Cureus最新文献

Anticholinergic toxicity typically presents with symptoms of cutaneous vasodilation, delirium, mydriasis, urinary retention, hyperthermia, anhidrosis, and tachycardia. This case report presents a 68-year-old female patient who exhibited some of these signs and symptoms after ingesting an unknown quantity of dicyclomine. However, she displayed one notable exception to the classic toxidrome. On hospital day 2, the patient experienced multiple incidences of prolonged sinus pause, culminating in witnessed asystole lasting 5-10 seconds. The patient continued to have numerous episodes of sinus pause that lasted 5-10 seconds each over the next two days. Treatment involved placement of multiple temporary transvenous pacemakers until the episodes of sinus pause eventually self-resolved, facilitating discharge home on hospital day 6. The patient recovered without any known complications. After considering alternative diagnoses such as sick sinus syndrome, electrolyte derangements, and intracranial hypertension, multiple hospital medical services ultimately attributed the arrhythmia to anticholinergic toxicity. There are no other documented cases of intermittent sinus pause associated with anticholinergic overdose. While rare, clinicians should consider anticholinergic toxicity as a potential cause of intermittent sinus pause, especially in patients taking anticholinergic medications. Increased clinical vigilance could impact treatment decisions, including potentially avoiding unnecessary procedures such as permanent pacemaker placement, if symptoms resolve with cessation of the offending agent.

Papillary tumors of the pineal region (PTPR) are extremely rare malignancies that make up less than 0.1% of primary brain tumors. They are usually treated with surgery and adjuvant tumor bed radiotherapy (RT). We review the case of a man in his late 60s who presented with two weeks of confusion and ataxia. Imaging the head with computed tomography (CT) and magnetic resonance imaging (MRI) showed hydrocephalus and a 2 cm pineal region mass. We review the presenting symptoms, investigations, and differential diagnosis for patients with pineal region masses. The pathological features, initial hydrocephalus management, and curative treatment of his tumor with surgery and RT are discussed. We also review the PTPR literature, including prognostic features and the evidence for treatment modalities, and report adjuvant radiotherapy treatment planning volumes. The patient is symptom-free and without evidence of recurrent disease on follow-up MRI 18 months after treatment. PTPR has very high recurrence rates following treatment; less than 20% of patients have local control at 10 years, and further research is needed to find more effective interventions and improve patient outcomes.

Acute chest pain is one of the most common reasons for ED visits in the United States. Most patients are eventually admitted to the hospital to "rule out ACS" even when there are no significant EKG abnormalities or elevated cardiac enzymes. In addition to undergoing expensive tests while in the hospital, patients are also exposed to iatrogenic harm thereby worsening the overall healthcare costs. Meanwhile, the use of coronary computed tomography angiography (CTA) as a "gatekeeper" diagnostic test for patients with low to intermediate risk for coronary artery diseases (CADs) has significantly lowered hospital admissions and associated costs. However, coronary CTA may not be helpful for all classes of patients. Therefore, this study seeks to determine if the distribution of patients presenting to the ED with chest pain in an acute care facility will justify an investment in coronary CTA and contribute to lowering healthcare costs. Patients' data between July 2022 and June 2023 were considered in our analysis. Results revealed that a significant number of patients who presented to the ED for chest pain and were subsequently admitted to the hospital for further work-up would have benefited from coronary CTA screening without any need for further inpatient work-up. Also, cost analysis showed that the use of coronary CTA would have helped significantly lower healthcare costs in this facility.

We report the case of a four-month-old male infant diagnosed incidentally with bilateral congenital diaphragmatic hernias. Our patient was found to have chest asymmetry during an unrelated hospital visit and bilateral diaphragmatic defects were confirmed on cross-sectional imaging. Surgical repair of a right-sided Bochdalek hernia and a left-sided Morgagni hernia was performed with excellent outcomes. This case report documents the rare occurrence of a bilateral late-presenting congenital diaphragmatic hernia, augments the limited existing knowledge, and highlights the variability in clinical outcomes. It provides valuable perspectives on the potentially improved survival rates in the uncommon manifestations of this condition.

Objective: Our study aims to assess the clinical effectiveness of using MRI in diagnosing various shoulder pain-related conditions among patients at King Abdulaziz University Hospital.

Methods: 383 patients who were admitted to King Abdulaziz University Hospital and had shoulder magnetic resonance imaging between January 2020 and July 2024 were studied retrospectively. The dataset was subjected to a thorough statistical analysis using descriptive and inferential approaches. The participants' demographic details, such as age, gender, and other attributes, were first compiled by a descriptive analysis, and then, a summary of the study population was given.

Results: 383 patients were enrolled in our study for MRI evaluation. Of them, 160 (41.8%) were men and 223 (58.2%) were women. The age ranged from 7 to 91 years, and the mean age was 48.4 years. While 120 (31.3%) individuals reported other problems such as motion limitation, trauma, edema, shoulder instability, or other clinical issues, 262 participants (68.4%) indicated shoulder pain as their primary complaint. 174 participants (45.4%) had their left shoulder MRI, and 209 participants (54.6%) had their right shoulder MRI. In contrast to normal MRI findings (n=24, 6.3%). Abnormal findings were more common (n=358, 93.5%).

Conclusion: Our research further supports the importance of MRI in diagnosing shoulder discomfort and associated disorders. The high frequency of anomalies found by MRI highlights its usefulness as a diagnostic technique. By comparing our results with previous research, we emphasize how crucial it is to combine MRI results with clinical evaluation to inform efficient treatment plans for patients with shoulder disorders. Future studies should focus on resolving existing issues and investigating how sophisticated imaging methods might improve diagnostic precision.

Aim and background: The success of dental implants is contingent upon various biological conditions, and any lapse in meeting these criteria can lead to complications such as peri-implantitis or implant failure. The objective of this research is to evaluate the level of understanding regarding peri-implant among general dentists practicing in Saudi Arabia.

Materials and methods: A quantitative approach was employed, utilizing an online questionnaire distributed to general dental practitioners (GDPs) in Saudi Arabia. The level of significance was predetermined at a p-value less than 0.05, and chi-square tests were performed utilizing IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York, United States). For collected data, descriptive analysis was also applied.

Results: In general, just a few numbers of participants demonstrated adequate knowledge concerning peri-implantitis. Approximately 13.5% of respondents had undergone training in dental implants and engaged in probing around implants. Smoking and uncontrolled diabetes were identified as significant contributors to peri-implantitis by 18% and 12% of participants, respectively.

Conclusion: Noteworthy concerns arose as 18.7% of practitioners did not conduct probing around implants. No statistically significant differences were observed based on gender, experience, or training level among the participants. This underscores the importance of addressing these lapses through targeted education and training programs to optimize overall patient care.

[This retracts the article DOI: 10.7759/cureus.43691.].

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Despite primarily affecting the lung, sarcoidosis can affect any organ, resulting in various clinical manifestations. We present a case of a 56-year-old man who developed thoracic pain over several months along with skin lesions. The chest CT revealed multiple mediastinal lymphadenopathies. The patient underwent an endobronchial ultrasound, and a lymph node biopsy was performed. The histological results showed lymphoid cells and small epithelioid granulomas, while bronchoalveolar lavage revealed lymphocytosis, with a significantly elevated CD4+/CD8+ ratio. Based on the results, a diagnosis of sarcoidosis was presumed. The study was concluded with cardiac MRI due to complaints of chest pain, which also confirmed cardiac involvement. The patient was successfully treated with corticosteroids, exhibiting significant improvements and recovering completely during the follow-up period. Despite cardiac involvement in sarcoidosis being rare, we present this case to emphasize the challenges in diagnosis, requiring high clinical suspicion and the use of complementary imaging methods, such as cardiac magnetic resonance. We also emphasize the importance of early initiation of corticosteroid therapy to prevent major complications and promote recovery.

Carpal tunnel syndrome (CTS) results from median nerve compression and may lead to significant pain. Surgical management through release is the gold standard approach for severe CTS patients. Gabapentin is used as an analgesic drug, but data on its postoperative effects on pain assessment and safety measures are unclear. We aimed to assess the clinical effectiveness of gabapentin in patients undergoing CTS release surgery. We searched PubMed, Scopus, Web of Science (WOS), and the Cochrane Library for randomized controlled trials (RCTs) addressing the effectiveness of gabapentin in patients with CTS release until September 2024. The primary outcome was the assessment of postoperative pain at one, six, 12, and 24 hours by a visual analog scale (VAS). Other specific outcomes were adverse events. Data were pooled as effect sizes (mean difference (MD) or odds ratio (OR)) with their 95% confidence interval (CI) in a random-effects model using Stata/MP 18. Three RCTs comprising 205 patients were included in the pooled meta-analysis. Gabapentin significantly reduced postoperative pain at six, 12, and 24 hours compared to placebo (MD = -0.6, 95% CI: -0.63 to 0.57, p < 0.001; MD = -2.14, 95% CI: -2.18 to -2.1, p < 0.001; and MD = -1.41, 95% CI: -1.82 to -0.99, p < 0.001, respectively). On the other hand, no significant differences were observed regarding other studied outcomes (i.e., safety) between the two groups. This pooled meta-analysis of 205 patients revealed that gabapentin was associated with reduced pain postoperatively at 6, 12, and 24 hours with comparable rates of adverse events compared to placebo. Further RCTs are warranted to validate the current findings.