ASIDE Journals (American Society for Inclusion, Diversity, and Equity in Healthcare)
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Human Readers versus AI-Based Systems in ASPECTS Scoring for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis with Region-Specific Guidance
Get PDFIntroduction: The Alberta Stroke Program Early CT Score (ASPECTS) is widely used to evaluate early ischemic changes and guide thrombectomy decisions in acute stroke patients. However, significant interobserver variability in manual ASPECTS assessment presents a challenge. Recent advances in artificial intelligence have enabled the development of automated ASPECTS scoring systems; however, their comparative performance against expert interpretation remains insufficiently studied.
Methods: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. We searched multiple scientific databases for studies comparing automated and manual ASPECTS on Non-Contrast Computed Tomography (NCCT). Interobserver reliability was assessed using pooled interclass correlation coefficients (ICCs). Subgroup analyses were made using software types, reference standards, time windows, and computed tomography-based factors.
Results: Eleven studies with a total of 1,976 patients were included. Automated ASPECTS demonstrated good reliability against reference standards (ICC: 0.72), comparable to expert readings (ICC: 0.62). RAPID ASPECTS performed highest (ICC: 0.86), especially for high-stakes decision-making. AI advantages were most significant with thin-slice CT (≤2.5mm; +0.16), intermediate time windows (120-240min; +0.16), and higher NIHSS scores (p=0.026).
Conclusion: AI-driven ASPECTS systems perform comparably or even better in some cases than human readers in detecting early ischemic changes, especially in specific scenarios. Strategic utilization focusing on high-impact scenarios and region-specific performance patterns offers better diagnostic accuracy, reduced interpretation times, and better and wiser treatment selection in acute stroke care
Efficacy and Safety of Penehyclidine Hydrochloride in Postoperative Nausea and Vomiting Prevention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Get PDFIntroduction: Postoperative nausea and vomiting (PONV) is a common complication following anesthesia. Penehyclidine hydrochloride (PHC), an anticholinergic medication, selectively inhibits the M1 Muscarinic and M3 Muscarinic receptors involved in the nausea and vomiting pathways. This study aims to evaluate the efficacy of PHC in preventing PONV and its potential advantages over existing treatments.
Methods: This study investigated the efficacy and safety of PHC in preventing PONV by analyzing randomized controlled trials (RCTs) identified through a comprehensive search of the PubMed, Scopus, Web of Science, and Cochrane Library databases up to December 2024.
Results: Five RCTs involving 979 patients were included. Compared to the control group, PHC reduced the incidence of PONV in the first 24-72 hours after surgery (RR: 0.64, 95% CI [0.50, 0.82], p = 0.0004) and the requirement of rescue antiemetics (RR: 0.46, 95% CI [0.22, 0.96], p = 0.04). However, PHC significantly increased the incidence of dry mouth (RR: 2.64, 95% CI [1.98, 3.5], p < 0.00001). No significant differences were observed between the two groups regarding other secondary outcomes. Risk of bias assessment was done using RoB2.
Conclusions: PHC shows promising efficacy in reducing PONV and the need for antiemetic medications. Further large-scale RCTs are necessary to verify these results and determine the optimal dose
Efficacy and Safety of Tofacitinib in Pediatric Ulcerative Colitis Patients: A Systematic Review
Get PDFIntroduction: Ulcerative colitis (UC), an inflammatory Bowel Disease (IBD), is a chronic illness of unknown mechanism affecting the colonic mucosa, mainly causing diarrhea and bleeding. It can potentially disrupt the quality of life. Tofacitinib, a Janus Kinase inhibitor, showed a promising effect in inducing remission in IBD patients. In this study, we aim to assess the efficacy and safety of Tofacitinib in treating children with ulcerative colitis.
Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA), we searched four electronic databases (PubMed, Scopus, Cochrane Library, Embase, and Web of Science) to identify eligible studies reported up to July 2024. We reported outcomes as frequencies and proportions in our study.
Results: We identified five studies encompassing 83 children diagnosed with IBD, of which 57 children had ulcerative colitis. The proportion of patients achieving a clinical response across one included study was 66.67%. The proportion of patients achieving clinical remission was 38.46%. Also, the proportion of patients achieving steroid-free remission across the three studies was 48.57%. The rate for serious adverse events was 25.53% across the three included studies.
Conclusion: Tofacitinib could be useful in achieving clinical remission in children with UC and reducing colectomy rates. Also, a low infection rate and the incidence of serious adverse events were observed. Future randomized controlled trials with larger samples and longer follow-up periods are needed to support these findings
Acute Myeloid Leukemia Presenting as Bilateral Proptosis: A Case Report with Literature Review
Get PDFIntroduction: Acute myeloid leukemia (AML), constituting 30% of pediatric malignancies, is the most common childhood cancer. This paper explores the rare presentation of AML with extramedullary involvement, specifically bilateral proptosis, in a 15-year-old boy.
Case report: The patient initially presented with worsening shortness of breath, palpitations, extreme fatigue, and bruising. Examination revealed bilateral proptosis, watery discharge from the right eye, and petechial rash. Blood investigations revealed low hemoglobin, severe thrombocytopenia, and high WBC count. Computed tomography (CT) revealed bilateral orbital infiltrative soft tissue lesions. Leukemia fusion gene screening identified RUNX1-RUNX1T1 later. The patient was admitted, received transfusions, and started on antibiotics. Despite initial improvement, he later developed sepsis, septic shock, and severe pancytopenia, necessitating intensive care and specific AML M2 targeting therapy.
Conclusion: Bilateral proptosis in AML, termed myeloid sarcoma (MS), is rare but responsive to chemotherapy. Orbital MS has higher responsiveness and survival rates in pediatric cases. The case highlights the importance of identifying AML subtypes, like RUNX1-RUNX1T1-positive AML, for tailored treatment strategies. This case underscores the challenges in diagnosing and treating pediatric AML with extramedullary involvement. Early recognition of AML subtypes is crucial for prognosis prediction and treatment tailoring
Alternative Gastrointestinal Conditions Identified in Patients Meeting Rome IV Criteria for Irritable Bowel Syndrome or Functional Diarrhea Referred to Secondary Care: A Prospective Study
Get PDFIntroduction: Organic gastrointestinal (GI) disorders can be missed in individuals with irritable bowel syndrome (IBS). This study investigated the frequency of organic disorders in patients with diarrhea-predominant IBS or functional diarrhea and the impact of treatment for any identified alternative diagnoses.
Methods: Between April 2019 and March 2020, the results of comprehensive investigations, including blood and fecal tests, a 75selenium homophobic acid taurine scan, a breath test, and endoscopies performed on consecutive eligible patients, were recorded. Symptom burden was reassessed after treatment for any GI conditions identified.
Results: 66 (15 males) consecutive patients were included. Two patients (3%) were diagnosed with colonic malignancy; 21 (38%) had bile acid diarrhea; one (1%) had pancreatic exocrine insufficiency; and 31 (54%) had small intestinal bacterial overgrowth. 21 patients (32%) had at least two GI diagnoses. Significant improvement in symptoms occurred following treatment (p<0.0001).
Conclusions: Multiple co-existing conditions were detected in many of these patients, with one-third of the cohort having more than one abnormal test. When these alternative diagnoses were treated, patients reported significant symptomatic improvement. Larger studies are required to validate our findings, and these patients\u27 investigative and management pathways should be amended accordingly
Pancreatic Rest Complicated by Actinomyces Gastric Abscess in a Young Male: A Case Report
Get PDFPancreatic rest, or ectopic pancreatic tissue, is a rare condition. It is characterized by pancreatic tissue outside its usual location, most commonly in the gastric antrum or proximal small intestine. We present a rare case of a 21-year-old male with recurrent epigastric pain, vomiting, and fever. Imaging and endoscopic ultrasound (EUS) identified a subepithelial lesion with features consistent with pancreatic rest. Subsequent fine-needle aspiration (FNA) grew Actinomyces and Streptococcus. Given persistent symptoms and incomplete resolution despite prolonged antibiotics, he underwent partial gastrectomy. This case highlights an unusual infectious complication of pancreatic rest with Actinomyces and underscores the need to consider surgical intervention in cases refractory to medical therapy
Lifestyle Practices in Reducing Cardiovascular Diseases: A Prospective Cohort Study from Pakistan
Get PDFBackground: Cardiovascular diseases (CVD) remain the leading cause of global mortality, especially in individuals with comorbidities like type II diabetes and hypertension. While pharmacological therapies are vital, lifestyle interventions may offer additional benefits in reducing CVD risk. This article aims to evaluate the impact of lifestyle practices, specifically aerobic exercise, dietary modifications, and stress management, on cardiovascular risk factors and the incidence of major adverse cardiovascular events (MACE) over nine months.
Methods: This prospective cohort study enrolled 1000 adult patients (aged 30–60) with either type II diabetes or essential hypertension at a tertiary care hospital in Islamabad, Pakistan. Participants were categorized into two groups based on lifestyle adherence: (1) the exposed group, comprising individuals who regularly engaged in aerobic exercise and received dietary and psychological counseling, and (2) the non-exposed group, who did not adopt such practices. Baseline and 9-month follow-up data were collected on BMI, blood pressure, lipid profile, HbA1c, and incidence of MACE.
Results: Participants in the exposed group demonstrated significantly greater reductions in BMI, systolic/diastolic blood pressure, LDL, and HbA1c, and significantly higher increases in HDL (p<0.01). MACE incidence was 0.4\% in the exposed group versus 4.8\% in the non-exposed group. Correlation analysis showed significant associations between BMI, blood pressure, HbA1c, lipid levels, and MACE.
Conclusion: Combining lifestyle interventions with pharmacologic therapy can significantly improve cardiovascular outcomes in high-risk patients. Our findings support integrating structured lifestyle counseling into routine care for patients with diabetes or hypertension
Twenty-Five Years of Angina–Related Mortality in Elderly Adults Aged ≥ 65 Years: A Retrospective Cohort Study Using Real-World Data from the USA
Get PDFIntroduction: Angina is one of the ischemic heart diseases (IHD) that contributes to major cardiovascular complications up to death. We aim to assess angina-related mortality among adults aged ≥65 years in the U.S.
Methods: Nationwide mortality records were obtained from the CDC-WONDER database from 1999 to 2023 among U.S. adults aged ≥65 with angina. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population. Joinpoint regression analysis was utilized to evaluate average annual percent changes (AAPCs).
Results: From 1999 to 2023, a total of 36,544 deaths occurred among the elderly with angina in the U.S. The overall AAMR per 100,000 decreased from 7.52 in 1999 to 3.73 in 2023 (AAPC of -3.18; 95%CI: -3.79 to -2.75; p < 0.001). The AAMR for men decreased from 8.22 in 1999 to 4.75 in 2023 (AAPC of -2.53%; 95%CI: -3.02 to -2.09), and for women decreased from 6.95 in 1999 to 3.02 in 2023 (AAPC: -3.55%; 95%CI: -4.12 to -3.09). Across racial/ethnic groups, the highest overall rates were observed among NH-White individuals, 3.56. Overall, AAMRs were highest in the West, 4.00. The majority of deaths occurred in medical facilities (40.19%). Between 1999 and 2020, rural areas had a higher overall AAMR of 4.37 compared to urban areas, which had a rate of 3.02.
Conclusion: Trends in angina-related mortality declined from 1999 to 2023. Higher mortality rates were observed in men, rural areas, the West region, and among NH White individuals. Our findings indicated that these categories require targeted interventions to reduce mortality
Multimodal Conservative Management of Nulliparous Female with Cervical Ectopic Pregnancy: A Case Report
Get PDFCervical ectopic pregnancy is an extremely rare condition with catastrophic sequelae if timely, appropriate management is not performed. Some risk factors predispose patients to this condition, but in our case, no predisposing risk factors were present. Nulliparity and young age are the most challenging points for fertility conservation, and multimodal conservative management is a highly successful option for appropriately selected patients.
A 22-year-old nulliparous patient presented to our tertiary university hospital for a viable 8-week cervical ectopic pregnancy after failure of treatment with two doses of methotrexate. Confirmation of the diagnosis was achieved, and our team selected a multimodal conservative management approach. During admission, severe bleeding was recognized early on, and the patient was successfully handled with satisfactory fertility preservation outcomes.
Fertility preservation is the most challenging point when dealing with cervical ectopic pregnancy, especially in young nulliparous women. However, the best way to manage cervical ectopic pregnancy has not yet been confirmed, and multimodal conservative management can be an effective method
Extrapelvic Endometriosis of the Rectus Abdominis Muscle After Cesarean Section: A Case Report
Get PDFAbdominal wall endometriosis is an uncommon form of extra-pelvic endometriosis that typically develops in association with prior uterine surgery, particularly cesarean delivery. Among its variants, isolated involvement of the rectus abdominis muscle is exceedingly rare and may mimic other postoperative abdominal wall pathologies, resulting in delayed diagnosis.
We report the case of a 28-year-old woman presenting with cyclic pain localized to the right lower abdomen, three years after a cesarean section. Magnetic resonance imaging revealed a 2 × 2 × 1.5 cm lesion within the right rectus abdominis muscle, showing signal characteristics suggestive of endometriosis. The lesion was completely excised through a Pfannenstiel incision with approximately 1 cm of healthy tissue margin, and no mesh reconstruction was required. Histopathological examination confirmed the diagnosis of endometriosis, showing endometrial glands and stroma within skeletal muscle fibers. The postoperative course was uneventful, and the patient remained symptom-free during 12 months of follow-up.
This case emphasizes the need to suspect abdominal wall endometriosis in post-cesarean patients presenting with cyclic pain and a palpable abdominal wall nodule near the surgical scar. Early recognition and complete surgical excision with clear margins are essential to ensure accurate diagnosis and prevent recurrence