Cureus最新文献

{"title":"Takotsubo Cardiomyopathy With an Unusually High Troponin Level Post-laparotomy for Small Bowel Obstruction Secondary to Adhesions in a Patient Presenting With Pelvic Inflammatory Disease.","authors":"Abrar Z Khan, Upeshala A Jayawardena, David Luke","doi":"10.7759/cureus.84685","DOIUrl":"10.7759/cureus.84685","url":null,"abstract":"<p><p>Pelvic inflammatory disease (PID) triggering adhesion-related small bowel obstruction (SBO) is rare. The occurrence of Takotsubo cardiomyopathy (TCM) with an unusually high level of troponin I in the clinical course presents a unique diagnostic challenge. We report the case of a female patient in her 40s who had repeatedly presented to the hospital with abdominal pain and initially showed signs of PID, which later developed to SBO due to adhesions requiring laparotomy. Six days post-laparotomy, she experienced chest pain with ST-segment elevation on electrocardiogram (ECG) and high troponin I level at 16,804 ng/L (reference range: 0-39 ng/L), and bedside echocardiography showed apical ballooning with severely impaired left ventricular ejection fraction. Her cardiac biomarkers and echocardiogram features improved over the next few days making TCM the likely cause, with ST-segment elevation myocardial infarction (STEMI) being the main differential diagnosis. Besides the unique series of events that created the level of complexity, this case highlighted the importance of considering PID as a potential trigger for SBO, the cautious evaluation of troponin in acute coronary syndrome (ACS)-mimicking presentation, and, above all, the necessity of timely multidisciplinary team involvement in dealing with complex cases.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84685"},"PeriodicalIF":1.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic Options for the Prevention of Thromboses in Cushing's Syndrome: A Propensity-Matched, Retrospective Cohort Analysis.","authors":"Maxim J Barnett, Sarah Eidbo","doi":"10.7759/cureus.84616","DOIUrl":"10.7759/cureus.84616","url":null,"abstract":"<p><p>Introduction Cushing's syndrome, or hypercortisolism, occurs after prolonged exposure to excess cortisol, and can be characterized by moon facies, central fat redistribution, proximal limb muscle weakness and wasting, and abdominal striae. Medical literature points to a relationship between hypercortisolism and hypercoagulability, with higher rates of venous thromboembolism noted. Current guidelines recommend prophylaxis with low-molecular weight heparin (LMWH), but there is little evidence to support LMWH over other forms of anticoagulation. Methods We utilized TriNetX US Collaborative Network (TriNetX, LLC, Cambridge, Massachusetts, United States) to investigate the efficacy of different forms of anticoagulation in patients with hypercortisolism, defined by International Classification of Diseases, Tenth Revision (ICD-10) codes. Adult patients with hypercortisolism and prescribed enoxaparin, a form of LMWH, were compared to patients with hypercortisolism prescribed unfractionated heparin, warfarin, apixaban, and aspirin at 81 mg. Groups were propensity-matched according to age at index event, sex, race, ethnicity, and comorbid conditions. The outcomes studied included pulmonary embolism (PE), upper extremity deep vein thrombosis (UE DVT), lower extremity deep venous thrombosis (LE DVT), superficial venous thrombosis (superficial VT), bleeding, transfusion, and all-cause mortality. Results No significant differences in outcomes were noted between enoxaparin and heparin, warfarin, or apixaban in patients with hypercortisolism of any cause. Uniquely, the enoxaparin cohort had significantly higher risk of PE, LE DVT, and all-cause mortality compared to the aspirin 81 mg cohort (PE: hazard ratio (HR) 1.697, 95%CI 1.444-1.994, p=0.0345; LE DVT: HR 1.492, 95%CI 1.28-1.738, p=0.0017; mortality: HR 1.272, 95%CI 1.167-1.386, p=0.0002). With further sub-analysis of pituitary-dependent (Cushing's Disease), enoxaparin continued to demonstrate a higher risk for LE DVT (HR 1.677, 95%CI 1.353-2.079, p=0.0081), and all-cause mortality (HR 1.597, 95%CI 1.422-1.794, p=0.0005). Conclusion Although LMWH is currently recommended as the gold standard for anticoagulation in patients with hypercortisolism, our evidence suggests that low-dose antiplatelets such as aspirin 81 mg could outperform it. Further research is warranted to confirm and replicate our findings.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84616"},"PeriodicalIF":1.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Backtracking to the Brain: A Journey From Cirrhosis to Hypothalamic Insight.","authors":"Holly N Haley, Farukh G Ikram, Anne M Ward","doi":"10.7759/cureus.84644","DOIUrl":"10.7759/cureus.84644","url":null,"abstract":"<p><p>We present a 31-year-old female patient with cryptogenic cirrhosis admitted for rectal bleeding secondary to rectal prolapse. During her hospital course, she was found to have severe multi-endocrine dysfunction as evidenced by persistent hypotension, bradycardia, and intermittent hypothermia with hypothyroidism, adrenal insufficiency, and diabetes insipidus, which were confirmed by laboratory testing. Due to the patient's hypothalamic-pituitary dysfunction along with biopsy-confirmed cirrhosis of unknown etiology, magnetic resonance imaging (MRI) of the brain was ordered. The MRI demonstrated a large, heterogeneously enhancing mass centered in the hypothalamus and infiltrating the pituitary stalk. This case stands out because of its diagnostic trajectory where investigating the cause of endocrine dysfunction revealed a cerebral neoplasm that contributed to the patient's development of cirrhosis. There is an established association between hepatic pathologies and hypothalamic masses with the proposed mechanism being deficiencies of growth hormone (GH), insulin-like growth factor-1 (IGF-1), thyroid stimulating hormone (TSH), and consequently, triiodothyronine (T3). GH deficiency predisposes patients to hepatic steatosis while IGF-1 and T3 deficiencies leave the liver more vulnerable to oxidative damage. As such, cranial imaging and endocrine evaluation should be considered in young patients with cryptogenic cirrhosis.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84644"},"PeriodicalIF":1.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progress to Date on Cranial Electromagnetic Field Stimulation to Modulate Brain Activity.","authors":"Alice S Wang, Paras Savla, James Brazdzionis, Katherine Ko, Dan E Miulli","doi":"10.7759/cureus.84653","DOIUrl":"10.7759/cureus.84653","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The electromagnetic field (EMF) of the brain can be modulated through EMF stimulation. The authors investigate whether longer duration of continuous EMF stimulation using a novel method to identify and provide feedback and adjustment of EMF recording would translate into sustained improvement in EMF patterns, such as higher amplitude with correlating improvement in clinical symptoms or deficits.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;From January 2025 to February 2025, a prospective study enrolled patients greater than 18 years old diagnosed with atraumatic and traumatic brain injury who underwent EMF stimulation within 24 hours of presentation. EMF data were collected using DAQami software (Dataq Instruments, Akron, Ohio) and analyzed using fast Fourier transformation (FFT) with Igor Pro 8 software (Wavemetrics Inc., Lake Oswego, Oregon). Based on each patient's clinical presentations and/or radiographic findings, localization of brain injuries, frequency selection, and optimal voltage stimulation were determined in real-time followed by delivery of incremental increase in duration of stimulation from 3, 5, 8, and 10 minutes until improvement in clinical symptoms and/or neurological deficits and sustained EMF change was achieved.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Ten patients were included in this study, with a mean age of 47.1 years. Mechanisms of injury included spontaneous hypertensive intracranial hemorrhage (1 patient) and head trauma after motor vehicle collision, dirt bike accident, and ground-level fall (9 patients). Radiographic findings included spontaneous basal ganglia hemorrhage (1 patient), isolated traumatic subdural hematoma (1 patient), traumatic subarachnoid hemorrhage (1 patient), and no intracranial abnormalities (7 patients). Clinical resolution of their neurological symptoms or remaining asymptomatic was achieved in five patients after three minutes of continuous EMF stimulation, two patients after five minutes of continuous EMF stimulation, and one patient after 10 minutes of continuous EMF stimulation (Table 1). Patient 8 declined to continue with the study after three minutes of continuous EMF stimulation, and patient 9 declined to continue with the study after five minutes of continuous EMF stimulation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study reveals the progress made to date utilizing a novel technology of EMF measurement at a distance, in real-time, using the non-invasive, lightweight portable helmet, and continuous feedback. The range of brain EMF can be stimulated at the optimal frequency and voltage with or without longer duration of stimulation in a precise and prescribed manner to produce sustained genetic and neuronal changes to improve, recover, and enhance the brain function in a sample of patients with atraumatic and traumatic brain injury and improve or resolve their neurological symptoms or deficits. It illustrates the necessity of real-time evaluation and adjustment of brain E","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84653"},"PeriodicalIF":1.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145126","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":"Anesthesia for Urgent Gastroscopy in Cold Agglutinin Disease: A Case Report and Literature Review.","authors":"Addison H Zhang, Cassie L Dow, Jack Bellamy","doi":"10.7759/cureus.84607","DOIUrl":"10.7759/cureus.84607","url":null,"abstract":"<p><p>We present the case of a 76-year-old lady who underwent an emergency gastroscopy for suspected upper gastrointestinal bleeding on a background of cold agglutinin disease, a rare autoimmune haemolytic anaemia triggered by cold temperatures. Several pre-operative and intra-operative precautions were taken to minimise the risk of hypothermia. Sedation anaesthesia was used with midazolam and gradual titration of propofol with high-flow nasal cannulae to maintain oxygenation. The anaesthetic proceeded safely and without complications, and we compared our technique to the literature.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84607"},"PeriodicalIF":1.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129521","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":"Urosepsis From Nephrolithiasis Caused by Candida glabrata: A Rare Etiology of Urinary Sepsis in an Immunocompetent Patient.","authors":"Jonathan Van Name, Krunal Shukla","doi":"10.7759/cureus.84600","DOIUrl":"10.7759/cureus.84600","url":null,"abstract":"<p><p>Nephrolithiasis can often serve as an infection nidus, as it is typically associated with urease-producing bacteria and can obstruct the urinary tract, leading to pyelonephritis. While most urinary tract infections from septic stones are bacterial in etiology, fungal causes are less commonly reported in immunocompetent patients and rarely manifest as fungemia. Among fungal causes, <i>Candida albicans</i> is the most common. We describe the case of a 41-year-old immunocompetent patient with a history of recurrent kidney stones and percutaneous nephrostomy tube placement, who developed sepsis from a urinary source secondary to a nephrolithiasis. Blood culture isolates grew <i>Candida glabrata</i>. Following identification of the fungus, the patient received a two-week intravenous micafungin course and outpatient stone removal per urological surgery.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84600"},"PeriodicalIF":1.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129732","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: Association Between Body Mass Index and the Efficacy of Calcium Channel Blockers for Hypertension in Cardiovascular Disease Patients.","authors":"Bassel Abdallah, Ahmed Jamal Chaudhary, Muhammad Waqas Javed, Marium Nadeem Khan, Ayesha Bibi, Muhammad Fayyaz Zafar, Muhammad Noor, Usman Tariq, Farzana Salman","doi":"10.7759/cureus.c225","DOIUrl":"https://doi.org/10.7759/cureus.c225","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.7759/cureus.81985.].</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"c225"},"PeriodicalIF":1.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12100456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145184","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 Rare Case of Disseminated Varicella Zoster Virus (VZV) Infection Complicated by VZV Pneumonia.","authors":"Suhel A Sabunwala, Tuhina Cornelius","doi":"10.7759/cureus.84630","DOIUrl":"10.7759/cureus.84630","url":null,"abstract":"<p><p>Disseminated varicella zoster virus (VZV) infection is rare in older adults. It is usually seen in immunocompromised adults. It usually manifests as generalized skin lesions, and most patients respond to Acyclovir treatment. Very few cases have been reported where the infection progresses to involve the lungs. Here we present a case of a young female with a history of uncontrolled human immunodeficiency virus (HIV) infection who presented with diffuse skin lesions that were tested positive for VZV. Despite starting on an appropriate regimen with Intravenous Acyclovir, the patient progressed to develop severe pneumonia and respiratory failure.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84630"},"PeriodicalIF":1.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12132666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217879","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 Knowledge, Attitude, and Practice Study on Trauma-Informed Care Among Nurses Working in a Hospital in Lucknow District.","authors":"Rajeev Misra, Akanksha Mishra, Rajgopal Reddy, Divyanshi Singh","doi":"10.7759/cureus.84652","DOIUrl":"10.7759/cureus.84652","url":null,"abstract":"<p><p>Background Trauma-informed care (TIC) is a framework that acknowledges the widespread impact of trauma and integrates knowledge about its effects into healthcare practices. As frontline caregivers, nurses frequently encounter patients with trauma histories. Their knowledge, attitude, and practice (KAP) regarding TIC are crucial in ensuring compassionate, effective, and patient-centered care. However, there is limited research assessing the understanding and implementation of TIC among nurses in Indian healthcare settings, particularly in Lucknow District. Materials and methods A cross-sectional, web-based survey was conducted from March 2024 to July 2024, using a random sampling method to assess nurses' KAP regarding TIC at Chandan and Fatima Hospitals. Results Among 208 nurses, 52.88% had 1-5 years of experience. No significant association was found between age and trauma-related perceptions (<i>p</i>> 0.05). Education (<i>p</i> = 0.049) and gender (<i>p</i> = 0.004) significantly influenced TIC techniques, with general nursing and midwifery (GNM) nurses and females predominantly using a broader range of therapeutic approaches. Conclusions This study is significant because it will provide evidence-based insights into the preparedness of nurses in Lucknow District regarding TIC. The findings can contribute to improved nursing education, hospital policies, and patient outcomes by promoting a more trauma-sensitive healthcare environment.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84652"},"PeriodicalIF":1.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12099021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145159","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":"Biologic Therapies in the Management of Sports-Related Tendon and Ligament Injuries: A Narrative Review.","authors":"David Koshy, Daniel I Koshy, Emma Ooi","doi":"10.7759/cureus.84556","DOIUrl":"10.7759/cureus.84556","url":null,"abstract":"<p><p>Sports-related tendon and ligament injuries are common among athletes and active individuals, often resulting in prolonged recovery and compromised performance. Traditional management strategies, including physiotherapy and surgical repair, may not yield optimal outcomes, prompting growing interest in biologic therapies such as platelet-rich plasma (PRP), mesenchymal stem cells (MSCs), and other regenerative modalities. This targeted narrative review synthesizes current evidence on the application of biologic therapies in treating tendon and ligament injuries, emphasizing their mechanisms of action, clinical efficacy, and limitations. Relevant studies were identified through a focused search of PubMed and Google Scholar from 2010 to 2024. PRP demonstrates sustained pain and function improvement in chronic tendinopathies, whereas MSCs show promise in enhancing graft integrity in ligament reconstruction; however, variability in preparation protocols and limited long-term randomized controlled trials constrain firm conclusions. Emerging approaches, including exosomes and scaffold-based delivery systems, offer new avenues for enhancing tissue healing. Biologic interventions hold considerable promise in augmenting soft tissue injury treatment, but standardized protocols and further high-quality trials are needed to support widespread adoption.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84556"},"PeriodicalIF":1.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145178","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}