Bo’s abdominal acupuncture treatment for adult-onset Still's disease: A case report

BACKGROUND

Adult-onset Still's disease (AOSD) is a rare autoinflammatory disease characterized by nonspecific symptoms such as fever, rash, sore throat and arthralgia. This paper reports a clinical case of AOSD successfully treated with Bo’s abdominal acupuncture (BAA).

CASE SUMMARY

We report a 20-year-old man who suffered from cold exposure, presenting with high fever, rash, sore throat, arthralgia, and elevated erythrocyte sedimentation rate, leukocytosis with neutrophilic predominance, elevated ferritin, elevated C-reactive protein, and negative rheumatoid factors. He was diagnosed with AOSD based on the Yamaguchi criteria. After treatment with traditional Chinese medicine (TCM) decoction and prednisone acetate tablets, there was some alleviation of sore throat, joint and muscle pain, and fever, but he still had persistent low-grade fever, rash, sore throat and arthralgia. He went to the TCM acupuncture outpatient department to receive BAA. Abdominal acupoints Zhongwan (CV12), Xiawan (CV10), 0.5 cm below Xiawan (CV10), Qihai (CV6), Guanyuan (CV4), bilateral Qixue (KI13), bilateral Huaroumen (ST24), bilateral Shangfengshidian (AB1) and bilateral Daheng (SP15) were selected. After 3 months treatment, all symptoms disappeared, and the laboratory examination returned to normal levels. He did not take glucocorticoids or nonsteroidal anti-inflammatory drugs afterwards, and no relapse was observed during the 3-year follow-up period.

CONCLUSION

BAA can be used as a complementary medical approach for treatment of AOSD.

Association of interleukin-6 with acute lung injury risk and disease severity in sepsis

Sepsis is a life-threatening condition caused by a dysregulated response of the body in response to an infection that harms its tissues and organs. Interleukin-6 (IL-6) is a significant component of the inflammatory response as part of the pathogenesis of sepsis. It aids in the development of Acute lung injury and, subsequently, multiple organ dysfunction syndrome. This letter probes into the correlation between plasma IL-6 levels and the risk of developing acute lung injury and multiple organ dysfunction syndrome in critically ill patients with sepsis. While it shows promising results, limitations like its observational study design, a limited sample size, a single center involvement, single-time-point measurement, and a lack of a control group restrain its cogency. The study is a big step in identifying IL-6 as a biomarker to improve patient care.

Transient extreme insulin resistance in a critically ill patient: A case report

BACKGROUND

Acute hyperglycemia due to insulin resistance is common in critically ill patients, typically managed with insulin infusion. However, the occurrence of transient extreme insulin resistance (EIR) requiring exceptional high-dose insulin is rare.

CASE SUMMARY

We present the case of a 68-year-old woman with pneumonia who suffered an out-of-hospital cardiac arrest, subsequently developing transient EIR following a new episode of sepsis. Remarkably, insulin resistance rapidly reversed when the insulin infusion rate peaked at 960 units/hour (a total of 18224 units on that day), and it was promptly titrated down to zero upon achieving the target glucose level.

CONCLUSION

Exceptional high-dose insulin infusion may be required in critically ill patients with stress-related EIR, which is typically transient. Clinicians should be aware of the phenomenon and cautious to avoid hypoglycemia and fluid overload during the steep titration of high-dose insulin infusion.

Herpes simplex virus 2-induced aseptic meningitis presenting with sudden deafness: A case report

BACKGROUND

Aseptic meningitis is defined as meningeal inflammation caused by various etiologies with negative cerebrospinal fluid (CSF) bacterial culture. The most common etiologies are viruses [enteroviruses, arboviruses, and herpes simplex virus type 2 (HSV-2)]. Aseptic meningitis can have various presentations, including sensorineural deafness. While sensorineural deafness from mumps meningoencephalitis has been reported, cases of HSV-2-induced hearing loss are rare. Herein, we report a case of HSV-2-induced meningitis that presented with sudden deafness.

CASE SUMMARY

A 68-year-old man experienced a profound sudden onset of left-sided hearing loss for one day. Pure-tone audiograms demonstrated sudden left-sided sensorineural hearing loss (thresholds 80-90 dB). After treatment with high-dose steroids for 1 week, he experienced an acute consciousness change with left hemiparesis. The laboratory data showed no significant abnormalities. Brain computed tomography without contrast and magnetic resonance imaging revealed no intracranial hemorrhage or obvious brain lesion. The CSF analysis and the Multiplex PCR panels showed HSV-2 positivity. Hence, under the diagnosis of herpes meningoencephalitis, acyclovir was prescribed and his symptoms gradually resolved.

CONCLUSION

This case report further demonstrates that a viral infection could be a cause of sudden sensorineural hearing loss.

Dermatitis bullosa caused by the immune checkpoint inhibitor camrelizumab: A case report

BACKGROUND

Since the advent of the 20^th century, alongside the progression of medical science and technological advancements, immunotherapy has emerged as a pivotal therapeutic approach for tumor patients subsequent to undergoing radiotherapy and chemotherapy. Arimab (camrelizumab), a flagship drug in the realm of immunotherapy, functions as a monoclonal antibody specifically targeting the programmed death protein 1 (PD-1). This drug engages with the human PD-1 receptor, effectively inhibiting the PD-1/programmed death ligand 1 signaling pathway. This inhibition results in the restoration of T cell activity and the induction of an anti-tumour response. However, it is noteworthy that such interference could lead to immune-related adverse events resembling autoimmune reactions. The growing availability and clinical use of immune checkpoint inhibitors have raised significant clinical concerns regarding their safety. Numerous instances of immune-related adverse reactions and the associated management strategies have been extensively reported. Timely identification and diagnosis, coupled with multidisciplinary consultation and the prompt administration of immunosuppressants, can effectively address severe immune-related adverse reactions.

CASE SUMMARY

Arimab (camrelizumab), a monoclonal antibody targeting programmed death protein 1 (PD-1), disrupts the PD-1/ programmed death ligand 1 (PD-L1) interaction, reactivating T cell function and triggering anti-tumor immunity. However, this disruption may trigger immune-mediated adverse events akin to autoimmune disorders. Approximately 2.8% of such events manifest as immune-related dermatologic reactions, with 0.7% classified as grade 3, which are infrequently documented. Here, this study describes a case of grade 3 bullous dermatitis occurring 15 days after initiating camrelizumab therapy. The patient, a 67-year-old male with oesophageal squamous cell carcinoma, received camrelizumab plus paclitaxel alongside chemotherapy and radiotherapy in early 2022. Due to disease progression, maintenance monotherapy with camrelizumab (200 mg) commenced in June 2022. On the fourth cycle, 15 days into treatment, the patient presented with an immune-checkpoint inhibitor-related rash, despite unremarkable test results. Dermatology and pharmacy consultations were conducted, leading to glucocorticoid therapy, topical interventions, and supportive care. Gastric mucosal protection, nutritional supplementation, and other adjunctive treatments were also provided. The patient's symptoms resolved within 15 days post-discharge, resulting in discontinuation of camrelizumab. Like other PD-1 inhibitors, camrelizumab is associated with immune-mediated dermatitis. Thus, optimal management of these events requires a multidisciplinary approach, vigilant monitoring, regular evaluations, prompt glucocorticoid administration, and specialized dermatologic care.

CONCLUSION

The increasing adoption of immune checkpoint inhibitors in clinical practice has prompted substantial concerns about their safety profile. A wide range of immune-related adverse events and corresponding management strategies have been well-documented. Early recognition and accurate diagnosis, combined with interdisciplinary collaboration and swift initiation of immunosuppressive therapy, are essential in managing severe immune-related adverse reactions effectively. This report details the treatment trajectory and outcome of a case involving immune-related cutaneous adverse reactions, providing pertinent clinical insights for future cases.

Use of graphene nanocomposites for air disinfection in dental clinics: A game-changer in infection control

This manuscript features the promising findings of a study conducted by Ju et al, who used graphene nanocomposites for air disinfection in dental clinics. Their study demonstrated that, compared with conventional filters, graphene nanocomposites substantially improved air quality and reduced microbial contamination. This manuscript highlights the innovative application of graphene materials, emphasizing their potential to enhance dental clinic environments by minimizing secondary pollution. On the basis of the unique antimicrobial properties of graphene and the original study’s rigorous methodology, we recommend using graphene nanocomposites in clinical settings to control airborne infections.

Chyle leak following root of mesentery dissection in pancreaticoduodenectomy with inferior infracolic superior mesenteric artery first approach

BACKGROUND

The root of mesentery dissection is one of the critical maneuvers, especially in borderline resectable pancreatic head cancer. Intra-abdominal chyle leak (CL) including chylous ascites may ensue in up to 10% of patients after pancreatic resections. Globally recognized superior mesenteric artery (SMA) first approaches are invariably performed. The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study.

AIM

To assess incidence, risk factors, clinical impact of CL following root of mesentery dissection, and the different treatment modalities.

METHODS

This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreatoduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1, 2021 to February 28, 2024. Intraoperative findings and postoperative outcomes were analyzed.

RESULTS

In three years, ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy. The mean age was 67.6 years with a male-to-female ratio of 4:5. CL was seen in four patients. With virtue of CL, Clavien-Dindo grade II or higher morbidity was observed in four patients. Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement. The mean operative time was 330 minutes. Curative resection was achieved in 100% of the patients. The mean duration of the intensive care unit and hospital stay were 2.55 ± 1.45 days and 15.7 ± 5.32 days, respectively.

CONCLUSION

Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL. After complete curative resection, these were managed with total parenteral nutrition without adversely impacting outcome.

Application of nanotechnology to dentistry: Impact of graphene nanocomposites on clinical air quality

Concerns about air quality in dental clinics where aerosol generation during procedures poses significant health risks, have prompted investigations on advanced disinfection technologies. This editorial describes the strengths and limitations of ventilation and aerosol control measures in dental offices, especially with respect to the use of graphene nanocomposites. The potential of graphene nanocomposites as an innovative solution to aerosol-associated health risks is examined in this review due to the unique properties of graphene (e.g., high conductivity, mechanical strength, and antimicrobial activity). These properties have produced promising results in various fields, but the application of graphene in dentistry remains unexplored. The recent study by Ju et al which was published in World Journal of Clinical Cases evaluated the effectiveness of graphene-based air disinfection systems in dental clinics. The study demonstrated that graphene-based disinfection techniques produced significant reductions in suspended particulate matter and bacterial colony counts, when compared with traditional methods. Despite these positive results, challenges such as material saturation, frequency of filter replacement, and associated costs must be addressed before widespread adoption of graphene-based disinfection techniques in clinical practice. Therefore, there is need for further research on material structure optimization, long-term safety evaluations, and broader clinical applications, in order to maximize their positive impact on public health.

Unusual ovarian hyperstimulation syndrome presentation: Pleural effusion without ascites. A case report

BACKGROUND

Ovarian hyperstimulation syndrome (OHSS) is a life-threatening complication that can occur in the luteal phase or early pregnancy after controlled ovarian stimulation. This case report highlights a unique manifestation of OHSS involving pleural effusion (PE) in a patient without identifiable risk factors.

CASE SUMMARY

A 39-year-old woman who underwent controlled ovarian hyperstimulation for an in vitro fertilization (IVF) cycle experienced dyspnea on the eleventh day of post oocyte retrieval. The diagnosis was severe OHSS with a unique manifestation of PE without ascites. Clinical management involved fluid balance and treatment with albumin, furosemide, thromboembolic prophylaxis, and thoracentesis. A continued drainage of the pleural cavity was performed. The patient had a favorable outcome, and a dichorionic diamniotic gestation passed without incident.

CONCLUSION

OHSS and its potential complications can include respiratory distress and PE, as well as thromboembolic disorders.

Fatal risk in hysteroscopic surgery that should not be overlooked: Uterine artery pseudoaneurysm

This article provides a detailed account of the diagnosis and treatment of a case involving a uterine artery pseudoaneurysm (UAP), as well as an analysis of UAP etiology. This finding emphasizes that UAP should be considered in patients presenting with abnormal genital bleeding after hysteroscopy and offers valuable insights and lessons for gynecologists in hysteroscopic procedures. The patient underwent timely relevant examinations to confirm the diagnosis, allowing for crucial time required for her treatment. In this study, the primary cause of UAP formation in the patient was attributed to a prior hysteroscopic surgical procedure conducted at another medical facility, suggesting that the selection and implementation of dilatation catheters are some of the predisposing factors for UAP. In conclusion, this case study offers a comprehensive analysis of the etiology of UAP and effectively provides timely diagnosis and treatment, offering valuable insights for the clinical diagnosis and management of UAP.

Prognostic impact of hypernatremia for septic shock patients in the intensive care unit

BACKGROUND

Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes, particularly in cases of intensive care unit (ICU)-acquired hypernatremia (IAH). Nevertheless, its relevance in patients with septic shock remains uncertain.

AIM

To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.

METHODS

In the present retrospective single-center study, a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University, between August 1, 2018, and May 31, 2023, were analyzed. Patients were categorized based on the timing of hypernatremia occurrence into the IAH group (n = 62), the non-IAH group (n = 41), and the normonatremia group (n = 54).

RESULTS

In the present study, there was a significant association between the high serum sodium concentrations, excessive persistent inflammation, immunosuppression and catabolism syndrome and chronic critical illness, while rapid recovery had an apparent association with normonatremia. Moreover, multivariable analyses revealed the following independent risk factors for IAH: Total urinary output over the preceding three days [odds ratio (OR) = 1.09; 95%CI: 1.02–1.17; P = 0.014], enteral nutrition (EN) sodium content of 500 mg (OR = 2.93; 95%CI: 1.13–7.60; P = 0.027), and EN sodium content of 670 mg (OR = 6.19; 95%CI: 1.75–21.98; P = 0.005) were positively correlated with the development of IAH. Notably, the area under the curve for total urinary output over the preceding three days was 0.800 (95%CI: 0.678–0.922, P = 0.001). Furthermore, maximum serum sodium levels, the duration of hypernatremia, and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients (P < 0.05).

CONCLUSION

The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU. It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.

Internal hernia as a rare cause of small bowel obstruction: An insight from 13 years of experience

BACKGROUND

Internal hernia (IH) is a rare culprit of small bowel obstruction (SBO) with an incidence of < 1%. It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis, improper treatment, and subsequent morbidity and mortality.

AIM

To determine the clinico-demographic profile, radiological and operative findings, and postoperative course of patients with IH and its association with SBO.

METHODS

Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow, India between September 2010 and August 2023 were reviewed.

RESULTS

Out of 586 patients, 7 (1.2%) were diagnosed with IH. Among these, 4 had congenital IH and 3 had acquired IH. The male-to-female ratio was 4:3. The median age at presentation was 32 years. Contrast-enhanced computed tomography (CECT) was the most reliable investigation for preoperative identification, demonstrating mesenteric whirling and clumped-up bowel loops. Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency (approximately 43% each). Intraoperatively, one patient was found to have bowel ischemia and one had associated malrotation of gut. During follow-up, no recurrences were reported.

CONCLUSION

IH, being a rare cause, must be considered as a differential diagnosis for SBO, especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery. A rapid imaging evaluation, preferably with CECT, is necessary to aid in an early diagnosis and prompt intervention, thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.

Insulin-induced severe thyrotoxic periodic paralysis: A case report

BACKGROUND

Thyrotoxic periodic paralysis (TPP) is an endocrine emergency caused by thyrotoxicosis, manifesting mainly as periodic myasthenia and hypokalemia, and posing a serious threat to the patient's health. Fatigue, strenuous exercise, alcohol abuse, high carbohydrate intake and insulin injections are common triggers of paralysis. This article reports a case of severe TPP induced by insulin injection, elucidates the characteristics and pathogenesis of the disease, analyses the risk factors for triggering TPP, and hopefully provides more clinical data for TPP patients.

CASE SUMMARY

A 38-year-old Asian man presented to the emergency department with a one-week history of limb weakness and worsening half-day. His medical history included poorly controlled type 2 diabetes and he had been switched to Aspart50 a week earlier. He was alert and oriented with upper extremity strength grade 3 and lower extremity strength grade 1. Emergency department tests showed hypokalemia of 1.6 mmol/L. The paramedics administered 1.5 g of potassium intravenously, followed by 4.0 g orally. Weakness in the arms and legs improved. He was referred to endocrinology where he was diagnosed with Graves' disease, with suboptimal control and insulin injections possibly causing TPP. We stopped his insulin and he was discharged with a potassium level of 4.0 mmol/L.

CONCLUSION

Insulin is a trigger for TPP and should be avoided in patients with hyperthyroidism. Early recognition and treatment of TPP is crucial, especially in patients presenting with hypokalemic periodic paralysis.

Late effects of the treatment of childhood cancer

Excellent progress has been made in the last few decades in the cure rates of pediatric malignancies, with more than 80% of children with cancer who have access to contemporary treatment being cured. However, the therapies responsible for this survival can also produce adverse physical and psychological long-term outcomes, referred to as late effects, which appear months to years after the completion of cancer treatment. Research has shown that 60% to 90% of childhood cancer survivors (CCSs) develop one or more chronic health conditions, and 20% to 80% of survivors experience severe or life-threatening complications during adulthood. Therefore, understanding the late side effects of such treatments is important to improve the health and quality of life of the growing population of CCSs.

Physical rehabilitation for sensorineural hearing loss in childhood: Progress and challenges

Early intervention for sensorineural hearing loss (SNHL) in childhood is crucial for auditory and language development. In recent years, innovative auditory stimulation techniques and speech therapy strategies, such as middle ear implants, cochlear implants, auditory brainstem implants, and midbrain implants, have provided new avenues for improving patient outcomes. Additionally, basic research advancements in cell reprogramming and regeneration, stem cell therapy, and targeted drug delivery offer promising approaches to meet the individualized needs of children with SNHL. However, many challenges and unresolved issues remain in the treatment of SNHL. This article comments on the case report, which describes a female pediatric patient with SNHL who underwent foot reflexology which led to the normalization of hearing thresholds. Reflexology is considered to have potential benefits in physical rehabilitation, but its efficacy in hearing restoration requires further scientific validation through rigorous clinical trials and large-scale prospective studies.

Foot reflexology in autoimmune diseases: Effectiveness and mechanisms

Foot reflexology (FR) is a Chinese-originated and non-invasive complementary therapy increasingly used by functional, alternative and para-medical professionals. Enhance attempts are made to study FR in non-functional organic conditions. The present invited Editorial discusses the application of FR in autoimmune diseases (AD), highlighting a few successful studies demonstrating symptomatic relief and objective improvements. Despite promising results, the FR domain remains under-investigated and an urgent need to confirm and understand the effect of FR in chronic diseases, including AD, is highly recommended.

Intersection of two rare conditions: Clinical reflection on tuberous sclerosis combined with primary lymphedema

This editorial discusses a case report recently published in the World Journal of Clinical Cases. The report describes the clinical presentation, imaging, diagnosis, and treatment of a patient with tuberous sclerosis complex (TSC) combined with primary lymphedema (PLE). Additionally, it retrospectively analyzes the data of 16 previously reported cases of children with TSC combined with PLE to summarize the epidemiology, genetic diagnosis, and current main treatments of these patients. The report also speculates on the pathological and physiological mechanisms underlying TSC combined with PLE. TSC combined with PLE is rare; therefore, the report provides a theoretical basis for understanding the pathophysiological mechanisms and treatment options for patients with TSC and PLE. Comprehensive clinical management of TSC is essential due to the diverse and multiorgan nature of its manifestations, often requiring a multidisciplinary approach for newly diagnosed cases.

Effect of esketamine on reducing postpartum pain and depression

In this editorial, we comment on a recent article by Chen et al, that addressed the effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section. Poor management of post-cesarean pain is associated with decreased maternal care for the baby, longer hospitalization, and higher risk of developing postpartum depression. Esketamine is a more potent S-enantiomer of ketamine which has shown promising analgesic and antidepressant properties for managing post-cesarean pain and depression in clinical studies. However, due to its potential adverse effects on the neurological and hemodynamic status of patients, it is recommended that its usage in low doses should be limited to cesarean candidates experiencing unbearable pain. Before any recommendation for routine perioperative use of esketamine, more standardized clinical trials are needed to strengthen our existing knowledge of its effectiveness in reducing postpartum pain and depression.

Mesenteric ischemia with intrasplenic gas: A case report

BACKGROUND

Acute mesenteric ischemia is a life-threatening disease. Intrasplenic gas is an extremely rare finding in such cases.

CASE SUMMARY

We report a case of a 79-year-old woman with a history of end-stage renal disease on hemodialysis for approximately 20 years, type 2 diabetes mellitus, and atrial fibrillation who presented with two days of epigastric pain. A computed tomography scan of the abdomen revealed intraperitoneal free air and significant intrasplenic gas. Laparoscopy revealed diffuse intestinal gangrene, and acute superior mesenteric ischemia was diagnosed. The patient died within 24 hours owing to profound shock.

CONCLUSION

Intrasplenic gas is an extremely rare finding on computed tomography imaging in cases of acute mesenteric ischemia.

Impact of time between meniscal injury and isolated meniscus repair on post-operative outcomes: A systematic review

BACKGROUND

Meniscal tears are one of the most common knee injuries. After the diagnosis of a meniscal tear has been made, there are several factors physicians use to guide clinical decision-making. The influence of time between injury and isolated meniscus repair on patient outcomes is not well described. Assessing this relationship is important as it may influence clinical decision-making and can add to the preoperative patient education process. We hypothesized that increasing the time from injury to meniscus surgery would worsen postoperative outcomes.

AIM

To investigate the current literature for data on the relationship between time between meniscus injury and repair on patient outcomes.

METHODS

PubMed, Academic Search Complete, MEDLINE, CINAHL, and SPORTDiscus were searched for studies published between January 1, 1995 and July 13, 2023 on isolated meniscus repair. Exclusion criteria included concomitant ligament surgery, incomplete outcomes or time to surgery data, and meniscectomies. Patient demographics, time to injury, and postoperative outcomes from each study were abstracted and analyzed.

RESULTS

Five studies met all inclusion and exclusion criteria. There were 204 (121 male, 83 female) patients included. Three of five (60%) studies determined that time between injury and surgery was not statistically significant for postoperative Lysholm scores (P = 0.62), Tegner scores (P = 0.46), failure rate (P = 0.45, P = 0.86), and International Knee Documentation Committee scores (P = 0.65). Two of five (40%) studies found a statistically significant increase in Lysholm scores with shorter time to surgery (P = 0.03) and a statistically significant association between progression of medial meniscus extrusion ratio (P = 0.01) and increasing time to surgery.

CONCLUSION

Our results do not support the hypothesis that increased time from injury to isolated meniscus surgery worsens postoperative outcomes. Decision-making primarily based on injury interval is thus not recommended.

Summary of the current guidelines for managing iatrogenic colorectal perforations and the evolving role of endoluminal vacuum therapy

Colonoscopy represents a safe procedure that is widely used in medical practice either to diagnose or treat various gastrointestinal diseases. During the last few years, the incidence rate of perforations in colonoscopic procedures has increased, especially in therapeutic colonoscopies. The recent advancements in endoscopic techniques and gastrointestinal tumoral resection procedures such as endoscopic mucosal resection, endoscopic full-thickness resection, and endoscopic submucosal dissection (ESD) could be a risk factor for this increased risk. The incidence rate of mortality of serious colonoscopic perforations is 7.1%. The management plan for these perforations starts with conservative treatment in mild cases, endoscopic closure, and surgical management in severe cases. Recently, endoluminal vacuum therapy was found to be effective in the management of colorectal perforations and this has been reported in multiple case reports. This editorial provides an overview of the current guidelines for the management of iatrogenic colorectal perforations. These insights are from the perspectives of endoscopists and gastroenterologists. We also present a management algorithm based on the guidelines of the European Society of Gastrointestinal Endoscopy, the American Gastroenterological Association, and the World Society of Emergency Surgery. We also discussed in brief the use of endoluminal vacuum therapy in colorectal perforations.

Advancements and challenges in neuroimaging for the diagnosis of intracranial aneurysms: Addressing false positive diagnoses and emerging techniques

Despite advancements in neuroimaging, false positive diagnoses of intracranial aneurysms remain a significant concern. This article examines the causes, prevalence, and implications of such false-positive diagnoses. We discuss how conditions like arterial occlusion with vascular stump formation and infundibular widening can mimic aneurysms, particularly in the anterior circulation. The article compares various imaging modalities, including computer tomography angiogram, magnetic resonance imaging/angiography, and digital subtraction angiogram, highlighting their strengths and limitations. We emphasize the importance of accurate differentiation to avoid unnecessary surgical interventions. The potential of emerging technologies, such as high-resolution vessel wall imaging and deep neural networks for automated detection, is explored as promising avenues for improving diagnostic accuracy. This manuscript underscores the need for continued research and clinical vigilance in the diagnosis of intracranial aneurysms.

Enhancing postoperative pain control by surgically-initiated rectus sheath block in abdominal aortic aneurysm open repair: A case report

BACKGROUND

Abdominal aortic aneurysm (AAA) repair often involves significant postoperative pain, traditionally managed with systemic opioids, which can cause undesirable side effects. This case report explores the novel use of a surgically-initiated rectus sheath block with a catheter-over-needle assembly for pain management in AAA repair.

CASE SUMMARY

A 67-year-old female with hypertension and previous aortic dissection underwent elective open repair of an infrarenal AAA, which had grown from 3.4 cm to 4.3 cm over 14 months. A rectus sheath block was initiated surgically for postoperative pain control. The patient reported low pain scores and did not require systemic intravenous opioids, enabling early ambulation and discharge on postoperative day seven without complications. By preventing complications of systemic opioids, the method indicating a promising direction for postoperative pain management in major vascular surgeries.

CONCLUSION

Surgically-initiated rectus sheath block as a valuable tool for managing postoperative pain in AAA repair.

Efficacy and safety of Tripterygium wilfordii glycosides tablets combined with Western medicine for patients with rheumatic immune diseases

BACKGROUND

Rheumatic immune diseases are a group of chronic inflammatory diseases characterized by joint and systemic multi-organ involvement, including rheumatoid arthritis, systemic lupus erythematosus, and Sjogren’s syndrome, among others. The pathogenesis of these diseases is related to the abnormal activation and regulatory imbalance of the immune system. The prevalence and morbidity of rheumatic immune diseases are high, imposing a significant burden on patients' quality of life and socio-economic costs. Currently, the treatment of rheumatic immune diseases mainly relies on Western medicine, such as non-steroidal anti-inflammatory drugs, glucocorticoids, disease-modifying antirheumatic drugs, and biologics. However, the therapeutic effects of Western medicine are not ideal, some patients poorly respond or are resistant to Western medicine, and long-term use often causes various adverse reactions.

AIM

To systematically evaluate the efficacy and safety of Tripterygium wilfordii glycosides tablets combined with Western medicine in the treatment of patients with rheumatic immune diseases.

METHODS

This study conducted a meta-analysis to systematically evaluate the efficacy and safety of Tripterygium wilfordii glycosides tablets combined with Western medicine for patients with rheumatic immune diseases. Chinese and English databases were searched for randomized controlled trials (RCTs) on the treatment of rheumatic immune diseases with Tripterygium wilfordii glycosides tablets combined with Western medicine. The quality of the included studies was assessed using the Cochrane risk of bias assessment tool. Meta-analysis was performed using RevMan 5.4 software.

RESULTS

The meta-analysis included 11 RCTs involving 1026 patients with rheumatic immune diseases. The combined treatment significantly reduced the risk of disease recurrence (relative risk = 1.07, 95% confidence interval: 1.01-1.15, P < 0.05) and showed no significant heterogeneity (I² = 0%, P = 0.53), indicating that Tripterygium wilfordii glycosides tablets combined with Western medicine is an effective method to reduce the possibility of postoperative recurrence in patients with rheumatic immune diseases. However, due to the limited number and quality of the studies included, these results should be interpreted with caution.

CONCLUSION

Tripterygium wilfordii glycosides tablets combined with Western medicine is an effective and safe treatment option for patients with rheumatic immune diseases and can be considered a clinical choice. However, more high-quality research is needed to validate this conclusion and provide more solid evidence for clinical practice.

Spectrum of venous thromboembolism in adult patients with ulcerative colitis in Pakistan: A single center retrospective study

BACKGROUND

Patients with inflammatory bowel disease are at a 2-8-fold higher risk of developing venous thromboembolism (VTE) as compared to the general population. Although the exact pathogenesis is unclear, the literature suggests that increased risk of thromboembolic events in such patients occurs as a result of increased coagulation factors, inflammatory cytokines, and reduction in anticoagulants leading to a prothrombotic state.

AIM

To assess the prevalence, risk factors, management, and outcome of ulcerative colitis (UC) patients who develop VTE.

METHODS

This was a retrospective chart review done in The Gastroenterology Department of The Aga Khan University Hospital. Data was collected from medical records for all patients admitted with a diagnosis of UC from January 2012 to December 2022.

RESULTS

Seventy-four patients fulfilled the inclusion criteria. The mean ± SD of age at presentation of all UC patients was 45 years ± 10 years whereas for those who developed VTE, it was 47.6 years ± 14.7 years. Hypertension and diabetes were the most common co-morbid seen among UC patients with a frequency of 17 (22.9%) and 12 (16.2%), respectively. A total of 5 (6.7%) patients developed VTE. Deep venous thrombosis was the most common thromboembolic phenomenon seen in 3 (60%) patients. All the patients with UC and concomitant VTE were discharged home (5; 100%).

CONCLUSION

The prevalence of VTE with UC in Pakistani patients corresponds with the international literature. However, multi-centric studies are required to further explore these results.