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Esophageal ulcers are rare but can become severe and require prompt treatment. Gastroesophageal reflux disease (GERD), one of the causes, is a frequently encountered disease that considerably affects the daily lives of patients; therefore, appropriate management is required. Acid-suppressive therapy is the mainstay of treatment. Here, we report a case in which potassium-competitive acid blocker (P-CAB) therapy was associated with ulcer healing and symptom improvement caused by GERD. An 81-year-old woman was referred for further evaluation after abnormal gastric imaging findings were detected during a routine health checkup. The patient had no remarkable medical history or comorbidities. Upper gastrointestinal endoscopy revealed an esophageal ulcer caused by severe GERD. Acid-suppressive therapy with P-CABs was effective, resulting in the rapid resolution of the ulcer and improvement of reflux-like symptoms. The dose was subsequently reduced as maintenance therapy, and the patient continued to do well without symptom recurrence. As illustrated in the present case, GERD has the potential to progress to esophageal ulceration; therefore, prompt initiation of treatment is necessary. P-CABs may be a useful therapeutic option in similar cases.

Background: Breast-conserving surgery (BCS) is the preferred treatment for early-stage breast cancer; however, excision-related volume loss frequently results in contour deformity, asymmetry, and reduced patient satisfaction. Conventional volume displacement and replacement techniques are limited by donor-site morbidity, technical complexity, and unpredictable aesthetic outcomes. High-purity type I collagen (HPTC) scaffolds represent a regenerative, biocompatible strategy designed to provide immediate volume support while promoting host tissue integration.

Methods: This prospective, single-arm, multicenter clinical trial was conducted at two tertiary care centers in India. Forty women undergoing BCS with an anticipated postoperative volume loss ≥20% received intraoperative implantation of an HPTC scaffold into the excision cavity. Patients were followed for two months. The primary outcome was breast volume restoration success, defined as ≥80% objective volume retention at two months with patient satisfaction ≥7/10. Secondary outcomes included objective volumetric analysis using MRI and three-dimensional surface imaging, radiologic integration assessed by the MRI Integration Score (MIS), cosmetic outcomes measured using the BREAST-Q, and safety. Longitudinal outcomes were analyzed using repeated-measures statistics, with effect sizes calculated to assess clinical relevance.

Results: All 40 enrolled patients completed the two-month follow-up. The composite primary endpoint (≥80% volume retention plus patient satisfaction ≥7/10) was achieved in 82.5% of patients (33/40). Mean breast volume retention at two months was 88.6% ± 9.8%, significantly exceeding the predefined benchmark of 75% (p < 0.001; Cohen's d = 1.39). MIS demonstrated progressive scaffold integration, improving from 3.2 ± 1.1 postoperatively to 9.1 ± 1.4 at eight weeks (p < 0.001; Cohen's d = 2.8), with no suspicious imaging features. BREAST-Q "Satisfaction with Breasts" scores improved by 24.7 points from baseline (54.2 ± 8.6 to 78.9 ± 7.4; p < 0.001; Cohen's d = 1.8). No device-related serious adverse events occurred; minor complications (seroma 10%, infection 5%) resolved with conservative management.

Conclusion: HPTC scaffold implantation following BCS demonstrates excellent safety, robust early volume restoration (88.6% retention at two months), progressive biological integration, and clinically meaningful improvement in patient satisfaction. This minimally invasive regenerative approach avoids donor-site morbidity while achieving outcomes comparable to traditional oncoplastic techniques, warranting evaluation in randomized controlled trials with longer follow-up to assess durability and radiotherapy response.

Intravenous iron is increasingly used in pregnancy for the treatment of iron deficiency anaemia due to its efficacy and rapid haematologic response. Cutaneous haemosiderin staining secondary to iron extravasation is a rare but distressing complication that is frequently described as persistent or permanent. Although therapeutic interventions have been reported and rare spontaneous cases may exist in the broader dermatologic literature, we found no well-documented reports demonstrating spontaneous improvement or complete resolution without treatment, particularly with long-term follow-up and photographic confirmation. We present the case of a nulliparous woman in her 20s who developed extensive haemosiderin staining of the right upper arm following peripheral intravenous iron polymaltose infusion at 22 weeks of gestation. Discolouration progressed over one month and was associated with intermittent discomfort. Laser therapy was recommended by the dermatology team for cosmetic management; however, the patient elected for expectant management. No therapeutic intervention was undertaken. Gradual fading became apparent approximately nine months after the extravasation event, with complete resolution confirmed at 39 months during assessment in a subsequent pregnancy. Although the interval between these reviews was extended, the patient reported steady improvement without any interim treatment. To our knowledge, this case provides the first clearly documented longitudinal evidence of complete spontaneous resolution of extensive iron staining, supported by long-term photographic follow-up. This conclusion is based on a literature search conducted via PubMed and MEDLINE, which revealed no previously reported cases of spontaneous resolution without intervention. Recognition that natural resolution may occur could support a shift toward expectant first-line management and offer reassurance, particularly for patients who may not have access to expensive dermatologic treatments.

Extraintestinal manifestations of Crohn's disease are rare but should be considered in patients with newly discovered lesions in organs not typically affected by inflammatory bowel disease (IBD). Here, we describe a case of a patient who presented with abdominal pain due to splenic lesions, with incidental discovery of pulmonary nodules. The patient was also found to have methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia on presentation, raising initial concern for septic emboli to the lungs and spleen. However, the patient's abdominal pain did not improve, and the splenic lesions and pulmonary nodules increased in size despite appropriate antibiotic therapy, prompting evaluation for an alternative diagnosis. After further workup and multidisciplinary discussion, the patient was started on corticosteroids for suspected extraintestinal Crohn's disease, with rapid clinical improvement. This case highlights the importance of reconsidering the differential diagnosis when a presumed etiology and its treatment do not explain the clinical course, and it reviews the literature on pulmonary nodules and splenic lesions as rare extraintestinal manifestations of Crohn's disease.

The postpartum period is marked by profound physical and psychosocial changes that can significantly influence how women perceive their bodies and overall emotional well-being. Despite growing recognition of postpartum body dissatisfaction, limited research has explored the cognitive factors that may contribute to these concerns. This study aimed to examine the relationship between appearance schema, appearance anxiety, and body image-related quality of life among postpartum women. A cross-sectional study was conducted among 92 postpartum women (aged 20-40 years) in Tamil Nadu, India. Participants completed standardized measures, including the Appearance Schema Inventory-Revised (ASI-R), Appearance Anxiety Inventory (AAI), and Body Image Quality of Life Inventory (BIQLI). Pearson's correlation analyses were used to assess associations between variables. Greater cognitive investment in appearance was significantly associated with higher levels of appearance anxiety (r = .338, p < .001) and poorer body image quality of life (r = -.272, p = .009). Appearance anxiety and its subcomponents-threat monitoring, camouflaging, and avoidance-were also negatively associated with quality of life (p < .05). In particular, women who closely linked their self-worth to appearance reported lower overall life satisfaction related to body image. The findings suggest that how women think about and value their appearance plays an important role in shaping emotional distress and quality of life during the postpartum period. Incorporating early psychological screening and cognitive-based support into postpartum care may help promote healthier body image and improved maternal well-being.

We report a seven-week-old male infant, born to consanguineous (double cousin) parents, incidentally through routine newborn screening, following an abnormal acylcarnitine profile caused by elevated formiminoglutamate (FIGLU), with subsequent biochemical confirmation of glutamate formiminotransferase cyclodeaminase (FTCD) deficiency. The infant was born at 37 weeks' gestation via spontaneous vaginal delivery, was vigorous at birth, and required no resuscitation. He remained clinically asymptomatic at the time of metabolic and genetic evaluation. Plasma acylcarnitine analysis demonstrated elevated formiminoglutamate (FIGLU) at a mass-to-charge ratio (m/z) of 287. Urine organic acid analysis revealed increased hydantoin-5-propionic acid, consistent with FTCD deficiency. Whole-genome sequencing identified a homozygous in-frame deletion in the FTCD gene, c.754_756del (p.Glu252del), inherited from both parents. This variant affects a conserved region of the bifunctional FTCD enzyme, which plays a critical role in histidine degradation and folate-dependent one-carbon metabolism. FTCD deficiency is an autosomal recessive disorder historically associated with megaloblastic anemia and mild neurodevelopmental delay. However, data from newborn screening programs increasingly demonstrate a spectrum of presentations, including individuals with isolated biochemical abnormalities and normal growth and neurodevelopment. In this case, the infant exhibited no clinical evidence of anemia, neurologic impairment, or failure to thrive. Complete blood count, folate, and vitamin B12 levels were within normal limits. Family history was notable for anemia of unknown etiology in a maternal aunt and grandmother, and breast cancer in a paternal aunt. This was the first child of the couple, with no prior affected siblings. This case reinforces that FTCD deficiency, while biochemically detectable, often follows a benign clinical course when identified presymptomatically. It highlights the expanding phenotypic spectrum of FTCD deficiency and underscores the importance of thoughtful biochemical follow-up, genotype-phenotype correlation, and tailored genetic counseling in the era of expanded newborn screening.

En masse retraction of the anterior teeth following first premolar extraction is a common orthodontic approach for correcting Class II malocclusion and bimaxillary protrusion. Several acceleration techniques have been proposed to reduce treatment duration, yet their comparative effectiveness remains uncertain. This systematic review evaluated randomized controlled trials published between January 1995 and May 2025 that investigated surgical, physical, mechanical, biochemical, hormonal, and pharmacological methods for accelerating en masse retraction in healthy orthodontic patients, with outcomes reported as the rate of retraction in millimetres per month. Six electronic databases and manual reference searches were screened, and the risk of bias was assessed using the Cochrane risk of bias 2 (RoB 2) tool. Nine trials involving 347 participants (mean age 21.6±2.97 years) met the inclusion criteria. One study was rated as high risk of bias, four had some concerns, and the remainder were rated as low risk. Flapless corticotomy increased the retraction rate by an average of 0.24 mm/month compared with conventional treatment (moderate‑quality evidence), while its combination with low‑level laser therapy produced the greatest and most sustained acceleration, achieving a 43.8% higher rate than conventional protocols (high‑quality evidence). Corticoalveolar perforations increased the rate by 0.28 mm/month (low‑quality evidence), and low‑intensity electrical stimulation accelerated retraction by approximately 28% (low‑quality evidence). Platelet‑rich plasma injections showed no meaningful benefit. Overall, flapless corticotomy, particularly when combined with low‑level laser therapy, appears to be a promising method for accelerating en masse retraction, offering clinically relevant reductions in treatment duration. However, these findings should be interpreted with caution due to the limited and heterogeneous evidence base, with most techniques supported by low‑to‑moderate quality evidence. The current data do not allow definitive conclusions regarding the superiority of one technique over another.

Adaptive digital interventions that respond to real-time physiological data from passive sensors are emerging as personalized tools for sleep improvement. The aim of this systematic review and meta-analysis was to evaluate the effectiveness of these interventions in improving sleep outcomes and overall health indicators in adults. A comprehensive literature search was conducted across PubMed, Embase, Cochrane CENTRAL, and ScienceDirect for studies published from January 2015 to July 2025. The included studies were randomized controlled trials (RCTs) involving adults (≥18 years), with or without diagnosed sleep disorders, evaluating adaptive digital interventions triggered by passive sensing technologies (actigraphy, wearables, smartphones), compared to static digital tools, usual care, or waitlist controls. The outcomes had to include at least one sleep-related or secondary health metric. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias using the Cochrane RoB 2 tool. Meta-analyses were conducted using random effects models. Effect sizes were expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Heterogeneity was evaluated using the I² statistic. Twelve RCTs (n = 798 participants) were included. Adaptive interventions significantly improved wakefulness after sleep onset (WASO, SMD = 3.22; 95% CI: 3.02-3.41), with moderate heterogeneity (I² = 70.7%). The effects on the Pittsburgh Sleep Quality Index (PSQI) score, sleep efficiency, and latency were small and not significant. However, the secondary outcomes, including improvements in quality of life (SMD = 1.36), depressive symptoms (SMD = 0.53), sleep duration (SMD = 0.41), and neuropsychiatric inventory scores (SMD = -1.21), were favorable. Subgroup analyses revealed greater benefits in populations with cognitive impairments and interventions using advanced sensing tools (MotionWatch8). Adaptive digital interventions triggered by passive sensing show promise for reducing night-time awakenings and enhancing mood and quality of life. Their utility may be greatest in cognitively vulnerable populations. Further research is needed to optimize adaptivity algorithms, ensure sustained engagement, and assess long-term outcomes in real-world settings.

[This corrects the article DOI: 10.7759/cureus.47671.].

Background Gestational diabetes mellitus (GDM) is a common global metabolic disorder affecting pregnant women with a rising prevalence and significant impact on the maternal-fetal outcomes. The expression of growth factors, such as vascular endothelial growth factor (VEGF) and its receptor (VEGFR1), and insulin-like growth factor (IGF), is altered in GDM, reflecting changes in placental vascularity and fetal growth regulation. Understanding these molecular alterations in GDM may help predict maternal-fetal outcomes. This study evaluates the expression of VEGF, VEGFR1, and IGF in placental tissue across different GDM treatment modalities. Methods This comparative cross-sectional observational study was conducted in the Department of Anatomy, Adichunchangiri Institute of Medical Sciences, BG Nagara, Mandya District, Karnataka. A total of 62 placentae were examined (31 from normoglycemic pregnancies and 31 from GDM patients). The GDM cases were further stratified into diet-controlled (n=9), oral-hypoglycemics-treated (n=11), and insulin-treated (n=11). The expression of VEGF, VEGFR1, and IGF was assessed using immunohistochemistry (IHC). Histological features, including villus morphology and vessel wall thickness, were observed with the help of hematoxylin and eosin, periodic acid-Schiff, Masson's Trichrome, and Congo Red stains. Statistical analysis was carried out using t-tests, ANOVA, and chi-square tests. Results Placentae from patients with GDM, regardless of treatment modality, exhibited significantly greater positive reactivity (p<0.001) with the special stains than those of normal individuals. On IHC, IGF and VEGF expression were upregulated in placentae of insulin-treated GDM patients. IGF showed highly strong positivity in 70% of GDM cases. VEGF expression was observed in placentae of both normal and GDM cases, but the staining intensity was significantly higher in GDM placentae, especially in the syncytiotrophoblast, endothelium, and mesenchymal cells (p<0.001). VEGFR1 showed very strong positive reactivity in all GDM cases, reflecting an adaptive response to hyperglycemic conditions. Conclusion The structural and molecular changes observed in GDM placentae suggest that insulin treatment is associated with significant alterations in placental morphology. These findings imply that placental adaptation due to metabolic stress in GDM may vary with the intensity of treatment. The expression patterns of IGF, VEGF, and VEGFR1 may serve as potential biomarkers for monitoring placental function in relation to treatment intensity.