Cureus最新文献

{"title":"A Wolf in Sheep's Clothing: Pseudohypobicarbonatemia in a Patient With Multiple Myeloma.","authors":"Ziad Alahmadi, Zain Haq, Ami Patel, Joshua D King","doi":"10.7759/cureus.80782","DOIUrl":"10.7759/cureus.80782","url":null,"abstract":"<p><p>There are multiple methods to measure serum bicarbonate level which is crucial for diagnosis and management of acid-base disturbances. The most common method is directly measuring the total serum carbon dioxide (CO₂) concentration in a basic metabolic panel. Another method is by indirect calculation of the bicarbonate concentration via the Henderson-Hasselbalch equation using the measured pH and partial pressure of CO₂ (pCO₂) in plasma. Multiple confounders can cause discrepancies in the measured bicarbonate in each method, such as increased concentration of serum lipids or proteins, that can alter measurement assays, leading to spuriously low serum bicarbonate values. In our case, we present a patient with falsely low reported bicarbonate levels in the setting of increased paraproteins due to multiple myeloma.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80782"},"PeriodicalIF":1.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11919310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659934","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":"Comparative Analysis of Culture and Sputum Smear Conversion Timelines and Their Associated Factors in Smokers Versus Non-smokers With Drug-Resistant Tuberculosis.","authors":"Sajjad Ali, Nabi Rahman Rahman, Ashraf, Rumman, Akmal Naveed, Abdul Ghafoor, Murad Ali, Ubaid Ullah","doi":"10.7759/cureus.80704","DOIUrl":"10.7759/cureus.80704","url":null,"abstract":"<p><p>Background Drug-resistant tuberculosis (DR-TB) is a global health challenge, with smoking potentially affecting treatment outcomes. Smoking compromises immune function and may interfere with the pharmacokinetics of anti-TB drugs. Delayed sputum smear and culture conversion are key indicators of prolonged treatment and infectiousness. This study explores the impact of smoking on these conversion timelines in DR-TB patients. Objective To identify and assess the overall treatment outcomes and the factors associated with delayed culture and sputum smear conversion in smokers compared to non-smokers among patients with drug-resistant tuberculosis. Methods This prospective cohort study was conducted at the Programmatic Management of Drug-Resistant TB (PMDT) unit at Mardan Medical Complex in Khyber-Pakhtunkhwa, Pakistan, from June 2020 to December 2024. All patients diagnosed with drug-resistant tuberculosis (DR-TB) were categorized into two groups based on their smoking status: smokers and non-smokers. Patient demographic and clinical information was collected through structured interviews and standardized questionnaires. The time to sputum smear and culture conversion (SCC) was longitudinally measured from the start of treatment until the patient achieved two consecutive negative smears and three consecutive negative cultures, respectively. Cox proportional hazards analysis was employed to evaluate the relationship between smoking status and time to SCC, adjusting for potential confounding factors. Kaplan-Meier survival curves were used to compare the time to SCC between the two groups, with statistical significance set at p < 0.05. Analyses were performed using SPSS software (version 29.0). Results Out of 281 DR-TB patients, 138 were smokers (49.12%) and 143 were non-smokers (50.88%). Non-smokers achieved faster sputum and culture conversion, with survival proportions dropping to 0.000 by 90 and 70 days, respectively. In contrast, smokers showed slower declines, with sputum conversion at 0.137 and culture conversion at 0.035 by 120 days. The mean sputum conversion time was 59 days for non-smokers and 104 days for smokers, while culture conversion took 43 days for non-smokers and 98 days for smokers. Multivariate analysis identified significant determinants for both groups: older age (≥36 years), lower BMI (<16 kg/m²), and higher sputum smear grades. Non-smokers were adversely affected by gastrointestinal upset and nephrotoxicity, while smokers were more negatively impacted by higher cigarette consumption, diabetes, and lung lesions. Long-term treatment regimens and resistance to antibiotics like levofloxacin and moxifloxacin reduced conversion rates in both groups. Conclusion Smoking not only impairs immune function but also influences the pharmacokinetics of anti-TB drugs, potentially leading to more prolonged and complicated treatment courses.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80704"},"PeriodicalIF":1.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11918488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659937","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 Literature Review on Whether Immobilization of the Shoulder in External Rotation Improves Healing and Prevents the Recurrence of Acute Shoulder Dislocations.","authors":"Yasmin H Kazim","doi":"10.7759/cureus.80713","DOIUrl":"10.7759/cureus.80713","url":null,"abstract":"<p><p>Shoulder dislocations are one of the most frequent joint dislocations, with recurrent dislocations being a common complication. Common practice is to immobilize the shoulder in internal rotation for two to three weeks following closed reduction. However, recent literature suggests immobilization in external rotation can be an alternative management strategy. External rotation braces have been manufactured over the years to support and maintain this position. This literature review aims to gather current evidence on the conservative management of primary traumatic anterior shoulder dislocations and compare the immobilization of the shoulder joint in internal and external rotation. A literature search and review was performed using PubMed and Google Scholar. Key phrases and words that were used in the search engines included \"shoulder immobilization\" AND \"external rotation\", \"anterior shoulder dislocation immobilization\" AND \"external rotation\", \"reduced recurrence rate of shoulder dislocation\" AND \"external rotation\", \"external rotation immobilization\" AND \"Bankart lesion\" and \"internal versus external rotation\" AND \"shoulder dislocation\". The reviewed articles included were dated from 2014 to 2024 but additional valuable studies dating earlier than 2014 were also included to provide a foundation of understanding to this review. Included were nine clinical studies and randomized controlled trials, three cadaveric studies, eight studies focusing on magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA) or arthroscopy, and seven systematic reviews and meta-analyses. Research revealed improved coaptation of the labrum on the glenoid rim in external rotation not only in cadavers but also in patients with the aid of various imaging techniques. However, these findings were not consistently observed when translated into clinical trials. Based on the available data presented in this literature review, there remains a deficiency in evidence to exclusively support the use of external rotation immobilization over conventional internal rotation immobilization after primary traumatic anterior shoulder dislocations. External rotation immobilization may benefit a specific population, particularly those that fall in the 20-40-year-old age group, with a specific injury pattern, such as Bankart lesions and greater tuberosity fractures; therefore, further studies are required to determine who will benefit the most from such interventions.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80713"},"PeriodicalIF":1.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652773","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":"Silent Dangers: The Growing Vulnerability of Older Adults in Fatal Road Traffic Accidents.","authors":"Stefania Ungureanu, Camelia-Oana Muresan, Veronica Ciocan, Raluca Dumache, Emanuela Stan, Georgiana-Denisa Gavrilita, Alexandra Enache","doi":"10.7759/cureus.80712","DOIUrl":"10.7759/cureus.80712","url":null,"abstract":"<p><strong>Introduction: </strong>Older adults represent a growing and vulnerable road user group. Our aim was to develop targeted interventions and preventive measures for decreasing road deaths in older adults by establishing the circumstances and the characteristics leading to such fatalities with regard to each type of road user.</p><p><strong>Materials and methods: </strong>Medico-legal autopsy records of victims of road traffic accidents from Timișoara Institute of Legal Medicine (TILM), Romania, in a five-year period (2017-2021) were analyzed. Data was retrieved and grouped according to the victims' demographics (age and gender), date of the accident, type of road user (driver, passenger, pedestrian, cyclist), and traumatic injuries. Moreover, data from the traffic police reports regarding additional circumstances of the crash were retrieved.</p><p><strong>Results: </strong>A total of 51 medico-legal autopsies involving older adults (aged above 70 years) were performed at TILM in 2017-2021. Regarding the type of road user, pedestrians were the most affected group among older adults (n=17), followed by cyclists (n=13), passengers (n=11), and drivers (n=10). Most cases (n=9) occurred when the victims were hit by a car behind them. The second most seen circumstance that led to fatally injured older victims was represented by being hit by a moving vehicle while crossing the street outside of a marked crosswalk (n=7).</p><p><strong>Conclusion: </strong>Our findings illustrate the need to focus on road fatalities among older adults, as these tragic events affect this vulnerable group. Unfortunately, less attention has been given to the severity and significance of these incidents. Preventive campaigns focusing on road user education, safe driving, safe walking and the implementation of facile public transport or improved pedestrian crossings should be the key points.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80712"},"PeriodicalIF":1.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652793","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":"Intra-abdominal Mucormycosis in an Immunocompetent Host: A Rare Presentation and Literature Review.","authors":"Sevag Hamamah, Nupur Savalia, Faizi Hai","doi":"10.7759/cureus.80730","DOIUrl":"10.7759/cureus.80730","url":null,"abstract":"<p><p>Mucormycosis is a severe, opportunistic infection caused by <i>Mucorales,</i> a taxonomical group of thermotolerant fungi primarily affecting the immunocompromised. Intra-abdominal involvement in mucormycosis is a rare entity, particularly in immunocompetent individuals. We present a fatal case of gallbladder and renal mucormycosis in an immunocompetent female, leading to septic shock and death. The diagnosis was confirmed via histopathology following cholecystectomy for suspected gangrenous cholecystitis and open right nephrectomy due to kidney infarction. Quantitative polymerase chain reaction of the tissue identified the presence of <i>Apophysomyces ossiformis.</i> The clinical picture was confounded by ongoing sepsis due to a <i>Klebsiella pneumoniae</i>-infected retroperitoneal hematoma<i>,</i> non-specific imaging findings, and the absence of traditional risk factors for mucormycosis, leading to a delayed diagnosis. Despite surgical debridement, initiation of liposomal amphotericin B with posaconazole, and aggressive treatment in the intensive care unit, the patient succumbed to complications of mucormycosis. Despite adequate antibiotic coverage, this case underscores the importance of considering Mucorales infection in otherwise immunocompetent patients with a deteriorating clinical condition. Early diagnosis and appropriate intervention are essential in enhancing mucormycosis survivability, though mortality rates remain high in severe cases.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80730"},"PeriodicalIF":1.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660023","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":"Diagnosis and Genetic Counseling Before and After the Birth of Children With Joubert Syndrome and Beckwith-Wiedemann Syndrome.","authors":"Yuri Hasegawa, Shoko Miura, Masayo Kagami, Sumito Dateki, Kiyonori Miura","doi":"10.7759/cureus.80677","DOIUrl":"10.7759/cureus.80677","url":null,"abstract":"<p><p>The patient was a second child prenatally diagnosed with Joubert syndrome (JS) by ultrasound examination and family history of a first child with JS. After birth, the patient was also diagnosed with Beckwith-Wiedemann syndrome. Here, we report this case as a lesson on the importance of focusing on diagnosing the first hereditary disease and also considering the possibility of the development of a second genetic disease when providing treatment. We were able to confirm the diagnosis of both syndromes by detailed genetic testing after birth, allowing genetic counseling for future treatment and the next pregnancy.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80677"},"PeriodicalIF":1.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652777","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":"Hindu Spiritual Music for Perioperative Anxiolysis and Stress Modulation: An Open-Label, Randomized Comparative Trial in Lower Limb Surgery Patients.","authors":"Anshul Jain, Brijendra Verma, Pankaj Saunakiya, Saurabh Agarwal, Pushpendra Agarwal, Paras Gupta, Charu Thakur","doi":"10.7759/cureus.80642","DOIUrl":"10.7759/cureus.80642","url":null,"abstract":"<p><p>Background Perioperative anxiety is a common concern in patients undergoing regional anesthesia, as they remain conscious during surgery. Various non-pharmacological interventions, including music therapy, have been explored to reduce anxiety and stress response. Spiritual interventions, particularly religious music, have been shown to provide emotional stability and enhance coping mechanisms during stressful situations. Objective This study aimed to evaluate the impact of Hindu religious music compared to patient-selected instrumental music on intraoperative anxiety, stress response, and patient satisfaction in individuals undergoing lower limb surgery under regional anesthesia. Methods This prospective, open-label, randomized controlled trial was conducted at Maharani Laxmi Bai Medical College, a tertiary care teaching hospital in Jhansi, India, after obtaining approval from the Institutional Ethics Committee (Certificate No. 5208/IEC/I/2022-2023) and registration with the Clinical Trials Registry of India (CTRI/2024/01/062006, registered on January 30, 2024). The trial included 150 ASA class 1 or 2 patients undergoing elective lower limb surgery under regional anesthesia. Participants were randomly assigned to two groups: Group A (Hindu spiritual music) and Group B (patient-preferred instrumental music). Music was played intraoperatively via noise-canceling headphones. The primary outcomes were intraoperative anxiety (measured using the Visual Analog Scale for Anxiety (VAS-A)) and serum cortisol levels as a biochemical marker of stress. Secondary outcomes included hemodynamic parameters, additional analgesic requirements, incidence of nausea and vomiting, and patient satisfaction. Results Group A had significantly lower intraoperative VAS-A scores compared to Group B (2.13 ± 0.91 vs. 3.41 ± 1.12; p = 0.01). Serum cortisol levels were also significantly lower in Group A at the end of surgery (28.54 ± 6.11 vs. 32.50 ± 8.82 µg/dL; p = 0.001) and remained lower on the first postoperative day (p = 0.001). The incidence of postoperative nausea and vomiting was significantly lower in Group A (6.8% vs. 17.5%; p = 0.028). Patient satisfaction was also higher in the Hindu spiritual music group (p = 0.03). Conclusion Hindu spiritual music reduced perioperative anxiety, attenuated the stress response, and decreased postoperative nausea and vomiting compared to non-spiritual instrumental music. It should be considered a non-pharmacological intervention in the perioperative period to alleviate anxiety and improve patient comfort. However, the study's findings may have limited generalizability to non-Hindu patients. Future research should explore whether similar benefits are observed in religious individuals listening to music of their own faith and cultural background.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80642"},"PeriodicalIF":1.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652780","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":"Obstructive Uropathy Secondary to Accidental Ureteric Placement of an Indwelling Urinary Catheter at the Time of Caesarean Section: A Case Report.","authors":"Sara E Hariz, Priti Pradhan","doi":"10.7759/cureus.80674","DOIUrl":"10.7759/cureus.80674","url":null,"abstract":"<p><p>This case describes a rare complication of Foley catheter insertion where accidental instrumentation of a ureter occurred at the time of caesarean section with the subsequent development of bladder obstruction and acute kidney injury. Rapid identification and management can minimise the associated long-term implications; this therefore necessitates greater awareness of this possible complication. The current understanding of this condition recognises neurogenic bladder and female sex as risk factors; however, physiological changes in pregnancy may also act as a significant risk factor for this complication.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80674"},"PeriodicalIF":1.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652788","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":"Surgical Approach in Management of Acute Appendicitis Within a De Garengeot Hernia: A Case Report.","authors":"Suanne C MacConnell, Joel D Stein","doi":"10.7759/cureus.80669","DOIUrl":"https://doi.org/10.7759/cureus.80669","url":null,"abstract":"<p><p>De Garengeot hernias are rare surgical occurrences and even more so when the histopathology reveals acute appendicitis. Varying approaches are documented with regards to open versus laparoscopic and the use of mesh. This case demonstrates the successful use of an open high McEvedy approach with primary suture closure in an elderly female who presented with an acute history of a right groin lump, right iliac fossa pain, nausea and fever.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80669"},"PeriodicalIF":1.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11910999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652843","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":"Scapulothoracic Dissociation Following a Fall From Standing Height: A Rare and Atypical Presentation of Severe Shoulder Girdle Injury.","authors":"Dimitrios Giotis, Christos Konstantinidis, Christos Koukos, Dimitrios Vardakas, Sotiris Plakoutsis","doi":"10.7759/cureus.80652","DOIUrl":"https://doi.org/10.7759/cureus.80652","url":null,"abstract":"<p><p>Scapulothoracic dissociation (SD) is a rare and severe injury, typically associated with high-energy trauma. It is characterized by scapular displacement, often leading to neurovascular compromise. SD resulting from low-energy mechanisms, such as a fall from standing height, is exceptionally rare. We present the case of a 93-year-old male who sustained SD after a fall from standing height. He was hemodynamically unstable upon arrival, with progressive neurological deficits in the right upper limb. Computed tomography (CT) revealed an isolated right scapular glenoid fracture with lateral scapular displacement and a large hematoma, while CT angiography ruled out major vascular injury. Conservative management included hemodynamic stabilization and immobilization with a Velpeau-type splint. One month post-injury, neurological function in the affected upper extremity had significantly improved. By five months, the patient had regained nearly full, painless shoulder range of motion without neurological deficits. Although SD is classically associated with high-energy trauma, this case highlights its occurrence following minor trauma in elderly patients. Clinicians should maintain a high index of suspicion for SD in atypical presentations to facilitate early diagnosis and optimize treatment.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 3","pages":"e80652"},"PeriodicalIF":1.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11910890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652792","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}