Adjunctive antimicrobials can enhance non-surgical periodontal therapy by suppressing residual pathogens within deep periodontal pockets. This article presents a reproducible, chairside protocol for delivering a biodegradable 14% doxycycline gel as an adjunct to scaling and root planing (SRP) in adults with stage III or IV periodontitis. The workflow includes participant screening and informed consent, randomization to three arms (SRP plus doxycycline gel; SRP plus placebo gel; SRP alone), allocation concealment, standardized full-mouth debridement, and blinded gel delivery using a blunt cannula with a base-to-margin filling approach. Postoperative instructions and scheduled follow-ups at 1, 3, and 6 months are described to support consistency across operators and visits. Clinical outcomes include probing pocket depth (PPD), clinical attachment level (CAL), gingival index (GI), and bleeding on probing (BOP). Site-specific microbiological sampling targets red-complex organisms (Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola) using sterile paper points followed by quantitative laboratory analysis with pre-defined quality controls. Examiner calibration, instrument sterility checks, and protocol stopping points are specified to strengthen fidelity and safety. Representative results show that adjunctive doxycycline gel is most likely to yield incremental benefit at deeper residual sites, with between-group differences at full-mouth averages expected to be smaller, consistent with prior evidence on locally delivered antimicrobials after meticulous SRP11-13. This protocol is designed to be video-capturable and readily implemented in clinical research and advanced periodontal training.

Borrelia miyamotoi is a relapsing-fever spirochete that conventional tick-borne testing does not detect. We report a case notable for two findings not emphasized in prior series: creatine kinase elevation to 1464 U/L and glucose concentrations above 500 mg/dL without ketoacidosis in a pump-treated patient with type 1 diabetes mellitus. A 36-year-old man with frequent wooded exposure presented with fever, headache, myalgias, and rash, along with leukopenia, thrombocytopenia, and mild transaminitis. Lyme serology, Babesia smear, Anaplasma and Ehrlichia PCR, spotted-fever group Rickettsia serology, and blood cultures were negative; blood real-time PCR identified B. miyamotoi after discharge. The hyperglycemia was attributable to infection-related insulin resistance and interruption of pump delivery. Seventeen days of doxycycline produced full clinical and laboratory recovery. Exercise and dehydration may have contributed to the hyperCKemia. This case supports early blood PCR during the febrile illness in culture-negative tick-borne disease and illustrates that insulin requirements may rise sharply when infection coincides with failure of insulin-delivery technology.

Amivantamab is an epidermal growth factor receptor (EGFR) and mesenchymal-epithelial transition (MET) antibody. Lazertinib is an EGFR tyrosine kinase inhibitor with central nervous system penetration. Used in combination, this targeted therapy is effective in treating non-small cell lung cancer (NSCLC). However, it has been associated with severe dermatologic adverse reactions. A 61-year-old woman with a history of EGFR-mutated NSCLC with brain metastases on amivantamab-lazertinib therapy presented for follow-up with drainage from her scalp incision after undergoing a right parietal craniotomy and mass excision five months prior. The patient denied constitutional and neurologic symptoms, but reported yellow staining on her pillow. Examination initially demonstrated yellow fibrinous exudate and hair matting along the surgical incision. Computed tomography (CT) of the head revealed overlying scalp swelling and minimal extra-axial dural thickening over the prior right parietal craniotomy site with stable intracranial metastatic lesions. Due to concern for dehiscence, her biologic therapy was paused, and she was taken to the operating suite where no evidence of infection, delayed healing, or wound dehiscence was noted. A 10 × 5 cm area of patchy granulation tissue and ulceration was observed along the right parietal scalp. Biopsy revealed granulation tissue and multinucleated giant cells and was negative for tumor. Given the risk of malignant progression with all targeted therapy paused, the patient was restarted on amivantamab monotherapy. Following disease progression two months later, she was transitioned to carboplatin and etoposide. EGFR is widely expressed in skin keratinocytes and intimately involved in epithelial differentiation. Therapies targeting EGFR, such as amivantamab plus lazertinib, are associated with adverse dermatologic reactions, ranging from dry skin to severe scalp ulceration, which can interrupt treatment, contribute to poorer clinical outcomes, and reduce quality of life. Standard of care includes limiting sun exposure and avoiding alcohol-based topical agents. The use of daily prophylactic antibiotics, such as oral doxycycline, topical clindamycin, chlorhexidine wash, and ceramide moisturizer, may significantly reduce the risk of adverse skin reactions. Implementation of this multicomponent regimen reduced the rate of severe scalp reactions from 26% to 10% relative to the standard of care, with sustained benefit observed for at least six months.

The growing contamination of water bodies by antibiotics necessitates the development of efficient and environmentally sustainable treatment technologies. Herein, a novel Cd-doped S-scheme Bi5O7I/Cd-Bi2MoO6 heterojunction was constructed for the sustainable remediation of doxycycline hydrochloride (DH). The optimal composite achieved 92.6 % removal of DH and 59.2 % mineralization (TOC removal) within 60 minutes under visible light. Notably, Bi/Cd-Bi-40 exhibited the highest reaction rate constant (0.03939 min[-1]), surpassing pristine Bi5O7I (0.00832 min[-1]) and 1Cd-Bi2MoO6 (0.01905 min[-1]) by 4.73 and 2.07 times, respectively. The catalyst retained excellent stability and maintained high efficiency over five cycles, confirming its practical application potential. The performance enhancement was attributed to the S-scheme charge transfer mechanism, which was validated by experimental characterization and DFT calculations. This mechanism, driven by a built-in electric field (IEF), significantly boosted carrier separation and generated dominant reactive species (•O2[‾] and •OH). Furthermore, possible degradation pathways were proposed based on LC-MS analysis and DFT calculations. For actual water treatment scenarios, the resistance of the catalyst to common anions and humic acids were evaluated. More importantly, the environmental sustainability was confirmed through a combined ecotoxicity assessment: degradation intermediates exhibited significantly reduced ecological toxicity, as evidenced by wheat germination bioassays and quantitative structure-activity relationship predictions. The study not only presents a high-performance photocatalyst but also offers a sustainable and clean strategy for mitigating the ecological risks posed by antibiotic pollution.

Tularaemia is a zoonotic infection uncommon in Switzerland, but its incidence is increasing. Thus, tularaemia should also be considered in returning travellers with compatible exposure history. We report a case of ulceroglandular tularaemia presenting with a necrotic bullous skin lesion.

Genetic loss-of-function (LoF) variants in SCN2A , a gene encoding the voltage-gated sodium channel Nav1.2, have been identified as one of the foremost monogenic causes of autism spectrum disorder (ASD). ASD encompasses a broad spectrum of behavioral phenotypes, with impaired sociability as a core characteristic. We have established Scn2a -deficient mice ( Scn2a gt/gt ) to model Scn2a -related ASD and found that this model recapitulates social impairment, exhibiting severe social deficits. Scn2a gt/gt mice exhibit neuronal hyperexcitability and a marked global reduction in potassium channel expression, which plays a crucial role in maintaining the resting membrane potential and repolarizing neurons after an action potential. Among these downregulated potassium channels, potassium voltage-gated channel subfamily A member 1 (Kv1.1) was one of the most affected. To explore whether Kv1.1 could be a potential therapeutic target in SCN2A -related ASD, we evaluated the in vivo efficacy of a genetic construct driven by the CaMKIIα promoter that allows for exogenous expression of human Kv1.1 (hKv1.1) in principal neurons. In Scn2a gt/gt mice, we found that hKv1.1 expression normalizes neuronal hyperexcitability. Importantly, doxycycline-induced hKv1.1 expression enhances sociability in Scn2a -deficient mice without influencing social behavior in wild-type mice, and this effect was reversed upon doxycycline withdrawal. Overall, we demonstrate the successful use of an inducible AAV-mediated gene delivery system to supplement hKv1.1 expression to mitigate neuronal hyperexcitability and ameliorate social impairments in a mouse model of SCN2A -related ASD. These findings highlight the contribution of Kv1.1 to SCN2A -associated pathophysiology and its potential as a therapeutic target for severe social deficits.

Canine Lyme borreliosis is commonly treated with a 28-day course of doxycycline, a regimen based on historical precedent rather than evidence. Most dogs exposed to Borrelia burgdorferi remain clinically normal despite seroconversion; of those that do develop clinical Lyme disease, the most common presentation is acute or recurrent shifting-leg lameness consistent with Lyme arthropathy. This Viewpoint proposes there is clinical equipoise to evaluate shorter durations of 10 days of doxycycline in dogs with uncomplicated Lyme arthropathy and outlines a prospective parallel-group randomized controlled trial to reassess treatment duration. Determining whether a shorter treatment course is clinically effective also has important implications for antimicrobial stewardship by minimizing unnecessary antimicrobial exposure and selection pressures for antimicrobial resistance.

Tetherin is an interferon-inducible transmembrane protein that inhibits the detachment of enveloped viruses from infected cells. HIV-1 Vpu counteracts this restriction by removing tetherin from sites of virus release. Accordingly, Vpu mutations that disrupt tetherin antagonism increase Env accumulation on the surface of HIV-infected cells. We found that Vpu mutations that impair tetherin antagonism also increase the susceptibility of HIV-infected cells to antibody-dependent cellular phagocytosis (ADCP). Increased sensitivity to ADCP was lost in tetherin-knockout cells and conditionally restored by doxycycline-inducible tetherin. Thus, Vpu protects HIV-infected cells from ADCP by preventing virion accumulation on the cell surface, similar to its protection against antibody-dependent cellular cytotoxicity (ADCC). By serving as a link between innate and adaptive immunity, the antiviral activity of tetherin may be amplified in vivo by Fc-mediated antibody effector functions and therefore much greater than initially appreciated based solely on its ability to inhibit virus release in cell culture assays.

Scrub typhus is an important cause of acute febrile illness in Nepal and can rarely present with meningoencephalitis and multiorgan involvement. We report a 32-year-old female farmer from rural Nepal who presented during the monsoon season with high-grade fever, myalgia, vomiting, and an eschar following an unidentified forest bite. She developed meningismus, hypotension, mild acute respiratory distress syndrome, and transaminitis. Cerebrospinal fluid showed lymphocytic pleocytosis and elevated protein, while bacterial culture, acid-fast staining, and GeneXpert were negative. Serum scrub typhus IgM was positive, whereas Brucella abortus IgM was borderline positive. CSF PCR for both pathogens was negative. Based on the characteristic eschar, clinical presentation, CSF findings, epidemiological exposure, and exclusion of alternative diagnoses, scrub typhus meningoencephalitis was considered the most likely diagnosis. She improved with doxycycline-based therapy and achieved complete neurological recovery. This case highlights the challenges of diagnosing scrub typhus in resource-limited settings despite negative PCR.