EDITORIAL When Progress Meets an Old Challenge

By Elvana RISTA, MD, PhD

Medicine has always advanced, but rarely as quickly as it does today. Nowhere is this clearer than in transplantation, a field that within a single decade has advanced from refined immunosuppression and wider donor criteria to the threshold of
xenotransplantation. Yet every step forward is shadowed by an old companion. Infection has challenged medicine in every century, and it challenges us still not as a problem of the past, but as one that grows alongside our progress. This is the paradox at the centre of the present issue. The more we suppress the immune system to protect a graft, the more we expose the patient to the pathogens that the immune system once held back. Progress and vulnerability advance together. Three articles follow this thread closely: a scoping review of parvovirus B19 in kidney transplant recipients, showing how a “minor” virus can cause refractory anaemia and diagnostic difficulty; a practical review of cytomegalovirus management that adapts complex guidelines to resource-limited settings; and a serostatus-based approach to Epstein–Barr virus surveillance and the prevention of post-transplant lymphoproliferative disorder. Together, they make one point: infection is not what transplantation has left behind, but what it must keep pace with. If infection is the constant, innovation is what carries us forward, and this issue reflects both. Alongside the transplant–infection theme, our authors look at artificial intelligence to make prescribing safer in polypharmacy: a fitting counterpoint, where the newest tools serve one of medicine’s oldest duties, to do no harm. Others widen the view further: extreme proteinuria in a rare triple
autoimmune overlap, multiple myeloma presenting as acute kidney injury, the laboratory picture of visceral leishmaniasis, the physical symptoms of anxiety and depression in Albanian adults, vertebral artery Doppler as an accessible diagnostic tool, and the role of physiotherapy in cardiorespiratory function. Case reports, reviews, and original research stand side by side, a fair reflection of medicine as it is practiced today. What ties this variety together is a single commitment: to meet both the lasting and the emerging challenges of our profession with rigour, curiosity, and care for the patient. I thank our authors, reviewers, and readers, and I invite you to explore a collection that looks ahead without losing sight of what remains constant.