Annals of Medicine and Surgery最新文献

Background: Eosinophilic esophagitis (EoE), a chronic immune-mediated inflammatory disorder, is increasingly recognized globally. Budesonide, a topical corticosteroid, is widely used for EoE; but its efficacy and safety profile require comprehensive evaluation.

Objective: To assess the efficacy and safety of budesonide in EoE through an updated systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods: Following PRISMA guidelines and AMSTAR guidelines, we searched PubMed, EMBASE, and Google Scholar for RCTs comparing budesonide with placebo in EoE patients (conception to January 2025). A GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was applied to rate the certainty of evidence across key outcomes. Primary outcomes included histologic response (≤15 eosinophils/high-power field), clinical symptom improvement, and safety. Data were pooled using random/fixed-effects models, with sensitivity analyses to address heterogeneity.

Results: Eleven RCTs (1089 participants) were included. Budesonide significantly improved histologic remission (RR: 26.85; 95% CI: 13.72-52.56; P < 0.00001) and reduced peak eosinophil counts (SMD: -1.08; 95% CI: -1.40 to 0.77; P < 0.00001). Clinical response (RR: 1.58; 95% CI: 1.03-2.42; P = 0.04) and dysphagia symptom scores (SMD: -0.29; 95% CI: -0.49 to 0.09; P = 0.004) also favored budesonide. However, fibrosis scores showed no significant improvement (P = 0.48). Adverse events were comparable to placebo overall (RR: 1.01; 95% CI: 0.82-1.24), though infections were more frequent with budesonide (RR: 2.14; 95% CI: 1.20-3.80; P = 0.009). Transient cortisol suppression occurred in sensitivity analyses (SMD: -0.41; 95% CI: -0.66 to 0.16; P = 0.001). Most infections were localized (e.g., oropharyngeal candidiasis) and rarely required treatment discontinuation.

Conclusion: Budesonide effectively induces histologic and clinical remission in EoE but does not reverse fibrosis. While generally safe, long-term adrenal monitoring is warranted due to cortisol suppression. GRADE evaluation suggested moderate-to-high certainty for efficacy outcomes and moderate certainty for safety outcomes. Persistent symptoms in fibrostenotic disease highlight the need for adjunct therapies. Future research should optimize dosing regimens and evaluate combination strategies.

Background: Schistosomiasis remains a major public health problem in East Africa, particularly Rwanda, Tanzania, and Uganda, driven by inadequate sanitation, unsafe water contact, and snail intermediate hosts.

Objective: This review summarizes recent epidemiological information and reviews schistosomiasis control efforts in East Africa to highlight the achievements, challenges, and pathways to elimination.

Methods: We reviewed 37 recent studies on prevalence, morbidity, and intervention, including mass drug administration (MDA), water sanitation and hygiene (WASH) measures, snail control, and health education. Emphasizing inter-sectoral approaches and One Health.

Results: Findings vary across regions, with 15.9% S. haematobium in the Simiyu Region in Tanzania, to declining but persistent S. mansoni in Uganda, while Rwanda has succeeded in lowering the prevalence of schistosomiasis using combined interventions. MDA and WASH have lessened morbidity in school-aged children; however, challenges persist, including low-sensitivity diagnostics, climate-mediated snail expansion, zoonotic aspects, and gender inequalities. Interventions for preschool-aged children and adolescent girls are often excluded, undermining control efforts.

Conclusion: Elimination of schistosomiasis requires improved diagnostics, climate-adapted snail control, equitable MDA coverage, and a One Health approach. Achieving WHO's 2030 targets demand innovation, political commitment, and equitable allocation of resources to address this public burden.

Introduction: Trichobezoars are rare but significant causes of gastrointestinal obstruction in children, most commonly confined to the stomach. In certain cases, these bezoars can grow large enough to extend into the duodenum, resulting in severe gastrointestinal complications.

Case presentation: A previously healthy 16-year-old female presented with an 8-hour history of nausea, vomiting, and diarrhea. Physical examination revealed a palpable mass in the epigastric and left hypochondriac regions. Paraclinical investigations, including laboratory tests and imaging, yielded no significant abnormalities. The patient subsequently underwent emergent exploratory laparotomy, which identified a large trichobezoar. An anterior gastrotomy was performed, and the bezoar was successfully removed in one piece. The postoperative course was uneventful, and the patient was discharged on postoperative day 17, after tolerating a regular diet. She was referred for psychiatric evaluation to address underlying trichotillomania and trichophagia, with the goal of preventing recurrence.

Discussion: Rapunzel syndrome predominantly affects young females with underlying psychiatric conditions. Delayed diagnosis is common, often leading to serious gastrointestinal complications, including perforation, infections, cholangitis, obstructive jaundice, intussusception, and pancreatitis. Early detection and intervention are crucial to prevent these potentially life-threatening outcomes. Surgical removal through gastrotomy is typically required, particularly for large bezoars.

Conclusion: Trichobezoars, though rare, present serious health risks when left untreated, especially in pediatric patients with underlying psychiatric disorders like trichotillomania and trichophagia. Prompt diagnosis and intervention, including surgical removal, are essential to avoid severe complications. This highlights the importance of early recognition and multidisciplinary care in managing trichobezoar-related gastrointestinal complications.

Gender-affirming healthcare is a comprehensive approach that aims to support individuals in transitioning from the gender assigned to them at birth to their affirmed gender, aligning with their gender identity. This type of care involves medically necessary and scientifically supported interventions within a multidisciplinary framework. Gender dysphoria, also known as gender incongruence or transsexuality, refers to the experience of a mismatch between an individual's biological sex and their internal sense of gender, known as gender identity. Gender identity can encompass a range of expressions and may include identifying as neither exclusively male nor female, allowing for a spectrum of gender diversity. Studies conducted in the past have revealed alarming statistics, showing that transgender and gender-diverse (TGD) individuals face a 41% lifetime prevalence of suicide attempts, a lifetime prevalence of binge drinking ranging from 7% to 61%, and a 33% prevalence of tobacco use. The increased vulnerability to adverse mental health outcomes among TGD individuals can be attributed to a variety of factors, including the presence of stigma, discrimination, pathologization, economic marginalization, violence, and the distress arising from a misalignment between their gender identity and societal expectations rooted in their assigned sex at birth. Research reveals that a significant proportion of gender and sexual minority adults have experienced discrimination from healthcare providers, with approximately 8% of sexual minorities and 25% of transgender individuals reporting being denied healthcare services. This review outlines the bridging of the communication and supportive gap in gender-affirming care to improve patient outcomes and overall quality of care.

Introduction: Cystic echinococcosis (CE) is a parasitic disease caused by the larval stage of Echinococcus granulosus, primarily affecting the liver and lungs. Cardiac involvement is rare, occurring in 0.5%-2% of cases. Multi-organ involvement, particularly including the liver, lungs, and heart, is exceptionally rare, posing significant diagnostic and management challenges.

Case presentation: We present a 26-year-old female with a 1.5-year history of recurrent left-sided chest pain, anorexia, and dry cough. Imaging revealed cystic lesions in the liver, lungs, and left ventricular wall of the heart. The patient underwent a multidisciplinary surgical intervention to excise the cysts, followed by postoperative albendazole therapy. Despite the mass effect on the heart, the patient's cardiac function remained preserved with an ejection fraction of 60%.

Discussion: This case underscores the importance of advanced imaging in diagnosing CE with multi-organ involvement. While medical therapy with albendazole is effective for managing uncomplicated CE, surgical excision is necessary for complex cases with risks of rupture or embolization. Multidisciplinary care is critical in achieving optimal outcomes in such rare and challenging presentations.

Conclusion: This report highlights a rare case of CE involving the liver, lungs, and heart. It emphasizes the importance of accurate imaging, multidisciplinary surgical intervention, and postoperative medical therapy in managing this complex condition and achieving successful outcomes.

Introduction: Peptic ulcer disease (PUD) and its consequences are prevalent in developing countries. This study aimed to identify predictors of postoperative complications and mortality among patients undergoing emergency surgery for perforated PUD in a tertiary care center of Nepal.

Methods: A prospective cohort study of consecutive adults undergoing emergency laparotomy with omental patch repair for perforated PUD was performed. Demographics, clinical, and perioperative data were recorded using a structured proforma. Predictors of complications and in-hospital mortality were assessed with logistic regression; results are reported as odds ratios (ORs) with 95% confidence intervals (CIs).

Results: Among the 85 patients (mean age 42 ± 15.4 years; 88% males), complications occurred in 42.4% and mortality in 5.9%. Age ≥60 years (adjusted OR 30.4, 95% CI 2.7-347.7; P = 0.006) and preoperative shock (adjusted OR 13.9, 95% CI 2-92.9; P = 0.006) were associated with higher odds of complications.

Conclusion: Age ≥60 years and preoperative shock may help identify patients at higher risk of postoperative complications after perforated PUD repair. Given the small sample size and event constraints, these results are exploratory; multicenter validation with adequate power is warranted.

Huntington's disease (HD) is a progressive, autosomal dominant neurodegenerative disorder caused by expanded Cytosine-Adenine-GuanineCAG repeats in the huntingtin (HTT) gene, leading to the production and accumulation of mutant huntingtin protein and subsequent neuronal dysfunction and loss. Current management remains largely symptomatic, with no established disease-modifying therapy. AMT-130 represents a novel and promising approach aimed at directly targeting the underlying molecular pathology of HD. AMT-130 is a one-time gene therapy that utilizes an adeno-associated virus serotype 5 (AAV5) vector to deliver an engineered microRNA (miHTT) into the caudate and putamen via stereotactic intracerebral infusion. This microRNA selectively reduces HTT mRNA levels, resulting in sustained lowering of mutant huntingtin protein. Preclinical studies in both large-animal and rodent models have demonstrated broad vector distribution, long-term expression, significant reduction in huntingtin levels, improved motor performance, decreased neuronal degeneration, and prolonged survival. Early Phase I/II clinical data indicate a favorable safety profile, reductions in neurofilament light chain levels, and stabilization of motor and functional decline, particularly in high-dose cohorts, suggesting a potential slowing of disease progression. While long-term efficacy and broader clinical validation are still required, AMT-130 shows strong potential to shift HD treatment from purely symptomatic care toward meaningful disease modification. Its success may also pave the way for microRNA-based therapies in other neurodegenerative disorders.