Controversies and Future Directions in Management of Acute Appendicitis: An Updated Comprehensive Review.

Globally, acute appendicitis has an estimated lifetime risk of 7-8%. However, there are numerous controversies surrounding the management of acute appendicitis, and the best treatment approach depends on patient characteristics. Non-operative management (NOM), which involves the utilization of antibiotics and aggressive intravenous hydration, and surgical appendectomy are valid treatment options for healthy adults. NOM is also ideal for poor surgical candidates. Another important consideration is the timing of surgery, i.e., the role of interval appendectomy (IA) and the possibility of delaying surgery for a few hours on index admission. IA refers to surgical removal of the appendix 8-12 weeks after the initial diagnosis of appendicitis. It is ideal in patients with a contained appendiceal perforation on initial presentation, wherein an initial nonoperative approach is preferred. Furthermore, IA can help distinguish malignant and non-malignant causes of acute appendicitis, while reducing the risk of recurrence. On the contrary, a decision to delay appendectomy for a few hours on index admission should be made based on the patients' baseline health status and severity of appendicitis. Post-operatively, surgical drain placement may help reduce postoperative complications; however, it carries an increased risk of drain occlusion, fistula formation, and paralytic ileus. Furthermore, one of the most critical aspects of appendectomy is the closure of the appendiceal stump, which can be achieved with the help of endoclips, sutures, staples, and endoloops. In this review, we discuss different aspects of management of acute appendicitis, current controversies in management, and the potential role of endoscopic appendectomy as a future treatment option.

Therapeutic approaches for spinal synovial sarcoma: a comprehensive review of the literature.

OBJECTIVE: Synovial sarcoma (SS) is a relatively rare type of soft-tissue sarcoma that is commonly treated with surgery, radiation, chemotherapy, and palliative care. Stereotactic radiosurgery (SRS) is an emerging approach that shows promise in treating CNS conditions, but it has not been studied for SS. The authors present a systematic review that explores the effectiveness of different treatments, with a focus on SRS, for managing spinal SS. METHODS: A systematic PubMed search was conducted that covered studies from 1964 to 2022, yielding 70 relevant studies. Inclusion criteria encompassed primary and metastatic spinal SS, various treatment modalities, patient age 17 years or older, English-language studies, retrospective series, and case reports. Based on these criteria, 26 studies were included in this review and 44 were excluded. RESULTS: Of the included studies, 15 patients from 9 studies were treated with surgical intervention followed by both conventional radiotherapy (RT) and chemotherapy, 10 patients from 10 studies were treated with surgery followed by RT, 5 studies comprising 8 patients were exclusively treated with surgery, 5 cases in 3 studies were treated with surgery plus concomitant chemotherapy, 4 patients in 2 studies were treated with SRS, and only 1 study reported treatment without surgery and with chemotherapy and RT. The median progression-free survival and overall survival periods observed in the SRS-treated patients were 37 months and 60 months, respectively, which were higher than those of any other treatment method or combination used. CONCLUSIONS: The authors' study offers a thorough review of spinal SS treatments. They are hopeful that this will aid clinicians in informed decision-making for better patient outcomes.

CRP Albumin Ratio: A novel noninvasive and cost-effective method for assessing the severity of acute pancreatitis.

Introduction: Acute pancreatitis is a significant and potentially life-threatening gastrointestinal disorder that requires prompt and accurate diagnosis for effective treatment. Current diagnostic methods often involve expensive and inaccessible imaging studies, such as CT scans, limiting their utility in emergency settings and underserved areas. Aim: This correspondence discusses an innovative and cost-effective approach to assessing the severity of acute pancreatitis, focusing on the C-Reactive Protein-Albumin Ratio (CAR). Methodology: We searched relevant articles and studies from 2015 till date on PubMed, Web of Science, and Google Scholar using these keywords: "C-Reactive Protein", "Albumin Ratio", "Acute pancreatitis", "Cost-effective", "Non-invasive", and "Severity". Result: The CAR diagnostic method involves a simple blood test that measures the levels of C-Reactive Protein (CRP) and albumin, both commonly used markers for assessing inflammation. Elevated CRP and decreased albumin levels are indicative of inflammation, and the CAR has shown a strong positive correlation with the severity of acute pancreatitis. This method offers a non-invasive, time-efficient, and cost-friendly alternative to traditional diagnostic techniques. Conclusion: The potential of CAR as an assessment tool for the severity of acute pancreatitis is highlighted, especially in resource-limited settings. This innovation holds promise for improving the timely and accurate diagnosis of acute pancreatitis, ultimately enhancing patient outcomes and reducing mortality rates.

"Veozah (Fezolinetant): A Promising Non-Hormonal Treatment for Vasomotor Symptoms in Menopause".

Vasomotor symptoms (VMS) are a common and distressing experience during menopause, affecting a significant portion of women. Hormone therapy (HT) has been the traditional treatment, but its limitations and potential risks have led to the search foar non-hormonal alternatives. Recently, the FDA approved Veozah (Fezolinetant) as a promising nonhormonal solution for moderate to severe VMS in menopause. Veozah, an innovative neurokinin 3 (NK3) receptor antagonist, targets the disrupted thermoregulation underlying VMS. It modulates neural activity within the thermoregulatory center by crossing the blood-brain barrier, offering relief from hot flashes and night sweats. Clinical trials, including SKYLIGHT 1TM, SKYLIGHT 2TM, and SKYLIGHT 4TM, have established Fezolinemtant's efficacy and safety profile. The recommended dosage of one 45 mg tablet per day demonstrates proportional pharmacokinetics, with generally mild side effects that require regular monitoring. Fezolinetant's oral availability makes it a convenient and accessible option for women seeking relief from VMS, potentially improving their overall well-being.

Celebrating breakthrough in dental diagnostics: FDA approval of an AI model for diagnosis of periodontal diseases: A correspondence.

Periodontal diseases are prevalent and have significant implications for oral health and overall well-being. Current diagnostic methods have limitations in accuracy and standardization. The recent Food and Drug Administration approval of Videa Perio Assist (VPA), an AI model for diagnosing periodontal diseases, presents a breakthrough in dental diagnostics. VPA is a cloud-based, AI-powered software that automatically measures and visualizes bone levels associated with each tooth from radiographic images. Clinical testing has demonstrated VPA's efficacy in accurately diagnosing periodontal diseases with high sensitivity and specificity. The integration of AI in dentistry has the potential to revolutionize periodontal disease diagnosis, improve patient care, and enhance decision-making. However, further research, education, cost-effectiveness, and collaboration are essential for maximizing the benefits of AI in dental settings. The approval and implementation of VPA mark a significant advancement in dental diagnostics, paving the way for more effective solutions and a healthier global population.