IF 1

Cureus Pub Date : 2025-01-08 eCollection Date: 2025-01-01 DOI: 10.7759/cureus.77133

Yousif F Yousif, Mahmood B Dhaif, Ali A Alaysreen, Saad I Mallah, Moosa AlHoda, Husain A Alrahma, Ahmed A Alekri, Tahera H Qaroof, Ahmed Alsaegh

{"title":"Clinical Epidemiology, Etiology, and Outcomes of Upper Gastrointestinal Bleeding at a Tertiary Center in Bahrain: A Retrospective Study.","authors":"Yousif F Yousif, Mahmood B Dhaif, Ali A Alaysreen, Saad I Mallah, Moosa AlHoda, Husain A Alrahma, Ahmed A Alekri, Tahera H Qaroof, Ahmed Alsaegh","doi":"10.7759/cureus.77133","DOIUrl":"10.7759/cureus.77133","url":null,"abstract":"Background Upper gastrointestinal bleeding (UGIB) is one of the most common major medical emergencies. This study sought to determine the epidemiology, clinical characteristics, and outcomes of UGIB in the largest major tertiary care center in Bahrain, compared to regional and international cohorts. Methods We conducted a retrospective cohort study of all patients diagnosed with UGIB between April 2021 and April 2022 in Salmaniya Medical Complex, Bahrain's largest tertiary-level public hospital. The primary outcomes measured included 30-day mortality rates and one-year readmission rates. Other variables collected included demographic factors, baseline characteristics, comorbidities, symptomatology, endoscopic findings, and etiologies of the bleeding. Results A total of 212 patients with UGIB were included. The mean age of the patients was 56.7 ± 19.1 years. More than 50% of patients with UGIB presented with melena and symptoms of anemia. The most common cause of UGIB in Bahrain was duodenal ulcers, which were found in 75 patients (37.7%). One in two patients with UGIB required packed red blood cells, while fresh-frozen plasma and platelet transfusions were reserved for severe cases. The readmission rate within one year of discharge (14.2%) was associated with smoking, cardiac history, melena, gastric malignancy, and rescope during admission. The 30-day mortality (15.6%) was associated with comorbidities of chronic kidney disease, cerebrovascular disease, and hematochezia on presentation. Conclusion Overall, the mortality rate of UGIB in Bahrain is higher than in countries in the region, the UK, and the US, signaling potential gaps in management and a reflection of a more complex patient population.","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 1","pages":"e77133"},"PeriodicalIF":1.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960559","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}

引用次数: 0

Outcomes and Prognostic Factors in Patients With Untreated Head and Neck Squamous Cell Carcinoma.

IF 1

Cureus Pub Date : 2025-01-08 eCollection Date: 2025-01-01 DOI: 10.7759/cureus.77141

Hisashi Kessoku, Yosuke Mizunari

{"title":"Outcomes and Prognostic Factors in Patients With Untreated Head and Neck Squamous Cell Carcinoma.","authors":"Hisashi Kessoku, Yosuke Mizunari","doi":"10.7759/cureus.77141","DOIUrl":"10.7759/cureus.77141","url":null,"abstract":"Objectives: Although several studies have reported the treatment prognosis in squamous cell carcinoma of the head and neck, few studies exist on the prognosis and mortality-related risk factors in untreated cases. This study aimed to determine the outcomes of patients with head and neck squamous cell carcinoma who underwent no treatment and investigate the associated factors.Methods: This retrospective, single-institution study initially included 718 patients with head and neck cancer who visited our hospital between January 2015 and December 2021; 43 untreated patients were included in the final analysis. This study was conducted in Japan, where universal health insurance ensures access to treatment for all citizens.Results: The median patient age was 79 years, with a predominance of male patients. The primary reasons for patients being untreated were patient refusal, dementia, and advanced age. The median survival time for untreated patients was 20.5 weeks, with 90% succumbing within one year of their first visit. Univariate analyses showed that an advanced clinical stage (stage IV) was a major determinant of survival. In patients with stage IV disease, living alone or without family support was the sole significant predictor of a poor prognosis.Conclusions: Our results inform healthcare providers about the consequences of not providing treatment and patients regarding treatment choices.","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 1","pages":"e77141"},"PeriodicalIF":1.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960608","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}

引用次数: 0

Chronic Progressive External Ophthalmoplegia: A Case Report.

IF 1

Cureus Pub Date : 2025-01-08 eCollection Date: 2025-01-01 DOI: 10.7759/cureus.77149

Rajiv V Seemongal-Dass, Durell J Gracen, Robin R Seemongal-Dass, Bernard Chang

引用次数: 0

Insulin-Like Growth Factor-1 (IGF-1) Deficiency and Metabolic-Dysfunction-Associated Steatotic Liver Disease in a Young Patient.

IF 1

Cureus Pub Date : 2025-01-08 eCollection Date: 2025-01-01 DOI: 10.7759/cureus.77146

Christina Flourou, Chara Azina, George Georgiou, Violetta Anastasiadou

{"title":"Insulin-Like Growth Factor-1 (IGF-1) Deficiency and Metabolic-Dysfunction-Associated Steatotic Liver Disease in a Young Patient.","authors":"Christina Flourou, Chara Azina, George Georgiou, Violetta Anastasiadou","doi":"10.7759/cureus.77146","DOIUrl":"https://doi.org/10.7759/cureus.77146","url":null,"abstract":"Metabolic-dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease in the Western world. MASLD-associated cirrhosis prevalence is on the rise along with the obesity and metabolic syndrome epidemic. Genetic factors are included in the multi-hit model of MASLD pathogenesis and insulin-like growth factor-1 (IGF-1) has an important role. We report the case of a man who was referred to a hepatology clinic due to elevated liver enzymes as probable drug-induced liver injury (DILI). A 35-year-old man was diagnosed with compensated cirrhosis with an estimated Child-Pugh score of 5 points (Class A) and underwent further investigation of the causative factor. MASLD-cirrhosis was the preliminary diagnosis, but high serum and urine copper levels needed further investigation. Whole-genome sequencing revealed heterozygosity for a rare variant of the IGF-1 receptor, a metabolic factor whose role is crucial in the GH/IGF-1 axis to fatty liver and cirrhosis. MASLD diagnosis is really challenging, especially at the progressive stages of fibrosis. Clinical features, somatometric parameters, laboratory tests and liver biopsy guide us to establish the diagnosis. Despite all these findings, the heterogeneity of disease's pathogenesis through metabolic pathways underlines the need for deeper investigation, especially genetic factors such as IGF-1 and their penetration in disease progression and liver fibrosis.","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 1","pages":"e77146"},"PeriodicalIF":1.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11709139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960583","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}

引用次数: 0

Munchausen Syndrome Presented as Guillain-Barré Syndrome: A Case Report and Literature Review.

IF 1

Cureus Pub Date : 2025-01-07 eCollection Date: 2025-01-01 DOI: 10.7759/cureus.77057

Luís Paulino Ferreira, Janice Alves, Joana Marta, Gonçalo V Bonifácio, Andre Militão

{"title":"Munchausen Syndrome Presented as Guillain-Barré Syndrome: A Case Report and Literature Review.","authors":"Luís Paulino Ferreira, Janice Alves, Joana Marta, Gonçalo V Bonifácio, Andre Militão","doi":"10.7759/cureus.77057","DOIUrl":"https://doi.org/10.7759/cureus.77057","url":null,"abstract":"Munchausen syndrome (MS), a complex form of factitious disorder (FD), presents significant diagnostic and management challenges in emergency and hospital settings. Patients deliberately fabricate or induce symptoms to gain medical attention, often leading to unnecessary interventions, resource misallocation, and iatrogenic harm. This study highlights the diagnostic complexity and the need for multidisciplinary management of Munchausen syndrome through a detailed case report and literature review. A 30-year-old woman presented with neurological symptoms mimicking Guillain-Barré syndrome (GBS), including quadriplegia and sensory deficits. Inconsistencies during physical examination and falsified imaging reports prompted further investigation, uncovering a history of fabricated symptoms and pathological lying. The psychiatric evaluation confirmed the diagnosis of Munchausen syndrome. Differentiating Munchausen syndrome from malingering, conversion disorder, and somatic symptom disorders requires meticulous evaluation and interdepartmental collaboration. Unlike malingering, Munchausen syndrome lacks external incentives, with psychological factors such as trauma and personality disorders playing a central role. Early recognition is essential to prevent unnecessary procedures, reduce costs, and avoid prolonged hospitalizations. This case underscores the need for clinical vigilance and a systematic approach to diagnosis. A multidisciplinary strategy involving psychiatry and other specialties is vital for effective management and improved patient outcomes.","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 1","pages":"e77057"},"PeriodicalIF":1.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960602","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}

引用次数: 0

A Rare Case of Epithelioid Haemangioendothelioma of the Lateral Orbit in a 22-Year-Old Patient.

IF 1

Cureus Pub Date : 2025-01-07 eCollection Date: 2025-01-01 DOI: 10.7759/cureus.77084

Jeffrey Abdullah, Amarpreet Kaur Chohan, Sadiq Mawji, Pradyumna Naredla, Matthew R Idle

引用次数: 0

Long-Term Effectiveness of Scleral Lens Treatment in the Management of Keratoconus: A Systematic Review.

IF 1

Cureus Pub Date : 2025-01-07 eCollection Date: 2025-01-01 DOI: 10.7759/cureus.77102

Adeel Mushtaq, Isaamuddin Alvi

{"title":"Long-Term Effectiveness of Scleral Lens Treatment in the Management of Keratoconus: A Systematic Review.","authors":"Adeel Mushtaq, Isaamuddin Alvi","doi":"10.7759/cureus.77102","DOIUrl":"https://doi.org/10.7759/cureus.77102","url":null,"abstract":"This systematic review evaluates the long-term effectiveness of scleral lenses in improving visual outcomes, patient satisfaction, and safety in patients with keratoconus. A systematic search of six databases (PubMed, Embase, Web of Science, Scopus, Cochrane Library, and MEDLINE) was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria included studies with more than or equal to three months of follow-up, included a minimum of 20 keratoconus patients, published after year 2020 and outcomes reporting visual acuity, comfort or quality of life. Methodological quality was assessed using the Newcastle-Ottawa Scale and Murad et al. case series tool. Five studies (463 eyes) met the inclusion criteria. Scleral lenses consistently improved best-corrected visual acuity (BCVA) across studies, with visual gains from baseline logMAR 0.50-0.53 to post-treatment logMAR 0.08-0.09. Significant improvements in vision-related quality of life (National Eye Institute Visual Function Questionnaire (NEI-VFQ) scores) were observed in validated assessments. Complications were infrequently reported but included lens handling issues (10.4%-63%), fogging (58%), and physiological events (e.g., corneal epitheliopathy). Long-term follow-up indicated that 14.6% of the patients experienced worsening visual acuity due to keratoconus progression. Methodological quality was variable, with limitations including variable outcome reporting and limited follow-up duration. Scleral lenses provide substantial and sustained improvements in visual acuity and quality of life for keratoconus patients, particularly those with advanced disease. However, the evidence is limited by methodological shortcomings and a lack of long-term controlled studies. Future research should prioritise randomised trials with standardised reporting and longer follow-up to better assess complications and durability of outcomes.","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 1","pages":"e77102"},"PeriodicalIF":1.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960587","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}

引用次数: 0

Enhancing Surgical Curriculum: Trainees' Perspectives on Laparoscopic Simulation and Assessment.

IF 1

Cureus Pub Date : 2025-01-07 eCollection Date: 2025-01-01 DOI: 10.7759/cureus.77054

Yousif Aawsaj, Jitendra Singh, Muhammad S Shamim

{"title":"Enhancing Surgical Curriculum: Trainees' Perspectives on Laparoscopic Simulation and Assessment.","authors":"Yousif Aawsaj, Jitendra Singh, Muhammad S Shamim","doi":"10.7759/cureus.77054","DOIUrl":"https://doi.org/10.7759/cureus.77054","url":null,"abstract":"Introduction Laparoscopic simulation has been used in many curricula. The United Kingdom (UK) surgical curriculum lacks summative assessment for laparoscopic skills. This study explores surgical trainees' perceptions of using simulated laparoscopic assessment as a summative tool in the UK. Methodology This was a semi-structured interview study conducted in person for 10 higher surgical trainees recruited voluntarily in the northern region of England. A thematic analysis was used to analyse the data. Results The findings generally showed positive perceptions among the trainees for simulated laparoscopic assessment. The trainees highlighted that the current assessments are formative and often subjective. Trainees suggested introducing summative assessment might fit with current changes in the national curriculum. The interviews also showed that simulated laparoscopic assessment would positively affect the trainees, curriculum, and patients. In addition, trainees expressed that the introduction of such a change should be staged and tailored to the training grade. However, the majority did not support making it part of CCT requirements. The trainees emphasised that implementing such a change can face challenges such as cost, tension between training and service provision, and culture change. The practicality of introducing simulated laparoscopic assessment was discussed in terms of skills to be assessed, fidelity, and progression signposting. Conclusion The study highlighted the trainees' perceptions about simulated laparoscopic assessment, which was generally positive, and raised issues regarding challenges in its implementation. Further discussion in surgical societies is required and in-depth research is needed before implementating simulated laparoscopic assessment for trainee certification.","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 1","pages":"e77054"},"PeriodicalIF":1.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960476","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}

引用次数: 0

Partnering With Patients to Improve a Multidisciplinary Sexual Dysfunction Program: A Survey of Patient Experience at a Single Institution.

IF 1

Cureus Pub Date : 2025-01-07 eCollection Date: 2025-01-01 DOI: 10.7759/cureus.77087

Noama Iftekhar, Patricia Mumby, Mary Lynn

{"title":"Partnering With Patients to Improve a Multidisciplinary Sexual Dysfunction Program: A Survey of Patient Experience at a Single Institution.","authors":"Noama Iftekhar, Patricia Mumby, Mary Lynn","doi":"10.7759/cureus.77087","DOIUrl":"https://doi.org/10.7759/cureus.77087","url":null,"abstract":"Background Sexual dysfunction is highly prevalent. The Loyola University Medical Center Sexual Wellness Program (LU-SWP), a multidisciplinary program, uses a biopsychosocial and educational model to collaborate with patients in their treatment. Objective This study aims to examine the reported satisfaction scores for the LU-SWP and its activities based on a patient survey completed at the end of the program. Patient involvement Patients of the LU-SWP completed surveys gauging their opinions on presentations given and techniques used during the 6-week program. These surveys aided in program adjustments that increased patient-centeredness. Methods It is a retrospective assessment of patient satisfaction scores of the LU-SWP from 2014 to 2020. Results Eighty-five of the 90 participants completed the survey, giving a 94% response rate. The mean age of the participants in this program was 49.8 years (SD = 13.768). The mean program satisfaction score was 8.51 (SD = ±1.43). Conclusions Because of this study, patient satisfaction scores aided in updating aspects of the LU-SWP. The scores give patients a voice in their care and allow previous patients to act as advocates for future patients.","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 1","pages":"e77087"},"PeriodicalIF":1.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974066","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}

引用次数: 0

Chest Pain With Significantly Elevated Troponins: Be Wary of False Positives.

IF 1

Cureus Pub Date : 2025-01-06 eCollection Date: 2025-01-01 DOI: 10.7759/cureus.77018

Taarunya T Narayanan, Tamara Naneishvili, William Moody, John Townend, Peter Ludman

引用次数: 0

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