Excisional haemorrhoidectomy in Crohn's disease - is it time to question an old dogma?

Background: Haemorrhoidectomy in Crohn's disease is controversial due to fears over poor wound healing leading to proctectomy. We aim to review the available literature and establish the role of excisional haemorrhoidectomy in Crohn's disease.

Methods: A review of the current scientific literature was conducted using Medline, PubMed and the Cochrane Central Registry of Controlled Trials.

Wakakosha "You are Worth it": reported impact of a community-based, peer-led HIV self-stigma intervention to improve self-worth and wellbeing among young people living with HIV in Zimbabwe.

Introduction: Self-stigma-negative self-judgements or core beliefs-can result in feelings of shame, worthlessness and self-blame, and impacts social interaction, mental health and health service utilization among people living with HIV (PLHIV). Few interventions target self-stigma among PLHIV and, to our knowledge, none until now for adolescents and young people LHIV (AYPLHIV) in sub-Saharan Africa. We present qualitative findings on the perceived impact of a self-stigma intervention (, "You are Worth it").

Adverse effects following botulinum toxin A injections in children with cerebral palsy.

The study aimed to analyze the adverse events associated with botulinum toxin A (BoNT-A) injections in children with cerebral palsy (CP). The literature search was completed using the Medline, PubMed, Google Scholar, Scopus, and Cochrane Library databases from the earliest date possible up to December 2021. Search terms included 'botulinum toxin', 'cerebral palsy', 'spasticity', 'adverse effects', 'side effects', 'undesirable effects', 'complications', 'lower limb', 'upper limb', and 'children' including combinations of index and free-text terms.

Cost-Effectiveness of First-Line Pembrolizumab Monotherapy Versus Chemotherapy in High Programmed Death-Ligand 1 Advanced Non-Small Cell Lung Cancer in the Irish Healthcare Setting.

Objectives: This study aimed to assess the cost-effectiveness of pembrolizumab monotherapy in the first-line treatment of advanced non-small cell lung cancer (NSCLC) in adults whose tumors expressed programmed death-ligand 1 (PD-L1) with a tumor proportion score (TPS) ≥ 50% in the Irish healthcare setting.

Methods: Effectiveness inputs were derived from the 5-year analysis of KEYNOTE-024 phase III clinical trial. The intervention was pembrolizumab monotherapy; the comparator was a weighted average of the 5 chemotherapy regimens from the trial.

Intramural Hematoma During a Complex Chronic Total Occlusion Intervention.

We describe a patient who presented for elective percutaneous coronary intervention to treat a chronic total occlusion of the right coronary artery. An intramural hematoma resulted from the intervention and was discovered with intravenous ultrasound. The complication was successfully managed conservatively, and follow-up showed patent coronary arteries.

Functional and radiological outcome of C-shaped intercondylar fractures in children.

The aim of this study was to retrospectively evaluate the clinical, functional, and radiographic outcomes of displaced C-shaped intercondylar fractures of the humerus in children and adolescents, and evaluate upper-extremity function with the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH). We retrospectively reviewed the data of nine children with displaced C-intercondylar fractures that were treated surgically. Age, sex, laterality, mechanism of injury, amount of displacement, type of treatment, fixation method, and outcome were recorded.

The Impact of the COVID-19 Pandemic on Radiology Resident Education: Where Do We Go From Here?

The Coronavirus Disease of 2019 (COVID-19) pandemic caused a dramatic shift in radiology resident education. Primarily, physical distancing prompted a general transition to virtual learning. Common changes made by radiology residency programs included virtual rounds and readouts, the use of simulation technology, and case-based learning which utilized pedagogical approaches such as the flipped classroom for teaching residents.

The potential for artificial intelligence to predict clinical outcomes in patients who have acquired acute kidney injury during the perioperative period.

Acute kidney injury (AKI) is a common medical problem in hospitalised patients worldwide that may result in negative physiological, social and economic consequences. Amongst patients admitted to ICU with AKI, over 40% have had either elective or emergency surgery prior to admission. Predicting outcomes after AKI is difficult and the decision on whom to initiate RRT with a goal of renal recovery or predict a long-term survival benefit still poses a challenge for acute care physicians.

Delayed post-hypoxic leukoencephalopathy following alcohol consumption and cardiopulmonary arrest.

Delayed post hypoxic leukoencephalopathy (DPHL) is a rare consequence of hypoxic brain injury that occurs several days to weeks following an initial hypoxic insult. Most of the previously published cases occur in the setting of drug overdoses or carbon monoxide poisoning, where the incidence of DPHL is as high as 3%. Our case depicts a patient with delayed hypoxic brain injury following cardiac arrest with cardiopulmonary resuscitation.

Unexpected bilateral pedicle stress fractures of the lumbar spine.

Bilateral fracture of the lumbar pedicles is a rare phenomenon that may arise secondary to underlying risk factors. Our case demonstrates bilateral pedicle stress fractures arising in an otherwise healthy 41-year-old male. After failing to respond to conservative measures, he was managed with bilateral pedicle screws.

Glucocorticoid-Induced Osteoporosis Prevention in Polymyalgia Rheumatica Patients.

Aim Studies indicate that <50% of polymyalgia rheumatica (PMR) patients receive bone protective therapy (BPT) forglucocorticoid-induced osteoporosis (GIOP) prevention. We sought to determine if PMR patients are protected fromGIOP by examining bone densitometry (DXA) scan results, BPT use, and adherence to guidelines. Methods PMR patients treated with glucocorticoids who underwent a DXA scan at Cork University Hospital from 01/01/2016 to27/10/2017 were included.

Prevention of adverse drug reactions in hospitalized older patients with multi-morbidity and polypharmacy: the SENATOR* randomized controlled clinical trial.

Background: Multi-morbidity and polypharmacy increase the risk of non-trivial adverse drug reactions (ADRs) in older people during hospitalization. Despite this, there are no established interventions for hospital-acquired ADR prevention.

Methods: We undertook a pragmatic, multi-national, parallel arm prospective randomized open-label, blinded endpoint (PROBE) controlled trial enrolling patients at six European medical centres.

Ventricular tachycardia and preload deficiency post LVAD - The importance of integrated assessment.

Ventricular tachycardia (VT) is common in LVAD recipients, and although often well tolerated, may result in symptoms and ICD therapies, and therefore require further evaluation and treatment. However, preload deficiency may also contribute to the development of ventricular tachycardia after LVAD implantation by provoking inflow cannula related VT. In this report, three cases are described where ventricular tachycardia was evaluated by integrated assessment utilizing echo and the HeartWare HVAD console, and successfully treated by modification of LV loading conditions.

Cost Implications of Reactive Versus Prospective Testing for Dihydropyrimidine Dehydrogenase Deficiency in Patients With Colorectal Cancer: A Single-Institution Experience.

Background: Severe toxicity is experienced by a substantial minority of patients receiving fluoropyrimidine-based chemotherapy, with approximately 20% of these severe toxicities attributable to polymorphisms in the gene. The codes for the enzyme dihydropyrimidine dehydrogenase (DPD) important in the metabolism of fluoropyrimidine-based chemotherapy. We questioned whether prospective mutation analysis in all patients commencing such therapy would prove more cost-effective than reactive testing of patients experiencing severe toxicity.

Proliferative myositis of the latissimus dorsi presenting in a 20-year-old male athlete.

We describe the case of a 20-year-old rower presenting with an uncommon condition of Proliferative Myositis (PM) affecting the Latissimus Dorsi (LD). PM is a rare, benign tumour infrequently developing in the upper back. Its rapid growth and firm consistency may mistake it for sarcoma at presentation.

Modern antiplatelet agents in coronary artery disease.

Dual antiplatelet therapy is well recognized in the prevention of thrombotic complications of acute coronary syndrome and percutaneous coronary interventions. Despite clinical benefits of aspirin and clopidogrel therapy, a number of limitations curtail their efficacy: slow onset of action, variability in platelet inhibitory response and potential drug-drug interactions. Furthermore, the single platelet-activation pathway targeted by these agents allows continued platelet activation via other pathways, ensuring incomplete protection against ischemic events, thus, underscoring the need for alternate antiplatelet treatment strategies.