Abnormal umbilical cord coiling and association with pregnancy factors

The umbilical cord, as a connecting bridge between two lives, plays an important role in fetal development. Though studies on the umbilical cord date back many years, extensive studies on certain umbilical cord characteristics, such as umbilical cord coiling, are rare. Cord coiling, measured by the umbilical coiling index, is a physiological phenomenon that offers resistance to external pressures. Umbilical cord coiling is a result of several factors, both environmental and genetic. However, umbilical cords sometimes coil abnormally, resulting in hypocoiling, hypercoiling, or non-coiling which have significant associations with adverse perinatal outcomes. An all-language literature search was conducted on Medline from 1970 to 2023. The following search terms were used; umbilical cord; umbilical coiling; coiling index; abnormal coiling; perinatal outcomes, and cross-referencing yielded further information. We comprehensively reviewed the literature on umbilical cord coiling, factors contributing to coiling, abnormal coiling of the umbilical cord, and the association with several factors including maternal age, gravida, gestational diabetes mellitus, pre-eclampsia, abruption, birth weight, intrauterine growth retardation, maternal iron status, small for gestational age, fetal heart rate variations, ponderal index, and sought possible explanations.

Role of Magnesium in Diabetic Nephropathy for Better Outcomes

Diabetic nephropathy (DN) is a major cause of end-stage renal disease worldwide, resulting from uncontrolled diabetes. Oxidative stress plays a critical role in the pathophysiology of DN, leading to cellular damage and disease progression. Magnesium, an essential mineral, has emerged as a potential therapeutic agent due to its antioxidative, anti-inflammatory, and antifibrotic properties. An extensive literature search was conducted on Medline using the keywords "Diabetic nephropathy," "Magnesium," and "Chronic Kidney Disease," and the results published after 2000 were exclusively studied to build this review. This review aims to summarize the role of magnesium in DN and explore its therapeutic potential. Magnesium acts as a cofactor for antioxidant enzymes, directly scavenges reactive oxygen species, and enhances the expression of antioxidant proteins. Furthermore, magnesium exhibits anti-inflammatory effects by suppressing pro-inflammatory cytokine production and inhibiting inflammatory signaling pathways. Magnesium supplementation has been shown to reduce oxidative stress markers and improve antioxidant enzyme activities in clinical studies. Additionally, magnesium has been found to mitigate renal fibrosis, maintain tubular integrity and function, improve endothelial function, and modulate renal hemodynamics. Although limited clinical trials suggest the renoprotective effects of magnesium in DN, further research is needed to determine the optimal dosage, duration, and long-term effects of magnesium supplementation. Despite existing drawbacks and gaps in the literature, magnesium holds promise as adjunctive therapy for DN by targeting oxidative stress and preserving renal function.

A Rare Presentation of Perivalvular Abscess and Infective Valve Endocarditis as Multiple Cerebral Septic Emboli Mimicking Ischemic Stroke

The perivalvular cardiac abscess is a severe condition associated with infective endocarditis, leading to significant morbidity and mortality if not diagnosed and managed promptly. Neurological complications, particularly stroke, can occur due to embolic events resulting from cardiac abscesses. A 63-year-old female with end-stage renal disease and multiple comorbidities presented with altered mental status. Imaging revealed acute ischemic infarcts in the frontotemporal lobes, suggesting the embolic phenomenon. Blood cultures grew Enterococcus faecalis, and an echocardiogram showed severe aortic valve destruction with perivalvular abscess. Cardiac abscesses can cause severe complications, including tissue destruction, valve damage, and embolic events. Echocardiography is crucial for diagnosis, detecting vegetation, and assessing associated complications. Transthoracic echocardiography is reliable but has limitations, whereas transesophageal echocardiography is highly sensitive. Prompt antibiotic therapy and surgical intervention are crucial for treatment. Early initiation of appropriate antibiotic therapy and surgical intervention is crucial for positive outcomes. The choice of treatment should be individualized based on the patient's specific condition and the medical team's expertise.

Neurosarcoidosis: A Rare Presentation as a Seizure

Neurosarcoidosis is a rare disorder that can develop in patients with a history of sarcoidosis or can develop even when sarcoidosis is not diagnosed. It is a granulomatous disease of the nervous system that causes different neurological disorders based on its location. However, diagnosing neurosarcoidosis remains a challenge as it mimics many other neurological disorders and does not have any biochemical markers of high specificity. A tissue-proven biopsy is the gold standard but is difficult to obtain in neurological illnesses. Thus, diagnosis is established based on the clinical syndrome and imaging, which mostly show meningeal/parenchymal lesion enhancement, in addition to the exclusion of other causes. Glucocorticoids, immunosuppressants, and anti-tumour necrosis factor (TNF) drugs are the mainstays of treatment. We discuss a case of neurosarcoidosis in a 52-year-old woman with a known history of sarcoidosis.

Myxedema Coma: A Grave Phenomenon Partially Reversed CKD Status With Treatment of Hypothyroidism

Myxedema coma is a grave medical condition that warrants emergent medical management to avoid adverse effects and unfavorable outcomes. Intravenous thyroid hormones (T3 and T4), along with intravenous hydrocortisone and frequent vital monitoring, are the mainstays of the management of myxedema coma. The interplay between CKD and hypothyroidism is fascinating and can affect each other. It is often very difficult for physicians to differentiate between sepsis and myxedema coma, especially in the early stages. Infections and medication non-compliance are the leading causes of precipitation myxedema coma. We describe a case report presented with myxedema coma and CKD, which was successfully managed and also led to a partial reversal of CKD status.

Aminotransferases in Relation to the Severity of Dengue: A Systematic Review

A systematic review was conducted to investigate the relationship between aminotransferases and the severity of dengue infection, which is a prevalent and significant infection in tropical and subtropical regions. Aminotransferases are enzymes that are often elevated in dengue due to the liver's physiological and immunological response to the infection. This review focused on analyzing various studies that examined the correlation between aminotransferase levels and the severity of dengue. Extensive literature searches were performed using ("dengue*" OR "dengue fever*" OR "dengue haemorrhagic fever*" OR "dengue shock syndrome*") AND ("alanine aminotransferase*" OR "aspartate aminotransferase*") on PubMed. The selected articles were thoroughly reviewed, encompassing epidemiology, pathogenesis, and clinical manifestations of dengue. The consistent findings across the studies indicated that aminotransferases can serve as predictive markers for dengue severity. Therefore, early assessment of liver enzyme levels is crucial in dengue cases, and elevated levels should be closely monitored to prevent adverse outcomes.

Postpartum Hemorrhage and Tranexamic Acid: A Literature Review

This review aims to explore the postpartum hemorrhage (PPH) burden and the efficacy of prophylactic tranexamic acid (TXA) in PPH and recent indications of TXA. A comprehensive review of the literature was conducted using a combination of Medical Subject Headings keywords including "Postpartum haemorrhage," "Tranexamic acid," and "Cesarean section." PPH has been explored for epidemiology, risk factors, and pathophysiology in the first part of the article. Recent indications of TXA, obstetric indications, and the role of TXA as prophylaxis for PPH are discussed in the second part of this article. TXA has many indications apart from obstetric indications and shows a significant effect in controlling bleeding. Furthermore, TXA is more efficient in preventing PPH if administered during the final stage of labor and is a valuable option for managing obstetric bleeding.

Non-ST-Segment Elevation Myocardial Infarction As Initial Thrombotic Event of Thrombotic Thrombocytopenic Purpura: A Rare Challenging Case

Thrombotic thrombocytopenic purpura (TTP) is a rare autoimmune and devastating blood disorder that results in micro-clots throughout the body, leading to tissue damage and organ dysfunction resulting in widespread microangiopathic hemolytic anemia, thrombocytopenia, fever, and neurological symptoms. TTP patients commonly manifest renal and neurological symptoms; however, cardiovascular involvement is not widely reported in the literature. We report a case of non-ST-segment elevation myocardial infarction (NSTEMI) as an initial manifestation of TTP. Although rare, TTP complications must be considered among other possible causes of unexpected thrombocytopenia during acute phase treatment of acute coronary syndrome because of high morbidity and mortality.

Artificial intelligence in pancreatic cancer: diagnosis, limitations, and the future prospects-a narrative review

PURPOSE

This review aims to explore the role of AI in the application of pancreatic cancer management and make recommendations to minimize the impact of the limitations to provide further benefits from AI use in the future.

METHODS

A comprehensive review of the literature was conducted using a combination of MeSH keywords, including "Artificial intelligence", "Pancreatic cancer", "Diagnosis", and "Limitations".

RESULTS

The beneficial implications of AI in the detection of biomarkers, diagnosis, and prognosis of pancreatic cancer have been explored. In addition, current drawbacks of AI use have been divided into subcategories encompassing statistical, training, and knowledge limitations; data handling, ethical and medicolegal aspects; and clinical integration and implementation.

CONCLUSION

Artificial intelligence (AI) refers to computational machine systems that accomplish a set of given tasks by imitating human intelligence in an exponential learning pattern. AI in gastrointestinal oncology has continued to provide significant advancements in the clinical, molecular, and radiological diagnosis and intervention techniques required to improve the prognosis of many gastrointestinal cancer types, particularly pancreatic cancer.