Cureus最新文献

{"title":"Escherichia coli Pyogenic Ventriculitis in an Infant Following Abdominal Surgery: A Rare Case Report.","authors":"Mohammed Maarad, Marwane Alaraibi, Mohamed Dahamou, Houssam Bkiyar, Brahim Housni","doi":"10.7759/cureus.84558","DOIUrl":"10.7759/cureus.84558","url":null,"abstract":"<p><p>Pyogenic ventriculitis is a severe and uncommon bacterial infection of the brain's ventricular system, most often associated with neurosurgical procedures or trauma, but it can rarely occur in other clinical settings. This case report describes an unusual presentation in an eight-month-old infant with no prior medical history, who developed this condition following abdominal surgery for acute intussusception. After an initially uneventful postoperative course, the patient presented with persistent high fever, seizures, and neurological deterioration. Diagnostic imaging revealed triventricular hydrocephalus on computed tomography (CT), and magnetic resonance imaging (MRI) confirmed the presence of pyogenic ventriculitis. Laboratory analysis of cerebrospinal fluid and blood cultures identified multidrug-resistant <i>Escherichia coli</i> as the pathogen. The infant was treated with mechanical ventilation, Anti-seizure medications, corticosteroids, broad-spectrum antibiotics, and external ventricular drainage. Clinical improvement was observed, and the patient was transferred for continued care. This case highlights the importance of considering central nervous system infections in infants with atypical postoperative courses and reinforces the value of MRI in early and accurate diagnosis, as well as the need for prompt, multidisciplinary management.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84558"},"PeriodicalIF":1.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121866","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":"Computational Fluid Dynamics Methodology for Aortic Aneurysm Analysis in Computed Tomography (CT) Datasets.","authors":"Charles G Jenkinson, Tristan L Wood","doi":"10.7759/cureus.84523","DOIUrl":"10.7759/cureus.84523","url":null,"abstract":"<p><p>Aortic aneurysms present significant clinical challenges due to the risk of rupture associated with the abnormal dilation of the aorta. Computational fluid dynamics (CFD) analysis is an emerging, non-invasive method to analyse haemodynamic forces within aneurysmal regions. We present a detailed, reproducible workflow for the CFD analysis of aortic aneurysms based on cardiac-gated computed tomography (CT) data. Using a structured toolchain of open-source software, namely, Horos (Horos Project, Annapolis, MD, USA) for image preparation, Image Tool Kit-SNAP (ITK-SNAP) (University of Pennsylvania, Philadelphia, PA, USA) for segmentation, MeshLab (Istituto di Scienza e Tecnologie dell'Informazione-Consiglio Nazionale delle Ricerche (ISTI-CNR), Pisa, Italy) for mesh refinement, Blender (Blender Foundation, Amsterdam, Netherlands, https://www.blender.org) for boundary patching, OpenFOAM (OpenFOAM Foundation, London, UK) for CFD simulation, ParaView (Kitware, Inc., Clifton Park, NY, USA) for visualisation, and R (R Foundation for Statistical Computing, Vienna, Austria, https://www.R-project.org/) for statistical analysis, the methodology achieves high fidelity in modeling patient-specific flow conditions. Key stages of the workflow address segmentation accuracy, mesh quality, and boundary condition assignment, ensuring that the model captures physiological flow characteristics. This approach provides a valuable and accessible tool for clinicians and researchers, supporting assessments of haemodynamic risk factors in cardiovascular research.  Our model aims to provide insights into wall shear stress (WSS), pressure distributions, and flow dynamics that may contribute to aneurysm progression and high-risk features.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84523"},"PeriodicalIF":1.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12098751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145181","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":"The Effectiveness of Topical Lactic Acid Gel in Episiotomy Wound Healing and Its Impact on Sexual Quality of Life After Childbirth: A Prospective Study.","authors":"Dragos Brezeanu, Ana-Maria Brezeanu, Sergiu Chirila, Vlad I Tica","doi":"10.7759/cureus.84517","DOIUrl":"10.7759/cureus.84517","url":null,"abstract":"<p><strong>Background: </strong>The postpartum period is essential for maternal recovery, significantly impacting both physical wound healing and the restoration of sexual function. Optimal episiotomy healing is directly correlated with improved postpartum sexual health, and lactic acid is being explored as a therapeutic agent in wound care due to its antimicrobial and regenerative properties. This study aims to evaluate the efficacy of topical lactic acid (Canesbalance®, Bayer, Leverkusen, Germany) in promoting episiotomy healing and its subsequent influence on postpartum sexual quality. Additionally, it explores how demographic factors, such as educational level, maternal age, and parity, affect postpartum sexual function.</p><p><strong>Methods: </strong>We conducted a prospective comparative study involving 100 postpartum women divided into two groups: an experimental group treated with topical lactic acid gel applied to the episiotomy site seven days postpartum and a control group undergoing spontaneous wound healing without intervention. Episiotomy healing quality and sexual function were assessed once at 40 days postpartum using a 12-item sexual quality of life questionnaire. This was the only follow-up point in the study, and no additional clinical visits or evaluations were conducted beyond the 40-day postpartum assessment. Statistical analyses included independent t-tests to compare healing scores, ANOVA for evaluating demographic influences on sexual function, and correlation analyses between healing quality and postpartum sexual function scores.</p><p><strong>Results: </strong>The lactic acid-treated group demonstrated significantly improved episiotomy healing scores compared to the control group. Educational level significantly influenced postpartum sexual quality, with higher education correlating with improved sexual function. Maternal age and parity did not demonstrate statistically significant effects on postpartum sexual function.</p><p><strong>Conclusion: </strong>Topical lactic acid application significantly improves episiotomy wound healing and positively impacts postpartum sexual function. Educational attainment emerged as an important determinant of sexual quality postpartum. These findings advocate for further studies to confirm the long-term benefits and wider clinical applicability of lactic acid in postpartum care.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84517"},"PeriodicalIF":1.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121672","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":"Beyond the Package Insert: A Postmarket Digital Ethnographic Study of FDA-Cleared Prescription Digital Therapeutics.","authors":"Shaheen E Lakhan","doi":"10.7759/cureus.84450","DOIUrl":"10.7759/cureus.84450","url":null,"abstract":"<p><p>Introduction Prescription digital therapeutics (PDTs) are FDA-cleared software interventions designed to treat a variety of clinical conditions. Despite clinical validation through randomized controlled trials, PDTs face postmarket challenges that remain unmonitored through traditional surveillance. This study introduces a novel framework of digital ethnography, utilizing social media, specifically Reddit, to capture spontaneous, community-driven insights on PDT experiences beyond clinical trials. It seeks to explore the nuanced realities of user engagement, interface friction, emotional impact, and public perception. Methods We conducted a digital ethnographic analysis of Reddit posts collected from condition-specific and general health subreddits. We focused on 13 FDA-cleared PDTs. Posts containing first-person accounts or caregiver perspectives were included, and a thematic analysis was performed to identify recurrent themes related to user experience. Descriptive statistics were generated to support qualitative findings. Results The study revealed that Reddit communities offer rich, culturally-specific contexts that shape PDT experiences. A final sample of 65 posts, each containing first-person or caregiver perspectives, was analyzed, discussing 11 of the 13 PDTs. Five major domains emerging included ambivalence about efficacy (belief and skepticism), common patterns of engagement and dropout (motivation and frustration), usability challenges (technical friction), and structural barriers to access (insurance and affordability). Additionally, users frequently expressed emotional meaning-making as they navigated their therapeutic journeys. Differences in discussion tone were noted across subreddits: for example, r/ADHD focused on pragmatic usability, while r/depression engaged in deeper emotional reflection. Discussion This digital ethnographic study highlights the importance of integrating user-generated data from digital platforms like Reddit to understand the real-world impact of PDTs. While clinical trials offer limited insights, social media provides a broader, more diverse range of experiences that reveal common usability barriers, engagement patterns, and access challenges. Our findings suggest that the context in which PDTs are discussed, shaped by community norms, beliefs, and expectations, plays a critical role in shaping user outcomes and perceptions. Conclusion Postmarket digital ethnography offers valuable insights into the user experience of FDA-cleared PDTs, which are not captured in traditional clinical trials or regulatory processes. This study advocates for the inclusion of structured social media analysis as part of postmarket surveillance to improve the design, accessibility, and effectiveness of PDTs. Listening to the voice of the patient in informal spaces like Reddit is essential for ensuring the real-world success of digital therapeutics.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84450"},"PeriodicalIF":1.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121860","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":"Impact of Comorbidities on the Prevalence and Recovery Outcomes in Elderly Patients With Neck of Femur Fractures.","authors":"Zahir Khan, Muhammad Arsalan Azmat Swati, Aimon Zia, Anwar Imran, Ashraf, Rumman, Amjad Ali","doi":"10.7759/cureus.84502","DOIUrl":"10.7759/cureus.84502","url":null,"abstract":"<p><p>Background Neck of femur (NOF) fractures are a major cause of morbidity and mortality in the elderly, with incidence rising due to the aging population. The presence of comorbidities in elderly patients can increase the risk of complications and extend recovery time. Understanding how these health conditions influence recovery is crucial for improving patient outcomes. The high mortality rates and functional decline linked to NOF fractures emphasize the need for tailored treatment strategies. Objective To examine how comorbidities affect the prevalence, recovery outcomes, and overall prognosis of neck of femur fractures in elderly trauma patients. Materials and methods A retrospective cohort study was conducted at the Orthopedic Department of Mardan Medical Complex, Pakistan, between December 2023 and March 2025. The study focused on elderly patients (aged ≥65 years) diagnosed with neck of femur (NOF) fractures. Data were extracted from patient medical records, including demographic information, comorbidities, medical history, and recovery outcomes. Statistical analyses, such as descriptive statistics, chi-square tests, and correlation analyses, were performed to investigate the relationships between comorbidities and all studied variables. Additionally, data visualizations, including boxplots, barplots, and heatmaps, were utilized to further explore the associations between comorbidities and all studied variables. Results The study population consisted of 163 patients, with 70.55% males (115 patients) and 29.45% females (48 patients). The mean age was 80.23 ± 9.02 years. Anemia had the highest prevalence, affecting 71.77% (117 patients), followed by hypertension in 60.12% (98 patients), diabetes in 57.05% (93 patients), and cardiovascular disease in 55.21% (90 patients). Postoperative complications were common, with hyperglycemia (31.90%, 52 patients), deep vein thrombosis (18.40%, 30 patients), and heart failure (12.88%, 21 patients) being the most frequent. Comorbidities such as anemia, diabetes, and cardiovascular diseases were strongly associated with longer hospital stays, delayed surgery, extended rehabilitation periods, and reduced follow-up care compliance. Additionally, a significant correlation was found between the number of comorbidities and higher pain levels, particularly in patients with anemia and diabetes. Conclusion Comorbidities notably impair recovery in elderly patients with NOF fractures, with anemia, hypertension, diabetes, and cardiovascular diseases contributing to delayed recovery, complications, and higher healthcare costs. Early intervention, personalized treatment plans, and targeted rehabilitation are crucial to improve outcomes. This study highlights the importance of thorough preoperative assessments and ongoing management of chronic conditions in this patient population.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84502"},"PeriodicalIF":1.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129717","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":"Bladder Spasm Discomfort After Transurethral Surgery: A Prospective Observational Study of Preoperative, Intraoperative, and Postoperative Predictive Factors.","authors":"Titos Markopoulos, Stamatios Katsimperis, Lazaros Lazarou, Lazaros Tzelves, Iraklis Mitsogiannis, Athanasios Papatsoris, Andreas Skolarikos, Ioannis Varkarakis","doi":"10.7759/cureus.84508","DOIUrl":"10.7759/cureus.84508","url":null,"abstract":"<p><p>Catheter-related bladder discomfort (CRBD) is a common and distressing complication following transurethral urologic procedures such as transurethral resection of the prostate (TURP) and transurethral resection of bladder tumors (TURBT). This prospective observational study investigated the role of preoperative, intraoperative, and postoperative factors in predicting the severity of postoperative bladder spasms. A total of 122 patients were enrolled, and bladder discomfort was assessed using the Visual Analogue Scale (VAS) during their postoperative hospital stay. Most clinical and surgical variables, including anesthesia type, procedure type, catheter type, energy modality, and patient demographics, showed no significant association with bladder discomfort severity. However, catheter balloon volume emerged as a significant predictor, with patients receiving 40 mL balloon volumes reporting higher VAS scores compared to those with smaller volumes (p = 0.003). Additionally, a weak but statistically significant correlation was found between hematocrit drop and VAS scores (rho = 0.18, p = 0.047), suggesting a possible link between intraoperative blood loss and postoperative discomfort. These findings highlight the potential for simple interventions, such as optimizing catheter balloon volume, to alleviate CRBD and enhance postoperative recovery.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84508"},"PeriodicalIF":1.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121862","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":"Decoding FDA Labeling of Prescription Digital Therapeutics: A Cross-Sectional Regulatory Study.","authors":"Shaheen E Lakhan","doi":"10.7759/cureus.84468","DOIUrl":"10.7759/cureus.84468","url":null,"abstract":"<p><p>Background Prescription digital therapeutics (PDTs) are software-only, FDA-regulated medical devices prescribed to prevent, manage, or treat disease. Despite increasing FDA clearance, there remains limited understanding of how PDTs are regulated and labeled from a product, sponsor, and indication standpoint. Objective This study aims to conduct the first systematic regulatory labeling analysis of all FDA-cleared PDTs, characterizing their approval pathways, sponsor profiles, clinical indications, and therapeutic language. Methods We performed a retrospective descriptive analysis of all software-only PDTs cleared by the FDA as of May 2025. Publicly available decision summaries, classification orders, and device listings were reviewed. Each PDT was examined by regulatory pathway, reviewing office, product code, sponsor geography, ICD-11 mapping, and FDA-approved labeling language, with a focus on terms of therapeutic intent and age-based eligibility. Results Thirteen PDTs were identified, with eight (61.5%) cleared via the 510(k) pathway and five (38.5%) via de novo classification. The most targeted neurological or psychiatric conditions were reviewed by the corresponding FDA offices. Sponsors were all US-based and concentrated in digital health hubs, particularly San Francisco. Therapeutic indications ranged from insomnia and diabetes to migraine and opioid use disorder. Labeling language varied: 11 PDTs included treatment claims, although most used modifiers such as \"symptom improvement\" or \"aid in the management.\" Only one PDT, CT-132 for migraine, received a clean treatment label, defined as unambiguous treatment language without qualifiers, reflecting direct disease-targeting intent. Two PDTs deviated notably: reSET-O was labeled solely to increase outpatient treatment retention for opioid use disorder, and EndeavorRx was indicated to improve attention function without claiming to treat ADHD. Age-based eligibility spanned pediatric to adult definitions, consistent with FDA device criteria. Conclusions This study reveals meaningful variation in how PDTs are classified, labeled, and geographically distributed. FDA-sanctioned language plays a critical role in defining therapeutic scope and impacts how PDTs are interpreted by clinicians, payers, and patients. These insights mark a step forward in understanding the regulatory architecture of digital medicine.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84468"},"PeriodicalIF":1.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113070","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":"Can Physical Prehabilitation Reverse Frailty in Elderly Patients Before Spine Surgery? A Case Report.","authors":"Regina Knudsen, Nicholas Ma, Keri Ann Markut, Basma Mohamed","doi":"10.7759/cureus.84465","DOIUrl":"10.7759/cureus.84465","url":null,"abstract":"<p><p>Frailty is a syndrome that results from age-associated decline of physiological function and decreased response to stressors. It has been associated with postoperative adverse events in the spine surgery population. Evaluation of frailty in older adults undergoing surgery is becoming increasingly incorporated in the preoperative evaluation due to the growing number of aging patients requiring surgery. However, which optimization strategies should be incorporated into the preoperative plan to improve the patient's overall health and quality of life is unclear. Physical prehabilitation has been evaluated in the spine surgery population. However, prehabilitation before spine surgery has mainly focused on cognitive behavioral therapy and physical exercise to alleviate pain. None of the current studies for prehabilitation in spine surgery addressed the role of physical prehabilitation in reversing frailty in older adults. This case report presents the impact of physical prehabilitation on frailty indices and immediate postoperative outcomes in frail spine surgery patients. We present two patients who participated in a physical prehabilitation program for frail older adults requiring spine surgery. Both patients had significant improvement in their frailty, functional capacity, and overall quality of life, as indicated subjectively by the patients. One patient opted out of surgery due to overall improved functional capacity. In this report, we also highlight the impact of physical prehabilitation on the possibility of reversing frailty. Frailty is a well-known risk factor for postoperative adverse events after spine surgery, and whether to modify this risk factor to improve outcomes is still a question that requires future well-designed research studies. This case report shows that physical prehabilitation is a feasible intervention to reverse or prevent the worsening of frailty in spine surgery patients.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84465"},"PeriodicalIF":1.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113065","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":"Pancreatic Cancer Presenting With Hematemesis and Hemorrhagic Shock Following Anticoagulation With Unfractionated Heparin for Cancer-Related Venous Thromboembolism.","authors":"Mayuko Tagaya, Naoyuki Otani, Ai Sato, Atsushi Irisawa, Yasuhiro Maejima","doi":"10.7759/cureus.84498","DOIUrl":"10.7759/cureus.84498","url":null,"abstract":"<p><p>Cancer-related venous thromboembolism (VTE) is a significant concern owing to its frequent occurrence and status as a leading cause of death in patients with cancer. Cancer-related VTE carries a higher risk of hemorrhage than VTE in patients without carcinoma. A 74-year-old woman with pancreatic head cancer presented with complaints of loss of appetite and weight loss. Contrast-enhanced computed tomography (CT) was performed for stage classification of pancreatic cancer, which incidentally revealed pulmonary thromboembolism. The patient remained clinically asymptomatic, with no evidence of hypoxemia or echocardiographic findings suggestive of pulmonary hypertension. Due to the unavailability of low-molecular-weight heparin for the treatment of acute pulmonary embolism and concerns about potential hemorrhage according to CT findings, unfractionated heparin was selected for its ability to be closely monitored and promptly discontinued if necessary. However, the treatment was immediately halted as the patient developed hematemesis and hemorrhagic shock. Subsequent CT confirmed gastrointestinal hemorrhage, and three-dimensional CT angiography identified the pancreaticoduodenal arcade as the source of bleeding. Emergency catheter angiography and transcatheter arterial embolization were performed, successfully achieving hemostasis. This case highlights the high risk of both recurrent VTE and bleeding complications in patients with cancer-related VTE, underscoring the need for individualized treatment strategies.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84498"},"PeriodicalIF":1.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120614","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":"Medically Refractory Nesidioblastosis as a Late Adverse Effect of Roux-en-Y Gastric Bypass.","authors":"Michael Ladna","doi":"10.7759/cureus.84429","DOIUrl":"10.7759/cureus.84429","url":null,"abstract":"<p><p>A male in his late 40s with a past medical history of morbid obesity status post Roux-en-Y gastric bypass in 2004 presented to the emergency department with recurrent hypoglycemia. The hypoglycemic episodes were triggered by preceding hyperglycemia shortly after a meal. Due to the rapid drop in glucose, he often did not have sufficient time to ingest a rapid-acting carbohydrate snack, resulting in the progression of neuroglycopenic symptoms to syncope. His wife would then immediately administer intramuscular glucagon. A thorough workup did not reveal decompensated liver cirrhosis, chronic kidney disease, congestive heart failure, hypothyroidism, adrenal insufficiency, or insulin use. Serum insulin and C-peptide levels were profoundly elevated. A magnetic resonance imaging (MRI) of the abdomen and pelvis showed no pancreatic mass to suggest an insulinoma. He was referred to interventional radiology (IR) for a selective arterial calcium stimulation test (SACST), which showed an insulin ratio >2 in the gastroduodenal and hepatic arteries, consistent with a diagnosis of nesidioblastosis. He was trialed on numerous medications, which included octreotide, acarbose, diazoxide, and verapamil. He did not tolerate the octreotide due to the adverse effect of worsening abdominal pain and elevated serum lipase consistent with an attack of acute on chronic pancreatitis. The remaining medical regimen was ineffective at preventing hypoglycemia. Although evidence is lacking for use in this context, empagliflozin was then added to prevent the hyperglycemic spikes; however, this too proved ineffective at preventing hypoglycemic episodes. He underwent placement of a percutaneous endoscopic gastrostomy tube intended to tightly control his serum glucose via carbohydrate-low, protein-rich enteral feeds to prevent hyperglycemic episodes; however, this too failed due to suboptimal compliance with oral diet. Endocrinologic surgery declined distal pancreatectomy due to high morbidity and mortality risk with questionable benefit. The patient opted to seek a second opinion at another medical center.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84429"},"PeriodicalIF":1.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113096","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}