Injuries of the external ear caused by blunt trauma are among the most characteristic lesions of contact sports and have likely accompanied athletic competition since antiquity. Auricular hematoma is a well-recognized consequence of blunt trauma to the external ear and remains a common injury in modern contact sports. If untreated, subperichondrial blood accumulation may lead to cartilage ischemia and permanent auricular deformity, commonly known as cauliflower ear. Evidence of this condition may already appear in ancient artistic representations.[1,2] The Hellenistic bronze statue known as the Boxer at Rest (late fourth-third century BCE) depicts an athlete with pronounced bilateral auricular deformities consistent with chronic auricular hematoma. In addition to these features, both ears display short, sharply defined linear lesions accentuated by copper inlays suggestive of active bleeding.[3] This study reexamines these markings from a clinical and anatomical perspective. Their morphology, symmetry, and anatomical location closely correspond to sites commonly used in modern surgical drainage of auricular hematomas.[1] This raises the possibility that the sculpture depicts not merely traumatic injury but a therapeutic intervention. Although classical medical texts do not explicitly describe the treatment of auricular hematoma, incision and evacuation of pathological fluid collections were well established in ancient medicine.[4-6] The statue may therefore represent one of the earliest visual depictions of the management of sports-related ear trauma. This interpretation highlights the continuity of traumatic injuries associated with contact sports and their medical consequences across more than two millennia.

Frailty is a multidimensional geriatric syndrome characterized by reduced physiologic reserve and increased vulnerability to stressors. Its prevalence is particularly high among patients with heart failure (HF), reflecting the interplay between aging, multimorbidity, and chronic cardiovascular disease. Frailty independently predicts poor outcomes, including higher hospitalization rates, mortality, and impaired quality of life. The Fried Frailty Phenotype defines frailty as the presence of three or more of the following five criteria: unintentional weight loss, exhaustion, weakness (grip strength), slow walking speed, and low physical activity. In this review, we explore the complex relationship between frailty and HF, with a focus on pathophysiology, clinical outcomes, biomarkers, and therapeutic considerations. We highlight differences across HF phenotypes-heart failure with reduced ejection fraction (HFrEF), preserved ejection fraction (HFpEF), and mildly reduced ejection fraction (HFmrEF)-underscoring the importance of tailored, phenotype-specific approaches. We also discuss emerging biomarkers including the stress hyperglycemia ratio (SHR) in HFpEF. Finally, we address limitations of current evidence and future directions for integrating frailty assessment into HF management.

Eosinophilic cholangitis (EC) is a rare inflammatory biliary disorder that can mimic primary sclerosing cholangitis and cholangiocarcinoma. We performed a PRISMA 2020-guided systematic review to summarize diagnostic features, management, and outcomes. Web of Science, PubMed, MEDLINE, Embase, Scopus, and CINAHL were searched; 55 studies (55 patients) were included. Among cases with a preoperative impression (n = 39), malignancy was suspected in 19 (48.7%). Among cases with reported localization (n = 44), isolated extrahepatic disease occurred in 15 (34.1%) and isolated intrahepatic disease in 7 (15.9%). Tissue eosinophilic infiltration was reported in 52/53 (98.1%). Steroids were the primary treatment (35/42, 83.3%), with symptom resolution in 36/37 (97.3%) and biochemical normalization in 39/39 (100%). Serum IgE, when reported, was normal in 4/15 cases by author classification. EC commonly presents as an indeterminate biliary stricture with frequent eosinophilia and is often misdiagnosed as malignancy.

Studies have compared proton pump inhibitors (PPI) with Histamine 2 receptor antagonists (H2RA) and placebo for upper gastrointestinal bleeding (UGIB) prophylaxis in mechanically ventilated patients. We conducted this meta-analysis to compare PPI with H2RA or placebo for UGIB prophylaxis in these patients. Our outcomes of interest were clinically important UGIB, overall UGIB, mortality, ventilator-associated pneumonia (VAP) and Clostridium difficile infection (CDI). We calculated pooled risk ratio (RR) with 95% confidence intervals (CI) for all outcomes. We included eight RCTs comprising 32,873 patients. Risk of clinically important UGIB was significantly lower in PPI group, RR (95%CI): 0.53 (0.32, 0.89). Risk of overall UGIB was also significantly lower in PPI group. There was no significant difference in mortality, VAP and CDI between groups. This meta-analysis demonstrates the superiority of PPI to H2RA and placebo for prophylaxis of UGIB in mechanically ventilated patients, without increasing the risk of adverse events.

Intraductal papillary mucinous neoplasm (IPMN) is a rare precancerous pancreatic tumor that accounts for about 1% of pancreatic neoplasms and can impair both exocrine and endocrine function. We present the case of a woman with long-standing type 2 diabetes mellitus who developed worsening glycemic control due to pancreatic IPMN and its pathogenesis. Laboratory evaluation revealed evidence of severe pancreatic exocrine insufficiency, while imaging demonstrated a ductal lesion consistent with IPMN. Endoscopic ultrasound with biopsy confirmed a main-duct IPMN, and the patient subsequently underwent pancreaticoduodenectomy, with pathology demonstrating low-grade disease without invasion. This case highlights the connection between pancreatic structural disease and glucose metabolism. Progressive ductal obstruction and parenchymal injury from IPMN can result in combined endocrine and exocrine dysfunction, manifesting as pancreatogenic (type 3c) diabetes and malabsorption. Early recognition is critical, as it enables timely diagnostic evaluation, appropriate surgical management, and optimization of metabolic and nutritional status. Additionally, this case underscores the need for individualized diabetes management in the setting of pancreatic insufficiency and highlights ongoing uncertainties regarding the safety of certain glucose-lowering therapies in patients with premalignant pancreatic lesions.

Obstructive sleep apnea (OSA) is a highly prevalent and heterogeneous disorder strongly associated with cardiovascular morbidity and mortality. This review examines the pathophysiological mechanisms linking OSA to cardiovascular disease, and evaluates current evidence regarding the impact of positive airway pressure (PAP) therapy on cardiovascular outcomes and mortality. OSA is an independent risk factor for hypertension, coronary artery disease, heart failure, arrhythmias, stroke, and metabolic dysfunction, mediated by mechanisms including intermittent hypoxia, sympathetic activation, oxidative stress, endothelial dysfunction, and systemic inflammation. Although PAP therapy improves symptoms, apnea-hypopnea index, and intermediate cardiometabolic parameters-particularly among adherent patients-randomized controlled trials have yielded inconsistent results for reducing cardiovascular events and mortality. Emerging evidence indicates that treatment adherence, disease severity, and distinct OSA phenotypes and endotypes substantially influence cardiovascular risk. Methodological limitations, population heterogeneity, and inadequate long-term follow-up continue to fuel controversy, highlighting the need for individualized, phenotype-driven research approaches.