Cureus最新文献

{"title":"Atrial Flutter With Intraventricular Conduction Delay, Hypotension, and Bradycardia in the Setting of High-Output Ileostomy With Renal Failure, Hyperkalemia, and Metabolic Acidosis: A Case Report With Brief Literature Review.","authors":"Edinen Asuka, Barbara Odac, Andrew Ndakotsu, Anastasia Postoev","doi":"10.7759/cureus.84158","DOIUrl":"https://doi.org/10.7759/cureus.84158","url":null,"abstract":"<p><p>After ostomy creation, some patients tend to develop high outputs from their ostomy site, which puts them at risk for volume depletion, renal failure, and electrolyte and acid-base abnormalities. This case emphasizes the need for a multidisciplinary team-based approach for the care of patients after ostomy creation, especially those with persistent high output and significant cardiac comorbidities, including cardiac arrhythmias. Patient education and subsequent follow-ups and assessments are important to prevent life-threatening complications in these patients.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84158"},"PeriodicalIF":1.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082927","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":"Euglycemic Diabetic Ketoacidosis Triggered by Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor Use in a Patient With Type 2 Diabetes Mellitus.","authors":"Yusuf Almascati, Ali Alhumaiqani","doi":"10.7759/cureus.84170","DOIUrl":"https://doi.org/10.7759/cureus.84170","url":null,"abstract":"<p><p>Euglycemic diabetic ketoacidosis (EuDKA) is a potentially life-threatening complication associated with sodium-glucose co-transporter 2 (SGLT2) inhibitors. Its subtle presentation, often lacking the hallmark of marked hyperglycemia, can lead to delayed recognition and treatment. We present the case of a 53-year-old female with type 2 diabetes mellitus who developed EuDKA following the abrupt discontinuation of long-term insulin therapy and transition to an SGLT2 inhibitor. Her vague symptoms and near-normal glucose levels concealed the severity of her condition, delaying the diagnosis. Once identified, she was managed with intravenous insulin, dextrose-containing fluids, and potassium replacement, resulting in resolution of acidosis and normalization of serum ketones. This case focuses on the diagnostic challenges posed by euglycemic DKA and highlights the importance of considering it in patients with SGLT2 inhibitors, even without significant hyperglycemia. It also emphasizes the need for careful clinical judgment when adjusting diabetic regimens and calls for more structured prescribing guidelines as these agents gain broader use.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84170"},"PeriodicalIF":1.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082451","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":"Research Trends and Structural Characteristics of Healthcare Research in Japan, Including the First Half of the New Coronavirus Spread Period: A Bibliometric Analysis.","authors":"Yasutoshi Moteki","doi":"10.7759/cureus.84197","DOIUrl":"10.7759/cureus.84197","url":null,"abstract":"<p><p>This study aims to conduct a bibliometric analysis to characterize the trends and research features of health administration in Japan, in terms of themes and structural aspects, such as institutional affiliations, up to the early stages of the spread of the new coronavirus. Literature data were obtained from the United States National Institutes of Health (NIH) database, using the search formula (Healthcare[Title/Abstract] AND Japan[Title]), and the dataset was obtained on March 15, 2025. The total number of data points analyzed was 1066. Research trends, such as the characteristics of themes based on KeyWords Plus (Clarivate, Philadelphia, USA) and their changes, and the academic structure focusing on the country of origin, institutional affiliations, and publication journals, were quantitatively analyzed using the bibliometrics tools in the R package (Biblioshiney interface) for literature up to 2021, when the impact of coronavirus disease of 2019 (COVID-19) became pronounced in Japan. The KeyWords Plus analysis revealed a substantial research emphasis on healthcare human resources, and confirmed an increase in COVID-19-related research around 2020, when the impact of the novel coronavirus infection spread in Japan. Notably, the results of the bibliometric analysis highlight the aspect that healthcare human resources was one of the main focuses of the study area. However, limitations of textmining methods were observed in the export function of the CiNii database (National Institute of Informatics, Tokyo, Japan), which comprehensively collects articles written in Japanese. In order to grasp research trends in the field of healthcare in Japan, regardless of language, it is necessary to enhance multilingual support in Japanese academic information databases and develop an international academic information database (such as Web of Science, Scopus, OpenAlex, etc.) to expand the scope of collection.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84197"},"PeriodicalIF":1.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121667","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":"Bowel Blockage Without a Block: Amyloidosis Presenting as Chronic Intestinal Pseudo-Obstruction.","authors":"Rangesh Modi, Guy Nguefang, Freny Patel, Prince Modi, Edgar M Luna Landa","doi":"10.7759/cureus.84189","DOIUrl":"https://doi.org/10.7759/cureus.84189","url":null,"abstract":"<p><p>We present the case of a 61-year-old man with a history of schizophrenia and non-ischemic cardiomyopathy who was admitted with chronic nausea, vomiting, and abdominal pain. His clinical course was marked by recurrent hospitalizations due to persistently dilated small bowel and multiple exploratory laparotomies, all failing to yield a definitive diagnosis, raising suspicion for chronic intestinal pseudo-obstruction. Extensive testing for vascular, paraneoplastic, infectious, and autoimmune causes was unremarkable. Given his unexplained cardiomyopathy and elevated serum light chains with a mild M spike, amyloidosis was suspected. A biopsy of the abdominal fat pad with Congo red staining confirmed amyloid deposition. His symptoms showed partial improvement with prucalopride, but he continues to require total parenteral nutrition and a venting gastrostomy tube for symptom management. Amyloid subtyping and a bone marrow biopsy are pending to determine the underlying etiology.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84189"},"PeriodicalIF":1.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082928","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":"Introducing Digital Pharmacometrics: A Pharmacokinetics (PK)/Pharmacodynamics (PD) Framework for Prescription Digital Therapeutics.","authors":"Shaheen E Lakhan","doi":"10.7759/cureus.84195","DOIUrl":"10.7759/cureus.84195","url":null,"abstract":"<p><p>Prescription digital therapeutics (PDTs) are FDA-authorized, clinically validated software applications that deliver behavioral and cognitive interventions through digital platforms. While these therapeutics are prescribed and regulated like drugs, they lack an established pharmacologic framework to define how digital content is delivered, processed, and translated into clinical benefit. In this editorial, we draw on rich experience in drug and PDT development to introduce the emerging discipline of digital pharmacometrics: the application of pharmacokinetics (PK) and pharmacodynamics (PD) principles to software-based medicine. We redefine classical concepts such as dose, exposure, and the absorption, distribution, metabolism, and excretion (ADME) framework for the context of digital therapeutics and identify Digital Working Alliance (DWA) formation as a critical modulator of therapeutic bioavailability. We also characterize digital PD through the development of dose-exposure-response curves that capture behavioral, biometric, and clinical outcomes, enabling closed-loop, adaptive therapeutic systems. This digital PK/PD model supports better trial design, labeling clarity, regulatory oversight, clinical guidance, and reimbursement models. By formally codifying how PDTs interact with patients and produce effects, digital pharmacometrics provides the scientific foundation necessary to scale precision software medicine.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84195"},"PeriodicalIF":1.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096387","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":"Missed Follow-Up and Kaposi Sarcoma Progression: The Consequences of Medication Non-adherence.","authors":"Kevin Chen, Byron Lee, Stanley Kim","doi":"10.7759/cureus.84196","DOIUrl":"10.7759/cureus.84196","url":null,"abstract":"<p><p>Kaposi sarcoma (KS) is a serious AIDS-defining malignancy that can progress rapidly in the setting of profound immunosuppression. Non-adherence to antiretroviral therapy (ART) remains a major barrier to viral suppression, particularly among underserved populations. We present the case of a 36-year-old African American man who has sex with men (MSM), living in an underserved community, with a history of HIV/AIDS and late latent syphilis. The patient developed disseminated KS after six months of non-adherence to bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy). He presented with a CD4 count of 44 cells/µL and a viral load of 592,000 copies/mL. Clinical findings included multiple violaceous skin lesions, pulmonary reticulonodular infiltrates with pleural effusion, and lymphadenopathy. Biopsy confirmed KS. He was restarted on ART and prophylactic antibiotics upon discharge. This case highlights the severe consequences of ART non-adherence in a vulnerable population. Targeted interventions, including long-acting ART, behavioral support, and telehealth innovations, are essential to improve retention in care and prevent advanced HIV-related complications like KS.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84196"},"PeriodicalIF":1.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096389","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":"Natural Orifice Specimen Extraction for Right-Sided Colon Cancer: A Systematic Review and Meta-Analysis of Propensity Score-Matched Studies.","authors":"Bernardo F Pompeu, Victória Mara Vieira Rocha, Ana Flávia Machado Oliveira, Patricia Marcolin, Luís C Dos Lucio Generoso, Sérgio Mazzola Poli De Figueiredo, Fernanda B Formiga","doi":"10.7759/cureus.84191","DOIUrl":"https://doi.org/10.7759/cureus.84191","url":null,"abstract":"<p><p>Minimally invasive surgery is the standard approach for right-sided colon cancer, but conventional laparoscopic specimen extraction (CVT) requires additional abdominal incisions, increasing the risk of postoperative complications and delayed recovery. Natural orifice specimen extraction (NOSE) minimizes abdominal incisions, potentially improving patient outcomes. This meta-analysis compares NOSE and CVT in terms of postoperative complications, operative characteristics, and long-term outcomes. A comprehensive literature search was conducted in PubMed, Scopus, the Cochrane Central Register of Clinical Trials, and Web of Science for studies available up to December 2024. A random-effects model was applied to compute ORs and mean differences (MDs) with 95% CIs. Heterogeneity was evaluated using the I² statistic. All statistical analyses were performed using R software (version 4.4.1, R Foundation for Statistical Computing). Seven propensity score-matched studies with 566 patients were included, with 240 (42.4%) undergoing NOSE and 326 (57.6%) undergoing CVT. NOSE was associated with significantly reduced postoperative pain on the 3rd day (MD -1.1; 95% CI -1.7 to -0.5; p < 0.01), lower SSI rates (OR 0.23; 95% CI 0.08-0.73; p = 0.012), and a shorter time to pass flatus (MD -0.8; 95% CI -1.2 to -0.4; p < 0.01). However, NOSE was linked to longer operative times (MD 36.4 minutes; 95% CI 3.4-69.4; p = 0.03). No significant differences were found in hospital stay (MD -0.5 days; 95% CI -2.1 to 1.1; p = 0.57), blood loss (MD -2.1; 95% CI -9.6 to 5.4; p = 0.58), or local recurrence (OR 0.44; 95% CI 0.07-3.01; p = 0.405). In conclusion, NOSE offers advantages such as reduced postoperative pain, lower SSI rates, and faster bowel recovery, with prolonged operative time as its main limitation. These findings support NOSE as a viable alternative to CVT for right-sided colon cancer without compromising safety or long-term outcomes.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84191"},"PeriodicalIF":1.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082590","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":"Continuous Re-MTAPA Block via SEDIC Catheter Placement: A Novel Analgesia Technique in Two Complex Surgical Cases.","authors":"Keisuke Nakazawa, Tasuku Watari, Rei Ikeda, Takahiro Suzuki","doi":"10.7759/cureus.84087","DOIUrl":"https://doi.org/10.7759/cureus.84087","url":null,"abstract":"<p><p>Epidural anesthesia is commonly used for perioperative pain management, but it can be challenging in patients with anatomical issues or those on anticoagulation therapy. We present two cases in which catheter placement in the space between the endothoracic fascia, diaphragm, and costodiaphragmatic recess (SEDIC) was used for postoperative analgesia. This technique was applied to two patients: one with severe thoracolumbar scoliosis (American Society of Anesthesiologists Physical Status (ASA-PS) 2) undergoing laparoscopic distal gastrectomy and another receiving antiplatelet therapy (ASA-PS 3) undergoing open abdominal aortic aneurysm repair. A continuous infusion of 0.125% levobupivacaine, supplemented with twice-daily boluses of 10 mL of 0.25% levobupivacaine via bilateral catheters, was administered. Both patients maintained Numeric Rating Scale scores below 3 throughout the observation period and did not require rescue analgesia. Continuous re-modified thoracoabdominal nerves through perichondrial approach block via SEDIC catheter placement provided effective postoperative analgesia in patients with contraindications to epidural techniques, supporting early mobilization without hemodynamic instability.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84087"},"PeriodicalIF":1.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082936","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":"Combined Transpetrosal Approach for Salvage Surgery in the Treatment of Recurrent and Advanced Nasopharyngeal Carcinoma: A Case Report.","authors":"Stephanie Suyhogo, Ness Jerold Justo, John Albert Dy","doi":"10.7759/cureus.84111","DOIUrl":"https://doi.org/10.7759/cureus.84111","url":null,"abstract":"<p><p>A 45-year-old female patient was diagnosed with nasopharyngeal carcinoma (NPC). She previously underwent chemotherapy and radiotherapy but now presents with multiple craniopathies and persistent severe headaches that significantly impair her daily activities due to local tumor progression. Notably, she had not been offered prior surgical intervention. Salvage surgical therapy following maximal chemotherapy and radiotherapy is a viable option for patients with local tumor progression and signs of brain compression, aiming to relieve increased intracranial pressure through tumor debulking. In this case report, we advocate for a multi-corridor approach - combining anterior and posterior petrosectomy with a retrosigmoid craniotomy - to optimize tumor resection. The choice of surgical approach is tailored to the extent of tumor invasion within the skull base, with the primary goal of achieving a safe and maximal resection. By utilizing multiple surgical corridors, extradural and intradural tumor burden can be effectively reduced. Mastery of various skull base approaches is essential to develop a comprehensive surgical repertoire, allowing for strategic combinations that optimize resection. Additionally, continuous monitoring and postoperative multidisciplinary care are crucial in guiding the next steps for these highly morbid conditions. In this case, the patient was discharged with a significant reduction in headache and no new neurological deficits. Salvage surgery remains a viable palliative option that can enhance the patient's quality of life.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84111"},"PeriodicalIF":1.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12077654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082930","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":"Successful Treatment of a Nonunion Fracture of the Femur With Extracorporeal Shockwave Therapy: An Evidence-Based Case Report.","authors":"Theodore Tandiono, Jessica Amelinda Mintarjo, Nunung Nugroho","doi":"10.7759/cureus.84138","DOIUrl":"10.7759/cureus.84138","url":null,"abstract":"<p><p>Nonunion fractures, especially of the femur, pose a considerable difficulty in orthopedic management due to their propensity to result in enduring physical disability and psychological complications. Conventional surgical procedures, although efficacious, may entail difficulties and have a reduced success rate for atrophic nonunions. Extracorporeal shockwave therapy (ESWT) has arisen as a viable non-invasive option, facilitating bone regeneration via many biological mechanisms. This case report describes the management of a 40-year-old male patient with a distal-third open femoral fracture resulting from a motor vehicle accident. Despite receiving open reduction internal fixation and an extensive rehabilitation regimen, the patient had little callus development after six months. ESWT was commenced once weekly for 23 weeks, combined with ultrasonic low-intensity pulsed ultrasound (LIPUS) therapy and leg extension exercises. The patient had full callus formation on the femur and made a full recovery. The comprehensive literature evaluation demonstrates that ESWT can achieve a healing rate of around 73% for nonunion femoral fractures. The therapy's effectiveness is due to its capacity to induce osteogenic responses, promote osteoblast development, and suppress osteoclast production. This non-invasive method diminishes the necessity for supplementary surgical interventions and related complications. Additional research is required to develop standardized methods and refine therapy parameters, guaranteeing consistent and dependable results across various patient groups.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84138"},"PeriodicalIF":1.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096391","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}