Annals of Medicine and Surgery最新文献

{"title":"Clotting, inflammation, and immunity: the multifaceted role of platelets in HIV and sickle cell disease - a narrative review.","authors":"Emmanuel Ifeanyi Obeagu","doi":"10.1097/MS9.0000000000003677","DOIUrl":"10.1097/MS9.0000000000003677","url":null,"abstract":"<p><p>Platelets, long recognized for their function in hemostasis, are increasingly acknowledged for their role in immune modulation and inflammation, especially regarding complex co-infections. This review examines the complex role of platelets in co-infection with HIV and sickle cell disease (SCD), highlighting their functions that go beyond coagulation and contribute to chronic inflammation, immune activation, and vascular dysfunction. In HIV, there is an increase in platelet activation, fostering inflammation and endothelial dysfunction, thereby raising the likelihood of thrombotic events. Likewise, in SCD, platelets play a role in vaso-occlusion, which worsens the microvascular issues associated with the disease. The overlap of HIV and SCD complicates platelet function, enhancing both pro-coagulant and pro-inflammatory pathways. In SCD, platelet aggregation speeds up endothelial damage, and immune activation from HIV worsens this condition, increasing the chances of thromboembolic incidents. Platelets engage with immune cells, enhancing T cell activation and HIV viral replication, while creating an inflammatory environment that exacerbates the pathology of both conditions. These interactions establish a detrimental cycle of platelet dysfunction, inflammation, and tissue injury, which presents considerable difficulties for patient care.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 9","pages":"5878-5886"},"PeriodicalIF":1.6,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991217","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":"Compartment syndrome of upper limb following snake bite, a case report.","authors":"Navin Bhattarai, Prasesh Dhakal, Devendra Bhandari, Srijana Katwal, Shristi Bhandari, Shilu Shrestha","doi":"10.1097/MS9.0000000000003674","DOIUrl":"10.1097/MS9.0000000000003674","url":null,"abstract":"<p><strong>Introduction: </strong>Snakebites, recognized as a neglected tropical disease by the WHO, cause significant morbidity and mortality globally. Although antivenom is the primary treatment, managing complications like compartment syndrome (CS) and soft tissue necrosis remains challenging. This case report describes a 39-year-old woman who developed CS following a green pit viper bite and subsequent antivenom administration, necessitating a fasciotomy.</p><p><strong>Case: </strong>The patient sustained a bite to her right middle finger, receiving 10 vials of polyvalent anti-snake venom. The next day, she developed symptoms suggestive of CS, prompting an emergency fasciotomy. The procedure included volar and dorsal forearm releases, finger incisions, and compartment releases. She was discharged on day 20 with optimal hand function and instructed to continue physiotherapy.</p><p><strong>Discussion: </strong>Snake venom contains toxic peptides and proteases that cause local and systemic effects, with severity influenced by venom quantity, bite location, and timely intervention. Upper extremity bites, particularly to the hand, are prone to CS due to the region's vascularity and anatomy. Although CS after snakebites is rare, its symptoms can mimic local envenomation, requiring careful differentiation and urgent management to prevent permanent damage. Fasciotomy may be necessary if CS persists despite antivenom therapy, as demonstrated in our case.</p><p><strong>Conclusion: </strong>Snakebites, particularly to the upper extremities, require careful monitoring for complications like CS. Timely diagnosis and fasciotomy are crucial to prevent limb loss and preserve function.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 9","pages":"6197-6200"},"PeriodicalIF":1.6,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991343","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":"Accidental formaldehyde injection during prostate biopsy: a rare cause of rectal necrosis and perforation. Case report and review of the literature.","authors":"Imad Kamaleddine, Clemens Schafmayer, Ahmed Alwali","doi":"10.1097/MS9.0000000000003648","DOIUrl":"10.1097/MS9.0000000000003648","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Accidental chemical injuries in medical settings are uncommon but can have devastating consequences. Formaldehyde (commonly in the form of formalin solution) is widely used as tissue fixative in clinics and laboratories. If inadvertently introduced into living tissue, formaldehyde causes rapid protein coagulation and tissue fixation, leading to cell death and necrosis. We present a rare case of rectal injury and perforation caused by accidental formaldehyde injection during a prostate biopsy.</p><p><strong>Case presentation: </strong>A 70-year-old male underwent a transrectal prostate biopsy which was complicated by the accidental injection of formaldehyde 4% into the rectum. One week later, he presented to our clinic with persistent rectal pain and was found to have an extensive rectal wall necrosis with perforation. Prompt intervention was undertaken with broad-spectrum intravenous antibiotics, transanal surgical debridement of necrotic tissue, and endoscopic vacuum therapy (EVT) to manage the rectal defect. The patient's condition improved with each sequential sponge change over an 11-day period, leading to cavity closure and granulation. He was discharged in stable condition on postoperative day 14. Two months later the rectal wound had completely healed.</p><p><strong>Clinical discussion: </strong>Accidental injection of formaldehyde into viable tissues is rare, but it can result in severe consequences. Early identification of the injury, followed by appropriate treatment (in our case, EVT), offered the best management approach and led to full recovery without the need for a diverting ostomy.</p><p><strong>Conclusion: </strong>This case highlights a rare iatrogenic chemical injury with formaldehyde, its successful management with minimally invasive endoscopic vacuum therapy (EVT), and underscores the need for stringent precautions to prevent such hazardous incidents.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 9","pages":"6177-6180"},"PeriodicalIF":1.6,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991338","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":"Symptomatic postoperative cyst following glioma excision in a pediatric patient: a case report.","authors":"R Praveen, Gianluca Scalia, Giuseppe Emmanuele Umana, Bipin Chaurasia","doi":"10.1097/MS9.0000000000003666","DOIUrl":"10.1097/MS9.0000000000003666","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Postoperative cyst formation is a rare but significant complication following central nervous system (CNS) tumor resection. This case report describes a 14-year-old girl who developed a postoperative cyst after glioma excision, successfully managed through a minimally invasive approach.</p><p><strong>Case presentation: </strong>A 14-year-old female presented with headache and seizures. Magnetic Resonance Imaging (MRI) revealed a mass in the trigonal region. She underwent surgical resection of the tumor. On postoperative day 7, she developed a symptomatic cyst at the tumor bed. The cyst was drained, resulting in symptomatic improvement. Follow-up assessments confirmed her clinical recovery.</p><p><strong>Clinical discussion: </strong>In pediatric patients, postoperative cyst formation is less frequently reported compared to adults. This highlights the need for further investigation into its underlying mechanisms and optimal treatment strategies in children.</p><p><strong>Conclusion: </strong>Minimally invasive percutaneous drainage followed by shunting successfully managed the postoperative cyst and prevented recurrence in this pediatric glioma case. Given the absence of standardized treatment protocols, individualized care is essential to ensure the best possible outcomes.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 9","pages":"6201-6205"},"PeriodicalIF":1.6,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144990895","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":"A tale of two valves: where rheumatic mitral disease meets aortic papillary fibroelastoma - a narrative review.","authors":"Maimoona Akhtar, Marhaba Fatima, Mohammed Mahmmoud Fadelallah Eljack","doi":"10.1097/MS9.0000000000003662","DOIUrl":"10.1097/MS9.0000000000003662","url":null,"abstract":"<p><p>Rheumatic heart disease (RHD) and papillary fibroelastoma (PFE) are distinct cardiovascular disorders that can rarely occur together. RHD is a chronic condition caused by untreated streptococcal infections, primarily affecting the mitral valve and resulting in severe valvular damage. On the other hand, PFE is a benign heart tumor, usually affecting the aortic valve, and is typically asymptomatic, often discovered incidentally through imaging. The simultaneous presence of RHD and PFE, especially involving the mitral and aortic valves, has only been reported in two case studies. This review examines the pathophysiology, clinical features, diagnostic challenges, and treatment options for both conditions. Echocardiography is the primary diagnostic tool, and surgery, involving tumor removal and valve replacement, is the standard treatment for symptomatic cases. Although this dual condition is rare, the review highlights the significance of early detection, particularly in areas where RHD is common, and calls for additional research to explore the potential connections between these conditions and improve patient care.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 9","pages":"5870-5877"},"PeriodicalIF":1.6,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991313","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":"Resilience amidst conflict: the pivotal role of Sudanese surgical residents and the Sudan medical specialization board in sustaining surgical training.","authors":"Alsadig Suliman","doi":"10.1097/MS9.0000000000003668","DOIUrl":"10.1097/MS9.0000000000003668","url":null,"abstract":"","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 9","pages":"5378-5380"},"PeriodicalIF":1.6,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991453","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":"A comorbidity of cardiac atherosclerotic disease with cardiac myxomas being concomitantly treated by coronary artery bypass grafting coupling with tumor resection: a case report.","authors":"Chao Han, Ning Guo, Jie Wang, Miao Xie, Fei Li","doi":"10.1097/MS9.0000000000003653","DOIUrl":"10.1097/MS9.0000000000003653","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Cardiac atherosclerotic disease (CAD), the leading cause to cardiovascular disease-related death, coexisting with cardiac myxoma, the commonest benign primary cardiac neoplasm, is rare. The treatment of the comorbidity is complicated due to the rarity and inexperience.</p><p><strong>Case presentation: </strong>A 65-year old male patient with intermittent chest tightness and shortness of breath for 10 years was admitted for further work-up. On admission, the comprehensive metabolic panel (CMP) revealed a normal liver, kidney and coagulant function, and the BNP, troponin and CK-MB were within the normal limits. ECG showed a sinus rhythm. Cardiac catheterization revealed a three-vessel disease of CAD. Incidentally, echocardiography and MRI found a mobile mass, highly suspicious of cardiac myxomas on the imaging, at the left atrium. A coronary artery bypass grafting (CABG) combining with a right-atrium approach resection of the lesion were devised and concomitantly performed. No surgical complications and major cardiac adverse events occurred post-procedure. After anti-infection and supportive care, the patient recovered uneventfully. Follow-up at 6 months revealed no discomfort of the patient.</p><p><strong>Clinical discussion: </strong>It was risky to treat the comorbidity separately. Due to the rarity of the comorbidity, it remains unsolved whether the prognosis will be truly affected by the concurrent procedures. Yet, this single case with a prosperous outcome post-surgery might provide a valuable reference to the treatment of cardiac myxomas incidentally diagnosed in CAD.</p><p><strong>Conclusion: </strong>The three-vessel CAD co-occurring with the single lesion cardiac myxomas at the left atrium can be managed safely and effectively by combining CABG with transseptal right atriotomy in the concomitant procedures.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 9","pages":"6186-6192"},"PeriodicalIF":1.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991182","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":"Awareness regarding surgical errors, its occurrence and their coping strategies among the surgeons of BPKIHS.","authors":"Diwakar Koirala, Abhijeet Kumar, Aashish Baniya, Ramesh Sapkota, Bivek Mishra","doi":"10.1097/MS9.0000000000003663","DOIUrl":"10.1097/MS9.0000000000003663","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical errors are a significant concern in medical practice, particularly in teaching institutions where trainees are frequently involved in patient care. These errors, which include deviations from standard surgical procedures, can lead to adverse patient outcomes in one hand whereas emotional distress among surgeons on the other hand as well. Understanding the prevalence, types, and coping mechanisms for surgical errors is essential for developing effective strategies to minimize their occurrence and impact.</p><p><strong>Results: </strong>This cross-sectional study involved 134 surgeons from various specialties at B.P. Koirala Institute of Health Sciences (BPKIHS), with 50.7% being resident doctors. A total of 79.1% admitted to committing surgical errors during their careers at some points of time. All errors, self-accepted by surgeons enrolled in the study were minor ones. Frequently reported errors included inappropriate incision (77.5%), anesthesia titration errors (75.7%), and unintentional organ/tissue injury (69.2%). Female surgeons were more likely to self-report errors than male surgeons. All errors had occurred during the early phase of surgical training. Surgeons attributed errors to systemic and personal factors, including insufficient staffing, fatigue, and poor communication. Common coping strategies included escape and self-instruction, though not all were effective in mitigating stress.</p><p><strong>Conclusion: </strong>The high incidence of minor errors seems to be acceptable part of learning in teaching institute where trainees are frequently involved in patient care. None of the error was major because in teaching institute like ours, the trainees are at frontline in patient care but are always under supervision of senior clinicians. All errors have occurred during the early phase of surgical training. There is need of targeted interventions, including training, support systems, and institutional reforms to reduce surgical errors and improve surgeon well-being.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 9","pages":"5442-5447"},"PeriodicalIF":1.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991219","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":"Depression and anxiety in family caregivers of cancer patient: a cross sectional study in Nepal.","authors":"Egesh Aryal, Suman Prasad Adhikari, Nimesh Lageju, Divas Adhikari, Kiran Dhonju, Himalaya Thapa, Ayush Mohan Bhattarai, Swojay Maharjan, Laxman Wagle","doi":"10.1097/MS9.0000000000003679","DOIUrl":"10.1097/MS9.0000000000003679","url":null,"abstract":"<p><strong>Introduction: </strong>With the growing incidence of cancer, the role of caregivers has become increasingly critical in ensuring comprehensive patient care. However, the prolonged and sustained nature of caregiving responsibilities can adversely affect the mental health of caregivers. This study aims to explore the prevalence of depression and anxiety among caregivers of cancer patients.</p><p><strong>Methods: </strong>We enrolled 101 caregivers of cancer patients from a tertiary care hospital in Kathmandu in this study and obtained demographic information from the patients and their caregivers. The prevalence of depression and anxiety was assessed by the use of Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) score, respectively. We used Chisquare/Fischer's exact test to analyze association between variables.</p><p><strong>Results: </strong>Out of 101 caregivers, 80 (79.2%) were males and 21(20.8%) were females. Overall, 58.4% had either mild, moderate, or severe anxiety according to GAD-7 scale. Overall, 28.7% had either mild moderate or moderately severe depression according to the PHQ-9. Male gender, relationship with the patient, the patient's ECOG performance score had significant association with higher severity of anxiety. Closer relationships with patients showed higher severity of depression.</p><p><strong>Conclusion: </strong>Anxiety and depression were considerably present among caregivers of the patient. Interventions aimed at reducing the mental health impact of cancer should focus not only on the patient but also to their caregiver.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 9","pages":"5448-5453"},"PeriodicalIF":1.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991106","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":"Smart dosing: revolutionizing uveal melanoma treatment with AI.","authors":"Omaima Ibrahim, Maliha Khalid, Muhammad Talha, Aminath Waafira","doi":"10.1097/MS9.0000000000003669","DOIUrl":"10.1097/MS9.0000000000003669","url":null,"abstract":"<p><p>Uveal melanoma, the most common primary intraocular malignancy in adults, presents a significant challenge due to its high metastatic potential and the need to preserve vision during treatment. While conventional therapies such as plaque brachytherapy and proton beam radiation aim to balance tumor control with ocular preservation, recent advances in artificial intelligence (AI) and machine learning (ML) offer transformative potential in personalizing radiation dosing. By integrating radiologic features with genomic markers such as BAP1 mutations, monosomy 3, and chromosome 8q gain, AI models can predict tumor radiosensitivity and guide dose modulation based on individual tumor biology. This precision approach may enhance treatment efficacy while minimizing toxicity to surrounding ocular structures. However, the deployment of AI in clinical oncology also raises ethical concerns, including the risk of algorithmic bias and the need for data diversity, regulatory oversight, and interdisciplinary collaboration. Responsible integration of AI into radiation oncology could redefine treatment strategies for uveal melanoma, ushering in a new era of radiogenomics-driven precision medicine.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 9","pages":"6238-6239"},"PeriodicalIF":1.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991423","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}