Cureus最新文献

Laparoscopic sleeve gastrectomy (LSG) is a popular bariatric procedure with significant effects on weight and metabolic health. However, its impact on gastroesophageal reflux disease (GERD) and esophageal symptoms remains debated. This study aims to evaluate the endoscopic changes five years post-LSG. We conducted a retrospective analysis of patients who underwent LSG at our center between June 2017 and June 2019. Inclusion criteria included preoperative and at least five-year follow-up esophagogastroduodenoscopy (EGD). We analyzed demographic factors, esophageal symptoms, and endoscopic findings. Out of 118 patients who underwent LSG, 24 met the inclusion criteria. Two patients were excluded due to conversion to Roux-en-Y gastric bypass (RYGB). The final cohort included 22 patients with a mean age of 42 ± 10 years and a mean BMI of 45 ± 7 kg/m². Preoperative EGD showed no GERD in 21 patients (95.5%) and GERD in 1 patient (4.5%). At five-year follow-up, 14 patients (63.6%) had no GERD, 7 (31.8%) had GERD A, and 1 (4.5%) had GERD B. Esophageal symptoms included heartburn (54.5%), nausea (36.4%), regurgitation (31.8%), and epigastric pain (22.7%). PPI or antacid use was reported in 10 patients (45.5%). Extra-esophageal symptoms were rare. BMI was significantly higher in patients with GERD (34.5 ± 6.3 kg/m²) compared to those without GERD (30.2 ± 5.1 kg/m², p = 0.04). LSG may lead to the development or worsening of GERD in a subset of patients, despite the majority showing no significant GERD changes over five years. Continuous monitoring and tailored management strategies are essential for optimizing outcomes.

Background: One in three adolescents with type 1 diabetes mellitus (T1DM) experiences diabetes distress, which predicts poor self-management and glycemic control. Mindfulness-based interventions such as meditation have been associated with reduced psychological distress and health outcomes in different populations. This study explores the psychosocial barriers and facilitators of diabetes self-management and beliefs about meditation practices.

Methods: Eight adolescents aged 15-19 who had been diagnosed with T1DM for more than a year were invited to participate in a 40-60-minute semi-structured one-on-one interview. Their parents were also invited to participate in the study. Three of the eight parents invited were able to participate in the study. Participants were asked about perceived psychosocial barriers and facilitators of diabetes self-management and their beliefs about meditation as a tool for addressing some of the psychosocial barriers to self-management. Data were analyzed using NVivo 10 (QSR International, Melbourne, Australia). Conventional content analysis was conducted based on an inductive coding approach.

Results: Adolescents with T1DM had similar psychosocial challenges with managing T1DM, including high levels of diabetes distress and forgetfulness due to competing demands on their time. They also noted similar facilitators to effective self-management, such as the presence of family and peer support. Acceptance of T1DM diagnosis and personal commitment to self-management were also indicated as common facilitators of self-management. Adolescents with T1DM and parents of adolescents with T1DM believe that meditation can play a positive role in T1DM self-management by reducing diabetes distress and improving mental health and overall well-being.

Conclusion: Results suggest that adolescents with T1DM and parents of adolescents with T1DM believe peer and family support is crucial to diabetes self-management. They also noted that diabetes distress and forgetfulness are primary barriers to self-management. Participants also see a potential for meditation to help manage general stress and diabetes distress, thereby aiding self-management. Further research is needed to explore meditation-based interventions to reduce diabetes distress in adolescents diagnosed with T1DM. The findings from this study can inform the development and implementation of meditation-based interventions that integrate family and peer support to reduce diabetes distress and enhance self-management in adolescents with T1DM.

[This corrects the article DOI: 10.7759/cureus.69610.].

Both paclitaxel-coated balloons (PCB) and drug-eluting stents (DES) are indicated for the treatment of de novo small-vessel coronary lesions. Since the evidence comparing these two types of devices is limited, we undertook a meta-analysis on this issue. Our meta-analysis compared the efficacy of PCB vs. DES in the treatment of patients with de novo coronary lesions of size ≤ 2.75 mm. Only randomized controlled trials (RCTs) were included. The two treatments under comparison were PCB vs DES; the endpoint was the rate of major adverse cardiovascular events (MACE). Our statistical methods were based on the reconstruction of individual patient data from Kaplan-Meier curves using the IPDfromKM algorithm. After this reconstruction, our statistical calculations included hazard ratio (HR) estimation with a 95% confidence interval (CI), assessment of between-trial heterogeneity, and risk of bias for each RCT. Our literature search identified six RCTs that met our inclusion criteria (PICCOLETO, BELLO, RESTORE SVD, BASKET-SMALL2, PICCOLETO-II, and DISSOLVE). In our main analysis, the six treatment groups using PCB were compared with the six control groups using DES. The results showed an HR of 1.029 (95%CI, 0.7446 to 1.422; P=0.86) over a follow-up of 36 months. Heterogeneity analysis across the six control groups showed worse outcomes in the BELLO trial and better outcomes in the three trials employing a limus-eluting stent. To evaluate trial heterogeneity through the comparison of the six PCB arms, five trials showed similar outcomes while the BELLO trial fared significantly worse. Risk of bias for each RCT was appropriate.  Our results indicate that in de novo small-vessel coronary lesions, PCB and DES showed similar outcomes, despite some cross-study variability. Our results provided meta-analytic confirmation that no recommendations can be made in favor of PCB or DES in the treatment of de novo small-vessel coronary lesions based on current data.

Introduction: Postural orthostatic tachycardia syndrome (POTS) is a chronic form of orthostatic intolerance characterized by various symptoms such as dizziness, lightheadedness, and increased heart rate. Conflicting reports exist regarding the prevalence of anxiety and depression in adults with POTS, while data on pediatric POTS remains scarce.

Method: A retrospective analysis of pediatric patients aged 11-17 years with POTS, who underwent autonomic testing at Nemours Children's Hospital in Orlando, Florida, was conducted. The patients were screened for anxiety, using the Severity Measure for Generalized Anxiety Disorder-Child Age 11-17 years (GAD-7) questionnaire, and depression, using PHQ-9 Modified for Adolescence (PHQ-A) for depression. The prevalence rates of anxiety and depression in the study cohort were compared to historical data from similar age groups in the existing literature. The study was approved by the Nemours Children's Hospital Institutional Review Board.

Results: The cohort comprised 27 children with POTS (26 females, age 15.8±1.6 years). Overall, 74% exhibited moderate-to-severe anxiety, depression, or both, with 44% having comorbid anxiety and depression. In total, 4/27 (14%) had pure depression and 4/27 (14%) had pure anxiety. Six patients had no depression or anxiety. On average, POTS symptoms began 1.9±1.3 years before diagnosis. Eleven patients took stable doses of psychotropic medications. After a follow-up period of 5.1±1.7 months of POTS therapy, seven patients had follow-up questionnaires. In 4/7 patients, the depression severity improved, and in 3/7 patients, the anxiety severity improved. Patients were not actively treated for depression and anxiety during this time.

Conclusion: Anxiety and depression are prevalent among pediatric patients with POTS. While preliminary data suggests POTS therapy may alleviate these psychological symptoms, further longitudinal studies are warranted to explore the therapeutic impact in greater detail.

Hernia repairs are among the most common surgical procedures performed by general surgeons annually in the United States, defined as the abnormal protrusion of tissue and/or organs through an anatomical defect in the surrounding wall at various locations in the human body. While some hernias can remain asymptomatic and seemingly harmless, some may lead to intestinal obstruction, ischemic bowel from strangulation of blood supply, or septic shock if not diagnosed and addressed within a short period of time. This case report is about an elderly woman who presented with a Richter's. A Richter's hernia is an atypical type of strangulation where only a portion of the bowel, the antimesenteric border, is trapped within the anatomical defect. Given the limited extent of entrapped bowel, numerous different presentations can be seen, including but not limited to signs of obstruction without signs of ischemia or, in some instances, lack of either sign of obstruction or ischemia. Within this report, we will discuss the need for high clinical suspicion for Richter's hernias when evaluating strangulated hernias without systemic signs of sepsis.

This case report discusses the presentation, management, and complications of acute urinary retention in a 70-year-old male with a history of heart failure, hypertension, diabetes, and benign prostatic hyperplasia (BPH). The case highlights the occurrence of post-catheterization hypotension, a known but poorly understood phenomenon, and underscores the need for a multidisciplinary approach in managing patients with complex medical conditions.

Introduction Guidelines state that all female patients of childbearing age presenting with acute abdominal pain to a surgical department must have a pregnancy test with either urinary or serum beta-human chorionic gonadotropin (𝜷-HCG) testing. This allows complete evaluation of the patient and consideration of a wider range of differential diagnoses, including those that must not be missed, such as a possible ectopic pregnancy. Additionally, management options for conditions unrelated to pregnancy may differ in pregnant women. This audit assessed adherence to guidelines for pregnancy testing in females presenting with abdominal pain to the general surgery department in a district general hospital and the impact of initiatives to improve compliance. Methods A retrospective audit to identify pregnancy test completion of all female patients aged between 11 and 55 years presenting to the general surgery department at a district general hospital with acute abdominal pain in August 2022 was conducted. A medical education session, posters, and discussion amongst multidisciplinary team members in a nursing huddle followed to raise awareness. A subsequent prospective audit was conducted in November 2022. Results In the initial audit conducted in August 2022, 55 female patients aged between 11 and 55 years presented to the surgical department with abdominal pain. Of these patients, pregnancy testing was only completed for 41.8% (n = 23). Following interventions, a second audit conducted in November 2022 found 30 female patients presenting with abdominal pain. In this cohort, pregnancy testing was completed for 80% of patients (n = 24). Conclusion This study highlights the need for regular clinical audits and multidisciplinary discussion in improving and maintaining high standards of patient care and ensuring pregnancy testing of all females of reproductive age presenting with abdominal pain to the general surgery department. Further consideration may be given to the incorporation of recording of pregnancy test status on electronic healthcare systems as part of admission and mandatory checklists.

Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA) that has gained recent popularity in its effective management of type 2 diabetes mellitus (T2DM) and obesity. Minimal evidence has reported the link between Semaglutide use and acute pancreatitis. In this case report, we discuss the case of a 36-year-old female presenting to the Emergency Department with sudden-onset epigastric pain, subsequently diagnosed with acute pancreatitis. Moreover, she had recently started subcutaneous semaglutide injections for weight loss, which she had procured from one of her acquaintances without seeking medical advice. Semaglutide was thus stopped and her lipase levels normalized with significant improvement of her symptoms, making semaglutide the likely causative factor for her acute pancreatitis. Given the increased use of GLP-1RA, we aim to increase awareness among patients taking this medication whether prescribed or not and increase clinician awareness when prescribing this medication.

Background Formative assessment is a crucial component of a Competency-Based Medical Education curriculum. Keywords are concise representations of the central ideas and themes explored within a subject. Taking a memory test evaluates knowledge as well as improves future memory. Aim and objectives This study intended to study the efficacy of the "keywords teaching" technique and "keywords recall" after a teaching-learning session as an effective tool for formative assessment and the correlation between the performance of students in summative assessments. Materials and methods Students of first-year professional faculty of medicine students 2022-23 batch attending pre-clinical (physiology) classroom lectures aged between 18-21 years belonging to both genders who consented to voluntary participation in the study were included in the study. Scores of formative sessions by multiple choice questions, keywords recall assessment tool, and summative sessions were analyzed using paired t-tests. Scores of formative assessments and summative assessments were correlated using Pearson correlation analysis. Results Analysis showed formative assessments had a significant (P < 0.05) relationship with summative assessment performance. The study indicates a positive correlation between scores for both formative and summative assessments, highlighting the importance of formative assessment in improved academic performance. Conclusion Optimal learning can be achieved by testing that emphasizes recall retrieval practice and that is repeated at intervals over time. This study suggests that "keywords recall" after a teaching-learning session is an effective tool for formative assessment.