Cureus最新文献

Thrombocytopenia is a common finding in pregnancy, with the majority due to gestational thrombocytopenia. Gestational thrombocytopenia is an innocuous condition that rarely requires treatment. Immune thrombocytopenia accounts for only a minority of thrombocytopenia in pregnancy and can have serious implications, especially in the peripartum period, including restrictions on birth plans and complications such as postpartum haemorrhage and neonatal thrombocytopenia. We present a case of possible immune thrombocytopenia secondary to influenza A infection. The case involves a 19-year-old, gravida-2, para-1, who developed severe thrombocytopenia shortly after influenza A, with a nadir platelet count of 31 × 10⁹/L. The platelet count returned to normal levels after six days of oral prednisolone 25 mg. This case highlights the importance of a thorough workup to identify more serious conditions causing thrombocytopenia.

Posterior shoulder dislocation is a rare and often missed injury, usually due to seizures, electrical shocks, or high-impact trauma. A 32-year-old man with a history of diabetes presented to the emergency department following an electric shock that threw him to the ground. He complained of right shoulder pain with limitation of movement. The initial radiographs of both shoulders did not show fracture or dislocation of either shoulder joint, and the condition was managed with an arm sling. A subsequent CT scan confirmed an irregular depression with sclerosis in the subchondral bone in the anterosuperior part of the humeral head, associated with a spontaneous reduction during the course of the electrical injury. He was managed conservatively, and the one-year follow-up showed excellent clinical results. Most shoulder injuries can be treated satisfactorily without surgery, provided there is no significant instability. This case report emphasizes the successful non-surgical treatment of this very rare posterior shoulder dislocation and highlights that careful rehabilitation, along with conservative management, is effective in ensuring significant recovery. This is further supported by evidence seen in the benefits of non-surgical procedures in similar cases.

Dr. Krishna Manohar Soman Rema (SR) (1956-2022) was a pioneering congenital cardiac surgeon and an inspiring educator who dedicated his life to advancing pediatric cardiac care and mentoring the next generation of surgeons. Trained in cardiac surgery at the Sree Chitra Tirunal Institute for Medical Sciences and Technology in Kerala, he served as faculty there for 20 years, contributing significantly to the development of the Chitra Heart Valve. His career also included tenures at the Madras Medical Mission, Frontier Lifeline Hospital, and the Sri Sathya Sai Hospital in Whitefield, Bengaluru. Dr. Krishna Manohar's most enduring contribution was his role in establishing cardiac surgical services at the Sri Sathya Sai Sanjeevani International Centre for Child Heart Care and Research in Palwal, Haryana, part of a network of hospitals offering free congenital heart surgery to underprivileged children. Under his leadership, these centers performed over 22,000 open-heart and interventional procedures over a decade, achieving excellent outcomes. An exceptional mentor, Dr. Krishna Manohar introduced a transformative ABCD framework for cardiac surgery, emphasizing adaptability, befriending collaboration, compassion, and discipline. He employed innovative teaching methods, such as the Handicraft Your Own Heart technique, to simplify complex concepts for trainees. Recognized for his dedication, he received numerous accolades, including the Lifetime Achievement Award from the Pediatric Cardiac Society of India in 2023. Dr. Krishna Manohar's legacy lives on through his students and the institutions he helped build, inspiring future generations to continue his mission of providing high-quality, accessible care to children with congenital heart disease (CHD).

Tumor neglect is a concerning phenomenon in which patients delay seeking medical attention despite the presence of obvious malignant growths. This rare and largely unexamined issue involves patients disregarding tumors as a means of coping with the outward, visible signs of cancer. Here, we present two cases of extensively neglected scalp tumors: the first, a 40-year-old male from a socially isolated community with a 26 × 22 cm squamous cell carcinoma, neglected for 14 years due to his role as the sole breadwinner, geographical isolation in a hilly region, and deep-rooted cultural beliefs in traditional healing. The second case, a 42-year-old male, presented with a 22 × 20 cm undifferentiated pleomorphic sarcoma, with a four-year delay attributed to prior experience with a benign lesion, medical anxiety, and financial constraints. Both patients exhibited massive, fungating tumors requiring complex surgical management. This report analyzes the factors contributing to extreme tumor neglect and underscores the need to address psychosocial barriers to timely medical care.

Organizing pneumonia (OP) is a pattern of pulmonary tissue repair injury. It can be cryptogenic or a response to a specific lung injury. Radiation therapy is a potential cause of secondary OP, especially after breast irradiation. The lesions may appear anywhere in the lung parenchyma with no relation to the irradiated side. Corticotherapy is the mainstay of treatment and prognosis is generally favorable. We describe a case of a female patient previously diagnosed with breast cancer who developed secondary OP within six months of postoperative radiotherapy. Initial diagnosis was challenging due to the rarity of the disease as well as management that required close follow-up with careful tapering given the frequent relapses associated with the withdrawal of corticosteroid therapy. The reported case emphasizes the importance of recognizing secondary OP as a rare complication of postoperative radiotherapy for breast cancer and puts into view the complexity of its management.

Introduction Humankind is suffering from the misuse and overuse of antibiotics, leading to antibiotic resistance. At this point, probiotics, if found effective, can lead to a better future. Probiotics are nothing but a colony of living-friendly bacteria. Lactobacillus reuteri is essential for use as a probiotic among many healthy bacteria. This study aims to compare the effectiveness of probiotics in periodontal treatment. Methods One hundred smokers diagnosed with chronic generalized periodontitis were randomly assigned into two groups. Group A received a seven-day course of amoxicillin 500 mg three a day and metronidazole 500 mg twice daily, followed by 30 days of probiotics, while Group B received a placebo antibiotic for seven days and 30 days of L. reuteri probiotics (2×10⁸ CFU daily). Periodontal parameters, including plaque index (PI), gingival index (GI), probing depth (PD), attachment loss (AL), and bleeding on probing (BOP), were utilized to asses at baseline, month one, and month one. Baseline differences were adjusted using the generalized estimating equation (GEE) model. Results At month three, Group B (probiotics) showed a significantly lower PI (0.52±0.49 vs. 0.88±0.52, p<0.001) and a 23% greater reduction in PD (p=0.004) compared to Group A (antibiotics + probiotics). These findings highlight the effectiveness of probiotics alone in improving periodontal health in smokers. Conclusions Both groups showed equal effectiveness in improving periodontal health. Hence, probiotics should be preferred over antibiotics.

This study evaluates the efficiency and dosimetric performance of RatoGuide, an artificial intelligence (AI)-assisted radiotherapy planning tool, by comparing AI-generated and manually created treatment plans for a 50-year-old male with right-sided oropharyngeal cancer (cT2N2bM0, cStage IVA) who underwent concurrent chemoradiotherapy. Treatment plans were created using volumetric-modulated arc therapy (VMAT) following the approach used by the Japanese Clinical Oncology Group (JCOG) protocol. RatoGuide generated two plans: one prioritizing the planning target volume (PTV) and the other focusing on organs at risk (OAR), while an experienced radiation oncologist manually developed a plan using a treatment planning system (TPS). Dosimetric comparisons focused on target coverage, OAR sparing, and dose homogeneity. Results showed that both AI-generated and TPS plans achieved comparable PTV coverage, with nearly identical values for Dmin, Dmean, and Dmax. The TPS plan exhibited slightly better dose homogeneity, whereas the AI-generated plan provided superior OAR sparing, particularly for the spinal cord and parotid glands, reducing the spinal cord's intermediate-dose volume (V30) by approximately 40%. However, the AI plan yielded slightly higher mean doses to both submandibular glands, though still within clinically acceptable thresholds. Additionally, the AI planning workflow was completed in just 30 minutes, significantly reducing the time required for manual planning. RatoGuide demonstrated efficiency in generating high-quality treatment plans, achieving comparable PTV coverage, and improving OAR sparing in certain areas. However, minor refinements are needed to optimize dose homogeneity and further minimize submandibular gland exposure. These findings suggest that AI-assisted planning has the potential to enhance radiotherapy efficiency and consistency.

Previous studies have shown that thrombi, upon retrieval, sometimes exhibit calcification and endothelialization, indicating that they are old, and they can be classified as red clots, white clots, or mixed clots according to the degree of heterogeneity of the thrombus. These findings suggest that, prior to the occurrence of acute myocardial infarction (AMI) and acute ischemic stroke (AIS), such large and heterogeneous thrombi may already be present. Pulmonary vein thrombi (PVTs) are common in patients with age-related diseases. During lung infection, neutrophil extracellular traps (NETs) are generated and have the potential to form thrombi. We previously reported that warfarin and novel oral anticoagulants (NOACs) can partially resolve PVTs, indicating that PVTs are heterogeneous. However, it is unclear whether PVTs contain areas of calcification. In the present case, we describe a patient with left atrium (LA) thrombi extending from PVTs that contained calcifications according to cardiac computed tomography (CT) and transesophageal echocardiography (TEE). On these imaging modalities, the calcifications of the extended LA thrombi appeared as white areas and white areas with white shadows, respectively. Some thrombi, including calcifications, can be resolved with dabigatran, whereas others cannot, indicating that thrombi, including calcifications, are heterogeneous. The effects of microclots, including NETs released from PVTs, have been well studied, and NETs have been reported to be related to many diseases. Treatments for PVTs also produce beneficial effects against these diseases; however, the direct effects of PVTs on the heart and lungs are not well known.

Background: Sleep is a crucial physiological phenomenon that enables the body to engage in restoration and rejuvenation. Remarkably, even limited periods of sleep deprivation (SD) can adversely affect cognitive functions such as memory retention, emotional regulation, data processing, and concentration. The Rose of Jericho (RoJ) has been considered more than a plant and has demonstrated potential therapeutic actions in childbirth, respiratory diseases, gastrointestinal disorders, and cancer. The effect of the RoJ on memory, cognition, and behavior has not yet been well-studied.

Objectives: The present study aimed to investigate the possible therapeutic effects of the RoJ on memory, cognition, behavior, and motor coordination in a rat model of SD.

Materials and methods: Thirty male Wistar albino rats weighing 120-150 g were used in the present study. The rats were acclimatized and trained and then randomly divided into three groups: control (C), sleep-deprived (SD), and SD treated with RoJ (SD+RoJ). Spatial memory and learning were assessed using the Morris Water Maze (MWM) test, while anxiety-related behaviors were evaluated through the Elevated Plus Maze (EPM) test. The rotarod test was used to assess motor coordination.

Results: The study revealed significant behavioral and cognitive performance improvements with the SD+RoJ group across all the tests. In the MWM test, the SD group exhibited a marked increase in test duration (29.5 ± 3.57 sec) and a reduction in average speed (1.9 ± 0.3 cm/s) when compared to the C group (13.41 ± 1.57 sec and 5.9 ± 0.34 cm/s, respectively). Interestingly, the SD+RoJ group significantly reduced test duration (19.75 ± 3.36 sec) and improved rats' speed (6.06 ± 0.27 cm/s) compared to the SD group. The EPM test demonstrated that the SD group spent significantly less time in the open arms (16.2 ± 9.44 sec) than the C group (59.8 ± 3.29 sec). Interestingly, the SD+RoJ group significantly improved the time spent in the open arms (45.8 ± 11.64 sec). Moreover, the SD+RoJ group showed notable improvement in open-arm entries (7 ± 2.39) compared to the SD group (1.6 ± 0.81). In the Rotarod test, the SD group demonstrated a significant decline in latency to fall (44.2 ± 9.5 sec) compared to the C group (228.67 ± 35.44 sec). The SD+RoJ group exhibited a significantly longer falling latency (165 ± 28.77 sec) than the SD group.

Conclusion: Treatment with the RoJ alleviated SD-dependent cognitive impairment, anxiety, and decline in motor coordination. Supplementation with the RoJ may offer potential therapeutic benefits, including boosting memory, improving cognition, reducing anxiety and depression, and enhancing motor coordination.

[This retracts the article DOI: 10.7759/cureus.57092.].