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Overlap syndrome of systemic sclerosis and idiopathic inflammatory myopathies is an increasingly frequent entity, but the association with immune-mediated necrotizing myositis has rarely been described. While myositis or myopathy may be features of scleroderma, it is imperative to correctly diagnose an overlap syndrome of these two, since it can be considered a different entity with specific management and a worse prognosis. Anti-signal recognition particle (anti-SRP) antibodies target the striated muscle fiber and inhibit myoblast regeneration, resulting in myofiber atrophy and necrosis. Anti-SRP antibodies are specific in immune-mediated necrotizing myopathy characterized by myonecrosis and minimal inflammatory reaction, with proximal muscle weakness and typical extra-muscular manifestation. There are controversial data on the association of cardiac manifestations and the presence of these antibodies, and recent studies cannot prove a significant correlation between the two. Myocarditis is a complication with an unpredictable, potentially severe outcome from heart failure and dilated cardiomyopathy to fatality. It can be difficult to diagnose, and a myocardial biopsy can be problematic in daily practice; thus, most practitioners rely on cardiac magnetic resonance with suggestive images for the correct diagnosis. This paper seeks to address the challenges associated with the diagnosis and treatment of collagen diseases by evaluating the role of anti-SRP antibodies in the pathogenesis of cardiac involvement. [ABSTRACT FROM AUTHOR]

Background/Objectives: Age-related macular degeneration (AMD) is one of the main causes of blindness and visual impairment worldwide. Intravitreal complement inhibitors are an emergent approach in the treatment of AMD, which have had encouraging results. This systematic review analyzes the outcomes and safety of complement inhibitor therapies for GA in AMD cases. Methods: A comprehensive search on the PubMed and Web of Science databases returned 18 studies involving various complement inhibitor agents, with a total of 4272 patients and a mean follow-up of 68.2 ± 20.4 weeks. Results: Most treated patients were white (96.8%) and female (55.8%), with a mean age of 78.3 ± 7.8 years and a mean GA area of 8.0 ± 3.9 mm2. There were no differences in visual function change between treated and control participants. The mean GA area change was 2.4 ± 0.7 mm2 in treated participants vs. 2.7 ± 0.8 mm2 in control groups (p < 0.001). The ocular and systemic side effects were similar to those of intravitreal anti-VEGF. A less-understood effect was that of the onset of choroidal neovascularization (CNV) in 1.1–13% of patients; this effect was found to be more frequent in patients with neovascular AMD in the fellow eye or nonexudative CNV in the study eye at baseline. Conclusions: Complement inhibitors may represent a useful therapy for GA in AMD, but a personalized approach to patient selection is necessary to optimize the outcomes. [ABSTRACT FROM AUTHOR]

Background and Objectives: Systemic inflammatory indices have been largely investigated for their potential predictive value in multiple inflammatory, infectious, and oncological diseases; however, their value in colorectal cancer is still a subject of research. This study investigates the dynamics of pre- and postoperative values of NLR, PLR, SII, and MLR in patients with colorectal cancer and their predictive value for early postoperative outcomes. Materials and Methods: A 2-year retrospective cohort study was performed on 200 patients operated for colorectal adenocarcinoma. Systemic inflammatory indices were calculated based on complete blood count preoperatively and on the first and sixth postoperative days. The patients were divided into two groups based on their emergency or elective presentation. The pre- and postoperative values of serum inflammatory biomarkers and their correlations with postoperative outcomes were separately analyzed for the two study subgroups. Results: There were no significant differences in sex distribution, addressability, associated comorbidities, or types of surgery between the two groups. Patients in the emergency group presented higher preoperative and postoperative values of WBC, neutrophils, NLR, and SII compared to elective patients. The postsurgery hospital stays correlated well with pre- and postoperative day one and day six values of NLR (p = 0.001; 0.02; and <0.001), PLR (p < 0.001), SII (p = 0.037; <0.001; <0.001), and MLR (p = 0.002; p = 0.002; <0.001). In a multivariate analysis, reintervention risk was higher for emergency presentation and anemia, and lower in right colon cancer. In the emergency group, a multivariate model including age, MLR PO1, and pTNM stage was predictive for severe postoperative complications (AUC ROC 0.818). First-day postoperative inflammatory indices correlated well with sepsis, with the best predictive value being observed for the first postoperative day NLR (AUC 0.836; sensibility 88.8%; specificity 66.7%) and SII (AUC 0.796; sensitivity 66.6%; specificity 90%). For elective patients, the first postoperative day PLR and anemia were included in a multivariate model to predict Clavien–Dindo complications graded 3 or more (AUC ROC 0.818) and reintervention (AUC ROC 0.796). Conclusions: Easy-to-calculate and inexpensive systemic inflammatory biomarkers could be useful in predicting early postoperative outcomes in colorectal cancer for both elective and emergency surgery. [ABSTRACT FROM AUTHOR]

Diagnosing cutaneous melanomas relies mainly on histopathological analysis, which, in selected cases, can be aided by immunohistochemical evaluation of conventional melanocytic markers. Nevertheless, these malignancies, particularly in metastatic settings, may display divergent differentiation with unusual histological and immunohistochemical features. In this context, we present the case of a 65-year-old male diagnosed with typical superficial spreading melanoma who developed recurrence and metastatic lesions featuring angiosarcomatous differentiation. The diagnosis of the initial tumour and the subsequently dedifferentiated lesions was confirmed by ample immunohistochemical analysis, which included several melanocytic markers, as well as mesenchymal and vascular markers. The recurrent tumour and lymph nodes metastases were completely negative for Melan-A and PRAME, and focally positive for SOX10. Additionally, they also displayed diffuse, intense positivity for CD10 and WT1 and focal positivity for CD99, ERB, and CD31. Thus, the diagnosis of primary cutaneous melanoma with recurrent and metastatic divergent angiosarcomatous differentiation was established. This occurrence is particularly rare and can pose important diagnostic challenges. Therefore, in addition to presenting this highly unusual case, we also performed a comprehensive review of the literature on divergent differentiation in melanomas. [ABSTRACT FROM AUTHOR]

Copyright of Farmacia is the property of Societatea de Stiinte Farmaceutice Romania and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Farmacia is the property of Societatea de Stiinte Farmaceutice Romania and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The introduction in surgical practice of NIR fluorescent systems with their augmented reality enhanced the visual abilities of the surgeons who imagined over just a decade a myriad of uses for this emergent technology. We reviewed the clinical applications of Indocyanine Green from intraoperative cholangiography and SLN identification to bowel perfusion assessment, endocrine surgery and evaluation of Crohn's disease and Barrett's esophagus. The immense value of this new method of functional and anatomical assessment is unequivocal, but there are pitfalls and drawbacks of the commercially available systems. By presenting all these we hope to disseminate the importance and the potential of the technology and to promote the interest in usage and research in the field. [ABSTRACT FROM AUTHOR]

Introduction. Rapid developments in medical technology have allowed the incorporation of Indocyanine green (ICG) fluorescent cholangyography in the surgical technique armamentarium. The visualization of the biliary anatomy with augmented reality devices during surgery reduces complications and offer the perspective of challenging the safety paradigms which prohibited surgery in certain acute biliary conditions. Materials and methods. 43 consecutive patients were enrolled in a prospective interventional study and randomly divided into a cohort of 19 patients who had ICG injected prior to laparoscopic cholecystectomy and a cohort of 23 patients who received no fluorescent dye prior to surgery. In the ICG lot a Near Infrared Fluorescent System was used for the acquisition of fluorescent data in order to produce real time augmented reality imaging (ICG fluorescent cholangiography). The surgical technique and the indications for surgery were the same for the same in both cohorts of patients. Results and discussion. The cohort of patients receiving ICG had no complications and the mean operating time was 10 minutes less. The biliary anatomy was identified immediately in the ICG cohort with a specificity of 89.4% for the common bule duct and 73.6% for the cystic duct. In the non ICG cohort 21% of the CBDs and 43.4% of the cystic ducts were identified with difficulty during the procedure. Conclusion. We demonstrated in a small cohort of patients that early laparoscopic cholecystectomy is safe and can be performed quicker with the aid of fluorescent dyes. In order to challenge the safety paradigms around the early laparoscopic cholecystectomy a larger study is necessary. [ABSTRACT FROM AUTHOR]

Despite rapid advances in endoscopic treatments and the development of updated and evidence based guidelines, morbidity and mortality in upper gastrointestinal bleeding (UGIB) remains high. A recent study conducted in a tertiary centre on 80 consecutive patients with UGIB demonstrated that lower doses of Adrenaline 1:10000 and diathermy were superior to high doses of Adrenaline injections only, but failed to reduce the mortality rates, despite a reduction in the need for transfusion, second look and surgical interventions. We believe that comorbid conditions have greater influence on survival rates in patients with UGIB than the achievement of immediate haemostasis and we attribute a paramount importance to rapid and correct resuscitation of the bleeding patient prior to any endoscopic assessment. [ABSTRACT FROM AUTHOR]

Despite recent advances in the treatment of upper gastrointestinal bleeding (UGI) lesions, mortality and morbidity have remained high. The introduction of scoring systems and novel endoscopic techniques have improved patients outcomes. Although guidelines for managing UGIB have been developed they have not been implemented ubiquitously. The authors offer a point of view in relation to the management of the non variceal UGIB with emphasis on the risk stratification, paradigms that have suffered changes or have been revalidated over the years, newly introduced pharmacological agents and timing of endoscopy. [ABSTRACT FROM AUTHOR]

Peritoneal cancer (PPC), a rare and aggressive malignancy, can develop from the peritoneal lining or as a secondary peritoneal cancer caused by metastases from neighbouring organs such as the ovaries, gastrointestinal tract, or breast. Early identification is still difficult due to its ambiguous signs, ranging from bloating, distension, and stomach pain. Due to their comparable histological and clinical characteristics, PPC and ovarian cancer are frequently misdiagnosed. Advanced imaging, histological investigation, and immunohistochemical markers are essential for accurate diagnosis. In order to control any remaining disease and enhance results, treatment usually encompasses an assortment of therapeutic approaches, such as hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgical procedure (CRS). We present a 69-year-old woman who got diagnosed with PPC after first being suspected of having ovarian cancer. The current instance emphasizes how crucial a thorough diagnostic process is to differentiating PPC from related cancers. [ABSTRACT FROM AUTHOR]

Introduction: Colorectal cancer (CRC) is one of the most common cancers occurring globally. Surgery for CRC often extends hospital stays due to complications, as patients must meet nutritional needs and regain mobility before discharge. Longer hospital stays, required for extended monitoring and care, can increase the risk of further complications, creating a cycle where extended stays lead to more issues. Predicting a patient's length of stay (LOS) is crucial for optimal resource management, financial control, and patient care., Methods: This study aimed to create a scoring system to predict postoperative complications and prolonged hospitalization in colorectal cancer surgery patients. Over 60 variables, including age, BMI, and tumor location, were analyzed for their correlation with complications., Results: A complication score was developed based on six factors linked to postoperative complications: hemoglobin (Hb), serum albumin, tumor localization, EC (epidural catheter), opioid use, and NPO (nil per os) days. Patients with three or more identified risk factors had a 6.17-fold higher complication rate, with a highly significant p-value of 0.0008, demonstrating the score's strong potential for identifying high-risk patients. The factors significantly associated with length of stay (LOS) include admission hemoglobin levels, tumor localization (right versus left colon), intraoperative fluid intake, the presence or absence of regional anesthesia and analgesia (RAA), the number of drainage tubes, and postoperative hematocrit levels. The analysis shows that patients with at least three of the six identified risk factors are 5.17 times more likely to experience prolonged hospitalization (over eight days) compared to those with fewer than three points, with a statistically significant correlation (p-value of 0.003). Our findings indicate that patients with three or more risk factors are significantly more likely to experience complications and extended hospital stays., Conclusions:  This scoring system can serve as an essential tool for healthcare providers to identify at-risk patients, optimize resource allocation, and ultimately enhance patient recovery and outcomes. Moreover, the integration of the complication and LOS scores into routine preoperative assessments can facilitate a more personalized care plan, enabling healthcare providers to identify patients who may benefit from closer monitoring and additional support during their recovery. Further validation in diverse populations and settings is needed to confirm the scoring system's generalizability and utility., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. The Ethics Committee of the Ilfov County Emergency Clinical Hospital issued approval 4192/7. The approval of the Ethics Committee of the Ilfov County Emergency Clinical Hospital was obtained on March 2022. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mihailescu et al.)