Management Considerations Research Articles

Interaction between sex and one-hour post-load glucose on metabolic syndrome and its components among Chinese people at high risk of diabetes

BackgroundRecently, International Diabetes Federation position statement has adopted one-hour post-load glucose (1hPG) ≥ 8.6 mmol/L for diagnosing intermediate hyperglycemia. We aimed to assess the association of 1hPG ≥ 8.6 mmol/L with metabolic syndrome (MetS) and its components, as well as interaction between sex and 1hPG ≥ 8.6 mmol/L on MetS and its components in Chinese people at high risk of diabetes.MethodsThe cross-sectional study was conducted in DaQing city of HeiLongJiang Province, China between August, 2023 and January, 2024. Eligible individuals with fasting glucose of 5.6–6.9 mmol/L and age of 25–55 years in health checkup data in the year of 2023 or with at least one risk factor of diabetes were invited to receive the oral glucose tolerance test and biochemical examinations. Individuals with self-reported presence of diabetes or usage of glucose-lowering medication were excluded. MetS was defined as presence of at least three of the five components according to the Chinese Diabetes Society criteria. Logistic regression was performed to evaluate the association of 1hPG ≥ 8.6 mmol/L with MetS and its components. Additive interaction was estimated using the relative excess risk due to interaction, attributable proportion due to interaction (AP), and synergy index.ResultsA total of 2419 subjects comprising 1465 men (60.6%) with a mean age of 45.77 ± 6.20 years were included, and the prevalence of MetS was 46.8%, with 59.7% in men and 27.1% in women. 1hPG ≥ 8.6 mmol/L was associated with MetS (aOR = 4.40, 95% CI 3.26–6.01), elevated blood pressure (aOR = 1.46, 95% CI 1.13–1.89), hyperglycemia (aOR = 15.46, 95% CI 11.56–20.98), and reduced HDL-C (aOR = 1.51, 95% CI 1.07–2.15) in the overall population, whereas no significant association between 1hPG ≥ 8.6 mmol/L and elevated blood pressure in men (aOR = 1.36, 95% CI 0.97–1.91) or dyslipidemia in women (elevated TG: aOR = 0.81, 95% CI 0.47–1.39; reduced HDL-C: aOR = 1.08, 95% CI 0.49–2.37). Additive interaction effect between sex and 1hPG ≥ 8.6 mmol/L on MetS was observed, with 31% attributed to the interaction effect between men and 1hPG ≥ 8.6 mmol/L (AP = 0.31, 95% CI 0.06–0.49).ConclusionsThere was an additive interaction effect between sex and 1hPG on MetS among Chinese people at high risk of diabetes. 1hPG test and sex-specific strategies should be taken into consideration in cardiometabolic disorder identification and management.

Left‐sided gallbladder and Chilaiditi syndrome in an infant

AbstractCongenital hepatic anomalies may be associated with important intestinal abnormalities, vascular anomalies, or may be asymptomatic and discovered incidentally. Uncommon and rare anatomic liver and biliary disorders include left‐sided gallbladder, wandering liver, malrotation of the liver, and hepato‐diaphragmatic interposition of the bowel (Chilaiditi syndrome). This report describes an infant with incidentally discovered malpositioning of the gallbladder to the superior surface of the left hepatic lobe, coupled with Chilaiditi syndrome, a configuration that has not been described in the literature. Management considerations are discussed.

Management of Hyperglycemia in Hospitalized Patients.

People with diabetes account for 25% of hospitalizations, or 8 million admissions annually. Poor glycemic control in the hospital is associated with increased morbidity, mortality, length of stay, and readmissions. Key considerations of inpatient diabetes management include initiation of appropriate insulin or medication regimens and frequent dose adjustments based on patient-specific factors. Inpatient diabetes management teams and new technologies are increasingly prevalent and can assist in achieving glycemic targets in the hospital. At discharge, standardized checklists should be used to ensure successful transitions of care.

Clinical Management and Transplant Considerations in Pediatric Pulmonary Hypertension Due to Left Heart Disease: A Scientific Statement From the American Heart Association.

Children with left heart disease are at risk for developing pulmonary hypertension, initially secondary to pulmonary venous hypertension that can progress to include elevated pulmonary vascular resistance, known as combined pre- and postcapillary pulmonary hypertension. Elevated pulmonary vascular resistance may pose a risk to the right ventricle of a newly transplanted heart because of increased afterload and is an important consideration for heart transplant eligibility. However, the epidemiology, pathophysiology, optimal diagnostic and treatment approaches, and thresholds for pulmonary vascular resistance in pulmonary hypertension associated with left heart disease remain unclear because of lack of evidence, particularly in pediatrics. The result is heterogeneity with respect to hemodynamic assessment, use of pulmonary vasodilator therapies, and heart transplant listing. This scientific statement aims to synthesize the available data and highlight areas of general consensus as well as important knowledge gaps.

Repeated fuel treatments fall short of fire-adapted regeneration objectives in a Sierra Nevada mixed conifer forest, USA.

Fire exclusion over the last two centuries has driven a significant fire deficit in the forests of western North America, leading to widespread changes in the composition and structure of these historically fire-adapted ecosystems. Fuel treatments have been increasingly applied over the last few decades to mitigate fire hazard, yet it is unclear whether these fuel-focused treatments restore the fire-adapted conditions and species that will allow forests to persist into the future. A vital prerequisite of restoring fire-adaptedness is ongoing establishment of fire-tolerant tree species, and both the type and reoccurrence of fuel treatments are likely to strongly influence stand trajectories. Here, we leveraged a long-term study of repeated fuel treatments in a Sierra Nevada mixed-conifer forest to examine the regeneration response of six native tree species to the repeated application of common fuel treatments: prescribed fire, mechanical, mechanical plus fire, and untreated controls. Our objectives were to (1) quantify differences in forest structure and composition following the repeated application of alternative fuel treatments that may influence the establishment environment and then (2) identify the stand structure and climate conditions influencing seedling dynamics. We found that both treatment type and intensity are highly influential in shifting forests toward more fire-adapted conditions and determining species-specific regeneration dynamics. Specifically, the conifer species tracked here increased in either colonization or persistence potential following repeated applications of fire, indicating fire may be most effective for restoring regeneration conditions broadly across species. Fire alone, however, was not enough to promote fire-adapted composition, with concurrent mechanical treatments creating more favorable conditions for promoting colonization and increasing abundances of fire-tolerant ponderosa pine. Yet, even with repeated fuel treatment application, establishment of fire-intolerant species far exceeded that of fire-tolerant species over this 20-year study period. Moreover, increasing growing season water stress negatively impacted seedling dynamics across all species regardless of treatment type and intensity, an important consideration for ongoing management under heightened climatic stress. While repeated treatments are waypoints in restoring fire-adapted conditions, more intense treatments via gap-creation or hotter prescribed fires targeting removal of fire-intolerant species will be necessary to sustain recruitment of fire-tolerant species.

ILAE genetic literacy series: Focal cortical dysplasia.

Focal cortical dysplasia (FCD) is a common cause of drug-resistant focal epilepsy in children and young adults and is often surgically remediable. The genetics of FCD are increasingly understood due to the ability to perform genomic testing including deep sequencing of resected FCD tissue specimens. There is clear evidence that FCD type II occurs secondary to both germline and somatic mTOR pathway variants, while emerging literature supports the role of SLC35A2, a glycosylation gene, in mild malformation of cortical development with oligodendroglial hyperplasia and epilepsy (MOGHE). Herein, we provide a review of FCDs focusing on their clinical phenotypes, genetic basis, and management considerations when performing genetic testing in this patient group.

Designing an Artificial Intelligence Maturity Model for Human Resources (HR-AIMM)

Artificial intelligence (AI) has the potential to change the world of work radically. Wherever information processing is involved, AI can be integrated into processes with added value. From the perspective of Human Resource (HR) management, this implies three things: first, business models and performance processes in the company will undergo change; second, employee requirements will change; and third, HR processes will change. While the literature describes various AI maturity models, there has been no dedicated consideration of HR management. This article, therefore, aims to identify relevant influencing factors for an AI-orientated approach to HR management and to describe these in more detail using maturity levels in a Human Resources Artificial Intelligence Maturity Model (HR-AIMM). The resulting HR-AIMM consists of eleven dimensions. These include anchoring the AI topic in the corporate and HR strategy, its use in selected HR processes, considering ethical, data-related, and infrastructural principles, and organisational, cultural, and competence-related anchoring. The characteristics of these factors enable the identification of four maturity levels for using AI in HR management: from a curious start to the level of holistic integration. Our framework supports researchers and companies in understanding and evaluating the factors influencing the professional application of AI in HR management.

How to Mitigate Risk in the Treatment of Patients with Borderline Personality Disorder.

Clinicians treating patients with borderline personality disorder (BPD) experience concerns about risk for adverse events that can lead to litigation or complaints to administrative boards. This paper's goal is to outline steps to ensure the safety of both the patient and clinician. Review of available data confirms that psychiatry is a subspeciality with relatively low risk for malpractice litigation, but high risk for complaints to administrative agencies. Examination of litigation and complaints suggests that familiar challenges in work with patients with BPD are frequently cited. Risk management considerations have been impacted in recent years by changes in psychiatric training, health care delivery, and regulations about patient information transparency. Concurrently, empirically validated treatments for BPD have been refined and disseminated. Clinicians can address safety concerns by adapting established risk management guidance with an appreciation of key elements of BPD.

Advancements and Future Prospects in the Hydraulic Fracturing of Geothermal Reservoirs

Reservoir reconstruction is a critical challenge in many significant underground energy projects, such as enhanced geothermal systems, oil shale extraction, and shale gas development. Effectively reconstructing geothermal reservoirs can significantly enhance the exploitation and production capacity of geothermal resources. However, this process requires stringent technical standards and varies with different geological conditions across regions, necessitating tailored reconstruction strategies. This review offers a comprehensive examination of hydraulic fracturing within geothermal reservoirs, covering the geological and physical characteristics inherent to these systems, the effects of injection methods and thermal stimulation on hydraulic fracturing processes, and the assessment and optimization of transformation effects, as well as environmental implications and risk management considerations. We explore the influence of various injection modes on hydraulic fracturing dynamics. Moreover, we compare the differences between hydraulic fracture propagation with and without thermal effects. Additionally, we summarize optimization strategies for reservoir reconstruction. Finally, we discuss several challenges and potential future directions for development, offering insights into possible advancements. This review is of substantial significance for both research and commercial applications related to hydraulic fracturing in geothermal reservoirs.

Management of pediatric thyroid carcinoma.

The incidence of thyroid carcinoma is increasing among children and adolescents, particularly in female individuals. Children and adolescents require special considerations in management as the molecular genetics of pediatric thyroid tumors are inherently different from their adult counterparts. The increased risk of malignancy, nodal metastases, and pulmonary metastases in pediatric patients warrants pediatric-specific management recommendations and pediatric-specific multidisciplinary teams. This article highlights the molecular origins of pediatric thyroid carcinoma and the implications of tumor genetics for the course of disease and treatment considerations. We highlight specific surgical considerations to optimize outcomes while minimizing lifelong risks of vocal paralysis and hypoparathyroidism. The landscape of treatment options is rapidly evolving with development of sophisticated molecular approaches to understand the genetic landscape, and this review features updated recommendations and systemic treatment options for the management of pediatric thyroid malignancy. Pediatric thyroid carcinoma is a lifelong burden and the treatment tailored to optimize outcomes minimizes long-term risks of treatments, surgery, radiation and targeted systemic therapies. Multidisciplinary teams that treat pediatric thyroid carcinoma should focus surgical experience and use the most updated guidelines and treatments available, particularly considering the landscape of molecular genetics in pediatric thyroid carcinoma.

Perioperative Considerations for Hip Arthroplasty in Patients with Rheumatoid Arthritis.

Due to its distinct features, rheumatoid arthritis (RA), an inflammatory autoimmune disorder, poses challenges in planning for surgical interventions. This review includes available evidence regarding perioperative considerations in management of RA patients, with a focus on hip surgery. RA can affect multiple joints, with development of extra-articular manifestations; therefore, preoperatively, comprehensive medical assessments, including cardiovascular or pulmonary evaluation must be considered in addition to surgical considerations. Modification of medications capable of controlling RA-related disease activity is critical, and requires collaboration with rheumatologists. Surgical considerations include the choice of surgical approach, implant selection, and problems related to weakened soft tissues, fragile bone density, and bony deformity such as protrusio acetabuli. Careful monitoring and more active rehabilitation are recommended for RA patients due to higher risk of postoperative complications. For achievement of optimal outcomes, use of a multidisciplinary perioperative approach is required for patients with RA.

BSHPC: Improve Big Data Privacy Based on Blockchain and High-Performance Computing (HPC)

The vast expansion and sharp rise in data across many facets of society have made it increasingly difficult to manage big data effectively. Using traditional methods to ensure the security and privacy of users’ data is no longer sufficient. In keeping with this worry, massive data storage is still crucial. High-Performance Computing (HPC) is examined to determine the need for handling blockchain issues and protecting large data in a decentralized manner that strives for resilience. This study proposes the Big Data Storage High-Performance Computing (BSHPC) approach, which addresses big data considerations in storage management to maintain accuracy and enables the usage of blockchain. The best storage management is the primary benefit of BSHPC, as only critical data is kept on the blockchain, and other data may be kept in an off-chain database using the interplanetary file system (IPFS). Furthermore, the network's node authentication in this strategy depends on trustworthy nodes. On HPC computers, data authenticity and provenance tracking would be guaranteed, and managing large data across blockchains would be more secure. The proposed method is simulated using the Python-MPI version, and the results confirm the effectiveness of the proposed method based on performance and transactions. Moreover, the proposed method is evaluated with another study in the literature on MEC-based sharing, and it proves its effectiveness. Doi: 10.28991/ESJ-2024-08-06-011 Full Text: PDF

The Applications and Challenges of Digital Twin Technology in Smart Grids: A Comprehensive Review

This comprehensive review explores the applications and challenges of Digital Twin (DT) technology in smart grids. As power grid systems rapidly evolve to meet the increasing energy demands and the new requirements of renewable source integration, DTs offer promising solutions to enhance the monitoring, control, and optimization of these systems. In this paper, we examine the concept of DTs in the context of smart grids, and their requirements, challenges, and integration with the Internet of Things (IoT) and Artificial Intelligence (AI). We also discuss different applications in asset management, system operation, and disaster response. This paper analyzes current challenges, including data management, interoperability, cost, and ethical considerations. Through case studies from various sectors in Canada, we illustrate the real-world implementation and impact of DTs. Finally, we discuss emerging trends and future directions, highlighting the potential of DTs to revolutionize smart grid networks and contribute to more efficient, reliable, and sustainable power systems.

Proactive influence tactics that increase work engagement for remote employees

Purpose COVID-19 accelerated the already growing prevalence of employees working remotely, and limited research exists on the effectiveness of proactive influence tactics in remote work settings. This study aims to identify which proactive influence tactics may best facilitate employee work engagement in a remote work setting. Design/methodology/approach Survey data stems from 231 employees who work remotely in the USA. Hierarchical regression was used to analyze the data and assess interaction effects. Findings Evidence was found for positive relationships between work engagement and multiple proactive influence tactics (collaboration, consultation, inspirational appeals, exchange, apprising, rational persuasion, personal appeals and ingratiation) and a negative relationship between work engagement and pressure. The percentage of time an employee spends working remotely moderated the proactive influence tactic-work engagement relationship. Significant interaction effects were found for exchange and personal appeals. Practical implications The results highlight several influence tactics that managers can consider using to increase employee work engagement. The findings also demonstrate the increasing effectiveness of certain influence tactics, such as exchange and personal appeals, as employees spend more time working remotely, shedding light on important considerations for managers seeking to optimize employee engagement in remote work environments. Originality/value The study contributes to the limited literature on proactive influence tactics and work engagement and examines these relationships in a remote work setting. In addition, it examines the moderating effect of the percentage of time an employee spends working remotely.

Primary Extradural Meningioma: A Systematic Review of Diagnostic Features, Clinical Management, and Surgical Outcomes.

Objective: This systematic review consolidates the literature on primary extradural meningiomas (PEMs), a rare subset of meningiomas. We describe the clinical features, management strategies used, and treatment outcomes for published cases. Methods: A systematic review was conducted using PRISMA guidelines across multiple databases to 29 July 2024. Inclusion criteria were adult patients with primarily extradural meningioma and where individual patient clinical data were provided. Results: Of 216 studies that met the initial search criteria, 41 satisfied the final inclusion criteria. These 41 studies included 82 patients with 84 total PEMs. The cohort was balanced between sexes with a median age of 46 (range 18-82). Frequent symptoms at initial presentation included pain/headache (46%), weakness (44%), paresthesias (24%), and a palpable superficial mass (23%). The median duration of symptoms to diagnosis was 11 months (range 0.75-120). Surgical resection was the primary treatment approach, achieving a gross total resection in 67% of cases. The majority of lesions were classified as WHO grade 1 (87%). A recurrence was identified during the published follow-up in 11% of cases and a higher WHO grade was expectedly associated with a greater risk of recurrence. The described practice was to use adjuvant radiotherapy in recurrent and high-grade cases. Most cranial lesions were located in the frontal bone, while most spinal lesions affected the cervical spine. Post-treatment symptom improvement or resolution was described in almost all patients at the last follow-up. Conclusions: In comparison to intradural meningiomas, PEMs largely follow a more indolent course with a longer duration of symptoms prior to diagnosis, more benign symptoms, a higher proportion of grade 1 tumors, and favorable outcomes; however, there is a small subset of PEMs with extension outside the cranium and spine that require specific considerations for management.

Exploring the association of dietary inflammatory index, disease progression and cellular integrity in chronic kidney disease: A cross-sectional study.

While the anti-inflammatory effects of specific nutrients are well established, there is limited research on the relationship between overall dietary patterns and chronic kidney disease (CKD). Therefore, we aimed to assess the association between dietary inflammatory index (DII) scores and biochemical and body composition parameters in pre-dialysis CKD patients. The DII scores of 143 pre-dialysis CKD subjects were calculated using 24-h recalls. Body composition was measured using bioelectric impedance-based InBody 770. Oxidative stress and total antioxidant capacity were measured using thiobarbituric acid reactive substances (TBARS), ferric-reducing antioxidant power (FRAP), and uric acid-independent FRAP (FRAP_UA) assays respectively. C-reactive protein (CRP) was selected as an inflammatory marker while other biochemical parameters were analysed using diagnostic kits. Subjects were categorized into early-stage CKD (ES; eGFR: 30 to 59 ml/min/1.73 m2) and late-stage CKD (LS; eGFR: < 30 ml/min/1.73 m2). The ES group had a lower extracellular to total body water ratio (p < 0.01) and higher levels of whole-body phase angle (p < 0.01) compared to the LS group. However, FRAP_UA was higher in the LS group (p < 0.05). For each increase in DII score by 1, eGFR decreased by 2.31 ml/min/1.73 m2 (p < 0.01) and phase angle by 0.11 degrees (p < 0.05). Consuming cereals and millets, other vegetables, roots and tubers, spices, poultry, oils and fats significantly contributed to the anti-inflammatory potential of the diet (p < 0.01). A pro-inflammatory diet was associated with disease progression and decreased cell integrity, underscoring the importance of its consideration in CKD management.

Artificial intelligence in environmental monitoring: in-depth analysis

This study provides a comprehensive bibliometric and in-depth analysis of artificial intelligence (AI) and machine learning (ML) applications in environmental monitoring, based on 4762 publications from 1991 to 2024. The research highlights a notable increase in publications and citations since 2010, with China, the United States, and India emerging as leading contributors. Key areas of research include air and water quality monitoring, climate change modeling, biodiversity assessment, and disaster management. The integration of AI with emerging technologies, such as the Internet of Things (IoT) and remote sensing, has significantly expanded real-time environmental monitoring capabilities and data-driven decision-making. In-depth analysis reveals advancements in AI/ML methodologies, including novel algorithms for soil mapping, land-cover classification, flood susceptibility modeling, and remote sensing image analysis. Notable applications include enhanced air quality predictions, water quality assessments, climate impact forecasting, and automated wildlife monitoring using AI-driven image recognition. Challenges such as the “black-box” nature of AI models, the need for high-quality data in resource-constrained regions, and the complexity of real-time disaster management are also addressed. The study highlights ongoing efforts to develop explainable AI (XAI) models, which aim to improve model transparency and trust in critical environmental applications. Future research directions emphasize improving data quality and availability, fostering interdisciplinary collaborations across environmental and computer sciences, and addressing ethical considerations in AI-driven environmental management. These findings underscore the transformative potential of AI and ML technologies for sustainable environmental management, offering valuable insights for researchers and policymakers in addressing global environmental challenges.

Entrepreneurship Skills needed by Youths for Entry into Oil Palm Production for Self-Employment and Job Creation in Delta State, Nigeria

This study focused on entrepreneurship skills needed by youths for entry into oil palm production in Delta State. Three research questions and two hypotheses were formulated and tested at 0.05 level of significance. The population of the study was one thousand five hundred(1500) youth farmers located in the three (3) senatorial districts in Delta State. The study adopted the use of descriptive survey method. Data was analyzed using frequency distribution, percentages, mean and standard deviation. The findings revealed that more males are involved in oil palm production than females. Also, that the combination of agricultural expertise, business skills, adaptability, and networking can empower youths in Delta State, Nigeria, to engage in oil palm production for self-employment, even while balancing other jobs. Findings also showed that combination of processing knowledge, operational skills, quality control, safety measures, resource management, and environmental considerations are needed. Findings from the research revealed that youth entrepreneurs in oil palm production have strong understanding of agronomy, including soil management, pest control and crop maintenance. The study recommended that Delta State youths can benefit from entrepreneurial education through formal programs and vocational trainings, focusing on oil palm production and self-employment. Special loan schemes and financial literacy training was also recommended.

Disseminated vaccine-strain varicella-zoster virus reactivation in an adolescent with secondary immunodeficiency: a case report and literature review

BackgroundRoutine childhood immunization against varicella-zoster virus has led to a dramatic reduction in the incidence of primary varicella. However, there are rare, yet significant cases reported of reactivated Oka-strain varicella, primarily in immunocompromised hosts.Case presentationA 16-year-old female with Hodgkin’s lymphoma developed a vesicular rash shortly after completing all chemotherapy treatment. Swabs obtained from the vesicles were positive for varicella-zoster virus. By the time of hospitalization, the patient developed a disseminated rash involving multiple dermatomes. Subsequent polymerase chain reaction confirmed Oka vaccine-strain varicella-zoster virus. The patient had previously received a primary series of immunizations against varicella in 2008 and 2012, with her 2nd dose given 11 years prior to her development of vaccine-strain herpes zoster and 10 years prior to her diagnosis of Hodgkin’s lymphoma, respectively. The patient was treated with parenteral acyclovir upon hospitalization and monitored clinically for cutaneous disease progression as well as sequelae. After 8 days of inpatient treatment, her rash had stopped spreading with no new lesions. All earlier lesions had crusted over. No serious sequelae of disease such as pneumonitis, hepatitis, encephalitis, or meningitis occurred, and she made a complete recovery.ConclusionsThere are individual and community-wide benefits to childhood immunization against varicella. This case highlights an unusual presentation of disseminated vaccine-strain herpes zoster in an adolescent with secondary immunodeficiency 11 years after completing primary immunization. In addition, this case informs pediatricians of complications that can arise in immunized subjects if they become immunosuppressed years later. The only way to distinguish between wild-type and vaccine-strain herpes zoster was by viral genotyping. Providers should be cognizant of potential vaccine virus reactivation in their differential. Considerations for work-up and management should include infection control and viral resistance in refractory cases.

AHP SO06 - A case report of the nutritional and multi-disciplinary team (MDT) management of an emergency oesophageal perforation associated with Eosinophilic Oesophagitis (EOE)

Abstract Background EOE once considered rare, is a chronic inflammatory condition of the oesophagus presenting as dysphagia and food impaction in children and adults. Awareness and management of EOE is variable despite an increasing prevalence and the condition deemed the most common cause of oesophageal perforation in adults and children by the British Society of Gastroenterology (BSG). This case review aims to increase the awareness of EOE, highlight the clinical presentation of EOE, discuss considerations for the nutritional management and the importance of an MDT approach to the care of this condition in relation to the BSG consensus guidelines. Method The patient was admitted to a specialist oesophago-gastric surgical centre in the Northwest of England. A retrospective review of the patient’s case notes was completed. This included exploration of all inpatient and outpatient contacts stored in the electronic patient records system. Results 18-year-old underweight male with IgE-mediated nut allergy and odynophagia, developed complex multi-site oesophageal perforations following OGD. Management included 40-day endoluminal vacuum therapy and extensive nutritional support. Although initial biopsies lacked diagnostic quality and conclusive results, EOE was subsequently confirmed. Dietetic evaluation included nutritional status, atopic history, symptoms, and dietary intolerances. MDT discussions influenced care continuity and patient compliance. Feeding delays attributable to frequent theatre visits impacted continued weight loss; addressed with allergen-free enteral and parenteral feeding, and dietary reintroduction, following six-food elimination once perforations had healed. Healthy BMI was achieved through patient’s preferred long-term management of normal diet and Budesonide. Conclusion Increased awareness of EOE is paramount for patients presenting with unexplained oesophageal perforation. Obtaining biopsy samples as per BSG guidance supports earlier diagnosis and management plan. A thorough clinical history including childhood eating behaviours, atopic history, dietary intolerances and symptom presentation from the patient and relatives gathers collateral information to support diagnosis and treatment planning. Joint discussions regarding pharmaceutical management, dietary elimination and reintroduction are important to achieve remission. The case highlights the importance of collaborative MDT working with the surgical, medical and dietetics whilst empowering the patient to make informed decisions regarding the nutritional and medical management of condition.