Thoracolumbar junction pathologies can be treated through various anterior and posterior approaches. In recent decades, minimally invasive endoscopic procedures, including percutaneous endoscopic transforaminal discectomy (PETD), have emerged to reduce tissue disruption and iatrogenic instability. This surgical video describes the steps required to perform PETD and highlights the importance of optimal preoperative planning. A 47-year-old male patient with a T12–L1 disc herniation in the left paracentral and foraminal region, compressing the spinal cord, was treated with PETD. Under fluoroscopic guidance, precise skin markings were made, followed by sequential placement of the needle, guidewire, dilator, and working cannula using an inside-outside technique. The advantages and limitations of this approach were described. Successful removal of the herniated fragment and associated osteophyte was achieved using PETD. The patient’s pain decreased abruptly after surgery and fully resolved in the medium term. The patient ambulated independently 1 month after the procedure. PETD is a safe and efficient alternative for treating thoracolumbar junction pathologies in patients with disc herniation and/or myelopathy caused by neural compression. This fully endoscopic technique can achieve ventral decompression even under sedation.

Immunoglobulin G4 (IgG4)-related sclerosing cholangitis (IgG4-SC) is a rare condition with symptoms often mimicking malignancy, infection, or other autoimmune diseases. This case report describes the unique case of a 62-year-old male initially diagnosed with IgG4-SC, followed by subsequent diagnosis of cholangiocarcinoma. Biliary tract cancer in the setting of IgG4 related disease has been previously described; however, this patient course is novel as it encompasses the spectrum of challenges in IgG4-SC management, including diagnostic uncertainty, risk of infection with immunosuppressive agents, and development of malignancy diagnosed shortly following IgG4-SC diagnosis. We review the literature of management, outcomes, and malignancy risk and furthermore, highlight a promising recent therapy in treatment of IgG4 related disease, inebilizumab.

Background and Objectives: The risk profiles, procedural characteristics, and clinical outcomes for women undergoing bifurcation percutaneous coronary intervention (PCI) are not well defined compared to those in men. Methods: COronary BIfurcation Stenting III (COBIS III) is a multicenter, real-world registry of 2,648 patients with bifurcation lesions treated with second-generation drug-eluting stents.We compared the angiographic and procedural characteristics and clinical outcomes based on sex. The primary outcome was 5-year target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization. Results: Women (n=635, 24%) were older, had hypertension and diabetes more often, and had smaller main vessel and side branch reference diameters than men. The pre- and post-PCI angiographic percentage diameter stenoses of the main vessel and side branch were comparable between women and men. There were no differences in procedural characteristics between the sexes. Women and men had a similar risk of TLF (6.3% vs. 7.1%, p=0.63) as well as its individual components and sex was not an independent predictor of TLF. This finding was consistent in the left main and 2 stenting subgroups. Conclusions In patients undergoing bifurcation PCI, sex was not an independent predictor of adverse outcome.

Nasal myiasis is an infestation by dipterous larvae within the nasal cavity, where they feed on both living tissue andfluid. This condition predominantly occurs in rural areas of tropical countries, where inadequate sanitation and ahot, humid climate create an ideal environment for larvae development. A 57-year-old, otherwise healthy male ruralworker presented with a toothache in the region of the maxillary incisors. Imaging studies identified a punctiformradiopaque/hyperdense area near the nasal septum in the left nasal fossa. The larva was surgically excised andsent for histopathological analysis. Histologic sections confirmed the clinical diagnosis, and the patient remainedasymptomatic after a 2-month follow-up. Nasal myiasis can mimic the symptoms of a toothache in the anterior region of the maxilla. This condition can affect even immunocompetent patients, and complementary imaging studies may be decisive in diagnosing it.

Background: The global resurgence of mpox, formerly monkeypox, poses an emerging threat to pregnant women due to immunological changes and potential vertical transmission, yet its impact on pregnancy remains underexplored. This study aims to pioneer a comprehensive assessment of pregnancy outcomes and the risks of vertical transmission associated with mpox infection during pregnancy. Materials and Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched three databases up to September 2024 for studies on pregnant women with mpox confirmed by quantitative polymerase chain reaction. Primary outcomes were composite adverse pregnancy outcomes:miscarriage or fetal death, congenital anomalies, and chorioamnionitis; the secondary outcome was vertical transmission. Study quality was assessed using Joanna Briggs Institute tools. Statistical analysis employed R software using a one-proportion model with Freeman-Tukey transformation and random-effects meta-analysis (restricted maximum-likelihood estimator, Knapp-Hartung adjustment), presenting estimated proportions with 95% confidence intervals (CIs). Results: Six studies (three case series, three case reports) comprising 11 singleton pregnancies were included.Diagnoses occurred in the first (27.3%), second (45.4%), and third trimesters (27.3%). Among the five genotypically identified Mpox cases, 20.0% were classified Clade I and 80.0% as Clade II. Meta-analysis indicated that an estimated 63% (95% CI, 43–83%) of pregnancies experienced composite adverse pregnancy outcomes. Specifically, miscarriage or fetal death occurred in 62% (95% CI, 21–102%), congenital anomalies in 50% (95% CI, 21–80%), and chorioamnionitis in 78% (95% CI, 44–96%). Vertical transmission was observed in 79% (95% CI, 6–151%). Despite small sample sizes leading to wide confidence intervals, high estimated proportions suggest that mpox severely impacts pregnancy outcomes, likely linked to maternal inflammation, placental invasion, and significant fetal risks from vertical transmission. Conclusion Mpox infection during pregnancy appears to be associated with high rates of adverse pregnancy outcomes and vertical transmission. Further large-scale studies are warranted to confirm these findings and develop preventive and management strategies mitigating this emerging threat.

Background/Aims: Patients with diverticular disease (DD) frequently have abnormal bowel movements. However, it is unknown whether the entity of these alterations is associated with the severity of DD. We aimed to assess bowel habits and their relationship with the severity of DD according to Diverticular Inflammation and Complication Assessment (DICA) classification, Combined Overview on Diverticular Assessment (CODA) score, and fecal calprotectin (FC). Methods: An international, multicenter, prospective cohort study was conducted in 43 centers. A 10-point visual analog scale (VAS) was used to assess the severity of constipation and diarrhea. The association of constipation and diarrhea with DICA classification, CODA score, and basal FC was tested using non-parametric tests. Survival methods for censored observations were applied to test the association of constipation and diarrhea with the incidence of acute diverticulitis over a 3-year follow-up. Results: Of 871 patients with DD were included in the study. Of these, 208 (23.9%) and 199 (22.9%) reported a VAS score for constipation and diarrhea at least 3 at baseline, respectively. Higher constipation and diarrhea scores were associated with increasing DICA classification, CODA score and basal FC (P< 0.001). Constipation and diarrhea scores were independently associated with an increased hazard of developing acute diverticulitis (hazard ratio [HR]constipation = 1.15 per 1-VAS point increase, 95% confidence interval [CI], 1.04–1.27; P=0.004; and HRdiarrhea =1.14; 95% CI, 1.03–1.26; P=0.014, respectively). Conclusions In newly diagnosed patients with DD, higher endoscopic and combined scores of DD severity were associated with higher scores of constipation and diarrhea at baseline. Both constipation and diarrhea were independent prognostic factors of acute diverticulitis.

Background: Valganciclovir (ValG) is the most widely used drug for cytomegalovirus (CMV) prophylaxis in kidney transplant recipients (KTRs). However, it is associated with dose-limiting side effects and considerable costs. Some centers have identified valacyclovir (ValA) as an economically attractive alternative with a lower risk of bone marrow suppression. The comparative effectiveness of these two drugs is not well-established.This study aims to compare the efficacy and safety of ValA and ValG for CMV prophylaxis in KTRs. Methods: Searches were conducted of the Medline, Cochrane, Web of Science, Embase, and Ovid databases. Endpoints encompassed the incidence of CMV disease, CMV viremia, acute rejection, leukopeniaeutropenia, and other infections, including BK polyomavirus and non-CMV herpesviruses (HVs). Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Results: Six studies, comprising 888 patients (438 receiving ValA), were included. The groups were comparable in CMV viremia incidence (RR, 0.70; 95% CI, 0.31–1.57; P=0.4) and the development of CMV disease (RR, 0.74; 95% CI, 0.09–5.97; P=0.8). No significant differences in acute rejection rates were observed (RR, 0.97; 95% CI, 0.50–1.91;P=0.8). However, the rate of leukopeniaeutropenia was significantly lower in the ValA group (RR, 0.57; 95% CI, 0.42–0.77; P<0.01). No significant differences were noted for BK viremia (RR, 0.67; 95% CI, 0.24–1.87; P=0.4) or other HV infections (RR, 1.43; 95% CI, 0.61–3.38; P=0.4). Conclusions The drugs demonstrate comparable efficacy in preventing CMV infection following kidney transplantation. However, ValA may have a lower impact on bone marrow suppression.

Background and Objectives: The risk profiles, procedural characteristics, and clinical outcomes for women undergoing bifurcation percutaneous coronary intervention (PCI) are not well defined compared to those in men. Methods: COronary BIfurcation Stenting III (COBIS III) is a multicenter, real-world registry of 2,648 patients with bifurcation lesions treated with second-generation drug-eluting stents.We compared the angiographic and procedural characteristics and clinical outcomes based on sex. The primary outcome was 5-year target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization. Results: Women (n=635, 24%) were older, had hypertension and diabetes more often, and had smaller main vessel and side branch reference diameters than men. The pre- and post-PCI angiographic percentage diameter stenoses of the main vessel and side branch were comparable between women and men. There were no differences in procedural characteristics between the sexes. Women and men had a similar risk of TLF (6.3% vs. 7.1%, p=0.63) as well as its individual components and sex was not an independent predictor of TLF. This finding was consistent in the left main and 2 stenting subgroups. Conclusions In patients undergoing bifurcation PCI, sex was not an independent predictor of adverse outcome.

Background and Objectives: The risk profiles, procedural characteristics, and clinical outcomes for women undergoing bifurcation percutaneous coronary intervention (PCI) are not well defined compared to those in men. Methods: COronary BIfurcation Stenting III (COBIS III) is a multicenter, real-world registry of 2,648 patients with bifurcation lesions treated with second-generation drug-eluting stents.We compared the angiographic and procedural characteristics and clinical outcomes based on sex. The primary outcome was 5-year target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization. Results: Women (n=635, 24%) were older, had hypertension and diabetes more often, and had smaller main vessel and side branch reference diameters than men. The pre- and post-PCI angiographic percentage diameter stenoses of the main vessel and side branch were comparable between women and men. There were no differences in procedural characteristics between the sexes. Women and men had a similar risk of TLF (6.3% vs. 7.1%, p=0.63) as well as its individual components and sex was not an independent predictor of TLF. This finding was consistent in the left main and 2 stenting subgroups. Conclusions In patients undergoing bifurcation PCI, sex was not an independent predictor of adverse outcome.