Cureus最新文献

{"title":"Angiotensin II in Catecholamine-Refractory Shock: A Systematic Review and Exploratory Analysis of the Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) Trial.","authors":"S Khallikane, Youssef Qamouss, Monsef Elabdi, Abdelmajid Bouzerda, Ali Khatouri, Mohamed Zyani, Rachid Seddiki","doi":"10.7759/cureus.86546","DOIUrl":"10.7759/cureus.86546","url":null,"abstract":"<p><p>Vasodilatory shock that does not respond to high-dose catecholamine vasopressors remains a life-threatening condition and is characterized by severe hypotension and high mortality. Angiotensin II, a non-catecholamine vasopressor that activates angiotensin type 1 receptors, has emerged as a potential therapeutic agent for restoring vascular tone in this setting. This systematic review aimed to evaluate the efficacy, safety, and hemodynamic effects of intravenous angiotensin II in adult patients with vasodilatory shock unresponsive to catecholamines, with a focus on data from the Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) randomized trial and related studies. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a systematic search was performed to identify randomized controlled trials and protocol-based investigations involving angiotensin II administration in adult patients with catecholamine-refractory vasodilatory shock. Eligible studies included the ATHOS-3 randomized trial, a renal-focused post hoc analysis, and the DARK-Sepsis protocol. Extracted outcomes included the proportion of patients achieving target mean arterial pressure, changes in catecholamine dose requirements, incidence of renal replacement therapy, and adverse event profiles. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Three studies involving a total of 321 patients were included. In the ATHOS-3 trial, angiotensin II significantly increased mean arterial pressure within 30 minutes. The proportion of patients achieving the target pressure threshold was 69.9% in the angiotensin II group versus 23.4% in the placebo group (P < 0.001). Angiotensin II administration was associated with a reduction in concurrent catecholamine use and a lower rate of renal replacement therapy initiation (19.0% versus 32.4%; P = 0.015). The overall incidence of adverse events, including thromboembolic and ischemic complications, did not differ significantly between groups. Exploratory findings indicated a greater therapeutic response in patients with elevated baseline plasma renin levels. All studies included were rated as low risk of bias. Angiotensin II appears to be a safe and effective adjunct to conventional vasopressor therapy in catecholamine-refractory vasodilatory shock, offering rapid hemodynamic improvement and potential organ protection. The observed reduction in renal replacement therapy initiation and the enhanced response in renin-elevated subgroups warrant further investigation in biomarker-guided clinical trials.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86546"},"PeriodicalIF":1.0,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478288","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":"Global Youth Tobacco Survey (2001-2022) in Saudi Arabia: An Analysis of Forecasting and Insights Pertaining to Dental Public Health and Tobacco Cessation Counseling.","authors":"Bugude Shiva Shankar","doi":"10.7759/cureus.86525","DOIUrl":"10.7759/cureus.86525","url":null,"abstract":"<p><strong>Background: </strong> Tobacco use among youth is a critical public health concern, particularly in Saudi Arabia, where a significant youth demographic and evolving tobacco control policies shape usage patterns. The Global Youth Tobacco Survey (GYTS) provides standardized data to monitor these trends, offering insights for dental public health and tobacco cessation counseling. This study analyzes GYTS data from 2001 to 2022 to evaluate trends in youth tobacco use, their association with tobacco control policy implementation, and implications for oral health interventions.</p><p><strong>Materials and methods: </strong> Data from the GYTS conducted in Saudi Arabia (2001, 2007, 2010, and 2022) among youth aged 13-15 years (n = 1,830-4,526) were analyzed. Key indicators included current cigarette smoking, environmental tobacco smoke exposure, cessation attempts, and knowledge/attitudes toward smoking. Descriptive statistics, percent change calculations, linear and joinpoint regression analyses, and gender-specific comparisons assessed trends and policy impacts. Prediction models forecast the prevalence to 2030. Statistical analyses were performed using Python (version 3.10; Python Software Foundation, Wilmington, DE) and the Joinpoint Regression Program (version 4.9.1.0; National Cancer Institute, Bethesda, MD).</p><p><strong>Results: </strong> Current cigarette smoking increased from 4.7% (2001) to 8.9% (2010) before declining to 2.9% (2022), a 38.3% relative decrease. Joinpoint analysis identified a significant trend reversal after 2010, coinciding with comprehensive MPOWER policy implementation (p < 0.001). Boys exhibited higher smoking prevalence than girls, but the gender gap narrowed from 4.0 to 1.3 percentage points (2001-2022). Environmental tobacco smoke exposure and living with smokers decreased by 28.8% and 33.0%, respectively. Cessation indicators showed declines in desire (74.0%-64.9%) and attempts to quit (69.3%-58.7%). Support for smoking bans rose by 14.6%. Predictions suggest smoking prevalence may approach 1.0%-2.0% by 2030 if trends persist.</p><p><strong>Conclusion: </strong> Comprehensive tobacco control policies after 2010 significantly reduced youth tobacco use in Saudi Arabia, with notable declines in smoking prevalence and environmental exposure. However, declining cessation indicators highlight the need for targeted interventions. Dental professionals can leverage these trends to integrate cessation counseling into routine care, enhancing oral health outcomes. Sustained policy enforcement and gender-sensitive strategies are crucial to further reduce youth tobacco use by 2030.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86525"},"PeriodicalIF":1.0,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487555","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 Performance of Four Risk Assessment Scores in Nonvariceal Upper Gastrointestinal Bleeding.","authors":"Omer Kheir, Mohammed Ghamdi, Sheikha Dossary, Anwar B Alotaibi, Elrasheed M Elsabani, Hanin Fahad, Mona Alfaifi","doi":"10.7759/cureus.86515","DOIUrl":"10.7759/cureus.86515","url":null,"abstract":"<p><strong>Introduction: </strong> Nonvariceal upper gastrointestinal bleeding (NVUGIB) continues to remain a life-threatening medical emergency, resulting in significant morbidity and mortality. Several scoring systems have been developed to predict outcomes, but the best risk stratification tool for emergency situations remains uncertain. This study examines four existing scoring systems: the blood urea nitrogen-to-serum albumin ratio (BAR), the international normalized ratio-to-albumin ratio (PTAR), the lactate-to-albumin ratio (LTA), and the National Early Warning Score (NEWS).</p><p><strong>Methods: </strong> This retrospective, hospital-based study was conducted at the Johns Hopkins Aramco Healthcare (JHAH) facility in eastern Saudi Arabia from January 2020 to September 2023. Eligible participants were non-trauma UGIB patients aged 18 years or older. Cancer patients were excluded. Patient characteristics, vital signs, test results, comorbidities, disposition, and survival status at discharge were among the information collected from medical records. The four score systems were calculated and compared based on their predictive performance.</p><p><strong>Result: </strong>NEWS demonstrated the highest overall predictive performance, particularly for hospital admission (AUC 84%) and 90-day mortality (AUC 77.2%). Both NEWS and BAR were equally effective in predicting blood transfusion (AUC 71.7%). LTA showed the highest sensitivity for mortality prediction (75%), while PTAR provided moderate predictive value across all outcomes.</p><p><strong>Conclusion: </strong>Among the four scoring systems evaluated, NEWS consistently outperformed others in predicting key clinical outcomes in NVUGIB, making it a reliable tool for initial risk stratification. BAR is also valuable for assessing transfusion needs, while LTA and PTAR may serve complementary roles depending on the clinical context.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86515"},"PeriodicalIF":1.0,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12221101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556170","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":"To IV or Not to IV: The Science Behind Intravenous Vitamin Therapy.","authors":"Abdulrahman Alangari","doi":"10.7759/cureus.86527","DOIUrl":"10.7759/cureus.86527","url":null,"abstract":"<p><p>Intravenous (IV) vitamin therapy has become an increasingly popular method for delivering essential micronutrients directly into the bloodstream, bypassing the gastrointestinal tract. This method offers enhanced bioavailability, higher therapeutic dosages, and targeted nutrient replenishment, making it particularly effective for individuals with malabsorption issues and chronic illnesses and those seeking optimal health benefits. In contrast, oral supplementation remains a convenient and practical option for routine vitamin and mineral intake. This article provides an overview of the physiological advantages and disadvantages of IV vitamin therapy, its clinical applications, and the scientific evidence supporting its efficacy.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86527"},"PeriodicalIF":1.0,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478301","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":"Mitral Valve Replacement via Minithoracotomy Versus Conventional Median Sternotomy in Rheumatic Mitral Valve Disease: A Multicenter Retrospective Study.","authors":"Hicham Kbiri, Rachid Seddiki, Abdellatif Chlouchi, Najib Bouhabba, Amine Meskine, Mourad Ababou, Youssef Qamouss, S Khallkane","doi":"10.7759/cureus.86482","DOIUrl":"10.7759/cureus.86482","url":null,"abstract":"<p><p>Background and objectives This study aimed to compare surgical outcomes, early postoperative complications, and midterm recovery in patients with severe rheumatic mitral insufficiency undergoing either minimally invasive cardiac surgery (MICS) or mitral valve replacement via conventional median sternotomy (CMS). While CMS remains the standard approach, MICS has emerged as a less invasive option with potential benefits. However, comparative data in resource-limited settings remain scarce. Methods This multicenter retrospective study included 55 adults with severe rheumatic mitral Insufficiency (RMI) who underwent elective mechanical mitral valve replacement between 2020 and 2024 in Morocco. Patients were divided into two groups: 27 received minimally invasive surgery (MICS) via minithoracotomy, and 28 underwent conventional sternotomy (CMS). The primary endpoint was 30-day all-cause mortality. Secondary outcomes included operative times, postoperative complications, intensive care unit (ICU)/hospital stay duration, 12-month functional recovery, valve performance, and event-free survival based on Kaplan-Meier analysis. Results Fifty-five patients underwent mechanical mitral valve replacement: 27 via minimally invasive cardiac surgery (MICS) and 28 via conventional median sternotomy (CMS). The 30-day mortality was similar between groups (3.7% vs 3.6%; p = .99). Compared with CMS, MICS was associated with significantly shorter cardiopulmonary bypass (68.3 vs 87.5 minutes; p < .001) and aortic cross-clamp times (54.7 vs 77.1 minutes; p < .001), reduced postoperative pneumonia (0% vs 10.7%; p = .03), and fewer arrhythmias (7.4% vs 39.3%; p = .04). Hospital stay was shorter in the MICS group (6.2 vs 7.3 days; p = .04), with similar ICU duration. At 12 months, both groups showed preserved left ventricular ejection fraction (60.1% vs 58.2%; p = .22) and comparable event-free survival (>90%), without significant differences in valve-related complications. Conclusions In this multicenter retrospective study, minimally invasive cardiac surgery (MICS) for severe rheumatic mitral insufficiency was associated with fewer early complications, shorter operative and recovery times, and equivalent 12-month outcomes compared with conventional median sternotomy. These findings support MICS as a safe and effective alternative in appropriately selected patients when performed in experienced surgical centers.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86482"},"PeriodicalIF":1.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478299","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":"Antepartum Serum Lactate Dehydrogenase and Adverse Obstetric Outcomes in Preeclampsia: A Systematic Review of Prognostic Evidence From Low- and Middle-Income Countries.","authors":"Ky D Nguyen, Anh Tn Khuc, Vu A Tran, Hieu S Nguyen, Phong H Nguyen, Anh Th Nguyen","doi":"10.7759/cureus.86496","DOIUrl":"10.7759/cureus.86496","url":null,"abstract":"<p><p>This systematic review evaluated the association between antepartum serum lactate dehydrogenase (LDH) levels and adverse maternal and perinatal outcomes in preeclamptic pregnancies in low- and middle-income countries (LMICs). A comprehensive search of PubMed, Embase, and Scopus identified 19 observational studies published between 2000 and 2025, comprising 5,039 pregnant women, including 3,782 preeclampsia diagnoses. Most studies were conducted in South Asia and the Middle East. Although LDH thresholds varied, a consistent trend was observed: higher LDH levels were associated with increased risk of maternal complications such as HELLP syndrome, disseminated intravascular coagulation, acute renal failure, and ICU admission. Perinatal complications, including stillbirth, intrauterine growth restriction, low Apgar scores, and neonatal intensive care unit (NICU) admission, were also more common at LDH levels >800 IU/L. For example, stillbirth occurred in up to 77.7% of cases in the highest LDH group compared to <3% in the lowest. Due to heterogeneity in cut-offs and outcome definitions, meta-analysis was not performed. Overall, elevated antepartum serum LDH appears to be a strong prognostic marker for severe outcomes in preeclamptic pregnancies and may aid clinical triage in LMICs. Further prospective studies are needed to establish standardized thresholds and validate their predictive utility.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86496"},"PeriodicalIF":1.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478290","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":"Management Challenges of Psychosis and Aggression Secondary to Traumatic Brain Injury: A Report of Two Cases.","authors":"Jude Beauchamp, Tania Sultana, Amir Meftah, Satwant Singh, Chino Ezema, Sana Elham Kazi, Muhammad Azam, Jacky S Petion, Bamidele O Johnson, Esther U Ezenagu, Bashir Aribisala, Thant Htet, Patrice Fouron, Jeffery Lawrence, Tolu Olupona","doi":"10.7759/cureus.86474","DOIUrl":"10.7759/cureus.86474","url":null,"abstract":"<p><p>Millions of people in the United States suffer from traumatic brain injury (TBI) yearly. Individuals recovering from moderate to severe TBI are at risk of developing medical and psychiatric comorbidities. Psychosis due to TBI appears to be an infrequent yet serious complication. Psychosis secondary to TBI is debilitating, and its management remains challenging. Individuals may have complex clinical presentations, such as behavioral disturbances (impulsivity or aggression) or other comorbid conditions (anxiety, depression, PTSD (post-traumatic stress disorder), substance use disorders, and seizure disorders). Atypical antipsychotics are the first line of treatment, along with psychotherapy. Mood stabilizers or antidepressants should be considered for mood disturbance. Other comorbid conditions must be addressed promptly to improve outcomes and stabilize the patient in the community. In this article, we discuss two cases that developed psychosis secondary to TBI along with comorbid conditions and their management.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86474"},"PeriodicalIF":1.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478298","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":"Durable Response to Cemiplimab in Advanced Cutaneous Squamous Cell Carcinoma With Extensive Gluteal and Sacral Bone Infiltration: A 12-Month Case.","authors":"Ivan Bivolarski","doi":"10.7759/cureus.86507","DOIUrl":"10.7759/cureus.86507","url":null,"abstract":"<p><p>Cutaneous squamous cell carcinoma (cSCC) is a common skin malignancy, which, in its advanced stages, may involve regional lymph nodes and osseous structures, resulting in poor prognosis. Massive tumor infiltration of the sacrum and pelvic bones is rare and typically associated with limited treatment options and unfavorable outcomes. We present the case of a 59-year-old male with advanced cSCC involving the gluteal region, sacrum, pelvic lymph nodes, and bones. As part of a personalized treatment approach, the patient received a combination of cemiplimab, a PD-1 checkpoint inhibitor, and denosumab for bone protection. Despite the aggressive nature and anatomical complexity of the disease, the patient demonstrated a marked and durable clinical response, with radiographic evidence of partial metabolic regression on PET/CT (SUVmax reduction from 9.87 to 6.37), resolution of sacral pain, and full recovery of ambulatory function. No serious immune-related toxicities were observed. This case illustrates the potential of integrating immunotherapy with supportive bone-targeted therapy to achieve meaningful disease control in rare presentations of bone-invasive cSCC.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86507"},"PeriodicalIF":1.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478294","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":"Internal Transmesenteric Hernia Causing Small Bowel Obstruction: A Case Report.","authors":"Pragya Sinha, Virendra S Chauhan, Surabhi Gupta","doi":"10.7759/cureus.86498","DOIUrl":"10.7759/cureus.86498","url":null,"abstract":"<p><p>Internal hernias often present with vague and nonspecific symptoms of bowel obstruction. However, they carry a potential for bowel ischemia; as such, they need immediate surgery. It is important to identify the etiology of small bowel obstruction as it may cause ischemia or strangulation of the bowel. Most guidelines suggest a wait-and-watch policy for small bowel obstruction. At the same time, if there are any signs of peritonitis, strangulation, or bowel ischemia, surgical exploration is recommended. We present a case of an 81-year-old man who came to the emergency department with complaints of vague but persistent abdominal pain. The pain was localized to the right flank and had become dull in nature. An abdominal X-ray showed a few air-fluid levels suggestive of subacute obstruction. The portable ultrasound was inconclusive. A non-contrast computed tomography (NCCT) scan of the abdomen was done for the non-resolution of pain. It revealed rotation/volvulus in the small bowel mesentery. A deeper look suggested the possibility of internal transmesenteric herniation with evidence of early bowel ischemia. Surgical exploration revealed ileal loops internally herniating inside a band of mesenteric tissue. The mesenteric band was cut, and the obstruction was relieved. Subsequently, the patient was discharged home.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86498"},"PeriodicalIF":1.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12183535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478297","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":"Cancer of Unknown Primary: A Case Report on the Recognition of Its Clinical Entity and Standard of Care Management.","authors":"Alexander Lazzaro, Maya Srinivasan, Hussein Assi","doi":"10.7759/cureus.86451","DOIUrl":"10.7759/cureus.86451","url":null,"abstract":"<p><p>Cancer of unknown primary (CUP) is a distinct and well-established clinical entity that encompasses a heterogeneous group of histologically proven cancers that present unique diagnostic and therapeutic challenges. This case describes a male patient in his late 60s who presented with nonspecific gastrointestinal complaints. A comprehensive workup, including clinical evaluation and various biochemical, imaging, and invasive histopathologic tests, led to the diagnosis of CUP following consultation with medical oncology specialists. A decision was made to forgo further invasive molecular tissue sampling in search of a primary malignant process in favor of initiating systemic chemotherapy. The patient possessed an unfavorable set of prognostic signs. Rapid clinical deterioration occurred the day after treatment initiation. A goals of care conversation led to a transition towards comfort measures only care, and the patient ultimately passed away. This case highlights the importance of non-oncologically trained providers recognizing CUP as its own entity to facilitate standard of care management. Future research is needed to establish benefits in clinical trials looking at molecular tumor profiling and site-specific therapies for this rare malignancy.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86451"},"PeriodicalIF":1.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478291","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}