Patients with neurological symptoms should be enquired about recent vaccination history. It is important after the COVID‐19 mRNA vaccine, which is newly introduced as it might link to the development of a wider variety of neurological diseases.

Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disorder characterized by loss of self-tolerance, immune complex deposition, and progressive organ damage. Despite advances in immunosuppressive therapy, a subset of patients develops treatment-resistant or refractory manifestations; terms used variably in the literature to describe inadequate response to multiple standard immunosuppressants. Chimeric antigen receptor T cell (CAR-T) therapy, a revolutionary modality in oncology, is now emerging as a promising approach in severe autoimmune diseases including SLE. By redirecting autologous T cells to target B cell antigens such as CD19 or BCMA, CAR-T therapy enables deep and sustained B cell depletion, potentially resetting immune tolerance.Early case series have reported encouraging remission rates and serologic improvements in refractory SLE; however, these observations derive from small, uncontrolled studies. The long-term durability, relapse risk, safety profile, and cost-effectiveness of CAR-T therapy in autoimmune disease remain uncertain and require confirmation in larger, controlled trials. This narrative review synthesizes the current understanding of CAR-T therapy in SLE, covering immunopathogenesis, rationale for B cell targeting, CAR-T mechanisms, preclinical evidence, clinical outcomes, safety considerations, and future directions. We integrate data from peer-reviewed studies, conference abstracts, and preprints up to August 2025, and propose a framework for integrating CAR-T into the treatment paradigm for refractory SLE.

Acute kidney injury (AKI) affects 30-50% of critically ill patients and is associated with increased mortality, longer ICU stays, and chronic kidney dysfunction. Current diagnostic markers, serum creatinine and urine output are delayed and often insensitive. Novel biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and the combined urinary assay of tissue inhibitor of metalloproteinases-2 and insulin-like growth factor-binding protein 7 (TIMP-2·IGFBP7) have emerged as promising tools for early AKI detection. To systematically evaluate the diagnostic accuracy of NGAL, KIM-1, and TIMP-2·IGFBP7 in predicting AKI in critically ill adults. A systematic search of PubMed, Embase, and Cochrane Library was conducted for studies from January 2015 to April 2025. Eligible studies assessed the diagnostic accuracy of NGAL, KIM-1, or TIMP-2·IGFBP7 in adult ICU patients and reported sensitivity, specificity, or AUC. Methodological quality was appraised using QUADAS-2. PROSPERO registration: CRD420251038322. Thirty-five studies were included: 13 assessed NGAL, 7 KIM-1, and 15 TIMP-2·IGFBP7. NGAL showed sensitivity of 65-89% and specificity of 60-85% (AUC: 0.70-0.91). KIM-1 showed moderate performance (AUC: 0.64-0.80). TIMP-2·IGFBP7, especially with higher cutoffs, demonstrated high specificity but variable sensitivity. Differences in assay thresholds, timing, and AKI definitions contributed to heterogeneity. NGAL and TIMP-2·IGFBP7 show the most consistent performance for early AKI detection in ICU settings. Standardized multicenter studies are needed to confirm clinical utility and support integration into AKI diagnostic workflows.

COVID-19 has surfaced as a multi-organ disease predominantly affecting the respiratory system. Detection of the viral RNA through reverse transcriptase–PCR (RT-PCR) from a nasopharyngeal or throat sample is the preferred method of diagnosis. Recent evidence has suggested that COVID-19 patients can shed the SARS-CoV-2 for several weeks. Herein, we report six cases of COVID-19 who had persistently positive SARS-CoV-2 on repeat RT-PCR testing reaching up to 9 weeks. The spectrum of cases described ranges from asymptomatic infection to severe COVID-19 pneumonia. A full understanding of the virus’s transmission dynamics needs further research. Prolonged viral shedding currently has unclear implications on the management and isolation decisions—the role of the cycle threshold (Ct) value in guiding therapeutic decisions is yet to be clarified. More data on the relationship between Ct values and viral cultivation are needed, especially in patients with prolonged viral shedding, to understand the virus’s viability and infectivity.

The long-term use of immunosuppressive drugs following kidney transplantation increases the risk of life-threatening infections, malignancies, and, paradoxically, eventual allograft rejection. Therefore, achieving a balance between over-immunosuppression and under-immunosuppression is critical to optimizing patient outcomes. One promising approach is immune cell-based therapy using suppressor immune cells to modulate the immune response more precisely. Among these, regulatory T cells (Tregs) are the most extensively studied and have shown significant potential in the post-transplant setting. Tregs are broadly categorized into thymus-derived and peripherally derived subsets. Physiologically, they play key roles in maintaining immune tolerance, including in autoimmune diseases and within the tumor microenvironment. Their immunosuppressive functions are mediated through both contact-dependent and contact-independent mechanisms. Studies investigating the use of Tregs following kidney transplantation have shown encouraging results. This review summarizes the biology of Tregs and highlights current evidence supporting their role in transplant immunotherapy.

Staphylococcus saprophyticus is one of the coagulase‐negative staphylococcus species. It is the second most frequent causative microorganism in acute uncomplicated urinary tract infections in young women. However, it is potentially capable of causing more invasive infections including bacteremia, particularly secondary to pyelonephritis. We present a young, previously healthy lady who presented with urinary symptoms and hemodynamic instability and was found to have multiple renal and ureteric calculi with pyelonephritis. Later, blood and urine cultures isolated methicillin‐resistant S. saprophyticus. The patient was successfully treated with a course of antibiotics targeting the organism with a favorable outcome. The clinical presentations and management of this rare entity of S. saprophyticus bacteremia‐related pyelonephritis are outlined. In addition, the literature on similar cases was reviewed to raise awareness and avoid devastating consequences.