The advent of RNA-based therapeutics for metabolic syndrome and associated conditions: a comprehensive review of the literature.

Metabolic syndrome (MetS) is a prevalent and intricate health condition affecting a significant global population, characterized by a cluster of metabolic and hormonal disorders disrupting lipid and glucose metabolism pathways. Clinical manifestations encompass obesity, dyslipidemia, insulin resistance, and hypertension, contributing to heightened risks of diabetes and cardiovascular diseases. Existing medications often fall short in addressing the syndrome's multifaceted nature, leading to suboptimal treatment outcomes and potential long-term health risks. This scenario underscores the pressing need for innovative therapeutic approaches in MetS management. RNA-based treatments, employing small interfering RNAs (siRNAs), microRNAs (miRNAs), and antisense oligonucleotides (ASOs), emerge as promising strategies to target underlying biological abnormalities. However, a summary of research available on the role of RNA-based therapeutics in MetS and related co-morbidities is limited. Murine models and human studies have been separately interrogated to determine whether there have been recent advancements in RNA-based therapeutics to offer a comprehensive understanding of treatment available for MetS. In a narrative fashion, we searched for relevant articles pertaining to MetS co-morbidities such as cardiovascular disease, fatty liver disease, dementia, colorectal cancer, and endocrine abnormalities. We emphasize the urgency of exploring novel therapeutic avenues to address the intricate pathophysiology of MetS and underscore the potential of RNA-based treatments, coupled with advanced delivery systems, as a transformative approach for achieving more comprehensive and efficacious outcomes in MetS patients.

Total laparoscopic hysterectomy and bilateral salpingo-oophrectomy for stage 1 endometrial carcinoma under regional anaesthesia.

Total Laparoscopic hysterectomy is most commonly performed under general anesthesia. In elderly patients with severe medical co-morbidities and endometrial malignancy, laparoscopic surgery under general anesthesia can be hazardous. In such patients, regional anesthesia is safe, and can be the only option. We present a case of 75-year old women with severe lung fibrosis, chronic obstructive airway disease and heart failure who presented with severe post-menopausal bleeding and was diagnosed with endometrial carcinoma. She was considered unfit for general anesthesia. After multidisciplinary team meeting, the patient underwent total laparoscopic hysterectomy, bilateral salpingo-oophrectomy and peritoneal washings under regional anaesthesia. The procedure was successful and the patient was discharged 24 h later. In this case report, we demonstrate the anesthetic and surgical techniques for total laparoscopic hysterectomy under regional anesthesia. In the presence of dedicated multidisciplinary team, laparoscopic hysterectomy for endometrial carcinoma under regional anesthesia is safe and feasible.

A Case Report of Hirschsprung's Disease in a Neonate: Early Detection and Review of Management.

Hirschsprung's disease is a rare disease characterized by the complete absence of ganglionic cells in the colon, thereby causing loss of peristalsis movement of the bowel. Most cases are diagnosed before the age of one. Here, we present a case of a newborn baby boy who was not feeding well and then developed a distended abdomen and began bilious vomiting. Blood mucoid stools were also observed. The diagnosis of Hirschsprung's disease was confirmed through a full-thickness rectal biopsy, and the Duhamel surgical procedure was performed as a course of treatment all within the first few days of birth. No complications were reported, and the baby was safely discharged after seven days. This case demonstrates the importance of timely treatment after prompt diagnosis due to the early recognition of the severe symptoms. Even though this disease is rare, pediatricians should be trained to recognize and treat the child to prevent further detrimental outcomes.

Meckel's diverticulum causing acute intestinal obstruction: A case report and comprehensive review of the literature.

Introduction: Meckel's diverticulum is a congenital anomaly that is often detected incidentally. When it presents symptomatically, it causes painless gastrointestinal bleeding. Nevertheless, in rare instances, it can cause acute intestinal obstruction, often obscuring the true clinical picture. Case presentation: A 31-year-old male presented to the emergency department with a 24-h history of unremitting nausea, biliary emesis, abdominal distension, and absolute constipation. After ruling out the most common etiologies of acute bowel obstruction, radiological imaging was obtained and was suggestive of meckel's diverticulum. Laparoscopic meckel's diverticulectomy was performed, with the subsequent histopathological analysis confirming ectopic gastric tissue. Discussion: Meckel's diverticulum occurs consequent to incomplete obliteration of the vitelline or omphalomesenteric duct, which connects the developing intestines to the yolk sac. It is found in roughly 2% of the population, of which only about 4% may become symptomatic due to any number of complications. Specifically, small bowel obstruction (SBO) and diverticulitis secondary to ectopic gastric or pancreatic tissue are the most common presentations of symptomatic MD. Conclusion: Although relatively rare in adults, MD should be considered in the list of differentials in patients with intussusception leading to SBO, especially on a background history unremarkable for the most common etiologies causing SBO including post-operative adhesions and hernias.

Scroto-perineal hidradenitis suppurativa complicated by giant scrotal elephantiasis.

Scrotal elephantiasis has been a recognized complication of inguinal node irradiation, filarial infection, tumor involvement and surgical lymphatic destruction, but has rarely been reported in association with hidradenitis suppurativa (HS). HS, also known as acne inversa, is a chronic and often debilitating disease primarily affecting the axillae, inframammary regions and perineum. The location of the lesions may lead to social embarrassment and failure to seek medical treatment. Scroto-preineal HS complicated by scrotal elephantiasis is a distressing disease. Excisional surgery with reconstruction is the recommended treatment with a high likelihood of good outcome. We present a 38-year-old male patient with long-standing scroto-perineal HS complicated by giant scrotal elephantiasis.

Intravesical immunotherapy for superficial bladder cancer.

OBJECTIVE: To compare and evaluate the efficacy and tolerance of intravesical instillation of Bacillus Calmette-Guerin (BCG) and interferon alpha-2b immunotherapy for superficial transitional cell carcinoma (TCC) of the urinary bladder. METHODS: Thirty-five patients with superficial TCC of the urinary bladder, primary and recurrent tumors, stage Ta, T1, and grade 1 and 2, were prospectively enrolled for intravesical immunotherapy at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia between January 1992 and December 2000. The treatment regimes used were either 120 mg of BCG weekly for 6 weeks followed by a 2nd 6 week course given only on first tumor recurrence, or 50 million i.u. of interferon alpha-2b weekly for 3 months, bi-weekly for the next 3 months and monthly for 6 months. Twenty-two patients received BCG and 13 received interferon alpha-2b. Adequate blood counts, renal and hepatic function profiles, and informed consent were required. Cystoscopy was repeated every 3 months for the first 2 years, then 6 monthly for another 2 years and then yearly. RESULTS: The follow-up period ranged from 9-96 months (median 31.33 months). Twenty patients attended the follow-up and were evaluable in the BCG group and 13 in the interferon alpha-2b group. In the BCG versus interferon alpha-2b group, the rates of complete response were 80% and 41.6%, partial response were 5% and 33.3%, and progression were 15% and 8.3%. Mild side effects occurred in 5 patients and all of them completed their treatments. There was only one cancer related death in each group after 6 and 7 years of starting the treatment. CONCLUSION: Bacillus Calmette-Guerin was confirmed as a more effective intravesical immunotherapy for superficial TCC of the urinary bladder as compared to interferon alpha-2b. Both agents' treatments are well tolerated.