ASIDE Journals (American Society for Inclusion, Diversity, and Equity in Healthcare)
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Efficacy and Safety of Tislelizumab in Combination with Chemotherapy versus Placebo Plus Chemotherapy in Patients with Advanced Gastric Cancer or Gastroesophageal Junction Cancer: A Systematic Review of Randomized Controlled Trials
Get PDFIntroduction: Advanced gastric cancer or gastroesophageal junction cancer (GC/GEJC) is an aggressive malignancy often having a poor prognosis. Despite current systemic therapies, GC/GEJC remains the third most common cause of cancer-related deaths worldwide. Tislelizumab, an anti-PD1 antibody, has shown promising results in treating various cancers. Therefore, this systematic review investigated the efficacy and safety of tislelizumab plus chemotherapy for patients with GC/GEJC.
Methods: Five databases were systematically searched until July 10, 2024. Articles identified in the screening process included two RCTs based on predefined inclusion criteria. We performed data extraction sheets and quality assessments using the Cochrane ROB2 tool.
Results: Out of the two randomized controlled trials (RCTs), 1646 patients were included in our systematic review. In Rational-306, efficacy outcomes improved, overall survival (OS) significantly improved from 10.6 months (95\% CI 9.3–12.1) to 17.2 months (95\% CI 15.8–20.1), and progression-free survival (PFS) from 5.6 months (4.9–6.0) to 7.3 months (6.9–8.3). Rational-305 also notably significantly improved.
Outcomes: Improved OS from 12.9 months (12.1-14.1) to 15 months (13.6-16.5), and PFS from 6.2 months (5.6 to 6.9) to 6.9 months (5.7 to 7.2). The proportion of patients with any grade 3 or worse treatment-related adverse events was similar between treatment groups.
Conclusion: Compared with chemotherapy and placebo, Tislelizumab plus chemotherapy demonstrates superior efficacy with a similar safety profile in the two groups, encouraging the use of the tislelizumab group in patients with GC/GEJC
National-Level Outcomes of Diabetic Ketoacidosis with and without Coma: A Retrospective Analysis of 2.3 Million U.S. Hospitalizations
Get PDFBackground: Diabetic ketoacidosis (DKA) remains a significant complication of diabetes associated with substantial morbidity and mortality. We aimed to evaluate clinical outcomes among patients with DKA, both with and without coma, using a nationally representative database and to identify associated factors.
Methods: We analyzed 2,381,619 DKA hospitalizations from the National Inpatient Sample (2016-2022), comparing outcomes between patients with (n=47,355, 1.99%) and without coma (n=2,334,264, 98.01%). Primary outcomes included length of stay (LOS), in-hospital mortality, and total hospital charges. Multivariable regression models adjusted for demographic, clinical, and hospital-level factors.
Results: Patients with DKA-related coma had significantly worse outcomes: longer LOS (8.65 vs. 4.91 days), higher mortality (16.36% vs. 3.12%), and higher hospital charges (61,240) compared to non-comatose patients. After adjustment, coma remained strongly associated with adverse outcomes (an additional 3.23 days of LOS, 5.38-fold higher mortality odds, $51,060 higher charges). Age >65 years, Type 2 diabetes, Asian/Pacific Islander race, and treatment at urban teaching hospitals were independently associated with worse outcomes. Female gender was associated with slightly better outcomes across all measures, with a significant interaction between gender and coma status.
Conclusion: Consciousness level is among the strongest independent predictors of adverse DKA outcomes. Age, diabetes type, race/ethnicity, and hospital characteristics also significantly impact mortality, length of stay, and hospital charges. These factors should be considered in the clinical management of DKA and hospital resource planning
Posterior Reversible Encephalopathy Syndrome (PRES) Beyond Hypertension: Triggers, Pathophysiology, Management, and Outcomes
Get PDFIntroduction: Posterior reversible encephalopathy syndrome (PRES) is a neurovascular disorder characterized by vasogenic edema, most often affecting the parieto-occipital lobes. Although typically reversible, some patients develop lasting neurological sequelae such as cognitive or visual impairment and epilepsy. This review summarizes the current understanding of PRES beyond its classical association with hypertension, emphasizing emerging triggers, mechanisms, and updates in management.
Methods: A structured narrative review was conducted in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) framework. Literature was systematically searched in PubMed, Web of Science, and Google Scholar for studies published between January 1996 and June 2025. Fifty-nine relevant publications, including original studies and reviews, were synthesized to integrate evidence on presentation, imaging, pathophysiology, genetics, and management.
Results: PRES can be triggered by a broad spectrum of hypertensive and non-hypertensive conditions, such as renal dysfunction, eclampsia, systemic lupus erythematosus, sepsis, and exposure to immunosuppressive agents (e.g., tacrolimus, cyclosporine, rituximab). The syndrome involves multifactorial mechanisms, including endothelial dysfunction, blood–brain barrier disruption, and dysregulated cerebral autoregulation. Emerging data indicate that genetic polymorphisms in endothelial nitric oxide synthase (eNOS), vascular endothelial growth factor (VEGF), and aquaporin genes may influence individual susceptibility, although causality remains unconfirmed.
Conclusion: PRES is a multifactorial syndrome that extends beyond hypertension. Early recognition, prompt neuroimaging, and targeted management of underlying triggers are critical for improving outcomes. Future studies should focus on clarifying genetic associations, standardizing diagnostic criteria for atypical cases, and optimizing therapeutic strategies through personalized medicine approaches
Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal Protein, and Skin Changes (POEMS) Syndrome in the Middle East: A Case Report
Get PDFPOEMS syndrome is a rare paraneoplastic syndrome characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal protein gammopathy, and skin changes. We report the first case of POEMS syndrome in Egypt. We report a 37-year-old Egyptian male who presented with left lower limb pain, numbness, weight loss, and urinary incontinence. Laboratory evaluation revealed monoclonal IgA lambda bands and 10\% plasma cells on bone marrow aspiration. Nerve conduction studies confirmed severe sensory-motor polyneuropathy with axonal degeneration. Bone scan showed sclerotic changes, and imaging revealed hepatosplenomegaly. The patient met the diagnostic criteria for POEMS syndrome and was treated with the VRD protocol. Follow-up over 23 months showed declining M-band levels with eventual normalization. However, β2-microglobulin levels rose. The patient achieved a partial response and was referred for autologous bone marrow transplantation. This represents the first reported case of POEMS syndrome in Egypt, emphasizing the need for clinical awareness in non-endemic regions. A multidisciplinary approach is essential for optimal management. Further studies are needed to explore the presentation and management of POEMS syndrome in the Middle East and North Africa region
Infective Endocarditis with Severe Aortic Regurgitation Complicated by Type A Aortic Dissection in a Tricuspid Aortic Valve: A Case Report
Get PDFInfective endocarditis (IE) is a severe infection of the endocardial surface, most commonly affecting cardiac valves. Aortic dissection (AD) is a rare but life-threatening complication of IE. We report a case of IE with severe aortic regurgitation (AR) complicated by Type A AD in a tricuspid aortic valve, presenting without chest pain.
A 40-year-old male with no comorbidities presented with intermittent low-grade fever for 4 months and progressive dyspnea for 5 days. Examination revealed blood pressure discrepancy (90/60 mmHg right arm, 110/70 mmHg left arm) and a diastolic murmur. Laboratory tests showed a WBC count of 15,000/µL, a CRP level of 15 mg/L, an ESR of 28 mm/hr, and a troponin level of 540 ng/L. Transthoracic echocardiography demonstrated a thickened tricuspid aortic valve with large vegetations, severe AR, and an intimal flap consistent with Type A AD. Blood cultures grew Streptococcus viridans. The patient received intravenous Penicillin G and Gentamicin for 2 weeks and underwent emergent surgical repair.
The coexistence of IE and AD is extremely rare, particularly in patients without bicuspid aortic valve or connective tissue disorders. Proposed mechanisms include microbial invasion of the aortic wall and hemodynamic stress from severe AR. This case underscores the importance of maintaining a high index of suspicion for AD in IE patients, even in the absence of chest pain. Early echocardiographic evaluation, rapid surgical intervention, and culture-directed antibiotics are critical for survival in IE complicated by AD
Dexmedetomidine as an Adjuvant to Ropivacaine in Thoracic Paravertebral Block: A Systematic Review with Meta-analysis
Get PDFBackground: One of the ongoing challenges in thoracic surgeries, especially video-assisted thoracoscopic surgery (VATS), is effective postoperative pain management. The thoracic paravertebral block (TPVB) using ropivacaine provides targeted analgesia but suffers from a limited duration of effect. This meta-analysis aims to assess the safety of combining dexmedetomidine with ropivacaine in TPVB for thoracic procedures and to explore potential analgesic benefits suggested by individual trials.
Method: A systematic review and meta-analysis of randomized controlled trials were conducted to compare the combination of dexmedetomidine and ropivacaine (PRD) with ropivacaine alone (PR) in thoracic procedures. Outcomes assessed included adverse effects (bradycardia, dizziness, hypotension, nausea, and vomiting). Analgesic and opioid-sparing effects were reported narratively, as data were heterogeneous and unsuitable for pooled analysis.
Result: Five studies were included. No statistically significant differences were found between PRD and PR in the incidence of bradycardia (RR: 2.14; 95% CI: 0.71–6.40; p=0.1750), dizziness (RR: 1.52; 95% CI: 0.71–3.27; p=0.2833), hypotension (RR: 0.78; 95% CI: 0.40–1.53; p=0.4676), nausea (RR: 1.15; 95% CI: 0.65–2.03; p=0.6018), or vomiting (RR: 1.04; 95% CI: 0.54–2.02; p=0.9122). Some individual trials suggested reduced postoperative pain scores and opioid use with dexmedetomidine, but these findings could not be synthesized quantitatively.
Conclusion: Adding dexmedetomidine to ropivacaine in TPVB for thoracic surgery appears safe, with no significant increase in adverse effects. While some individual trials indicated potential analgesic and opioid-sparing benefits, these results remain heterogeneous and cannot be confirmed by pooled evidence. Further high-quality, standardized trials are needed
Emphysematous Gastritis in a Patient with Concomitant COVID-19 Infection and Celiac Trunk Stenosis: A Case Report
Get PDFThis case report reviews a 75-year-old male with several comorbidities who presented with acute encephalopathy and sepsis in the setting of COVID-19 pneumonia, who was noted to have significant gaseous distention of the stomach, emphysematous gastritis (EG), and severe stenosis of the celiac trunk on initial CT imaging. He was treated with empiric IV antibiotics, including ceftriaxone and metronidazole, which were changed to intravenous piperacillin-tazobactam after 24 hours. After being evaluated by surgery and gastroenterology, it was determined that risks outweighed the benefits of EGD and surgical intervention as the patient had a labile hemodynamic status. After extensive goals of care discussions with the patient’s family, he was transitioned to comfort measures only on day 4 of admission and ultimately passed the same day due to cardiopulmonary arrest. EG is often diagnosed late in its course and is associated with extremely high mortality, even with surgical intervention. Evidence from recent case series suggests increasing success with conservative management in selected patients; there are no formal guidelines
Mycophenolate Mofetil for the Treatment of Resistant Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
Get PDFBackground: This systematic review evaluates the efficacy and safety of Mycophenolate Mofetil (MMF) for managing treatment‐resistant Inflammatory Bowel Disease (IBD), emphasizing remission rates and adverse effects.
Methods: Observational and controlled trials assessing MMF’s impact on IBD were included, excluding non-English and pediatric studies. Comprehensive searches were conducted in Embase, Medline/PubMed, Scopus, and Web of Science through October 2023. The risk of bias was evaluated using the NIH quality assessment tool, and results were synthesized using a random-effects meta-analysis model.
Results: Twelve studies comprising 446 participants (333 with Crohn’s disease and 113 with ulcerative colitis) were analyzed. The meta-analysis revealed remission rates of 62.2% at 8 weeks and 52.8% at 6 months. Adverse effects occurred in 26.1% of patients, with nausea and vomiting being the most common. Treatment discontinuation due to failure and intolerance was observed in 29.7% and 20% of cases, respectively.
Discussion: The findings suggest that MMF effectively induces remission in IBD patients unresponsive to conventional therapies, although a notable proportion experienced adverse events or treatment failure. Careful patient selection and monitoring are essential.
Conclusion: MMF presents a promising alternative for managing resistant IBD, but its adverse effect profile warrants cautious application. Further research is needed to optimize dosing strategies and assess long-term outcomes in this challenging patient population. These results underscore the potential of MMF as an effective therapeutic option while emphasizing the importance of individualized treatment plans and rigorous clinical monitoring. Future studies should focus on long-term safety and dosing. Additional robust research is required
Investigating Racial Disparities in Insulin Pump Use Among People with Type 1 Diabetes Across the United States: A Retrospective Multicenter Study
Get PDFIntroduction: Despite technological advances in Type 1 Diabetes Mellitus (T1D) management, racial disparities in insulin pump utilization persist. We investigated patterns of insulin pump adoption across different racial groups using a large-scale, multi-institutional database to quantify these disparities and identify potential intervention points.
Methods: We conducted a retrospective cohort study using the TriNetX research network, analyzing data from 978,665 T1D patients across 66 healthcare organizations. Propensity score matching was employed to balance cohorts, with a focused sub-analysis of Buffalo, NY (n=6,080) to examine regional variations in comparison to the United States nationwide present data.
Results: Nationwide data revealed significant racial disparities in insulin pump utilization, with White patients showing the highest adoption rate (11.74%) compared to Black or African American (AA) patients (4.056%). Buffalo cohort demonstrated higher overall adoption rates but maintained similar disparity patterns (White: 30.18%, Black or AA: 13.75%). Post-matching analysis confirmed these disparities persisted independent of demographic factors.
Conclusions: Our findings reveal significant racial disparities in insulin pump adoption, with regional variations suggesting the influence of institutional factors. These results highlight the need for targeted interventions to promote equitable access to diabetes technology and prevent the widening of health disparities in T1D care
Epidemiological Patterns, Treatment Response, and Metabolic Correlations of Idiopathic Intracranial Hypertension: A United States-Based Study From 1990 to 2024
Get PDFIntroduction: Idiopathic Intracranial Hypertension (IIH) presents an increasing health burden with changing demographic patterns. We studied nationwide trends in IIH epidemiology, treatment patterns, and associated outcomes using a large-scale database analysis within the United States (US).
Methods: We performed a retrospective analysis using the TriNetX US Collaborative Network database (1990-2024). We investigated demographic characteristics, time-based trends, geographic distribution, treatment pathways patterns, comorbidity profiles and associated risks with IIH. We used multivariate regression, Cox proportional hazards modeling, and standardized morbidity ratios to assess various outcomes and associations.
Results: Among 51,526 patients, we found a significant increase in adult IIH incidence from 16.0 to 127.0 per 100,000 (adjusted RR: 6.94, 95% CI: 6.71-7.17). Female predominance increased over time (female-to-male ratio: 3.29, 95% CI: 3.18-3.40). Southern regions showed the highest prevalence (43.0%, n=21,417). Initial medical management success rates varied between acetazolamide (42.3%) and topiramate (28.7%). Advanced interventional procedures showed 82.5% success rates in refractory cases. Cox modeling revealed significant associations between IIH and metabolic syndrome (HR: 2.14, 95% CI: 1.89-2.39) and cardiovascular complications (HR: 1.76, 95% CI: 1.58-1.94), independent of BMI.
Conclusions: Our findings highlight IIH as a systemic disorder with significant metabolic implications beyond its neurological manifestations. The marked regional disparities and rising incidence rates, especially among adults, suggest the need for targeted healthcare strategies. Early intervention success strongly predicts favorable outcomes, supporting prompt diagnosis and treatment initiation. These results advocate for an integrated approach combining traditional IIH management with broad metabolic screening care