Cureus最新文献

This case report presents a unique clinical presentation of small bowel obstruction secondary to congenital partial malrotation of the gut in adults. Partial malrotation may have variable clinical presentations and this case highlights a constellation of patient history, radiographic signs, and operative findings leading to appropriate diagnosis and successful surgical management. A 56-year-old female patient presented with severe abdominal pain, nausea, and anorexia. She reported acute on chronic vague, intermittent cramping abdominal pain for approximately five months. Prior evaluations of her gastrointestinal symptoms did not reveal a clear etiology. On examination, the patient's vital signs were within normal limits and the abdominal exam was benign. Computed tomography (CT) of the abdomen and pelvis with IV contrast, obtained in the emergency department, was concerning for paraduodenal hernia but was also notable for the lack of a duodenal sweep. With the severity of abdominal pain being out of proportion to the physical exam and the aforementioned radiographic findings, we decided to proceed with diagnostic laparoscopy. Intraoperative findings included a Ladd band forming a potential space for the incarceration of the bowel, internal herniation of the partially reducible small bowel, and a narrow mesenteric base. A laparoscopic Ladd procedure was performed and the patient recovered without complications. Her chronic gastrointestinal complaints have abated since the operative intervention. This case underscores the importance of considering a rare diagnosis such as partial malrotation of the gut in adults presenting with acute on chronic abdominal pain, the key clinical features associated with this pathology, and its successful operative management. Furthermore, this case highlights the importance of early recognition and management to minimize the morbidity and mortality of devastating sequelae such as midgut volvulus and closed-loop obstruction.

The multitarget oral tyrosine kinase inhibitor sorafenib is an effective first-line treatment option in unresectable hepatocellular carcinoma. Through its mechanism of action, it has been associated with cardiotoxicity, mainly hypertension, which is usually low-grade and well-managed with behavioral changes and antihypertensor treatment adjustment, if needed. Acute, symptomatic heart failure is rarely described. We present the case of a patient with priors of arterial hypertension, dyslipidemia, type 2 diabetes mellitus, and non-alcoholic steatohepatitis-related cirrhosis of the liver, with the diagnosis of hepatocellular carcinoma treated with sorafenib, with previous excellent tolerability and stable disease. Dyspnea and detection of atrial fibrillation with severe reduction of left ventricular ejection fraction (26%), three years after the beginning of treatment, led to the diagnosis of acute heart failure with reduced ejection fraction and class IV New York Heart Association symptoms, confirmed to be enhanced by sorafenib, and partially reversible after its suspension and optimization of cardiological treatment. A multidisciplinary approach, prompt recognition, and aggressive treatment of this rare and severe toxicity are essential in determining a favorable outcome.

Facial paralysis is an infrequent and serious potential complication of acute otitis media (AOM). We describe a pediatric case of rapidly progressive facial paralysis as a secondary complication alongside AOM, caused by the non-typeable Haemophilus influenzae (NTHi) strain, which was managed with facial nerve decompression, glucocorticoid medication, and antimicrobial chemotherapy. The reasons why NTHi becomes pathogenic in certain patients are not yet fully understood, and the specific interactions and adaptations that lead to complications must be further investigated, as they result in more complex treatment approaches.

The management of temporomandibular disorders (TMDs) in elderly patients can present a significant challenge for dentists due to its multifactorial etiology, aging-related changes that contribute to TMD, and the fragile psychological state of these patients. Despite the growing prevalence of TMD in the elderly population, the scientific literature provides limited information about effective management strategies for this group. Therefore, it is crucial for researchers and clinicians to focus on improving our understanding of TMD in the elderly population and to develop more effective treatment approaches. This article provides an overview of the prevalence, etiology, pathophysiology, and management of TMD in elderly patients, with a particular emphasis on the challenges associated with this population. By increasing our knowledge of TMD in the elderly, we can improve the quality of care provided to this vulnerable patient group.

Background Ectopic pregnancy (EP) is a significant cause of maternal morbidity and mortality. Accurate and timely diagnosis is crucial, particularly in women of reproductive age presenting with acute abdominal pain. This audit aimed to assess the completeness and accuracy of gynecological history documentation, including pregnancy status, in female patients admitted for emergency surgery due to abdominal pain. Methods A retrospective audit was conducted within a single NHS Trust, analyzing the surgical assessment documents of 50 female patients aged 12-50 years admitted for emergency surgery. Data collected included documentation of pregnancy status, gynecological history, last menstrual period, sexual activity, and contraceptive use. A subsequent audit cycle assessed the impact of an educational intervention on documentation practices. Results Initial findings revealed significant deficiencies in the documentation of key gynecological parameters. Pregnancy status was documented in only 14% of cases, and contraceptive use in 20%. A substantial proportion of cases lacked documentation of gynecological history 50% and sexual history 56%. An educational intervention resulted in a significant improvement in the documentation of sexual history, contraceptive use, and pregnancy status. Conclusion This audit revealed significant deficiencies in the initial gynecological assessment of female patients with acute abdominal pain, particularly regarding the documentation of pregnancy status, menstrual history, and contraceptive use. The study highlights the need for improved clinical practices, including enhanced medical education, standardized assessment protocols, and electronic documentation of pregnancy status. Continued research is crucial to address these deficiencies and optimize patient care within the NHS.

Minimally invasive dentistry (MID) has revolutionized pediatric dental care by emphasizing the preservation of healthy tooth structures, reducing treatment-related trauma, and improving patient compliance. This narrative review explores advancements in MID techniques, including silver diamine fluoride (SDF), resin infiltration, atraumatic restorative treatment (ART), bioactive materials, laser-assisted therapies, and three-dimensional (3D) printing technologies. These approaches prioritize early diagnosis, prevention, and conservative management, aligning with patient-centered and sustainable practices. SDF demonstrates high efficacy in arresting caries progression but presents esthetic challenges due to discoloration. Resin infiltration provides esthetic and noninvasive treatment for white spot lesions, while ART offers cost-effective and child-friendly caries management in resource-limited settings. Bioactive materials support tissue regeneration, and laser technologies enable precise and painless procedures, although their adoption is limited by high costs and training requirements. Emerging tools, such as artificial intelligence and 3D printing, enhance diagnostic accuracy and treatment precision. Despite challenges related to cost, operator training, and infrastructure, MID techniques continue to evolve, offering promising solutions for pediatric dental care. Future research should focus on optimizing materials, improving accessibility, and integrating digital technologies to broaden the impact of minimally invasive approaches. This review highlights MID's transformative role in improving oral health outcomes and ensuring sustainable, patient-focused care for children.

Background Ear, nose, and throat (ENT) disorders are common and significantly impact the quality of life. This study aimed to assess the prevalence of ENT problems among the Saudi population and to explore its association with sociodemographic factors, knowledge, and healthcare utilization. Methodology A cross-sectional study was conducted among 405 participants aged 18-80 years across Saudi Arabia. Data were collected using a self-administered, anonymous electronic questionnaire distributed through social platforms. Data was cleaned on Excel (Microsoft® Corp., Redmond, WA, USA) and analyzed using IBM SPSS Statistics for Windows, Version 27 (Released 2020; IBM Corp., Armonk, NY, USA). Results The study revealed that 38.5% of participants were diagnosed with a chronic ENT condition, with sinusitis being the most common (n = 90, or 22.2%). Chronic nasal congestion (n = 187, or 46.2%), tinnitus (n = 182, or 44.9%), and hoarseness (n = 176, or 43.5%) were the most frequently reported symptoms. Significant differences in total ENT problem scores were observed based on gender, with females having higher median scores than males (p = 0.038). Knowledge of ENT problems was rated as average by 213 (52.6%) participants, with 376 (92.8%) supporting the need for public awareness campaigns. Healthcare utilization showed that 164 (40.5%) sought medical care over the past year, while 178 (44.0%) visited an otolaryngologist for ENT symptoms. Conclusion The study highlights a high prevalence of ENT problems in Saudi Arabia, particularly among the female population. There is a need for targeted public health interventions and educational campaigns to improve the awareness of the population, and to reduce the burden of ENT disorders. Future research should focus on longitudinal studies to explore causal relationships between risk factors and ENT conditions.

Isolated foot drop is a neurological sign frequently linked to lower motor neuron (LMN) lesions, including peroneal nerve damage or L4-L5 radiculopathy. Nonetheless, upper motor neuron (UMN) lesions, such as strokes or tumors located in the parasagittal motor cortex, may sometimes manifest as isolated foot drops. The main causes of isolated foot drop secondary to central etiologies are uncommon, with few instances documented in the literature. An 83-year-old male presented with a four-day history of left isolated foot drop that started in the big toe and then spread to involve the whole foot. Clinical examination was negative for any other neurological deficit. Magnetic resonance imaging (MRI) of the cervical, thoracic, and lumbar spine showed only mild lumbar spinal stenosis at the L4/L5 level. Brain MRI revealed acute infarction foci in the right superior frontal gyrus. While uncommon, central causes of isolated foot drop should be taken into account when peripheral examinations yield inconclusive results. This case highlights the significance of a thorough diagnostic method, encompassing brain imaging, to detect lesions in the central nervous system. Timely identification and management of these cases are essential for enhancing patient outcomes and avoiding misdiagnosis.

Objective People's attitudes about aging are formed in early childhood, develop in adulthood, and are fully shaped in old age. Our study aimed to investigate the effect of self-esteem on attitudes toward aging in the elderly. Method A total of 264 people over the age of 65 without any known psychiatric or neurologic disease were included in the study. The sociodemographic data form, Rosenberg Self-Esteem Scale (RSES) with 12 sub-dimensions, and Attitude to Aging Questionnaire (AAQ) with three sub-dimensions were applied to each participant. Pearson correlation analysis was used to evaluate the relationship between quantitative variables. Hierarchical multiple regression analysis was used to determine the factors predicting the attitude toward aging. Results A moderately significant negative relationship was found between the AAQ sub-dimension of psychosocial loss score and RSES sub-dimension self-esteem (r=-0.340, p=0<0.001), continuity of self-concept (r=-0.258, p<0.001), depressive affect (r=-0.423, p<0.001), and psychosomatic symptoms (r=-0.311, p<0.001). Self-esteem was found to be predictive of attitude toward aging. When sociodemographic factors were controlled, it was found that 25.6% of the variance in attitude toward psychosocial loss (R² change=25.6; p<0.001), 30.5% of the variance in attitude toward physical change (R² change=30.5; p<0.001), and 34.9% of the variance in attitude toward psychosocial development (R² change=34.9; p<0.001) could be explained by the specified sub-dimensions of RSES. Conclusion In our study, it was observed that self-esteem shaped from childhood to the present day is at least as effective as sociodemographic characteristics in the attitude toward aging.