Basidiobolomycosis is arare and potentially fatal fungal infection caused by Basidiobolus ranarum (B. ranarum). Retroperitoneal or mesenteric basidiobolomycosis can mimic malignant tumors clinically and radio-logically. We describe a 15-year-old girl who developed retroperitoneal and mesenteric fungal masses due to B. ranarum. The patient presented with gradual onset of jaundice, significant weight loss, abdominal pain, and vomiting. Computed tomography revealed masses in the retroperitoneal and mesenteric regions with radiological findings suggestive of malignant neoplasm. Tru-Cut biopsy of the retroperitoneal mass confirmed basidiobolomycosis on histological examination. Following diagnosis, antifungal therapy was initiated with intravenous voriconazole (4 mg/kg/day for 2 weeks), followed by oral itraconazole (200 mg every 12 h). Regular follow-up through May 2026 demonstrated significant clinical improvement without major adverse effects. This case underscores the importance of recognizing basidiobolomycosis as a potential cause of retroperitoneal or mesenteric masses that may be misinterpreted as malignant tumors. Non-specific symptoms often delay diagnosis and appropriate treatment. Clinicians in regions where B. ranarum is endemic should include basidiobolomycosis in the differential diagnosis when evaluating patients with retroperitoneal or mesenteric masses.
Background:Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, with evolving etiologic patterns. While viral hepatitis has historically been the predominant cause, non-infective etiologies such as alcohol-associated liver disease and metabolic dysfunction-associated fatty liver disease (MAFLD) are increasingly driving the disease burden. We evaluated long-term trends in HCC-related mortality in the United States by etiology and demographic subgroups. Methods:Mortality data from 1999 to 2020 were obtained from the Centers for Disease Control and Prevention's Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) database. HCC-related deaths were classified as infective (viral hepatitis-associated) or non-infective (liver disease and metabolic disorder) using International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes. Age-adjusted mortality rates (AAMRs) were extracted using CDC WONDER. Joinpoint regression was used to assess temporal trends and estimate annual percent change (APC) and average annual percent change (AAPC). Analyses were stratified by sex, age, race/ethnicity, geographic region, and urbanization. Results:Overall HCC-related mortality increased substantially from 1999 to 2020, driven predominantly by non-infective etiologies. Infective AAMRs rose from 1999 to 2013 followed by a significant decline, whereas non-infective AAMRs increased persistently from 1999 to 2020. Mortality rates were consistently higher in males than females. Infective mortality was highest among Asians, while non-infective mortality disproportionately affected Hispanic and American Indian populations. Western US states exhibited the highest mortality rates, and non-infective etiologies accounted for most deaths among individuals aged ≥ 65 years. Conclusions:HCC-related mortality in the United States has increased over the past two decades, largely driven by non-infective etiologies. Targeted public health strategies addressing metabolic risk factors, alcohol use, and demographic disparities are urgently needed to curb this growing burden.
Background: Conventional cold snare polypectomy (CCSP) is the standard technique for removal of small non-pedunculated colorectal polyps. However, incomplete resection remains a concern. Recent data suggested that underwater cold snare polypectomy (UCSP) with no submucosal injection may enhance resection depth and histologic clearance. We aimed to compare the two polypectomy techniques with emphasis on efficacy and safety. Methods: We systematically searched PubMed, Embase, Cochrane Central, and ClinicalTrials.gov from inception through March 2026, for randomized controlled trials (RCTs) comparing UCSP and CCSP for 4-10 mm non-pedunculated colorectal polyps. The primary outcome was en bloc resection. Secondary outcomes included non-R0 resection, intraprocedural bleeding, histologic complete resection (R0), and perforation. Random-effects models using DerSimonian-Laird were used to calculate risk ratios (RRs) with 95% confidence intervals (95% CIs). Results: Three RCTs met criteria (n = 822 polyps, total; UCSP 418, CCSP 404). En bloc resection was higher in UCSP compared to CCSP (RR 1.03, 95% CI 1.00-1.06, I2 = 0%). UCSP increased histologic complete resection (RR 1.15, 95% CI 1.01-1.31, I2 = 81.8%). Adverse events were uncommon; intraprocedural bleeding was similar between groups (RR 0.57, 95% CI 0.16-2.07, I2 = 29.5%). No perforations were reported in any arm. Conclusions: UCSP improves en bloc resection of small polyps with out increasing adverse events. Further multicenter trials with longitudinal follow-up are needed to assess long-term residual disease.
Background: Helicobacter pylori (H. pylori) is a gram-negative bacterium linked to various gastrointestinal disorders. Our study evaluates the comparative effectiveness, safety, and cost-efficiency of vonoprazan-amoxicillin (VA) dual therapy as an alternative to traditional proton pump inhibitor (PPI)-based triple therapy for eradicating H. pylori. Methods: This real-world, observational, single-center clinical study used medical records of 94 adult patients diagnosed with H. pylori infection in India between July 2024 to March 2025. The patients received 14 days of VA dual therapy or PPI-amoxicillin-clarithromycin (PAC) triple therapy. The primary outcome included H. pylori eradication using a repeat rapid urease test, and the secondary outcomes included the need for rescue therapy, time for symptom resolution, incidence of adverse drug reactions, and cost-comparison of the treatment regimens. Results: Eradication rates were numerically higher with VA than PAC (93.33% vs. 85.71%), although the difference was not statistically significant. As second-line therapy, eradication was achieved in 100% of PAC-to-VA switchers and 33.3% of VA-to-PAC switchers. Symptom resolution was significantly earlier with VA compared to PAC (median, 3 vs. 5 days; P < 0.001). Adverse events were fewer with VA (13.33%) than PAC (28.57%), with taste disturbances more frequent in the PAC group. VA also showed a significantly lower median treatment cost (Indian rupee (INR) 1,020 (US dollar (USD) 12.29) vs. INR 3,380 (USD 40.72); P <0.001) and a better cost-comparison ratio (10.67 vs. 39.43). Conclusions: VA showed numerically higher eradication rates, faster symptom relief, lower costs, and better tolerability than PAC in the Indian setting, supporting its potential as a practical alternative first-line regimen, particularly in settings where clarithromycin resistance is prevalent or suspected.
Background: Sarcopenia is a known negative prognostic factor in oncology and is frequently observed in patients with pancreatic ductal adenocarcinoma (PDAC). Computed tomography (CT) enables longitudinal muscle assessment and may provide additional prognostic information. This study aims to assess their association with prognosis in pancreatic cancer and explore the diagnostic and prognostic value of CT radiomics. Methods: A retrospective single-center study included 62 patients with primary PDAC who underwent at least three abdominal CT scans: baseline (t0), 3 months (t1), 6 months (t2), and, in 35 patients, 12 months (t3). CT-based sarcopenia was assessed using the psoas muscle index (PMI) based on reference cutoffs and cohort-specific sex-specific quartiles. Skeletal muscles at the L3 level were semi-automatically segmented. Radiomic features of the psoas were extracted and analyzed using k-nearest neighbor, decision tree, and random forest models. Prognostic relevance was evaluated using logistic regres sion and feature selection via least absolute shrinkage and selection operator (LASSO) regression. Tumor progression was assessed radio-logically according to RECIST 1.1 criteria. Results: CT-based sarcopenia prevalence was 45.3% using reference-based PMI thresholds. PMI declined significantly from baseline to t1 and remained stable thereafter, with women exhibiting consistently lower values. Outcome analysis showed a higher proportion of disease progression at t1 in sarcopenic patients using reference cutoffs, whereas cohort-specific quartiles demonstrated no consistent differences. Random forest models predicted sarcopenia with up to 0.73 accuracy and receiver operating characteristics area under the curve (ROC-AUC) of 0.81. LASSO regression identified the psoas short axis and cross-sectional area as the most informative features. Logistic regression using baseline radiomic features predicted disease progression status at 12 months with 0.85 accuracy, weighted F1 0.841, and AUC 0.823. Interobserver agreement for psoas measurements was high (r = 0.86). Conclusion: Longitudinal CT-based assessment of PMI demonstrates progressive sarcopenia within the studied PDAC cohort, with sex-specific declines. Radiomic analysis of skeletal muscle provides complementary information and predictive insights, highlighting their potential to enhance the characterization of muscle status and its association with disease course in patients able to undergo repeated imaging.
