Annals of Medicine and Surgery最新文献

{"title":"Acute intestinal obstruction revealing an undiagnosed jejunal sarcoidosis in a 59-year-old female.","authors":"Yumna Njoum, Mohammed Hinnawi, Khaled Alshawwa, Hamza A Abdul-Hafez, Omar AbuZaydeh, Bashar Jaber","doi":"10.1097/MS9.0000000000003085","DOIUrl":"https://doi.org/10.1097/MS9.0000000000003085","url":null,"abstract":"<p><strong>Background: </strong>Sarcoidosis is a granulomatous illness with no known cause, defined histopathologically by noncaseating granulomas. While 90% of cases involve the lungs and mediastinal lymph nodes, clinically recognizable gastrointestinal sarcoidosis occurs in only 0.1-0.9% of patients, with small bowel involvement occurring in as few as 0.03% of all cases, and when it does occur, it is usually late in the disease course in patients with multisystem disease.</p><p><strong>Case presentation: </strong>Herein, we report a case of 59-year-old patient who presented with a picture of complete jejunal obstruction and gastrointestinal bleeding. Imaging revealed jejunal thickening and mesenteric lymphadenopathy. Later, intra-operatively, it be found caused by a jejunal stricture and enlarged mesenteric lymph nodes secondary to an undiagnosed sarcoidosis. Postoperative complications included hepatic hematoma and gastrointestinal bleeding. She stabilized after multidisciplinary management. A 1-year follow-up showed mediastinal lymphadenopathy without pulmonary involvement.</p><p><strong>Discussion: </strong>To provide individualized therapeutic care and follow-up, gastrointestinal sarcoidosis is a complex, possibly lethal condition that requires a multidisciplinary approach and early clinical suspicion. Without a prior diagnosis, sarcoidosis must be taken into account as a possible cause of acute intestinal blockage.</p><p><strong>Conclusion: </strong>Our case of jejunal sarcoidosis is unique for the rarity of disease location, the lack of pre-existing diagnosed sarcoidosis, and the necrotized jejunal resected segment indicating bowel ischemia.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 5","pages":"2996-3001"},"PeriodicalIF":1.7,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness of intra-arterial thrombolysis vs. mechanical thrombectomy: a literature review.","authors":"Bisrat Abate Bekele, Olivier Uwishema, Abel Haileyesus Adam, Abdi Degefu Gashu, Charbel Kachouh, Sarah Mshaymesh, Jack Wellington","doi":"10.1097/MS9.0000000000003139","DOIUrl":"https://doi.org/10.1097/MS9.0000000000003139","url":null,"abstract":"<p><strong>Background: </strong>Acute ischemic stroke (AIS) remains one of the leading causes of morbidity and mortality worldwide. Time is the single most critical factor in the management of patients presenting with AIS, where re-opening of occluded blood vessels is paramount. Intra-arterial thrombolysis (IAT) and mechanical thrombectomy (MT) are two such therapies employed to reestablish cerebrovascular blood flow in patients with AIS. This review compares both IAT and MT according to their efficacy, safety profiles, recanalization rates, clinical outcomes, and adverse procedural events.</p><p><strong>Methods: </strong>Study abstraction from electronic search databases comprising PubMed/MEDLINE, ResearchGate, and the National Library of Medicine was used. Screening and selection of relevant articles were comprehensively conducted for this review. Direct comparisons between IAT and MT in terms of variables including recanalization rates, clinical outcomes, and adverse procedural events were warranted for study inclusion. Research determined to exhibit insufficient data or without comparable groups were subsequently excluded.</p><p><strong>Results: </strong>MT was prompter when executing procedures than IAT, achieving greater rates of recanalization. Both interventions displayed similar results regarding rates of symptomatic intracranial hemorrhage (sICH) and mortality. Despite current available data indicating MT to demonstrate more efficiency as a procedure, further research is needed to examine IAT in light of specific patient demographics, clinical presentation, and circumstances.</p><p><strong>Conclusion: </strong>This review elucidated that MT often takes less time peri-procedurally, achieving greater success in revascularization compared with that of IAT. Regarding mortality and sICH rates, IAT and MT comparison showed equivocal results. Thus, while making therapeutic decisions, it is important to consider the unique clinical features of each patient as well as the timing of interventions in order to maximize treatment outcomes.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 5","pages":"2749-2757"},"PeriodicalIF":1.7,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noncardiac surgery for severe pulmonary hypertension: two surgeries in one patient and a review of the literature.","authors":"Maciej Wiewiora, Alicja Nowowiejska-Wiewiora, Mariusz Gasior, Jerzy Piecuch","doi":"10.1097/MS9.0000000000002828","DOIUrl":"https://doi.org/10.1097/MS9.0000000000002828","url":null,"abstract":"<p><strong>Introduction and importance: </strong>We present an analysis of the use of the multimodality approach for the treatment of patients with severe pulmonary arterial hypertension (PAH) who underwent surgery due to recurrent jaundice in the course of biliary obstruction and three years after surgery for breast cancer.</p><p><strong>Case presentation: </strong>A 66-year-old woman with a 5-year documented history of associated PAH related to scleroderomia. Because of cholangitis, she underwent endoscopic stenting of the common bile duct. At the time of the operation, she underwent three rounds of endoscopic removal of the prosthesis from the choledochal duct and restenting procedures due to recurrent jaundice during biliary obstruction. She underwent surgery via epidural thoracic anesthesia with intravenous sedation. Three years later, the patient was diagnosed with breast cancer. She underwent surgery via regional neuraxial blocks with intravenous sedation, and mastectomy with axillary lymphadenectomy was performed.</p><p><strong>Clinical discussion: </strong>According to the Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension, a general recommendation before surgery cannot be made. The perioperative optimization of pulmonary hypertension (PH) therapy should include assessments of functional status, severity of disease and comorbidities. The optimal specific treatment of PH by a cardiologist before the planned surgery of a patient and the selection of the optimal surgery time were crucial. The second very important element was the selection of the type of anesthesia.</p><p><strong>Conclusion: </strong>Our patient underwent high-risk surgery because, first, a large abdominal procedure was performed, and second, the operation was performed without the possibility of special preoperative modification therapy. The third, PH severity was very advanced, with higher pulmonary artery pressure than systemic blood pressure. Patients with advanced PH could experience a relatively smooth intra-operative course in non-cardiac surgery when managed with current operative and anesthetic strategies, as in the case described.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 5","pages":"2963-2969"},"PeriodicalIF":1.7,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can supplementation with antioxidants improve cognitive functions in patients with multiple sclerosis? A literature review.","authors":"Ali Rezaei, Majid Hamidi, Homa Seyedmirzaei, Abdorreza Naser Moghadasi","doi":"10.1097/MS9.0000000000003124","DOIUrl":"https://doi.org/10.1097/MS9.0000000000003124","url":null,"abstract":"<p><p>Multiple sclerosis (MS) is a chronic neuroinflammatory and neurodegenerative disease of the central nervous system (CNS) with a complex and multifactorial pathophysiology. Although these mechanisms are not yet fully elucidated, it is established that oxidative stress (OS) plays a key role in driving neurodegeneration in MS. These pathological mechanisms contribute to a wide range of symptoms, including motor and sensory deficits, as well as cognitive impairment. The impairments in cognitive functions can cause a major burden for these patients and significantly affect their quality of life. For example, memory is one of the most frequently impaired cognitive domains in MS. These deficits often correlate with biomarkers of neurodegeneration and disease progression. Despite the substantial burden of cognitive impairment in MS, no established treatments currently exist to prevent or mitigate cognitive decline in these patients, aside from the disease-modifying treatments. Several clinical trials have investigated the potential of antioxidant supplementation to improve cognitive outcomes in MS patients. However, their findings are often controversial. This review discusses trials evaluating the effects of supplementation with various antioxidants, including <i>Ginkgo biloba</i>, melatonin, omega-3 fatty acids, vitamins A, N-acetylcysteine, lipoic acid, xanthophylls, and crocin, on cognitive performance. We discuss the findings of these studies, highlight methodological limitations, and explore the underlying mechanisms by which these compounds may modulate cognition. These mechanisms range from mitigating OS, inflammation, and glutamate-induced neurotoxicity in the CNS to addressing secondary symptoms such as depression and fatigue, which are often linked to cognitive decline. By reviewing the current evidence, this review not only underscores the therapeutic potential and limitations of antioxidant supplementation but also provides guidance for future research to optimize study design and advance our understanding of cognitive preservation strategies in MS.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 5","pages":"2736-2748"},"PeriodicalIF":1.7,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare case of schwannomatosis presenting with cauda equina syndrome: a case report.","authors":"Allahdad Khan, Nehan Zahoor, Abdul Ahad Riaz, Humaira Siddique, Anam Malik, Raheel Ahmed, Fnu Poombal, Mohamed Antar","doi":"10.1097/MS9.0000000000003268","DOIUrl":"https://doi.org/10.1097/MS9.0000000000003268","url":null,"abstract":"<p><strong>Background: </strong>Schwannomatosis is a rare disorder characterized by multiple schwannomas without vestibular schwannomas or other features of neurofibromatosis type 2 (NF2). It commonly presents with neuropathic pain, neurological deficits, and soft tissue tumors but rarely leads to cauda equina syndrome, a serious condition requiring urgent intervention.</p><p><strong>Materials and methods: </strong>We report a 28-year-old Pakistani female with progressive back pain, lower limb weakness, sensory deficits, bladder and bowel incontinence, and multiple tender swellings, consistent with cauda equina syndrome. Neurological examination revealed right-sided lower limb weakness. MRI of the brain showed no vestibular schwannomas, while spinal MRI identified a heterogeneously enhancing schwannoma from D11 to L5 with cystic extension into the neural foramina, proximal central canal dilation, and spinal cord compression. Multiple additional schwannomas were detected. Right thigh mass biopsy confirmed schwannoma, showing Antoni A and B regions, Verocay bodies, and S-100 positivity. Genetic testing was not performed due to financial constraints.</p><p><strong>Results: </strong>The patient underwent partial spinal schwannoma resection, leading to spinal decompression and resolution of cauda equina syndrome symptoms. Symptomatic cutaneous schwannomas were excised. Neuropathic pain was managed with pregabalin and NSAIDs. At 6-month follow-up, she showed improved lower limb strength, resolution of incontinence, and no significant tumor regrowth.</p><p><strong>Conclusion: </strong>This case highlights schwannomatosis presenting with cauda equina syndrome, emphasizing the importance of early recognition, spinal decompression, and differentiation from NF2 for optimal management.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 5","pages":"3043-3047"},"PeriodicalIF":1.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of peppermint essential oil on postoperative nausea, vomiting, and pain in rhinoplasty patients: a randomized clinical trial.","authors":"Arman Parvizi, Reza Pour Mohammad, Soudabeh Haddadi, Shaghayegh Rezaei Kia, Maryam Akbari, Mohammad Ali Yazdanipour","doi":"10.1097/MS9.0000000000003032","DOIUrl":"https://doi.org/10.1097/MS9.0000000000003032","url":null,"abstract":"<p><strong>Background: </strong>The present study aims to determine the effect of peppermint essential oil on postoperative nausea, vomiting, and pain in rhinoplasty patients.</p><p><strong>Materials and methods: </strong>This randomized clinical trial included 80 patients aged 18-65 randomly assigned to either the peppermint or the control group. The peppermint group received 20 oral drops of 2% peppermint essence 30 minutes before surgery, while the control group received an equal amount of distilled water. Blinding was maintained for recovery staff and patients. Nausea, vomiting, and pain were assessed at three intervals: upon entry into the recovery room, upon ward admission, and one-hour post-admission, using the Visual Analogue Scale (VAS) and observational methods.</p><p><strong>Results: </strong>The evaluation of pain and vomiting in patients during recovery, upon ward admission, and one-hour post-admission did not reveal a statistically significant difference between the two intervention groups (those administered with peppermint essence and the control group) (<i>P</i> > 0.05). However, a statistically significant association was observed between nausea at different measurement times and the groups under study (<i>P</i> < 0.001). Specifically, at all three measurement times, the incidence of nausea was significantly lower in patients who were administered mint compared to those in the control group. Nevertheless, intra-group comparisons did not reveal a significant difference in the occurrence of nausea across different measurement times (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>The application of peppermint essential oil is efficacious in mitigating postoperative nausea following rhinoplasty. Consequently, peppermint can be considered a safe and effective antiemetic intervention in the surgical setting.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 5","pages":"2689-2695"},"PeriodicalIF":1.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Female genital tuberculosis mimicking advanced ovarian cancer - a diagnostic dilemma in resource limiting setup: case repot and literature review.","authors":"Tadele Demilew Chekol, Hailemariam Awoke Engedaw, Eyaya Misgan Asres, Tewodros Ayenew Yismaw, Gebeyaw Addis Bezie, Sirak Mekonnen Fentaye, Addisu Assfaw Ayen","doi":"10.1097/MS9.0000000000003262","DOIUrl":"https://doi.org/10.1097/MS9.0000000000003262","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Tuberculosis (TB), a major global health issue, predominantly affects the lungs but can manifest as extrapulmonary TB, including rare genitourinary TB. Isolated genital TB is uncommon, making diagnosis challenging and requiring careful evaluation to differentiate it from tumors, especially in low-resource settings.</p><p><strong>Case presentation: </strong>A 20-year-old nulliparous Ethiopian woman presented with a history of long-standing abdominal swelling and constitutional symptoms, including fever and significant ascites. Investigations revealed bilateral adnexal masses and lymphocyte-predominant ascitic fluid, negative for malignant cells. Initially, advanced ovarian tumor was the primary differential diagnosis, leading to consideration for exploratory laparotomy. However, due to the patient's unfitness for surgery, tubo-ovarian tuberculosis was considered following further evaluation. The patient demonstrated improvement after initiating anti-tuberculosis therapy.</p><p><strong>Case discussion: </strong>TB remains a major global health issue. Genitourinary TB is a common extrapulmonary manifestation, but isolated genital TB is challenging to diagnose due to non-specific symptoms mimicking ovarian tumors. Diagnosis requires confirming mycobacteria via tests like GeneXpert, and while cancer antigen 125 can be elevated, it is not specific. Treatment is a standard anti-TB regimen, with most patients improving without surgery.</p><p><strong>Conclusion: </strong>Ovarian tuberculosis, often mistaken for ovarian tumors, requires thorough evaluation in young patients, especially those from low-resource settings, to avoid unnecessary surgery and prevent complications like infertility.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 5","pages":"3032-3036"},"PeriodicalIF":1.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolving therapeutic approaches in achalasia: a comprehensive review of peroral endoscopic myotomy (POEM) vs. Heller's myotomy.","authors":"Khadija Ahmed, Sameer Abdul Rauf, Tooba Hussain, Areeba Siddiqui, Rubayyi Ahmed, Najam Ahmed Khan, Hussain Haider Shah, Md Ariful Haque","doi":"10.1097/MS9.0000000000003271","DOIUrl":"https://doi.org/10.1097/MS9.0000000000003271","url":null,"abstract":"<p><p>This comprehensive narrative review thoroughly explores the treatment landscape for achalasia, a rare esophageal motility disorder. Beginning with an introduction outlining the anatomical and clinical aspects of achalasia, the review delves into its historical perspective, tracing the evolution of treatment options from early nonsurgical methods to advanced surgical techniques such as Heller's myotomy and peroral endoscopic myotomy (POEM). Technical perspectives on surgical interventions, including key steps, clinical practice guidelines, and modifications to POEM techniques, are extensively discussed. A comparative analysis between POEM and Heller's myotomy elucidates their indications, contraindications, efficacy, outcomes, and interventions for persistent symptoms or complications. Furthermore, the review explores the adverse events associated with both procedures, highlighting their safety profiles and management strategies. Finally, from a financial perspective, considerations such as operative time, hospital stay length, readmission rates, and quality-adjusted life years are examined, emphasizing the implications for patient decision-making. This review underscores the importance of a multidimensional approach to understanding and managing achalasia, advocating for further research to enhance treatment efficacy and reduce adverse effects.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 5","pages":"2855-2867"},"PeriodicalIF":1.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Profiling the pathological findings of diagnostic curettage for abnormal uterine bleeding a retrospective cross-sectional study among reproductive-aged women.","authors":"Maryam Iranpour, Fatemeh Boroumandfar, Sadra Faramarzpour, Mahsa Faramarzpour","doi":"10.1097/MS9.0000000000003263","DOIUrl":"https://doi.org/10.1097/MS9.0000000000003263","url":null,"abstract":"<p><strong>Background: </strong>Abnormal uterine bleeding (AUB) is a common condition among women of reproductive age. This symptom is characterized by irregularities in menstrual frequency, duration, and volume. Early detection and management of AUB are crucial for improving women's health outcomes. This study aimed to assess the pathological findings of diagnostic curettage (D&C) in women of childbearing age with AUB at Afzalipour Hospital, Kerman, Iran.</p><p><strong>Methods: </strong>This cross-sectional study included 1053 women aged 15-49 who underwent D&C for AUB between 2020 and 2021. Patient demographics and histopathological findings were gathered retrospectively from the pathology reports. Statistical analysis was conducted using the Kruskal-Wallis test to evaluate the relationship between pathological findings and patient age.</p><p><strong>Results: </strong>Among the participants, 99.3% of the findings were benign, with pregnancy-related issues, normal-phase lesions, and hormone imbalances being the most common diagnoses, respectively. The average ages for the normal phase and pregnancy-related issues were significantly lower than those for malignancies, which were predominantly found in older women (average age of 45 years). Statistical analysis revealed significant age-related differences in the types of pathologies (<i>P</i>-value <0.001).</p><p><strong>Conclusion: </strong>This study suggests that benign conditions are the primary cause of AUB in younger women, whereas the risk of malignancy increases with age. These findings underscore the importance of targeted diagnostic approaches, timely interventions, and appropriate management, particularly in resource-limited countries, such as Iran.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 5","pages":"2653-2658"},"PeriodicalIF":1.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epigenetic therapy for alcoholic hepatitis: can larsucosterol change the treatment landscape?","authors":"Faiza Fatima, Mahnoor Fatima, Ahmed Raza, Bilal Ahmad, Aymar Akilimali","doi":"10.1097/MS9.0000000000003260","DOIUrl":"https://doi.org/10.1097/MS9.0000000000003260","url":null,"abstract":"<p><p>Alcohol-induced liver disease, encompassing steatosis, hepatitis, cirrhosis, and liver failure, is a significant global health burden, affecting 10-35% of individuals with alcohol use disorder. Alcoholic hepatitis, characterized by hepatocyte inflammation due to chronic alcohol consumption, arises from toxic intermediates produced during alcohol metabolism. These intermediates disrupt cellular function, trigger immune responses, and promote fibrosis, leading to cirrhosis and liver failure. Despite current treatments like corticosteroids and liver transplantation, which alleviate symptoms but fail to reverse cellular damage, the rising prevalence of alcoholic hepatitis underscores the urgent need for innovative therapies. Larsucosterol, a novel epigenetic modulator, has emerged as a promising candidate. By inhibiting DNA methyltransferase, larsucosterol reduces DNA hypermethylation and modulates genes involved in inflammation, lipid metabolism, and cell survival, thereby mitigating liver damage. Early-phase clinical trials, including a phase 2a study, demonstrated its safety, tolerability, and improved biochemical parameters in patients. However, the phase 2b AHFIRM trial did not achieve its primary endpoint, though a lower mortality rate in the 30 mg group suggests potential benefits requiring further investigation. Larsucosterol's immunomodulatory and anti-inflammatory properties offer advantages over corticosteroids, particularly in patients unresponsive to standard therapies. Despite its promise, limitations such as the need for larger, more diverse trials, long-term safety data, and exploration of combination therapies remain. In conclusion, larsucosterol represents a groundbreaking approach to treating alcoholic hepatitis, but extensive research is essential to fully establish its therapeutic potential and address existing gaps in knowledge.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 5","pages":"3050-3051"},"PeriodicalIF":1.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}