Posttraumatic Subepineural Hematoma of the Median Nerve Diagnosed With Ultrasound Imaging.

This case report demonstrates the utility of ultrasound (US) in the diagnosis, characterization, and follow-up of an intraneural median nerve hematoma following peripherally inserted central catheter (PICC) placement. A patient presenting with neuropathy in the median nerve distribution was evaluated in the US clinic. US successfully identified an intraneural hematoma of the median nerve, characterized it as subepineural, and detected its incomplete resolution during follow-up imaging.

A new perinatal quality measure in nulliparous term singleton vertex births: integrating cesarean rate, maternal, and neonatal outcomes into a single maternal-newborn dyadic metric.

Background: Traditionally, hospital perinatal quality and rankings have been based on cesarean rates among nulliparous, term, singleton, vertex patients, and recently added unexpected term newborn complication rates as a separate outcome category. The drawbacks of this methodology are two-fold: first, maternal complications are not considered and second, the maternal-newborn outcomes, which may not be aligned with each other, are reported separately.

Objective: The objectives were to: 1) evaluate the relationships between cesarean, maternal and neonatal complication rates in nulliparous, term, singleton, vertex patients; 2) develop unified measures incorporating cesarean, maternal, and neonatal complications, utilizing desirability of outcome ranking methodology, to evaluate individual hospital performances; and 3) compare hospital rankings using the most desirable dyadic outcome "vaginal delivery with no maternal and no neonatal complications" to cesarean rate-based rankings for the overall population, as well as for low- and high-risk patients.

NSBBs, EBL or Combined Therapy for High-Risk Varices: Systematic Review and Meta-Analysis.

Background And Aims: Non-selective beta blocker (NSBB) is the preferred treatment option for primary prophylaxis of high-risk oesophageal varices, and endoscopic band ligation (EBL) is reserved for those intolerant to NSBB. In this meta-analysis, we aim to compare the outcomes of NSBB, EBL and combined therapy for primary prophylaxis of high-risk oesophageal varices.

Methods: Major databases, such as MedLine, Embase and Cochrane Library were searched in October 2024 to identify studies comparing clinical outcomes between combined approaches versus NSBB versus EBL only.

Pembrolizumab-Associated Acute Esophageal Necrosis: A Case Report and Literature Review.

Background: Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment. They pose challenges, particularly in the form of immune-related adverse events (irAEs). Although cases of gastrointestinal irAEs have been well-documented, acute esophageal necrosis (AEN) characterized by a circumferential blackening and fragility of the esophagus, weeks after immunotherapy discontinuation, has not been reported.

Response and Survival With Immune Checkpoint Inhibitor in Patients With Advanced Urothelial Carcinoma and Histology Subtypes.

Background: Immune Checkpoint Inhibitors (ICIs) are used for advanced urothelial carcinoma (aUC) in different settings. Most patients have pure UC (PUC) but about one-third have UC mixed with histology subtypes (HS). We examined outcomes in patients with HS aUC treated with ICI.

A Unique Case of a Successful Endoscopic Retrograde Cholangiopancreatography Through a Previously Placed Gastro-Jejunostomy Lumen Apposing Metal Stent.

Originally used for minimally invasive drainage of pancreatic fluid collections, the uses of lumen-apposing metal stents (LAMS) have expanded to encompass several other pathologies including gastric outlet obstruction, strictures, and cases with surgically altered anatomy. We describe a rare case of an endoscopic retrograde cholangiopancreatography that was successfully completed through a previously placed LAMS between the stomach and the jejunum, in a patient with challenging anatomy due to progressing malignancy resulting in gastric outlet obstruction. This case highlights the technical complexity of performing endoscopic retrograde cholangiopancreatography through a previously placed LAMS and underscores the importance of patient-centered care with readiness for adaptability in complex cases.

When Two Chambers Collide: A Rare Case of an Acquired Gerbode Defect in Infective Endocarditis.

Introduction: The Gerbode defect is a rare cardiac anomaly characterised by abnormal communication between the left ventricle and right atrium. Although primarily congenital, it can also be acquired, typically as a complication of myocardial infarction or infective endocarditis. This report examines a unique case of multivalvular infective endocarditis caused by group B Streptococcal bacteraemia, which led to the development of an acquired Gerbode defect.

Acute Non-Rheumatic Myocarditis Following Group G Streptococcal Pharyngitis: A Rare Mimic of Acute Myocardial Ischemia in a Young Adult.

Background: Acute myocarditis is a rare but serious inflammatory condition of the myocardium, often triggered by infections or rheumatic heart disease. While group A is commonly associated with bacterial myocarditis, group G is rarely implicated. This case highlights a rare instance of non-rheumatic acute myocarditis also known as Streptococcal pharyngitis acute myocarditis caused by group G in a 19-year-old male without rheumatic fever.

Plasmacytoid urothelial carcinoma of the urinary bladder: A single institution experience with focus on next-generation sequencing (NGS) and PD-L1 immunohistochemistry.

Plasmacytoid urothelial carcinoma (PUC) of the urinary bladder is an aggressive UC subtype characterized by infiltrating cells with plasmacytoid appearance, and somatic CDH1 mutations leading to E-cadherin loss. 32 PUC cases were found in our pathology archives from 2018 to 2024; next-generation sequencing (NGS) was available in 18 cases, and PD-L1 immunohistochemistry in all 32 cases. PD-L1 tumor proportion score (TPS) and combined positive score (CPS) were calculated.

Failure of the tyrosine kinase inhibitors osimertinib and erlotinib to manage a patient with EGFR-mutant lung adenocarcinoma: a case report.

Background: Lung adenocarcinoma, a type of non-small cell lung cancer (NSCLC), is the most common type of lung cancer among non-smokers. Lung adenocarcinoma in exon 19 deletion (E19del) mutation-positive cases respond well to treatment with tyrosine kinase inhibitors (TKIs). Our case demonstrates the development of resistance to first- and third-generation TKIs in a 48-year-old woman with epidermal growth factor receptor (EGFR) mutation-positive advanced NSCLC.

Intracranial Aneurysms in Autosomal Dominant Polycystic Kidney Disease: A Practical Approach to Screening and Management.

Autosomal dominant polycystic kidney disease (ADPKD), the most prevalent genetic kidney disorder, is characterized by diffuse kidney cysts, hypertension, and progressive kidney function decline, often leading to kidney failure by the age of 60 years. Compared with the general population, patients with ADPKD have an increased risk for development of saccular intracranial aneurysms (IAs), which can lead to intracranial bleeding and result in significant disability and mortality. Of both modifiable and nonmodifiable risk factors, the most significant is a family history of IAs or aneurysm rupture.

Predicting the limit to ceftriaxone's use in gonorrhea treatment: impending resistance and logistical challenges.

Introduction: The increasing prevalence of antimicrobial resistance in Neisseria gonorrhoeae threatens the efficacy of ceftriaxone, the last widely effective treatment for gonorrhea. Resistance mechanisms challenge the adequacy of current dosing strategies and minimum inhibitory concentration (MIC) thresholds, with treatment failures documented at MICs as low as 0.125 mcg/mL.

Effective treatment of listeria liver abscesses with high-dose oral antibiotics: Case insights and review of clinical challenges.

Listeria monocytogenes (L. monocytogenes) is a rare but serious pathogen, particularly in immunocompromised individuals. Hepatic listeriosis is exceptionally uncommon, making this case of multiple liver abscesses in a 55-year-old woman notable.

Development and validation of the discharge severity index for post-emergency department hospital readmissions.

Introduction: Hospital readmissions often result from a combination of factors, including inadequate follow-up care, poor discharge planning, patient non-adherence, and social determinants of health (SDOH) that impact access to healthcare and follow-up resources, many of which are beyond provider control. Enhanced post-discharge strategies, including risk stratification, are essential. This study aims to develop and validate the Discharge Severity Index (DSI) to predict readmission risk and optimize resource allocation for effective follow-up care.

Intubation in Eosinophilic Lung Disease: Predictors, Outcomes, and Characteristics from a National Inpatient Sample Analysis.

: Eosinophilic lung diseases (ELD) encompass disorders with an abnormally high number of polymorphonuclear eosinophils in the lungs. Presentation severity can range from low-grade fever and cough to life-threatening acute respiratory distress syndrome (ARDS). Due to the rarity of these conditions, no large sample studies have been performed to assess the characteristics of patients with pulmonary eosinophilia.

Association Between Type of Residency Interview, Virtual Versus In-Person, and Distance From Applicants' Dental School to Oral and Maxillofacial Surgery Program Matched: Report From the American Association of Oral and Maxillofacial Surgeons Committee on Education and Training.

Background: Oral and maxillofacial surgery (OMS) residency interviews for the 2021 match during the Covid-19 pandemic were near universally virtual in contrast to in-person interviews of prior years. In deciding whether to conduct in-person or virtual interviews, it is important for residency programs to understand the association of interview type on the distance between dental school attended and the program to which the applicant matched.

Purpose: The study purpose was to measure the association between the type of residency interview conducted and the distance from the dental school attended to the program which the applicant matched.

Plasma extracellular cold inducible RNA-binding protein levels are elevated for 1 month post-colectomy which may promote metastases.

Background: Cold-inducible RNA-binding protein (CIRP) is related to a family of stress-induced RNA-binding proteins. It is primarily found in the nucleus, where it regulates transcription. Under stress, CIRP translocates to the cytoplasm where it modulates translation; a subset is secreted as extracellular CIRP (eCIRP) which is a damage-associated molecular pattern (DAMP) molecule that stimulates the production of inflammatory mediators.

Suppression of an accessory and cavitated uterine mass with norethindrone: a case report.

Objective: To describe conservative management for accessory and cavitated uterine mass (ACUM) with norethindrone acetate. The patient gave signed written, informed consent authorizing publication.

Design: We present a case report of a patient with ACUM who desired delay in surgical management.

The burden of mental disorders and substance abuse in the Middle East and North Africa (MENA) region: findings from the Global Burden of Disease Study.

Background: Mental disorders pose significant morbidity and mortality risks globally. Despite this, research on mental health in the Middle East and North Africa (MENA) region is scarce, hindered by social stigmas and limited healthcare expenditure. This study, utilizing the Global Burden of Disease (GBD) database, aims to address this gap by examining the prevalence, incidence, and demographic patterns of mental disorders in MENA.

Endoscopic Sleeve Gastroplasty Versus Laparoscopic Sleeve Gastrectomy: A Comparison in Effectiveness and Safety Profile.

Background And Objectives: Current treatment options for obesity typically involve a combination of lifestyle changes, medications, and bariatric surgeries. This study aimed to assess the safety profile of the endoscopic sleeve gastroplasty (ESG), which is a novel non-invasive approach, as compared to laparoscopic sleeve gastrectomy (LSG) and to correlate their weight loss effectiveness and complication risk in Lebanese patients.

Subjects And Methods: This is a retrospective study, including 70 patients who underwent ESG at Fouad Khoury Hospital and 70 patients who underwent LSG at Trad Hospital, between September 2021 and March 2023.