Anthracyclines remain central to the treatment of many malignancies, yet their use is limited by the risk of anthracycline-induced cardiomyopathy (AIC), a complication associated with substantial long-term cardiovascular morbidity and mortality. The occurrence of cardiotoxicity during cancer treatment may adversely affect both treatment success rates and patient survival, especially when dose reduction or premature discontinuation of anthracycline therapy is necessitated, leading to treatment discontinuity, reduced therapeutic efficacy, and overall reduced quality of life. While anthracyclines improve cancer outcomes, the resulting cardiac damage may lead to heart failure, disability, repeated hospitalizations, and premature death, with the long-term cardiovascular complications often becoming a greater determinant of survival than the original cancer itself. Growing understanding of the biological mechanisms underlying anthracycline cardiotoxicity has improved the recognition of patients at increased risk and clarified the progressive nature of this condition, which typically evolves from subclinical myocardial injury to left ventricular dysfunction and, if unrecognized, overt heart failure. Risk stratification has traditionally relied on cardiac imaging and circulating biomarkers. Although some current surveillance methods for cardiotoxicity monitoring detect myocardial damage at subclinical and partially or fully reversible stages, many traditional methods are relatively late markers and detect myocardial damage usually after it reaches a stage where treatment becomes unable to reverse the damage. The limitations of left ventricular ejection fraction as a sole monitoring parameter have prompted increasing use of more sensitive imaging markers and biochemical indicators of early myocardial injury. This review conducts a medical evaluation of AIC to study triggers, patient manifestations, and risk factors that develop during treatment. It evaluates present diagnostic methods, including echocardiography, cardiac magnetic resonance imaging, and cardiac biomarkers, and investigates new methods that enable healthcare practitioners to detect diseases at their initial stages through artificial intelligence (AI)-based analytical tools, wearable technologies, and remote patient monitoring systems. Finally, we consider future directions aimed at earlier identification and personalized prevention of anthracycline-related cardiac dysfunction.
BACKGROUND:Guillain-Barré syndrome is a rare but clinically significant complication in pregnancy, associated with high maternal and perinatal risks. Diagnosis may be delayed because early neurological symptoms overlap with common pregnancy-related complaints. Although case reports describe variable maternal severity and neonatal outcomes, evidence is fragmented, and no prior systematic review has synthesized these data. OBJECTIVE:To systematically review published case reports and series of Guillain-Barré syndrome (GBS) with onset during pregnancy, focusing on maternal disease course, obstetric management, and neonatal outcomes. STUDY DESIGN:A systematic revie w was conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD420251127698). PubMed, Embase, and Scopus were searched to August 2025 for case reports and series of pregnancy-onset GBS. Eligible studies required a confirmed diagnosis and at least 1 maternal, obstetric, or neonatal outcome. RESULTS:A total of 90 studies comprising 101 cases were included. Mean maternal age was 27.3 years, with symptom onset most frequent in the third trimester (52.5%). Preceding infection was reported in nearly half. Limb weakness (98%) and areflexia (87.6%) were predominant, and acute inflammatory demyelinating polyneuropathy accounted for 70% of subtypes. ICU admission occurred in 64%, and mechanical ventilation in 45%. Bulbar weakness (OR 5.29, P=.001) and autonomic dysfunction (OR 7.17, P<.001) were strongly predictive of ICU requirement. Neurological recovery was complete in 35%, partial in 59.4%, with maternal mortality of 5.2%. Obstetric outcomes showed cesarean delivery in 54.8% and preterm birth in 36%. One-third of neonates were low birthweight, though overall survival was 85.6%. Third-trimester onset correlated with higher risks of preterm delivery and maternal respiratory compromise, underscoring the vulnerability of late gestation. CONCLUSION:GBS in pregnancy carries substantial maternal morbidity and obstetric risk. Early recognition and multidisciplinary care are crucial. Despite high neonatal survival, risks of preterm birth and maternal ventilation remain significant.
Introduction Most private hospitals in the United Kingdom perform colonoscopies under intravenous sedation. We aimed to compare patients who had colonoscopies using Entonox (50:50 mixture of nitrous oxide and oxygen) or intravenous sedation in the setting of a private hospital. Method Patients undergoing colonoscopy from January 1, 2014 to December 31, 2014 at Shirley Oaks Hospital, a JAG accredited private healthcare provider, were offered a choice of intravenous sedation or patient activated Entonox inhalation. It was confirmed that there were no contraindications to use of Entonox. All patients had Moviprep (Norgine) as bowel preparation. Pulse oximetry was used for monitoring patients during the procedure. Entonox (BOC Healthcare) was administered through a hand held mouthpiece which was activated by patient breath. They were offered intravenous sedation during the procedure if they were not able to tolerate the discomfort. Statistical analysis was performed using chi square test and t-test. Results There were 144 patients who had Entonox (Group A) and 504 patients who had intravenous sedation (Group B). Procedures were performed by 5 experienced colonoscopists in Group A and 7 in Group B. 15 patients (10%) in Group A had to be converted to intravenous sedation. The time to colonoscopy is the time from entry into endoscopy room to the completion of procedure. In Group B, intravenous sedation included a combination of Midazolam in 494 (98%), Pethidine in 432(86%), Fentanyl in 50(10%), Propofol (1). There were no complications in Group A and 1 patient each had a bleed and cardio-respiratory compromise in Group B. No reversal agents were used. Other results are shown in Table 1. Conclusion There was statistical significance for higher adenoma detection in the sedation group although there was no difference in the polyp detection rate. More patients having Entonox had moderate discomfort during the procedure while more patients had none/minimal discomfort in sedation group. As expected, time to colonoscopy was more in the sedation group. Larger studies are required to identify the group of patients who may benefit from Entonox in the private sector. Disclosure of interest None Declared.
BACKGROUND:Red scrotum syndrome (RSS) is not infrequent but is often misdiagnosed or underdiagnosed, and seldom reported. The exact etiopathogeneis is still unknown but it almost always follows the prolonged application of topical corticosteroids and is characterised by persistent erythema of the scrotum, associated with severe itching, hyperalgesia and a burning sensation.OBJECTIVE:To evaluate the clinicoepidemiological profile and assess the efficacy of various treatment modalities in addition to corticosteroid abstinence in the treatment of RSS.METHODS:Twelve patients with RSS, who presented to us during 2010 and 2011, were identified, and various aspects of their illness and treatment were studied. Patch testing was performed in all patients. A skin biopsy was done in seven patients.RESULTS:The average age of the patients was 45.83 years (26-62 years). The average duration of illness or the duration of topical steroid use was 27.41 months (6-56 months). Psychiatric comorbidities were seen in 9 (75%) out of 12 patients. Histopathology revealed features resembling erythematotelengiectatic rosacea in four of the biopsied patients. Patch test results were negative. All patients reported improvement of their symptoms within 4 weeks of starting doxycycline with amitriptyline or pregabalin; the treatment had to be continued for 3-4 months.CONCLUSIONS:RSS appears to be a manifestation of corticosteroid misuse rather than a primary disease. We suggest that RSS is a rosacea-like dermatosis or steroid-induced rebound vasodilation based on clinical and histopathological features. Our patients responded to cessation of steroids and doxycycline in combination with amitryptaline or pregabalin.
