Cureus最新文献

{"title":"Predictors of Mortality in Acute Myocardial Infarction Patients With Systemic Lupus Erythematosus.","authors":"Etuk Aniekeme, Bruno De Souza Goncalves, Komal Sodhi, Carlos Rueda Rios, Ellen Thompson","doi":"10.7759/cureus.79578","DOIUrl":"10.7759/cureus.79578","url":null,"abstract":"<p><p>Introduction Acute myocardial infarction (AMI) remains a leading cause of mortality globally, with systemic lupus erythematosus (SLE) posing additional risks for adverse outcomes. Methods This retrospective cohort study utilized data from the Healthcare Cost and Utilization Project National Inpatient Sample from 2016 to 2020 to investigate predictors of mortality among hospitalized AMI patients, stratified by SLE status. Results A total of 81,935 patients were included, with variables analyzed using multivariate logistic regression. Among SLE patients, being female, aged ≥65 years, and having a prolonged hospital stay >5 days were associated with higher mortality. Elective admissions were protective while non-Hispanic Black SLE patients showed reduced odds of mortality compared to their non-Hispanic White counterparts. Among non-SLE patients, predictors of increased mortality included being non-Hispanic Black and having prolonged hospital stays. Private insurance coverage was associated with lower mortality in this group. Conclusion These findings highlight critical patient- and hospital-related factors influencing mortality in AMI patients with and without SLE. Targeted strategies focusing on early recognition, effective interventions, and reducing healthcare disparities are essential to improve outcomes in this population.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 2","pages":"e79578"},"PeriodicalIF":1.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11856213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506573","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":"Enhancing Pediatric Bone Age Assessment Using Artificial Intelligence: Implications for Orthopedic Surgery.","authors":"Nalin Zadoo, Nathaniel Tak, Akshay J Reddy, Rakesh Patel","doi":"10.7759/cureus.79507","DOIUrl":"10.7759/cureus.79507","url":null,"abstract":"<p><p>Background Bone age assessment is a critical tool in pediatric orthopedic surgery, guiding treatment decisions for growth-related disorders and surgical interventions. Traditional methods, such as the Greulich-Pyle and Tanner-Whitehouse techniques, rely on manual interpretation of hand and wrist radiographs, making them time-intensive and susceptible to inter-operator variability. Artificial intelligence (AI) has emerged as a promising tool to enhance accuracy, efficiency, and standardization in skeletal maturity assessment. Methods This study evaluates the application of AI in pediatric bone age prediction using the Radiological Society of North America (RSNA) 2017 Pediatric Bone Age Challenge dataset. A deep learning model based on the ResNet-50 architecture (Microsoft Research, Redmond, Washington, USA) was developed and trained on 12,611 hand and wrist radiographs, validated on 1,425 images, and tested on 200 images. Model performance was assessed using root mean square error (RMSE), mean absolute error (MAE), and coefficient of determination (R²). Results The AI model achieved an RMSE of 11.07 months, an MAE of 8.54 months, and an R² of 0.929, indicating strong alignment with radiologist-determined bone ages. The Pearson correlation coefficient (0.963) and Spearman's rank correlation (0.955) confirmed the model's predictive robustness. Compared to traditional methods, which have reported variability with errors ranging from 6 to 18 months, the AI model demonstrated a reduction in inter-operator variability and improved reliability. Conclusion The implementation of AI in bone age assessment offers a more standardized, rapid, and precise alternative to conventional methods. By improving the accuracy and efficiency of skeletal maturity evaluations, AI has significant implications for pediatric orthopedic surgery, optimizing treatment timing and expanding access to high-quality bone age assessments. Further validation studies are needed to ensure clinical applicability across diverse patient populations.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 2","pages":"e79507"},"PeriodicalIF":1.0,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11847569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484897","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":"Punch Biopsy as a Diagnostic Keystone for Metastatic Cardiac Angiosarcoma Treated With Anthracycline-Based Chemotherapy: A Case Report.","authors":"Aonghus Joyce, Gráinne Murphy, Cynthia C Heffron, David Aherne, Richard M Bambury","doi":"10.7759/cureus.79524","DOIUrl":"10.7759/cureus.79524","url":null,"abstract":"<p><p>Angiosarcoma is a rare, aggressive malignancy originating from endothelial cells and associated with a poor prognosis. Diagnosis is histologically challenging. We present a rare case of cardiac angiosarcoma involving multiple presentations and investigations, which were inconclusive until a diagnosis was finally reached on a biopsy of a cutaneous lesion. Clinical and radiologic response to systemic anthracycline-based chemotherapy is discussed. This is the first reported case of right atrial primary cardiac angiosarcoma presenting with cardiac symptoms rather than systemic symptoms. The case illustrates the challenges associated with the diagnosis of this rare malignancy. It also highlights the feasibility of using anthracycline-based chemotherapy despite the potential cardiotoxicity of these agents.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 2","pages":"e79524"},"PeriodicalIF":1.0,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11859415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517760","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":"Feasibility of Proton Beam Therapy for Para-Aortic Lymph Node Recurrence in Patients With Gynecologic Cancer After Pelvic Irradiation: A Case Series.","authors":"Yuka Mizuno, Ayumi Shikama, Kaoru Fujieda, Hiroya Itagaki, Yuri Tenjimbayashi, Yusuke Kobayashi, Tsukasa Saida, Takashi Saito, Hideyuki Sakurai, Toyomi Satoh","doi":"10.7759/cureus.79514","DOIUrl":"10.7759/cureus.79514","url":null,"abstract":"<p><strong>Aim: </strong>Irradiation of para-aortic lymph node recurrences in patients with prior pelvic irradiation raises concerns about overlapping irradiated fields, which should be minimized to reduce severe adverse events. We report six gynecologic cancer patients treated with proton beam therapy for para-aortic lymph node recurrence after pelvic irradiation.</p><p><strong>Methods: </strong>Six patients who received proton beam therapy for para-aortic lymph node recurrence after pelvic irradiation between 2010 and 2022 were included. Overlapping fields were assessed using the 50% dose distance between the initial and proton therapy fields.</p><p><strong>Results: </strong>A 5- to 10-mm overlap was observed in three patients. Grade 2 rectal hemorrhage occurred in three patients, grade 3 hematuria in two, and grade 4 sigmoid perforation in one. These adverse events were linked to pelvic irradiation and peritoneal dissemination. Among five patients who died, the median survival after proton therapy was 13 months (range: 9-34). One patient survived with disease at 34 months. Re-enlargement of treated para-aortic lymph nodes was not observed in four patients.</p><p><strong>Conclusions: </strong>Proton beam therapy was well-tolerated and achieved favorable local control in para-aortic lymph node recurrence after pelvic irradiation. It may be a useful option for gynecologic cancer patients with overlapping irradiated fields.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 2","pages":"e79514"},"PeriodicalIF":1.0,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143495086","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":"Evaluation of the Antimicrobial Activity of 20 Essential Oils and Their Combinations on Bacterial and Fungal Strains.","authors":"Nihal Ezzariga, Abdellah Moukal, Ali Asdadi, Zohra Lemkhente, Fatima Moustaoui, Abderrazak Kaaya, Mohamed Aghrouch","doi":"10.7759/cureus.79499","DOIUrl":"10.7759/cureus.79499","url":null,"abstract":"<p><strong>Introduction: </strong>Growing antibiotic resistance is driving the search for natural alternatives, such as essential oils (EOs), which are known for their antimicrobial properties. This study evaluated the antimicrobial efficacy of 20 EOs on bacterial and fungal strains and the impact of their combinations.</p><p><strong>Materials and methods: </strong>Twenty EOs were selected to evaluate their antimicrobial potential in vitro. Stock solutions were prepared and tested on three bacterial strains (<i>Staphylococcus aureus, Escherichia coli</i>, and <i>Pseudomonas aeruginosa)</i> and three yeast strains of the genus <i>Candida</i>. The antimicrobial activity of EOs was initially evaluated by aromatogram, making it possible to classify oils according to their effectiveness. The sensitivity of microorganisms to EOs was then determined by measuring the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). EO combination tests were also performed to detect synergistic or antagonistic effects.</p><p><strong>Results: </strong>Tests revealed that <i>Origanum vulgare, Cymbopogon citratus,</i> and <i>Thymus leptobotrys</i> were particularly effective against Gram-positive bacteria and yeasts, while others, such as <i>Citrus limon</i>, showed negligible activity. The combinations of oils generally produced indifferent or antagonistic effects, especially against <i>P. aeruginosa.</i> Conclusion: The results could open new perspectives for natural antimicrobial treatments, thus contributing to the fight against antibiotic resistance. In addition, the study will highlight the importance of judicious use of EO combinations to avoid interactions that could compromise their effectiveness.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 2","pages":"e79499"},"PeriodicalIF":1.0,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11847504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484920","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 Case of Pancreaticoduodenectomy for Grade V Traumatic Pancreatic Injury in an Elderly Patient.","authors":"Tsuyoshi Terada, Susumu Matushime, Keisuke Kamo, Kazuki Hashida, Nobuichiro Tamura","doi":"10.7759/cureus.79533","DOIUrl":"10.7759/cureus.79533","url":null,"abstract":"<p><p>Traumatic pancreatic injury is a rare condition, but cases involving main pancreatic duct injury often require surgical intervention and are associated with high mortality rates. Recently, two-stage surgical approaches, with initial damage control surgery followed by delayed pancreatic resection and reconstruction, have been increasingly reported. However, we argue that not all cases need a two-stage approach; instead, surgical strategies should be tailored based on the patient's vital signs. Furthermore, in pancreatic surgery, effective collaboration between trauma surgeons and hepatopancreatobiliary (HPB) surgeons is essential. Here, we report a case of a grade V traumatic pancreatic injury in an elderly patient that was successfully managed with one-stage pancreaticoduodenectomy, performed through coordinated efforts between trauma and HPB surgeons, resulting in a favorable outcome.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 2","pages":"e79533"},"PeriodicalIF":1.0,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11859414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517748","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":"Mediastinal Lymphadenopathy Diagnosed as Prostate Cancer via Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) in a Patient With a History of Renal Cell Carcinoma: A Case Report.","authors":"Naoaki Tsuji, Hirai Soichi, Kano Yukari, Tanimura Mai, Shiotsu Shinsuke","doi":"10.7759/cureus.79446","DOIUrl":"10.7759/cureus.79446","url":null,"abstract":"<p><p>In individuals with a history of renal cell carcinoma (RCC), mediastinal lymphadenopathy is frequently attributed to metastatic recurrence. However, secondary malignancies, despite their rarity, should also be considered. During routine follow-up examinations, a 63-year-old male with a history of renal cell carcinoma demonstrated progressive mediastinal lymphadenopathy. This was initially suspected to be a recurrence of renal cell carcinoma (RCC). The diagnosis of metastatic prostate adenocarcinoma was confirmed by prostate biopsy and elevated prostate-specific antigen (PSA) levels, as determined by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Treatment with androgen deprivation therapy (ADT) and chemotherapy was initiated after the patient was diagnosed with metastatic prostate cancer. This case underscores the critical role of EBUS-TBNA in the accurate diagnosis of patients with a history of RCC who demonstrate atypical mediastinal lymphadenopathy. The provision of tissue samples for histopathological analysis by EBUS-TBNA facilitated the differentiation between metastatic recurrence and secondary malignancies. Comprehensive diagnostic methods, including tumor marker analysis, immunohistochemistry, and tissue biopsy, are essential for accurate diagnosis. EBUS-TBNA is indispensable for accurate diagnosis, especially in differentiating metastatic recurrence from secondary malignancies, as it provides a minimally invasive method of tissue access for precise evaluation.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 2","pages":"e79446"},"PeriodicalIF":1.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143485084","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":"Ectopic Pancreatic Tissue in the Gallbladder Following Laparoscopic Cholecystectomy: A Rare Case.","authors":"Mustafa Anil Turhan, Furkan Atakan Akin, Zumrut Merve Yasaran Benk","doi":"10.7759/cureus.79445","DOIUrl":"10.7759/cureus.79445","url":null,"abstract":"<p><p>Ectopic pancreatic tissue (EPT) is a rare clinical condition characterized by the presence of pancreatic tissue without any anatomical or vascular connection to the main pancreas. We aim to present a highly unusual case of EPT (fewer than 40 reported cases in the literature), located in the wall of the gallbladder. A 41-year-old female presented with episodes of right upper quadrant and epigastric pain, nausea, and vomiting. Diagnostic imaging revealed multiple gallstones, with the largest measuring 12 mm. The gallbladder wall was normal in thickness, and there were no abnormalities in the liver, bile ducts, spleen, or pancreas. Laboratory tests were normal, except for iron-deficiency anemia. Amylase and lipase levels were within normal limits. The patient underwent an uncomplicated elective laparoscopic cholecystectomy. Pathological examination of the gallbladder revealed chronic cholecystitis and EPT classified as type 3 EPT according to the Gaspar Fuentes classification. Due to its various clinical presentations and the low discriminative power of routine imaging tests, preoperative diagnosis of EPT is nearly impossible. However, considering the potential for malignant transformation and complications of EPT, physicians should be aware of this clinical entity and consider cholecystectomy when there is a high degree of suspicion. EPT in the gallbladder is an extremely rare finding. Patients are either asymptomatic or present with nonspecific symptoms, and the definitive diagnosis is almost always made through pathological examination following cholecystectomy.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 2","pages":"e79445"},"PeriodicalIF":1.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484830","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 Dilemma in the Diagnosis of Group A Streptococcus (GAS) Meningitis Versus Drug-Induced Aseptic Meningitis: A Case Report.","authors":"Rahul Sharma, Nadim Jaafar, Navami Guru, Edward Oh, Siddartha Guru","doi":"10.7759/cureus.79443","DOIUrl":"10.7759/cureus.79443","url":null,"abstract":"<p><p>Group A <i>Streptococcus</i> (GAS), also called <i>Streptococcus pyogenes</i>, is a rare cause of adult meningitis. In recent years, many outbreaks of invasive <i>S. pyogenes</i> infections in Europe, involving the <i>emm</i>1.0 subtype of the M1UK lineage, have led to a rising prevalence of GAS meningitis. We present a case with a diagnostic dilemma involving a 55-year-old female with otitis media, <i>S. pyogenes</i> bacteremia, and symptoms of meningitis. However, cerebrospinal fluid (CSF) tests were not completely consistent with bacterial meningitis, with normal glucose levels on CSF analysis, no organism seen on gram stain, and no growth on CSF culture. Drug-induced aseptic meningitis (DIAM) was considered, given the patient's use of ibuprofen prior to admission, and thus, non-steroidal anti-inflammatory drugs (NSAIDs) were avoided during her hospitalization. The GAS bacteremia was treated with intravenous ampicillin. She improved a few days later, but we are uncertain whether the antibiotics or the avoidance of NSAIDs resolved her meningitis symptoms. On discharge, ampicillin was switched to intravenous ceftriaxone, 2 g every 12 hours, to treat possible GAS meningitis for a four-week duration.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 2","pages":"e79443"},"PeriodicalIF":1.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143495084","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":"Magnetic Resonance Imaging (MRI) Findings in Pediatric Autoimmune Encephalitis: A Case Report.","authors":"Amira E Raslan","doi":"10.7759/cureus.79453","DOIUrl":"10.7759/cureus.79453","url":null,"abstract":"<p><p>Autoimmune encephalitis (AE) is a rare condition that involves an immune-mediated attack on the brain, often presenting with seizures, altered consciousness, and other neuropsychiatric symptoms. This case report describes a seven-year-old girl who presented with acute brain dysfunction, including seizures and disturbed consciousness, following a gastrointestinal illness. Magnetic resonance imaging (MRI) findings revealed early signs of AE, including hyperintensities in the external capsules and medial temporal lobe. Following negative infectious workups, the diagnosis of AE was confirmed, and the patient was treated with immunomodulatory therapy, leading to gradual improvement. This case emphasizes the importance of early recognition, the role of MRI in diagnosis, and the need for prompt treatment to improve outcomes in pediatric AE.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 2","pages":"e79453"},"PeriodicalIF":1.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143495088","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}