Cureus最新文献

{"title":"A Case of Advanced Basal Cell Carcinoma of the Head and Neck: Diagnostic Challenges and Sequential Systemic Therapy.","authors":"Ivan Bivolarski, Tanio Stefanov, Martin Dimitrov, Anita R Hvarchilkova-Baycheva, Yavor S Pavlov, Stanislav Marangozov","doi":"10.7759/cureus.118413","DOIUrl":"https://doi.org/10.7759/cureus.118413","url":null,"abstract":"<p><p>Advanced cutaneous malignancies with basaloid morphology can present diagnostic and therapeutic challenges, particularly when pathological interpretations differ and disease progresses during systemic treatment. We describe the clinical course of a 53-year-old woman with an extensive, unresectable cutaneous tumor involving the posterior neck and occipital region, accompanied by bilateral cervical lymphadenopathy and additional clinically suspected cutaneous deposits. The initial diagnosis was trichoblastic carcinoma, whereas expert pathological review favored basal cell carcinoma. The extent of disease precluded surgery and definitive radiotherapy. First-line vismodegib was initiated, and palliative radiotherapy delivering 30 Gy in 10 fractions to the occipital lesions and bilateral cervical lymph nodes was completed one year later. Clinical progression was documented three months after completion of radiotherapy; one month after this, MRI demonstrated extensive infiltration involving the left parotid gland and adjacent pharyngeal spaces. Second-line cisplatin and 5-fluorouracil were subsequently administered. Follow-up MRI six months after the earlier MRI demonstrated substantial tumor volume reduction. PET/CT three months later showed a heterogeneous response compared with a year earlier, including regression at several previously involved sites and newly apparent metabolically active right axillary lymph nodes. A subsequent biopsy was reported as basaloid carcinoma. The patient later experienced clinical deterioration, received one cycle of cemiplimab, and died before further treatment or response assessment. This case illustrates the importance of pathological clarification, longitudinal imaging, and careful interpretation of treatment response during sequential systemic therapy for advanced basal cell carcinoma.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118413"},"PeriodicalIF":1.3,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279033","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":"Diagnostic Tools Used for Tuberculous Pleural Effusion and Their Association With Treatment Outcomes.","authors":"Afraa Mohammed, Elrasheid Ali Awouda, Ashwag Elbadri, Ahmed Abuelgasim","doi":"10.7759/cureus.118376","DOIUrl":"https://doi.org/10.7759/cureus.118376","url":null,"abstract":"<p><p>Background Tuberculous pleural effusion (TPE) is difficult to confirm because pleural disease is often paucibacillary. Pleural-fluid biomarkers, culture, molecular assays, and pleural biopsy can improve diagnostic certainty, but their availability varies substantially in resource-limited settings. Objective To describe the diagnostic investigations used for suspected TPE at AlShaab and Abu Anjaa Teaching Hospitals in Khartoum, Sudan, from February to July 2017, and assess their association with treatment outcomes. Methodology This retrospective cohort study included 69 patients with a clinician-recorded diagnosis of TPE at two teaching hospitals in Khartoum, Sudan, from February to July 2017. The first author collected demographic, clinical, investigation, treatment, and outcome data from patient records using a standardized data-collection checklist. Investigations were classified according to whether a test and result were documented. Associations with outcome were assessed using Fisher's exact test and odds ratios (ORs) with 95% confidence intervals (CIs). Results Chest radiography was performed in 67/69 patients (97.1%). Pleural-fluid adenosine deaminase (ADA) was recorded in 1/69 (1.4%), culture in 6/69 (8.7%), polymerase chain reaction (PCR) in 4/69 (5.8%), and pleural biopsy in 7/69 (10.1%). GeneXpert MTB/RIF (Cepheid, Sunnyvale, CA) and pleural-fluid interferon-gamma testing were not performed. HIV testing was not documented in 50/69 patients (72.5%). Thirteen patients (18.8%) received antituberculous treatment without pleural-fluid or tissue testing. Five (38.5%) had a favorable outcome, and eight (61.5%) had an unfavorable outcome, including four subsequently diagnosed with malignant effusion and one death. Among 56 patients who underwent at least one pleural-fluid or tissue test, 39 (69.6%) had a favorable outcome. Any diagnostic testing was associated with higher odds of favorable outcome (OR 3.67, 95% CI 1.05-12.87; Fisher's exact <i>P</i> = 0.054), although the association did not cross the conventional statistical-significance threshold. Conclusions Confirmatory testing for suspected TPE was used inconsistently, while several clinically useful tests were rarely or never available. Patients treated without pleural-fluid or tissue testing had more unfavorable outcomes, including missed malignant effusion. The findings support a pragmatic minimum diagnostic bundle before prolonged empiric treatment, while recognizing that this observational study cannot establish that testing caused better outcomes.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118376"},"PeriodicalIF":1.3,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13689961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279034","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":"Routes to Diagnosis and Stage at Diagnosis of Colorectal Cancer in Patients Aged ≥ 50 Years: A Multicentre Retrospective Cohort Study From North Wales, UK.","authors":"Mikaella Toquero, Sushmitha Thiagarajah Naidu, Anna D Williams, Joseph Waddon, Rebekah Emmas, Aashna Das, Asifa Noor, Vignesh Balasubaramaniam, Steve Dixon","doi":"10.7759/cureus.118400","DOIUrl":"https://doi.org/10.7759/cureus.118400","url":null,"abstract":"<p><p>'Route to diagnosis', the clinical pathway through which a cancer is first identified, is associated with stage at presentation in colorectal cancer (CRC), but recent regional data in the UK describing this relationship following the wider adoption of symptomatic faecal immunochemical testing (FIT) is limited. This study describes contemporary routes to diagnosis among patients aged ≥ 50 years with CRC in a single Welsh health board and compares unadjusted stage distribution between routes. A retrospective cohort study was conducted across three secondary care sites within Betsi Cadwaladr University Health Board, North Wales, including patients aged ≥ 50 years with newly diagnosed primary colorectal cancer between 1 January 2023 and 31 December 2024. Routes were Bowel Screening Wales (BSW), asymptomatic FIT, symptomatic FIT, symptoms only, emergency presentation, and incidental detection. Stage was the pre-treatment tumour, node, and metastasis (TNM) stage where available; otherwise, pathological stage. Stage was compared across routes using Pearson's chi-square test, with four pre-specified pairwise comparisons of advanced-stage (III-IV) disease. The asymptomatic FIT group was described only. Of 976 patients, two (0.2%) were diagnosed via asymptomatic FIT. Among the remaining 974, symptomatic FIT was the most common route (506, 52.0%), followed by BSW (172, 17.7%), symptoms only (131, 13.4%), emergency presentation (112, 11.5%), and incidental detection (53, 5.4%). Overall, 515/974 (52.9%) had advanced-stage disease, and stage differed by route (p < 0.001). Advanced disease was lowest in BSW (37.8%), intermediate in symptomatic FIT (51.8%), higher in symptoms-only (60.3%) and emergency (60.7%) diagnoses, and highest in incidental diagnoses (77.4%). Compared with BSW, the proportion with advanced disease was 22.9 percentage points higher in emergency presentations (95% CI 11.3-34.5) and 39.6 points higher in incidental diagnoses (95% CI 26.2-53.0). The difference between symptomatic FIT and emergency presentations (8.9 points, 95% CI -1.1 to 19.0) was not statistically significant. In this unadjusted analysis, which may partly reflect differences in age, tumour location and staging method, screening-detected cancers had the lowest proportion of advanced disease and incidental diagnoses the highest. Just over half of cancers diagnosed after a positive symptomatic FIT were stage III-IV; as only diagnosed patients were included, this does not assess FIT effectiveness. These findings provide a regional benchmark and identify pathways where the reasons for late-stage diagnosis warrant further investigation.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118400"},"PeriodicalIF":1.3,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278957","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 Cross-Sectional Study on the Prevalence of Asthma-Chronic Obstructive Pulmonary Disease Overlap in Patients Attending the Pulmonology Outpatient Department at Apollo Institute of Medical Sciences and Research, Chittoor, India.","authors":"C V Nandeshwara Reddy, Saikrishna P, Dimple Swetha Mopati, Cheedella V H N Sandhya, P Sree Ramulu","doi":"10.7759/cureus.118425","DOIUrl":"https://doi.org/10.7759/cureus.118425","url":null,"abstract":"<p><p>Background Bronchial asthma and chronic obstructive pulmonary disease (COPD) exhibit distinct clinical characteristics; nevertheless, it is common to come across patients who display clinical signs of both conditions in clinical settings. The identification of this phenomenon has resulted in the adoption of the term \"asthma-COPD overlap\" (ACO), which characterizes a set of clinical characteristics rather than defining a singular entity. Different studies have indicated a prevalence of 15 to 55% for ACO. Individuals diagnosed with ACO experience more frequent severe episodes, leading to higher rate of inpatient care, emergency visits, and increased healthcare expenses compared to patients diagnosed with asthma and COPD. The present study was undertaken to determine the prevalence and phenotype of asthma-COPD overlap in patients attending the pulmonology outpatient department at Apollo Institute of Medical Sciences and Research (AIMSR) and District Headquarters Hospital (DHH) in Chittoor, India. Methods This was a prospective cross-sectional study conducted in patients attending the pulmonology department at AIMSR and DHH during May 2025 to August 2026. The demographic details were collected from the patients included in the study. All patients underwent Chest X-ray and pulmonary function test. The observations were tabulated and represented in frequency and percentage. The comparisons based on sex were done and the association was assessed using the Chi-square test and Student's t-test.  Results This study included 79 subjects, of which 35 (44%) were females and 44 (56%) were males. Among females, 18 (51.43%) did not have a prior COPD diagnosis, while 17 (48.57%) were diagnosed with COPD. Among males, 14 (31.82%) did not have a prior COPD diagnosis, whereas 30 (68.18%) were diagnosed with COPD. The mean forced expiratory volume in one second to forced vital capacity (FEV1/FVC) ratio was 0.68±0.19 in female subjects and 0.64±0.17 in males. Among previously diagnosed asthmatics, 12 males and 20 females exhibited ACO, while it was seen in 30 males and 17 females in previously diagnosed COPD patients. Conclusion In the present study, the prevalence of ACO based on Global Initiative for Asthma 2016 guidelines in asthmatics was found to be seven in men and 12 in females, but in individuals with COPD, the prevalence was found to be eight in males and three in females.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118425"},"PeriodicalIF":1.3,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13691444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279008","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":"Transcatheter Aortic Valve Implantation Followed by Lung Cancer Resection in an Older Patient: A Case Report.","authors":"Leena Khan, Syed S Qadri","doi":"10.7759/cureus.118353","DOIUrl":"https://doi.org/10.7759/cureus.118353","url":null,"abstract":"<p><p>The individual incidences of lung cancer and cardiovascular disease in the elderly population mean that there is a strong likelihood of both occurring simultaneously. Common practice for severe aortic stenosis (AS) would be surgical aortic valve replacement (AVR), unless deemed high-risk for this surgical procedure. Age and lung cancer both increase a patient's surgical risk; hence, the less invasive transcatheter aortic valve implantation (TAVI) to manage valve disease ahead of lung resection for lung cancer is an acceptable alternative after assessing other factors such as procedural risk, comorbidities, and prognosis. We present the case of an 82-year-old female patient who underwent a TAVI seven months before lung resection for an incidental diagnosis of lung cancer with staging T1b N0 M0. Postoperatively, she was treated for atrial fibrillation and lung collapse, then discharged after resolution of these complications on the eighth day after surgery, and remained well at follow-up three months later. This case report explores a situation when this sequence of interventions was appropriate due to increased surgical risk in the elderly population.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118353"},"PeriodicalIF":1.3,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279028","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":"Extending the Lower Limits of Body Weight for Bi-directional Glenn Shunt in Developing Countries: Is it Feasible?","authors":"Sachin Talwar, Debasis Das, Vishal V Bhende, Anjani A Gohil, Mathangi Krishnakumar, Ashwin S Sharma","doi":"10.7759/cureus.118383","DOIUrl":"https://doi.org/10.7759/cureus.118383","url":null,"abstract":"<p><p>The bi-directional Glenn (BDG) shunt is an established stage of palliation for functionally single-ventricle congenital heart disease, but optimal timing and the influence of severe underweight remain uncertain. We report a 102-day-old male infant, born at 38 weeks' gestation and weighing 2.7 kg at surgery, with double-outlet right ventricle, difficult/non-routable intracardiac anatomy, D-malposed great arteries, and severe pulmonary stenosis who underwent a right-sided BDG with atrial septectomy and partial main pulmonary artery (PA) ligation. The infant was discharged on postoperative day 11 with an oxygen saturation of 92%. Available follow-up documentation over 18 months described a patent BDG on two-dimensional echocardiography. This single case demonstrates technical feasibility in a selected severely underweight infant; it does not establish a safe lower age or weight threshold, comparative mortality, or long-term Fontan outcome. Larger studies with complete nutritional, hemodynamic, and longitudinal follow-up data are required.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118383"},"PeriodicalIF":1.3,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279070","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":"Extracorporeal Membrane Oxygenation Education and Training: A Review of Current Practices and Future Directions at a Single Center in Phoenix, Arizona.","authors":"Meriam Avades, Mark Molitor, Melissa Filipiak, Christina Salisbury, Mohammed Elkhwad","doi":"10.7759/cureus.118381","DOIUrl":"https://doi.org/10.7759/cureus.118381","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of the study is to describe extracorporeal membrane oxygenation (ECMO) training and education practices at our institution and participants' self-reported comfort with ECMO tasks before and after training sessions.</p><p><strong>Background: </strong>ECMO is a life-sustaining intervention for critically ill patients with cardiac and/or respiratory failure. ECMO circuit management is complex and requires specialized training. This study describes pediatric and neonatal ECMO education practices at Phoenix Children's Hospital (PCH).</p><p><strong>Methods: </strong>We conducted a retrospective analysis of prospectively collected program-evaluation data. The education program ran from 2021 to 2025; anonymous pre- and post-training survey data were available only for 2024-2025. Registered nurses and ECMO primers completed surveys around 2024 water labs, and fellows completed surveys around boot camps in 2024 and 2025.</p><p><strong>Results: </strong>Survey response rates were 90% (27/30) for spring 2024 water labs and 83% (25/30) for fall 2024 water labs. Among registered nurses and ECMO primers, self-reported comfort was numerically higher after training for managing ECMO emergencies (52% to 74%), ambulating patients (56% to 74%), independently maintaining circuit components (60% to 84%), and escalating pump issues (84% to 96%); all 95% confidence intervals for differences included zero. Fellow item-level response counts varied. Between 2021 and 2025, 273 patients were cannulated onto ECMO at PCH.</p><p><strong>Conclusion: </strong>In this single-center descriptive evaluation, self-reported comfort was numerically higher after sessions, with imprecise estimates; findings are descriptive and hypothesis-generating. Neither competence nor patient outcomes were measured.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118381"},"PeriodicalIF":1.3,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13692392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279081","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":"Delayed Presentation of a Traumatic Retroperitoneal Hematoma With Low-Grade Renal Injury After a Low-Speed Electric Scooter Handlebar Impact in a Child: A Case Report.","authors":"Ibtihal Almeshawi, Ibrahim N Alghannam, Yara AlGoraini","doi":"10.7759/cureus.118358","DOIUrl":"https://doi.org/10.7759/cureus.118358","url":null,"abstract":"<p><p>Electric scooters (e-scooters) are an increasingly common cause of injury in children, but their capacity to cause occult intra-abdominal injury is under-recognized. We report a seven-year-old boy with type 1 diabetes mellitus who presented to the pediatric emergency department seven days after a witnessed low-speed fall from an electric scooter with a direct handlebar impact to the right abdomen. He was initially asymptomatic, developed right-sided abdominal pain on the second day after injury, and became progressively pale. On arrival, he was hemodynamically stable, with right upper quadrant tenderness and fullness, no peritonism, and no external signs of injury. Bedside sonography showed no free intraperitoneal fluid, but marked anemia prompted contrast-enhanced computed tomography (CT), which demonstrated a large right retroperitoneal hematoma extending from the subhepatic region into the right hemipelvis, a right perinephric hematoma, and no active contrast extravasation. Targeted renal Doppler ultrasonography identified a small inferior-pole cortical laceration that was not discernible on computed tomography, and the renal injury was classified as low grade. He received a single red blood cell transfusion, was managed nonoperatively in a pediatric high-dependency unit, and was discharged in stable condition on day 5. This case shows that a low-speed handlebar impact without external signs can cause major retroperitoneal bleeding with a delayed presentation, that unexplained anemia after blunt abdominal trauma warrants cross-sectional imaging despite normal vital signs and negative bedside sonography, and that large retroperitoneal hematomas can be managed nonoperatively in stable children without active extravasation.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118358"},"PeriodicalIF":1.3,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Paradoxical Increase in Body Mass Induced by Beta-Guanidinopropionic Acid in Juvenile Spontaneously Hypertensive Rats.","authors":"L M Brewster","doi":"10.7759/cureus.c494","DOIUrl":"https://doi.org/10.7759/cureus.c494","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.7759/cureus.19394.].</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"c494"},"PeriodicalIF":1.3,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13687453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278991","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":"Persistent Sleepiness After Effective Positive Airway Pressure Therapy Deserves Independent Clinical Evaluation.","authors":"Binh Pham","doi":"10.7759/cureus.118303","DOIUrl":"https://doi.org/10.7759/cureus.118303","url":null,"abstract":"<p><p>Positive airway pressure (PAP) therapy often improves excessive daytime sleepiness in obstructive sleep apnea (OSA), yet effective control of sleep-disordered breathing does not invariably restore normal daytime alertness. Persistent sleepiness after PAP therapy should therefore be regarded as a clinical observation requiring explanation rather than automatically attributed to treated OSA. The term \"residual excessive daytime sleepiness\" may become misleading when it is interpreted as an etiologic conclusion rather than a descriptive label. Evaluation should distinguish PAP adherence from treatment efficacy and symptomatic recovery, determine whether the complaint reflects sleepiness rather than fatigue or apathy, and consider alternative contributors including insufficient sleep, circadian misalignment, medication or substance effects, medical and psychiatric conditions, coexisting sleep disorders, and central disorders of hypersomnolence. Additional testing should be guided by a defined clinical question, and wake-promoting therapy should follow rather than replace diagnostic reassessment. Persistent sleepiness after effective PAP describes an observation, not an etiology, and deserves independent clinical evaluation.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118303"},"PeriodicalIF":1.3,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13685584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149248033","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}