Cureus最新文献

{"title":"Atypical Presentation of a Malignant Tumor of the Appendix: A Case Report.","authors":"Maria H Garcia Ramírez, Jose M Zepeda Torres, Luis O Suárez Carreón, Laura B Alegría López, Estefanía Íñiguez Muñoz, Rodrigo Hernández Ramírez, José de J Murrieta Vallejo, Víctor M Ulloa Ulloa, Daniel A Ángel Montoya, Juan G García González","doi":"10.7759/cureus.108201","DOIUrl":"https://doi.org/10.7759/cureus.108201","url":null,"abstract":"<p><p>A 56-year-old man presented with weight loss, abdominal pain, and altered bowel habits. Computed tomography revealed an appendiceal mass with hepatic lesions and regional lymphadenopathy, suggestive of advanced appendiceal malignancy. Surgical exploration identified a mucin-producing appendiceal tumor with metastatic involvement of the mesentery, liver, and lymph nodes. Histopathological examination confirmed an invasive, moderately differentiated mucinous adenocarcinoma of the appendix, without lymphovascular or perineural invasion. The mesenteric lesion showed malignant neoplastic cells consistent with metastatic appendiceal adenocarcinoma, infiltrating the surrounding tissue. The patient underwent surgical resection followed by systemic chemotherapy. During follow-up, clinical evolution was consistent with advanced metastatic disease requiring ongoing multidisciplinary management. This case highlights the diagnostic and therapeutic challenges of advanced appendiceal mucinous adenocarcinoma and emphasizes the importance of complete pathological characterization and coordinated oncologic care.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 5","pages":"e108201"},"PeriodicalIF":1.3,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13136546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847696","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":"From Spreadsheet To Prediction Tool: A Practical Artificial Intelligence Guide For Urologists.","authors":"Ankit Joshi, Kinju Adhikari, Ravi Taori, Deepak Krishnappa, Aadhar Jain, Lingesh Chelliah, Layeeq Fatima, Raghunath Krishnappa","doi":"10.7759/cureus.108082","DOIUrl":"https://doi.org/10.7759/cureus.108082","url":null,"abstract":"<p><p>Artificial intelligence (AI) and machine learning (ML) are transforming urological practice; however, most clinicians lack the technical background required to develop, evaluate, or critically appraise predictive models. Existing resources are often written by data scientists for a technical audience, highlighting the need for a practical, clinician-oriented framework that enables urologists to build and deploy meaningful AI tools using data they already possess. Following an overview of the AI landscape in urology, we present a structured nine-part framework that includes clinical data appraisal; data cleaning and variable engineering; model selection (e.g., logistic regression, Random Forest, Extreme Gradient Boosting (XGBoost), and Cox regression); train-test splitting; cross-validation; performance evaluation (including area under the curve (AUC), calibration, and decision curve analysis); AI-assisted coding using platforms such as Google Colab and large language models (LLMs); web application deployment (e.g., Hugging Face, Gradio, GitHub, Render, and Google Cloud); manuscript preparation aligned with Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis-Artificial Intelligence (TRIPOD-AI) reporting standards; and ethical considerations for responsible AI deployment. Each component is illustrated with real-world examples and supported by validated prompt templates. Applying this framework to a high-risk prostate cancer cohort, the lead author, without prior programming experience, successfully developed and publicly deployed a validated multi-outcome prediction tool within 72 hours using entirely free, open-source infrastructure. AI-based clinical prediction tools are increasingly accessible to urologists with structured datasets and a systematic approach. This guide aims to democratize AI model development by enabling clinicians to extract actionable insights from existing data, build validated tools, and contribute meaningfully to the evolving landscape of AI-driven urological care, without the need to write code from scratch.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 5","pages":"e108082"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824847","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":"Peripheral Precocious Puberty Revealing McCune-Albright Syndrome in a Three-Year-Old Girl: A Case Report.","authors":"Omayma El Athmani, Khadija Mouaddine, Bouchra Chkirate","doi":"10.7759/cureus.108084","DOIUrl":"https://doi.org/10.7759/cureus.108084","url":null,"abstract":"<p><p>McCune-Albright syndrome (MAS) is a rare genetic disorder characterized by the triad of café-au-lait skin pigmentation, fibrous dysplasia, and peripheral precocious puberty. We report the case of a three-year-old girl presenting with recurrent vaginal bleeding and progressive breast development. Clinical examination revealed café-au-lait macules, and hormonal evaluation showed elevated estradiol levels with suppressed gonadotropins. Pelvic ultrasound demonstrated ovarian cysts. Bone age was advanced compared to chronological age. Additional imaging with technetium-99m bone scintigraphy revealed increased radiotracer uptake in multiple long bones, suggestive of increased bone turnover and supporting skeletal involvement. These findings were consistent with a diagnosis of MAS. The patient was treated with letrozole, resulting in clinical improvement. This case highlights the importance of considering MAS in cases of peripheral precocious puberty and emphasizes the role of multimodal clinical and imaging assessment in supporting the diagnosis.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 5","pages":"e108084"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824872","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":"The Down Low Among Latino Men Who Have Sex With Men: A Review and Theoretical Analysis.","authors":"Keith R Head","doi":"10.7759/cureus.108108","DOIUrl":"https://doi.org/10.7759/cureus.108108","url":null,"abstract":"<p><p>Being on the \"down low\" (DL) describes men who identify as straight and secretly engage in same-sex encounters while maintaining heterosexual public identities. While the DL phenomenon has been discussed primarily in the context of African American men, Latino men in the United States experience similar patterns of sexual concealment shaped by cultural forces not experienced similarly by other groups. Relatively little is still known about how machismo, familismo, and religious values affect the sexual decisions and health outcomes of Latino men who have sex with men (MSM), and most existing research aggregates Latino MSM with other racial and ethnic minorities without examining their experiences separately. This article applies three theoretical frameworks to the DL among Latino men. The concealment-specific model is used to explore how the act of hiding same-sex behavior produces anxiety, depression, and ongoing self-monitoring, particularly within cultural settings where discovery threatens masculine standing and family belonging. Sexual configuration theory is used to examine why Western categories of gay and bisexual do not fit the way many Latino men understand their own sexuality, especially in cultural contexts where sexual role rather than partner gender defines sexual identity. Syndemic theory is used to examine how conditions such as homophobia, HIV stigma, substance use, poverty, and immigration status interact to worsen health outcomes for this population. The findings of this analysis suggest that DL behavior among Latino men is shaped by the interaction of cultural, psychological, and structural conditions and cannot be understood through any single framework alone. Applied in combination, these theories explain DL behavior among Latino men more fully than established Western approaches. This article is intended to support future empirical research and the development of culturally informed interventions for Latino MSM.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 5","pages":"e108108"},"PeriodicalIF":1.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824910","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":"Correction: Healthcare Worker's Satisfaction Assessment for a Healthcare Adverse Event Reporting Framework and the Management Approach for Such Reporting in the Emergency Department of Rural Government Hospitals.","authors":"Jyotsana Singh, Anita Choudhary, Somendra P Singh, Pankaj Singh","doi":"10.7759/cureus.c427","DOIUrl":"https://doi.org/10.7759/cureus.c427","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.7759/cureus.62905.].</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 4","pages":"c427"},"PeriodicalIF":1.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147825057","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":"Beyond Dementia: A Case Series of Primary Delusional Parasitosis in Cognitively Intact Octogenarians From North India.","authors":"Dhiraj Raja, Shikha Singh, Alankrita Singh","doi":"10.7759/cureus.108013","DOIUrl":"https://doi.org/10.7759/cureus.108013","url":null,"abstract":"<p><p>Delusional parasitosis is an uncommon psychiatric condition in which a person strongly believes that insects or parasites are present on or inside the body, even when there is no medical evidence to support it. Because the sensations feel real, most patients first approach dermatologists and only later come to psychiatric services. In older patients, these symptoms are often taken as part of a medical or neurological illness, such as dementia, so the possibility of a primary psychiatric condition may be overlooked. In this case series, we describe three patients aged 80 years or older who presented with similar complaints of crawling sensations, continuous itching, and a fixed belief that something was present on their bodies. All of them had already consulted several doctors before reaching psychiatry. On examination, they were alert, oriented, and able to communicate well, with only mild age-related cognitive changes that were not sufficient to diagnose dementia. Routine investigations, including blood tests, brain imaging, and dermatological evaluation, were normal in all cases. Treatment with second-generation antipsychotics led to some improvement in symptoms such as itching, sleep, and distress, but the main belief persisted. These cases suggest that, even in very old age, such symptoms are not always due to an underlying medical or brain disorder and may represent a primary psychiatric illness.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 4","pages":"e108013"},"PeriodicalIF":1.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13130268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824994","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":"The Resurgence of Dorsal Plating for Distal Radius Fractures in Malaysia: An Epidemiological Study at a Tertiary Hand Centre.","authors":"Zareze Abd Rahman, Syahril R Arsad, Rashdeen Fazwi Muhammad Nawawi","doi":"10.7759/cureus.107949","DOIUrl":"https://doi.org/10.7759/cureus.107949","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to define the contemporary epidemiological profile of adult distal radius fractures (DRFs) at a dedicated Hand and Microsurgery Centre in Malaysia.</p><p><strong>Methods: </strong> A retrospective cross-sectional study included 387 adult patients with nonpathological DRFs presenting to the Hospital Selayang, Malaysia, over a 24-month period (January 2023-December 2024). Demographic variables, injury mechanisms, fracture classifications (OTA and Frykman), and treatment modalities were analysed. Between-gender comparisons were performed using Mann-Whitney and chi-square tests.</p><p><strong>Results: </strong> The mean age was 52.8 ± 19.8 years, with a bimodal distribution peaking at 30-40 years and 65-75 years. Males predominated overall (n = 208, 53.7%), but with a striking age disparity: median age for females was 63 years compared to 39 years for males (p < 0.001). Fall on an outstretched hand (FOOSH) was the predominant mechanism (n = 233, 60.3%). Notably, fragility fractures constituted nearly half of all DRFs (n = 176, 45.5%), occurring predominantly in elderly females (n = 128, 72.7%) with a mean age of 70.1 ± 9.4 years. Conservative management with casting was employed in 75.7% (n = 293) of patients. Among surgically treated cases, volar rim plating (n = 27, 7%) and variable-angle locking compression plating (n = 21, 5.4%) were the most common.  Discussion: This study confirms a bimodal age distribution for DRFs in Malaysia but reveals an alarmingly high proportion of fragility fractures (n = 176, 45.5%), exceeding rates reported in Western populations. These findings mandate urgent implementation of fracture liaison services to address the secondary prevention gap. The predominance of conservative management, even for complex fractures, reflects regional practice patterns that warrant prospective evaluation against functional outcomes.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 4","pages":"e107949"},"PeriodicalIF":1.3,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13130828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824874","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":"Bacteriological Profile and Antibiogram of Culture-Confirmed Orthopaedic Wound Infections in a Tertiary Care Hospital.","authors":"Pinky Lahon, Manabjyoti Talukdar","doi":"10.7759/cureus.107998","DOIUrl":"https://doi.org/10.7759/cureus.107998","url":null,"abstract":"<p><p>Introduction Orthopaedic infections are one of the common causes of high morbidity and are challenging complications to treat. It includes non-healing ulcers, osteomyelitis, diabetic foot, compound fractures, and SSIs (surgical site infections), such as implant-associated infections and prosthetic joint infections. The most commonly associated organisms include <i>Staphylococcus aureus, Escherichia coli, Pseudomonas, Proteus,</i> and <i>Enterococcus </i>species. However, most of the bacterial isolates exhibit resistance to commonly used antibiotics. Moreover, the spectrum of microbial flora and the antibiotic susceptibility pattern may vary across regions. Therefore, the present study was undertaken with the primary objective of identifying the bacteria isolated from pus samples received for culture in the microbiology laboratory from the Department of Orthopaedics, Tezpur Medical College and Hospital, and determining the antimicrobial susceptibility pattern among the isolated bacteria. The secondary objectives were to analyze the distribution of culture-positive cases by age and wound aetiology and to report MRSA (methicillin-resistant <i>Staphylococcus aureus</i>) prevalence among the isolates. Materials and methods This hospital-based retrospective study was conducted between January 2023 and December 2023. A total of 76 culture-positive pus samples obtained from orthopaedic wound infections were included in the study. The samples were subjected to culture according to standard microbiological procedures and were identified using conventional biochemical tests. Antibiotic susceptibility testing was performed using the Kirby-Bauer disk diffusion method and interpreted according to the Clinical and Laboratory Standards Institute (CLSI) 2023 guidelines. Data were retrieved from laboratory records, test requisition forms, and hospital records. Results Of the 76 culture-positive pus samples, most of the positive samples were from the 21-40 age group and from male patients. The majority of the positive cultures were from compound fractures. Although Gram-negative bacilli constitute an overall large proportion, the most common isolate in the present study was <i>Staphylococcus aureus</i> (32, 42.1%). MRSA accounts for 3/32 (9.4%) among the <i>Staphylococcus aureus</i> isolates. Overall, the Gram-positive bacteria demonstrated higher susceptibility to linezolid and levofloxacin, whereas the Gram-negative bacteria showed good susceptibility to aztreonam, carbapenems (imipenem and meropenem), and piperacillin/tazobactam. Conclusion The study highlights the diverse bacterial aetiology of orthopaedic wound infections, with <i>Staphylococcus aureus</i> being the most predominant organism. It provides insight into the need for periodic surveillance to determine the local bacterial profile and its antibiogram to initiate effective empirical therapy and optimize patient outcomes.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 4","pages":"e107998"},"PeriodicalIF":1.3,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824916","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":"Complex Regional Pain Syndrome Following CO₂ Laser Labioplasty: A Case Report and Multimodal Interventional Management.","authors":"Joseph A Veraza, Mabel Z Almeida","doi":"10.7759/cureus.107979","DOIUrl":"https://doi.org/10.7759/cureus.107979","url":null,"abstract":"<p><p>Complex Regional Pain Syndrome (CRPS) is an uncommon and potentially debilitating neuropathic pain condition that may develop after surgical or iatrogenic nerve injury. Although CRPS predominantly affects the extremities, pelvic and perineal involvement is rare and poorly characterized. We report the case of a 54-year-old woman who developed CRPS following CO₂ laser labioplasty performed as part of a combined gynecologic surgical procedure. The patient presented with progressive neuropathic pain, allodynia, vasomotor and trophic skin changes, and motor impairment predominantly affecting the perineal region and right lower limb. Structural pathology was excluded by imaging. The diagnosis of CRPS was established using the Budapest Criteria. Initial pharmacologic therapy and a selective pudendal nerve block provided limited and transient relief. A multimodal interventional strategy combining repeated caudal epidural blocks, intravenous lidocaine and magnesium sulfate, and epidural preservative-free ketamine resulted in complete pain resolution, reversal of trophic changes, and full functional recovery. This case highlights CRPS as a potential complication of CO₂ laser labioplasty and supports early, mechanism-based multimodal interventional management in refractory cases, particularly when central sensitization is suspected.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 4","pages":"e107979"},"PeriodicalIF":1.3,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824993","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":"Thyroid-Stimulating Hormone (TSH)-Secreting Pituitary Tumor Misdiagnosed for 20 Years: Possible Effect of Long-Term Treatment With Thyroid Hormone.","authors":"Rodhan Khthir","doi":"10.7759/cureus.107985","DOIUrl":"https://doi.org/10.7759/cureus.107985","url":null,"abstract":"<p><p>Thyroid-stimulating hormone (TSH)-secreting pituitary adenomas (TSHomas) are rare causes of central hyperthyroidism. Misdiagnosis may lead to prolonged inappropriate thyroid hormone therapy. I present a 65-year-old woman who was treated with high-dose levothyroxine for 20 years for presumed primary hypothyroidism despite persistently elevated TSH with normal to high free T4 and T3 levels. Central hyperthyroidism was not considered. A 9-11 mm pituitary lesion remained stable for two decades. Biochemical evaluation revealed an elevated alpha-subunit with negative heterophile antibodies, confirming a TSHoma. She underwent transsphenoidal resection; pathology confirmed a plurihormonal PIT-1-positive adenoma. This case challenges the traditional view that TSHomas are uniformly resistant to thyroid hormone feedback. The tumor's long-term radiographic stability during supraphysiologic levothyroxine therapy raises the possibility of partial feedback sensitivity. The absence of measurable growth over two decades could be supportive of this hypothesis. Discordant thyroid function tests should prompt evaluation for central hyperthyroidism. Biological heterogeneity among TSHomas may influence tumor behavior and therapeutic responsiveness.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 4","pages":"e107985"},"PeriodicalIF":1.3,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13130833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824838","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}