Groove pancreatitis: From enigma to future directions-A comprehensive review.

Groove pancreatitis (GP) is a rare and clinically distinct form of chronic pancreatitis affecting the pancreaticoduodenal groove comprising the head of the pancreas, duodenum, and the common bile duct. It is more prevalent in individuals in their 4-5th decade of life and disproportionately affects men compared with women. Excessive alcohol consumption, tobacco smoking, pancreatic ductal stones, pancreatic divisum, annular pancreas, ectopic pancreas, duodenal wall thickening, and peptic ulcers are significant risk factors implicated in the development of GP. The usual presenting symptoms include severe abdominal pain, nausea, vomiting, diarrhea, weight loss, and jaundice. Establishing a diagnosis of GP is often challenging due to significant clinical and radiological overlap with numerous benign and malignant conditions affecting the same anatomical location. This can lead to a delay in initiation of treatment leading to increasing morbidity, mortality, and complication rates. Promising research in artificial intelligence (AI) has garnered immense interest in recent years. Due to its widespread application in diagnostic imaging with a high degree of sensitivity and specificity, AI has the potential of becoming a vital tool in differentiating GP from pancreatic malignancies, thereby preventing a missed or delayed diagnosis. In this article, we provide a comprehensive review of GP, covering the etiology, pathogenesis, clinical presentation, radiological and endoscopic evaluation, management strategies, and future directions. This article also aims to increase awareness about this lesser known and often-misdiagnosed clinical entity amongst clinicians to ultimately improve patient outcomes.

Comparing plaque removal efficacy of biodegradable toothbrush and nonbiodegradable toothbrush in children of 8-10 years of age: A randomized clinical study.

INTRODUCTION: In the 21st century, we are surrounded by plastic, disposal of which has a detrimental effect on the environment. Around 700 million plastic toothbrushes are sold which contributes to a large portion of plastic waste. To aid in the restoration of the environment, there is a need to replace plastic toothbrushes with recyclable toothbrushes. The purpose of the study was to evaluate and compare the plaque removal efficacy of biodegradable toothbrushes and nonbiodegradable toothbrushes in children 8-10 years of age. METHODOLOGY: Ninety children 8-10 years old from school were included in the study. Toothbrush types to groups A (nonbiodegradable toothbrush, Colgate® Palmolive India Ltd.), B (Biodegradable toothbrush, Bamboo India), and C (Biodegradable toothbrush, Palette™ India) were randomly allocated and plaque score was evaluated using plaque disclosing agent and Turesky Modification of Quigley Hein Index at day 1, 7, and 14. The data were analyzed using unpaired "t" and analysis of variance to find the significance of study parameters between the groups and paired t-test was used to find the significance of study parameters within the group (pre- and postbrushing). RESULTS: The comparison of plaque scores pre- and postbrushing in all groups manifested reduction from day 1 to 14. However, Group B showed a significant reduction of plaque on day 14 with a difference of 0.50 which is statistically significant with a P < 0.001. CONCLUSION: According to the results, it can be concluded that a biodegradable toothbrush has adequate plaque removal efficacy. Therefore, the use of biodegradable toothbrushes can be recommended which will reduce nonbiodegradable waste.

Beyond the Liver: Unveiling Rhabdomyolysis as a Rare Complication of Hepatitis A.

Hepatitis A is a mild self-limiting infection of the liver with spontaneous resolution of symptoms in most cases. However, clinicians should be aware of some commonly encountered complications and extrahepatic manifestations associated with hepatitis A for timely diagnosis and treatment. Rhabdomyolysis, an exceedingly rare complication of hepatitis A, is scarcely documented. We present a case of a 64-year-old man with symptoms consistent with rhabdomyolysis and an evanescent rash secondary to acute hepatitis A. He eventually recovered with conservative management. This case emphasizes the importance of recognizing and treating atypical presentations of acute hepatitis A infection. LEARNING POINTS: Recognition of atypical presentations: The case underscores the importance of recognizing and treating atypical presentations of acute hepatitis A infection. Clinicians should be vigilant for unusual manifestations of common infections, facilitating timely diagnosis and appropriate management.Understanding rare complications: Rhabdomyolysis is identified as an exceedingly rare complication of hepatitis A infection, which is scarcely documented in the literature. This case contributes to the growing understanding of extrahepatic manifestations associated with hepatitis A, emphasizing the importance of considering uncommon complications in the differential diagnosis, especially when typical clinical presentations are observed.Management strategies: The article discusses the treatment approach for rhabdomyolysis secondary to acute hepatitis A, which involves aggressive fluid resuscitation to prevent kidney damage from myoglobinuria, correction of electrolyte imbalances, and metabolic abnormalities. Additionally, vaccination against hepatitis A and advocating for sanitation measures are highlighted as important preventive strategies.

Charting a Path to the Quintuple Aim: Harnessing AI to Address Social Determinants of Health.

The Quintuple Aim seeks to improve healthcare by addressing social determinants of health (SDOHs), which are responsible for 70-80% of medical outcomes. SDOH-related concerns have traditionally been addressed through referrals to social workers and community-based organizations (CBOs), but these pathways have had limited success in connecting patients with resources. Given that health inequity is expected to cost the United States nearly USD 300 billion by 2050, new artificial intelligence (AI) technology may aid providers in addressing SDOH. In this commentary, we present our experience with using ChatGPT to obtain SDOH management recommendations for archetypal patients in Philadelphia, PA. ChatGPT identified relevant SDOH resources and provided contact information for local organizations. Future exploration could improve AI prompts and integrate AI into electronic medical records to provide healthcare providers with real-time SDOH recommendations during appointments.

A Multi-Aperture Technique for Longitudinal Miniaturization of UWB 3 dB Dual-Layer SIW Coupler.

Microwave couplers are used in large numbers in beamforming networks, and their miniaturization can lead to a significant size reduction in the overall phased array. While the miniaturization of 3 dB couplers in the transverse direction (width) has been given considerable attention in the literature, there is minimal to no information on reducing coupler length. This is because of the trade-off between aperture length, bandwidth and coupling strength. The Bethe-Hole theory requires adding multiple apertures in the longitudinal direction for wide bandwidth, thus increasing the device length. Another factor is the aperture size, which determines the coupling strength and puts additional strain on the compactness of a 3 dB coupler. Contrariwise, this paper proposes to merge two weak (and hence compact) coupling mechanisms to design a wideband 3 dB coupler. This is achieved by using a longitudinal rectangular slot and three cross-slots in the transverse direction. Because of weak coupling, the slot sizes are smaller than a conventional 3 dB coupler, hence yielding a device whose length is less than one guided wavelength (λg) without compromising the bandwidth. The presented coupler is 0.63 λg in length, which is smaller than the state-of-the-art while maintaining a fractional bandwidth of 37% that is comparable to half-mode substrate integrated waveguide (HMSIW) couplers.

Intermittent fasting and cardiovascular disease: A scoping review of the evidence.

Intermittent fasting (IF), characterized by alternating periods of fasting and unrestricted eating, typically within an 8-hour window or less each day, has gained significant attention as a possible dietary approach. While it is recognized for its metabolic advantages, like weight loss and enhanced glucose and insulin sensitivity, its effect on cardiovascular health remains a topic of mixed opinions. Recent findings suggest a potential downside, with reports indicating a concerning association: a 91 % higher risk of cardiovascular disease (CVD) mortality compared to eating spread across a 12- to 16-hour period. Despite this alarming statistic, the evidence cannot establish a causal link. The impact of IF on CVD is still insufficiently understood, with benefits sometimes exaggerated and risks downplayed in popular discourse. This scoping review aims to consolidate the current evidence, addressing unresolved questions about the benefits and risks of IF, particularly its association with CVD risks and mortality. The goal is to provide a balanced perspective on the potential health implications of IF, emphasizing the need for further research to clarify its long-term effects on cardiovascular health.

Effectiveness of integrated palliative care telehealth intervention in patients with chronic heart failure: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Heart failure (HF) represents a substantial burden, impacting both health and financial domains. Despite the presence of evidence-based interventions for prevention and management, suboptimal care has been recognized as a critical contributor to adverse HF-related outcomes. We aim to analyze the impact of palliative care telehealth intervention compared to usual care in quality of life (QoL) and resource utilization of chronic HF patients. METHODS: We conducted a systematic search across various databases, including MEDLINE (via PubMed), Google Scholar, the Cochrane Library, and ScienceDirect to identify randomized controlled trials (RCTs) examining the impact of palliative care telehealth interventions on the QoL and health outcomes of HF patients from inception until May 2024. Statistical analysis was performed using RevMan 5.4, pooling odds ratios (OR), and weighted mean differences (WMD) via a random effects model for primary and secondary outcomes. The study protocol has been registered in PROSPERO (CRD42024542371). RESULTS: In our study, 16 RCTs involving 2,324 HF patients, averaging 69.2 years old, were included. Upon analyzing the primary outcome, QoL, assessed through the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Functional Assessment of Chronic Illness Therapy-Palliative Care (FACIT-Pal) Scale, we found a statistically significant improvement in QoL among patients who received palliative care or palliative care telehealth interventions compared to those who received usual care. The WMD for KCCQ was 3.56 (95% CI: 0.43 to 6.69, p = 0.03; I2 = 46%) and for FACIT-Pal was 2.54 (95% CI: 1.00 to 4.08, p = 0.001; I2 = 14%). Furthermore, HF patients receiving palliative care experienced a notable decrease in hospitalizations (OR: 0.60; 95% CI: 0.41 to 0.86; p = 0.006; I2 = 52%). However, we did not observe a significant change in all-cause mortality, with an OR of 1.22 (95% CI: 0.77 to 1.94, p = 0.39; I2 = 37%). CONCLUSION: The implementation of palliative care telehealth interventions demonstrates a notable impact, positively influencing the QoL and decreasing hospitalization rates among patients with chronic HF.

The Social Determinants of Health Industry: Two Years On.

Social determinants of health (SDOH) have been insufficiently addressed by payers and providers despite increased prioritization at the national level. This led to the development of a separate, for-profit "SDOH industry" found to have a valuation of $18.5 billion (all dollar amounts in U.S. dollars) with $2.4 billion in funding as of July 2021. The purpose of this article is to determine the growth of the industry from 2021 to 2023 and provide a multifaceted explanation for this development. The authors conducted an analysis of 57 SDOH industry companies using a third-party market research platform. Over the previous two-year period, 10 out of 57 (18%) companies were acquired, and the industry gained an additional $1.1 billion (46% increase) in funding and $13.7 billion (74% increase) in valuation. The authors propose four contributing factors to explain the nature of this industry's evolution. They include developments in national health care policy favoring SDOH, standardization of SDOH information as actionable claims data, multi-source investment in SDOH, and improved methods of industry intervention measurement. These trends appear likely to continue, requiring additional scrutiny by all relevant stakeholders to ensure maximum improvement of rampant SDOH disparities that impact millions of individuals daily.

Outcomes and variables that impact pneumatic retinopexies.

AIM: To evaluate the efficacy of pneumatic retinopexy (PR) in patients undergoing PR as primary treatment for rhegmatogenous retinal detachment (RRD) and analyze the factors associated with success and failure in the studied population. METHODS: A retrospective chart review was done of patients with RRD treated with PR as primary management method treated at New York Eye and Ear Infirmary of Mount Sinai between January 2017 and December 2021. Primary outcome measured success or failure of PR. Secondary outcome measured best corrected visual acuity (BCVA) after PR. A separate risk analysis was done to identify and stratify risks associated with success and failure of PR. RESULTS: A total of 179 eyes from 179 patients were included for final analysis. The 83 patients (46.37%) achieved anatomical reattachment of the retina after primary PR with no need for additional surgery. The 96 patients (53.63%) had a failed primary PR and required a PPV and 6 of them required pars plana vitrectomy (PPV) with scleral buckle (SB). In total, 19 cases (10.61%) were done as temporizing pneumatics, 18 (94.74%) underwent PPV, and 1 (5.26%) did not require further intervention. The visual acuities at postoperative month 1 (POM1) for patients who underwent primary PR successfully and for those that underwent PPV after, were 0.58 (20/80) and 1.03 (20/200) respectively. Patients who met Pneumatic Retinopexy Versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) criteria had a statistically significant decreased risk of primary PR failing (hazard ratio 0.29, P=0.00). Majority of missed or new breaks were found superotemporally. CONCLUSION: PR is a good treatment option for treating RRDs in patients that meet PIVOT criteria and can be conducted as a temporizing measure. PIVOT criteria and fovea on status decrease the risk of PR failure.

The Impact of Coronary Artery Disease on Outcomes in Patients Hospitalized With Pre-eclampsia.

Introduction Pre-eclampsia leads to long-lasting cardiovascular effects in women in the postpartum period, but prevalence and in-hospital adverse events of coronary artery disease (CAD) in women with pre-eclampsia are poorly understood. The prevalence, outcomes, and mortality risks identified in this study allow for possible routes of clinical intervention of CAD in women with pre-eclampsia. The purpose of this study was to determine the prevalence and outcomes of CAD in women diagnosed with pre-eclampsia compared to those with pre-eclampsia with no history of CAD. Predictors of mortality in pre-eclampsia were also analyzed. Methods Data were obtained from the National Inpatient Sample from January 2016 to December 2019. We used the multivariate logistic regression to assess the independent association of CAD with outcomes in patients admitted with pre-eclampsia. We also used the multivariate logistic regression to analyze predictors of mortality in patients hospitalized with pre-eclampsia. Results Women with pre-eclampsia admitted between January 2016 and December 2019 were included in our analysis. A total of 256,010 patients were diagnosed with pre-eclampsia. Of these patients, 174 (0.1%) patients had CAD. Multivariate analysis demonstrated that CAD in patients with pre-eclampsia was independently associated with angioplasty (adjusted odds ratio [aOR] 62.28; 95% CI 20.459-189.591; p=0.001), permanent pacemaker (aOR 35.129; 95% CI 13.821-89.287; p=0.001), left heart catheterization (aOR 29.416; 95% CI 7.236-119.557; p=0.001), non-ST-elevation myocardial infarction (NSTEMI) (aOR 25.832; 95% CI 7.653-87.189; p=0.001), and congestive heart failure (CHF) (aOR 13.948; 95% CI 7.648-25.438; p=0.001). We also used the multivariate logistic regression model to assess predictors of mortality in patients admitted with pre-eclampsia. These included age at admission (aOR 1.064; 95% CI 1.009-1.121; p=0.021), Asian/Pacific-Islander race (aOR 4.893; 95% CI 1.884-12.711; p=0.001), and comorbidities such as CHF (aOR 19.405; 95% CI 6.408-58.768; p=0.001), eclampsia (aOR 17.253; 95% CI 5.323-55.924; p=0.001), syndrome of HELLP (hemolysis, elevated liver enzymes, low platelets) (aOR 6.204; 95% CI 2.849-13.510; p=0.001), coagulopathy (aOR 6.524; 95% CI 1.997-21.308; p=0.002), and liver disease (aOR 5.217; 95% CI 1.156-23.554; p=0.032). Conclusion In a large cohort of patients admitted with pre-eclampsia, we found the prevalence of CAD to be 0.1%. CAD was associated with several clinical outcomes, including NSTEMI. Predictors of mortality in patients with pre-eclampsia included demographic variables such as age and Asian race, as well as comorbidities such as CHF and coagulopathy.

The Impact of Coronary Artery Disease on Outcomes in Patients With Peripartum Cardiomyopathy.

Introduction The purpose of this study was to determine the prevalence of coronary artery disease (CAD) among patients admitted with peripartum cardiomyopathy (PPCM) as well as to analyze the independent association of CAD with in-hospital outcomes among PPCM patients. Methods Data were obtained from the National Inpatient Sample from January 2016 to December 2019. We assessed the independent association of CAD with outcomes in patients admitted with PPCM. Predictors of mortality in patients admitted with PPCM were also analyzed. Results There was a total of 4,730 patients with PPCM, 146 of whom had CAD (3.1%). Multivariate analysis demonstrated that CAD in patients with PPCM was independently associated with several outcomes, and, among them, ST-segment elevation myocardial infarction (STEMI) (adjusted odds ratio (aOR): 58.457, 95% CI: 5.403-632.504, p= 0.001) was positively associated with CAD. CAD was found to be protective against preeclampsia (aOR: 0.351, 95% CI: 0.126-0.979, p = 0.045). Predictors of in-hospital mortality for patients with PPCM include cardiogenic shock (aOR: 12.818, 95% CI: 7.332-22.411, p = 0.001), non-ST elevation myocardial infarction (NSTEMI) (OR: 3.429, 95% CI: 1.43-8.22, p = 0.006), chronic kidney disease (OR: 2.851, 95% CI: 1.495-5.435, p = 0.001), and atrial fibrillation (OR: 2.326, 95% CI: 1.145-4.723, p = 0.020). Conclusion In a large cohort of patients admitted with PPCM, we found the prevalence of CAD to be 3.1%. CAD was associated with several adverse outcomes, including STEMI, but protective against preeclampsia.

Basic Principles and Role of Endoscopic Ultrasound in Diagnosis and Differentiation of Pancreatic Cancer from Other Pancreatic Lesions: A Comprehensive Review of Endoscopic Ultrasound for Pancreatic Cancer.

Pancreatic cancer is one of the leading causes of cancer-related deaths worldwide. Pancreatic lesions consist of both neoplastic and non-neoplastic lesions and often pose a diagnostic and therapeutic challenge due to similar clinical and radiological features. In recent years, pancreatic lesions have been discovered more frequently as incidental findings due to the increased utilization and widespread availability of abdominal cross-sectional imaging. Therefore, it becomes imperative to establish an early and appropriate diagnosis with meticulous differentiation in an attempt to balance unnecessary treatment of benign pancreatic lesions and missing the opportunity for early intervention in malignant lesions. Endoscopic ultrasound (EUS) has become an important diagnostic modality for the identification and risk stratification of pancreatic lesions due to its ability to provide detailed imaging and acquisition of tissue samples for analysis with the help of fine-needle aspiration/biopsy. The recent development of EUS-based technology, including contrast-enhanced endoscopic ultrasound, real-time elastography-endoscopic ultrasound, miniature probe ultrasound, confocal laser endomicroscopy, and the application of artificial intelligence has significantly augmented the diagnostic accuracy of EUS as it enables better evaluation of the number, location, dimension, wall thickness, and contents of these lesions. This article provides a comprehensive overview of the role of the different types of EUS available for the diagnosis and differentiation of pancreatic cancer from other pancreatic lesions while discussing their key strengths and important limitations.

The thyroid-pericardium connection: Unveiling the influence of hypothyroidism severity on pericardial effusion in South Gujarat's patient population-A cross-sectional study.

Context: Hypothyroidism and pericardial effusion are two conditions that are associated with previous research. Nevertheless, the correlation between the severity of hypothyroidism and the occurrence of pericardial effusion remains uncertain. Aims: 1. To explore and examine the association between the severity of hypothyroidism and the occurrence of pericardial effusion. 2. To compare clinical characteristics and demographic factors with varying degrees of hypothyroidism severity and pericardial effusion. Settings and Design: Tertiary care hospital and cross-sectional study using a pretested, semistructured questionnaire and echocardiography. Method and Material: The cross-sectional study encompassed a cohort of 60 patients diagnosed with hypothyroidism. Statistical Analysis Used: Epi-info version 7.0 and Open epi version 3.1, Chi-square, mean, and standard deviation were used. Results: There were 16 male participants, accounting for 26.7% of the total, and 44 female participants, constituting 73.3% of the cohort. The participants' average age was 35.5 years. Based on TSH levels, the severity of hypothyroidism in the study was classified into three categories: mild (33.4%), moderate (43.3%), and severe (23.3%). The most common symptoms were lethargy, weight gain, and cold intolerance. Also, an association between the severity of hypothyroidism and pericardial effusion was noted. Conclusion: This research established a noteworthy correlation between hypothyroidism severity and pericardial effusion incidence that is statistically significant. Nevertheless, no significant associations were detected with demographic factors or pulse rate. These results underscore the significance of monitoring and addressing pericardial effusion in patients with moderate-to-severe hypothyroidism. Further investigations are warranted to extend these findings.

Geographical accessibility to functional emergency obstetric care facilities in urban Nigeria using closer-to-reality travel time estimates: a population-based spatial analysis.

BACKGROUND: Better accessibility for emergency obstetric care facilities can substantially reduce maternal and perinatal deaths. However, pregnant women and girls living in urban settings face additional complex challenges travelling to facilities. We aimed to assess the geographical accessibility of the three nearest functional public and private comprehensive emergency obstetric care facilities in the 15 largest Nigerian cities via a novel approach that uses closer-to-reality travel time estimates than traditional model-based approaches. METHODS: In this population-based spatial analysis, we mapped city boundaries, verified and geocoded functional comprehensive emergency obstetric care facilities, and mapped the population distribution for girls and women aged 15-49 years (ie, of childbearing age). We used the Google Maps Platform's internal Directions Application Programming Interface to derive driving times to public and private facilities. Median travel time and the percentage of women aged 15-49 years able to reach care were summarised for eight traffic scenarios (peak and non-peak hours on weekdays and weekends) by city and within city under different travel time thresholds (≤15 min, ≤30 min, ≤60 min). FINDINGS: As of 2022, there were 11·5 million girls and women aged 15-49 years living in the 15 studied cities, and we identified the location and functionality of 2020 comprehensive emergency obstetric care facilities. City-level median travel time to the nearest comprehensive emergency obstetric care facility ranged from 18 min in Maiduguri to 46 min in Kaduna. Median travel time varied by location within a city. The between-ward IQR of median travel time to the nearest public comprehensive emergency obstetric care varied from the narrowest in Maiduguri (10 min) to the widest in Benin City (41 min). Informal settlements and peripheral areas tended to be worse off compared to the inner city. The percentages of girls and women aged 15-49 years within 60 min of their nearest public comprehensive emergency obstetric care ranged from 83% in Aba to 100% in Maiduguri, while the percentage within 30 min ranged from 33% in Aba to over 95% in Ilorin and Maiduguri. During peak traffic times, the median number of public comprehensive emergency obstetric care facilities reachable by women aged 15-49 years under 30 min was zero in eight (53%) of 15 cities. INTERPRETATION: Better access to comprehensive emergency obstetric care is needed in Nigerian cities and solutions need to be tailored to context. The innovative approach used in this study provides more context-specific, finer, and policy-relevant evidence to support targeted efforts aimed at improving comprehensive emergency obstetric care geographical accessibility in urban Africa. FUNDING: Google.

Sepsis during short bowel syndrome hospitalizations: Identifying trends, disparities, and clinical outcomes in the United States.

BACKGROUND: Short bowel syndrome (SBS) hospitalizations are often complicated with sepsis. There is a significant paucity of data on adult SBS hospitalizations in the United States and across the globe. AIM: To assess trends and outcomes of SBS hospitalizations complicated by sepsis in the United States. METHODS: The National Inpatient Sample was utilized to identify all adult SBS hospitalizations between 2005-2014. The study cohort was further divided based on the presence or absence of sepsis. Trends were identified, and hospitalization characteristics and clinical outcomes were compared. Predictors of mortality for SBS hospitalizations complicated with sepsis were assessed. RESULTS: Of 247097 SBS hospitalizations, 21.7% were complicated by sepsis. Septic SBS hospitalizations had a rising trend of hospitalizations from 20.8% in 2005 to 23.5% in 2014 (P trend < 0.0001). Compared to non-septic SBS hospitalizations, septic SBS hospitalizations had a higher proportion of males (32.8% vs 29.3%, P < 0.0001), patients in the 35-49 (45.9% vs 42.5%, P < 0.0001) and 50-64 (32.1% vs 31.1%, P < 0.0001) age groups, and ethnic minorities, i.e., Blacks (12.4% vs 11.3%, P < 0.0001) and Hispanics (6.7% vs 5.5%, P < 0.0001). Furthermore, septic SBS hospitalizations had a higher proportion of patients with intestinal transplantation (0.33% vs 0.22%, P < 0.0001), inpatient mortality (8.5% vs 1.4%, P < 0.0001), and mean length of stay (16.1 d vs 7.7 d, P < 0.0001) compared to the non-sepsis cohort. A younger age, female gender, White race, and presence of comorbidities such as anemia and depression were identified to be independent predictors of inpatient mortality for septic SBS hospitalizations. CONCLUSION: Septic SBS hospitalizations had a rising trend between 2005-2014 and were associated with higher inpatient mortality compared to non-septic SBS hospitalizations.

Advances in Gluten Hypersensitivity: Novel Dietary-Based Therapeutics in Research and Development.

Gluten hypersensitivity is characterized by the production of IgE antibodies against specific wheat proteins (allergens) and a myriad of clinical allergic symptoms including life-threatening anaphylaxis. Currently, the only recommended treatment for gluten hypersensitivity is the complete avoidance of gluten. There have been extensive efforts to develop dietary-based novel therapeutics for combating this disorder. There were four objectives for this study: (i) to compile the current understanding of the mechanism of gluten hypersensitivity; (ii) to critically evaluate the outcome from preclinical testing of novel therapeutics in animal models; (iii) to determine the potential of novel dietary-based therapeutic approaches under development in humans; and (iv) to synthesize the outcomes from these studies and identify the gaps in research to inform future translational research. We used Google Scholar and PubMed databases with appropriate keywords to retrieve published papers. All material was thoroughly checked to obtain the relevant data to address the objectives. Our findings collectively demonstrate that there are at least five promising dietary-based therapeutic approaches for mitigating gluten hypersensitivity in development. Of these, two have advanced to a limited human clinical trial, and the others are at the preclinical testing level. Further translational research is expected to offer novel dietary-based therapeutic options for patients with gluten hypersensitivity in the future.

Sweet or Not? Azathioprine-Induced Sweet Syndrome Mimicking Erythema Nodosum in a Patient With Inflammatory Bowel Disease.

This case report highlights the clinical challenge and need to distinguish Sweet syndrome and erythema nodosum (EN) in a 50-year-old woman with newly initiated azathioprine for inflammatory bowel disease. While she initially presented with clinical features concerning for drug-induced Sweet syndrome, a subsequent histopathological examination confirmed early-stage EN. Both Sweet syndrome and EN share common triggers and therapeutic responses, but have distinctive clinical characteristics. Subtle histologic differences also exist in lesion distribution and depth of infiltration. This case underscores the need for accurate differentiation in patients with inflammatory bowel disease to initiate appropriate management and avoid potential complications.

Perioperative risk predictors for gender affirming surgery in the NSQIP database.

INTRODUCTION: Gender affirming surgeries (GAS), such as phalloplasty (PLPs) and vaginoplasty (VGPs), are important aspects of medical care for transgender patients. Here, we aim to better characterize patient demographics and surgical outcomes for PLPs and VGPs using the National Surgical Quality Improvement Program (NSQIP). We hypothesized that frailty indices would be predictive of perioperative PLP and VGP risk and outcomes for PLPs and VGPs. MATERIALS AND METHODS: Primary GAS, specifically PLPs and VGPs performed from 2006-2020 were identified in NSQIP. Baseline frailty was based on NSQIP's modified frailty index (mFI) and preoperative morbidity probability (morbprob) variable. RESULTS: Fifty-eight PLPs and 468 VGPs were identified. The overall 30-day complication rate for PLP was 26%, with 17% of total patients experiencing minor complications and 16% experiencing major complications. The overall, minor, and major complication rates for VGP were 14%, 7%, and 9% respectively. Readmissions and reoperations occurred in 7% PLP and 5% VGP patients. No deaths occurred in either group within 30 days. The mFI scores were not predictive of 30-day complications or LOS. NSQIP morbprob was predictive of 30-day complications for both PLP (OR 4.0, 95% CI 1.08-19.59, p = 0.038) and VGP (OR 2.39, 95% CI 1.46-3.97, p = 0.0005). NSQIP's morbprob was also predictive of extended LOS for PLP patients (6.3 ± 1.3 days, p = 0.03). CONCLUSIONS: This study describes patient characteristics and complication rates of PLPs and VGPs. The NSQIP preoperative morbprob is an effective predictor of surgical complications and is better than the mFI.