David Tvildiani Medical University

Myasthenia gravis (MG) is a long-lasting autoimmune neuromuscular disorder usually reflected by the presence of autoantibodies against acetylcholine receptors at the neuromuscular junction and characterized by either ocular or generalized disease with possible respiratory crisis. The situation has not changed, as diagnostic difficulties and recurrences are still the main problems despite the improvements in diagnostics and immunosuppression. Moreover, the totality of the evidence is pointing to the fact that MG is a disease that also has non-motor manifestations of important clinical significance. The aim of this narrative review was to summarize the literature on MG which takes the position of a multisystem neuroimmune disease and to clarify the mechanisms of immune dysregulation, neuroinflammation, and gut-immune-brain axis that are the cause of the non-motor symptoms such as fatigue, cognitive impairment, mood disturbances, sleep changes, and autonomic dysfunction. A thorough search in PubMed and Google Scholar using terms connected to MG, non-motor symptoms, gut microbiota, gut-brain axis, neuroinflammation, and immune dysregulation led to the discovery of full-text English studies highlighting both systemic and central mechanisms; a qualitative synthesis of themes was drawn up and focused on microbiome composition, metabolites, cytokines, and the changes in immune cells. Studies were consistent in correlating MG with diminished variety of gut microbes, loss of Firmicutes (including Clostridia/Lachnospiraceae and Faecalibacterium) producing butyrate, and increase in munificent taxa (e.g., Streptococcus and Enterococcus), which was in line with Treg cell (Treg) function being diminished and Th17/Treg balance being shifted. The research involving multi-omics techniques pointed toward the conclusion that dysbiosis was a major reason for the widespread disturbance of SCFAs, and also that it disrupted the pathways of KP and BA through the action of receptors such as AhR and TGR5, which was reflected in the metabolomic profile changes of feces (e.g., of cytosine, xanthine, adenine, and methylmalonic).

Healthcare professionals' and students' willingness to provide abortion influences access to care and workforce readiness. We conducted a literature synthesis to identify patterns in willingness across various clinical scenarios. Systematic review and meta-analysis. We searched five databases (PubMed, Scopus, Web of Science, Medline, and CINAHL) and gray literature for studies (January 2014 to February 2025) without language restrictions. Eligible studies reported cross-sectional data on providers' willingness, while we excluded conditionally framed scenarios. Willingness was defined as the intent, readiness, or affirmative response to provide abortion. Summary-level data on theme-specific willingness were extracted and re-coded into binary or proportional format (yes/no or n/N). Estimates were pooled using random-effects models. Meta-regression and publication bias assessments were performed. Study quality was assessed using a novel in-house tool tailored for survey-based research. We included 36 studies (n = 18,779), reporting 137 estimates across 24 themes. Willingness to provide was highest for lethal fetal anomalies (88.7%, 95% CI: 76.1%-95.1%) and maternal physical health risks (88.6%, 95% CI: 55.7%-98.0%) but substantially lower for on-request scenarios (33.1%, 95% CI: 14.9%-58.4%), surgical abortion (32.1%, 95% CI: 11.6%-63.0%), and social reasons (range 20.1%-32.0%). Multilevel modeling captured both converging and diverging response patterns across categories. Meta-regression indicated that students had consistently higher willingness than professionals. Dominant religion was also observed to be more strongly associated than legal status and other country-level indices. Evidence of small-study effects was limited apart from in a few themes. Risk of bias was high in 31% of studies, with our tool showing strong structural overlap with Checklist for Reporting Results of Internet E-Surveys (CHERRIES) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) frameworks. Providers often prioritized abortion in life-threatening contexts but hesitated in non-urgent scenarios. Values-based training and systemic reforms are needed for equitable access to and expansion of abortion care. PROSPERO: CRD42025634868.

Clonal Hematopoiesis of indeterminate potential (CHIP) has been increasingly recognised as a risk factor for cardiovascular disease (CVD). Recent epidemiological and experimental studies have linked CHIP as an independent risk factor for myocardial infarction, stroke, and coronary artery disease, with specific mutations carrying a higher CVD risk. During the aging process, somatic mutations in genes, including DNMT3A and TET2, accumulate in the hematopoietic stem cells (HSCs), conferring both epigenetic and metabolic advantages that not only drive hematopoiesis towards a pro-inflammatory myeloid lineage but also reprogram innate immune cells, promoting a persistent inflammatory state. These myeloid derivatives, via increased IL-1β and IL-6 production, establish a pro-atherogenic environment and contribute to plaque instability, leading to an increased thrombotic risk and accelerated vascular aging. Although routine screening is not recommended for asymptomatic adults, targeted detection in high-risk individuals could benefit from preventive strategies. Incorporating CHIP into risk models may enable precision prevention, but prospective trials are needed to determine whether CHIP-guided interventions improve cardiovascular outcomes.

Background:Little is known about the relationship between weight gain during treatment and the subsequent risk of cardiovascular and metabolic (cardiometabolic) diseases. We assessed the relationship between changes in body mass index (BMI) during TB treatment with prevalence post-TB metabolic syndrome, a strong predictor of cardiometabolic diseases.Methods:We enrolled a prospective cohort of individuals successfully treated for TB disease in Tbilisi, Georgia, from 2019 – 2022. Eligible participants were HIV-negative individuals aged ≥16 years with newly diagnosed and laboratory-confirmed pulmonary TB. Our study exposure was the relative change in BMI from treatment initiation to treatment completion, dichotomized using ≥5% relative increase cut-off. Our primary study outcome was prevalence post-TB metabolic syndrome (i.e., having ≥3 of the following: elevated blood pressure, elevated triglycerides, low high-density lipoprotein, elevated glycated hemoglobin [HbA1c], and abdominal obesity) at any study visits (including the end of, 6- and 12-months post-TB treatment). Multilevel models were used to estimate the effect of BMI change on post-TB metabolic syndrome.Results:Among 120 participants, the adjusted risk of having metabolic syndrome after TB treatment among those with ≥5% relative increase in BMI was 2.07 times (95% confidence interval [CI] 1.07–4.01) the risk of those with <5% relative increase in BMI during treatment. Additionally, the adjusted mean of post-TB HbA1c among those with ≥5% relative increase in BMI was 0.37 (95%CI 0.03–0.71) points higher compared to those with <5% relative increase in BMI.Conclusions:Our findings indicate that weight gain during TB treatment may influence the risk of cardiovascular/metabolic diseases after TB treatment.

Background: Paroxysmal atrial fibrillation (PAF) is an intermittent arrhythmia with self-terminating episodes lasting fewer than seven days. Its development involves multiple factors, with body mass index (BMI) as a key modifiable risk factor. Elevated BMI promotes atrial remodeling and inflammation, increasing PAF susceptibility. Catheter ablation is now central to rhythm control and symptom management. Objective: To evaluate regional and sex-specific patterns in BMI and catheter ablation selection among patients with PAF. Methods: 84 PAF patients from Georgia (n = 43) and Kazakhstan (n = 41) were retrospectively analyzed. Age, sex, BMI, and ablation type were collected and stratified by center and sex. Inter-sex differences were assessed with t-tests, effect sizes calculated using Cohen's d/h, and BMI distributions evaluated using kernel density estimation. Results: Analyses captured 97% of BMI variation. Females were generally older than males (d = 0.55), particularly in Kazakhstan (d = 0.70), while BMI differences were small and not statistically significant. Cryoablation was preferred overall (16% higher), with the largest sex disparity in Kazakhstan (42.9% higher in males); Georgia showed slight RFA preference in females (8.3%). Conclusion: This study of PAF patients in Kazakhstan and Georgia reveals regional- and sex-specific variations in age, BMI, and ablation selection. We highlight the need for tailored risk assessment, early interventions, and awareness of potential clinical biases to ensure equitable care.

Alzheimer’s disease (AD) is a chronic neurodegenerative disorder with declining memory and cognitive impairment, largely mediated by extracellular amyloid-beta (Aβ). Although the amyloid cascade and tau protein hypotheses have long served as established frameworks for AD pathology, recent evidence suggests that long-term infections, particularly with Chlamydia pneumoniae (C. pneumoniae), may contribute to disease progression. A systematic search strategy was used to identify relevant literature using PubMed, Scopus, Google Scholar, and Web of Science. Keywords and Boolean operators such as “Chlamydia pneumoniae and Alzheimer’s disease,” “neuroinflammation,” “amyloid-beta,” and “tau protein” were applied, with filters for peer-reviewed articles, human and experimental studies, and publications from the past 25 years. Epidemiological and background data were supplemented by official sources, including the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). This review examines the potential relationship of C. pneumoniae infection with AD pathogenesis. Studies have identified DNA and antigens of C. pneumoniae in AD-infected brain regions, often co-localized within Aβ plaques and neurofibrillary tangles (NFTs). Proposed mechanisms of CNS invasion include olfactory, hematogenous, and immune cell-mediated routes, leading to persistent glial activation, neuroinflammation, altered amyloid precursor protein processing, and tau protein hyperphosphorylation. Experimental models support these associations, with infected animals developing AD-like pathology. Diagnostic challenges persist due to the limitations of PCR and immunohistochemistry, though advanced approaches such as next-generation sequencing and TSPO-PET imaging are emerging. Potential therapeutic approaches include antimicrobial and immunomodulatory strategies, although human trials have shown mixed results. While current evidence suggests a possible link, causality remains unproven. Future research must prioritize large-scale, longitudinal, and mechanistic studies to clarify these relationships. Establishing a definitive role for C. pneumoniae in AD pathogenesis could reshape current understanding of disease etiology and inform the development of novel preventive and therapeutic strategies.

Myelodysplastic syndromes (MDS) represent a heterogeneous group of clonal hematopoietic diseases sharing ineffective hematopoiesis, cytopenias, and a high risk of evolution to acute myeloid leukemia (AML). The current MDS classification systems, such as the International Consensus Classification (ICC) and the WHO 2022 classification, have incorporated molecular and cytogenetic markers to improve the stratification of risk and guide therapy. However, treatment options for high-risk MDS (HR-MDS) remain limited, with hypomethylating agents (HMAs) providing only modest survival benefits. Emerging treatments such as immune checkpoint blockade and novel targeted therapies could further improve patient outcomes. While early excitement was significant, clinical trials of the immune checkpoint inhibitors (ICIs) ipilimumab and durvalumab have produced no definitive results, highlighting the need for better patient selection and combination regimens. Emerging drugs luspatercept and imetelstat have been suggested for lower-risk MDS (LR-MDS) by promoting transfusion independence and global hematologic response. In contrast, exploratory agents such as pevonedistat, magrolimab, and sabatolimab are under further investigation for HR-MDS. The future of MDS treatment currently addresses precision medicine, in which molecular characterization guides therapeutic options. Identification of predictive biomarkers for response to targeted therapies and immunotherapies is crucial to optimize patient outcomes. An integrated, patient-centered approach combining genomics, novel therapeutics, and immunomodulation is therefore essential to address the current needs in MDS management.

SummaryBackground and ObjectivesSystemic treatment of pregnant/breastfeeding atopic dermatitis (AD) patients is challenging due to limited safety data. We explored treatment practices with systemic agents, including the guideline‐recommended cyclosporine as the first systemic choice as well as emerging therapies, in this vulnerable population.Patients and MethodsThe Global Allergy and Asthma Excellence Network (GA2LEN) ADCARE initiative collected data from physicians worldwide who treat pregnant women with AD. Physicians completed an electronic questionnaire on the use of systemic agents in pregnant/breastfeeding AD patients.Results103 physicians from 32 countries completed the survey, primarily dermatologists (n = 48) or allergologists (n = 43). Antihistamines were the systemic drug most often considered to be used during pregnancy/breastfeeding (n = 73/81, 90.1%), with fewer physicians considering the use of systemic agents for the first trimester compared to later stages of pregnancy. For acute flares, systemic corticosteroids (n = 34/80, 42.5%) were preferred, followed by biologics and antihistamines (each n = 15/80, 18.8%). Although the guideline‐recommended cyclosporine is sometimes considered for AD during pregnancy (n = 38/81, 46.9%), it was rarely considered as the preferred drug by physicians (n = 1/80, 1.25%).ConclusionsOur study shows a misalignment between guideline recommendations and prescription patterns and highlights an unmet need for knowing and using the existing recommendations.