Cureus最新文献

A technique of modified mucosal incision is discussed here for easy submucosal entry during peroral endoscopic myotomy (POEM). An L-shaped mucosal incision was used during peroral endoscopic myotomy in six cases of achalasia cardia. The incision was closed by clips in all the cases after the complete myotomy. Peroral endoscopic myotomy was successful in all six cases without any complication. The mucosal incision was closed by clips without any difficulty. The L-shaped mucosal incision for submucosal entry during peroral endoscopic myotomy made the procedure easy and quick.

Adaptive radiation therapy is a modern technological advancement that allows radiation treatments to be adjusted daily to account for changes in the patient's anatomy, such as bladder and rectal filling, as well as changes in the tumor volume and position. In this case report, we present a patient with locally advanced cervical cancer who received definitive radiation therapy of 4500 cGy in 25 fractions using the Varian's Ethos system. We observed substantial daily uterine movement, which required re-optimization of each treatment fraction. Without the daily plan adaptation, the treatment would have resulted in markedly suboptimal dose coverage to the tumor. This case report highlights the importance of adaptive radiotherapy in managing anatomical changes in cervical cancer treatment and improving outcomes.

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy resulting from compression of the median nerve. This condition is more common in females than in males. The earlier the diagnosis, the better the prognosis and treatment outcomes.

Material and methods: This is a cross-sectional hospital-based study conducted at Soba Teaching Hospital in obstetrics and gynecology outpatient clinic in Khartoum in the period from February 2022 to March 2022. A simple random sampling was applied, and an interview was conducted using a four-part questionnaire. The first part was based on socio-demographic data, the second was lifestyle, and the third and fourth were based on the Boston Carpal Tunnel Questionnaire (BCTQ). The data were analyzed using the statistical package for social sciences (SPSS) software, version 23 (IBM Corp., Armonk, NY) to find the correlation between the various variables.

Results: A total of 113 women participated in the study (response rate=100%). The prevalence of CTS was found to be 5%. No significant association was found between lifestyle and medical history, e.g., obesity and oral contraceptives and CTS were p=0.167, 0.841 respectively. Conversely, there was a significant association between age and residency, with p=0.005 and 0.049, respectively.

Conclusions: The prevalence of CTS is increasing in Sudan. Therefore, it is essential to thoroughly assess patients for any symptoms related to hand pain by asking detailed questions during consultations. In addition, further studies covering more states are needed to better understand the regional variation in CTS prevalence.

Introduction The objective of this study is to find out if there are any differences in upper urinary tract recurrence and overall mortality between patients who underwent a frozen section analysis during radical cystectomy and those who did not. Materials and methods In an observational retrospective cohort study, we evaluated data from 164 patients who underwent radical cystectomy in our institution over a five-year period from 2013 to 2018. Fisher's exact test was applied to find any difference in upper urinary tract recurrence between the two groups. The Kaplan-Meier method and the log-rank (Mantel-Cox) test were used to determine differences or equivalence between treatment groups. Results The sensitivity was 84.6% and the specificity was 95.3% for the frozen section. There was no statistically significant relationship between performing a frozen section and upper urinary tract recurrence, as indicated by Fisher's exact test (p=0.619). The Kaplan-Meier test showed no statistically significant relationship between performing a frozen section analysis and overall mortality. Discussion The use of ureteric frozen section analysis during radical cystectomy is traditionally taught during surgical training, but the evidence base for this practice is sketchy. Frozen section analysis is thought to reduce the chances of local recurrence and arguably upper urinary tract recurrence. The overall upper urinary tract recurrence after radical cystectomy is reported to be 2-6%, consistent with the 3.3% observed in our study. Conclusion Our study demonstrates that while frozen section analysis is sensitive and specific in detecting dysplasia, it does not significantly impact upper tract recurrence or overall mortality.

Persistent left superior vena cava (PLSVC) is a rare congenital venous anomaly. It is often asymptomatic and has atypical venous drainage that can complicate central venous catheterisation, pacemaker implantation, and cardiac surgeries. In most cases, the PLSVC drains into the right atrium via the coronary sinus, but in a minority of cases, it drains into the left atrium, leading to a right-to-left shunt, which can cause mild hypoxia or paradoxical embolism. Due to its abnormal anatomy, PLSVC can complicate lead placement during permanent pacemaker (PPM) insertion. Lead navigation becomes more complex, sometimes necessitating alternative lead placement techniques or imaging guidance to ensure proper functionality. In most cases, the PLSVC is identified incidentally during the initial venogram. We present the case of a 64-year-old male with sarcoidosis, hypercholesterolemia, hypertension, hepatitis, and recent atrial fibrillation (AF) who presented for elective direct current cardioversion (DCCV). Pre-DCCV, the ECG showed AF with a slow ventricular response, and following a 200-joule synchronised shock as per local protocol, sinus rhythm was restored. Post-DCCV ECG showed a first-degree AV block, which progressed to an intermittent 2:1 block, leading to a decision to implant a dual-chamber PPM. An echocardiogram revealed normal left ventricular function, a dilated left atrium and normal right ventricle, mild tricuspid regurgitation, and a possible patent foramen ovale (PFO). A venogram performed during PPM implantation revealed a PLSVC, which posed challenges in lead placement. Despite initial success, a post-procedure chest X-ray revealed displacement of the atrial lead, prompting a successful repositioning. The patient remained stable and asymptomatic; outpatient follow-ups showed satisfactory PPM function. PLSVC is a congenital anomaly arising from incomplete regression of the left anterior cardinal vein during embryonic development. Though it is often discovered incidentally, the anomaly becomes clinically significant during procedures such as pacemaker implantation due to its impact on venous anatomy and lead placement. This case also underscores the need for specialised techniques when managing patients with PLSVC during device implantation. Given the abnormal venous pathway, alternative strategies such as utilising the coronary sinus or imaging guidance, like fluoroscopy, may be necessary to ensure proper lead placement and avoid complications such as lead displacement or venous thrombosis. The literature supports using advanced imaging modalities and tailored surgical approaches to improve outcomes in patients with PLSVC. Ultimately, this case illustrates the complexity of cardiac device implantation in the presence of venous anomalies and highlights the importance of individualised procedural planning to optimise patient care and reduce the risk of complications.

This case report describes the application of the radio electric asymmetric conveyer (REAC) gamma brain wave optimization (BWO-G) treatment in a 16-year-old female patient with a history of emotional trauma, depressive symptoms, and gender dysphoria. The patient underwent 18 sessions of REAC Neuro Psycho Physical Optimization (NPPO) BWO-G, with quantitative electroencephalography (QEEG) conducted pre- and post-treatment. Initial QEEG analyses indicated altered brain wave activity, with peaks in alpha rhythm frequencies in occipital and right posterior temporal areas. Following treatment, significant improvements were observed, including a reduction in delta and theta rhythms and increased alpha and gamma rhythms, corresponding to enhanced cognitive clarity and emotional regulation. Clinically, the patient experienced reduced anxiety, improved mood, heightened social engagement, better auditory tolerance, and resumed weight management. These findings suggest that the REAC NPPO BWO-G treatment may be an effective, non-invasive approach to enhancing cognitive and neuropsychological resilience in individuals with complex psychosocial challenges.

Pancreatic cancer is one of the most lethal malignancies, characterized by late diagnosis, rapid progression, and limited treatment options. This literature review comprehensively examines the epidemiology, risk factors, diagnostic challenges, treatment modalities, and prognosis of pancreatic cancer. It highlights the global disparities in incidence and outcomes, exploring the influence of socioeconomic, environmental, and genetic factors on disease progression. In addition, this review discusses recent advancements in diagnostic tools and treatment strategies, identifying gaps in current research and clinical practices. The synthesis aims to inform future research directions and policy-making efforts to reduce the global burden of pancreatic cancer and improve patient outcomes.

Acanthamoeba, a free-living amoeba (FLA) found in diverse ecosystems, poses significant health risks globally, particularly in Malaysia. It causes severe infectious diseases, e.g., Acanthamoeba keratitis (AK), primarily affecting individuals who wear contact lenses, along with granulomatous amoebic encephalitis (GAE), a rare but often life-threatening condition among immunocompromised individuals. AK has become increasingly prevalent in Malaysia and is linked to widespread environmental contamination and improper contact lens hygiene. Recent studies highlight Acanthamoeba's capacity to serve as a "Trojan horse" for amoeba-resistant bacteria (ARBs), contributing to hospital-associated infections (HAIs). These symbiotic relationships and the resilience of Acanthamoeba cysts make treatment challenging. Current diagnostic methods in Malaysia rely on microscopy and culture, though molecular procedures like polymerase chain reaction (PCR) are employed for more precise detection. Treatment options remain limited due to the amoeba's cyst resistance to conventional therapies. However, recent advancements in natural therapeutics, including using plant extracts such as betulinic acid from Pericampylus glaucus and chlorogenic acid from Lonicera japonica, have shown promising in vitro results. Additionally, nanotechnology applications, mainly using gold and silver nanoparticles to enhance drug efficacy, are emerging as potential solutions. Further, in vivo studies and clinical trials must validate these findings. This review highlights the requirement for continuous research, public health strategies, and interdisciplinary collaboration to address the growing threat of Acanthamoeba infections in Malaysia while exploring the country's rich biodiversity for innovative therapeutic solutions.

Periprosthetic joint infection (PJI) is considered a rare but devastating complication after total joint arthroplasty (TJA). The problem lies in the fact that there is a paucity of "gold standard" diagnostic tests that make the diagnosis of PJI extremely challenging. Recently, there have been increasing evidence-based guidelines that have been introduced to standardise the approach to a patient with a suspected PJI. Diagnosing a case of PJI traditionally involves initial screening for elevated serum inflammation markers C-reactive protein (CRP) (mg/dL) and erythrocyte sedimentation rate (ESR), and aspiration remains the sole confirmatory investigation. However, several factors would affect the values of the aforementioned markers, such as gender, age, and the presence of inflammatory circumstances. Serum D-dimer that detects fibrinolytic activities during infection has high sensitivity, but the specificity was not persuasive as it would elevate during other conditions, such as venous thromboembolism. Therefore, there is also a need for a simultaneous and secondary marker. There are also several synovial biomarkers, including ESR, CRP, alpha-defensin, and synovial fluid leukocyte count and differential for the detection of PJI. In this narrative review, we want to sum up the serum and inflammatory markers that have been introduced so far for detecting PJI.

Symptoms of gallstone disease are the most common reason for cholecystectomy. Fenestration reduces the likelihood of severe inflammation or scarring after normal treatments are used, and it also enhances control over bile outflow. The goal of reconstituted cholecystectomy is to lessen symptoms like pain and jaundice without undergoing the high-risk procedures associated with more invasive procedures. The reconstituted and fenestrated procedures were assessed by a meta-analysis and systematic review. Of the five studies, 189 (34.2%) had a reconstituted subtotal cholecystectomy, and 363 (65.8%) had a fenestrated subtotal cholecystectomy, which had populations from the United States of America, the United Kingdom, Japan, and Turkey. Two individuals from three trials had bile duct injury, according to three studies. Whereas the fenestrated group reported no bile injury from 236 individuals (0%), the reconstituted group reported two bile duct injuries from 100 patients (2%). The incidence was found to be lower in the fenestrated group (OR 10.81; CI 95% 1.03-113.65; p = 0.39; I2 = 0%) than in the reconstituted group. Four studies revealed 92 cases of bile leaks: 19 out of 155 cases (12.3%) were reconstituted, and 73 out of 351 cases (20.8%) were fenestrated. Between the two groups, there was a significant difference in bile leakage (OR 0.72; CI 95% 0.23-2.32; p = 0.03; I2 = 66%). Two studies reported the establishment of fistulas following surgery in 58 patients in the reconstituted group (5.2%) and 120 patients in the fenestrated group (2.5%) (p = 0.56, I2 = 0%, and OR 0.65; CI 95% 0.12-3.38); however, there was no statistically significant difference between the groups. Following a fenestrated partial cholecystectomy, postoperative bile leakage, fistula development, wound infection, and retained stones are more prevalent. Additionally, we saw that the fenestrated method was being used more frequently for post-operative endoscopic retrograde cholangiopancreatography (ERCP). The subtotal cholecystectomy technique used should be chosen according to the surgeon's comfort level and experience with the various techniques and intraoperative findings, even if the reconstituted procedure could be preferred when feasible. To completely understand the role of each method in the general surgeon's toolkit for treating complex gallbladder (GB) patients, longer-term follow-up studies are still necessary.