Factors Contributing to Anastomotic Leakage Following Colorectal Surgery: Why, When, and Who Leaks?

Anastomotic leakage is a common yet one of the most feared complications following colorectal surgery. Dehiscence of the anastomosis can result in fatal complications such as peritonitis, abscess formation, and sepsis, thereby increasing morbidity and mortality, cost and length of hospital stay. Multiple factors contribute to the development of anastomotic dehiscence. Several studies have been published identifying various risk factors that may play a role in causing AL. Our study reviewed prospective and retrospective studies and summarized the risk factors into three categories: preoperative, intraoperative, and postoperative. Among these are various risk factors such as age, gender, comorbidities, American Society of Anesthesiologists (ASA) scores, operative time, smoking, alcohol use, obesity, nutritional status, mechanical bowel preparation, and steroid use. It is crucial for surgeons to have a thorough understanding of the risk factors associated with anastomotic leakage to identify patients at high risk preoperatively. It may also be relevant to intraoperative decision-making when establishing an anastomosis, such as considering proximal diversion or placing a drain if such high-risk features are present. Knowing high-risk features also helps to detect leaks as early as possible postoperatively.

Sickle Cell Disease and Its Respiratory Complications.

Sickle cell disease (SCD) is a hematological disorder that is inherited in an autosomal recessive (AR) fashion. It is caused by mutations in the genes encoding for the globin apoprotein of hemoglobin (Hb), leading to diminished oxygen-carrying ability. Its pathophysiologic mechanism affects multiple organ systems, making it crucial to understand the complications of SCD and find the best ways to prevent and treat them. Some important ways that SCD manifests in the respiratory system are acute chest syndrome (ACS), pulmonary hypertension (PH), asthma, and venous thromboembolism (VTE). This article summarizes their salient features, including pathogenesis related to the adverse outcomes, screening practices, and management guidelines, with the intent to provide greater insight into forming better practices that increase the quality of life in SCD patients.

Chronic Pain-Induced Depression: A Review of Prevalence and Management.

Chronic pain is ongoing pain that has persisted beyond standard tissue healing time along with comorbidities such as depression. This article discusses studies that have shown the prevalence of chronic pain and chronic pain-induced depression and explained methods of prevention for these conditions. The molecular mechanisms such as monoamine neurotransmitters, brain-derived neurotrophic factor, inflammatory factors, and glutamate that are similar in chronic pain and depression have also been discussed. This article reviews the methods of management that utilize the identification of these molecular mechanisms to treat this condition further. It also emphasizes the importance of the awareness of chronic pain-induced depression for the upcoming advances in the subject of mental health.

Hypothyroidism and Depression: A Narrative Review.

There has been an established relationship between hypothyroidism and depression. Studies have demonstrated that somatostatin and serotonin influence the hypothalamus-pituitary-thyroid axis, which links hypothyroidism to depression. Multiple studies concluded that undiagnosed, untreated, undertreated patients with hypothyroidism are at increased risk of developing depression. Autoimmune thyroiditis is also associated with an increased risk of depression. Elevated thyroid-stimulating hormone (TSH), antithyroglobulin (TgAb), and thyroid peroxidase antibodies (TPOAb) levels have all been linked to depression and an increased risk of suicide. Moreover, hypothyroidism is known to be one of the leading causes of treatment-resistant depression. Treating underlying hypothyroidism with thyroid replacement therapy could significantly improve mood disorders such as depression. Levothyroxine therapy is also used as adjunctive therapy to antidepressants in the management of depression, and it is known to improve the symptoms of depression rapidly when compared to antidepressants alone. This review strengthens the link between hypothyroidism and depression, and it also demonstrates how treating the underlying hypothyroidism in people who have been diagnosed with depression will be very beneficial.