Vui Heng Chong

Although kidney replacement therapy increases longevity, it often imposes a heavily encumbered lifestyle with significant psychosocial and medical costs.

Achalasia is a rare disorder affecting the esophagus, in which the lower esophageal sphincter (LES) is spastic and fails to relax, causing food retention. This leads to esophageal dilatation over time. The condition often presents late and is frequently not suspected, resulting in delayed diagnosis. Traditionally, it is diagnosed through manometry, which shows failure of relaxation of the LES, along with ineffective or absent peristalsis. Barium swallow imaging reveals the pathognomonic "rat’s tail" sign and a dilated esophagus. We report an interesting case of achalasia that was initially suspected on chest radiography, diagnosed using point-of-care ultrasound (POCUS), and later confirmed with a computed tomography scan. The patient improved after two sessions of balloon dilation, and monitoring with POCUS showed improvement. This case highlights the potential role of POCUS in both the diagnosis of achalasia and in monitoring after treatment.

Stomach cancer remains a significant cause of mortality, as most patients are diagnosed at advanced stages. The primary method for diagnosis is endoscopy, along with tissue acquisition, supplemented by endoscopic ultrasound or computed tomography for disease staging. While point-of-care ultrasound (POCUS) is now firmly integrated into clinical practice, it is still not widely utilized. POCUS can be performed at the initial point of contact and provides instant information that can influence investigation strategies. We report two cases of gastric antral carcinoma detected by POCUS, which led to targeted investigations. Both patients underwent expedited upper gastrointestinal endoscopies that confirmed distal gastric carcinoma. These cases highlight the important role of POCUS in triaging patients for timely and appropriate targeted organ investigations.

A pyogenic liver abscess (PLA) is uncommon and a potentially life-threatening condition. Clinical manifestations and laboratory investigations can be non-specific and the detection of PLAs requires imaging, which can often be delayed. Point-of-care ultrasound (POCUS) is now becoming more widely adopted and plays an important role in clinical practice. We report two cases of PLA, one of which was a gas-forming PLA that we encountered in a district general hospital where POCUS played an important role in the diagnosis and management. The diagnoses of PLAs were initially unsuspected due to a combination of non-specific symptom manifestations, initial negative imaging, and a subtle radiological clue that was missed due to a lack of awareness. Bedside POCUS examinations were done due to clinical deterioration in one patient and lack of inflammatory marker improvement in both patients. These cases highlight the important role of POCUS in the management of patients with liver abscesses.

During the 20th century, inflammatory bowel disease (IBD) was considered a disease of early-industrialized regions in North America, Europe, and Oceania. At the turn of the 21st century, incidence of IBD increased in newly-industrialized and emerging regions in Africa, Asia, and Latin America, while prevalence in early-industrialized regions started to grow steadily. Changes in incidence and prevalence denote evolution of IBD across four epidemiologic stages: Stage 1 (Emergence), characterized by low incidence and prevalence; stage 2 (Acceleration in Incidence), characterized by rapidly rising incidence and low prevalence; and stage 3 (Compounding Prevalence), characterized by decelerating, plateauing, or declining incidence and steadily rising prevalence. A fourth stage (Prevalence Equilibrium) has been proposed where the slope of prevalence plateaus due to shifting demographics of an aging IBD population, but it has not yet been evidenced. To date, these stages have been theoretical without specific incidence/prevalence indicators defining transition points. Using real-world data from 490 population-based studies comprising 80 global regions and spanning over a century (1920–2023), we show spatiotemporal transitions across stages 1–3 and model transition towards stage 4. Understanding the evolution of IBD across epidemiologic stages allows healthcare systems to better prepare for the future worldwide burden of IBD.

Sajid A Raja, Vui Heng Chong; Role of Optical Coherence Tomography Imaging in Treatment of Diabetic Macular Oedema, QJM: An International Journal of Medicine, ,