ASIDE Journals (American Society for Inclusion, Diversity, and Equity in Healthcare)
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Volvulus of Left Descending Colon: A Case Report and Systematic Review
Get PDFColonic volvulus has been described as the third most common cause of intestinal obstruction worldwide, with sigmoid volvulus representing more than 70% of all colonic volvulus. The descending colon is an atypical location for volvulus, with only a few documented cases in the literature. We report a case of non-viable left descending colon volvulus managed with left hemicolectomy in a 64-year-old male with no previous history of colorectal surgery. In addition, we conducted a systemic review of the literature for case reports of descending colon volvulus. We searched PubMed, Scopus, and Web of Science until November 2024 using the following search terms: (Volvulus AND “descending colon”). We extracted and summarized relevant data to better understand our case, and how it compares to previously documented reports. Our search yielded seven case reports that met our inclusion criteria. Our population consisted of four males and three females, with a mean age of 49.5 years and a range of (15 to 86) years. Most of our population was over the age of 30 (5/7). The most reported symptoms were abdominal distension, colicky or cramping abdominal pain, and vomiting. Left-sided colon volvulus is a rare cause of large bowel obstruction with variable and often atypical presentations, posing diagnostic challenges. Future research should investigate anatomical and clinical predictors of volvulus, optimize imaging modalities for early diagnosis, and evaluate long-term outcomes of various surgical approaches
Esophageal Stenting and Endoscopic Vacuum Therapy for Esophageal Defects: A Systematic Review and Meta-Analysis
Get PDFBackground: Spontaneous esophageal perforation, particularly Boerhaave syndrome, is a life-threatening condition associated with high morbidity and mortality. Traditional surgical management is increasingly being supplemented by minimally invasive approaches, including esophageal stenting and endoscopic vacuum therapy (EVT). However, the optimal treatment strategy remains debated due to variations in reported outcomes and the lack of randomized controlled trials. This systematic review and meta-analysis aim to evaluate the efficacy and safety of esophageal stenting and EVT in managing esophageal defects by specifically assessing sealing rates, failure rates, and mortality.
Methods: A comprehensive literature search was conducted in PubMed, Scopus, and the Cochrane Library up to March 24, 2025. Only observational studies and case series were included. The primary outcomes were the pooled sealing rate, failure rate, and mortality for esophageal stenting, and the closure rate for EVT. Data were analyzed using a random-effects model, and heterogeneity was assessed using the I² statistic.
Results: Fourteen studies on esophageal stenting demonstrated a pooled sealing rate of 86.1% (95% CI: 80.2–92.0%) with a failure rate of 14.9% (95% CI: 8.5–21.3%). Mortality associated with stenting was 7.4% (95% CI: 3.5–11.4%). EVT studies reported a closure rate ranging from 80% to 94%.
Conclusion: Both esophageal stenting and EVT show high efficacy in sealing esophageal defects. Although EVT exhibits promising closure rates, further comparative studies are needed to establish definitive treatment guidelines
Bridging the Gap: Addressing Language Barriers to Advance Equity in Internal Medicine
Get PDFLanguage barriers in healthcare are a persistent challenge that disproportionately affect patients with limited English proficiency (LEP), contributing to disparities in care, poor health outcomes, and patient dissatisfaction. In internal medicine, where effective communication is essential for diagnosis, management, and chronic disease follow-up, these barriers hinder quality and equity. This review synthesizes the current evidence on the impact of language discordance in internal medicine, explores effective mitigation strategies including interpreter services, culturally competent care, and technological tools and offers policy and practice recommendations to promote equitable healthcare delivery
Evaluating Biliary Complications in Jaundiced Patients with Alcohol-Related Hepatitis: A Retrospective Study
Get PDFIntroduction: This study aims to differentiate whether jaundice in patients with alcoholic hepatitis (AH) is due to alcohol-related liver disease or underlying biliary pathology, including choledocholithiasis, primary sclerosing cholangitis, primary biliary cholangitis, benign strictures, cholangiocarcinoma, or pancreatic cancer. Accurate differentiation is crucial for appropriate treatment decisions.
Methods: A non-interventional retrospective study examined patients admitted to our institute for presumed alcohol-related hepatitis management from 2016 to 2023. The primary outcome was the occurrence of biliary processes, whether benign or malignant, in patients managed for alcohol-related hepatitis within 90 days. Secondary outcomes assessed bilirubin level trends over seven days to evaluate steroid effects on alcohol-related hepatitis and predict underlying biliary processes. Variables were analyzed using bivariate and multivariate logistic regression with biliary process as the dependent variable.
Results: Our study revealed that patients with alcohol-related hepatitis and jaundice who had dilated common bile duct (CBD) or pancreatic duct (PD) on cross-sectional imaging were more likely to have biliary processes regardless of cholecystectomy history p-value 0.007 (CI 0.03-0.242) OR 7.5 and p-value 0.001 (CI 0.58-1.34), OR 1.2 respectively. However, there was no correlation between biliary process incidence and various demographic or clinical factors.
Conclusion: Cross-sectional imaging should be routinely used to evaluate biliary tree conditions in alcohol-related hepatitis patients with jaundice who have dilated CBD, particularly those with previous cholecystectomy or gallstones on imaging studies. This systematic approach enables early identification of underlying biliary issues and facilitates prompt, appropriate management decisions
Benign Pheochromocytoma Coming Back with Bony Metastasis: A Case Report and Literature Review
Get PDFPheochromocytoma is an uncommon adrenal medulla tumor that secretes catecholamines. It is usually a benign condition and is generally treated with adrenalectomy; in a small proportion of cases, however, it might return or spread. Pheochromocytoma is uncommon to recur or metastasize, meaning every reported case is clinically relevant.
A 46-year-old Caucasian woman initially presented with conventional catecholamine excess symptoms—refractory hypertension, palpitations, diaphoresis, and headaches. Imaging showed a sizable right adrenal mass; biochemical testing indicated very high plasma metanephrines. A medical decision was made to perform a right adrenalectomy; pathology confirmed a benign pheochromocytoma. After surgery, her symptoms went away, but she was missed for follow-up. Four years later, she came back with comparable symptoms; biochemical screening found increased metanephrines once more, and a computed tomography (CT) scan revealed local recurrence in the right adrenal bed. Notably, the CT also disclosed a lytic lesion in a lumbar vertebra and evidence of bone metastases from the pheochromocytoma. This instance highlights a rare situation in which a pheochromocytoma, initially thought to be innocuous, reoccurred with distant skeletal involvement.
In conclusion, a very rare, recurrent pheochromocytoma with bone metastases underscores the importance of continuous monitoring even after complete tumor removal. Early recognition of metastasis or relapse can significantly impact therapy and outcomes. This case highlights the necessity of ongoing follow-up in patients with pheochromocytoma and alerts individuals to potential late metastatic symptoms
Autism Spectrum Disorder in a Rural Pakistani Child with a History of Early Excessive Screen Exposure: A Case Report
Get PDFDeficits in communication, social interaction, and behavior mark autism spectrum disorder (ASD). In low-resource settings, diagnostic delays and excessive early screening exposure complicate clinical profiles and access to therapy. We present a 7-year-old female from a rural community in Pakistan who presents with profound regression in speech, social interaction, and adaptive behavior. A child psychiatrist used DSM-5 criteria to diagnose ASD, which should be regarded as a working clinical impression. The child had no prior family history of neurodevelopmental disorders. Still, beginning in infancy, the patient had a history of extended unsupervised mobile screen exposure (3–5 hours/day of animated content). Symptoms included echolalia, idiosyncratic language, violence toward animals and peers without remorse, toileting difficulties, and emotional detachment. Carers reported fewer violent outbursts (from daily to 1-2/week) and better sleep (from 3-4 to 6-7 hours/night). Over the course of six months, risperidone (up to 1 mg/day) and carbamazepine (200 mg/day) partially improved aggression (from daily to 1-2 times/week) and sleep (from 3 to 7 hours/night), but social and language impairments remained. There were confounding variables, such as low socioeconomic position, and no standardized developmental assessments were conducted. This single case suggests that excessive early screen time may be associated with or modulate neurodevelopment. Due to the dearth of research and the absence of standardized ASD tests, it is not possible to conclude on screen time. This case illustrates gaps in ASD diagnosis and management and emphasizes the need for awareness campaigns, low-cost therapies, and culturally contextualized interventions
Usage of Trapezoid RX Wire Guided Retrieval Basket with the Alliance™ II Inflation Handle for Treatment of Bouveret Syndrome: A Rare Clinical Entity
Get PDFBouveret Syndrome is an infrequent manifestation of gallstone disease, causing gastric outlet obstruction. This syndrome has diagnostic and therapeutic challenges due to its rarity and non-specific clinical presentation. Here, we present a case report involving a 78-year-old female patient who experienced gastric outlet blockage due to the presence of a sizable gallstone. A novel technique was applied wherein a trapezoid RX wire-guided retrieval basket (Boston Scientific) was utilized with Esophagogastroduodenoscopy to remove the stone without the need for surgical intervention. Post-procedure monitoring demonstrated a smooth recovery with immediate relief of symptoms. Imaging confirmed the absence of residual gallstones or obstruction
Management of Venous Thromboembolism in a Patient with Duplicated Inferior Vena Cava: A Case Report and Literature Review
Get PDFAnatomic variations of the inferior vena cava (IVC) are rare, occurring in less than 3% of the population, yet they can pose significant clinical and procedural challenges. We report the case of a 68-year-old male with a contraindication to anticoagulation due to gastrointestinal bleeding, in whom IVC filter placement was indicated for pulmonary embolism prophylaxis. During intra-procedural venography, the patient was found to have a duplicated inferior vena cava (DIVC), a rare vascular anomaly. Bilateral Denali filters were successfully deployed in both IVC limbs to ensure complete thromboembolic protection. This patient remains clinically stable at three-year follow-up with no recurrence of thromboembolism or filter-related complications. This case highlights the placement of bilateral filters in patients with DIVCs that do not converge below the renal veins. Recognizing this was crucial to ensure effective filter placement and avoid incomplete protection against embolism. This case underscores the importance of evaluating venous anomalies prior to interventional procedures involving the IVC. Failure to recognize such variations can lead to technical difficulties, procedural delays, or suboptimal outcomes, including persistent or recurrent thromboembolism. We also review the types of IVC anomalies, their embryology, and some of the potential complications they may cause. Careful procedural planning is essential for optimal patient management
Challenges and Infectious Complications in Living Donor Liver Transplantation in Egypt: A Comprehensive Review
Get PDFBackground: Living donor liver transplantation (LDLT) is a crucial therapeutic option for patients with end-stage liver disease in Egypt, where deceased donor grafts are scarce. This study aims to investigate the challenges and infectious complications associated with LDLT in Egypt.
Methods: A comprehensive review of relevant literature was conducted, focusing on factors affecting donor selection, the prevalence of infections in recipients, and the impact of healthcare providers\u27 knowledge on organ donation. The study included data on complications affecting donors and recipients in the context of LDLT.
Results: The high prevalence of the hepatitis C virus and poverty in Egypt negatively impact the live donor pool. Lack of knowledge about liver donation, inadequate media coverage, and family pressure contribute to the low number of liver donors. Infectious complications play a significant role in the outcomes of LDLT, with bacterial infections being the most common. Donors also experience complications, with intraabdominal collections and pneumonia being the most frequent. Healthcare providers\u27 knowledge and attitudes toward organ donation need improvement, and educational efforts should be tailored to the cultural and religious context.
Conclusion: Addressing the challenges in donor selection, raising public awareness about organ donation, and improving healthcare providers\u27 knowledge are essential steps toward optimizing LDLT outcomes in Egypt. Moreover, it is crucial to monitor and manage infectious complications in both donors and recipients to ensure the success of the transplantation process
Potential Use of Icosapent Ethyl in the Management of Acute Pancreatitis
Get PDFDear Editor,
We are writing to highlight the potential use of Icosapent Ethyl (Vascepa) as a management option for acute pancreatitis. To the best of my knowledge, a limited number of studies have investigated this use, but it is not yet Food and Drug Administration (FDA) approved for this indication.
Previous studies have suggested that omega-3 fatty acids, such as Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA), may have anti-inflammatory properties and could potentially be beneficial in reducing the inflammation and triglyceride levels associated with acute pancreatitis [1]. These mechanisms consist of systemic inflammation reduction by the inhibition of inflammatory mediators since omega-3 fatty acids inhibit the synthesis of pro-inflammatory cytokines such as IL-1β and IL-6 [2]. Moreover, they alter intracellular signaling pathways linked to transcription factors such as nuclear factor-κB, which impacts the expression of genes linked to inflammation [3]. Surprisingly, it helped with inflammation resolution by enhancing the removal of inflammatory cells and promoting the production of certain pro-resolving mediators in mice with pancreatitis [4].
EPA may serve as a valuable dietary supplement for individuals with risk factors for heart disease. It has potential benefits for conditions such as cardiovascular disease, diabetes, obesity, cancer, and stroke. EPA has been shown to lower inflammation, cholesterol, blood pressure, and blood clotting, and improve coronary artery function. Additionally, it can reduce inflammation and enhance body composition, supporting weight loss efforts [5].
A case study reported the use of Icosapent Ethyl as a treatment for severe acute pancreatitis in a 31-year-old male patient with abrupt acute alcoholic pancreatitis, requiring ICU admission, intubation, and mechanical ventilation, renal replacement therapy, and pressors; the patient showed remarkable improvement after initiation of icosapent Ethyl treatment via gastrostomy tube (G-tube) and had a complete recovery [1].
A randomized clinical trial (RCT) by Wang (2008) investigated the impact of omega-3 fatty acid supplementation on inflammation and systemic disease progression in severe acute pancreatitis. 40 patients with severe acute pancreatitis were randomly assigned to receive parenteral nutrition with either soybean oil or fish oil. Results revealed that patients who received fish oil had higher levels of EPA, reduced C-reactive protein (CRP) levels, and improved oxygenation index after five days of treatment. Additionally, the fish oil group had a shorter duration of continuous renal replacement therapy compared to the control group. The study concludes that supplementing parenteral nutrition with omega-3 fatty acids can effectively decrease inflammation, enhance respiratory function, and reduce the need for Continuous Renal Replacement Therapy (CRRT) in severe acute pancreatitis [6].
Currently, treatment options for acute pancreatitis caused by hypertriglyceridemia are limited as there are no FDA-approved options for intractable hyperchylomicronemia. Lifestyle modifications, such as weight loss and dietary intake limitations, are essential in treating patients with hypertriglyceridemia [7].
However, these findings suggest that Vascepa may be a breakthrough therapy for severe acute pancreatitis due to its anti-inflammatory activity and the absence of direct therapy for the disease. More research including RCTs is needed to confirm the safety and efficacy of Vascepa as a management option for acute pancreatitis