Imaging modalities in the diagnosis and monitoring of IgG4-Related disease: Utilization patterns and clinical implications

Objective: Immunoglobulin G4-related disease (IgG4-RD) is a chronic fibroinflammatory disorder affecting multiple organ systems, often requiring imaging for diagnosis and monitoring. Despite its critical role, an optimal imaging strategy, including modality preference and follow-up intervals, remains undefined. This study evaluates the utilization patterns of different imaging modalities in IgG4-RD. Materials and methods: This retrospective, single-center study included 18 patients diagnosed with IgG4-RD according to ACR/EULAR criteria between May 2020 and December 2024. Clinical, laboratory, histopathological, and imaging data were collected. Computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET-CT) were analyzed for diagnostic and follow-up trends. Patients were stratified based on the presence of acute kidney injury (AKI) at diagnosis. Results: At diagnosis, CT (83.3%) was the most frequently used modality, followed by PET-CT (61.1%) and MRI (27.8%). Combined imaging was performed in 66.6% of cases initially but declined during follow-up. The choice of the first follow-up imaging differed between patients with and without AKI (p=0.072). Notably, follow-up imaging intervals were significantly shorter in AKI patients (30.5 vs. 49 months, p=0.049). Over time, PET-CT use decreased, while MRI became the preferred modality. Despite these variations, no standardized follow-up approach was observed. Conclusion: Our findings indicate a shift from multimodal to single-modality imaging during follow-up, with variations based on AKI status. The lack of a standardized imaging protocol indicates the need for consensus guidelines to enhance disease monitoring and optimize patient outcomes

Cervico-thoracic necrotizing fasciitis in an adolescent: Delayed presentation, staged treatment, and long-term follow-up

Necrotizing fasciitis (NF) is a severe soft tissue infection characterized by rapid progression and significant morbidity and mortality. It predominantly affects immunocompromised adults, with cases in previously healthy adolescents are relatively rare. This case report describes the clinical presentation, diagnosis, and successful staged management of necrotizing fasciitis in a previously healthy 15-year-old male. The purpose of this report is to highlight the importance of early recognition, prompt surgical intervention, and multidisciplinary management in achieving a favorable outcome in pediatric patients with NF. By sharing this case, we aim to increase awareness and facilitate early diagnosis, ultimately improving patient outcomes

Use of Histidine-Tryptophan Ketoglutarate and St. Thomas Cardioplegia solutions in cardiac surgery: A narrative review

Cardioplegia is the mainstay of myocardial protection in cardiac surgery with cardiopulmonary bypass. Historically, cardioplegia emerged in the late 19th century when scientists discovered that high concentrations of potassium could stop the heart in diastole and that this could be used as an approach in open heart surgery. The most important finding in cardioplegia is that the heart restores its function after cardiac arrest without myocardial damage. In this article, the myocardial protective effects of St Thomas cardioplegia and histidine-tryptophan-ketoglutarate cardioplegia solutions were evaluated in adult cardiac surgery. Both cardioplegia solutions continue to be useful and important in cardiac surgery, but their superiority over each other remains controversial. We also believe that cardiovascular surgeons and perfusionists should focus mainly on the myocardial protective effect in the selection of different cardioplegia solutions. In conclusion, whatever the preferred cardioplegia solution, it should provide basic cardioplegia properties such as preservation of energy stores, rapid diastolic cardiac arrest, reversibility and minimal toxicity

Sociodemographic and lifestyle determinants of insulin resistance scores in 273,154 Spanish workers: A cross-sectional analysis using TyG, METS-IR, and SPISE-IR

Objective: Insulin resistance (IR) is a pivotal factor in the pathophysiology of metabolic syndrome, type 2 diabetes mellitus, and cardiovascular disease. Surrogate indices such as the triglyceride-glucose (TyG) index, the metabolic score for insulin resistance (METS-IR), and the single-point insulin sensitivity estimator (SPISE-IR) offer non-invasive, cost-effective tools to assess IR in large populations. Our aim was to investigate the sociodemographic and lifestyle determinants of insulin resistance in a large occupational cohort of Spanish workers using TyG, METS-IR, and SPISE-IR indices, and to identify high-risk subgroups for targeted preventive strategies. Materials and methods: A cross-sectional analysis was conducted on 273,154 Spanish workers (128,197 men and 144,957 women). Sociodemographic (sex, age, social class) and lifestyle variables (smoking, physical activity, Mediterranean diet adherence, alcohol consumption) were examined in relation to TyG, METS-IR, and SPISE-IR scores. Prevalence estimates, stratified mean comparisons, and multinomial logistic regression models were applied to assess independent associations. Results: Men exhibited higher TyG and METS-IR scores and lower SPISE-IR scores than women. Insulin resistance increased with age and was more prevalent among individuals from lower social classes. Physically inactive individuals and those not adhering to a Mediterranean diet had markedly higher IR scores across all indices. Alcohol consumption and smoking were also associated with increased odds of insulin resistance, although patterns varied by sex. Multivariate models confirmed that male sex, older age, lower social class, unhealthy diet, inactivity, smoking, and alcohol use were independently associated with elevated IR scores. Conclusion: This study highlights the utility of TyG, METS-IR, and SPISE-IR indices in detecting insulin resistance in working populations. Sociodemographic inequalities and modifiable lifestyle factors strongly influence IR profiles, supporting workplace health programs that promote physical activity, healthy eating, and behavioral change as strategies to reduce metabolic risk

Priapism as an initial clinical manifestation in hematological disease: A case report and literature review

Priapism is defined as an erection lasting more than 4 hours and is considered a urological emergency in pediatrics. The goal of treatment is to prevent both short and long-term erectile dysfunction. The incidence in boys has not yet been estimated because priapism is considered a rare clinical manifestation. A 15-year-old male was transferred to our clinic with priapism of 48 hours' duration, following two unsuccessful attempts to drain the corpora cavernosa at another facility. Preoperative evaluation revealed hyperleukocytosis with leukemic blasts in peripheral blood, prompting a hematology consultation for a multidisciplinary approach. In the operating room, aspiration and lavage of the corpora cavernosa were performed. Due to unsatisfactory results, a percutaneous shunt procedure was attempted, followed by a corpora cavernosa–spongiosum shunt. Postoperatively, hematology continued to monitor the patient, eventually diagnosing him with type B lymphoblastic leukemia as the underlying cause of the priapism episode. Priapism is an uncommon clinical manifestation in the onset of systemic diseases, with hematological causes being the primary etiology. The diagnosis is clinical, based on a comprehensive medical history, physical examination, and complementary studies, including blood gas analysis of the corpora cavernosa and penile color Doppler ultrasound. Treatment is staged, beginning with patient stabilization and pain control, followed by more invasive surgical interventions if necessary. The understanding and management of priapism in children remain challenging for healthcare providers, and further studies are needed to ensure timely and effective management

Stigma assessment: Scales review

Objective: The assessment of stigma is a multifaceted process requiring a comprehensive understanding of stigma itself, quantification of its degree, evaluation of changes over time, and assessment of the effectiveness of interventions aimed at reducing or preventing it. This study aims to review some of the most widely used scales in health-related stigma assessment and to compare them in terms of their specific characteristics, strengths, and limitations. Materials and methods: In January 2025, a review was conducted using the PubMed database to analyze publications addressing the assessment of stigma through scales or questionnaires. Specific descriptors were employed, focusing on mental illnesses, infectious diseases, overweight and obesity, and sexual and gender minorities. Comparative reviews and studies detailing the application and performance of these scales were included in the analysis. Results: The review identified and compared 20 scales for assessing mental health stigma, 12 scales for stigma related to infectious diseases and symptoms, 17 scales for weight stigma, and 17 scales for stigma affecting sexual and gender minorities. Conclusion: Stigma limits the life opportunities of individuals experiencing discrimination due to illness or personal and social circumstances. Most stigma assessment scales and questionnaires lack specificity, methodological rigor, and clear definitions tailored to the particular stigma being evaluated. Future research should prioritize the development of robust conceptual frameworks, enhance methodological validity, and promote early-stage interventions to mitigate harm caused by stigma

Egyptian perspective of research in sickle cell disease

Objective: Hemoglobinopathies including sickle cell disease (SCD) are prevalent inherited disorders in most Arab countries including Egypt. The heterogeneous distribution with variable prevalence in Egypt may be due to the historical trade exchange, high prevalence of consanguineous marriage, and internal migration. Materials and methods: The literature search was conducted in the PubMed MEDLINE database including articles indexed as of 15th Apr 2024, if they involved patients with SCD in Egypt. Results: In this work, we presented the research originated from Egypt addressing the SCD which includes case reports, original articles, and randomized clinical trials, and highlighted how this research efforts open the doors for understanding the prevalence and pathophysiology, improvement of the diagnostic methods, and the breakthrough treatment. Conclusions: Although scanty research was carried out in the nineteenth century and the first decade of the twentieth century, SCD became an area of focus for research in 2010. The standard of care and the infrastructure improved with the involvement of several centres in multicenter international clinical trials

The pathophysiology of abdominal surgical diseases and the therapeutic potential of mesenchymal stem cells

Mesenchymal stem cells (MSCs) represent a promising therapeutic option for abdominal surgical diseases that are refractory to conventional treatments. Their unique immunomodulatory, antifibrotic, and pro-regenerative properties offer a novel biological platform for tissue repair and inflammatory regulation. In this letter, we summarize current evidence regarding MSC applications in key gastrointestinal and hepatopancreatobiliary conditions, including refractory peptic ulcer, inflammatory bowel disease, acute pancreatitis, and decompensated cirrhosis. Specific emphasis is placed on the relevance of administration routes—such as local, intravenous, or portal applications—tailored to each pathology. Notably, MSCs have demonstrated clinical efficacy in promoting mucosal healing, fistula closure, cytokine suppression, and hepatic function improvement. These findings highlight the translational potential of MSC-based interventions in surgical gastroenterology. Further research should aim to standardize delivery protocols and identify optimal patient populations. We believe this concise synthesis may guide future clinical strategies and regenerative innovations in the field

The role of mesenchymal stem cells in the treatment of ARDS and cytokine storms in COVID-19

The COVID-19 pandemic continues to challenge global healthcare systems, particularly due to the lack of effective treatment options for patients who develop acute respiratory distress syndrome (ARDS), cytokine storms, and long-term pulmonary complications. While antiviral agents and vaccines have mitigated some of the burden, these approaches are not universally effective—especially against emerging variants. In this context, mesenchymal stem cells (MSCs) have emerged as a promising therapeutic strategy due to their unique immunomodulatory and regenerative properties

Epidemiological and clinical characteristics of head trauma patients admitted to the emergency department: A prospective study

Objective: Head trauma is a significant reason for emergency department admissions. In this study, we prospectively examined head trauma cases admitted between October and December 2011, aiming to identify risk factors and contribute to the epidemiological database in our country. Materials and methods: Head trauma cases admitted to the emergency department between 08:00 and 17:00 during October-December 2011 were evaluated. Data collected included admission time, gender, vital signs, Glasgow Coma Scale (GCS) score, mechanism of injury, associated organ injuries, comorbidities, substance or alcohol use, neuroradiological findings, interventions performed in the emergency department, neurosurgical consultations, and surgical requirements. Statistical analysis was performed to determine the patients' epidemiological characteristics, discharge rates, hospitalizations, and mortality rates, providing results specific to our institution. Results: A total of 206 patients were included. Among the patients, 59.22% were admitted due to domestic accidents, while 21.84% were brought in after traffic accidents. Of the 206 patients evaluated, 149 had normal findings on computed tomography (CT), while pathological findings were detected in 10 patients. Twelve patients were hospitalized, 3 underwent emergency surgery, and 191 were discharged from the emergency department. Conclusion: In our study, domestic falls were more common than traffic accidents as a cause of head trauma; however, traffic accidents were associated with a higher risk level based on GCS scores. Patients aged 60 years and older demonstrated a higher prevalence of pathological findings on CT, identifying advanced age as a significant risk factor. The most frequently observed pathology was traumatic subarachnoid hemorrhage (SAH)