Cureus最新文献

Background: Delirium after cardiac surgery is associated with poor outcomes. Cardiopulmonary bypass (CPB) increases blood-brain barrier (BBB) permeability and neuroinflammation, contributing to delirium. While microglial activation after CPB has been reported, the role of astrocytes remains unclear. This study aimed to determine whether astrocytes are activated in the hippocampus after CPB in a rat model.

Methods: Male Sprague-Dawley rats (13-15 weeks, 400-450 g) were anesthetized, mechanically ventilated, and randomized to sham (n=4) or CPB (n=4). CPB was performed with a primed circuit using a membrane oxygenator at 150 mL/kg/min for 60 min. Immunofluorescence and immunohistochemistry were performed to assess inflammatory markers and glial fibrillary acidic protein (GFAP) expression. GFAP-positive area density in the hippocampus was quantified, and groups were compared using the Mann-Whitney U test (p<0.05).

Results: GFAP immunofluorescence demonstrated increased astrocyte activation in the hippocampal CA3 region after CPB. Area density of GFAP-positive astrocytes was significantly higher in the CPB group than in the sham group (p=0.047).

Conclusion: CPB induced astrocyte activation in the hippocampal CA3 region. These findings indicate that CPB induces astrocyte activation in the hippocampus, consistent with a neuroinflammatory response.

Venous stent infection is a rare but serious complication in hemodialysis patients, associated with significant morbidity. Early recognition and management remain challenging due to the nonspecific presentation. A 29-year-old female on maintenance hemodialysis presented with fever and leukocytosis following cephalic arch venoplasty and stent placement. Despite targeted intravenous antibiotics, she failed to improve clinically. Subsequent stent removal was performed, leading to resolution of the infection. This case underscores the importance of considering stent infection in febrile dialysis patients with recent venous intervention. It highlights that in immunocompromised hosts, prompt stent removal may be necessary for source control when medical therapy fails. This report adds to the limited literature on the management of infected hemodialysis access stents.

Hospital scheduling, particularly for on-call shifts and daily assignments, is a complex task that must account for numerous factors, such as service requirements, staff preferences, and unplanned absences. Traditional methods often result in significant administrative burden and can lead to staff frustration, potentially affecting the quality of care. This study explores the use of artificial intelligence-based large language models (AI LLMs) to automate hospital scheduling through widely accessible tools, aiming to simplify the process, reduce manual effort, and enhance fairness. ChatGPT^® (OpenAI, San Francisco, CA, USA) is used to translate natural language instructions into VBA (Visual Basic for Applications) macros, which automate the creation of on-call and daily activity schedules. The process involves collecting staff preferences via a Microsoft Excel (Microsoft Corporation, Redmond, WA, USA) sheet, followed by AI-generated VBA macros that automate the creation of the schedule, ensuring adherence to various constraints such as equitable shift distribution and prioritization of specific roles. The system was developed by a non-IT professional and does not require advanced programming skills. The implementation of this AI-driven scheduling system resulted in a significant reduction in administrative time and increased schedule fairness, as decisions were based on clear, consistently applied rules. The system also minimized conflicts within teams, improving both organizational efficiency and staff satisfaction. However, the development of such a process was not without its challenges, particularly in terms of rule formulation and Excel cell references. The integration of Microsoft Excel^® and AI LLM provides a simple and reproducible solution for hospital schedule organization, reducing administrative burden and promoting fairness. This model, which can be adapted to other sectors facing similar challenges, enables teams to retain control over the process.

Background Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening infection with significant morbidity and mortality. Rural and remote regions face unique challenges in the timely diagnosis and management of NF. Methodology This retrospective study included all patients diagnosed with NF in the Kimberley region, Western Australia, between June 2020 and June 2025. Data were extracted from medical and surgical records, microbiology databases, and theater logs. Demographic, clinical, microbiological, and outcome variables were analyzed descriptively. Results In total, 21 patients were identified during the five-year period. The estimated incidence rate was 12 per 100,000 population. The median age was 49 years (interquartile range = 37-56); 8 (38%) were males, and 13 (62%) were females. Overall, 16 (76%) identified as Aboriginal and/or Torres Strait Islander. Diabetes (76%, 16), obesity (86%, 18), and smoking (62%, 13) were common. The most frequent site of infection was the lower limb, accounting for 52% (11) of cases, followed by the gluteal or buttock in 24% (5). All patients underwent operative management, and 9% (2) of patients died in the hospital. Conclusions The incidence of NF in the Kimberley is higher than the national and international average. This presents unique diagnostic and management challenges due to geographic remoteness, workforce shortages, and comorbidity burden. This study contributes valuable insights into the regional epidemiology and the management of NF in rural settings.

Introduction Renal complications are increasingly recognized after chimeric antigen receptor (CAR) T-cell therapy. We evaluated the incidence and severity of acute kidney injury (AKI), the prevalence of electrolyte disturbances, and clinical factors associated with AKI in adult patients with hematological malignancies. Methods We retrospectively reviewed all adult patients with hematological malignancies who received CAR T-cell therapy at a single tertiary center between November 2023 and April 2025. Baseline demographics, comorbidities, prior therapies, and post-infusion events were collected from electronic medical records. AKI was defined and staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines based on serum creatinine (Cr) levels. Electrolyte disturbances (sodium, potassium, and phosphate) occurring within 100 days post-infusion were recorded. Data were analyzed using R statistical software (version 4.5.1). Continuous variables are presented as the mean ± SD or median (IQR). Groups were compared using t-tests, Wilcoxon rank-sum tests, and Fisher's exact tests. Associations between AKI and patient characteristics were assessed using logistic regression. Hospitalization outcomes were evaluated using Kaplan-Meier and Cox proportional hazards models. A p-value < 0.05 was considered statistically significant. Results This study included 16 patients (mean age: 56.7 ± 17.7 years; 50% male), 25% of whom developed AKI (all stage 1). Pre-existing chronic kidney disease (CKD), baseline Cr ≥75 μmol/L, and diabetes mellitus showed the strongest associations with AKI. Electrolyte disturbances were common, particularly potassium and phosphate abnormalities. AKI was not significantly associated with ICU admission, longer hospitalization, or early mortality. Conclusion In this cohort, renal events after CAR T-cell therapy were mainly mild. Pre-existing CKD and diabetes mellitus were associated with an increased risk of AKI. Therefore, we suggest close monitoring of kidney function and other risk factors (such as nephrotoxic medications, contrast exposure, and dehydration) during treatment. Further studies with larger cohorts and longer follow-up are required to clarify the mechanisms of renal impairment and better assess outcomes.

The Coronary Artery Calcium (CAC) score is primarily used in asymptomatic individuals at intermediate risk for developing cardiovascular disease (CVD), particularly when there is uncertainty whether to initiate statins or intensify primary prevention measures. In this systematic review, we examined the value of the CAC score as a predictor of incident CVD events and mortality among asymptomatic working-age adults. We reviewed studies published from November 2009 to December 2022 examining asymptomatic adults 18-65 years of age. A total of 908 studies were identified. After the elimination of 578 and 326 studies based on abstract and full-text review, respectively, we examined four studies that met the inclusion criteria. Two of the studies showed that any CAC score above zero was associated with a four- to fivefold increased risk of incident cardiac events. In addition, we found that increasing CAC score was associated with a higher risk of incident cardiac events and/or all-cause mortality in a dose-response relationship documenting a strong criterion of causality. Furthermore, one of the studies elicited a higher discriminatory power of the CAC score compared to the Framingham and the Atherosclerotic Cardiovascular Disease (ASCVD) risk scores in distinguishing high-risk from intermediate-risk individuals for all-cause mortality. Our review showed that the CAC score is predictive of elevated risk for incident CVD events and mortality among asymptomatic working-age adults. However, prospective studies are warranted to perform cost-benefit analyses on the utility of CAC scoring as a screening tool in the general population.

Objective: Pharyngeal fish bone impaction is a common ENT emergency with significant potential morbidity. Most cases are managed perorally, but deeper or complex impactions often require removal under general anaesthesia (GA). Retrieval using forceps through the working channel of a nasendoscope is an established alternative, though uptake has been limited by the decontamination requirements of reusable channelled nasendoscopes. Single-use channelled nasendoscopes may enable wider adoption of this technique, improving care and reducing costs. This study aims to evaluate the clinical effectiveness and economic impact of awake single-use channelled nasendoscope-guided retrieval of pharyngeal fish bones compared with removal under GA.

Methods: A retrospective case series at a tertiary London hospital reviewed adults treated between February and May 2025 for pharyngeal fish bone impaction unsuitable for peroral extraction. Awake retrieval was performed using a single-use channelled nasendoscope and flexible crocodile forceps. Data were analysed for success, complications, GA requirement, and costs using NHS England 2024/25 tariffs and device prices.

Results: A total of 10 patients (median age 53.5 years, range 37 to 80 years; 7:3 female:male) met the inclusion criteria. Nasendoscopic retrieval succeeded in 8/10 cases (80%) with no complications. Two patients required theatre removal under GA. The mean cost per nasendoscopic case was £202 compared with £3,922 for GA removal, saving £3,720 per successful case (94.8% reduction). Cost modelling showed the technique remained cost-neutral above a 5.2% success rate.

Conclusion: Awake single-use channelled nasendoscope-guided removal of pharyngeal fish bones is safe, effective, and substantially cheaper than GA removal. Wider adoption could reduce theatre demand, anaesthetic exposure, and overall healthcare costs.

Objective Late-onset neonatal sepsis (LONS) remains a significant cause of neonatal morbidity and mortality, especially in developing countries. Our objective was to identify vitamin D deficiency in LONS, its association with maternal vitamin D deficiency, and its relationship with microbial profile and mortality in late-onset sepsis (LOS). Study design We conducted an analytical observational study with two matched groups (Group A and Group B) over 29 months, from November 2018 to March 2021, in the level III outborn neonatal unit at a tertiary-care centre in New Delhi, India. A total of 320 neonates were enrolled (160 septic, 160 non-septic). Outborn neonates aged 3 to 28 days were screened; those with LOS confirmed by sepsis screen or culture were enrolled as cases, while age-matched non-septic neonates were selected as controls. Epidemiological profiles, vitamin D status, and clinical outcomes, including sepsis severity and mortality, were compared between groups. Results Neonatal 25(OH) vitamin D levels in Group A (20.95±18.37 ng/mL) were significantly lower than those in Group B (25.09±16.21 ng/mL) (p < 0.001). Mothers of septic neonates had significantly lower 25(OH) vitamin D levels (25.0±16.21 ng/mL) than mothers of the non-septic group (29.86±14.13 ng/mL) (p = 0.001). Vitamin D deficiency was significantly more common in the sepsis group (40.6%) compared to the non-septic group (20.6%) (p < 0.001). Gram-negative and fungal sepsis (Acinetobacter, E. coli, Klebsiella, and Candida spp.) were associated with severe vitamin D deficiency. Mortality was 23.8% in the sepsis group, with significantly lower mean vitamin D levels among non-survivors (13.9±11.9 ng/mL vs. 23.3±19.6 ng/mL, p < 0.001). Receiver operating characteristic (ROC) analysis identified a 25(OH)D cutoff of 20.85 ng/mL (AUC 0.64) for predicting LOS. Conclusions Neonatal and maternal vitamin D deficiency is associated with an increased risk of LONS, particularly due to gram-negative and fungal pathogens, and correlates with higher mortality.

Pediatric femoral shaft fractures are commonly treated with titanium elastic nailing (TENS), submuscular plating (SMP), or external fixation (EF), but the optimal fixation strategy remains controversial. This systematic review and meta-analysis compared perioperative metrics, union, complications, and functional outcomes between SMP, TENS, and EF in skeletally immature patients. A comprehensive search of PubMed, Scopus, Web of Science, Embase, and Google Scholar (up to November 2025) identified comparative studies of diaphyseal pediatric femoral shaft fractures treated with at least two of these modalities. Thirteen studies involving 759 fractures were included: 410 managed with TENS, 246 with submuscular or locking plates, and 89 with EF, plus a small hybrid intramedullary external construct subgroup. Data were pooled using fixed- or random-effects models to calculate standardized mean differences and odds ratios with 95% confidence intervals, and methodological quality was assessed using the Downs and Black checklist. TENS was associated with significantly shorter operative time and lower blood loss than SMP, while hospital stay and time to union were broadly similar. SMP, however, achieved a higher proportion of excellent Flynn functional outcomes and markedly fewer soft-tissue irritation symptoms related to hardware prominence, with no clear differences in infection, unplanned reoperation, implant removal, or radiation exposure. Compared with EF, TENS provided faster or equivalent radiographic union, substantially lower surgical-site and pin-tract infection rates, fewer pin-site problems, and a trend toward reduced refracture after frame or implant removal while maintaining reliable limb alignment and function. Heterogeneity ranged from low to high across outcomes, but no meaningful publication bias was detected. Overall, TENS appears to be an efficient, low-morbidity option for most length-stable pediatric femoral shaft fractures; SMP offers superior stability and functional outcomes in heavier children and length-unstable patterns; and EF should be reserved for severe open injuries, polytrauma, or damage-control scenarios rather than routine femoral shaft fracture management.

Duloxetine is a commonly prescribed serotonin-norepinephrine reuptake inhibitor (SNRI) used to treat depression, anxiety disorders, and chronic pain syndromes. Renal adverse effects are considered rare. We present the case of a 43-year-old female who developed acute kidney injury (AKI) eight weeks after initiating duloxetine and escalating the dose from 30 mg to 60 mg daily, necessitating hospitalization. The patient presented with mental lethargy, disorientation, and generalized weakness and was found to have marked azotemia with a significant reduction in estimated glomerular filtration rate. Her condition improved following intravenous hydration and discontinuation of all medications, with gradual normalization of renal function over approximately six weeks. Notably, the patient had no history of dehydration, gastrointestinal losses, or reduced oral intake before presentation. Hemoglobin and hematocrit levels remained normal throughout the course of AKI. The close temporal association with duloxetine initiation and recovery following drug cessation supports a probable causal relationship. This report highlights the importance of vigilance for potential renal adverse effects associated with SNRIs.