World Journal of Clinical Cases最新文献

Background: Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes, particularly in cases of intensive care unit (ICU)-acquired hypernatremia (IAH). Nevertheless, its relevance in patients with septic shock remains uncertain.

Aim: To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.

Methods: In the present retrospective single-center study, a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University, between August 1, 2018, and May 31, 2023, were analyzed. Patients were categorized based on the timing of hypernatremia occurrence into the IAH group (n = 62), the non-IAH group (n = 41), and the normonatremia group (n = 54).

Results: In the present study, there was a significant association between the high serum sodium concentrations, excessive persistent inflammation, immunosuppression and catabolism syndrome and chronic critical illness, while rapid recovery had an apparent association with normonatremia. Moreover, multivariable analyses revealed the following independent risk factors for IAH: Total urinary output over the preceding three days [odds ratio (OR) = 1.09; 95%CI: 1.02-1.17; P = 0.014], enteral nutrition (EN) sodium content of 500 mg (OR = 2.93; 95%CI: 1.13-7.60; P = 0.027), and EN sodium content of 670 mg (OR = 6.19; 95%CI: 1.75-21.98; P = 0.005) were positively correlated with the development of IAH. Notably, the area under the curve for total urinary output over the preceding three days was 0.800 (95%CI: 0.678-0.922, P = 0.001). Furthermore, maximum serum sodium levels, the duration of hypernatremia, and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients (P < 0.05).

Conclusion: The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU. It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.

Excellent progress has been made in the last few decades in the cure rates of pediatric malignancies, with more than 80% of children with cancer who have access to contemporary treatment being cured. However, the therapies responsible for this survival can also produce adverse physical and psychological long-term outcomes, referred to as late effects, which appear months to years after the completion of cancer treatment. Research has shown that 60% to 90% of childhood cancer survivors (CCSs) develop one or more chronic health conditions, and 20% to 80% of survivors experience severe or life-threatening complications during adulthood. Therefore, understanding the late side effects of such treatments is important to improve the health and quality of life of the growing population of CCSs.

Background: Acute mesenteric ischemia is a life-threatening disease. Intrasplenic gas is an extremely rare finding in such cases.

Case summary: We report a case of a 79-year-old woman with a history of end-stage renal disease on hemodialysis for approximately 20 years, type 2 diabetes mellitus, and atrial fibrillation who presented with two days of epigastric pain. A computed tomography scan of the abdomen revealed intraperitoneal free air and significant intrasplenic gas. Laparoscopy revealed diffuse intestinal gangrene, and acute superior mesenteric ischemia was diagnosed. The patient died within 24 hours owing to profound shock.

Conclusion: Intrasplenic gas is an extremely rare finding on computed tomography imaging in cases of acute mesenteric ischemia.

Early intervention for sensorineural hearing loss (SNHL) in childhood is crucial for auditory and language development. In recent years, innovative auditory stimulation techniques and speech therapy strategies, such as middle ear implants, cochlear implants, auditory brainstem implants, and midbrain implants, have provided new avenues for improving patient outcomes. Additionally, basic research advancements in cell reprogramming and regeneration, stem cell therapy, and targeted drug delivery offer promising approaches to meet the individualized needs of children with SNHL. However, many challenges and unresolved issues remain in the treatment of SNHL. This article comments on the case report, which describes a female pediatric patient with SNHL who underwent foot reflexology which led to the normalization of hearing thresholds. Reflexology is considered to have potential benefits in physical rehabilitation, but its efficacy in hearing restoration requires further scientific validation through rigorous clinical trials and large-scale prospective studies.

In this editorial, we comment on a recent article by Chen et al, that addressed the effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section. Poor management of post-cesarean pain is associated with decreased maternal care for the baby, longer hospitalization, and higher risk of developing postpartum depression. Esketamine is a more potent S-enantiomer of ketamine which has shown promising analgesic and antidepressant properties for managing post-cesarean pain and depression in clinical studies. However, due to its potential adverse effects on the neurological and hemodynamic status of patients, it is recommended that its usage in low doses should be limited to cesarean candidates experiencing unbearable pain. Before any recommendation for routine perioperative use of esketamine, more standardized clinical trials are needed to strengthen our existing knowledge of its effectiveness in reducing postpartum pain and depression.

Background: Internal hernia (IH) is a rare culprit of small bowel obstruction (SBO) with an incidence of < 1%. It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis, improper treatment, and subsequent morbidity and mortality.

Aim: To determine the clinico-demographic profile, radiological and operative findings, and postoperative course of patients with IH and its association with SBO.

Methods: Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow, India between September 2010 and August 2023 were reviewed.

Results: Out of 586 patients, 7 (1.2%) were diagnosed with IH. Among these, 4 had congenital IH and 3 had acquired IH. The male-to-female ratio was 4:3. The median age at presentation was 32 years. Contrast-enhanced computed tomography (CECT) was the most reliable investigation for preoperative identification, demonstrating mesenteric whirling and clumped-up bowel loops. Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency (approximately 43% each). Intraoperatively, one patient was found to have bowel ischemia and one had associated malrotation of gut. During follow-up, no recurrences were reported.

Conclusion: IH, being a rare cause, must be considered as a differential diagnosis for SBO, especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery. A rapid imaging evaluation, preferably with CECT, is necessary to aid in an early diagnosis and prompt intervention, thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.

Foot reflexology (FR) is a Chinese-originated and non-invasive complementary therapy increasingly used by functional, alternative and para-medical professionals. Enhance attempts are made to study FR in non-functional organic conditions. The present invited Editorial discusses the application of FR in autoimmune diseases (AD), highlighting a few successful studies demonstrating symptomatic relief and objective improvements. Despite promising results, the FR domain remains under-investigated and an urgent need to confirm and understand the effect of FR in chronic diseases, including AD, is highly recommended.

Background: Meniscal tears are one of the most common knee injuries. After the diagnosis of a meniscal tear has been made, there are several factors physicians use to guide clinical decision-making. The influence of time between injury and isolated meniscus repair on patient outcomes is not well described. Assessing this relationship is important as it may influence clinical decision-making and can add to the preoperative patient education process. We hypothesized that increasing the time from injury to meniscus surgery would worsen postoperative outcomes.

Aim: To investigate the current literature for data on the relationship between time between meniscus injury and repair on patient outcomes.

METHODSPubMed, Academic Search Complete, MEDLINE, CINAHL, and SPORTDiscus were searched for studies published between January 1, 1995 and July 13, 2023 on isolated meniscus repair. Exclusion criteria included concomitant ligament surgery, incomplete outcomes or time to surgery data, and meniscectomies. Patient demographics, time to injury, and postoperative outcomes from each study were abstracted and analyzed.

Results: Five studies met all inclusion and exclusion criteria. There were 204 (121 male, 83 female) patients included. Three of five (60%) studies determined that time between injury and surgery was not statistically significant for postoperative Lysholm scores (P = 0.62), Tegner scores (P = 0.46), failure rate (P = 0.45, P = 0.86), and International Knee Documentation Committee scores (P = 0.65). Two of five (40%) studies found a statistically significant increase in Lysholm scores with shorter time to surgery (P = 0.03) and a statistically significant association between progression of medial meniscus extrusion ratio (P = 0.01) and increasing time to surgery.

Conclusion: Our results do not support the hypothesis that increased time from injury to isolated meniscus surgery worsens postoperative outcomes. Decision-making primarily based on injury interval is thus not recommended.

Background: Thyrotoxic periodic paralysis (TPP) is an endocrine emergency caused by thyrotoxicosis, manifesting mainly as periodic myasthenia and hypokalemia, and posing a serious threat to the patient's health. Fatigue, strenuous exercise, alcohol abuse, high carbohydrate intake and insulin injections are common triggers of paralysis. This article reports a case of severe TPP induced by insulin injection, elucidates the characteristics and pathogenesis of the disease, analyses the risk factors for triggering TPP, and hopefully provides more clinical data for TPP patients.

Case summary: A 38-year-old Asian man presented to the emergency department with a one-week history of limb weakness and worsening half-day. His medical history included poorly controlled type 2 diabetes and he had been switched to Aspart50 a week earlier. He was alert and oriented with upper extremity strength grade 3 and lower extremity strength grade 1. Emergency department tests showed hypokalemia of 1.6 mmol/L. The paramedics administered 1.5 g of potassium intravenously, followed by 4.0 g orally. Weakness in the arms and legs improved. He was referred to endocrinology where he was diagnosed with Graves' disease, with suboptimal control and insulin injections possibly causing TPP. We stopped his insulin and he was discharged with a potassium level of 4.0 mmol/L.

Conclusion: Insulin is a trigger for TPP and should be avoided in patients with hyperthyroidism. Early recognition and treatment of TPP is crucial, especially in patients presenting with hypokalemic periodic paralysis.

This editorial discusses a case report recently published in the World Journal of Clinical Cases. The report describes the clinical presentation, imaging, diagnosis, and treatment of a patient with tuberous sclerosis complex (TSC) combined with primary lymphedema (PLE). Additionally, it retrospectively analyzes the data of 16 previously reported cases of children with TSC combined with PLE to summarize the epidemiology, genetic diagnosis, and current main treatments of these patients. The report also speculates on the pathological and physiological mechanisms underlying TSC combined with PLE. TSC combined with PLE is rare; therefore, the report provides a theoretical basis for understanding the pathophysiological mechanisms and treatment options for patients with TSC and PLE. Comprehensive clinical management of TSC is essential due to the diverse and multiorgan nature of its manifestations, often requiring a multidisciplinary approach for newly diagnosed cases.