Cureus最新文献

{"title":"Active Fire Detections and Hospital Admissions for Circulatory Diseases in Brazil: An Ecological Panel Study (2013-2024).","authors":"Gabriel P Andreotti, Gabriella Ramos Martines, Guilherme A Carilo, Piettra S Wladimirski, Rafaella Ottaviani, Jaqueline E Beirith","doi":"10.7759/cureus.118676","DOIUrl":"https://doi.org/10.7759/cureus.118676","url":null,"abstract":"<p><strong>Background: </strong>Wildfire smoke has been associated with cardiovascular outcomes, yet annual counts of fire detections capture a different exposure pattern from the short-term smoke concentrations on which much of that evidence rests. We examined whether fire detection density was associated with hospital admissions for circulatory diseases across Brazil between 2013 and 2024.</p><p><strong>Methods: </strong>The ecological panel covered 27 federative units over 12 years, giving 324 unit-year observations. Admissions for International Classification of Diseases, 10th Revision, Chapter IX diseases, came from the hospital information system/unified health system; fire detections from the Brazilian National Institute for Space Research; and population and territorial area from the Brazilian Institute of Geography and Statistics. We calculated Spearman correlations and then fitted negative binomial models of admission counts with a population offset and state fixed effects, adding year effects, temperature, poverty, and primary care coverage in successive specifications. Robustness was examined through three temporal subsets and a state-clustered standard-error analysis.</p><p><strong>Results: </strong>The period comprised 13,801,934 admissions and 2,318,883 fire detections. Ischemic heart disease was the largest individually specified diagnostic group, with 3,301,354 admissions (23.9%). All three correlations lay close to zero: between states ρ = -0.03 (p = 0.87), in the pooled panel ρ = -0.02 (p = 0.70), and after within-state centering ρ = 0.01 (p = 0.89). Across five regression specifications, rate ratios per additional 1,000 detections/100,000 km²/year ranged from 0.979 to 1.020, with the full model at 0.998 (conventional 95% confidence interval (CI), 0.970-1.028; p = 0.913). CIs included unity in every temporal subset and under state-clustered inference as well.</p><p><strong>Conclusions: </strong>No statistically significant association was detected at the annual state level. These findings do not establish the absence of cardiovascular effects from wildfire smoke; rather, the indirect exposure measure, temporal aggregation, crude outcome rates, and methodological changes in population and healthcare indicators each limit what the data can show.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118676"},"PeriodicalIF":1.3,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13712246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149290540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparative Review of Performance and Concurrent Cardiac Rhythm Assessment Across Home Sleep Apnea Testing Devices.","authors":"Brian Brockway, Arjun Sharma, Clara Stein, Sarthak Jain, Marina Brockway","doi":"10.7759/cureus.118688","DOIUrl":"https://doi.org/10.7759/cureus.118688","url":null,"abstract":"<p><p>Home sleep apnea testing (HSAT) is now widely used in place of in-laboratory polysomnography (PSG) for the evaluation of sleep-disordered breathing (SDB), but published performance varies across FDA-cleared devices. This narrative review aimed to summarize the published performance of FDA-cleared Type III HSAT devices currently marketed in the United States and compare their labeled capabilities for assessing SDB over multiple nights and concurrently evaluating cardiac rhythm and atrial fibrillation (AF) burden. A search of the FDA 510(k) database identified 68 devices with MNR as the primary product code that were cleared after August 1, 2016, or were cleared earlier but released for sale after that date. There were 13 devices that met these criteria and the Centers for Medicare and Medicaid Services (CMS) criteria for a Type III HSAT. For each device, sensitivity and specificity against PSG, scored under American Academy of Sleep Medicine Rule 1B (4% oxygen desaturation), were obtained from the FDA 510(k) Summary or a peer-reviewed validation study. Balanced accuracy (the mean of sensitivity and specificity) was calculated at apnea-hypopnea index (AHI) thresholds of 5, 15, and 30 events per hour. Five devices were excluded from the comparison and are reported for information only because their performance data were not reported using a methodology consistent with that of the other devices: they used a different scoring rule or severity threshold, reported central apnea detection only, or relied on a less credible source for the reported data. Among the remaining eight devices, reported sample sizes ranged from 30 to 476 subjects. All eight reported performance at AHI ≥ 15, five at AHI ≥ 5, and three at AHI ≥ 30. At AHI ≥ 15, balanced accuracy was highest for AcuPebble Ox200 (Acurable Limited, London, UK) (96.5), followed by WatchPAT SW (Itamar Medical, Caesarea, Israel) (94.0) and RX-1 Sleep (Rhythm Express, St. Paul, MN) (92.2). RX-1 Sleep reported the highest balanced accuracy at AHI ≥ 5 (90.9) and AHI ≥ 30 (92.9). These comparisons are indirect and descriptive: each device was validated against PSG in a separate cohort, none was evaluated against another device in the same patients, and between-device differences were not statistically tested. Prospective head-to-head studies against a common reference standard would be needed to confirm differences in relative performance. Among the devices compared, RX-1 Sleep system provides an aid for concurrent assessment of SDB and AF burden in a single test. Other devices can flag or record rhythm information but cannot quantify AF burden. Together with its published performance and multi-night testing capability, this may offer clinical benefit given the severity-dependent association between SDB and AF burden and the elevated cardiovascular risk observed when the two conditions coexist.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118688"},"PeriodicalIF":1.3,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13712896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149290594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retraction: Spinal Cord Stimulation in Complex Regional Pain Syndrome: A Narrative Review.","authors":"John Salib, Mark Salib, Lisa M Tran, David K Sum","doi":"10.7759/cureus.r256","DOIUrl":"https://doi.org/10.7759/cureus.r256","url":null,"abstract":"<p><p>[This retracts the article DOI: 10.7759/cureus.100919.].</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"r256"},"PeriodicalIF":1.3,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13712389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149290629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retraction: A Systematic Review and Meta-Analysis of Clinical Effectiveness of Intravenous Magnesium Sulphate in the Treatment of Acute Fast Atrial Fibrillation in Non-surgical Adult Patients.","authors":"Kelvin Mupunga, Willmore Chandavengerwa, Durai Pardon Nyabadza, Adelaide Belinda Masungo","doi":"10.7759/cureus.r257","DOIUrl":"https://doi.org/10.7759/cureus.r257","url":null,"abstract":"<p><p>[This retracts the article DOI: 10.7759/cureus.110978.].</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"r257"},"PeriodicalIF":1.3,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13712392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149290700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Verminous Aneurysm: A Rare Case.","authors":"Omaima Taie, Amira Benjelloun, Michel Henry, Mustafa Taberkant, Hassan Chtata, Asmaa Mikou, Claude Laurian","doi":"10.7759/cureus.118674","DOIUrl":"https://doi.org/10.7759/cureus.118674","url":null,"abstract":"<p><p>Verminous aneurysm is an exceptionally rare vascular manifestation potentially associated with parasitic infection, particularly when involving unusual anatomical locations such as the facial region. We report the case of a 30-year-old man presenting with a facial vascular lesion in the setting of a previous history of filarial infection. This exceptional case highlights the diagnostic challenges associated with suspected filarial involvement in unusual vascular lesions. Surgical management involved direct exposure and resection of the vascular lesion, with a satisfactory postoperative clinical outcome. This case contributes to the medical literature by offering a new perspective on the management of rare vascular lesions with suspected filarial involvement, particularly in unusual anatomical locations, and emphasizes the diagnostic challenges and individualized management of such vascular manifestations. The rarity of this presentation and its clinical management provide valuable insights for both research and medical practice.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118674"},"PeriodicalIF":1.3,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13712242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149290658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Population-Level Shifts in Cervical Cancer Stage Distribution in the United States Following Human Papillomavirus (HPV) Vaccine Implementation.","authors":"Eva Koshy, Christina Son","doi":"10.7759/cureus.118618","DOIUrl":"https://doi.org/10.7759/cureus.118618","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether human papillomavirus (HPV) vaccine introduction is associated with shifts in stage at cervical cancer diagnosis and to examine whether sociodemographic disparities and evolving imaging practices have influenced these observed trends.</p><p><strong>Methods: </strong>We analyzed 103,831 cervical cancer cases diagnosed between January 2004 and December 2022 from the Surveillance, Epidemiology, and End Results (SEER) database. Stage at diagnosis was classified as non-distant or distant disease and compared across sociodemographic subgroups, including age group at diagnosis (<40 vs. ≥40 years), race/ethnicity, income, and urban-rural status. Temporal trends in distant-stage disease were evaluated using a linear probability model including year of diagnosis, age group, and an age group-by-year interaction term.</p><p><strong>Results: </strong>Across the entire cohort (N = 103,831), 14,622 patients (14.1%) presented with distant-stage disease. Among patients <40 years, distant disease increased from 5.6% in 2004 to 9.2% in 2022, corresponding to an annual increase of 0.18 percentage points per year (95% CI 0.12-0.23, p < 0.001). Among patients ≥40 years, distant disease increased from 12.6% in 2004 to 20.4% in 2022, corresponding to an annual increase of 0.39 percentage points per year (95% CI 0.34-0.44, p < 0.001). The annual increase was 0.21 percentage points greater among patients ≥40 years (95% CI 0.14-0.29, interaction p < 0.001).</p><p><strong>Conclusion: </strong>Over the past two decades, distant-stage cervical cancer increased in the United States, with a significantly steeper increase among women ≥40 years than among women <40 years. The comparatively smaller increase among younger women is consistent with a possible contribution of HPV vaccination at the population level; however, individual vaccination status was unavailable, and a causal relationship cannot be established. Persistent racial, socioeconomic, and geographic disparities in distant-stage presentation emphasize the ongoing need for equitable access to vaccination and screening.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118618"},"PeriodicalIF":1.3,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13700735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Cumulative Dissipated Energy Between Two Phacoemulsification Systems Using a Modified Flip-and-Chop Technique With Multidirectional Jerking Movement From a Phacoemulsification Handpiece.","authors":"Ming Chen, Hung-Yuan Lin, Emily J Kang","doi":"10.7759/cureus.118645","DOIUrl":"https://doi.org/10.7759/cureus.118645","url":null,"abstract":"<p><p>Introduction The four-dimensional Unity phacoemulsification tip is designed to optimize tip motion and reduce time and energy consumption in cataract surgery. This study highlights a modified flip-and-chop technique with an added multidirectional jerking motion to the phacoemulsification handpiece intraocularly (referred to as the \"five-dimensional flip-and-chop\") and compares the cumulative dissipated energy (CDE) between the four-dimensional Unity system (Alcon Inc., Geneva, Switzerland) and the torsional Centurion system (Alcon Inc., Geneva, Switzerland) under this technique. Methods This is a retrospective, sequential, non-randomized comparison of 40 consecutive cases of Centurion to 40 consecutive cases of Unity performed by a single surgeon at a single ambulatory surgical suite. The initial cataract density between the groups was compared using optical coherence tomography (OCT) image quality (IQ) values from a single Maestro 2 device (Topcon, Tokyo, Japan). Results The two groups had comparable mean ages, sex distributions, and IQs. The mean CDE was significantly lower in the Unity group (5.39; SD=2.8) than in the Centurion group (8.23; SD=5.9), with p=0.0075. Conclusion Utilizing the modified \"five-dimensional flip-and-chop\" technique, the four-dimensional Unity system produced significantly lower CDE than the torsional Centurion system. The addition of this technique to the phacoemulsification handpiece may further improve the efficiency of phacoemulsification.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118645"},"PeriodicalIF":1.3,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13712403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149290632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiorespiratory Arrest in the Context of Graves' Disease: A Rare Presentation.","authors":"Mariana Marques, Joana Couto, Madalena Martins Vale, Pedro Pinto, Paula Felgueiras","doi":"10.7759/cureus.118542","DOIUrl":"https://doi.org/10.7759/cureus.118542","url":null,"abstract":"<p><p>Thyroid storm is the most severe and life-threatening expression of thyrotoxicosis, and its diagnosis remains clinical. Although sinus tachycardia and atrial fibrillation dominate its cardiovascular manifestations, malignant ventricular arrhythmias are rare, and cardiorespiratory arrest as the presenting manifestation of Graves' disease has been reported only in a limited number of cases. We report the case of a 44-year-old man with a one-week history of symptoms consistent with hyperthyroidism who suffered a witnessed out-of-hospital cardiorespiratory arrest with ventricular fibrillation as the initial rhythm. Return of spontaneous circulation was achieved after three defibrillations, and urgent coronary angiography showed no obstructive coronary artery disease. Laboratory evaluation revealed severe thyrotoxicosis with positive thyroid-stimulating hormone (TSH)-receptor antibodies, and thyroid ultrasound findings supported the diagnosis of Graves' disease. Thyroid storm was suspected and treated empirically, but the diagnosis could not be confirmed: the Burch-Wartofsky score reached the diagnostic threshold only when post-arrest coma was included, and the Japan Thyroid Association criteria were not met. Cardiac magnetic resonance imaging and an ajmaline provocation test did not identify structural heart disease, myocarditis, or a Brugada pattern. Thyroid hormone excess was therefore considered the most likely precipitant of the arrhythmia, although causality cannot be proven. The patient was maintained on antithyroid therapy, and a subcutaneous implantable cardioverter-defibrillator was implanted for secondary prevention following an individualized risk-benefit assessment. This case highlights the importance of considering thyrotoxicosis in the etiological workup of unexplained cardiac arrest. When a clearly established and reversible cause of the arrhythmia cannot be confirmed, management, including the decision on defibrillator implantation, should be based on an individualized risk-benefit assessment.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118542"},"PeriodicalIF":1.3,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13695765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Amyloidosis in Monoclonal Gammopathy of Undetermined Significance.","authors":"Samuel Copen, Stephen Copen","doi":"10.7759/cureus.118586","DOIUrl":"https://doi.org/10.7759/cureus.118586","url":null,"abstract":"<p><p>Patients with monoclonal gammopathy of undetermined significance are followed for years in hematology clinics, and most do not progress to develop defining events of multiple myeloma such as pathologic fractures or a high percentage of plasma cells on a bone marrow biopsy. Newer technologies such as cardiac MRI may lead to the definition of cardiovascular involvement by illness related to monoclonal gammopathy at an earlier time point than previously detected in clinical practice. The link between monoclonal gammopathy and an increased prevalence of transthyretin (ATTR) cardiac amyloidosis also confounds the question of whether changes detected on cardiac MRI indicate AL or ATTR cardiac amyloidosis. Here, a patient with both monoclonal gammopathy, cardiac amyloidosis, and a positive technetium pyrophosphate scan is referred for endomyocardial biopsy to clarify whether he suffers from AL or ATTR cardiac amyloidosis.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118586"},"PeriodicalIF":1.3,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13696110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mild Cognitive Impairment Identification in Geriatric and Primary Care Clinics and Driving Assessment Outcomes.","authors":"Kourosh A Moshiri, Mahon Mahmodian","doi":"10.7759/cureus.118578","DOIUrl":"https://doi.org/10.7759/cureus.118578","url":null,"abstract":"<p><strong>Background: </strong>Mild cognitive impairment (MCI) can affect complex daily activities, including driving. This quality-improvement project compared documented MCI case counts in an outpatient geriatric clinic and a traditional primary care clinic and described Department of Motor Vehicles (DMV) referral documentation and driving assessment outcomes.</p><p><strong>Materials and methods: </strong>A retrospective Epic electronic health record (EHR) review (Epic Systems Corporation, Verona, WI, USA) covered 2021-2023 and adults aged 65 years and older. Electronic G31.84 queries identified candidates; preserved basic and instrumental daily function and verified Montreal Cognitive Assessment (MoCA) scores of 19-25 were required for inclusion. Scanned MoCA tests and both DMV forms were located by manual chart review. Completed written and behind-the-wheel testing and overall pass/fail outcomes were distinguished. Counts and proportions were summarized descriptively, with exact binomial 95% confidence intervals (CIs) for assessment outcomes.</p><p><strong>Results: </strong>Clinic totals were 3,233 geriatric and 3,943 primary care visits. The geriatric query identified 60 candidates. Scanned MoCA tests were located in 36; 24 without located tests were excluded. Two scores were 11, leaving 34 eligible patients. The primary care code query returned zero patients. All 34 were offered DMV assessment through shared decision making; 17 (50.0%) had documented referrals with DMV notification and initial reporting forms in their charts. The later provider form was documented for 10 of the 17. Eight completed testing (47.1% of referred patients; 80.0% of those with the later form documented). Two passed (25.0%; 95% CI, 3.2%-65.1%) and six failed (75.0%; 95% CI, 34.9%-96.8%). Eight patients continued driving without a documented referral; the reasons were undocumented.</p><p><strong>Conclusions: </strong>Documented MCI case capture differed between clinics. Findings among assessment completers support routine clinical review of driving safety, individualized referral for formal evaluation, and coordinated follow-up. The failure proportion from this small, selected subgroup cannot be generalized to the wider MCI population. Prospective evaluation should examine patient safety, experience, and continued mobility.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118578"},"PeriodicalIF":1.3,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13696037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}