ASIDE Journals (American Society for Inclusion, Diversity, and Equity in Healthcare)
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Efficacy and Safety of Optic Nerve Sheath Fenestration for Idiopathic Intracranial Hypertension: A Subgroup-Focused Systematic Review and Meta-Analysis
Get PDFIntroduction: Optic nerve sheath fenestration (ONSF) is an important surgical management option for patients with idiopathic intracranial hypertension (IIH) who have failed medical treatment. We conducted a systematic review and meta-analysis to evaluate the outcomes of ONSF and identify factors affecting treatment success.
Methods: A literature search was conducted up to December 2024. Primary outcomes included improvement in visual acuity, visual fields, and optic disc swelling resolution. We performed a detailed subgroup analysis based on geographic location, study design, surgical approach, and technical variations.
Results: Nineteen studies with a total of 1,159 patients were included in our study. ONSF significantly improved visual acuity in 34.5% (95% CI: 31.8-37.3%) and visual fields in 69.4% (95% CI: 65.9-72.7%) of cases. A 90.9% improvement rate was observed in reducing optic disc swelling. Significant heterogeneity was noted in visual acuity (I²=92.1%) and visual field improvements (I²=73.8%). The overall complication rate was 9% (95% CI: 5-16%). Centers that included 30 or more patients in their study demonstrated significantly lower postoperative complications.
Conclusions: ONSF demonstrates favorable efficacy in improving visual outcomes with an acceptable safety profile, lower postoperative complications were observed when the procedure was performed in high-volume centers using appropriate surgical techniques. Geographic variations and surgical approaches significantly affected outcomes, highlighting the importance of standardized protocols and adequate surgical experience. Future prospective studies with standardized outcome measures are needed to optimize patient selection and surgical techniques
A Comprehensive Review of Fluid Resuscitation Techniques in Sepsis in Patients with Heart Failure
Get PDFIntroduction: Fluid management in sepsis patients with pre-existing heart failure presents a complex clinical challenge, as these patients require adequate resuscitation while avoiding fluid overload that could worsen cardiac function. This article aims to explore optimal fluid resuscitation strategies for patients with pre-existing heart failure who develop sepsis, a group at high risk for fluid management complications.
Methods: We conducted a narrative review of studies published between 2010 and 2024, utilizing PubMed, ScienceDirect, and Google Scholar. We employed Boolean formulas and search terms that evolved from broad to specific, refining the focus on fluid resuscitation in septic heart failure patients. Human studies focusing on fluid resuscitation, sepsis management, and outcomes in heart failure were included. Exclusion criteria included animal studies, non-English articles, and case reports.
Results: Guideline-recommended fluid resuscitation (≥30 mL/kg within 3 hours) shows a neutral or positive effect on mortality in sepsis patients with pre-existing heart failure when monitored appropriately. Patients with reduced ejection fraction (HFrEF) and those with preserved ejection fraction (HFpEF) exhibit different tolerances to fluids. Advanced hemodynamic monitoring — including bedside echocardiography, lactate clearance, central venous pressure, and BNP levels — is essential for personalizing fluid therapy.
Conclusion: Early guideline-compliant fluid resuscitation followed by a conservative, individualized fluid strategy guided by hemodynamic monitoring optimizes outcomes in sepsis patients with heart failure. Future prospective studies are needed to develop standardized protocols
Probiotics: A Promising Ally in Burn Treatment
Get PDFThis review explores the potential therapeutic benefits of probiotics in the treatment of burn injuries, with the aim of addressing the limitations of traditional therapeutic approaches. It offers a comprehensive analysis of burn pathophysiology, including a wide range of burn forms and the biological reactions they induce, such as pain, inflammation, fluid imbalance, and metabolic alterations. It also specifically explains the mechanisms by which probiotics contribute to the improved healing of wounds and modified gut microbiota, as they are particularly effective in these two directions. This study looks at the ways probiotic treatment can facilitate the regeneration of the skin, which is crucial for accelerating burn recovery . Furthermore, it examines the barriers and limits of probiotic therapy, such as strain regularity and safety issues in immunocompromised patients, while emphasizing the interdependent benefits of probiotics and nutrition in promoting burn healing. This review highlights the advantages of probiotics in burn management and their potential as an adjuvant therapy for enhancing treatment results and patient well-being in the burn care context
Dual association of autoimmune encephalitis with anti-NMDAR and anti-GAD65 antibodies: A Case Report with Literature Review
Get PDFAnti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is the most common type of autoimmune encephalitis, whereas anti-glutamic acid decarboxylase 65 (antiGAD65) encephalitis is a rare autoimmune condition. The coexistence of these two conditions has been rarely reported. In this article, we will discuss this rare association through a case report and attempt to determine its main characteristics. We report the case of an 18-year-old male with no medical history, admitted to the medical Intensive Care Unit (ICU) with a decreased level of consciousness, bizarre behavior, and abnormal movements for one week. These symptoms followed the progression of initial signs such as delirium, which had begun two months earlier. Laboratory analysis revealed an inflammatory syndrome with rhabdomyolysis. Cerebral angio-MRI findings were unremarkable. The electroencephalogram (EEG) showed slow, non-reactive activity. Cerebrospinal fluid (CSF) analysis and infectious studies were normal. However, immunological testing using the immunofluorescence technique revealed the presence of anti-NMDAR antibodies in both serum and CSF, as well as anti-GAD65 antibodies in the serum. The positron emission tomography (PET) scan screening for neoplasm was negative. Therapeutically, the patient was treated with anticonvulsants, antipsychotics, intravenous immunoglobulins, corticosteroids, plasma exchanges, cyclophosphamide, and rituximab. Consequently, he demonstrated a remarkable gradual clinical improvement. This case highlights an aspect of autoimmune dysregulation that may lead to atypical and severe clinical presentations. The co-occurrence of anti-NMDAR and anti-GAD65 encephalitis is a rare condition that can lead to severe manifestations. Early diagnosis using a broad antibody panel facilitates timely and appropriate management
Annular Pancreas in Adults Presenting as Chronic Pancreatitis and Duodenal Obstruction: Literature Review and a Case Report
Get PDFBackground: Annular pancreas is a rare congenital anomaly with an estimated incidence of 3.4 per 1,00,000 live births. It is more commonly diagnosed in infants. Its occurrence in adults is exceptionally rare but clinically significant, as seen in our case, where it presented as a duodenal obstruction.
Case presentation: We present a case of an adult male who presented with a 3-week history of projectile bilious vomiting associated with postprandial abdominal pain and early satiety. Imaging studies revealed a segment of the pancreas encircling the second part of the duodenum, along with pancreatolithiasis. Based on the diagnosis of annular pancreas with chronic calcific pancreatitis, the patient underwent pylorus-preserving pancreatoduodenectomy.
Materials and Methods: A structured literature review was performed using PubMed and Scopus databases, covering the period from 2018 to 2024. A total of 24 case reports were analyzed.
Results: The review confirms that annular pancreas remains a rare condition, often undiagnosed in asymptomatic individuals with abdominal pain (83.3%) and vomiting (41.6%) as the most common symptoms. The most common diagnostic modality is the CT scan (computed tomography), at 64.1%, and surgical procedures, such as gastrojejunostomy, are the most common treatment modality, at 46.5%.
Conclusions: It is a rare congenital condition that usually remains undiagnosed in asymptomatic individuals but typically presents with abdominal pain and vomiting when symptomatic. Diagnosis relies primarily on CT imaging. Conservative management is preferred for asymptomatic cases, and surgery is for symptomatic patients. Further research is needed to develop standardized management protocols
Migraine Headache in Patients with Allergic Rhinitis: A Systematic Review and Meta-Analysis of Observational Studies
Get PDFBackground: Migraine is a condition characterized by recurrent episodes of unilateral headache. Allergic rhinitis (AR) is an IgE-mediated inflammatory condition of the nasal mucosa that is triggered by exposure to allergens. Migraine and AR may share underlying immunological mechanisms, including histamine release and mast cell activation. Despite the growing interest in the immunological interplay between allergic conditions and neurological symptoms, the specific relationship between AR and migraine remains underexplored.
Methods: PubMed, Scopus, and Web of Science were systematically searched to identify relevant studies. Pooled odds ratio (OR) and pooled risk ratio (RR) were calculated with 95% confidence intervals (CI) using a random-effects model. The Newcastle-Ottawa Scale (NOS) was used for quality assessment. Heterogeneity assessment and subgroup analysis were also performed.
Results: Eleven studies involving 4,704,591 participants were included. The pooled OR for migraine in individuals with AR was 2.94 (95% CI: 2.02–4.29; p < 0.0001; I² = 95.62%). The pooled RR from two cohort studies was 2.27 (95% CI: 1.10–4.65; p = 0.026; I² = 99.72%). Subgroup analysis revealed significant differences in the pooled OR regarding the source of individuals with AR and the method of AR assessment, with a higher pooled OR in hospital patients (OR = 7.32) and when using skin tests (OR =6.93), respectively.
Conclusion: Migraine headaches are significantly associated with AR, particularly in hospital settings and when objectivemethodsareusedforARdiagnosis.Thefindingsofthisstudyshouldbeinterpreted cautiously owing to the high heterogeneity
Improving Inpatient Care for Acute Chronic Obstructive Pulmonary Disease Exacerbations: A Quality Improvement Initiative
Get PDFBackground: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) account for high hospital use; guideline-concordant diagnostics, oxygen titration, and discharge planning are often under-delivered. We aim to measure baseline compliance with eight AECOPD process standards and evaluate whether EHR-embedded prompts plus staff education were associated with observed improvements.
Methods: We audited 50 consecutive adult admissions with primary AECOPD (ICD-10 J44.1 or clinician-documented diagnosis) between July and October 2024, implemented EHR prompts, an orderset, and targeted education (Nov–Dec 2024), then re-audited 50 consecutive admissions (Jan–Mar 2025) using identical methods. Primary process measures were pre-specified; analyses were descriptive with 95% Wilson confidence intervals (CIs) for proportions and two-sided Fisher exact tests for pre/post comparisons. This work was performed as a service evaluation/pilot.
Results: After implementation, six of eight process standards showed observed increases. Pulmonary rehabilitation referrals rose from 32/50 (64.0%, 95% CI 50.1–75.9%) to 43/50 (86.0%, 95% CI 73.8–93.0%), p = 0.0198. Oxygen titration improved from 40/50 (80.0%, 95% CI 66.0–88.6%) to 46/50 (92.0%, 95% CI 78.6–95.7%), p = 0.148. Other measures (ABG timing, bronchodilator and corticosteroid delivery, appropriate antibiotic use, CXR timing, smoking advice) showed observed improvements; p-values and CIs are reported in the text.
Conclusions: Embedding guideline-aligned prompts and an orderset in the EHR, together with staff education, was associated with observed improvements in several AECOPD process measures in this pilot QI project. Findings should be interpreted cautiously, given the pilot design, multiple comparisons, and limited sample size; further controlled and longitudinal evaluation is indicated
Disparities and Trends in Polycythemia Vera–Related Mortality in U.S. Adults Aged ≥45 Years from 1999 to 2023
Get PDFBackground: Polycythemia vera (PV) is a rare myeloproliferative neoplasm characterized by excessive red blood cell production, leading to increased risk of thrombosis and other complications. Despite its clinical significance, trends in PV mortality across demographic groups in the US remain understudied.
Methods: Nationwide mortality records were obtained from the CDC-WONDER database from 1999 to 2023 among U.S. adults aged ≥45 with PV. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated for variables. Joinpoint regression analysis was utilized to evaluate annual percent changes (APCs).
Results: From 1999 to 2023, a total of 24,236 deaths occurred among adults with PV in the U.S. The overall AAMR decreased from 1.15 in 1999 to 0.73 in 2023 (AAPC: -1.96; 95% CI: -2.28 to -1.73; p < 0.001). The AAMR for men decreased from 1.38 in 1999 to 0.87 in 2023 (AAPC-1.88; 95% CI: -2.36 to -1.37; p < 0.001), and for women decreased from 1 in 1999 to 0.62 in 2023 (AAPC: -2.03; 95% CI: -2.66 to -1.43; p < 0.001). Across racial/ethnic groups, AAMR was highest in non-Hispanic White (0.93 per 100,000). Overall, AAMRs were highest in the Midwest (0.95). The majority of deaths occurred in medical facilities (39.36%). Rural areas had a higher overall AAMR (0.91) compared to urban areas (0.82).
Conclusion: Trends in (PV) mortality declined overall from 1999 to 2023—higher trends observed in men, rural areas, the Midwest region, and NH White
Gastrointestinal Non-Hodgkin Lymphoma: A Multifaceted Malady
Get PDFLymphomas account for approximately 5% of human malignancies and are classified as Hodgkin or non-Hodgkin variants. Non-Hodgkin lymphomas (NHL) constitute nearly 90% of all lymphomas, with diffuse large B-cell lymphoma (DLBCL) being the most prevalent histological subtype. Although primarily nodal, extranodal involvement is common in NHL, with the gastrointestinal (GI) tract being the most frequently involved extranodal site. Lymphomas constitute only 1–4% of gastrointestinal malignancies, with appendix being an exceedingly rare site of involvement. Lymphomas are conventionally staged utilizing the Ann-Arbor system and risk categorized per the International Prognostic Index (IPI). The Dawson’s criteria differentiate primary versus secondary gastrointestinal lymphoma. Diagnosis of lymphoma relies heavily on conventional and immune stained histopathology. Surgery offers the best therapeutic option in localized disease, while chemotherapy is preferred in diffuse or non-resectable diseases. We present a unique and an exceedingly uncommon combination of recurrent DLBCL with appendicular involvement, gastrointestinal hemorrhage, hepatic metastases, and obstructive jaundice. This case highlights the diagnostic challenges posed by extranodal lymphoma, particularly in rare sites such as the appendix. It underscores the critical role of multimodal imaging, endoscopic intervention, and immunohistochemical profiling in diagnosing, staging, and managing intraabdominal lymphomas
Ellis–van Creveld Syndrome with Common Atrium: A Clinically Diagnosed Case Report with Literature Review
Get PDFEllis-van Creveld (EVC) syndrome is a rare, autosomal recessive disorder defined by a classic tetrad of features: chondroectodermal dysplasia causing disproportionate short stature, postaxial polydactyly, ectodermal defects affecting the nails and teeth, and congenital heart disease. The most significant cause of morbidity and mortality is the associated cardiac anomaly, most commonly a large atrial septal defect resulting in a functional common atrium. Early and accurate diagnosis is critical for managing cardiovascular risk and implementing appropriate long-term care.
We report the case of a 12-year-old female from Pakistan, with a weight of 26 kg (BMI 18.8 kg/m²), who presented with a classic EVC phenotype. Clinical examination revealed short-limb dwarfism, bilateral postaxial polydactyly of all four limbs, genu valgum, and ectodermal dysplasia. Her parents were non-consanguineous. Cardiovascular evaluation confirmed a common atrium via echocardiography, with corresponding ECG findings of right axis deviation and an incomplete right bundle branch block. Based on this distinct constellation of clinical and imaging evidence, a clinical diagnosis was made, as molecular genetic testing was not available.
This case confirms the importance of recognizing the distinct clinical phenotype of Ellis-van Creveld syndrome. In settings where molecular diagnostics are unavailable, a confident diagnosis can be made through thorough clinical assessment. Prompt identification is paramount for initiating multidisciplinary management, thereby improving the patient\u27s long-term health and quality of life, with the patient currently awaiting surgical repair of her cardiac defect and referral for orthopedic and dental care