The meteoric rise of antimicrobial resistance (AMR), marked by decreased antibiotic effectiveness against pathogenic bacteria, has sparked widespread concern. This phenomenon increases potential threats to public health by significantly hampering the clinical use of currently available antimicrobial agents, such as macrolides, β-lactam and glycopeptides antibiotics. Staphylococcus aureus (S. aureus), namely the Methicillin-Resistant Staphylococcus aureus (MRSA), is a common opportunistic pathogen that causes various types of infections and has become one of the top healthcare problems, particularly in low-income countries. In light of bacterial evolution and the unintentional use of antibiotics for medical purposes in communities and hospitals, as well as in agriculture and livestock for non-medical purposes. These events have contributed to the development and spread of antimicrobial resistance. Furthermore, resistant to our most muscular treatments against invasive S. aureus infections, such as vancomycin, is no longer successful due to the emergence of Vancomycin-Resistant S. aureus (VRSA). The scientific community is looking for creative and spectacularly effective strategies to address this global issue in response to this pandemic threat generated by the spread of antimicrobial resistance strains, with the threat of limited treatment choices against S. aureus. In this review, we highlighted the molecular mechanisms of antibiotic resistance and explained the antibiotic resistance profile of Methicillin-resistant S. aureus. On the other hand, we discuss distinguished tactics for manipulating S. aureus resistance mechanisms, such as the discovery of new chemical entities that possess antimicrobial activity with novel mechanisms of action, utilization of combinatorial antibiotic therapies, chemical derivatization and repurposing of existing known drugs to improve their antibacterial efficacy, design novel vaccine for S. aureus, antimicrobial peptides and nanoparticles as a magic bullet, and finally, by implementing the One Health Agenda against S. aureus, this holistic strategy seeks to address the spread of antibiotic resistance across the interrelated health loop of human, animals, and environments.

Key Clinical Message: Metformin‐associated lactic acidosis is a rare but serious complication in patients with type 2 diabetes, especially those with multiple health conditions. Prompt recognition and treatment, including potential renal replacement therapy, are crucial for managing severe acidosis and improving patient outcomes. Metformin (MTF) is commonly prescribed as a first‐line treatment for diabetes, effectively preventing microvascular and macrovascular complications. However, metformin‐associated lactic acidosis is a rare yet severe complication, associated with a mortality rate of up to 50%. We encountered a case involving a 73‐year‐old woman with type 2 diabetes, mental illness, and hypothyroidism, who developed life‐threatening lactic acidosis while on metformin therapy. Upon presenting to the emergency department with complaints of weakness, nausea, and decreased urination for 5 days, she also reported abdominal pain and shortness of breath. Hypotension was noted with a blood pressure of 80/50 mmHg. Initial laboratory results revealed severe acidosis, prompting discontinuation of MTF. Despite resuscitation efforts and vasopressor therapy, severe acidemia persisted, leading to the initiation of renal replacement therapy. Following treatment with continuous renal replacement therapy, her acidemia resolved, and she was discharged from the hospital on the sixth day without complications, with normal kidney function.

Intestinal parasitic infections (IPIs) are a silent struggle affecting people globally. Their impact is particularly devastating in developing countries like Sudan, a sub-Saharan African country where the healthcare system was already on the brink; the eruption of a devastating war has resulted in many outbreaks of infectious diseases. This study sheds light on the distressing resurgence of Intestinal parasitic infections (IPIs) amidst the armed conflict and siege in the United Villages Region, Northern Khartoum State, a stark reminder of the human cost of such crises. This cross-sectional study was conducted in two resource-limited community clinics, which provided basic healthcare from July 1, 2024, to October 31, 2024. The study included 1,500 patients who presented with abdominal complaints and diarrhea. Each patient was asked to provide a stool sample for a general test. Among the 1,500 study participants, 200 (13.3%) had one or more intestinal parasitic infections (IPIs). Of these, 115 were females (57.5%) and 85 were males (42.5%). The most common intestinal parasite identified was Entamoeba histolytica (53%, n = 106), followed by Giardia lamblia (42.5%, n = 85). Mixed infections were found in eight cases (4%), involving both E. histolytica and G. lamblia, and in one case (0.5%), involving G. lamblia and Schistosoma mansoni. Most participants reported using Nile water (77.5%, n = 155), followed by well water (17.5%, n = 35). Few used a combination of Nile and well water (5%, n = 10). Intestinal parasitic infections (IPIs) surged concurrently with armed conflict, which left a collapsed healthcare system, water shortages, and massive contamination of water sources. The calculated prevalence of 13.3% underestimates the actual burden due to many complications that prevent many people from reaching the health center. This picture reveals the vulnerability of such a community amid war; the information may be useful for future rehabilitation processes. Not applicable.

Staphylococcus aureus (S. aureus), particularly Methicillin-resistant S. aureus (MRSA), is a life-threatening pathogen that causes a variety of infections in hospital and community settings. It poses a significant risk and challenge for global health that hinders our ability to control and treat bacterial infections. Recently, the emergence and spread of variant strains of bacteria, misuse of the limited available options of effective antibiotics, spread of fake drugs, and climate change that increased the contact between humans and animals’ populations carrying different bacterial has significantly increased the incidence of Multi-Drug Resistance strains (MDR). This in turn, has created a severe problem in the infection control treatment of S. aureus infected patients. Treatment options for MRSA infection are increasingly limited and complicated. Unfortunately, different strains of MRSA are showing tolerance and resistance toward vancomycin, which is the standard of care for complicated MRSA. Therefore, it is crucial now to invest developing new effective anti-biotics and synergies, develop and implement national action plans for the management of an-tibiotic resistance, as well as improving our understanding of the antimicrobial resistance mechanisms. Here, in this review we explain the main mechanisms of antibiotic resistance in MRSA and describes different approaches to manipulate it in MRSA, providing a basis for de-signing effective drugs, and shedding some light on the evolution of S. aureus.

This letter highlights the critical need for clinicians to understand antinuclear antibody (ANA) testing methodologies and autoantibody specificities to prevent diagnostic errors and accurately applying classification criteria. Anti‐Ro52 is an antinuclear antibody whose detection fulfills the 2019 EULAR/ACR classification entry criterion.