BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is increasingly used in severe acute respiratory distress syndrome (ARDS) when conventional mechanical ventilation (CMV) fails. While large trials such as Conventional ventilatory Support vs Extracorporeal membrane oxygenation for Severe Adult Respiratory failure and Extracorporeal membrane Oxygenation for Severe Acute Respiratory Distress Syndrome have demonstrated ECMO's benefit in general ARDS, trauma-induced ARDS remains underrepresented. This systematic review and meta-analysis aimed to assess ECMO's efficacy and safety compared with CMV in adult trauma patients with ARDS. METHODS: We systematically searched PubMed, Embase, and Cochrane Central from inception to March 2025 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies included adult trauma patients with ARDS treated with ECMO (venovenous or venoarterial) versus CMV. The primary outcome was mortality; secondary outcomes included complications, ventilator-associated pneumonia, duration of mechanical ventilation, hospital length of stay (LOS), and intensive care unit (ICU) LOS. Risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions tool. RESULTS: Four observational cohort studies involving 1,526 patients (ECMO, 179; CMV, 1,347) were included. Extracorporeal membrane oxygenation was associated with significantly lower mortality (odds ratio, 0.29; 95% confidence interval [CI], 0.14–0.62; p = 0.001), with an even greater benefit in the venovenous ECMO subgroup (odds ratio, 0.19; 95% CI, 0.07–0.53; p = 0.002). Extracorporeal membrane oxygenation recipients had significantly longer ICU stays (standardized mean difference, 1.54; 95% CI, 0.97–2.12; p < 0.01), but no significant differences were found in total complications, ventilator-associated pneumonia, or hospital LOS. CONCLUSION: Extracorporeal membrane oxygenation appears to reduce mortality in adult trauma-induced ARDS but is associated with prolonged ICU stay and substantial resource demands. Given the limitations of observational data, variable selection criteria, and heterogeneity across studies, these findings remain hypothesis generating. Prospective trauma-specific studies are needed to confirm the benefit and guide optimal use. LEVEL OF EVIDENCE: Systematic Review and Meta-analysis; Level IV.

Caudal Epidural Block (CEB) is a well-established regional anesthesia technique for abdominal and sub-abdominal pediatric surgeries. However, it has a short duration, often leading to additional analgesic administration. Erector Spinae Plane Block (ESPB), for instance, is an emerging technique that, like CEB, provides analgesic effect to a specific dermatome of the body during surgery and in the postoperative period. Therefore, we performed this systematic review with meta-analysis to compare both techniques. We searched PubMed, Embase and Cochrane Central for Randomized Controlled Trials (RCTs) comparing ESPB versus CEB in pediatric patients undergoing abdominal and sub-abdominal surgeries. The primary outcome was the time to first analgesic request. Secondary outcomes were I) FLACC score; II) Postoperative nausea and vomiting, and III) Urinary retention. Nine randomized controlled trials encompassing 507 patients were included in this analysis (1‒9). The patients were predominantly male and under 10 years of age. There was an equal distribution between the two groups regarding the number of patients and patients' baseline characteristics. The main results were: time to first analgesic request (MD = 3.71; 95% CI: -1.88-9.29; I² = 99%; p = 0.19); FLACC scores at 2 hours (MD = 0.15; 95% CI: -0.30-0.59; I² = 0%; p = 0.52); FLACC scores at 24 hours (MD = -0.17; 95% CI: -0.39-0.05; I² = 41%; I² = 41%; p = 0.13); urinary retention events (RR = 0.12; 95% CI: 0.02-0.94; I² = 0%; p = 0.04); and Postoperative Nausea and Vomiting (PONV) which was null in both groups in three studies. However, it is important to clarify that some limitations were identified, such as significant heterogeneity in the following outcomes: time to first analgesic request and FLACC score at 24h, possibly due to different age groups, different types of surgeries, different background analgesia administration, and a relatively small sample size. As for the risk of bias, two studies were found to have some concerns in "bias due to deviations from intended interventions" (8,9). Our findings suggest that the administration of ESPB did not statistically differ from CEB regarding the time to first analgesic request. FLACC scores also did not show a statistically significant difference between groups. The ESPB group, however, experienced minor urinary retention events compared to the CEB group. According to the GRADE assessment, all outcomes evaluated in this study were classified as high-quality evidence. Quality assessment is detailed in Supplementary Table 1.

Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare adnexal tumour of the skin, predominantly affecting individuals over 50 years of age, with no established gender predilection. It can arise on various anatomical sites without a clear preference. To date, fewer than 200 cases have been documented in the literature. We present a case of a young, otherwise healthy female who developed a slow-growing painless, skin-coloured scalp nodule. Histopathological examination of an excisional biopsy revealed a dermal tumour composed of basaloid cells arranged in a characteristic cribriform pattern. A thorough diagnostic workup, including sonographic imaging, immunohistochemical analysis and multidisciplinary team discussions, ultimately confirmed the diagnosis of PCACC. This case underscores the diagnostic and therapeutic challenges associated with PCACC.

Neonatal appendicitis is a rare and often life-threatening condition due to its non-specific presentation and diagnostic overlap with other neonatal abdominal pathologies. We describe a case of a previously healthy full-term female neonate who presented with fever and progressive abdominal distension. Imaging revealed pneumoperitoneum, prompting emergency exploratory laparotomy, which identified a perforated appendix with no other anomalies. An appendectomy was performed, and the patient recovered uneventfully with intravenous antibiotics and supportive care. We also present a brief review of the literature to highlight the diagnostic challenges, role of imaging and the importance of early surgical intervention in improving outcomes for this rare condition.