Cureus最新文献

A bilobed gallbladder is a rare congenital anomaly with two lobes sharing a single cystic duct, typically diagnosed preoperatively and rarely identified intraoperatively. Only a small number of cases have been documented in medical literature with limited information on associated conditions. A 22-year-old male patient, with a past medical history of cholelithiasis and no prior surgical history, presented with acute right upper quadrant pain and was diagnosed with acute cholecystitis. Initial ultrasound and magnetic resonance cholangiopancreatography imaging showed a distended gallbladder with multiple stones, but the bilobed gallbladder was only discovered during laparoscopic cholecystectomy, with an intraoperative retrospective imaging review confirming the diagnosis. This anatomical variation can complicate surgery, particularly in achieving the critical view of safety. In this case, a dome-down approach was used to complete laparoscopic cholecystectomy without intraoperative or postoperative issues. Early and accurate diagnosis is challenging but crucial for successful management. In this report, we present our surgical approach to managing this patient. This report aims to contribute to the limited literature on bilobed gallbladders.

This study aims to evaluate the therapeutic application of N-acetylcysteine (NAC) as a treatment or adjunct therapy for various medical conditions. While its efficacy in treating acetaminophen overdose, cystic fibrosis, and chronic obstructive pulmonary disease is well-established, emerging evidence suggests that NAC may also benefit a broader spectrum of illnesses due to its safety, simplicity, and affordability. A comprehensive review was conducted by searching PubMed, relevant books, and conference proceedings for publications discussing NAC about the specified health conditions. The clinically relevant data were analysed using the American Family Physician Evidence-Based Medicine Toolkit, following a standard integrated review methodology. NAC shows potential as an adjunctive treatment for a wide range of medical conditions, particularly chronic diseases. It may be beneficial for polycystic ovary syndrome, endometriosis, male infertility, cataracts, glaucoma, dry eye syndrome, parkinsonism, multiple sclerosis, Alzheimer's disease, stroke outcomes, non-acetaminophen-induced acute liver failure, Crohn's disease, ulcerative colitis, schizophrenia, bipolar disorder, and obsessive-compulsive disorder. Although evidence for some conditions is less robust, NAC's therapeutic potential warrants further investigation. Given the aging population and the decline in glutathione levels, the use of NAC should be considered across a variety of medical conditions. This paper suggests that NAC supplementation could play a significant role in reducing morbidity and mortality associated with numerous chronic diseases.

Background The aim of this study was to investigate the protective effect of thymoquinone, an antioxidant, on hearing loss induced by acoustic trauma in rats. Material and methods This study included 32 Wistar Albino rats divided into four groups: control, acoustic trauma, thymoquinone + acoustic trauma, and thymoquinone only, with eight rats per group. The control group received 0.5 mL of corn oil intraperitoneally for 10 days. The acoustic trauma group was exposed to 100 dB white noise at 4 kHz for 16 hours. The thymoquinone + acoustic trauma group received thymoquinone (10 mg/kg) intraperitoneally for two days before acoustic trauma and eight days after acoustic trauma. The thymoquinone only group received thymoquinone (10 mg/kg) for 10 days. Distortion product otoacoustic emissions (DPOAEs) were measured before and after treatments on days 1, 4, and 10. Results In the control group, DPOAE measurements showed no significant change over the study period. The acoustic trauma group exhibited a significant decrease in DPOAE on the first day after trauma, followed by some recovery. The thymoquinone + acoustic trauma group showed no significant decrease in DPOAE on the first day post-trauma, suggesting a protective effect. The thymoquinone only group also indicated no significant change in DPOAE measurements, suggesting that thymoquinone alone did not affect hearing function. Conclusion Thymoquinone demonstrated a protective effect against acoustic trauma-induced hearing loss in rats, as evidenced by stable DPOAE measurements post-trauma. These findings suggest that thymoquinone may help preserve hearing function by reducing oxidative stress in the cochlea. Further studies are needed to confirm these results in humans and optimize dosage and treatment protocols.

Objective: This study aimed to compare the shear bond strength (SBS) of enamel-bonded orthodontic brackets with the conventional acid etching (CAE) system and the self-etching primer (SEP) in vitro and to compare the clinical performance of both systems when used in the treatment of malocclusion patients.

Materials and methods: In the first part of the study, 40 extracted human premolars were randomly divided into two groups containing 20 teeth. The first group (the conventional enamel etching group) employed 37% phosphoric acid before bonding the metallic brackets (0.022-inch slot, MBT prescription, American Orthodontics, Sheboygan, WI, USA). The etching system was Tetric 5th (Ivoclar Vivadent, Schaan, Liechtenstein). The second group used a SEP (Sep Tetric 7th, Ivoclar Vivadent, Schaan, Liechtenstein) to bond the same brackets. In the first part of the study, SBS was evaluated, followed by the adhesive remnant index (ARI) assessment. The second part of the study (i.e., the clinical part) assessed a cohort of 30 patients during a 6-month observation period. The upper 10 teeth (from the second premolar on the right side to the second on the right side) were bonded using the chosen method for each patient in the clinical assessment. That is, 150 teeth in each group were evaluated regarding the failure rate. The ARI was assessed for those teeth that lost their brackets.

Results: The mean SBS was greater in the SEP group compared to the CAE group (17.93 MPa and 16.60 MPa, respectively; P = 0.014). The difference was not statistically significant. Conversely, the failure rate was lower in the CAE group compared to the SEP group, with a failure rate of 6% and 14.7%, respectively. The difference was statistically significant (P = 0.014). However, the ARI showed no statistically significant difference in in-vivo and in-vitro analyses, as most bracket failures were at the adhesive level.

Conclusion: Laboratory results showed no statistical difference in the SBS mean values between the two groups. Clinically, the SEP group showed a greater failure rate than the CAE group, but both failure rates in the two groups were within the clinically acceptable range. The ARI did not show any difference between the two groups in terms of the failure site when the evaluation was conducted in vivo and in vitro, as most of the areas of failure were concentrated in the material itself.

Introduction: There is an increase in the prevalence of diabetes mellitus (DM) globally. Individuals with diabetes mellitus are at higher risk of impairment of kidney function. This study evaluated the diagnostic performance of Cystatin C in the early detection of diabetic kidney disease (DKD).

Methods: Across a sectional analytical study of 300 participants (200 study group and 100 control group). A relevant clinical history was obtained, and a physical examination was carried out. Venous blood was collected to assay for serum creatinine, serum albumin, serum cystatin C, serum urea, fasting blood glucose, and urine for the quantification of urine albumin excretion rate.

Results: The median age of the study group versus the control group was 62.50 for DM with proteinuria, 60.00 for DM without proteinuria, and 60.00 years for the control group (F = 3.524, p = 0.172). The laboratory parameters that were higher in the study group compared to the control group were FBG (141.0, 130, vs. 104 mg/dl, F = 68.456, p = <0.001), serum creatinine (109.0, 88.5, vs. 105.0 umol/l, F = 35.50, p = <0.001), serum cystatin C (1.24, 1.11, vs. 0.84 mg/L, F = 59.27, p = <0.001), and urine albumin excretion (230.0, 102.0, vs. 30.0 mg, F = 128.62, p = <0.001). The diagnostic performance of cystatin C using MDRD and cystatin C eGFR <60ml/min/1.73m2 was 13% and 23%, respectively, for the study group without proteinuria. Also, when the diagnostic efficiency of the variables was compared using ROC, the AUC of creatinine eGFR (MDRD) was less than that of cystatin C eGFR between the cut-off levels of 30 mg and 300 mg of urine albumin excretion. Cystatin C eGFR had a strong negative correlation with urine albumin excretion when compared to creatinine eGFR (MDRD).

Conclusion: This study showed the diagnostic performance of serum cystatin C in the early detection of DKD and that cystatin C-derived eGFR is more sensitive than serum creatinine-derived eGFR in detecting DKD early in people with DM.

Background The continuous light force with a wide range of activation describes the excellent properties of nickel-titanium (NiTi) archwires. Shape memory is mainly affected by intraoral thermal changes. This study evaluated the effect of three different constant temperatures (i.e., 12°C, 37°C, and 50°C) on the unloading value of three different 0.016 × 0.022 NiTi archwires. Methodology Three types of 0.016 × 0.022-inch diameter NiTi archwires (American Orthodontics®, Sheboygan, Wisconsin, USA) were used. These were the superelastic type (NT3-SE®), the heat-activated type at 25°C (Thermal Ti-D®), and the thermally activated type at 35°C (Thermal Ti-Lite®). The unloading forces of the wires were evaluated using a classic three-point bending test (a universal testing machine: Testometric 350M®, Instron, Lincoln Close, Rochdale, England) under three different constant temperatures (12°C, 37°C, and 50°C). Results All types of wires showed thermal sensitivity; at higher temperatures, the unloading forces increased differentially between small and large deflections, while at lower temperatures, the residual strain increased for all wire types. The most affected type by the thermal changes was thermal Ti-Lite®, followed by thermal Ti-D®, and the superelastic type NT3-SE® showed a behavior similar to thermal wires. At the low temperature (12°C), all wire types showed an incomplete load/deflection curve, whereas no value was measured at unloading points 2, 1, and 0.5 mm. At the normal temperature (37°C), NT3-SE® type and thermal Ti-D® were similar in force level, while significant differences were noted between both previous types and Thermal Ti-Lite®. At the high temperature (50°C), all wire types showed a higher force level, while significant differences between the wire types were inconsistent. In contrast, increasing the temperature from 37°C to 50°C increased the force levels between 40% and 84% for NT3-SE®, between 44% and 64% for the thermal Ti-D®, and between 61% and 268% for the Thermal Ti-Lite®. When comparing the force levels between 12°C and 50°C at 3 mm, the force levels increased by 66% for NT3-SE®, 25% for Thermal Ti-D®, and 109% for thermal Ti-Lite®, while on comparing the forces between 12°C to 37°C, the forces increased between 15% and 95% for NT3-SE®, 20% and 88% for thermal Ti-D®, and 26% and 78% for thermal Ti-Lite®. The value of residual strain was greater at low temperatures and smaller at higher temperatures, while no significant differences were detected between 37°C and 50°C. Conclusions The temperature degree deeply affected the mechanical behavior of all test NiTi wires; the superelastic type behaved similarly to thermal wires. Increasing the temperature degree leads to more unloading forces and less residual strain.

Recurrent urinary tract infections (rUTIs) present a significant clinical challenge, particularly due to the associated overuse of antibiotics and the rise in antimicrobial resistance. This systematic review evaluates the current literature on the use of intravesical therapies as an alternative treatment for rUTIs. Two established primary therapies are reviewed: glycosaminoglycan (GAG) instillations and intravesical antibiotic instillations. Both therapies offer localised treatment, reducing systemic antibiotic exposure and targeting infection sites more directly. A literature search was conducted using PubMed and Cochrane Controlled Register of Trials (CENTRAL), yielding 5,963 relevant articles, of which seven studies met the inclusion criteria. The review indicates that both GAG and antibiotic instillations significantly reduce UTI recurrence rates and improve symptoms such as pain and urinary urgency. However, significant variations in treatment schedules and dosages exist, and no direct comparative studies between GAG instillations and intravesical antibiotics were found. Moreover, intravesical antibiotics show great potential in minimising antimicrobial resistance, though further large-scale studies are needed to confirm these findings. While intravesical therapies are generally well-tolerated, GAG instillations can cause mild irritation. Further research is required to optimise therapy regimens and to perform cost-benefit analyses, particularly considering the high costs of these therapies compared to traditional antibiotic prophylaxis. Randomised controlled trials comparing different intravesical treatments are crucial to inform future clinical practice.

We report a rare case of shunt valve failure due to obstruction during ventriculoperitoneal (VP) shunt surgery for hydrocephalus after subarachnoid hemorrhage due to aneurysm rupture. The hydrocephalus shunt surgery was started normally, and there was no bending or twisting of the valve, nor blood contamination. However, after irrigation of the shunt valve, the shunt valve obstructed and malfunctioned before catheter connection and insertion into the subcutaneous space. Shunt valves are rarely damaged during surgery. In this case, the cause of the malfunction could not be identified during surgery, and it was necessary to use a shunt valve made by another company for patient safety. The surgery was completed without incident, but the cause of the obstruction, which was discovered after surgery, was that the needle guard inside the valve had come off from the bottom. The CODMAN CERTAS Plus Programmable Valve (CCPPV) in particular has excellent functionality, but the regular type needle guard is attached to the bottom of the valve pump. Therefore, it cannot withstand the handling during surgery that other valves tolerate. In the future, improvements in medical equipment and more careful operation of shunt valves by surgeons are required for risk management during surgery.

Infective endocarditis (IE) is associated with significant morbidity and mortality. Its diagnosis can be especially challenging, as can the identification of a causative pathogen, which, in turn, is crucial for appropriate management. Here, we present a rare case of Streptococcus intermedius endocarditis complicated by lung and cerebral abscess in which clinicians employed cell-free deoxyribonucleic acid (cfDNA) testing to confirm the diagnosis, establish a causative pathogen, and determine appropriate antibiotic therapy. Notably, the positive cfDNA test prevented the need for brain biopsy in this case and has implications for diagnostic and therapeutic guidelines.