongoing wellness monitoring, underscoring the role of technology in fostering personal health and supporting healthcare effectiveness.

Primary melanocytic neoplasms of the central nervous system are rare entities and can present in different clinical forms with mild and non-specific symptoms (such as headache and tinnitus) to severe and limiting symptoms (focal deficits and intracranial hypertension), mimicking the most diverse pathologies. In addition to the peculiar changes in imaging tests, diagnosis is always a challenge given the multitude of possible differential diagnoses, including aseptic meningitis. Given this, we bring here the case of a 59-year-old patient who attended care due to headache and vertigo followed by involvement of the cranial nerves and spinal cord, corroborated by physical examination and imaging study suggesting diffuse involvement of the meninges, which was subsequently confirmed by anatomopathological examination as a primary melanocytic neoplasm of the central nervous system but ended up dying due to complications resulting from late diagnosis. The objective of this work is to raise awareness about the possibility of this pathology as a differential diagnosis in these cases where there are often frustrating clinical manifestations but with changes in imaging tests, to enable an early diagnosis and consequently the possibility of a better therapeutic result, in addition to a brief review of the propaedeutic findings of this pathology.

In the realm of dental surgery, implants are essential for replacing missing teeth. To facilitate implant placement, techniques such as bone grafting and sinus lifts are utilized to augment the volume of atrophied alveolar bone in candidates for dental implants. Typically, patients undergo a period of recovery following bone grafts before proceeding with implant placement. This study investigates the efficacy of Cone Beam Computed Tomography (CBCT) in measuring the residual bone volume and assessing bone quality after the healing phase. A texture analysis was conducted on CBCT scans from 42 patients requiring maxillary sinus lift reconstruction. These patients were categorized into two groups based on the type of grafting material used: Xenograft or allograft. The study analyzed the distribution of various texture parameters and conducted a Mann-Whitney U test to identify significant statistical differences between the groups. Results indicated non-normal distributions for specific variables such as Area_S(1,0) and S(1,0)SumOfSqs, while others like S(1,0)Entropy displayed normal distributions. The findings revealed no significant statistical differences in the primary outcomes between the xenograft and allograft groups. However, the average values of the gray shades of pixels in the allograft group were statistically significantly higher compared to the xenograft group, suggesting differences in bone texture post-procedure.

The Injection of autologous Adipose-Derived Stem Cells (ADSCs) and Stromal Vascular Fraction (SVF) into dermal and subdermal layers can improve skin volume and rejuvenation. The SEFFI (Superficial Enhanced Fluid Fat Injection) technique, which involves minimal manipulation of autologous microfragmented adipose tissue, was utilized for harvesting and re-injection, using the SEFFILLER™ disposable medical device. Mechanical fragmentation of adipose tissue is a well-established surgical technique that stimulates tissue regeneration, filler, and biological activity. The study evaluated the biological properties (regenerative and anti-aging) of different harvest and processing fat graft methods among which the fragmented adipose tissue, specifically focusing on the presence of exosomes. Exosomes, nanometer-sized vesicles produced by cells for cellular communication, were found to contain miRNAs with anti-inflammatory, regenerative, and vascular content. The products’ contained exosomes were confirmed in the study through electron microscopy, Western Blotting, gene expression, and sequencing of miRNA content. 

Background: Endometrial morular metaplasia, a clinical conundrum from a diagnostic and management angle given its rarity and low oncogenic potential, has been linked to endometrial hyperplasia and carcinoma. Case report: A 77-year-old woman with no significant past medical history, was found to have an asymptomatic thickened endometrium on pelvic imaging, after presenting with lower abdominal pain, 3yrs ago. Diagnostic hysteroscopy identified an endometrial polyp within a pyometra. Histopathology showed focal complex endometrial hyperplasia without atypia with superimposed morular metaplasia(EMM) with a negative microbiology assay.Following conservative management with multidisciplinary team(MDT) overview, as-per patient choice with 6-monthly follow-up hysteroscopy, endometrial biopsies and a short use of the Mirena® Intrauterine system (discontinued following poor tolerance), histopathology shows resolved hyperplasia with persistent EMM. Due to persistent disease, a hysterectomy is under consideration.Discussion: Current evidence suggests that a sub-type of EMM, a likely histological manifestation of beta-catenin (CTNNB1) gene mutation: could be a precursor of endometrial hyperplasia and low-grade endometrioid-endometrial carcinoma sub-type. Though low-grade in nature, the increased recurrence risk raises significant concerns.Prognostication following gene mutation identification can help with management options which include conservative, hormonal therapy with adjunct repeat endometrial sampling: or hysterectomy. The optimal frequency of endometrial sampling when uterine-sparing, is unclear, leading to a management conundrum, whilst persistent disease may require a hysterectomy.Conclusion: Management of endometrial morular metaplasia can be difficult but must reflect the woman’s choice with a MDT-overview. Immuno-histochemical tools utilizing new molecular biological advances, can simplify the diagnostic and prognostication processes, aiding clinical management.

Renal lymphangiectasia, a rare lymphatic disorder, manifests as cystic infiltration in the perirenal and para-pyelic space due to lymphatic drainage defects. Diagnosis hinges on imaging modalities like ultrasound, CT, and MRI. However, lack of awareness can lead to confusion with other renal cystic pathologies. Here, we present a case of renal lymphangiectasia in a child, detailing diagnostic and therapeutic strategies. The patient, a 2-year-old and 2-month-old girl from a consanguineous marriage, presented with persistent abdominal distension. Clinical examination revealed growth retardation and normal blood pressure but abdominal distension with dullness. Lab investigations indicated acute renal failure with non-nephrotic proteinuria. Radiologically, renal lymphangiectasia was confirmed by ultrasound showing microcysts and perirenal cystic lesions with ascites, corroborated by MRI and CT scans. Treatment involved nephroprotective therapy and diuretics for ascites. Surgical intervention was necessitated due to cyst size and compressive nature, involving iterative punctures, marsupialization, and percutaneous drainage. Postoperatively, recurrent ascites temporarily worsened renal function but returned to baseline afterward. renal lymphangiectasia necessitates careful management due to its potential to progress to chronic renal failure. The prognosis depends on factors like initial proteinuria severity, treatment response, and complication management. Personalized approaches are pivotal in its diagnosis and management.

Rheumatic heart disease persists as a significant concern in developing regions, often resulting in multivalvular heart conditions. Treatment options are limited, though percutaneous transvenous mitral commissurotomy effectively addresses rheumatic mitral stenosis. Non-surgical interventions for aortic stenosis include balloon aortic valvotomy and Transcatheter aortic valve replacement (TAVR), tailored to patient factors like age and comorbidities.We describe two cases of Rheumatic multivalvular disease which were managed non-surgical. The first case is a pioneering procedure performed on a young patient combined percutaneous transvenous mitral commissurotomy with balloon aortic valvotomy, guided by 4-dimensional transoesophageal echocardiography (4D TEE). This represents the first documented instance in medical literature, showcasing the potential of integrated interventions and advanced imaging techniques. In the second challenging case involving a heavily calcified, retrovirus, and Hepatitis B positive 55-year-old, a staged approach was adopted, involving percutaneous transvenous mitral commissurotomy followed by Transcatheter aortic valve replacement (TAVR). Despite complexities, this sequential strategy demonstrates the adaptability of transcatheter techniques in managing complex valvular pathologies. These cases highlight the evolving landscape of interventional cardiology and underscore the importance of tailored, multidisciplinary approaches in optimizing outcomes for patients with rheumatic heart disease and multivalvular involvement, especially in resource-limited settings. Further exploration and dissemination of such innovative strategies hold promise for enhancing cardiac care quality and expanding treatment options globally.

Aim: This study examines the pathological outcomes of chronic liver injuries, with a focus on liver fibrosis. It emphasizes understanding the structural changes within the liver that may lead to cirrhosis and functional impairments, crucial for developing targeted antifibrotic therapies.Methods: Our approach reviews existing literature detailing the use of traditional diagnostic methods—biochemical and serological tests alongside liver biopsies. Additionally, we evaluate the reliability and efficacy of non-invasive techniques such as serological test panels and imaging examinations. These methods are compared to understand their viability as supplementary or alternative diagnostic tools to liver biopsy.Significance: Liver fibrosis, if unmanaged, can progress to severe conditions such as cirrhosis and hepatocellular carcinoma, making it vital to understand its progression and treatment options. This study underscores the need for precise and non-invasive diagnostic tools in the clinical management of liver fibrosis, providing insight into the progression of chronic liver diseases and potential therapeutic targets.Conclusion and future perspectives: The research confirms that while liver biopsy remains the definitive method for staging liver fibrosis, its risks and limitations necessitate the use of enhanced non-invasive diagnostic techniques. These methods have shown promising results in accuracy and are critical for broadening clinical applications and patient safety.It is recommended that the scientific community continue to develop and validate non-invasive diagnostic tools. Enhancing the accuracy and reliability of these tools can provide a cost-effective, accessible, and safer alternative for large-scale screening and management of liver fibrosis in asymptomatic populations. Additionally, integrating advancements in radiologic and serological markers can further refine these diagnostic methods, improving overall patient outcomes.

The N-hydroxydodecanamide (HA12) and its complexes tri-hydroxamato-iron(III) and di-hydroxamto-iron(III) chloride (HA8Fe3 and HA12Fe3Cl, respectively) showed antibacterial and antimycobacterial activities. The proteomic analysis demonstrated that the targets of Hydroxamic Acid (HA) and their complexes were involved in the biosynthesis of mycobacterial cell walls. The Reactive Oxygen Species (ROS) is one of the key elements to cause oxidative stress, damaging DNA, and cell membranes impaired during the procedure to kill bacteria. Here, the ROS production was determined to evaluate the compounds HA12, HA8Fe3, HA12Fe3Cl, and ZnCl2 against bacteria using 2’,7’-dichlorofluorescein diacetate (DCFDA) by spectrofluorometric analysis. The low fluorescence was observed using the compounds HA12, HA8Fe3, HA12Fe3Cl, and ZnCl2 treating the S. aureus and E. coli, indicating that the ROS production could not be observed using the compounds used at a dose higher than the Minimum Inhibitory Concentration (MIC). It was noted that the ROS determination could be performed with a concentration less than or equal to the MIC. This would enable the mechanism of action linked to the ROS production by HA and their metal complexes to be determined.

Introduction: Immune checkpoint inhibitors (ICI) have significantly improved cancer treatment outcomes, but cardiovascular complications such as ICI-associated myocarditis are a major concern. Diagnosing myocarditis requires integrating biomarkers, electrocardiogram (EKG), cardiac imaging, and endomyocardial biopsy. We present a case illustrating these diagnostic challenges, involving a female patient treated with pembrolizumab who developed fatal acute myocarditis mimicking infiltrative cardiomyopathy.Case report: A 54-year-old woman with mucosal melanoma, treated with pembrolizumab, was hospitalized in May 2023 due to dyspnea and elevated troponin levels. Initial cardiac workups were normal, but subsequent tests revealed borderline cardiac magnetic resonance imaging findings. In late May 2023, the patient was admitted with worsening dyspnea, elevated NT-pro-BNP, and severe hyperlactatemia. Imaging and endomyocardial biopsy confirmed acute myocarditis with atypical presentation, mimicking infiltrative cardiomyopathy. Despite aggressive immunosuppressive therapy, the patient’s condition deteriorated, resulting in cardiogenic shock and death seven days post-admission.Conclusion: This case underscores the diagnostic and management challenges of ICI-associated myocarditis, particularly with atypical presentations. It highlights the need for vigilant, comprehensive monitoring and further research to improve diagnostic and therapeutic strategies for managing these severe side effects in patients undergoing ICI therapy.