Globally, acute appendicitis has an estimated lifetime risk of 7–8%. However, there are numerous controversies surrounding the management of acute appendicitis, and the best treatment approach depends on patient characteristics. Non-operative management (NOM), which involves the utilization of antibiotics and aggressive intravenous hydration, and surgical appendectomy are valid treatment options for healthy adults. NOM is also ideal for poor surgical candidates. Another important consideration is the timing of surgery, i.e., the role of interval appendectomy (IA) and the possibility of delaying surgery for a few hours on index admission. IA refers to surgical removal of the appendix 8–12 weeks after the initial diagnosis of appendicitis. It is ideal in patients with a contained appendiceal perforation on initial presentation, wherein an initial nonoperative approach is preferred. Furthermore, IA can help distinguish malignant and non-malignant causes of acute appendicitis, while reducing the risk of recurrence. On the contrary, a decision to delay appendectomy for a few hours on index admission should be made based on the patients’ baseline health status and severity of appendicitis. Post-operatively, surgical drain placement may help reduce postoperative complications; however, it carries an increased risk of drain occlusion, fistula formation, and paralytic ileus. Furthermore, one of the most critical aspects of appendectomy is the closure of the appendiceal stump, which can be achieved with the help of endoclips, sutures, staples, and endoloops. In this review, we discuss different aspects of management of acute appendicitis, current controversies in management, and the potential role of endoscopic appendectomy as a future treatment option.

Background: Chemotherapy-related cardiac dysfunction (CTRCD) significantly affects patients undergoing anthracycline (AC) therapy, with a prevalence ranging from 2% to 20%. Reduced left ventricular ejection fraction (LVEF) and left ventricular global longitudinal strain (LV GLS) are prognostic parameters for CTRCD detection. Our study aimed to investigate the role of emerging parameters such as left atrial strain (LAS). Methods: We searched multiple databases for studies comparing LAS changes post-AC versus pre-AC therapy in patients with cancer. Primary outcomes included left atrial reservoir strain (LASr), left atrial conduit strain (LAScd), and left atrial contractile strain (LASct). RevMan (v5.4) was used to pool the standardized mean difference (SMD) under a random effects model, with p < 0.05 as the threshold for statistical significance. Results: In an analysis of 297 patients across five studies, AC therapy significantly lowered LASr (SMD = −0.34, 95% CI:−0.55, −0.14, I² = 0%, p = 0.0009) and LAScd (SMD = −0.41, 95% CI: −0.59, −0.23, I² = 0%, p < 0.00001) levels. Conversely, LASct demonstrated no significant change (SMD = 0.01, 95% CI: −0.21, 0.23, I² = 9%, p = 0.95). AC therapy also significantly reduced LV GLS (SMD = −0.31, 95% CI: −0.51, −0.11, I² = 0%, p = 0.003). While not statistically significant, LVEF decreased (SMD = −0.20, 95% CI: −0.42, 0.03, I² = 0%, p = 0.09), and left atrial volume index trended higher (SMD = 0.07, 95% CI: −0.14, 0.27, I² = 0%, p = 0.52) after AC therapy. Conclusions: AC treatment led to reduced LAS and LV GLS values, indicating its potential as an early CTRCD indicator. Larger trials are required to fully explore their clinical significance.

Background: Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI) with high mortality rates. While mechanical circulatory support devices like intra-aortic balloon pump (IABP) and Impella are used to manage CS, their comparative effectiveness remains unclear. This meta-analysis aims to evaluate the safety and efficacy of Impella in the treatment of AMI-associated CS. Methods: A comprehensive literature search was performed across PubMed, EMBASE, Google Scholar, SCOPUS, and Web of Science. The primary efficacy endpoint was 6-month all-cause mortality. Secondary efficacy endpoints included 30-day mortality, major bleeding, limb ischemia, sepsis, and left ventricular ejection fraction. Pooled odds ratios (OR) and standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated using the random-effects model via Revman version 5.4. Statistical significance was determined at P < .05. Results: Four RCTs with a total of 442 patients were included in this meta-analysis. The pooled analysis showed that the odds of 6-month all-cause mortality were significantly lower with Impella compared to standard of care (OR: 0.64, 95% CI: 0.43–0.95; P value: .03). However, 30-day mortality reported no statistically significant difference between the 2 groups (OR: 1.03; 95% CI: 0.43–2.48; P = .95). Our analysis found that the use of impella is associated with a statistically significant increase in the odds of major bleeding (OR: 3.61; 95% CI: 1.14–11.40; P = .03), limb ischemia (OR: 4.91; 95% CI: 1.37–17.59; P = .01), and sepsis (OR: 2.75; 95% CI: 1.25–6.08; P = .01). No statistical significance was found in left ventricular ejection fraction at follow-up between the 2 groups (SMD: −0.35; 95% CI: −0.78 to 0.07; P = .11). Conclusion: Impella significantly reduces 6-month all-cause mortality in patients with CS following AMI compared to standard of care. However, this survival benefit is offset by a substantial increase in major bleeding, limb ischemia, and sepsis risks associated with Impella. Future large scale trials are needed to validate these findings and refine clinical guidelines for the optimal use of Impella in treating CS.

Although many chronic inflammatory conditions are linked to elevated cardiovascular risk, the specific extent of this risk in ANCA-associated vasculitis (AAV) remains elusive, largely due to the disease's rarity. Our study sought to clarify the cardiovascular risks and mortality linked to AAV. A systematic literature review was conducted across multiple databases from their inception until April 2024 to identify studies comparing cardiovascular outcomes in patients with and without AAV. R Studio's meta package was used to pool risk ratios under the random-effects model, and statistical significance was set at p < 0.05. Nine observational studies involving 45024 individuals were included in this analysis. Patients with AAV exhibited a significantly elevated risk of stroke (RR = 1.43, 95 % CI: 1.12–1.83, I2 = 62 %, p = 0.0048), myocardial infarction (RR = 1.49, 95 % CI: 1.25–1.79, I² = 0 %, p < 0.0001), ischemic heart disease (RR = 1.40, 95 % CI: 1.24–1.58, I² = 1 %, p < 0.0001), venous thromboembolism (RR = 2.57, 95 % CI: 1.70–3.90, I² = 74 %, p < 0.0001), and pulmonary embolism (RR = 3.53, 95 % CI: 2.82–4.42, I² = 9 %, p < 0.0001), deep vein thrombosis (RR: 4.21; 95 % CI: 2.00–8.86; p = 0.0002), heart failure (RR = 1.63, 95 % CI: 1.39–1.90, I² = 0 %, p < 0.0001), and cardiovascular disease-related mortality (RR = 1.79, 95 % CI: 1.07–3.00, I2 = 0 %, p = 0.0256) compared to patients without AAV. This meta-analysis underscores a notable increase in adverse cardiovascular events among patients with AAV, underscoring the need for comprehensive cardiovascular care and diligent monitoring in this patient cohort.

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Vasomotor symptoms (VMS) are a common and distressing experience during menopause, affecting a significant portion of women. Hormone therapy (HT) has been the traditional treatment, but its limitations and potential risks have led to the search foar non‐hormonal alternatives. Recently, the FDA approved Veozah (Fezolinetant) as a promising nonhormonal solution for moderate to severe VMS in menopause. Veozah, an innovative neurokinin 3 (NK3) receptor antagonist, targets the disrupted thermoregulation underlying VMS. It modulates neural activity within the thermoregulatory center by crossing the blood‐brain barrier, offering relief from hot flashes and night sweats. Clinical trials, including SKYLIGHT 1TM, SKYLIGHT 2TM, and SKYLIGHT 4TM, have established Fezolinemtant's efficacy and safety profile. The recommended dosage of one 45 mg tablet per day demonstrates proportional pharmacokinetics, with generally mild side effects that require regular monitoring. Fezolinetant's oral availability makes it a convenient and accessible option for women seeking relief from VMS, potentially improving their overall well‐being.