Purpose: Ventilator-associated pneumonia (VAP) is a common ICU complication linked to high morbidity and mortality. Inhaled antibiotics may offer targeted prophylaxis, but their effectiveness has shown mixed results. This study aims to further evaluate whether inhaled antibiotics reduce VAP incidence and ICU mortality through a systematic review and meta-analysis of the most updated available evidence. Methods: A systematic review was conducted following PRISMA 2020 guidelines. Multiple databases were searched for studies published up to November 14, 2024. Ten studies including 2876 patients (1485 intervention; 1391 control) met inclusion criteria. A random-effects meta-analysis was performed to estimate pooled risk ratios (RR) for VAP incidence and ICU mortality. Risk of bias was assessed using ROBINS-I and certainty of evidence via GRADE. Results: Inhaled antibiotics significantly reduced the incidence of VAP compared to controls (RR = 0.67; 95% CI: 0.58–0.77; p < 0.001), but showed no significant effect on ICU mortality (RR = 0.92; 95% CI: 0.79–1.06; p = 0.25). Moderate heterogeneity was observed in VAP outcomes ( I ² = 46.8%), while mortality analysis showed no heterogeneity. Funnel plot analysis suggested minimal publication bias, and GRADE rated the evidence as moderate in certainty. Conclusion: Inhaled antibiotics significantly reduce VAP incidence but show no clear mortality benefit. While promising for prevention, their survival impact remains uncertain. Clinical use should consider patient context and microbial patterns for targeted approach. Future research should identify high-risk subgroups, assess long-term outcomes, and evaluate antibiotic resistance.

Enterococcus is a gram-positive, non-sporing, facultative anaerobe. It is a common cause of nosocomial infections in the United States. Enterococcal bacteremia is primarily a nosocomial infection in the medical intensive care unit (ICU), with a preference for elderly patients with multiple comorbidities. This is a retrospective cohort study using the publicly accessible National (Nationwide) Inpatient Sample (NIS) database from October 2015 to December 2017. We examined data from 75,430 patients aged 18 years and older in the NIS who developed enterococcal bacteremia, as identified from the ICD-10 CM codes (B95), to discuss the epidemiologic effects and outcomes of enterococcal bacteremia. Patients were classified based on demographics, and comorbidities were identified. Three primary outcomes were studied: in-hospital mortality, length of stay, and healthcare cost. The secondary outcome was identifying any comorbidities associated with enterococcal bacteremia. Length of stay was defined as days from admission to discharge or death. Healthcare costs were estimated from the hospital perspective from hospital-level ratios of costs-to-charges. SAS 9.4 (2013; SAS Institute Inc., Cary, North Carolina, United States) was used for univariate and multivariate analyses. For data analysis, mortality was modeled using logistic regression. Length of stay and costs were modeled using linear regression, controlling for patient and hospital characteristics. Statistical analyses were performed using SAS. Statistical significance was defined as P<0.05. A total of 75,430 patients with enterococcal bacteremia were included in the study. Of this, 44,270 were males and 31,160 females. A total of 50,270 (68.67%) were Caucasians, 11,210 (15.31%) were African Americans, 6,445 (8.80%) were Hispanic and 2,025 (2.77%) were native Americans. Important comorbidities were congestive heart failure (25.91%), valvular disease (8.08%), neurological complications (11.87%), diabetes mellitus with complications (18.89%), renal failure (28.52%), and obesity (11.61%). In-hospital mortality was 11.07%, length of stay was 13.8 days, and a healthcare cost of 41,232.6 USD. Enterococcal bacteremia is a nosocomial infection with a preference for the elderly with renal failure, cardiac failure, cardiac valvular diseases, stroke, obesity, and diabetes with complications. Further studies are needed to see whether the mortality caused by enterococcal bacteremia is attributable to comorbidities or to the bacteremia. It is associated with a more extended hospital stay and higher healthcare expenditure. Implementing contact precautions to contain the spread of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) has also checked the spread of enterococci. Further prospective studies can be planned using chart-based data.

Pulmonary embolism (PE) and acute ischemic stroke (AIS) are serious conditions with high morbidity and mortality. In the USA, PE causes around 100,000 deaths annually, with higher incidence in males. AIS following PE occurs in 1-10% of cases and is a leading cause of death within 2 - 4 weeks post-stroke. Managing concurrent PE and AIS is complex due to the need for anticoagulation, which is contraindicated after thrombolysis for AIS. This review evaluates the impact of various PE treatments - anticoagulation, thrombolysis, and embolectomy - on mortality in patients with both conditions. Following PRISMA 2020 guidelines, a systematic review was conducted across six databases from January 2010 to December 2023. The primary outcome measured was mortality, comparing treated vs. untreated patients for PE. Secondary outcomes included marked symptom improvement, slight improvement or deterioration of symptoms, and the complications. Data were analyzed descriptively, summarizing patient demographics, clinical characteristics, and treatment outcomes. Treatment modalities, such as anticoagulation, thrombolysis, catheter-directed thrombectomy, surgical thrombectomy, and conservative management, were evaluated based on their impact on symptom improvement, survival, and mortality. Initial querying of six databases yielded 1,679 articles, with only 21 remaining after a thorough review. Thrombolysis led to 100% symptom improvement and survival, with 0% mortality. Anticoagulation resulted in symptom improvement and survival in 62.5% of cases, with a 12.5% mortality rate. Catheter-directed and surgical thrombectomy had symptom improvement and survival in 66.7% and 75% of cases, respectively, with no mortality. Conservative management, defined here as management without anticoagulation or thrombolytic therapy, was associated with symptom worsening or no improvement and 50% mortality. This systematic review, based on observational data from case reports, highlights the diverse strategies used by physicians. Proactive and aggressive treatments, especially thrombolysis, show better outcomes and lower mortality rates. However, specific recommendations cannot be made from these results alone, emphasizing the need for well-designed prospective, randomized controlled trials to design structured guidelines for healthcare providers.

Background: Liver cancer mortality is increasing in the United States, driven by evolving risk factors. While hepatitis C virus was historically the leading cause, alcohol use and metabolic-associated steatohepatitis are now major contributors. Methods: A retrospective cohort analysis was conducted using the Global Burden of Disease 2021 database to assess liver cancer mortality by etiology from 2010–2021. Joinpoint regression identified significant shifts in mortality trends (P < 0.05). Results: Between 2010 and 2021, U.S. liver cancer mortality rose by 53%. Hepatitis C and alcohol use accounted for 39.7% and 29.9% of liver cancer deaths in 2021, respectively. Liver cancer deaths rose by 32.14% from 2010–2016 but slowed to 15.81% from 2016–2021 (P = 0.0082). Mortality from hepatitis C increased by 32.77% (4.84% AAGR) from 2010–2016 but slowed to 15.15% (2.86% AAGR) from 2016–2021 (P = 0.0195). Hepatitis B-related mortality declined from 24.72% (3.75% AAGR) in 2010–2016 to 7.12% (1.38% AAGR) in 2016–2021 (P = 0.0001). Alcohol-related deaths rose by 34.52% (5.07% AAGR) from 2010–2016, tapering to 20.01% (3.72% AAGR) from 2016–2021 (P = 0.0122). Deaths attributed to MASH increased by 26.64% (8.19% AAGR) from 2010–2013, followed by slower growth of 24.80% (2.81% AAGR) from 2013–2021 (P = 0.1178). Mortality from other causes rose by 25.16% (3.81% AAGR) in 2010–2016 and by 19.03% (3.55% AAGR) in 2016–2021 (P = 0.0059). Conclusion: Declines in hepatitis-related mortality reflect progress in antiviral treatment. However, persistently rising alcohol- and MASH-related deaths highlight the urgent need for public health strategies targeting modifiable risk factors such as alcohol use and obesity.

Multiple myeloma (MM) remains an incurable plasma cell malignancy despite advances with proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies. Bispecific antibodies (BsAbs) have emerged as a transformative, off-the-shelf immunotherapeutic strategy that redirects immune effector cells to eliminate malignant plasma cells. The recent FDA approvals of teclistamab, talquetamab, elranatamab and linvoseltamab have reshaped the therapeutic landscape of relapsed/refractory MM (RRMM), achieving overall response rates (ORR) exceeding 60% in heavily pretreated patients. Teclistamab, targeting BCMA, demonstrated an ORR of 63%, while talquetamab, targeting GPRC5D, achieved an ORR of 74%, even in patients previously treated with T-cell redirection therapies. Elranatamab and linvoseltamab further enriched this armamentarium with comparable efficacy and favorable safety profiles. In addition to these milestones, early-phase data from emerging trispecific antibodies, such as ISB 2001, show ORRs as high as 75% and deep responses, including stringent complete responses (sCR) and minimal residual disease (MRD) negativity. This review provides an integrated analysis of BsAbs in MM, encompassing mechanisms of action, clinical development, efficacy, safety profiles, and future directions. We synthesize the latest clinical trial data, explore strategies for overcoming resistance, and discuss ongoing efforts to optimize combination regimens and sequencing. By critically evaluating these advancements, we highlight the evolving role of BsAbs and trispecific antibodies in redefining treatment paradigms, with the ultimate goal of improving patient outcomes and advancing toward a potential cure for multiple myeloma.