Posterior reversible encephalopathy syndrome (PRES) is a rare neurological condition characterized by vasogenic edema, primarily affecting the posterior cerebral hemispheres. Although typically reversible with prompt treatment, PRES can lead to severe complications if not recognized early. This report presents an unusual and fatal case of PRES in a pediatric patient with celiac disease, a combination that is rarely documented in medical literature. A 9‐year‐old child with a history of celiac disease and dermatitis herpetiformis presented to the Emergency Room with a two‐month history of vomiting and loose stools, accompanied by a recent 20‐min seizure. Initial examination revealed pallor, emaciation, drowsiness, and a generalized rash. The patient was tachycardic, hypertensive (blood pressure 150/100 mmHg), and had an oxygen saturation of 65%. Neurological examination showed a glasgow coma scale (GCS) score of 10/15, increased muscle tone, and heightened reflexes. CT and MRI scans revealed intraparenchymal and subarachnoid hemorrhages. Despite aggressive management including intubation, antihypertensive therapy, anticonvulsants, and broad‐spectrum antibiotics, the patient's condition deteriorated rapidly. Complications included pneumoperitoneum and eventual cardiac arrest, leading to the patient's death. This case highlights the potential for severe, life‐threatening complications of PRES in pediatric patients with underlying autoimmune conditions such as celiac disease. It underscores the importance of considering PRES in the differential diagnosis for children with celiac disease presenting with neurological symptoms, even in the absence of typical radiological findings. The case also illustrates the need for further research into the relationship between celiac disease and PRES to improve outcomes in similar cases.

Introduction Bone metastases (BMs) are a major cause of cancer-related pain. Palliative radiotherapy is effective for controlling these symptoms, but up to 40% of patients experience transient exacerbations of bone pain despite this. Glucocorticoids have been investigated for pain flare (PF) prophylaxis, but randomised controlled trials (RCTs) have yielded mixed results. The goal of this systematic review and meta-analysis was to analyse the pooled efficacy of glucocorticoids for PF prophylaxis after palliative radiotherapy to BMs. Methods The PubMed, EMBASE and Cochrane CENTRAL databases were systematically searched from inception until August 2024. RCTs that compared PF incidence after radiotherapy to BMs in patients who received prophylaxis with glucocorticoids versus placebo were included. Meta-analyses were conducted using a Mantel-Haenszel random effects model. Risk-of-bias was assessed using the Cochrane Risk of Bias 2 tool. Results We included four RCTs with a total of 765 patients. Three trials compared dexamethasone with placebo, while one trial compared methylprednisolone with placebo. Pooled analysis showed significantly reduced PF incidence after glucocorticoid prophylaxis (risk ratio: 0.59 (95% CI: 0.35 to 0.98), risk difference=−0.13 (95% CI: −0.24 to −0.02)). Study quality assessment indicated that two studies had a low risk of bias, while the other two had moderate and high risk, respectively. Conclusion Current randomised evidence supports the efficacy of glucocorticoid prophylaxis for the prevention of PFs in patients with BMs after the receipt of palliative radiation. Clinicians may consider this intervention to improve patient quality of life and symptom control.

Locoregional therapies are used across the hepatocellular carcinoma (HCC) treatment spectrum, including for curative treatment of small tumors, as bridging or downstaging therapy before liver transplant, for treatment of intermediate-stage disease, and as part of combination treatment with systemic therapy in selected patients. This narrative review summarizes recent developments in transarterial radioembolization (TARE), transarterial chemoembolization (TACE), and percutaneous ablation techniques and separates established clinical advances from early investigational work. The strongest evidence supports personalized TARE dosimetry and radiation segmentectomy, selective TACE with reassessment before repeat treatment, and image-guided thermal ablation with objective margin assessment. Phase 3 trials of TACE combined with antiangiogenic and immune checkpoint therapy demonstrated improved progression-free survival in selected patients with unresectable, nonmetastatic HCC, although the survival benefit of these combinations so far extends only to progression-free survival, and the best treatment sequence remains to be defined. Histotripsy, pulsed electric-field ablation, electrochemotherapy, cryoablation, high-intensity focused ultrasound, imageable or alternative radioembolic microspheres, new embolic agents, robotics, and artificial intelligence remain at different stages of clinical development. Most supporting data are derived from single-arm studies, retrospective cohort studies, trials in mixed liver-tumor populations, or studies in preclinical models. Treatment selection should account for tumor burden and location, liver function, portal hypertension, vascular invasion, transplant candidacy, available alternatives, local expertise, and patient preferences. Future studies should focus on durable local control, preservation of liver function, quality of life, transplant eligibility, overall survival, and cost.

Key Clinical Message: This case highlights the importance of a definite diagnosis of an IgG4‐related chronic sclerosing duodenitis based on histological and radiological findings to rule out any malignancy in the mass. While dealing with patients having concentric duodenal thickening resulting in stricture formation, one should think of inflammatory etiology as well. IgG4‐related disease is one of these inflammatory disorders where we see soft tissue thickening without a large mass or any associated lymphadenopathy as in our case. Immunoglobulin G4‐related disease (IgG4‐RD) is distinguished as an infiltration of IgG‐4‐positive plasmacytes involving inflammatory lesions across multiple organs which is accompanied by raised IgG4 levels in the serum. Several inflammatory disorders are recognized as part of the IgG4‐RD family based on shared histopathological features, which include Mikulicz's disease, chronic sclerosing sialadenitis, or Riedel's thyroiditis. Our case highlights a distinctive presentation of IgG4‐related diseases; a 58‐year‐old man presenting with duodenal stricture highly suspicious of a duodenal mass/ampullary mass later found to be due to IgG4‐related sclerosing duodenitis with negative malignancy on biopsy. We present the diagnostic challenges faced and relevant findings noted.

Objective To determine whether closed-loop automated oxygen control increases time within the target oxygen saturation range in preterm infants compared with manual titration. Study Design: Randomised, open-label crossover trial in a tertiary neonatal unit in Karachi, Pakistan, registered prospectively (ClinicalTrials.gov NCT06622161, 1 October 2024). Twenty-five preterm infants on invasive or non-invasive support underwent consecutive 12-h periods of automated (OxyGenie) and manual oxygen management in randomised order. Room air was identified second-by-second from the set FiO ₂ . Comparisons used Wilcoxon signed-rank tests. Result Automated control increased time at SpO ₂ 90–94% from 37.8% to 55.9% (mean difference 14.5 percentage points, 95% CI 7.1–21.7; p = 0.007). Time below 90% fell from 11.5% to 6.6% (p = 0.015) and below 80% from 1.1% to 0.3% (p = 0.019). Restricted to supplemental oxygen, time above 94% fell from 16.1% to 3.1% (p < 0.001). Mean FiO ₂ was unchanged (p = 0.62). Conclusion Automated oxygen control improved saturation targeting and reduced hypoxaemia and hyperoxaemia during supplemental oxygen without increasing oxygen exposure. Trial registration ClinicalTrials.gov NCT06622161 (submitted 25 September 2024, posted 1 October 2024).

Locoregional therapies are used across the hepatocellular carcinoma (HCC) treatment spectrum, including for curative treatment of small tumors, as bridging or downstaging therapy before liver transplant, for treatment of intermediate-stage disease, and as part of combination treatment with systemic therapy in selected patients. This narrative review summarizes recent developments in transarterial radioembolization (TARE), transarterial chemoembolization (TACE), and percutaneous ablation techniques and separates estab-lished clinical advances from early investigational work. The strongest evidence supports personalized TARE dosimetry and radiation segmentectomy, selective TACE with re-assessment before repeat treatment, and image-guided thermal ablation with objective margin assessment. Phase 3 trials of TACE combined with antiangiogenic and immune checkpoint therapy demonstrated improved progression-free survival in selected patients with unresectable, nonmetastatic HCC, although the effect on overall survival and the optimal treatment sequence remain uncertain. Histotripsy, pulsed electric-field ablation, electrochemotherapy, cryoablation, high-intensity focused ultrasound, imageable or al-ternative radioembolic microspheres, new embolic agents, robotics, and artificial intel-ligence remain at different stages of clinical development. Most supporting data are de-rived from single-arm studies, retrospective cohort studies, trials in mixed liver-tumor populations, or studies in preclinical models. Treatment selection should account for tumor burden and location, liver function, portal hypertension, vascular invasion, transplant candidacy, available alternatives, local expertise, and patient preferences. Future studies should focus on durable local control, preservation of liver function, quality of life, transplant eligibility, overall survival, and cost.