Cureus最新文献

{"title":"Long-Term Outcomes of Sleeve Gastrectomy Versus Gastric Bypass.","authors":"Omar Alaidaroos, Azzam A Al Jaber, Abdulrahman A Al Jaber, Abdullah H Alshehri, Majed B Alkehaimi, Omar A Alsannat","doi":"10.7759/cureus.72961","DOIUrl":"10.7759/cureus.72961","url":null,"abstract":"<p><strong>Background: </strong>Extremely obese patients can benefit greatly from bariatric surgery, a common and successful therapeutic procedure for treating obesity and accompanying medical issues. Although sleeve gastrectomy and gastric bypass have already demonstrated their effectiveness in this demographic, long-term results were not stated in the literature. The purpose of this research is to examine the long-term outcomes of sleeve gastrointestinal surgery and gastric bypass.</p><p><strong>Method: </strong>This retrospective, single-center study compares 100 patients aged 25 years and older who visited the gastrointestinal tract surgical unit at Dar El-Fouad Hospital in Cairo, Egypt, between January 1 and August 31, 2019, according to the inclusion and exclusion criteria. The patients underwent either a Roux-en-Y gastric bypass (RYGB-50%) or sleeve gastrectomy (SG-50%) for severe obesity. Follow-up occurred at one year and up to four years following surgery to collect information from the study subjects. Two tools were used to assess BMI, weight loss, complications after surgery, and incidence outcome of comorbidities after the two surgeries. Qualitative data were presented as number and percentage and frequency distribution tables, and every analysis was done at a significance value < 0.05.</p><p><strong>Result: </strong>The average age of patients within the SG group was 43.02 ± 9.19 years, whereas the average age of patients within the RYGB group was 41.02 ± 11.06 years. In addition, 74% of patients were women in both procedures. The BMI mean of the SG group was 43.90 ± 5.78, the BMI mean of the RYGB group was 42.73 ± 5.12, and the main comorbidity in both techniques was joint pain. The mean BMI at one year was 29.70 kg/m² after SG compared with 28.64 kg/m² after RYGB. After four years, BMI was regained within the obese range in both techniques - 30.67 kg/m² and 30.32, respectively. Fewer postoperative complications occurred in SG than in RYGB. RYGB was superior to SG in managing dyslipidemia (DL), hypertension (HT), type 2 diabetes (T2DM), joint pain, and gastroesophageal reflux disease (GERD).</p><p><strong>Conclusion: </strong>There are no significant differences between the SG and RYGB in long-term outcomes regarding BMI before surgery and at follow-up, after four years, while there were statistically significant differences between them after four years than one year after surgery, and both groups showed a significant decrease in weight. However, RYGB shows improvement to some extent in comorbidities within follow-up period, including BMI, T2DM, HT, DL, HT, DL, GERD, and joint pain than SG, but with a higher rate of minor complications, while greater resolution of OSAS occurred in SG. Finally, at four years, there were no discernible variations in BMI between SG and RYGB because the patients' mean BMI was within the obese range once more.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11533043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577274","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":"Pediatric Collagenous Gastroduodenitis: A Rare Cause of Iron-Deficiency Anemia.","authors":"Palack Agrawal, Keshav Bhattar, Claudia Rojas, Jacqueline Larson","doi":"10.7759/cureus.72939","DOIUrl":"10.7759/cureus.72939","url":null,"abstract":"<p><p>Collagenous gastroenteritidesare rare disorders of unknown etiology diagnosed histologically by marked subepithelial deposition of collagen bands thicker than 10µm in the lamina propria with a mononuclear inflammatory infiltrate. Collagenous gastritis (CG) is divided into two phenotypes - pediatric-onset and adult-onset. Up until recently, pediatric-onset CG was thought to be confined to the stomach presenting with abdominal pain and anemia with limited involvement of the colon. Whereas adult-onset CG is often associated with involvement of the small and/or large intestine presenting with chronic non-bloody diarrhea and weight loss. It is now acknowledged that adult-onset and pediatric-onset CG should be considered a similar disease on a continuous spectrum. There are limited case reports of pediatric patients diagnosed as CG with concurrent collagenous duodenitis (CD) and/or collagenous colitis (CC). There are no accepted therapeutic standards for treating these patients. We present a rare case of an adolescent male with selective IgA deficiency and growth hormone deficiency presenting with severe iron deficiency anemia and abdominal pain with an ultimate diagnosis of collagenous gastroduodenitis with suspected jejunal involvement.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11532023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577276","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":"Psychiatric Camouflage: A Case Series.","authors":"Sreedevi S, Deepthi Pallurath Thekkethil, Bindu Menon","doi":"10.7759/cureus.72912","DOIUrl":"10.7759/cureus.72912","url":null,"abstract":"<p><p>Organic brain disorders are often camouflaged by psychiatric manifestations. Management of such 'pseudo-psychiatric' illnesses can be complicated due to the disruptive behaviour of the patients and/or lack of appropriate response to treatment. In this case series, we present three cases, each of which was initially diagnosed as a psychiatric illness but was later found to have an underlying neurological disorder. The presence of atypical symptoms, poor response to medications, disproportionate cognitive impairment and delirium should act as warning signs for the clinician to look for an underlying organic brain disorder.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577279","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":"Strategies to Overcome Erroneous Outcomes in Reverse Transcription-Polymerase Chain Reaction (RT-PCR) Testing: Insights From the COVID-19 Pandemic.","authors":"Sm Shafiul Alam Sajal, Dewan Zubaer Islam, Shahad Saif Khandker, Elizabeth Solórzano-Ortiz, Manal Fardoun, Md Firoz Ahmed, Mohd Raeed Jamiruddin, Nafisa Azmuda, Miral Mehta, Santosh Kumar, Mainul Haque, Nihad Adnan","doi":"10.7759/cureus.72954","DOIUrl":"10.7759/cureus.72954","url":null,"abstract":"<p><p>The reverse transcription-polymerase chain reaction (RT-PCR) test to detect SARS-CoV-2, the virus causing COVID-19, has been regarded as the diagnostic gold standard. However, the excessive sensitivity of RT-PCR may cause false-positive outcomes from contamination. Again, its technical complexity increases the chances of false-negatives due to pre-analytical and analytical errors. This narrative review explores the elements contributing to inaccurate results during the COVID-19 pandemic and offers strategies to minimize these errors. False-positive results may occur due to specimen contamination, non-specific primer binding, residual viral RNA, and false-negatives, which may arise from improper sampling, timing, labeling, storage, low viral loads, mutations, and faulty test kits. Proposed mitigation strategies to enhance the accuracy of RT-PCR testing include comprehensive staff training in specimen collection, optimizing the timing of tests, analyzing multiple gene targets, incorporating clinical findings, workflow automation, and implementing stringent contamination control measures. Identifying and rectifying sources of error in RT-PCR diagnosis through quality control and standardized protocols is imperative for ensuring quality patient care and effective epidemic control.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11532724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577280","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 Modified Mucosal Incision for Easy Entry Into the Submucosal Space During Peroral Endoscopic Myotomy.","authors":"Krishn K Rawal, Avval Sadikot, Chintan Kansagra, Chintan Mori","doi":"10.7759/cureus.72914","DOIUrl":"10.7759/cureus.72914","url":null,"abstract":"<p><p>A technique of modified mucosal incision is discussed here for easy submucosal entry during peroral endoscopic myotomy (POEM). An L-shaped mucosal incision was used during peroral endoscopic myotomy in six cases of achalasia cardia. The incision was closed by clips in all the cases after the complete myotomy. Peroral endoscopic myotomy was successful in all six cases without any complication. The mucosal incision was closed by clips without any difficulty. The L-shaped mucosal incision for submucosal entry during peroral endoscopic myotomy made the procedure easy and quick.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11531799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570759","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":"Adaptive Approach to Treating Cervical Cancer in a Patient With Dramatic Uterine Movement.","authors":"Mohammad Ghafouri, Steven Miller, Jay Burmeister, Ramesh Boggula","doi":"10.7759/cureus.72938","DOIUrl":"10.7759/cureus.72938","url":null,"abstract":"<p><p>Adaptive radiation therapy is a modern technological advancement that allows radiation treatments to be adjusted daily to account for changes in the patient's anatomy, such as bladder and rectal filling, as well as changes in the tumor volume and position. In this case report, we present a patient with locally advanced cervical cancer who received definitive radiation therapy of 4500 cGy in 25 fractions using the Varian's Ethos system. We observed substantial daily uterine movement, which required re-optimization of each treatment fraction. Without the daily plan adaptation, the treatment would have resulted in markedly suboptimal dose coverage to the tumor. This case report highlights the importance of adaptive radiotherapy in managing anatomical changes in cervical cancer treatment and improving outcomes.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577265","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":"Prevalence and Risk Factors Associated With Carpal Tunnel Syndrome Among Sudanese Females: A Cross-Sectional Study.","authors":"Gaffar Abbas, Mohamed B Ahmed, Fatima S Almohannadi, Khaled E Elzawawi, Ahmed B Ahmed, Abeer Alsherawi","doi":"10.7759/cureus.72943","DOIUrl":"10.7759/cureus.72943","url":null,"abstract":"<p><strong>Background: </strong>Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy resulting from compression of the median nerve. This condition is more common in females than in males. The earlier the diagnosis, the better the prognosis and treatment outcomes.</p><p><strong>Material and methods: </strong>This is a cross-sectional hospital-based study conducted at Soba Teaching Hospital in obstetrics and gynecology outpatient clinic in Khartoum in the period from February 2022 to March 2022. A simple random sampling was applied, and an interview was conducted using a four-part questionnaire. The first part was based on socio-demographic data, the second was lifestyle, and the third and fourth were based on the Boston Carpal Tunnel Questionnaire (BCTQ). The data were analyzed using the statistical package for social sciences (SPSS) software, version 23 (IBM Corp., Armonk, NY) to find the correlation between the various variables.</p><p><strong>Results: </strong>A total of 113 women participated in the study (response rate=100%). The prevalence of CTS was found to be 5%. No significant association was found between lifestyle and medical history, e.g., obesity and oral contraceptives and CTS were p=0.167, 0.841 respectively. Conversely, there was a significant association between age and residency, with p=0.005 and 0.049, respectively.</p><p><strong>Conclusions: </strong>The prevalence of CTS is increasing in Sudan. Therefore, it is essential to thoroughly assess patients for any symptoms related to hand pain by asking detailed questions during consultations. In addition, further studies covering more states are needed to better understand the regional variation in CTS prevalence.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11532370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577454","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":"Evaluating the Clinical Impact of Ureteral Frozen Section Analysis During Radical Cystectomy: A Single-Center Retrospective Study.","authors":"Saleh Al-Gburi, Magi Williams, Ketan Agarwal, Thiagarajan Nambirajan","doi":"10.7759/cureus.72908","DOIUrl":"10.7759/cureus.72908","url":null,"abstract":"<p><p>Introduction The objective of this study is to find out if there are any differences in upper urinary tract recurrence and overall mortality between patients who underwent a frozen section analysis during radical cystectomy and those who did not. Materials and methods In an observational retrospective cohort study, we evaluated data from 164 patients who underwent radical cystectomy in our institution over a five-year period from 2013 to 2018. Fisher's exact test was applied to find any difference in upper urinary tract recurrence between the two groups. The Kaplan-Meier method and the log-rank (Mantel-Cox) test were used to determine differences or equivalence between treatment groups. Results The sensitivity was 84.6% and the specificity was 95.3% for the frozen section. There was no statistically significant relationship between performing a frozen section and upper urinary tract recurrence, as indicated by Fisher's exact test (p=0.619). The Kaplan-Meier test showed no statistically significant relationship between performing a frozen section analysis and overall mortality. Discussion The use of ureteric frozen section analysis during radical cystectomy is traditionally taught during surgical training, but the evidence base for this practice is sketchy. Frozen section analysis is thought to reduce the chances of local recurrence and arguably upper urinary tract recurrence. The overall upper urinary tract recurrence after radical cystectomy is reported to be 2-6%, consistent with the 3.3% observed in our study. Conclusion Our study demonstrates that while frozen section analysis is sensitive and specific in detecting dysplasia, it does not significantly impact upper tract recurrence or overall mortality.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577271","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":"Incidental Finding of a Persistent Left Superior Vena Cava During Permanent Dual-Chamber Pacemaker Implantation: A Case Report.","authors":"Shehnoor Kaur, Shaik Firdaus, Jhiamluka Solano, Sachin Manjunath, Adnan Ahmed","doi":"10.7759/cureus.72865","DOIUrl":"10.7759/cureus.72865","url":null,"abstract":"<p><p>Persistent left superior vena cava (PLSVC) is a rare congenital venous anomaly. It is often asymptomatic and has atypical venous drainage that can complicate central venous catheterisation, pacemaker implantation, and cardiac surgeries. In most cases, the PLSVC drains into the right atrium via the coronary sinus, but in a minority of cases, it drains into the left atrium, leading to a right-to-left shunt, which can cause mild hypoxia or paradoxical embolism. Due to its abnormal anatomy, PLSVC can complicate lead placement during permanent pacemaker (PPM) insertion. Lead navigation becomes more complex, sometimes necessitating alternative lead placement techniques or imaging guidance to ensure proper functionality. In most cases, the PLSVC is identified incidentally during the initial venogram. We present the case of a 64-year-old male with sarcoidosis, hypercholesterolemia, hypertension, hepatitis, and recent atrial fibrillation (AF) who presented for elective direct current cardioversion (DCCV). Pre-DCCV, the ECG showed AF with a slow ventricular response, and following a 200-joule synchronised shock as per local protocol, sinus rhythm was restored. Post-DCCV ECG showed a first-degree AV block, which progressed to an intermittent 2:1 block, leading to a decision to implant a dual-chamber PPM. An echocardiogram revealed normal left ventricular function, a dilated left atrium and normal right ventricle, mild tricuspid regurgitation, and a possible patent foramen ovale (PFO). A venogram performed during PPM implantation revealed a PLSVC, which posed challenges in lead placement. Despite initial success, a post-procedure chest X-ray revealed displacement of the atrial lead, prompting a successful repositioning. The patient remained stable and asymptomatic; outpatient follow-ups showed satisfactory PPM function. PLSVC is a congenital anomaly arising from incomplete regression of the left anterior cardinal vein during embryonic development. Though it is often discovered incidentally, the anomaly becomes clinically significant during procedures such as pacemaker implantation due to its impact on venous anatomy and lead placement. This case also underscores the need for specialised techniques when managing patients with PLSVC during device implantation. Given the abnormal venous pathway, alternative strategies such as utilising the coronary sinus or imaging guidance, like fluoroscopy, may be necessary to ensure proper lead placement and avoid complications such as lead displacement or venous thrombosis. The literature supports using advanced imaging modalities and tailored surgical approaches to improve outcomes in patients with PLSVC. Ultimately, this case illustrates the complexity of cardiac device implantation in the presence of venous anomalies and highlights the importance of individualised procedural planning to optimise patient care and reduce the risk of complications.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11531317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570771","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":"Non-invasive Gamma Brain Wave Optimization (BWO-G) for Cognitive and Emotional Recovery in an Adolescent: A Case Study on Radio Electric Asymmetric Conveyer (REAC) Neuro Psycho Physical Optimization (NPPO) BWO-G Treatment.","authors":"Valeria Modesto', Arianna Rinaldi, Vania Fontani, Salvatore Rinaldi","doi":"10.7759/cureus.72819","DOIUrl":"10.7759/cureus.72819","url":null,"abstract":"<p><p>This case report describes the application of the radio electric asymmetric conveyer (REAC) gamma brain wave optimization (BWO-G) treatment in a 16-year-old female patient with a history of emotional trauma, depressive symptoms, and gender dysphoria. The patient underwent 18 sessions of REAC Neuro Psycho Physical Optimization (NPPO) BWO-G, with quantitative electroencephalography (QEEG) conducted pre- and post-treatment. Initial QEEG analyses indicated altered brain wave activity, with peaks in alpha rhythm frequencies in occipital and right posterior temporal areas. Following treatment, significant improvements were observed, including a reduction in delta and theta rhythms and increased alpha and gamma rhythms, corresponding to enhanced cognitive clarity and emotional regulation. Clinically, the patient experienced reduced anxiety, improved mood, heightened social engagement, better auditory tolerance, and resumed weight management. These findings suggest that the REAC NPPO BWO-G treatment may be an effective, non-invasive approach to enhancing cognitive and neuropsychological resilience in individuals with complex psychosocial challenges.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11531326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570775","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}