Pulmonary disease caused by Mycobacterium avium complex (MAC) most often occurs in patients with structural lung disease or immunocompromising conditions and typically follows recognized fibrocavitary or nodular-bronchiectatic radiographic patterns. Advanced cavitary disease discovered incidentally in an asymptomatic patient represents an uncommon and diagnostically challenging presentation that may be initially attributed to malignancy, aspiration pneumonia, or endemic fungal infection. We report the case of a 45-year-old man without known immunodeficiency who had alcohol use disorder and active deep vein thrombosis treated with apixaban and presented with acute right groin pain secondary to a reducible inguinal hernia. Abdominal computed tomography performed during hernia evaluation incidentally demonstrated a 6.9 × 5.3 cm thick-walled cavitary opacity in the left lower lobe with an air-fluid level and bilateral reticulonodular opacities. The patient denied cough, dyspnea, hemoptysis, fever, night sweats, and weight loss. Serial sputum acid-fast bacillus smears were positive, and mycobacterial cultures grew MAC. In the setting of compatible cavitary imaging, these findings fulfilled the American Thoracic Society/European Respiratory Society/European Society of Clinical Microbiology and Infectious Diseases/Infectious Diseases Society of America (ATS/ERS/ESCMID/IDSA) diagnostic criteria for pulmonary MAC disease. Tuberculosis and HIV testing were negative. A respiratory molecular panel was also positive for Haemophilus influenzae. Because bacterial cultures showed no growth, this finding was interpreted as a possible coinfection rather than a confirmed bacterial infection. Given the leukocytosis and bilateral infiltrates, intravenous ceftriaxone was initiated empirically. However, MAC-directed multidrug therapy was complicated by two pharmacologic barriers: the risk of reduced apixaban exposure with rifabutin-containing therapy and a baseline corrected QT interval of 512 ms, limiting routine macrolide use. The patient was therefore transferred to a tertiary care center for multidisciplinary regimen selection. This case underscores that incidental cavitary pulmonary lesions demand systematic microbiologic evaluation regardless of symptom burden and that early pharmacologic risk assessment is essential when standard MAC therapy is constrained.

Pimozide overdose is uncommon, with limited published cases worldwide. Its long elimination half-life predisposes to delayed and prolonged toxicity, including extrapyramidal symptoms (EPS) that may mimic neuroleptic malignant syndrome (NMS). Herein, we report a case of a 33-year-old female with dysthymic disorder, recurrent depression, and obsessive-compulsive disorder who presented with rigidity, mutism, psychomotor retardation, and reduced responsiveness for 4 days. She had intentionally ingested around 20-30 pimozide tablets 4 days prior. Initial suspicion of catatonia was revised after the patient disclosed overdose. She developed fever (100°F), worsening rigidity, tremors, and ankle clonus. Creatine phosphokinase (CPK) was mildly elevated at 523 U/L, which argued against NMS. Fever resolved with antibiotics, and EPS improved with supportive care and levodopa-carbidopa. However, the patient developed aspiration pneumonia and succumbed. Thus, pimozide overdose can cause severe EPS mimicking NMS. Differentiation relies on CPK levels and fever response. Supportive care and prolonged observation are critical for favorable outcomes.

Despite its established efficacy, the long-term safety profile of amitriptyline among broad patient populations remains insufficiently characterized. We thoroughly characterized the real-world safety profile of amitriptyline through a systematic analysis of the FDA Adverse Event Reporting System (FAERS). Adverse events were collected from Q1 2004 to Q1 2026, and four disproportionality algorithms-reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian confidence propagation neural network (BCPNN), and multi-item gamma Poisson shrinker (MGPS)-were employed to identify safety signals. Weibull distribution modeling was used to assess temporal trends, with subgroup analyses stratified by age and sex. Among 5301 amitriptyline-related cases involving 20,451 adverse events, risk signals were identified for psychiatric, nervous system, and cardiac disorders. Analysis confirmed recognized risks, including somnolence, confusional state, drug interaction, and xerostomia. Additional risk signals were identified for potential drug abuse or misuse and for serious adverse events not currently listed on package insert, like aspiration pneumonia, cardiorespiratory arrest, and specific congenital anomalies (e.g., syndactyly, polydactyly, and adactyly). Temporal analysis revealed 52.84% of events occurred within 30 days, whereas 26.14% occurred beyond six months. Subgroup analyses revealed distinct susceptibility patterns: cardiovascular events were more common in females, neuropsychiatric events (e.g., migraine, nightmares) in males; fetal exposure was concerning in pediatric populations, suicide and overdose predominant among adults, and confusion and drug interactions prominent in elderly patients. This pharmacovigilance study confirmed amitriptyline's established adverse reactions and highlighted previously under-characterized risks. These findings recommended implementing integrated risk management in clinical practice to improve patient safety.

Postoperative respiratory depression (PORD) and other postoperative pulmonary complications (PPCs) represent significant contributors to perioperative morbidity and mortality in companion animal practice. The Confidential Enquiry into Perioperative Small Animal Fatalities (CEPSAF) established that cardiovascular and respiratory causes account for approximately 74% and 72% of perioperative deaths in dogs and cats, respectively, with 47% of canine and 61% of feline anesthetic-related deaths occurring in the postoperative period. PORD arises from a convergence of opioid-induced respiratory depression (OIRD), residual inhalant anesthetic effects, other drug-induced effects (e.g., neuromuscular blockade), and patient-specific vulnerabilities. PPCs encompass a broad spectrum of conditions, including atelectasis, aspiration pneumonia, pneumonia, hypoventilation, acute respiratory distress syndrome (ARDS), and respiratory arrest, with laparotomy studies reporting a PPC incidence of 22% in dogs. This narrative review synthesizes current evidence on the pathophysiology, risk factors, diagnostic approaches, prevention strategies, and treatment of PORD and PPCs in veterinary practice, incorporating insights from both veterinary-specific and translational human anesthesia literature, while explicitly identifying areas where veterinary-specific evidence remains limited. The importance of continuous monitoring during the postanesthetic period, multimodal analgesia to reduce opioid exposure, protective lung ventilation strategies, and early intervention is highlighted as a key strategy to improve outcomes, together with the unmet need for reversal-independent ("agnostic") respiratory stimulants capable of countering PORD irrespective of the causative agent.

Aspiration pneumonia is often associated with specific obligate anaerobic bacteria, particularly oral commensals, as causative agents; however, these infections are frequently misdiagnosed in clinical settings. This retrospective analysis of two patients presenting with fever and cough demonstrates that, in the setting of inconclusive routine microbiological testing and tNGS results, along with ineffective empirical antimicrobial therapy, comprehensive mNGS analysis of BALF microbiota-combined with the presence of high-risk oral factors (such as dental caries and severe periodontitis)-facilitated the diagnosis of anaerobic pneumonia. In both cases, tNGS was unable to detect anaerobic pathogens due to the limited scope of anaerobic bacterial targets in commercial panels. In contrast, comprehensive mNGS, when correctly interpreted in conjunction with clinical context, can detect anaerobic sequences. The key difference lies in that mNGS offers a broader detection capability, but it requires careful correlation with clinical circumstances to distinguish between true pathogens and colonizing bacteria. Specifically, Case 1 revealed the presence of Bacteroides timidum and Fusobacterium nucleatum. Case 2 identified Prevotella oralis, Streptococcus australis, and Actinomyces caries. The administration of targeted anti-anaerobic therapy (metronidazole, ornidazole) subsequently resulted in significant improvement in clinical symptoms and radiographic findings. These cases underscore the diagnostic value of integrating metagenomic next-generation sequencing (mNGS) with clinical risk factor assessment when conventional diagnostics produce negative results.

Airborne micro- and nanoplastics are emerging environmental contaminants of increasing concern, yet their inhalation toxicity and pulmonary fate remain insufficiently understood. In this study, we investigated how particle morphology and surface oxidation influence pulmonary inflammation and clearance using environmentally relevant, size-controlled polystyrene (PS) nanoplastics. Spherical and fragmented PS were generated via bottom-up and top-down approaches, respectively, and subjected to ultraviolet irradiation to simulate environmental aging. Fragmented and ultraviolet (UV)-aged nanoplastics exhibited enhanced surface oxidation and a higher intrinsic oxidative potential than pristine spherical particles. Following a single pulmonary exposure in mice via pharyngeal aspiration at doses of 25-100 μg per mouse, these environmentally transformed nanoplastics induced more severe acute pulmonary inflammation. In particular, UV-aged fragmented PS (100 μg per mouse) increased neutrophil counts by 3.9-fold compared with pristine spherical PS, along with increased pro-inflammatory cytokine production, which was closely associated with particle-derived oxidative reactivity. Although acute inflammatory responses were largely reversible, time-course analysis of lung burden after a single non-overload exposure (25 μg per mouse) revealed delayed pulmonary clearance of fragmented nanoplastics relative to spherical particles, with estimated clearance half-lives of 13.5 days for pristine spherical PS and 27.4 days for UV-aged fragmented PS. Overall, this study demonstrates that nanoplastics most relevant to real-world environmental exposure may pose a greater risk of respiratory health effects, along with prolonged lung residence.

Dysphagia is a common clinical symptom, often accompanied by insufficient lubrication of the oral cavity and pharynx, which reduces eating efficiency and nutrient intake, increases the risk of complications such as aspiration pneumonia. Artificial saliva is a product designed to mimic natural saliva, commonly used to provide oral lubrication. However, few studies have demonstrated its efficacy in improving dysphagia. Epidemiological data clarify the characteristics of populations for dysphagia, while the process of swallowing dysfunction induced by etiological factors provides a clinical basis for the application of artificial saliva. This review highlights the importance of artificial saliva in the management of dysphagia, summarizes the current status of research on artificial saliva in recent years, and elucidates the mechanisms underlying the lubrication behavior of artificial saliva from the perspective of the salivary multilayer through its interaction with the salivary conditioning film (SCF), thereby paving the way for next generation artificial saliva.