Peroxisome proliferator-activated receptors (PPARs) are nuclear receptors that sense lipophilic molecules and act as transcription factors to regulate target genes. PPARs have been implicated in the regulation of innate immunity, glucose and lipid metabolism, cell proliferation, wound healing, and fibrotic processes. Some synthetic PPAR ligands are promising molecules for the treatment of inflammatory and fibrotic processes in immune-mediated intestinal diseases. Some of these are currently undergoing or have previously undergone clinical trials. Dietary PPAR ligands and changes in microbiota composition could modulate PPARs’ activation to reduce inflammatory responses in these immune-mediated diseases, based on animal models and clinical trials. This narrative review aims to summarize the role of PPARs in immune-mediated bowel diseases and their potential therapeutic use.

Background: Migraine is a highly prevalent and disabling primary headache disorder frequently accompanied by gastrointestinal symptoms and comorbid gastrointestinal diseases. Increasing evidence suggests that alterations in the gut microbiota and dysregulation of the microbiome–gut–brain axis may contribute to migraine pathophysiology through immune activation, oxidative stress, impaired intestinal barrier function, and neuroinflammatory signaling. Objectives: This narrative review aims to summarize current mechanistic and clinical evidence linking the gut–brain axis to migraine, with a particular focus on the potential roles of probiotics, prebiotics, and postbiotics as adjunctive strategies in migraine management. Methods: A narrative synthesis of experimental, translational, and clinical studies was performed, focusing on microbiome composition, gut barrier integrity, immune and oxidative pathways, and interventional trials evaluating probiotics, prebiotics, synbiotics, and microbiota-derived metabolites in adult and pediatric migraine populations. Results: Migraine has been associated with intestinal dysbiosis, increased gut permeability, and low-grade systemic inflammation. Probiotics, most commonly strains of Lactobacillus and Bifidobacterium, may modulate inflammatory cytokine profiles, enhance tight junction integrity, reduce oxidative stress, and influence neurotransmitter-related pathways along the gut–brain axis. Clinical trials evaluating probiotic supplementation report heterogeneous but promising signals, including reductions in migraine frequency, severity, disability scores, and analgesic use, particularly in chronic migraine and pediatric populations. Emerging evidence also supports a potential role for prebiotics (e.g., inulin-type fructans) and microbiota-derived metabolites such as short-chain fatty acids, although direct clinical data remain limited. Conclusions: Modulation of the microbiome–gut–brain axis represents a biologically plausible adjunct approach in migraine management. While probiotics, prebiotics, and postbiotics show potential benefits with favorable safety profiles, current evidence of their strain-, formulation-, and population-specific characteristics is lacking. Well-powered, placebo-controlled trials with standardized migraine endpoints and integrated microbiome and metabolomic analyses are needed to define responders, optimal interventions, and clinical relevance.

West Nile Virus (WNV) infection is a world-wide zoonotic disease transmitted by mosquitoes. The infection is usually self-limiting; however, elderly patients or those with comorbidities are predisposed to developing severe, and sometimes fatal complications of the infection. Recently, the incidence of WNV infection in Europe had seen a sharp increase, as compared to previous years. We are currently reporting on the clinical presentation and laboratory findings in 23 cases of WNV infection, of which one resulted in a fatal outcome. The clinical picture was predominantly that of meningitis/meningoencephalitis of varying severity. One patient suffered a fatal outcome, and a rare manifestation of chorioretinal lesions and iridocyclitis was also reported as a result of WNV infection. Cerebrospinal fluid analysis predominantly showed lymphocytic pleocytosis, and total protein levels were increased in all but three of the patients. Levels of total protein in CSF samples were found to show a positive correlation with age. Given the ever-increasing incidence of WNV infection in Europe, a high index of clinical suspicion should always accompany cases of meningitis, especially during the summer period, as a similar epidemic pattern is predicted to recur.

Purpose: Clostridioides difficile infection (CDI) represents a major healthcare associated infection with potentially life-threatening complications. While gastrointestinal and systemic manifestations are well recognized, severe micronutrient deficiencies, particularly vitamin K deficiency are rarely described. We aimed to report a unique case of CDI-and antibiotic-associated dysbiosis and malabsorption leading to profound vitamin K deficiency and coagulopathy, thereby highlighting the clinical intersection between infection, microbiome disruption, and hemostasis. Methods: We report the clinical course, diagnostic work-up, and therapeutic management of an elderly female patient with CDI complicated by life-threatening coagulopathy. In addition, a narrative review of published case reports of antibiotic-associated vitamin K deficiency was performed to contextualize our findings. Results: The patient developed extensive subcutaneous hematomas with a severely deranged coagulation profile (PT > 100 s, INR > 8, markedly reduced activities of vitamin K–dependent factors). Normal liver function and preserved platelet count excluded disseminated intravascular coagulation and hepatic failure. The findings were consistent with severe vitamin K deficiency secondary to antibiotic-induced dysbiosis, malnutrition, and persistent diarrhea. High-dose intravenous vitamin K supplementation resulted in rapid normalization of coagulation parameters within 24 h, with subsequent clinical stabilization and resolution of bleeding manifestations. Conclusion: This case illustrates a rare but clinically significant complication of CDI: profound vitamin K deficiency–associated coagulopathy. Clinicians should maintain a high index of suspicion for vitamin K deficiency in elderly, malnourished, and antibiotic-exposed patients with CDI who present with unexplained coagulopathy or bleeding.

Introduction: As the COVID-19 pandemic enters its sixth year, effective vaccination strategies remain a cornerstone, particularly given the limitations in access, timing, and efficacy of currently available antiviral therapies. Methods: In this retrospective study, we analyzed neutralizing antibody responses in serum samples from 100 vaccinated and boostered individuals using standardized cell-culture and in vitro neutralization assays. Samples were tested against the original Wuhan-Hu-1 spike protein as well as major SARS-CoV-2 variants of concern (B.1.351, B.1.617, and B.1.1.529/Omicron). We also investigated the potential for antibody-dependent enhancement (ADE) in monocyte-derived macrophages. Results: Only 61% of serum samples effectively neutralized the Wuhan-Hu-1 variant; among these, 20.6% demonstrated cross-neutralization of both B.1.351 and B.1.617. Of those cross-neutralizers, 66.6% were also able to neutralize Omicron. Notably, individuals who had been both vaccinated and previously infected showed stronger neutralizing responses than those who were only vaccinated and boostered. ADE was observed in 1% of samples. Discussion: This retrospective analysis offers a valuable insight to contextualize immune responses in real-world settings, revealing how actual immunological outcomes diverged from early expectations; at least in our studied population, and underscores the importance of continuously reassessing vaccine strategies as viral evolution unfolds.

Background: Toscana virus (TOSV), a sandfly-borne phlebovirus, is a leading cause of viral meningitis in the Mediterranean region and central Italy. Despite its prominence in endemic areas, TOSV infection is frequently underdiagnosed, particularly among international travellers. Case presentation: A 24-year-old Hungarian male patient developed acute serous meningitis two weeks after returning from Naples, Italy. Symptoms began with a severe headache, accompanied by two episodes of vomiting. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis, elevated protein, and normal glucose levels. TOSV RNA was detected in CSF by RT-PCR, and a 350-nucleotide S-segment sequence showed 99% nucleotide identity to a TOSV lineage A strain previously identified in Italy. Seropositivity in the convalescent serum sample also confirmed the acute infection. Interestingly, blood panel tests showed markedly elevated total IgE levels (437 kU/L). Conclusion: To our knowledge, this represents the first molecularly confirmed case of TOSV neuroinvasive disease acquired in the Campania region since 2005. This report emphasizes TOSV as an emerging travel-associated neurotropic pathogen beyond its traditional central Italian focus, and supports the inclusion of TOSV in diagnostic panels for travellers with acute neurological symptoms following exposure in Mediterranean regions.