Cureus最新文献

{"title":"A Novel Appointment Protocol to Accelerate Orthodontic Treatment: A Case Report.","authors":"Uday Kumar Alle","doi":"10.7759/cureus.84808","DOIUrl":"10.7759/cureus.84808","url":null,"abstract":"<p><p>The need for orthodontic treatment among adult patients has been steadily increasing. A considerable number of these patients request to expedite their treatment owing to personal circumstances, including travel, relocation to another country, university enrollments, and preparations for weddings or other celebrations. To achieve expedited outcomes, various techniques have been devised over the years to expedite tooth movement during orthodontic treatment, encompassing pharmacological, surgical, and physical methods. Efficient scheduling is acknowledged as a crucial factor in the timely completion of orthodontic treatment. A uniform approach is not appropriate for scheduling orthodontic appointments. The optimal time frame varies depending on the specific contextual factors. We have implemented a novel orthodontic appointment protocol that entails scheduling orthodontic adjustment appointments every 10 days and employing metal passive self-ligating brackets combined with rapid archwire sequencing from lightest archwires to thick archwires in a gradual approach starting with lighter archwires, which efficiently facilitated expedited treatment.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84808"},"PeriodicalIF":1.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12119151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176195","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":"Outcomes of Total Hip Arthroplasty for Congenital Hip Dislocation: A Retrospective Study.","authors":"Mohamed-Anas Zeroual, Mohamed Nassiri, Mostapha El Kasseh, Abdessalam Achkoun, Rachid Chafik","doi":"10.7759/cureus.84797","DOIUrl":"10.7759/cureus.84797","url":null,"abstract":"<p><p>Introduction Congenital hip dislocation (CHD) represents a long-standing public health issue in Morocco, with a late diagnosis often leading to advanced joint degeneration. While periacetabular osteotomy is preferred in young adults with preserved joint space, total hip arthroplasty (THA) becomes necessary in end-stage cases. However, THA poses challenges due to anatomical deformities and the increased likelihood of revision surgeries. This study evaluates the clinical, radiological, and functional outcomes of THA performed for CHD and compares them with existing literature. Materials and methods A retrospective study was conducted on 16 patients (19 hips) who underwent THA for CHD between 2008 and 2022 at a single orthopedic unit. Patients aged over 15 years with a minimum follow-up of 18 months were included. Clinical assessment using the Postel and Merle d'Aubigné score (PMA), radiological classification using modified Cochin classification (Co), and postoperative complications were analyzed. Results The mean age was 35.1 years, with a female predominance (68.75%). High dislocations (fixed or non-fixed) represented the majority of cases (75%). Preoperatively, the average PMA score was 8.41/18. Lameness was present in 87.5% of cases, and leg length discrepancies (LLDs) were significant, with an average of 39.25 mm, especially in high dislocations. All THAs used cemented components, with the use of bone grafts in three cases (18.75%) and release techniques in six cases (37.5%). The average follow-up period for patients was 22 months. At the final assessment, the mean PMA score postoperatively improved to 17.23/18. Complications included intraoperative fractures in three cases (18.75%), nerve injury in two cases (12.5%), dislocation in one case (6.25%), and trochanteric non-union in one case (6.25%). Conclusion THA in CHD can achieve satisfactory mid-term functional outcomes when performed with meticulous preoperative evaluation and adapted surgical techniques. However, the procedure requires significant surgical expertise due to its complexity and potential complications.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84797"},"PeriodicalIF":1.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145185","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 Less Common Anatomical Variant of Bilateral Multiple Lesser Metatarsal Sesamoids With Radiologic and Clinical Correlation.","authors":"Christos Lyrtzis, Dimitra Mpei, Kallisti St John, George Paraskevas, Nikolaos Lazaridis","doi":"10.7759/cureus.84771","DOIUrl":"10.7759/cureus.84771","url":null,"abstract":"<p><p>Accessory or supernumerary bones are bones that are not normally present in the body but can be found as an anatomical variant. While hallucal sesamoids are common, lesser metatarsal sesamoids are uncommon and often underreported. These ossicles develop through endochondral ossification and aid biomechanics by enhancing muscle function and reducing tendon friction. This report presents the first documented case of bilateral multiple lesser metatarsal sesamoids involving several metatarsophalangeal joints, supported by radiologic and clinical correlation. A 48-year-old woman presented with bilateral plantar foot pain, exacerbated by weight-bearing activities. Radiographs and computed tomography (CT) confirmed multiple lesser metatarsal sesamoids bilaterally, along with ossa peronea. Conservative management, including non-steroidal anti-inflammatory drugs, footwear modifications, and physical therapy, led to symptom improvement after six months. Lesser metatarsal sesamoids are usually asymptomatic but can contribute to metatarsalgia. Recognizing these ossicles as anatomical variants is essential to avoid misdiagnosis and unnecessary interventions. This case underscores their potential role in forefoot pain and diagnostic challenges.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84771"},"PeriodicalIF":1.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164384","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":"Severe Hypokalemic Paralysis Following Rituximab Infusion in a Patient With Microscopic Polyangitis.","authors":"Yousuf Sherwani, Ayham Alsaab, Mohan Sengodan","doi":"10.7759/cureus.84750","DOIUrl":"10.7759/cureus.84750","url":null,"abstract":"<p><p>Rituximab is an anti-CD20 monoclonal antibody that has become an increasingly popular choice for the treatment of various autoimmune diseases. Various adverse effects have been attributed to the use of rituximab. Hypokalemia is one rare adverse reaction that is under reported in the literature and is life threatening. Here we report the case of a patient with symptomatic hypokalemia after IV rituximab infusion. Acute hypokalemia should be taken into account by healthcare professionals as a possible side effect after rituximab infusion.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84750"},"PeriodicalIF":1.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145128","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":"Pulsatile Tinnitus as a Manifestation of Radiation-Induced Internal Carotid Artery Stenosis in a Nasopharyngeal Carcinoma Survivor: A Case Report.","authors":"Yun-Chiang Chen, Shiang-Ru Lu, Yi-Chi Wang, Shu-Yu Yang, Pei-Chi Hsiao","doi":"10.7759/cureus.84762","DOIUrl":"10.7759/cureus.84762","url":null,"abstract":"<p><p>Nasopharyngeal carcinoma (NPC) is prevalent in East and Southeast Asia, with radiotherapy being the primary treatment modality. Carotid artery stenosis is a serious but often overlooked complication of radiotherapy. We present the case of a middle-aged NPC survivor who developed progressive symptoms, including left facial numbness, dysphagia, tongue atrophy, postural dizziness, and pulsatile tinnitus, 18 years after concurrent chemoradiation. Carotid ultrasound revealed high-grade stenosis of the left cervical internal carotid artery. Following carotid stenting, his dizziness and tinnitus resolved. This case illustrates the insidious progression of carotid stenosis after radiotherapy and underscores the importance of early vascular assessment in post-radiation patients with atypical symptoms such as pulsatile tinnitus. Clinicians should maintain a high index of suspicion in at-risk individuals, and physical therapists should adopt precautionary rehabilitation strategies to minimize the risk of vascular complications.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84762"},"PeriodicalIF":1.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164465","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":"Unexpected Development of Pericardial Effusion in a Patient With Influenza and Secondary Bacterial Infection.","authors":"Pooriya Bahadoran, Daniel Echeverria, Hansani Angammana, Redi Nikollari, Lisa N Glass","doi":"10.7759/cureus.84757","DOIUrl":"10.7759/cureus.84757","url":null,"abstract":"<p><p>Influenza poses a significant burden on healthcare systems worldwide, particularly when complicated by bacterial coinfections. Such cases often require intensive medical management. We present the case of a previously healthy young man whose influenza infection was complicated by bacterial coinfection, necessitating complex therapeutic intervention. During treatment with intrapleural fibrinolytic therapy, the patient was found to have developed a large pericardial effusion. While a causal relationship cannot be definitively established, this temporal association raises concern for a potential, previously unreported complication. We present this case to raise clinical awareness of this life-threatening possibility and encourage its consideration in the differential diagnosis when managing similar patients.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84757"},"PeriodicalIF":1.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145130","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":"Sentiment and Thematic Analysis of User Reviews for FDA-Cleared Prescription Digital Therapeutics: A Mixed-Methods Real-World Evidence Study.","authors":"Shaheen E Lakhan","doi":"10.7759/cureus.84710","DOIUrl":"10.7759/cureus.84710","url":null,"abstract":"<p><p>Background Prescription digital therapeutics (PDTs) are FDA-cleared, evidence-backed, smartphone-based interventions. While clinical trials establish efficacy under controlled conditions, the patient experience in real-world settings remains poorly characterized. App store reviews, though informal, offer a potential source of real-world evidence (RWE) reflecting user sentiment, barriers to engagement, and perceived benefit. Objective To characterize the real-world user experience of FDA-cleared PDTs through a mixed-methods analysis of publicly available app store reviews, combining quantitative sentiment classification with qualitative thematic analysis. Methods FDA-cleared PDTs via FDA's De Novo or 510(k) pathways were identified. Reviews were collected from the Apple App Store and Google Play Store using structured scraping tools. A rules-based sentiment classifier was applied based on user star ratings, and thematic content analysis was conducted using a hybrid natural language processing and manual coding approach. Reviews were grouped by app and platform, and dominant themes were extracted using unsupervised topic modeling. Results Of the 13 PDTs identified, seven had publicly accessible user reviews, yielding a dataset of 247 unique entries: AspyreRx, EndeavorRx, Regulora, Rejoyn, reSET, reSET-O, and Stanza. Sentiment classification revealed that 25.1% of reviews were positive, 12.6% neutral, and 62.3% negative. Thematic analysis identified six recurrent themes, including pediatric benefit and engagement, rewards and incentives, access and activation barriers, technical issues, emotional reactions and cost sensitivity, and boredom and frustration. While negative sentiment was more prevalent overall, several products, particularly Rejoyn and EndeavorRx, received meaningful reports of perceived benefit and therapeutic value. Company transitions were noted to have disrupted the continuity of historical review data of some PDTs. Conclusions App store reviews provide a rich, user-centered source of RWE and insights for PDTs. They highlight dimensions of access, usability, and trust not typically captured in clinical trials. Integrating such feedback into post-market evaluation may inform future design, regulation, and reimbursement of software-based therapeutics.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84710"},"PeriodicalIF":1.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145127","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":"Takotsubo Cardiomyopathy With an Unusually High Troponin Level Post-laparotomy for Small Bowel Obstruction Secondary to Adhesions in a Patient Presenting With Pelvic Inflammatory Disease.","authors":"Abrar Z Khan, Upeshala A Jayawardena, David Luke","doi":"10.7759/cureus.84685","DOIUrl":"10.7759/cureus.84685","url":null,"abstract":"<p><p>Pelvic inflammatory disease (PID) triggering adhesion-related small bowel obstruction (SBO) is rare. The occurrence of Takotsubo cardiomyopathy (TCM) with an unusually high level of troponin I in the clinical course presents a unique diagnostic challenge. We report the case of a female patient in her 40s who had repeatedly presented to the hospital with abdominal pain and initially showed signs of PID, which later developed to SBO due to adhesions requiring laparotomy. Six days post-laparotomy, she experienced chest pain with ST-segment elevation on electrocardiogram (ECG) and high troponin I level at 16,804 ng/L (reference range: 0-39 ng/L), and bedside echocardiography showed apical ballooning with severely impaired left ventricular ejection fraction. Her cardiac biomarkers and echocardiogram features improved over the next few days making TCM the likely cause, with ST-segment elevation myocardial infarction (STEMI) being the main differential diagnosis. Besides the unique series of events that created the level of complexity, this case highlighted the importance of considering PID as a potential trigger for SBO, the cautious evaluation of troponin in acute coronary syndrome (ACS)-mimicking presentation, and, above all, the necessity of timely multidisciplinary team involvement in dealing with complex cases.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84685"},"PeriodicalIF":1.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145129","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":"Therapeutic Options for the Prevention of Thromboses in Cushing's Syndrome: A Propensity-Matched, Retrospective Cohort Analysis.","authors":"Maxim J Barnett, Sarah Eidbo","doi":"10.7759/cureus.84616","DOIUrl":"10.7759/cureus.84616","url":null,"abstract":"<p><p>Introduction Cushing's syndrome, or hypercortisolism, occurs after prolonged exposure to excess cortisol, and can be characterized by moon facies, central fat redistribution, proximal limb muscle weakness and wasting, and abdominal striae. Medical literature points to a relationship between hypercortisolism and hypercoagulability, with higher rates of venous thromboembolism noted. Current guidelines recommend prophylaxis with low-molecular weight heparin (LMWH), but there is little evidence to support LMWH over other forms of anticoagulation. Methods We utilized TriNetX US Collaborative Network (TriNetX, LLC, Cambridge, Massachusetts, United States) to investigate the efficacy of different forms of anticoagulation in patients with hypercortisolism, defined by International Classification of Diseases, Tenth Revision (ICD-10) codes. Adult patients with hypercortisolism and prescribed enoxaparin, a form of LMWH, were compared to patients with hypercortisolism prescribed unfractionated heparin, warfarin, apixaban, and aspirin at 81 mg. Groups were propensity-matched according to age at index event, sex, race, ethnicity, and comorbid conditions. The outcomes studied included pulmonary embolism (PE), upper extremity deep vein thrombosis (UE DVT), lower extremity deep venous thrombosis (LE DVT), superficial venous thrombosis (superficial VT), bleeding, transfusion, and all-cause mortality. Results No significant differences in outcomes were noted between enoxaparin and heparin, warfarin, or apixaban in patients with hypercortisolism of any cause. Uniquely, the enoxaparin cohort had significantly higher risk of PE, LE DVT, and all-cause mortality compared to the aspirin 81 mg cohort (PE: hazard ratio (HR) 1.697, 95%CI 1.444-1.994, p=0.0345; LE DVT: HR 1.492, 95%CI 1.28-1.738, p=0.0017; mortality: HR 1.272, 95%CI 1.167-1.386, p=0.0002). With further sub-analysis of pituitary-dependent (Cushing's Disease), enoxaparin continued to demonstrate a higher risk for LE DVT (HR 1.677, 95%CI 1.353-2.079, p=0.0081), and all-cause mortality (HR 1.597, 95%CI 1.422-1.794, p=0.0005). Conclusion Although LMWH is currently recommended as the gold standard for anticoagulation in patients with hypercortisolism, our evidence suggests that low-dose antiplatelets such as aspirin 81 mg could outperform it. Further research is warranted to confirm and replicate our findings.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84616"},"PeriodicalIF":1.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129725","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":"Backtracking to the Brain: A Journey From Cirrhosis to Hypothalamic Insight.","authors":"Holly N Haley, Farukh G Ikram, Anne M Ward","doi":"10.7759/cureus.84644","DOIUrl":"10.7759/cureus.84644","url":null,"abstract":"<p><p>We present a 31-year-old female patient with cryptogenic cirrhosis admitted for rectal bleeding secondary to rectal prolapse. During her hospital course, she was found to have severe multi-endocrine dysfunction as evidenced by persistent hypotension, bradycardia, and intermittent hypothermia with hypothyroidism, adrenal insufficiency, and diabetes insipidus, which were confirmed by laboratory testing. Due to the patient's hypothalamic-pituitary dysfunction along with biopsy-confirmed cirrhosis of unknown etiology, magnetic resonance imaging (MRI) of the brain was ordered. The MRI demonstrated a large, heterogeneously enhancing mass centered in the hypothalamus and infiltrating the pituitary stalk. This case stands out because of its diagnostic trajectory where investigating the cause of endocrine dysfunction revealed a cerebral neoplasm that contributed to the patient's development of cirrhosis. There is an established association between hepatic pathologies and hypothalamic masses with the proposed mechanism being deficiencies of growth hormone (GH), insulin-like growth factor-1 (IGF-1), thyroid stimulating hormone (TSH), and consequently, triiodothyronine (T3). GH deficiency predisposes patients to hepatic steatosis while IGF-1 and T3 deficiencies leave the liver more vulnerable to oxidative damage. As such, cranial imaging and endocrine evaluation should be considered in young patients with cryptogenic cirrhosis.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84644"},"PeriodicalIF":1.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145162","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}