Abdominal Pain Research Articles

Indications and findings of upper gut endoscopy in pediatric patients

Children undergoing more gastrointestinal endoscopies without the necessary indications risk serious adverse effects. Therefore, upper GI (UGI) endoscopy examination requires selective indications to minimize the risk of unnecessary use of UGI endoscopy. This study aimed to analyze the indications for endoscopy based on the main UGI complaints in pediatric patients at Dr. Saiful Anwar General Hospital Malang. A retrospective analysis of the first diagnostic endoscopy in children was conducted between July 2022 to July 2023 at Dr. Saiful Anwar General Hospital Malang. Among 60 patients were included with an age of 0-15 years old; 51.7% were boys and 48.3% were girls. The results showed recurrent abdominal pain (RAP) as the primary cause of UGI endoscopic indications (38.3%), followed by blood vomiting (33.3%), acute abdominal pain (21.6%), and prolonged vomiting (6.66%). In conclusion, recurrent abdominal pain in children is the most typical reason for upper gastrointestinal endoscopy, and persistent gastritis is the most typical underlying condition.

Polythiophene/Copper Vanadate Nanoribbons and their Electrochemical Sensing Properties for Detecting Benzoic Acid

Background: Excessive intake of benzoic acid may cause serious diseases, including disordered metabolism, abdominal pain, and diarrhea. Hence, it is important to explore a reliable method to determine the quantity of benzoic acid for protecting human health. In this regard, polythiophene/ copper vanadate nanoribbon composites act as electrode materials for the detection of benzoic acid. Objective: The objective of this research was to synthesize polythiophene/copper vanadate nanoribbons via an in-situ polymerization approach and evaluate their electrochemical performance for the detection of benzoic acid. Methods: Polythiophene/copper vanadate nanoribbons were obtained via an in-situ polymerization approach. The obtained composite nanoribbons were analyzed using X-ray diffraction, electron microscopy, Fourier Transform Infrared Spectroscopy, and electrochemical method. Results: Amorphous polythiophene nanoparticles with a size of less than 100 nm were homogeneously attached to the copper vanadate nanoribbons. Electrochemical sensing properties of the polythiophene/ copper vanadate nanoribbons modified electrode for detecting benzoic acid were analyzed using the Cyclic Voltammetry (CV) method. An irreversible CV peak was observed at +0.36 V in 0.1 M KCl solution with 2 mM benzoic acid. The polythiophene/copper vanadate nanoribbons modified electrode indicated a linear range of 0.001-2 mM with the limit of detection (LOD) of 0.29 μM. Conclusion: Polythiophene greatly enhanced the electrochemical sensing properties of copper vanadate nanoribbons. Polythiophene/copper vanadate nanoribbons modified electrode was found to be stable and repeatable owing to the synergistic effect of various components.

Giant benign mesenteric cysts (mesothelioma and lymphangioma): A report of two cases

Introduction and importanceMesenteric cysts are a rare group of intra-abdominal tumors located in the mesentery or omentum, most of this lesion are asymptomatically but occasionally presents with non-specific symptoms, which makes diagnosis difficult. Case presentationWe present two cases of giant mesenteric cyst in our Institution, the first case is a women of 23 years with previous gynecologic surgery with chronic abdominal pain and large abdominal mass CT showed a giant intraabdominal 30 × 25 × 15 cm, the patient went to laparotomy and a large mesenteric tumor found. The Histopathology reported a Benign cyst mesothelioma (BCM). The second case is a 47 year male with intermittent abdominal pain and abdominal CT shows a 20x21x15 cm tumor. Laparotomy was performed. Histopathology reported a large lymphangioma. Clinical discussionBCM tumors are rare intrabdominal lesions often diagnosed in premenopausal women. Its etiopathogenesis is still unclear, associated risk factors are endometriosis, pelvic inflammatory disease and previous pelvic surgery. Lymphangiomas are an infrequent cyst tumors. It results from a failure in the evolutionary development of the lymphatic system, often localized in the head and neck and its localization in the abdomen is even rare. The definitive diagnosis is made by histopathology. ConclusionMesenteric cysts diagnosis if often challenge due to nonspecific symptoms and significant overlap in imaging appearance between the different entities, its diagnosis should be in mind when encounter a cystic abdominal tumor, surgical complete removal of this tumors is the optimal treatment to prevent recurrence and complications.

Utilization of the Lateral Extracavitary Approach for the Resection of a Giant Extradural Paraspinal Schwannoma: A Case Report

BACKGROUND AND IMPORTANCE: Spinal schwannomas are benign neoplasms originating from the spinal nerve sheath and account for around one-third of primary spine neoplasms. The most common treatment modality for these tumors is complete surgical resection. Compared with intradural tumors, the resection of an extradural spinal schwannoma is generally associated with a more complex approach, including longer incisions and increased lateral exposure. One useful surgical technique is the lateral extracavitary approach (LECA), which enables dorsal and ventrolateral access to the thoracolumbar spine with decreased rates of morbidity. Herein, the authors describe this approach for the resection of a giant extradural paraspinal schwannoma. CLINICAL PRESENTATION: A 74-year-old female patient presented with right flank pain and difficulty breathing during strenuous exercise. Imaging revealed a large 8.5 × 5.2 × 6.3 cm solid paraspinal lesion spanning from T11-L2 vertebral body levels, with mass effect on the right posterior diaphragm and lung. Before surgical resection, the lesion was confirmed to be a schwannoma by needle biopsy. A LECA approach was used, achieving gross total resection. At 1-month follow-up, the patient reported great symptomatic resolution. CONCLUSION: LECA proved to be an instrumental approach in a technically challenging resection of a giant extradural paraspinal schwannoma.

Acute hepatitis in children: A wide clinical spectrum

Introduction: Acute hepatitis remains an important health problem in children. viral hepatitis particularly hepatitis A remains the most common cause. Nevertheless, other causes such as non A non B hepatitis and mixed infections like enteric fever are other causes particularly in developing countries like India. The spectrum of acute hepatitis is also varied with many atypical presentations in the form of fever along with icterus as presenting features. Use of lab parameters as prognostic markers for development of acute liver failure (ALF) needs further exploration as it can be used to identify patients who need better monitoring and may be the potential candidates for liver transplantation. In our study we have tried to find a possible association between liver enzyme values and number of children who develop ALF. Methods: Children between 1 and 15 years of age who presented with features of acute hepatitis were enrolled in the study after taking informed consent from their parents. Data was collected about their epidemiological and clinical characteristics in a predesigned study performa. Quantitative data were described as means and standard deviations and qualitative data were computed into frequency (No) and percentages (%). Chi-square (χ2) test was used to determine the statistical difference between the categorical variables, while means were compared using student’s t test. For all statistical analyses, p value < 0.05 was adopted as level of significance. Results: We enrolled 68 patients of acute hepatitis. Most of them were males (78%) and majority were in 6 to 10 years age category. The most common clinical presentation was with abdominal pain followed by fever and icterus. Liver enzymes were raised to the tune of 10 to 20 times in the second week of illness. Serum bilirubin mean value was 5.3. Serum bilirubin values remained almost constant over 3 weeks period while liver enzymes showed a decline. 26% patients presented with ALF. Also, liver enzyme values in the second week showed a positive association with development of ALF with higher values associated with a higher chance of development of ALF. Conclusion: Hepatitis A was the most important cause of acute hepatitis in children and albeit early, a significant proportion of them develop features of ALF. Regular monitoring of liver enzymes can serve as a prognostic marker for development of ALF. It requires larger level studies to use liver enzymes as prognostic markers of ALF in paediatric patients.

Effect of comprehensive management combined with cognitive intervention on patient cooperation and complications during digestive endoscopy

BACKGROUND As lifestyles continue to change worldwide, the incidence of digestive tract carcinoma has gradually increased. Digestive endoscopy is an important tool that can assist in the diagnosis, treatment, and surgical intervention for this disease. However, the examination process is affected by many factors, and patient cooperation is often poor, which can increase the risk of complications. AIM To explore the effects of integrated management and cognitive intervention on cooperation and complications in patients undergoing endoscopy for early gastrointestinal neoplasms. METHODS A total of 354 patients with early stage gastrointestinal cancer who underwent digestive endoscopy procedures between January and December 2023 at our hospital were divided into observation and control groups (177 patients in each group) in a randomized controlled blind trial. The control group received routine interventions, while the observation group received comprehensive integrated management combined with cognitive interventions. We compared the changes in adverse mood, discomfort, examination time, cooperation with the examination, and complications before and after the intervention between the two groups. RESULTS The self-rated anxiety and depression scale scores were lower in the observation group than in the control group (P < 0.05). The visual analog scale scores for discomfort during intubation and examination were also lower in the observation group than in the control group (P < 0.05). Furthermore, the examination time was shorter in the observation group than in the control group (P < 0.05), and the degree of cooperation (94.35%) was higher in the observation group than in the control group (84.75%; P < 0.05). Lastly, the incidence rates of gastrointestinal adverse reactions (10.17% vs 20.34%), choking agitation (14.69% vs 24.86%), abdominal pain (8.47% vs 18.08%), and muscle tension (5.08% vs 14.12%) were all lower in the observation group than in the control group (P < 0.05). CONCLUSION Integrated management and cognitive intervention in early gastrointestinal neoplasm endoscopy alleviate mood, reduce discomfort, shorten examinations, improve cooperation, and reduce complications.

Effect of surgical timing on postoperative outcomes in patients with acute cholecystitis after delayed percutaneous transhepatic gallbladder drainage

BACKGROUND To date, the optimal timing for percutaneous transhepatic gallbladder drainage (PTGBD), particularly for patients who have missed the optimal window for emergency laparoscopic cholecystectomy (LC) (within 72 hours of symptom onset) has not been determined. AIM To study the effects of LC timing on outcomes of grade II/III acute cholecystitis (AC) in patients with delayed PTGBD. METHODS Data of patients diagnosed with Tokyo Guidelines 2018 grade II or III AC who underwent delayed PTGBD followed by LC at a single hospital between 2018 and 2022 were retrospectively studied. According to the interval between gallbladder drainage and cholecystectomy, the patients were divided into early and delayed LC groups. Outcomes including surgery time, postoperative complications and hospital stay, and patient satisfaction were analyzed and compared between the two groups using t - and χ 2 tests. RESULTS There were no significant differences between the two groups in intraoperative blood loss, postoperative abdominal drainage tube placement time, pain index, or total disease duration (all P > 0.05). Compared with those of the early LC group, the delayed group showed significant decreases in the length of procedure (surgery time), conversion rate to open surgery, degree of adhesions, surgical complications, postoperative hospital stay, and total treatment costs, and increased patient satisfaction despite a longer interval before PTGBD (all P < 0.05). CONCLUSION For patients with grade II/III AC with delayed PTGBD, LC should be performed 2 weeks after PTGBD to decrease postoperative complications and hospital stays and improve patient satisfaction.

Clinical significance of appendicoliths in elderly patients over eighty years old undergoing emergency appendectomy: A single-center retrospective study

BACKGROUND Acute appendicitis with an appendicolith is one of the most common abdominal emergencies in elderly patients and is more likely to progress to gangrene and perforation. AIM To analyze the clinical data of elderly patients undergoing emergency appendectomy for acute appendicitis, aiming to improve treatment strategies. METHODS The clinical data of 122 patients over 80 years old who underwent emergency appendectomy for acute appendicitis at the Department of Emergency Surgery of Zhongshan Hospital, Fudan University from January 2016 to March 2023 were retrospectively analyzed. The patients were divided into two groups based on the presence of an appendicolith or not, and clinicopathological and surgery-related features were compared between the two groups. RESULTS The duration of abdominal pain in all 122 patients ranged from 5 to 168 h. All patients underwent emergency appendectomy: 6 had an open appendectomy, 101 had a laparoscopic appendectomy, and 15 required conversion from laparoscopic to open surgery, resulting in a conversion rate of 12.9% (15/116). The patients were divided into two groups: Appendicolith group (n = 46) and non-appendicolith group (n = 76). Comparisons of clinicopathological features revealed that patients with appendicoliths were more likely to develop appendiceal gangrene (84.8% vs 64.5%, P = 0.010) and perforation (67.4% vs 48.7%, P = 0.044), and had a lower surgical conversion rate (2.2% vs 19.7%, P = 0.013). The median length of hospital stay was 5.0 d for both groups and there was no significant difference between them. All patients were successfully discharged. CONCLUSION Around 40% of patients over 80 years old with acute appendicitis have an appendicolith, increasing their risk of developing appendiceal gangrene and perforation, and therefore should receive timely surgical treatment.

Primary hepatic leiomyosarcoma masquerading as liver abscess: A case report

BACKGROUND Primary hepatic leiomyosarcoma (PHL) is a rare malignant tumor and has non-specific clinical manifestations and imaging characteristics, making preoperative diagnosis challenging. Here, we report a case of PHL presenting primarily with fever, with computed tomography imaging showing a thick-walled hepatic lesion with low-density areas, resembling liver abscess. CASE SUMMARY The patient was a 34-year-old woman who presented with right upper abdominal pain and fever over 4 days before admission. Based on the patient’s medical history, laboratory examinations, and imaging examinations, liver abscess was suspected. Mesenchymal tumor was diagnosed by percutaneous liverbiopsy and partial hepatectomy was performed. Postoperative pathology revealed PHL. The patient is currently undergoing intravenous chemotherapy with the AD regimen and shows no signs of recurrence. CONCLUSION When there is a thick wall and rich blood supply in the hepatic lesion with a large proportion of uneven low-density areas, PHL should be considered.

Improving early diagnosis of multiple endocrine neoplasia type 1 by assessing the gastrointestinal symptoms, hypercalcemia, and elevated serum gastrin

Despite advancements in the field, early diagnosis of multiple endocrine neoplasia type 1 (MEN1) remains unachievable. This letter to the editor highlighted the importance of carefully assessing gastrointestinal symptoms, hypercalcemia, and elevated serum gastrin levels, as suggested by Yuan et al in their paper. They focused on a patient with recurrent abdominal pain and diarrhea whose diagnostic path led to establishing a MEN1 diagnosis within a year. This emphasized the need for clinicians to consider MEN1 in patients with similar presentations, particularly when gastrointestinal symptoms persist or recur after discontinuation of proton pump inhibitors, especially knowing that early recognition and intervention are crucial for improving patient outcomes.

Elevated Calprotectin Levels Reveal Loss of Vascular Pattern and Atrophy of Villi in Ileum by Digital Chromoendoscopy and Magnification Colonoscopy in Patients with Spondyloarthritis Without Having Inflammatory Bowel Disease

Objective: This study aimed to establish a correlation between fecal calprotectin levels (FC) and intestinal inflammation in patients with spondyloarthritis without inflammatory bowel disease. Methods: A total of 180 SpA patients were included in the study of them 20.6% required Digital chromoendoscopy (DCE). FC, C-reactive protein (CRP), HLA-B*27 and clinical indices were assessed. Results: Positive fecal calprotectin (PFC) and high fecal calprotectin (HFC) levels were observed in 27.0% and 16.0% of patients, respectively. HFC correlated with a Bath Ankylosing Spondylitis Functional Index (BASFI) score > 4.0 (p = 0.036) and a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score > 4.0 (p = 0.047). Loss of vascular pattern in the ileum (LVPI) was observed in approximately 70.0% of patients (p = 0.005), which was associated with PFC and abdominal bloating (p = 0.020). LVPI was also linked to microscopic inflammation (p = 0.012) and PFC with abdominal pain (p = 0.007). HFC was significantly associated with alterations in the ileal mucosa (p = 0.009) and LVPI (p = 0.001). Additionally, HFC and diarrhea were associated with LVPI in 27.3% of patients (p = 0.037) and with erosions in the ileum (p = 0.031). Chronic ileal inflammation correlated with HFC (p = 0.015), ASDAS-CRP > 2.1 (p = 0.09), LVPI (p = 0.001), and villous atrophy (p = 0.014). Factorial analysis of mixed data (FAMD) identified significant associations between micro/macroscopic changes in chronic inflammation and HFC (CC = 0.837); increased levels of CRP and microscopic acute inflammation (CC = 0.792); and clinical activity scores of ASDAS-CRP and BASDAI (CC = 0.914). Conlusions: FC levels were significantly elevated in patients with SpA, particularly those with LVPI, suggesting their potential as a valuable biomarker for managing SpA when joint manifestations coincide with ileal villous atrophy. This indicates a shared immune pathway linked to chronic gut damage.

Placental Abruption: Pathophysiology, Diagnosis, and Management

Placental abruption is a complete or partial separation of the placenta from the uterine decidua. Clinical manifestations include vaginal bleeding, abdominal pain, uterine contractions, and abnormalities in the fetal heart rate tracing. Placental abruption occurs in 0.4% to 1.0% of all pregnancies. However, the pathophysiology remains incompletely understood. We present a review of the pathophysiology, diagnosis, and management of placental abruption, exploring overlapping processes which contribute to premature placental separation. Classic findings and limitations of ultrasound in evaluating placental abruption are explained. Finally, we discuss the management of placental abruption based on gestational age, fetal status, and maternal hemodynamic stability.

Diagnosis and Treatment of Polycythemia Vera

ImportancePolycythemia vera (PV), a myeloproliferative neoplasm characterized by an increased red blood cell mass and increased risk of thrombosis, affects approximately 65 000 people in the US, with an annual incidence of 0.5 to 4.0 cases per 100 000 persons.ObservationsErythrocytosis (hemoglobin >16.5 mg/dL in men or >16.0 mg/dL in women) is a required diagnostic criterion, although thrombocytosis (53%) and leukocytosis (49%) are common. Patients may have pruritus (33%), erythromelalgia (5.3%), transient visual changes (14%), and splenomegaly (36%) with abdominal discomfort. More than 95% of patients have a JAK2 gene variant, which helps distinguish PV from secondary causes of erythrocytosis, such as tobacco smoking or sleep apnea. Among 7 cohorts (1545 individuals), the median survival from diagnosis was 14.1 to 27.6 years. Prior to or at the time of PV diagnosis, arterial thrombosis occurred in 16% of patients and 7% had venous thrombotic events, which could involve unusual sites, such as splanchnic veins. PV is also associated with an increased bleeding risk, especially in patients with acquired von Willebrand disease, which can occur with extreme thrombocytosis (platelet count, ≥1000 × 109/L). All patients with PV should receive therapeutic phlebotomy (goal hematocrit, <45%) and low-dose aspirin (if no contraindications). Patients who are at higher risk of thrombosis include those aged 60 years or older or with a prior thrombosis. These patients and those with persistent PV symptoms may benefit from cytoreductive therapy with hydroxyurea or interferon to lower thrombosis risk and decrease symptoms. Ruxolitinib is a Janus kinase inhibitor that can alleviate pruritus and decrease splenomegaly in patients who are intolerant of or resistant to hydroxyurea. About 12.7% of patients with PV develop myelofibrosis and 6.8% develop acute myeloid leukemia.Conclusions and RelevancePV is a myeloproliferative neoplasm characterized by erythrocytosis and is almost universally associated with a JAK2 gene variant. PV is associated with an increased risk of arterial and venous thrombosis, hemorrhage, myelofibrosis, and acute myeloid leukemia. To decrease the risk of thrombosis, all patients with PV should be treated with aspirin and therapeutic phlebotomy to maintain a hematocrit of less than 45%. Cytoreductive therapies, such as hydroxyurea or interferon, are recommended for patients at high risk of thrombosis.

Escherichia coli diarrhoea among the adults – prospective research

Introduction: Eschrichia coli is common diarrhea causing agent. This study aimed to identify the bacterial pathogens responsible for diarrhea and abdominal pain in adults. Foodborne illnesses remain a significant public health concern, with Escherichia coli. Methods: The study, conducted from January to May 2021 at GSL Medical College, included adults with diarrhea and abdominal pain. Stool samples were collected, processed, and cultured on selective media to identify bacterial pathogens. Statistical analysis was performed to assess pathogen prevalence and its association with symptoms, using descriptive statistics for findings interpretation. Results: Among 100 adults with diarrhea and abdominal pain, 52% were male, and the majority (40%) were aged 31–45 years. Abdominal pain (80%) and diarrhea (75%) were the most common symptoms. Escherichia coli was the leading isolate (30%), followed by Salmonella spp. (25%) and Staphylococcus aureus (20%). Conclusion: In conclusion, this study highlights Escherichia coli as the primary bacterial cause of diarrhea among adults, followed by Salmonella spp. and Staphylococcus aureus. These findings underscore the importance of targeted food safety measures and public health interventions to address foodborne pathogens and prevent related illnesses in communities. Key words: Escherichia coli, Diarrhea, Foodborne pathogens, Abdominal pain, Bacterial isolation

Isolation and identification of bacterial pathogens associated with foodborne illnesses in stool samples: A prospective study

Introduction: Foodborne illnesses significantly impact public health, necessitating the isolation and identification of bacterial pathogens such as Salmonella, Escherichia coli, and Staphylococcus aureus. This study aims to isolate and identify bacteria from stool samples of individuals exhibiting food poisoning symptoms, enhancing understanding and prevention of these infections. Methods: This prospective study, conducted at GSL Medical College from August to September 2021, involved individuals over 18 years with food poisoning symptoms. Stool samples were collected, cultured on selective media, and analyzed for bacterial identification using Gram staining and biochemical tests, followed by statistical analysis of prevalence and symptoms. Results: The study included 100 participants, with 52% male and a majority (40%) aged 31–45 years. Abdominal pain (80%) and diarrhea (75%) were the most common symptoms. The predominant isolates were E. coli (30%) and Salmonella spp. (25%), with symptom correlations revealing distinct clinical presentations among the pathogens. Conclusion: This study underscores the significant role of pathogens in foodborne illnesses, particularly E. coli and Salmonella spp. The correlation between these pathogens and symptoms highlights diverse clinical presentations, emphasizing the need for effective food safety measures and public health interventions to mitigate the impact of foodborne infections on community health.

New Non‐Invasive Approach for a Woman With Dyssynergic Defecation Associated With Dyspareunia: A Case Report

ABSTRACTBackgroundThe pelvic floor muscles are a complicated muscular structure with three major functions: defecation, urination, and sexual function. Constipated patients rarely have sexual or urinary complaints. The objective of this case is to provide a new and successful therapy strategy for a patient with dyssynergic defection and dyspareunia.Study DesignThe case study below discusses physical therapy rehabilitation and the consequences for both current and future physical therapy programs of constipation caused by PFM dyssynergia and dyspareunia.Case DescriptionA 22‐year‐old married nulliparous woman was referred by her urogynecologist for the management of PFM tightness, with the main complaints being pain during intercourse and chronic constipation. The diagnosis had been confirmed by MR defecography, which revealed puborectalis and external anal muscle tightness. Neuromuscular reeducation employing electromyography biofeedback, improved rectal sensation, intravagival massage, the application of an intermittent pneumatic compression belt on the abdominiopelvic region, and suprapubic water bag ultrasound therapy were among the pelvic floor rehabitation strategies.ConclusionThe intermittent pneumatic compression belt and water bag ultrasound approach, combined with standard program rehabitation, was successfully used in patients with defection dyssynergia and dyspareunia. After 3 weeks, stool frequency decreased from once every 10 days to one bowel movement per week; a condition reported less bloating and stomach pain, as well as a pain rating of 5/10 during sexual activity and 0/10 immediately afterward; and FSFI increased from 15.1 to 19.1. After 12 weeks, stool frequency is three bowel movements per week, a condition has less bloating and stomach discomfort and rates pain as 1/10 during sexual activity and 0/10 immediately, and FSFI has risen from 15.1 to 25.1.

Cascabela Thevetia Ethnobotanical, Phytochemistry, Pharmacological Activities and Medicinal Uses: A Detailed Study

There are a few different names for the member of the Apocynaceae family known as Cascabela thevetia. Some of these names include digoxin, lucky nut, and yellow oleander. The lovely and evergreen Cascabela thevetia is a dicotyledonous shrub that is known for its evergreen nature. There are a number of countries in Central and South America, as well as a number of Asian nations, where the Cascabela thevetia plant is indigenous. These countries include India and Sri Lanka. The Cascabela thevetia plant has been found to have a wide variety of secondary metabolites, such as alkaloids, flavonoids, steroids, terpenoids, tannins, saponins, and cardiac glycosides. These plants include a number of cardiac glycosides, including neriifolin, thevetin A, thevetin B, and oleandrin, and each and every one of them is dangerous. The leaves of the plant are used in traditional medicine not just for their alleged medicinal benefits, but also for their diuretic and cardiotonic effects. The pharmacological activity of a number of plant components, including seeds, flowers, bark, fruits, and leaves, has been reported in a number of different experiments. It is common for T. peruviana to be the cause of toxicological emergencies in tropical and subtropical climates all over the world. Numerous cardiac glycosides, including neriifolin, oleandrin, thevetin A, and thevetin B, are discovered in this potentially hazardous plant. These glycosides are only a few examples. After consuming oleander, some of the symptoms that may manifest themselves include hyperkalaemia, nausea, vomiting, diarrhoea, and abdominal pain. Oliander can also cause diarrhoea. The purpose of this review is to provide a comprehensive data collection that includes information on morphology, cultivation and propagation, distribution, phytochemistry, traditional uses, and pharmacological qualities.

Exploring the predictive factors in the gastrointestinal involvement of patients with immunoglobulin A vasculitis

Background. Immunoglobulin A vasculitis (IgAV), the most common systemic vasculitis in children, typically presents with gastrointestinal (GI) symptoms in about half of cases. This study aimed to analyze the clinical and laboratory findings of patients with IgAV regarding GI involvement. Methods. We compared the GI involvement data of the patients diagnosed with IgAV. Results. Of the 210 patients (60.5% female and 39.5% male), 101 had GI involvement, with abdominal pain being the predominant symptom (n=98). White blood cell, neutrophil, monocyte, and platelet counts, C-reactive protein, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were significantly elevated in patients with GI involvement (p<0.001, p<0.001, p=0.01, p=0.005, p=0.002, p<0.001, p=0.03, p=0.001, p<0.001, p<0.001, respectively). The cutoff values for SII (>1035.7), SIRI (>1.65), NLR (>2.73), and MLR (>0.28) were determined, yielding respective sensitivities of 46%, 59%, 47%, and 53%, specificities of 83.1%, 69.1%, 81.3%, and 71.9%. Corresponding areas under the curve were 0.658, 0.668, 0.649, and 0.634, respectively (all p<0.001). Conclusion. Although IgAV is a self-limiting disease, GI involvement can lead to serious consequences. Systemic inflammatory indices such as SII and SIRI may be indicative in identifying patients with GI involvement.

The impact of diet on the inflammatory bowel disease course – a literature review

Introduction and Objective. Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic gastrointestinal disorder marked by relapsing symptoms. Current treatments mainly involve immunosuppressive therapies, which are effective but may have significant side effects. Diet as an adjunctive treatment is appealing due to its accessibility, low cost, and minimal adverse effects. This review explores the role of diet in managing IBD, focusing on dietary strategies during both active disease and remission. Methods. A literature review was conducted using PubMed and Google Scholar with search terms like "inflammatory bowel disease", "Crohn’s disease", "ulcerative colitis", "diet", "IBD treatment", "anti-inflammatory food" and related variations. Articles published within the last five years were prioritized. Brief description of the state of Knowledge. Ulcerative colitis and Crohn’s disease cause gastrointestinal inflammation. Crohn’s disease symptoms include abdominal pain, fistulas and rectal lesions, while UC is characterized by diarrhea, severe discomfort, and blood in the stool. Certain foods often exacerbate IBD symptoms. Proper nutrition during disease stages can improve patients’ quality of life. Diets high in processed foods, sugar, and red meat may increase IBD risk, while fiber and vitamin D3 are associated with fewer flare-ups. Regular malnutrition screening is essential for all IBD patients. Conclusions. Understanding the dietary components that influence inflammation in IBD could lead to better treatment outcomes and longer-lasting symptom relief. Integrating nutrition into personalized treatment strategies should become standard practice for managing IBD.

Rare Cause of Pediatric Abdominal Pain Diagnosed on Point of Care Ultrasound (POCUS)

An 11-year-old postmenarchal female presented to the pediatric emergency department (ED) with 2 days of periumbilical and right lower abdominal pain. Radiology-performed ultrasound (RADUS) did not visualize the appendix, and there was a plan for surgical consultation to decide between serial abdominal exams versus computed tomography (CT) scan. While awaiting consultation and to help further narrow the differential diagnosis, the emergency provider performed a point of care ultrasound (POCUS) of the urinary tract. This revealed several anomalies including a solitary left kidney with hydronephrosis, and a well-circumscribed, fluid-filled structure with mixed echogenicity posterior to the bladder and inferior to the uterus. Given these findings on POCUS, further imaging was pursued, including a RADUS of the pelvis followed by a magnetic resonance imaging (MRI) of the abdomen. Further imaging ultimately diagnosed a bicornuate uterus, septate vagina with hematocolpos and solitary left kidney consistent with Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) syndrome. This case is an illustration of how POCUS is an invaluable tool to narrow the differential diagnosis and guide advanced imaging or consultation for both common and rare causes of pediatric abdominal pain.