Annals of Medicine and Surgery最新文献

Ovarian cancer remains a major clinical challenge, largely because most patients present with advanced-stage disease. Early detection is essential for improving outcomes, yet current biomarkers such as CA-125 and HE4 have limited sensitivity in early-stage tumors. Advances in bioinformatics and multi-omics research offer new opportunities to identify reliable early detection biomarkers, but their clinical relevance is often obscured by highly technical descriptions. This review summarizes integrative bioinformatics approaches used in early detection biomarker discovery for ovarian cancer, with a specific focus on presenting these methods in clinically meaningful terms. A narrative review framework was used to examine current multi-omics datasets, analytic strategies, and validation approaches. The description of data preprocessing, quality control, and integration methods was revised to emphasize clinical implications - such as reliability, diagnostic accuracy, and translational potential - rather than technical processes. Integrative analysis of genomics, transcriptomics, proteomics, and epigenetic data reveals several promising biomarker candidates that may allow earlier recognition of ovarian cancer. Simplified and clinically oriented explanations are provided for multi-omics integration strategies, supported by a conceptual figure to enhance understanding. Across studies, combined biomarker panels consistently outperform single-marker approaches and may support earlier detection when interpreted in a clinical context. Integrative bioinformatics offers important opportunities for identifying clinically meaningful early detection biomarkers in ovarian cancer. By presenting these methods in a more accessible and clinically focused manner, this review supports improved communication between researchers and clinicians and highlights pathways through which multi-omics discoveries may be translated into practical diagnostic tools.

Introduction and importance: Immunoglobulin A vasculitis (IgAV), though primarily a childhood disease, is uncommon in adults and often presents atypically, leading to diagnostic delays. We report the first known case of adult-onset IgAV from Nepal, presenting as recurrent episodes of acute gastroenteritis. The delayed appearance of purpuric rash - nearly a year after symptom onset - and the rapid response to oral corticosteroids make this case unique and thus add to the existing literature on adult IgAV.

Case presentation: A 57-year-old male presented with 4 days of purpuric rash, abdominal pain, and loose stools. He reported five similar gastroenteritis-like episodes over the prior year, resolving temporarily with antibiotics. Examination revealed palpable purpuric lesions on limbs and trunk. IgAV was diagnosed clinically per EULAR/PRINTO/PRES criteria. Oral prednisolone (60 mg/day) with gastric protection led to complete symptom resolution within 1 week. Antibiotics were discontinued after negative stool cultures. Steroids were tapered over 2 months without relapse.

Clinical discussion: IgAV presents with purpura, abdominal pain, arthralgia, and renal involvement. Diagnosis is often delayed in adults due to atypical symptoms and the absence of rash. Early corticosteroid therapy is effective even without biopsy confirmation in resource-constrained settings. This case underscores the importance of considering IgAV in recurrent gastrointestinal complaints and highlights the effectiveness of corticosteroids, emphasizing the need for clinical vigilance.

Conclusion: IgAV should be considered in adults with unexplained recurrent abdominal pain. Early recognition of the condition, even before the skin manifestations, can significantly improve the prognosis and patient outcome.

Introduction and importance: MALS is a rare condition where the celiac trunk is compressed by the median arcuate ligament, typically presenting with postprandial abdominal pain and weight loss; vomiting may occur less frequently.

Case presentation: A 43-year-old female patient came to our center with mild postprandial abdominal pain in the epigastric region and a bloating sensation. Abdomen ultrasonography revealed hepatomegaly with fatty liver grade I and a computed tomography scan showed U-shaped stenosis of the proximal coeliac trunk just distal to its origin: Findings suggestive of median arcuate ligament syndrome. The patient underwent laparoscopic release of the median arcuate ligament.

Discussion: The diagnosis of Median Arcuate Ligament Syndrome is made based on typical post-prandial symptoms and abdominal imaging techniques such as Doppler ultrasonography, computed tomography angiography, or magnetic resonance angiography. Other potential intestinal disorders should be ruled out before confirming the diagnosis. The primary treatment for this condition is celiac artery decompression through various methods.

Conclusion: Median arcuate ligament syndrome should be considered in patients with unexplained post-prandial abdominal pain. The treatment involves celiac artery decompression through the release of the median arcuate ligament.

Introduction: Cutaneous squamous cell carcinoma (SCC) commonly affects sun-exposed areas, particularly the dorsum of the hand. However, palmar SCC is rare and can remain undiagnosed for a prolonged period. This case describes a unique instance of SCC originating from the palm with metastasis, initially misdiagnosed as primary breast cancer.

Case presentation: A 75-year-old woman, a retired agricultural laborer, presented with a chronic ulcerated mass on her right palm, with associated weight loss and regional nodal swellings. She had a traumatic palm injury treated with skin grafting 12 years prior. She previously underwent axillary and breast surgeries for lesions diagnosed as SCC, presumed to be of breast origin. Current examination revealed a 2.5 × 2 cm palmar mass and multiple nodal swellings. Biopsies confirmed well-differentiated SCC at all sites, and imaging showed no distant metastases but significant right-sided nodal involvement. The patient underwent wide local excision of the palm, modified radical mastectomy, and neck dissection, followed by split-thickness skin grafting. Recovery was uneventful.

Clinical discussion: Palmar SCC may arise from chronic inflammatory changes or trauma rather than UV exposure, as seen in this case. Misdiagnosis delayed appropriate treatment and allowed for significant nodal progression. SCC in atypical sites can be aggressive and necessitate early, multidisciplinary intervention.

Conclusion: Palmar squamous cell carcinoma, although rare, must be considered in chronic non-healing hand ulcers, especially in patients with previous trauma or grafting. Thorough clinical correlation with histopathology, early biopsy, and prompt surgical management are essential to reduce morbidity from metastatic spread.

Leukemia incidence among older adults is rising globally, presenting complex challenges that extend beyond conventional hospital-based treatment. Older patients often face multiple comorbidities, functional impairments, and social barriers that complicate disease management and diminish quality of life. This review explores the critical role of community-based care models that provide decentralized, patient-centered leukemia management tailored to the unique needs of the aging population. Community-based approaches encompass outpatient services, home healthcare, telemedicine, and psychosocial support programs designed to improve accessibility, continuity, and holistic care. These models enable early detection of complications, personalized symptom management, and integration of rehabilitation services, thereby reducing hospitalizations and enhancing patient independence. Moreover, leveraging digital health technologies further facilitates real-time monitoring and remote consultations, addressing logistical challenges for frail older adults. Public health policies supporting community-based leukemia care are essential for sustainable healthcare delivery amid demographic shifts. Investment in workforce training, infrastructure, and equitable access to services can optimize outcomes for elderly leukemia patients while alleviating pressure on hospital resources. As healthcare systems evolve, embracing community-centered strategies will be pivotal in improving survival, quality of life, and overall health equity for older adults living with leukemia.

The expanding volume and heterogeneity of post-marketing drug-safety data have exposed the limitations of conventional pharmacovigilance systems. Artificial intelligence (AI) offers scalable solutions for detecting adverse drug reactions by integrating electronic health records, spontaneous reporting systems, and patient-generated data. Recent advances in natural language processing and deep learning enable earlier identification of rare and complex safety signals while reducing reporting delays. Nevertheless, issues related to algorithmic transparency, bias, and regulatory oversight remain critical. This letter highlights emerging applications, current challenges, and future directions for responsible AI integration in pharmacovigilance.

Introduction: Approximately one-third of maternal deaths worldwide are attributed to unsafe contraceptive practices, a major contributor to maternal mortality. In Ethiopia, immediate postpartum family planning services are not yet widely used. Only 9% of postpartum women use immediate postpartum family planning. Additionally, there was insufficient information regarding the utilization of immediate postpartum family planning in the study area.

Objective: The objective was to assess immediate postpartum family planning utilization and associated factors among mothers attending childbirth at a tertiary hospital in Ethiopia.

Methods: A facility-based cross-sectional study was employed among 402 postpartum women from 1 June to 30 July 2023, using a systematic random sampling technique. Training was provided to data collectors, and data were collected using a structured questionnaire that had been pretested and revised as necessary. The collected data were entered into EpiData 4.6. The data were exported into the software SPSS Version 26 for data cleaning and further analysis. Factors associated with the utilization of immediate postpartum family planning were declared by odds by 95% CI and P < 0.05.

Result: This study involved 393 postpartum mothers, yielding a response rate of 97.76%. As identified from this study, utilization of immediate postpartum family planning was 24.9% (95% CI: 20.6, 29.2) in the study area. Planned pregnancy [adjusted odds ratio (AOR) = 1.84, 95% CI: 1.10-3.13], Postpartum mothers who had five and above children (AOR = 4.68, 95% CI: 1.70-12.88), counseled about family planning before delivery (AOR = 1.78, 95% CI: 1.03-3.10), and intention of postpartum mothers to space their pregnancy (AOR = 3.77, 95% CI: 1.50-9.52) identified associated factors.

Conclusion and recommendation: The utilization of immediate post-partum family planning is low in the study area. Planned pregnancy, the greater number of children, prior information about family planning, and intention to space births during reproductive age were factors significantly associated with the utilization of family planning. Health workers should provide strengthening advice and counseling about family planning, from antenatal care follow-up to the postpartum period. Furthermore, the collaboration of health extension workers provides awareness for the community.