World Journal of Clinical Cases

Prothrombotic state and thrombotic events in COVID-19 pandemic period, including portal vein and splenic artery thromboses
Karcioglu O, Akman C and Ozturk GA
This editorial article is intended to perform a discussion on the manuscript entitled "Simultaneous portal vein thrombosis and splenic vein thrombosis in a COVID-19 patient: A case report and review of literature" written by Abramowitz . The article focuses on the diagnostic processes in a 77-year-old-male patient with a simultaneous portal vein and splenic artery thrombosis accompanying coronavirus disease 2019 (COVID-19). The authors postulated that splanchnic thrombosis should be on the list of differential diagnoses in a patient presenting with abdominal pain in presence of a COVID-19 infection. The tendency for venous and arterial thrombosis in COVID-19 patients is encountered, largely attributed to hypercoagulopathy. In general, venous thromboembolism mostly manifest as deep vein thrombosis (DVT), pulmonary embolism (PE) or catheter-related thromboembolic events. Acute PE, DVT, cerebrovascular events and myocardial infarction are seen as the most common thromboembolic complications in COVID-19 patients. COVID-19-associated hemostatic abnormalities include mild thrombocytopenia and increased D-dimer level. Similar to other coagulopathies, the treatment of the underlying condition is the mainstay. Addition of antiplatelet agents can be considered in critically ill patients at low bleeding risk, not on therapeutic anticoagulation, and receiving gastric acid suppression Early administration of antithrombotic drugs will have a beneficial effect in both the prevention and treatment of thrombotic events, especially in non-ambulatory patients. Low molecular weight heparin (LMWH) should be started if there is no contraindication, including in non-critical patients who are at risk of hospitalization LMWH (enoxaparin) is preferred to standard heparin.
Current evidence on artificial intelligence in regional anesthesia
Swain BP, Nag DS, Anand R, Kumar H, Ganguly PK and Singh N
The recent advancement in regional anesthesia (RA) has been largely attributed to ultrasound technology. However, the safety and efficiency of ultrasound-guided nerve blocks depend upon the skill and experience of the performer. Even with adequate training, experience, and knowledge, human-related limitations such as fatigue, failure to recognize the correct anatomical structure, and unintentional needle or probe movement can hinder the overall effectiveness of RA. The amalgamation of artificial intelligence (AI) to RA practice has promised to override these human limitations. Machine learning, an integral part of AI can improve its performance through continuous learning and experience, like the human brain. It enables computers to recognize images and patterns specifically useful in anatomic structure identification during the performance of RA. AI can provide real-time guidance to clinicians by highlighting important anatomical structures on ultrasound images, and it can also assist in needle tracking and accurate deposition of local anesthetics. The future of RA with AI integration appears promising, yet obstacles such as device malfunction, data privacy, regulatory barriers, and cost concerns can deter its clinical implementation. The current mini review deliberates the current application, future direction, and barrier to the application of AI in RA practice.
Integrating the health belief model into health education programs in a clinical setting
Kam BS and Lee SY
The article demonstrates that health belief model (HBM)-based health education in hypertensive patients effectively improves blood pressure control and medication adherence at 3 months and 6 months. The HBM addresses perceived barriers, benefits, susceptibility, severity, and self-efficacy, leading to better health behaviors. HBM-based education has been effective in various contexts, including managing chronic diseases, promoting cancer screenings, and preventing infectious diseases. However, the model has limitations, such as cultural applicability and addressing complex health behaviors influenced by environmental factors. Future research should integrate HBM with other theories and conduct longitudinal studies to assess long-term impacts. Despite these limitations, HBM-based education significantly improves patient outcomes, highlighting its potential in health education and promotion when appropriately adapted and implemented. This reinforces the model's value in designing effective health interventions and advancing public health.
Advancements and challenges in gastrointestinal imaging
Gong EJ and Bang CS
A recent review by Gulinac , provides an in-depth analysis of current clinical issues and challenges in gastrointestinal imaging. This editorial highlights the advancements in imaging techniques, including the integration of artificial intelligence and functional imaging modalities, and discusses the ongoing relevance of traditional nuclear medicine tests. The future of gastrointestinal imaging looks promising, with continuous improvements in resolution, enhanced ability to analyze color and texture beyond visual diagnosis, faster image processing, and the application of molecular imaging and nanoparticles expected to enhance diagnostic accuracy and clinical outcomes.
Foregut tuberculosis: Too close but miles apart
Shahid Y, Anis MA and Abid S
The worldwide burden of tuberculosis (TB) has increased and it can involve virtually any organ of the body. Intestinal TB accounts for about 2% of the cases of TB worldwide. The ileocecal region is the most commonly affected site, and the foregut is rarely involved. The reported incidence is approximately 0.5%. Esophageal TB presents with dysphagia, weight loss, and hematemesis in rare cases. Gastroduodenal TB usually manifests with symptoms such as nausea, vomiting, weight loss, and sometimes with gastric outlet obstruction. Gastroscopy may reveal shallow ulcers in stomach and duodenal deformity when underlying TB is suspected, therefore histopathology plays pivotal role. On computed tomography, duodenal TB typically manifests as duodenal strictures predominantly, accompanied by extrinsic compression, and occasionally as intraluminal mass. But their diagnosis can easily be missed if proper biopsies are not taken and samples are not sent for GeneXpert testing, TB polymerase chain reaction investigation and histopathological analysis. Despite being in close proximity to the lungs, the esophagus and stomach are rare sites of TB. The reasons could be low gastric pH and acidity which does not let mycobacterium grow. But there are various case reports of TB involving the foregut. We have summarized the rare cases of foregut TB in different sections and highlighted the importance of esophagogastroduodenoscopy, histopathology and advanced techniques like endoscopic ultrasound in establishing the diagnosis.
Influence of sarcopenia and frailty in the management of elderly patients with acute appendicitis
Fransvea P, Chiarello MM, Fico V, Cariati M and Brisinda G
In developed countries, the average life expectancy has been increasing and is now well over 80 years. Increased life expectancy is associated with an increased number of emergency surgical procedures performed in later age groups. Acute appendicitis is one of the most common surgical diseases, with a lifetime risk of 8%. A growing incidence of acute appendicitis has been registered in the elderly population and in the oldest groups (> 80 years). Among patients > 50-year-old who present to the emergency department for acute abdominal pain, 15% have acute appendicitis. In these patients, emergency surgery for acute appendicitis is challenging, and some important aspects must be considered. In the elderly, surgical treatment outcomes are influenced by sarcopenia. Sarcopenia must be considered a precursor of frailty, a risk factor for physical function decline. Sarcopenia has a negative impact on both elective and emergency surgery regarding mortality and morbidity. Aside from morbidity and mortality, the most crucial outcomes for older patients requiring emergency surgery are reduction in function decline and preoperative physical function maintenance. Therefore, prediction of function decline is critical. In emergency surgery, preoperative interventions are difficult to implement because of the narrow time window before surgery. In this editorial, we highlight the unique aspects of acute appendicitis in elderly patients and the influence of sarcopenia and frailty on the results of surgical treatment.
Platelet-rich plasma treatment for chronic wounds: A case report and literature review
Dimova A, Boroš M, Dimov S, Konjevod J and Svetec M
Wound healing is a complicated process that can be heavily influenced by patient comorbidities, in some cases leading to a chronic non-healing wound. Evidence presented in the medical literature supporting the clinical use of autologous platelet-rich plasma (PRP) in treatment of such wounds is becoming increasingly compelling. Mechanisms involved include complex interactions between the patient's thrombocytes, cytokines, and growth factors.
Diagnostic and therapeutic challenges of myeloid sarcoma in the oral cavity
Martínez Nieto M, González Gómez LA, Gómez Mireles JC and Lomelí Martínez SM
Myeloid sarcoma (MS) is a rare neoplasm characterized by the proliferation of immature myeloid precursor cells outside the bone marrow. The pathogenesis of MS is complex and not completely understood. Moreover, it develops in any extramedullary site of the body. In this editorial, we discuss the article published by Li , which presents a clinical case involving a 32-year-old man who exhibited gingival inflammation in the maxillary region. It was initially diagnosed as periodontal disease. However, clinical evaluation revealed a firm, grayish-white mass which underscored the need for comprehensive diagnostics to distinguish MS from other oral conditions. This article emphasizes the different clinical presentations of similar case studies in the literature, and highlights the difficulty in diagnosing oral MS due to its rarity and variability in clinical manifestation. The treatment of MS depends on the clinical presentation, tumor location, and the patient's response to conventional therapies. The various therapeutic options currently available are analyzed and discussed. Early intervention and multidisciplinary management are crucial for improving treatment outcomes. Increased awareness and education about the various clinical presentations of MS lead to earlier diagnosis and timely treatment, thereby enhancing patients' survival and quality of life. Continued research is essential for optimizing therapeutic strategies and addressing the challenges presented by this rare neoplasm.
Flexner's legacy and the future of medical education: Embracing challenge and opportunity
Zeren Q, Zeng Y, Zhang JW and Yang J
This editorial comments on the article by Alzerwi. We focus on the development course, present challenges, and future perspectives of medical education. Modern medical education is gradually undergoing significant and profound changes worldwide. The emergence of new ideas, methodologies, and techniques has created opportunities for medical education developments and brought new concerns and challenges, ultimately promoting virtuous progress in medical education reform. The sustainable development of medical education needs joint efforts and support from governments, medical colleges, hospitals, researchers, administrators, and educators.
Targeting nuclear factor erythroid 2-related factor 2-regulated ferroptosis to treat nervous system diseases
Huang YQ, Huang ZW and Zhang XJ
By critically examining the work, we conducted a comprehensive bibliometric analysis on the role of nuclear factor erythroid 2-related factor 2 (NRF2) in nervous system diseases. We also proposed suggestions for future bibliometric studies, including the integration of multiple websites, analytical tools, and analytical approaches, The findings presented provide compelling evidence that ferroptosis is closely associated with the therapeutic challenges of nervous system diseases. Targeted modulation of NRF2 to regulate ferroptosis holds substantial potential for effectively treating these diseases. Future NRF2-related research should not only focus on discovering new drugs but also on designing rational drug delivery systems. In particular, nanocarriers offer substantial potential for facilitating the clinical translation of NRF2 research and addressing existing issues related to NRF2-related drugs.
Risk factors and risk prediction model for mucocutaneous separation in enterostomy patients: A single center experience
Liu Y, Li H, Wu JJ and Ye JH
Mucocutaneous separation (MCS) is a common postoperative complication in enterostomy patients, potentially leading to significant morbidity. Early identification of risk factors is crucial for preventing this condition. However, predictive models for MCS remain underdeveloped.
Tricuspid mass-curious case of Li-Fraumeni syndrome: A letter to the editor
Al-Haggar MS and Abdelmoneim ZA
We focus specifically on the rare occurrence of cardiac thrombi in Li-Fraumeni syndrome (LFS). LFS is a hereditary risk to a diverse range of specific, uncommon, malignancies. Children and young adults have a heightened susceptibility to many malignancies, particularly soft-tissue and bone tumors, breast malignancies, central nervous system malignancies, adrenocortical carcinoma, and blood cancers. Additionally, LFS patients may experience other cancer types such as gastrointestinal, lung, kidney, thyroid, and skin cancers, along with those affecting gonadal organs (ovaries, testicles, and prostate). An accurate diagnosis of LFS is crucial to enable affected families to access appropriate genetic counseling and undergo surveillance for early cancer detection.
Evaluation of the mental health of COVID-19 patients discharged from the intensive care unit
Sarac E
In this editorial, I address the mental health status of patients who have been discharged from intensive care units (ICUs) after battling coronavirus disease 2019 (COVID-19). An ICU admission is generally a stressful experience, and for severe COVID-19 survivors prolonged treatment in the ICU can lead to significant psychological consequences. These individuals may experience psychiatric distress, including symptoms such as insomnia, anxiety, depression, and even post-traumatic psychological issues. Research indicates that during the first 6 months to 1 year following an ICU stay, nearly one-third of survivors exhibit symptoms similar to those of depression and post-traumatic stress disorder. Several factors may have contributed to the development of depressive and anxious symptoms during the COVID-19 pandemic, particularly for those who underwent an ICU stay. The ICU environment itself is inherently stressful, filled with the constant noise of various medical devices. Studies have provided strong evidence that the prolonged need for ventilation support and the loss of freedom of movement are key factors in the development of psychological problems among COVID-19 patients who had been treated in the ICU.
Revisiting tuberculosis as a cause of gastric outlet obstruction: Insights from a case report
Meng J, Zhang LM, Wang ZG, Zhao X, Bai HX, Wang Y, Chen DY, Liu DL, Ji CC, Liu Y, Wang L, Li BY and Yin ZT
Gastroduodenal tuberculosis (GD-TB) is exceptionally rare. The clinical manifestations of gastrointestinal TB are diverse and non-specific, which makes diagnosis difficult, leading to delayed diagnosis and high mortality. As a peer-reviewer of , I would like to share my opinion on the article published by this journal. The patient had no family history of TB or contact with people with TB. Primary GD-TB presenting as gastric outlet obstruction and normal findings of thoracic computed tomography increased the difficulty of diagnosis and treatment in this patient. The diagnosis and treatment scheme of this typical case have reference value for the clinical treatment of GD-TB.
Infection with meningoencephalitis: A case report
Xu DZ and Tan QH
Listeria meningitis is an infectious disease of the central nervous system caused by . This bacterium is widely present in the natural environment and can be transmitted through channels such as food and water. Patients usually show symptoms such as fever, headache, and neck stiffness. In severe cases, coma, convulsions, or even death may occur. Traditional diagnostic methods, such as cerebrospinal fluid (CSF) culture and serological tests, have certain limitations. Although CSF culture is the "gold standard" for diagnosis, it is time-consuming and has a relatively low positivity rate. Serological detection may also result in false positive or false negative results. The emergence of metagenomic sequencing (mNGS) technology has led to a significant breakthrough in diagnosing Listeria meningitis, allowing quick and accurate detection of various pathogens in samples.
Optimal traditional Chinese medicine formulas in treating ulcerative colitis: Choose one or take it all?
Zeng Y, Zhang JW and Yang J
Ulcerative colitis (UC) is a chronic inflammatory bowel disease that presents significant treatment challenges due to its complexity, especially in terms of the various side effects that traditional medications may bring during the chronic course of the disease. Traditional Chinese medicine (TCM) has emerged as a promising complementary therapy for UC. Based on the latest research, our editorial explored the current issues and potential essential research directions for TCM in treating UC. We anticipate that future high-quality research will pave the way for the optimization of TCM formulas for UC and their broader global application.
Secondary diabetes due to different etiologies: A problem worthy of attention
Wei Z and Wang XJ
There are many factors in the occurrence of diabetes, which can result in insufficient insulin secretion and insulin receptor resistance. Including pituitary tumors, can also lead to the occurrence of diabetes, if the primary disease can not be well controlled in time, such secondary diabetes control is more difficult. In the process of clinical diagnosis and treatment, these factors need to be taken into account, timely detection and treatment of primary diseases, so as to reduce the possibility of clinical missed diagnosis.
Virtual reality: The bridge between medical education and clinical practice
Liu YQ
After perusing the paper by Kim , I discovered that this is an interesting manuscript and a successful study. Virtual reality (VR) is an emerging and promising technology employed in the domain of medical practice and medical education over the past decade. In the era of big data, VR is constantly progressing in the fields of medical education and clinical diagnosis and treatment. As a novel scientific and technological tool, VR not only overcomes multiple limitations of the traditional medical teaching mode but also reduces the reliance on personnel and equipment. VR can simulate the real clinical situation, stimulate the enthusiasm of young doctors and nurses for clinical study, and simultaneously safeguard and promote medical safety and doctor-patient harmony. Favorable outcomes have been attained in clinical teaching and diagnosis and treatment activities. While enhancing the training conditions of medical cosmetics and elevating the level of clinical practice and teaching, the risks resulting from improper clinical diagnosis and treatment have been circumvented. All of this is evident and comprehensible.
Journey to diagnosis: An unfinished exploration of IgG4-related sclerosing cholangitis
Liang MX, Chen Y, He Y and He YH
IgG4-related sclerosing cholangitis (IgG4-SC) is an inflammatory disease that leads to bile duct stricture, characterized by the infiltration of IgG4-positive plasma cells into the bile duct wall, thickening of the bile duct wall, and narrowing of the lumen. The differential diagnosis of IgG4-SC mainly includes primary sclerosing cholangitis, cholangiocarcinoma, and pancreatic cancer. IgG4-SC is often associated with autoimmune pancreatitis and can be accurately diagnosed based on clinical diagnostic criteria. However, isolated IgG4-SC is difficult to distinguish from biliary tumors. Given the significant differences in biological behavior, treatment, and prognosis between these diseases, accurately identifying isolated IgG4-SC has very important clinical significance.
Advanced lung adenocarcinoma with 19-del mutation transforms into squamous cell carcinoma after tyrosine kinase inhibitor treatment
Qi RB and Wu ZH
In this editorial we comment on the article by Ji . We focus specifically on the EGFR tyrosine kinase inhibitor (EGFR-TKI) treatment and the development of drug resistance to EGFR-TKIs.
Early screening to identify and diagnose primary nasal tuberculosis in patients with tumor necrosis factor inhibitors
Shen DX, Wang YW, Lin ZM, Jin D, Ying ZH and Li C
In this editorial, we comment on the article by Liu . Based on our analysis of a case report, we consider that early screening and recognition of primary nasal tuberculosis are crucial for patients undergoing treatment with tumor necrosis factor inhibitor (TNFi). While TNFi therapy increases the risk of reactivating latent tuberculosis, primary nasal tuberculosis remains rare due to the protective mechanisms of the nasal mucosa. Risk factors for primary nasal tuberculosis include minimally invasive nasal surgery, diabetes, and human immunodeficiency virus. Patients with early symptoms such as nasal congestion, rhinorrhea, altered olfaction, epistaxis, or ulceration, and unresponsive to conventional antibiotics and antihistamines should undergo early rhinoscopy, possibly followed by repeated tissue biopsies and acid-fast bacilli culture when necessary. When diagnosis is challenging, it is essential to consider local tuberculosis epidemiology and the efficacy of diagnostic anti-tuberculosis treatment. The preferred method for tuberculosis screening is the Interferon Gamma Release Assay, with a general recommendation for screening at 3 and 6 months after initial treatment and then every six months. However, the optimal frequency is not yet consensus-driven and may be increased in economically viable settings.