World Journal of Clinical Cases最新文献

{"title":"Ruptured primary intrahepatic ectopic pregnancy: A case report and review of literature.","authors":"Gajendra Bhati, Federico Maria Mongardini, Kamna Bhati, Pushpinder Singh, Raghav Bansal, Ayush Bansal, Samridhi Mahajan, Ludovico Docimo, Marco Caricato, Gabriella Teresa Capolupo, Filippo Carannante","doi":"10.12998/wjcc.v14.i6.118135","DOIUrl":"https://doi.org/10.12998/wjcc.v14.i6.118135","url":null,"abstract":"<p><strong>Background: </strong>Primary hepatic ectopic pregnancy is an exceptionally rare subtype of abdominal ectopic pregnancy and carries a very high risk of catastrophic hemorrhage. Due to its atypical clinical presentation and unusual implantation site, diagnosis is often delayed, leading to significant maternal morbidity and mortality.</p><p><strong>Case summary: </strong>A woman of reproductive age presented with acute upper abdominal pain and hemorrhagic shock. Pregnancy testing was positive, and transabdominal ultrasonography revealed massive hemoperitoneum with the absence of intrauterine gestation. Focused abdominal ultrasound demonstrated a heterogeneous lesion arising from the right hepatic lobe, suspicious for ruptured intrahepatic ectopic pregnancy. Initially, a diagnostic laparoscopy was performed but due to hypotension and anesthetist advice, emergency exploratory laparotomy was performed, and a ruptured intrahepatic gestational mass was identified. Complete surgical excision with hemostasis was achieved. Histopathology confirmed intrahepatic ectopic pregnancy. The postoperative course was uneventful.</p><p><strong>Conclusion: </strong>Prompt recognition, appropriate imaging sequence, and emergency surgical intervention are essential to prevent maternal mortality in hepatic ectopic pregnancy.</p>","PeriodicalId":23912,"journal":{"name":"World Journal of Clinical Cases","volume":"14 6","pages":"118135"},"PeriodicalIF":1.0,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left ventricular mass in newborn with perinatal asphxia: Assessment of allometric relations and impact of birth weight.","authors":"Josephat M Chinawa, Okechukwu S Ani, Odutola I Odetunde","doi":"10.12998/wjcc.v14.i6.117269","DOIUrl":"https://doi.org/10.12998/wjcc.v14.i6.117269","url":null,"abstract":"<p><strong>Background: </strong>Utero-placental insufficiency seen in perinatal asphyxia may adversely affect left ventricular (LV) geometry.</p><p><strong>Aim: </strong>To document the LV mass values in perinatal asphyxia and to elicit associated factors.</p><p><strong>Methods: </strong>This was a cross-sectional study conducted in a tertiary health facility among newborns with perinatal asphyxia. Echocardiography was used to compare the LV mass of 84 new-borns with perinatal asphyxia with the LV mass of 48 new-borns without perinatal asphyxia matched for age. The data was analysed using SPSS version 25 (IBM, United States).</p><p><strong>Results: </strong>The mean LV mass (7.9 ± 2.3 g) of perinatal asphyxia is lower than control (10.1 ± 0.7 g) <i>P</i> = 0.001. New-borns with severe perinatal asphyxia had the lowest mean LV mass (7.1 ± 1.5), while the moderate group had the highest (8.8 ± 2.5), with the Analysis of Variance (ANOVA) result of <i>F</i> = 1.26 and <i>P</i> = 0.289. The mean LV mass was highest on day 1 (8.1 ± 2.5) and slightly lower on days 2 and 3 (both 7.7 ± 1.9 and 7.7 ± 2.0, respectively). Though ANOVA result (<i>F</i> = 2.47, <i>P</i> = 0.7282) indicates no significant relationship between the age of the newborn and LV mass, a weak positive correlation was observed between LV mass and gestational age which is statistically significant (<i>r</i> = 0.269 <i>P</i> = 0.028). A moderate positive correlation between the LV mass and birth weight of newborn was observed. This is statistically significant (<i>r</i> = 0.610, <i>P</i> = 0.001). There was weak negative correlation (<i>r</i> = -0.10, <i>P</i> = 0.752), between LV mass and age of the newborn without perinatal asphyxia but a moderate positive correlation (<i>r</i> = 0.69, <i>P</i> = 0.015) was observed, between LV mass and weight in non-asphyxiated newborn.</p><p><strong>Conclusion: </strong>This study showed that the LV mass in perinatal asphyxia was significantly lower than those without asphyxia. There was a direct correlation between LV mass and birth weight of neonates with perinatal asphyxia. Early detection of the cardiac disease, appropriate management and sustained reduction of birth asphyxia, and improved intra-partum quality of care are key.</p>","PeriodicalId":23912,"journal":{"name":"World Journal of Clinical Cases","volume":"14 6","pages":"117269"},"PeriodicalIF":1.0,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for appendiceal mucocele tumors: Five case reports and review of literature.","authors":"Ribal Aby Hadeer, Souad Ghattas, Hadi Farhat, Hani Maalouf, Jad El Bitar, Dany Ayash, Faten Mohtar, Bachir Elias, Raja Wakim","doi":"10.12998/wjcc.v14.i6.117655","DOIUrl":"https://doi.org/10.12998/wjcc.v14.i6.117655","url":null,"abstract":"<p><strong>Background: </strong>Appendiceal mucocele with pseudomyxoma peritonei (PMP) is a rare entity that often presents late and requires specialized management. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has become the standard of care, yet real-world surgical experiences from diverse institutions remain limited. This case series highlights five patients presenting with appendiceal mucoceles complicated by PMP, emphasizing diagnostic challenges, operative strategies, and postoperative outcomes.</p><p><strong>Case summary: </strong>We report five patients (aged 45-75 years) who presented with symptoms ranging from abdominal distension and umbilical nodules to incidental imaging findings. All patients underwent a comprehensive diagnostic evaluation, including laboratory testing, tumor markers, and advanced imaging. Intraoperative findings revealed mucinous dissemination consistent with PMP. CRS was performed in all cases, with the extent determined by disease burden, followed by HIPEC using mitomycin C or oxaliplatin-based regimens. Pathology demonstrated low-grade or ruptured mucinous neoplasms as the primary etiology. Postoperative recovery was generally favorable, and although three patients developed recurrence requiring repeat CRS, all achieved meaningful disease control. These cases illustrate PMP's chronic nature and the importance of multidisciplinary management.</p><p><strong>Conclusion: </strong>CRS with HIPEC remains the most effective strategy for managing appendiceal mucocele-associated PMP.</p>","PeriodicalId":23912,"journal":{"name":"World Journal of Clinical Cases","volume":"14 6","pages":"117655"},"PeriodicalIF":1.0,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Areas of uncertainty in endophthalmitis care.","authors":"Ramesh Venkatesh, Prathibha Hande, Edwin James, Nagesha Krishnappa Chokkahalli, Prashanth Ranganath, Rupal Kathare, Vishma Prabhu, Chaitra Jayadev, Karishma Tendulkar, Pragati Raj, Gaurav Malwe, Shubhangi Tripathi, Preksha Biradar, Alisha Sirsikar, Naresh Kumar Yadav","doi":"10.12998/wjcc.v14.i6.118263","DOIUrl":"https://doi.org/10.12998/wjcc.v14.i6.118263","url":null,"abstract":"<p><p>Endophthalmitis remains one of the most feared presentations in ophthalmic practice, not only because of its potential for rapid and irreversible vision loss but also due to the substantial diagnostic, therapeutic, and prognostic uncertainty that accompanies its management. Despite landmark trials, advances in vitreoretinal surgery, antimicrobial therapy, imaging, and molecular diagnostics, many aspects of endophthalmitis care continue to rely on clinical judgment rather than uniformly applicable, high-quality evidence. This review synthesizes contemporary areas of uncertainty spanning disease definition, diagnosis, treatment, antimicrobial resistance, and outcome prediction. We highlight the conceptual challenges in distinguishing infectious endophthalmitis from sterile or immune-mediated intraocular inflammation, particularly in culture-negative cases and post-intravitreal injection scenarios. Diagnostic ambiguity is compounded by limited microbiological yield, evolving molecular techniques with uncertain clinical interpretation, and supportive but non-specific imaging findings. Treatment-related uncertainties include the optimal timing and extent of vitrectomy in the era of small-gauge surgery, selection and dosing of intravitreal antimicrobials amid rising resistance and geographic variability, the contentious role of adjunctive corticosteroids, and management strategies for fungal and culture-negative endophthalmitis. Prognostication remains imprecise, with anatomical success often failing to predict functional recovery. Rather than reiterating established guidelines, this review focuses on real-world clinical gray zones and unresolved questions. Endophthalmitis is best viewed as a heterogeneous clinical syndrome shaped by microbial, host, and treatment-related factors. Recognizing uncertainty as an inherent feature of care underscores the need for individualized, adaptive decision-making and highlights priorities for future research, including standardized endpoints, region-specific surveillance, and integration of emerging imaging, molecular, and computational tools.</p>","PeriodicalId":23912,"journal":{"name":"World Journal of Clinical Cases","volume":"14 6","pages":"118263"},"PeriodicalIF":1.0,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low salivary thioredoxin-1 levels in periodontitis.","authors":"Leonardo Lorente, Esther Hernández Marrero, Pedro Abreu-Gonzalez, Angel Daniel Lorente Martín, Marina Lorente Martín, María José Marrero González, Carmen Hernández Marrero, Olga Hernández Marrero, Alejandro Jiménez, Cándido Manuel Hernández Padilla","doi":"10.12998/wjcc.v14.i6.118460","DOIUrl":"https://doi.org/10.12998/wjcc.v14.i6.118460","url":null,"abstract":"<p><strong>Background: </strong>The protein thioredoxin-1 (TRX-1) has anti-oxidative, anti-inflammatory and anti-apoptotic effects, and it has been related to the regulation of ageing and different diseases. TRX-1 in periodontitis has been scarcely studied, and the results in humans and in mice are contradictory. In three small studies with humans (the highest with 96 subjects), it was found that patients with periodontitis, compared to periodontally healthy subjects, showed a higher expression of TRX-1 or of the <i>TRX-1</i> gene in saliva. However, in one study with mice, it was found that mice with periodontitis, compared to periodontally healthy mice, showed a lower expression of TRX-1 in the periodontal tissues.</p><p><strong>Aim: </strong>To explore the possible association of salivary TRX-1 concentrations with periodontitis and its severity, and of determining the capability of salivary TRX-1 concentrations to predict the diagnosis of periodontitis in a larger sample size study.</p><p><strong>Methods: </strong>Salivary TRX-1 concentrations were measured in subjects with and without periodontitis in this observational and prospective study. Criteria to establish periodontal health were the nonexistence, or existence in less than 10% of sites, of bleeding on probing, and the nonexistence of interproximal attachment and bone loss. Criteria to establish localized gingivitis were the existence of bleeding between 10%-30% of sites, and the nonexistence of interproximal attachment and bone loss. Criteria to establish periodontitis were the existence of interproximal attachment or bone loss. We carried out a multivariate logistic regression analysis to determine the variables associated with periodontitis, a correlation analysis to determine the possible association between salivary TRX-1 concentrations and periodontitis severity, and a receiver operating characteristic (ROC) analysis to determine the capability of salivary TRX-1 concentrations to predict the diagnosis of periodontitis.</p><p><strong>Results: </strong>A total of 144 subjects (58 with periodontitis and 86 without periodontitis) were included. Low salivary TRX-1 concentrations showed an association with periodontitis (<i>P</i> = 0.04) according to regression analysis, an association with periodontitis severity (rho = -0.47; <i>P</i> < 0.001) according to correlation analysis, and an area under curve of 75% (95%CI: 67%-82%; <i>P</i> < 0.001) for periodontitis diagnosis according to ROC analysis.</p><p><strong>Conclusion: </strong>Novel findings of this study were the association of low salivary TRX-1 concentrations with periodontitis and its severity, and the capacity of salivary TRX-1 concentrations to help in the periodontitis diagnosis.</p>","PeriodicalId":23912,"journal":{"name":"World Journal of Clinical Cases","volume":"14 6","pages":"118460"},"PeriodicalIF":1.0,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of acute choroidal neovascularization related submacular hemorrhage: Three case reports.","authors":"Georges El Mollayess, Mahmoud Jaroudi, Yehya Tlaiss, Rayan Itaoui, Bachir Abiad","doi":"10.12998/wjcc.v14.i6.118545","DOIUrl":"https://doi.org/10.12998/wjcc.v14.i6.118545","url":null,"abstract":"<p><strong>Background: </strong>Acute submacular hemorrhage (SMH) secondary to choroidal neovascularization (CNV), most commonly in neovascular age-related macular degeneration, is a vision-threatening emergency. Thick, fovea-involving SMH can cause rapid photoreceptor injury, and timely intervention aimed at clot lysis and displacement, while continuing CNV suppression with anti-vascular endothelial growth factor (anti-VEGF) therapy, may improve anatomic outcomes.</p><p><strong>Case summary: </strong>We report a retrospective case series of three eyes with acute, fovea-involving CNV-related SMH treated with pars plana vitrectomy (PPV), subretinal tissue plasminogen activator (tPA), and expansile gas tamponade, with intravitreal anti-VEGF administered at the end of the procedure and continued postoperatively. Two cases had early intraocular pressure-related events (transient hypotony in one patient and transient ocular hypertension in another) requiring close postoperative monitoring and medical management. Follow-up color fundus photography and optical coherence tomography documented postoperative evolution of the hemorrhage compared with baseline, with ongoing anti-VEGF therapy planned to control the underlying CNV.</p><p><strong>Conclusion: </strong>PPV with subretinal tPA and gas tamponade is a practical surgical strategy for acute, thick, fovea-involving SMH secondary to CNV, particularly when rapid displacement is desired. Careful documentation of operative parameters, strict postoperative monitoring for pressure-related complications, and continued anti-VEGF therapy are essential components of care.</p>","PeriodicalId":23912,"journal":{"name":"World Journal of Clinical Cases","volume":"14 6","pages":"118545"},"PeriodicalIF":1.0,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Undifferentiated testicular pleomorphic sarcoma: A case report.","authors":"Jordan Sarver, Ali Baydoun, Marko Gudziak","doi":"10.12998/wjcc.v14.i6.118138","DOIUrl":"https://doi.org/10.12998/wjcc.v14.i6.118138","url":null,"abstract":"<p><strong>Background: </strong>Genitourinary sarcomas include testicular sarcomas and are the most common subtype of sarcoma within the genitourinary system. Undifferentiated pleomorphic sarcoma is a subtype of soft tissue sarcomas that may affect the extremities and retroperitoneum. However, the presence within the testicle is rare. Here, we present a case of an undifferentiated testicular pleomorphic sarcoma, which will explore the presentation and treatment of a rare type of testicular cancer.</p><p><strong>Case summary: </strong>Here we present a 56-year-old male who comes to the urology clinic for left testicular swelling. The patient then underwent left radical orchiectomy <i>via</i> an inguinal approach for a left testicular mass seen on examination and on scrotal ultrasound. Pathology revealed undifferentiated pleomorphic sarcoma (Federation of the French Cancer Centres grade 3), 9.5 cm in size, and it was limited to the testicle. The surgical margins were negative. A follow-up positron emission tomography computed tomography scan was obtained, which showed no evidence of hypermetabolic lymph nodes or masses in the abdomen or pelvis.</p><p><strong>Conclusion: </strong>Testicular sarcomas are a rare type of soft tissue sarcoma. The standard treatment of the testicular mass usually begins with radical inguinal orchiectomy. Patients with scrotal sarcomas are at high risk of local and distant recurrence, emphasizing the importance of surgical excision and wide margins. There is little studied regarding the integration of radiotherapy and chemotherapy for these cases as neoadjuvant or adjuvant therapies. This case highlights the presentation and treatment of a patient with a rare phenotype of testicular pleomorphic sarcoma treated by radical inguinal orchiectomy. In this study, our patient continued without nodal or distant disease in his initial positron emission tomography computed tomography scan after surgery.</p>","PeriodicalId":23912,"journal":{"name":"World Journal of Clinical Cases","volume":"14 6","pages":"118138"},"PeriodicalIF":1.0,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tubercular chorioretinitis mimicking sarcoidosis in a patient with celiac disease and erythema nodosum: A case report.","authors":"Nihil Singh, Arvind Kumar Morya, Shweta Walia, Hemlata Udenia","doi":"10.12998/wjcc.v14.i6.118184","DOIUrl":"https://doi.org/10.12998/wjcc.v14.i6.118184","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis remains an important cause of uveitis in tuberculosis-endemic regions and can closely resemble other granulomatous disorders, such as sarcoidosis, especially in the presence of erythema nodosum. The diagnosis is even more challenging in the presence of an underlying autoimmune condition such as celiac disease.</p><p><strong>Case summary: </strong>We report a case of a middle-aged female, a known case of celiac disease and recurrent severe anaemia presenting with progressive, recurring episodes of bilateral diminished vision, ocular pain, photophobia, and floaters over a period of 1.5 years. Ocular examination revealed bilateral vitritis with chorioretinal lesions consistent with posterior uveitis, more severe in the left eye. Initially, the presence of erythema nodosum and systemic symptoms raised the possibility of sarcoidosis; however, an extensive systemic workup ruled it out. A positive QuantiFERON-TB Gold test, past history of treated cervical lymph node tuberculosis, relevant family history, and favourable clinical response to antitubercular therapy favoured the diagnosis of presumed tubercular chorioretinitis. The treatment included antitubercular therapy, systemic corticosteroids, and posterior subtenon triamcinolone injections which led to clinical improvement; however, there was a recurrence of the disease after completing treatment, which required initiation of systemic azathioprine.</p><p><strong>Conclusion: </strong>This case highlights the need for a high index of suspicion for ocular tuberculosis in patients presenting with posterior uveitis and erythema nodosum. Detailed assessment and exclusion of close differentials are essential so that timely diagnosis and optimum management can be done, especially in endemic areas.</p>","PeriodicalId":23912,"journal":{"name":"World Journal of Clinical Cases","volume":"14 6","pages":"118184"},"PeriodicalIF":1.0,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a dedicated consult shift on reducing time to resolution of diagnostic disagreements: A quality improvement initiative.","authors":"Mayur Virarkar, Ceylan Altintas Taslicay, Emilio Supsupin, Hrishabh Bhosale, Ritu Shah, Ahmed Hassan, Oswaldo A Guevara Tirado, Ruben G Ortiz Cordero, Ajaykumar C Morani","doi":"10.12998/wjcc.v14.i5.117610","DOIUrl":"https://doi.org/10.12998/wjcc.v14.i5.117610","url":null,"abstract":"<p><strong>Background: </strong>Delays in resolving diagnostic disagreements within the quantitative imaging analysis core can impede clinical workflow and compromise patient care. To address this, a dedicated consult shift was initiated in 2023. This intervention included real-time monitoring through a dashboard overseen by an imaging specialist who alerted the designated consultant for immediate evaluation and resolution.</p><p><strong>Aim: </strong>To evaluate the impact of a dedicated consult shift on diagnostic disagreement resolution times and operational efficiency.</p><p><strong>Methods: </strong>This retrospective quality improvement study analyzed timestamp data from 1245 cases of diagnostic disagreement spanning the period from 2017 to 2025. Cases were stratified into two groups: Pre-implementation (2017-2022) and post-implementation (2023-2025). The primary metric was time to resolution in days. Both means and medians were compared using an independent samples <i>t</i>-test and a Mann-Whitney <i>U</i> test, respectively.</p><p><strong>Results: </strong>The average time to resolution significantly decreased from 100.58 days (2017-2022) to 33.05 days (2023-2025) (<i>t</i> = 10.02, <i>P</i> < 0.0001). Additionally, the median time to resolution dropped from 20.90 days to 5.02 days, a statistically significant reduction confirmed by the Mann-Whitney <i>U</i> test (<i>U</i> = 241577, <i>P</i> < 0.0001).</p><p><strong>Conclusion: </strong>The introduction of a dedicated consult shift, supported by real-time dashboard tracking, led to a significant improvement in both average and median resolution times for diagnostic disagreements. This intervention optimized the workflow and reinforced quality assurance processes in a clinical trial imaging setting.</p>","PeriodicalId":23912,"journal":{"name":"World Journal of Clinical Cases","volume":"14 5","pages":"117610"},"PeriodicalIF":1.0,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12897448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atherogenic index of plasma in stroke: A comprehensive review of its diagnostic, prognostic, and pathophysiological significance.","authors":"Hemanth Dhananjaya, Himanshu S Jog, Shashank Gupta, Arankesh Mahadevan, Shaylika Chauhan, Rupak Desai","doi":"10.12998/wjcc.v14.i5.117846","DOIUrl":"https://doi.org/10.12998/wjcc.v14.i5.117846","url":null,"abstract":"<p><p>The atherogenic index of plasma (AIP), defined as log [triglycerides (TG)/high-density lipoprotein cholesterol], an emerging lipid-based biomarker reflecting circulating TG and high-density lipoprotein cholesterol levels, has been associated with metabolic syndrome, coronary heart disease, and atherosclerosis. Its role in cardiovascular disease has been well established, yet there is growing interest in its application in cerebrovascular conditions, particularly stroke. Stroke is one of the leading causes of death and disability worldwide; hence, there is a need for integrative biomarkers to help improve risk prediction and accuracy of prognostication. Recent studies suggest that elevated AIP is independently associated with stroke incidence, especially among individuals with diabetes, prediabetes, and metabolic syndrome. Higher AIP levels have been associated with worse stroke severity at presentation, a higher risk of early neurological deterioration, and worse short-term outcomes. This is likely a consequence of AIP indicating vascular inflammation, endothelial dysfunction, and intracranial atherosclerosis. In observational studies, AIP has demonstrated comparable or stronger associations than other markers of insulin resistance, such as the TG-glucose index and the Chinese Visceral Adiposity Index, in specific metabolic populations. It is a low-cost and easily available biomarker, making it useful in primary prevention clinics, stroke units, and for managing metabolic syndrome. Given the increasing number of observational studies and population-based data, a comprehensive synthesis is needed to evaluate AIP's diagnostic, prognostic, and pathophysiological significance in stroke. This narrative review consolidates current findings on AIP's relevance in ischemic stroke and explores its potential integration into stroke risk stratification. Existing evidence is largely observational in nature, limiting causal interpretation.</p>","PeriodicalId":23912,"journal":{"name":"World Journal of Clinical Cases","volume":"14 5","pages":"117846"},"PeriodicalIF":1.0,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12897488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}