Cureus最新文献

{"title":"Retraction: Impact of a Probiotic-Fiber Blend on Body Weight, Metabolic Regulation, and Digestive Function in Obese Adults: A Randomized, Placebo-Controlled, Multicentric Trial.","authors":"Manohar Kn, Ramshyam Agarwal, Aparana Patange, Pariksha Rao, Gayatri Ganu, Kaynat Khan, Sanjana Sawant","doi":"10.7759/cureus.r255","DOIUrl":"https://doi.org/10.7759/cureus.r255","url":null,"abstract":"<p><p>[This retracts the article DOI: 10.7759/cureus.82613.].</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"r255"},"PeriodicalIF":1.3,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13687464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278921","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":"Retraction: Impact of Tight Collars and Neckties on Cervical Dysfunction Among Corporate Workers.","authors":"Anjum S Inamdar, Suraj Kanase","doi":"10.7759/cureus.r254","DOIUrl":"https://doi.org/10.7759/cureus.r254","url":null,"abstract":"<p><p>[This retracts the article DOI: 10.7759/cureus.113906.].</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"r254"},"PeriodicalIF":1.3,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13687467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278941","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":"Super-Refractory Status Epilepticus (SRSE) Secondary to Neurosyphilis Complicated by a Prolonged Drug-Induced Cardiac Arrest Successfully Bridged With Extracorporeal Membrane Oxygenation (ECMO) and Impella®: A Case Report.","authors":"Daniela Gutfreund, Lucca Loretz, Andreas Bloch, Lara Diem, Sascha Albrecht, Matthias Bossard","doi":"10.7759/cureus.118335","DOIUrl":"https://doi.org/10.7759/cureus.118335","url":null,"abstract":"<p><p>Neurosyphilis is a rare but readily treatable cause of status epilepticus (SE). Nevertheless, SE has a substantial morbidity and mortality if treatment is refractory and/or life-threatening complications occur. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has previously been successfully employed following life- threatening arrhythmias with refractory circulatory failure due to antiseizure medications (ASM) in the context of SE. Here we describe the combined use of VA-ECMO along with an Impella CP® micro-axial pump to provide full circulatory support and left ventricular unloading in a patient with a presumed drug-induced, refractory cardiac arrest amidst treatment for super-refractory status epilepticus (SRSE). This patient presented with a recurrent episode of convulsive SE with subsequent treatment-refractory nonconvulsive seizure activity on incremental ASM therapy. Investigations consistent with neurosyphilis prompted the initiation of antimicrobial therapy. ASM adjustments were made in view of suspected lacoseamide-induced arrhythmias, but subsequently a treatment-refractory cardiac arrest occurred with ensuing pulseless electrical activity and asystole. Mechanical life support followed by VA-ECMO was promptly initiated and an Impella CP® device was then placed given a non-ejecting heart. Subsequently, hemodynamic stabilization and seizure control were readily achieved and full cardiac recovery occurred after seven days. VA-ECMO plus Impella® provided effective circulatory support under which seizure control could be achieved and cardiac function recovered. Increased pro-arrhythmic risks due to possible synergistic inhibition of cardiac ionic channels need to be anticipated when multiple ASM and anesthetic agents are introduced during SE treatment. Neurosyphilis needs to always be considered as a rare cause of SE.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118335"},"PeriodicalIF":1.3,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13692437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278993","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":"Navigating Outcomes and Tailored Treatment Choices in a Cesarean Scar Ectopic Pregnancy: Insights From Five Cases in a Resource-Limited Facility.","authors":"Dancy Patel, Saunri Hansadah, Sonali Jagati","doi":"10.7759/cureus.118308","DOIUrl":"https://doi.org/10.7759/cureus.118308","url":null,"abstract":"<p><p>Once considered a rare entity, cesarean scar pregnancy (CSP) is now increasingly encountered. However, relatively little is known about its clinical characteristics and management due to the lack of large population-based studies. It results from implantation of a gestational sac within the fibrous scar of a previous cesarean section. Despite increasing awareness, there is no standardized management protocol, which can lead to delayed diagnosis and considerable variation in treatment approaches and outcomes. We report five cases of CSP managed at a tertiary care center between 2023 and 2024. The patients were 27 to 38 years of age, had one to two previous cesarean deliveries, and presented at gestational ages ranging from seven to nearly 17 weeks. Initial presenting complaints included vaginal bleeding, passage of a fleshy mass, and abdominal pain. Two patients had used over-the-counter medical termination kits, and one had a history of failed suction and evacuation. The diagnosis was established primarily by ultrasonography, with serum beta-human chorionic gonadotropin (hCG) used to support the diagnosis and monitor treatment response. Management was individualized: One patient was initially treated with methotrexate and mifepristone but required emergency laparotomy because of persistent vaginal bleeding; another underwent scar site resection and repair after hemodynamic stabilization; a third, with suspected arteriovenous malformation, required bilateral uterine and internal iliac artery ligation before scar excision; a fourth underwent hysterectomy; and the fifth underwent scar excision with concurrent bilateral tubal ligation. There were no maternal deaths, and all patients were discharged in stable condition. These cases demonstrate the varied clinical presentations and management challenges associated with CSP, including misdiagnosis and the need for individualized treatment ranging from conservative, fertility-preserving surgery to hysterectomy. CSP can mimic incomplete abortion and, if misdiagnosed and treated with unsupervised medical termination kits, can lead to catastrophic hemorrhage and potentially fatal outcomes. Therefore, obstetricians should maintain a high degree of suspicion for scar ectopic pregnancy in women with a history of cesarean section who present with early pregnancy bleeding. Early diagnosis and individualized, timely management - medical, surgical, or a combination of both - can achieve satisfactory maternal outcomes and, in many cases, preserve future fertility.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118308"},"PeriodicalIF":1.3,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279127","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":"Confusion in Acute Occipital Infarcts: Why Blame Delirium?","authors":"Chloe R Plater, Amy Green, Hakim Eluzai","doi":"10.7759/cureus.118289","DOIUrl":"https://doi.org/10.7759/cureus.118289","url":null,"abstract":"<p><p>Acute occipital infarction is a diagnostic challenge due to overlapping symptoms with delirium, another common hospital presentation. We describe a 94-year-old patient presenting with acute confusion and visual changes on imaging. CT imaging shows bilateral occipital infarcts, resulting in a display of Anton syndrome and impacting the patient's cognition. She was treated for an acute infarct and managed appropriately under the stroke team with the relevant therapy teams. We explore the challenges in differentiating causes of delirium and offer a diagnostic aid to prompt swifter identification of occipital infarcts in the absence of obvious cause for delirium. This provides an opportunity to encourage efficient diagnosis of occipital infarcts and to improve awareness for identifying key features early.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118289"},"PeriodicalIF":1.3,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13716151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149303223","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":"Assessment of Sleep Quality and Modifiable Disruptors in Postoperative Paediatric Patients: A Clinical Audit.","authors":"Zeenia Merali, Mohammed Hazara","doi":"10.7759/cureus.118296","DOIUrl":"https://doi.org/10.7759/cureus.118296","url":null,"abstract":"<p><p>Background Sleep disruption is common during postoperative hospitalisation and may be influenced by pain, overnight clinical care, and environmental factors. This quality improvement project assessed sleep quality among postoperative paediatric inpatients and identified potentially modifiable contributors to sleep disturbance. Methodology A clinical audit was conducted on a paediatric inpatient ward between April and June 2026. Children aged 0-18 years admitted following elective or emergency orthopaedic surgery and requiring at least one overnight postoperative stay were eligible. Parents or carers completed a questionnaire after the child's first postoperative night assessing sleep quality, nighttime awakenings, causes of sleep disturbance, ward noise and lighting, clustering of overnight care, assessment of sleep needs, and parent/carer sleep. Responses were analysed descriptively using frequencies and percentages. Results In total, 19 questionnaires were included: 14 from children accommodated in multi-bed bays and five from children in individual cubicles. In bays, eight of 14 (57.1%) children were reported to have fair sleep and six (42.9%) woke more than five times overnight. In cubicles, two of five (40.0%) children were reported to have good sleep and one (20.0%) woke more than five times. Nursing observations were reported as a contributor to sleep disturbance in 10 of 14 (71.4%) children in bays and four of five (80.0%) in cubicles. Pain contributed to sleep disturbance in 10 of 19 (52.6%) children overall. Most respondents reported that the ward was quiet overnight and that lights were kept low. However, only seven of 19 (36.8%) families reported being asked about their child's sleep needs. Parent/carer sleep was also frequently disrupted. Conclusions Postoperative sleep disruption was common, with nursing observations and pain among the most frequently reported contributors. Despite generally favourable perceptions of overnight noise and lighting, opportunities for improvement were identified in assessment of individual sleep needs, coordination of overnight care where clinically appropriate, and optimisation of pain management. A subsequent audit cycle following implementation of these measures will assess their impact on sleep-related outcomes.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118296"},"PeriodicalIF":1.3,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13696089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149278968","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":"Laparoscopic Endometriosis Phenotypes and Preoperative Non-suspicion of Endometriosis in Women With Superficial Disease: A Retrospective Study in Kinshasa.","authors":"Guy Lambert M Monzango Sibo, Laetitia Itewa Monka","doi":"10.7759/cureus.118310","DOIUrl":"https://doi.org/10.7759/cureus.118310","url":null,"abstract":"<p><p>Background Superficial peritoneal endometriosis (SPE) is difficult to identify before surgery, especially without concomitant ovarian or deep disease. We described laparoscopic phenotypes and examined factors associated with the absence of documented preoperative suspicion of any endometriosis among women subsequently found to have SPE. Methods We retrospectively analyzed gynecologic laparoscopies performed at three Kinshasa sites between January 2019 and June 2026 by one surgeon. Superficial, ovarian, and deep phenotypes were recorded as non-mutually exclusive. The analytical outcome was absence of documented preoperative suspicion of endometriosis of any phenotype among women with laparoscopically identified SPE and classifiable preoperative records. Modified Poisson models with robust variance estimated exploratory adjusted prevalence ratios (aPRs). Results Of 1,743 gynecologic laparoscopies, 216 (12.4%; 95% CI, 10.9%-14.0%) showed endometriosis and 1,527 (87.6%) did not. SPE occurred in 139/216 (64.4%), ovarian disease in 137/216 (63.4%), and deep disease in 68/216 (31.5%); 104/216 (48.1%) had overlapping phenotypes. Among 135 women with SPE whose preoperative records were classifiable, 83 (61.5%; 95% CI, 53.1%-69.3%) lacked documented suspicion of endometriosis; this proportion was 46/56 (82.1%) in isolated SPE. In the clinical model, infertility was associated with higher non-suspicion (aPR 1.59; 95% CI, 1.07-2.35), while deep dyspareunia was associated with lower non-suspicion (aPR 0.65; 95% CI, 0.45-0.94). With additional adjustment for coexisting operative phenotypes, the infertility association weakened (aPR 1.39; 95% CI, 0.95-2.04) and the dyspareunia estimate remained borderline (aPR 0.70; 95% CI, 0.49-1.00). Conclusions SPE and ovarian disease were the most common laparoscopic phenotypes in this selected surgical cohort. An absence of documented suspicion of any endometriosis was frequent among women with SPE, especially isolated SPE. Associations with infertility and deep dyspareunia are exploratory and may reflect clinical documentation, surgical referral pathways, and coexisting disease. Prospective standardized assessments are needed.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118310"},"PeriodicalIF":1.3,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279092","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: Diagnostic Yield of Opportunistic Upper Gastrointestinal Endoscopy During Elective Colonoscopy in Asymptomatic Patients: A Retrospective Cross-Sectional Study.","authors":"Caroline Assis Aleixo Chaves Freitas, Sandro Rodrigues Chaves, Rafael P Pessoa, Lucas Gallo de Alvarenga Mafra, Júlia Gallo de Alvarenga Mafra, Eduardo Seubert Coelho Vieira, Gabriela Vieira Brito, Giovanna De Giuli, Rodrigo Roda","doi":"10.7759/cureus.c495","DOIUrl":"https://doi.org/10.7759/cureus.c495","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.7759/cureus.118181.].</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"c495"},"PeriodicalIF":1.3,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13687463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149279016","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":"Technique of Intravenous Regional Block for Complex Regional Pain Syndrome Using Methylprednisolone, Lidocaine, and Labetalol.","authors":"Parker L Dillin","doi":"10.7759/cureus.118301","DOIUrl":"https://doi.org/10.7759/cureus.118301","url":null,"abstract":"<p><p>Intravenous regional block (IVRB), adapted from the Bier block technique, is a minimally invasive, low-risk interventional option for complex regional pain syndrome (CRPS). This technical report describes a reproducible IVRB protocol using methylprednisolone, lidocaine, and labetalol and emphasizes procedural details that may influence treatment delivery. Key elements include obtaining venous access distal to the involved region, selecting tourniquet position and pressure according to the affected extremity, slowly infusing the injectate, and performing deep friction massage while the extremity remains isolated from the systemic circulation. The report also describes staged tourniquet deflation, the use of anesthesia to limit procedure-related pain, an initial series of repeated blocks before judging response, and subsequent adjustment of block frequency according to the duration of pain relief. Practical methods for obtaining venous access in an edematous hand or foot and approaches to patients with remission, palliation, or an inadequate response are discussed. The objective is to provide clinicians with a detailed technique that can be reproduced and critically evaluated in the treatment of CRPS.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118301"},"PeriodicalIF":1.3,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13685579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149248048","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":"Assessment of Compliance With the National Institute for Health and Care Excellence Guidance in the Management of Patients Referred Following a First Suspected Seizure: A Retrospective Clinical Audit.","authors":"Mohammed T Hazara, Zeenia Merali, Priyarenjini Sarasamma, Sinead Blake, Gibran Merali","doi":"10.7759/cureus.118323","DOIUrl":"https://doi.org/10.7759/cureus.118323","url":null,"abstract":"<p><p>Introduction A first suspected seizure requires timely specialist assessment and appropriate investigation to establish an accurate diagnosis, identify seizure mimics, assess the risk of recurrence, and provide appropriate safety advice. The National Institute for Health and Care Excellence (NICE) guidance recommends urgent specialist assessment following a first suspected seizure, alongside appropriate electrocardiography, electroencephalography, neuroimaging, recurrence-risk assessment, and patient safety advice. This audit evaluated adherence to these standards within a first-seizure clinic. Materials and methods A retrospective clinical audit was undertaken on patients referred to a first-seizure clinic from the Emergency Department and Acute Medicine Unit over a three-month period from January to March 2025. Data were obtained from electronic patient records, clinic correspondence, and discharge documentation. Compliance with predefined standards from NICE guidance was assessed. The primary outcome measures were timely specialist assessment, 12-lead electrocardiography, documentation of individualized seizure recurrence risk, timely electroencephalography where clinically indicated, timely neuroimaging where indicated, and documentation of safety-netting and driving advice. Results Sixty-three patient records were initially identified. Ten patients did not attend or were lost to follow-up and were excluded from the final clinical analysis, leaving 53 patients. Five of 53 patients (9.4%) received specialist assessment within two weeks. A 12-lead ECG was documented in all 53 patients (100%), and an individualized seizure recurrence risk assessment was documented in all patients (100%). An electroencephalogram (EEG) was indicated in 17 patients, of whom one (5.9%) underwent EEG within 72 hours; 15 (88.2%) underwent EEG after 72 hours, and one patient did not attend. The mean time to EEG among those who eventually underwent the investigation was approximately 12.5 weeks. Neuroimaging was indicated in 41 patients, of whom 22 (53.7%) underwent imaging within six weeks and 19 (46.3%) underwent imaging after six weeks. Safety-netting, including documentation of driving/Driver and Vehicle Licensing Agency (DVLA) advice, was documented in all 53 patients (100%). Conclusion The audit demonstrated high compliance with core assessment and documentation standards but substantial delays in specialist review and time-critical investigations. The greatest gap was in timely EEG access, followed by delays in specialist assessment and neuroimaging. The findings support service-level interventions aimed at improving urgent access to first-seizure assessment and investigations. A repeat audit, following the implementation of targeted interventions, will be important to determine whether pathway changes improve compliance.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"18 10","pages":"e118323"},"PeriodicalIF":1.3,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13718880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149303268","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}