Cureus最新文献

{"title":"Severe Hypokalemic Paralysis Following Rituximab Infusion in a Patient With Microscopic Polyangitis.","authors":"Yousuf Sherwani, Ayham Alsaab, Mohan Sengodan","doi":"10.7759/cureus.84750","DOIUrl":"10.7759/cureus.84750","url":null,"abstract":"<p><p>Rituximab is an anti-CD20 monoclonal antibody that has become an increasingly popular choice for the treatment of various autoimmune diseases. Various adverse effects have been attributed to the use of rituximab. Hypokalemia is one rare adverse reaction that is under reported in the literature and is life threatening. Here we report the case of a patient with symptomatic hypokalemia after IV rituximab infusion. Acute hypokalemia should be taken into account by healthcare professionals as a possible side effect after rituximab infusion.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84750"},"PeriodicalIF":1.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145128","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":"Pulsatile Tinnitus as a Manifestation of Radiation-Induced Internal Carotid Artery Stenosis in a Nasopharyngeal Carcinoma Survivor: A Case Report.","authors":"Yun-Chiang Chen, Shiang-Ru Lu, Yi-Chi Wang, Shu-Yu Yang, Pei-Chi Hsiao","doi":"10.7759/cureus.84762","DOIUrl":"10.7759/cureus.84762","url":null,"abstract":"<p><p>Nasopharyngeal carcinoma (NPC) is prevalent in East and Southeast Asia, with radiotherapy being the primary treatment modality. Carotid artery stenosis is a serious but often overlooked complication of radiotherapy. We present the case of a middle-aged NPC survivor who developed progressive symptoms, including left facial numbness, dysphagia, tongue atrophy, postural dizziness, and pulsatile tinnitus, 18 years after concurrent chemoradiation. Carotid ultrasound revealed high-grade stenosis of the left cervical internal carotid artery. Following carotid stenting, his dizziness and tinnitus resolved. This case illustrates the insidious progression of carotid stenosis after radiotherapy and underscores the importance of early vascular assessment in post-radiation patients with atypical symptoms such as pulsatile tinnitus. Clinicians should maintain a high index of suspicion in at-risk individuals, and physical therapists should adopt precautionary rehabilitation strategies to minimize the risk of vascular complications.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84762"},"PeriodicalIF":1.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164465","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":"Unexpected Development of Pericardial Effusion in a Patient With Influenza and Secondary Bacterial Infection.","authors":"Pooriya Bahadoran, Daniel Echeverria, Hansani Angammana, Redi Nikollari, Lisa N Glass","doi":"10.7759/cureus.84757","DOIUrl":"10.7759/cureus.84757","url":null,"abstract":"<p><p>Influenza poses a significant burden on healthcare systems worldwide, particularly when complicated by bacterial coinfections. Such cases often require intensive medical management. We present the case of a previously healthy young man whose influenza infection was complicated by bacterial coinfection, necessitating complex therapeutic intervention. During treatment with intrapleural fibrinolytic therapy, the patient was found to have developed a large pericardial effusion. While a causal relationship cannot be definitively established, this temporal association raises concern for a potential, previously unreported complication. We present this case to raise clinical awareness of this life-threatening possibility and encourage its consideration in the differential diagnosis when managing similar patients.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84757"},"PeriodicalIF":1.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145130","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":"Sentiment and Thematic Analysis of User Reviews for FDA-Cleared Prescription Digital Therapeutics: A Mixed-Methods Real-World Evidence Study.","authors":"Shaheen E Lakhan","doi":"10.7759/cureus.84710","DOIUrl":"10.7759/cureus.84710","url":null,"abstract":"<p><p>Background Prescription digital therapeutics (PDTs) are FDA-cleared, evidence-backed, smartphone-based interventions. While clinical trials establish efficacy under controlled conditions, the patient experience in real-world settings remains poorly characterized. App store reviews, though informal, offer a potential source of real-world evidence (RWE) reflecting user sentiment, barriers to engagement, and perceived benefit. Objective To characterize the real-world user experience of FDA-cleared PDTs through a mixed-methods analysis of publicly available app store reviews, combining quantitative sentiment classification with qualitative thematic analysis. Methods FDA-cleared PDTs via FDA's De Novo or 510(k) pathways were identified. Reviews were collected from the Apple App Store and Google Play Store using structured scraping tools. A rules-based sentiment classifier was applied based on user star ratings, and thematic content analysis was conducted using a hybrid natural language processing and manual coding approach. Reviews were grouped by app and platform, and dominant themes were extracted using unsupervised topic modeling. Results Of the 13 PDTs identified, seven had publicly accessible user reviews, yielding a dataset of 247 unique entries: AspyreRx, EndeavorRx, Regulora, Rejoyn, reSET, reSET-O, and Stanza. Sentiment classification revealed that 25.1% of reviews were positive, 12.6% neutral, and 62.3% negative. Thematic analysis identified six recurrent themes, including pediatric benefit and engagement, rewards and incentives, access and activation barriers, technical issues, emotional reactions and cost sensitivity, and boredom and frustration. While negative sentiment was more prevalent overall, several products, particularly Rejoyn and EndeavorRx, received meaningful reports of perceived benefit and therapeutic value. Company transitions were noted to have disrupted the continuity of historical review data of some PDTs. Conclusions App store reviews provide a rich, user-centered source of RWE and insights for PDTs. They highlight dimensions of access, usability, and trust not typically captured in clinical trials. Integrating such feedback into post-market evaluation may inform future design, regulation, and reimbursement of software-based therapeutics.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84710"},"PeriodicalIF":1.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145127","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":"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}