Cureus最新文献

Visual impairment and eye disease remain a significant burden, highlighting the need for further support regarding eye care services. Artificial intelligence (AI) and its rapid advancements are providing an avenue for transforming healthcare. As a result, this provides a potential avenue to address the growing challenges with eye health and could assist in settings such as eye casualty departments. This review aims to evaluate current studies on AI implementation in eye casualty triage to understand the potential application for the future. A systematic review was conducted across a range of sources and databases producing 77 records initially identified, with four studies included in the final analysis. The findings demonstrated that AI tools are able to produce consistent and accurate triaging of patients and provide improvement in work efficiency without compromising safety. However, we note limitations of the studies including limited external validations of results and general applicability at present. Additionally, all the studies highlight the need for further studies and testing to allow for better understanding and validation of AI tools in eye casualty triaging.

[This retracts the article DOI: 10.7759/cureus.43906.].

Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory vascular disease of medium-sized arteries that causes abnormal cellular growth in arterial walls and most commonly affects young to middle-aged women (20-50 years of age). While FMD often involves the renal arteries, it can affect any arterial bed. FMD has a characteristic angiographic appearance of a "string of beads." However, rarely patients may present with an FMD-like clinical phenotype without characteristic angiographic FMD evidence. An FMD phenotype consists of a specific constellation of arterially-induced symptomatology (e.g., pulsatile tinnitus in cerebrovascular FMD) in the setting of acute arterial disturbances typically found in FMD (e.g., arterial dissection). This case report discusses a cerebrovascular FMD clinical phenotype manifesting as a distal spontaneous coronary artery dissection (SCAD) in a middle-aged man with chronic migraines, pulsatile tinnitus, and no prior cardiac history. In this case, a patient presented to the emergency room with elevated high-sensitivity troponin levels and anginal chest pain thought to be secondary to a non-ST-elevated myocardial infarction (NSTEMI). A left heart catheterization revealed non-obstructive atherosclerosis and a spontaneous coronary artery dissection in the distribution of the distal left anterior descending artery. To assess potentially involved arterial beds, further work-up consisting of a bilateral carotid and renal artery duplex demonstrated significant carotid arterial tortuosity, a finding consistent with cerebrovascular FMD. Per consultation with neurology and cardiovascular surgical services, a computed tomography angiography (CTA) aorta and CTA head and neck were obtained, which demonstrated subtle irregularities and tortuosities concerning for FMD but without characteristic findings. Further medical optimization was initiated for blood pressure and migraine symptomatology control. After completion of the diagnostic FMD work-up, the patient was discharged with monthly cardiovascular and neurological follow-up. This case report illustrates the important multifactorial practice of history-taking, laboratory evidence evaluation, and diagnostic imaging interpretation to ascertain the correct diagnosis in an atypical presentation of an uncommon disease spectrum.

Purpose In recent years, research on caregivers has highlighted the importance of integrating advanced technologies, such as wearable devices. Furthermore, when investigating the characteristics of persons with dementia (PWD), comparative analyses should be conducted based on the presence or absence of the condition. We aimed to elucidate the relationship between caregivers' subjective burdens, tasks, and heart rate (HR) using wearable sensors to objectively assess the health status of caregivers of PWD and older adults requiring long-term care. Methods The study recruited 21 caregivers of PWDs and older adults requiring long-term care between September 2022 and December 2024 from one hospital, two care plan centers, and visiting nursing stations in Fukuoka Prefecture, Japan. We collected the participants' sociodemographic data using a questionnaire survey for caregivers. We also measured the caregiver's HR, walking steps, and total sleep time using a wearable sensor. Results Data from 17 participants with no missing values were included in this analysis among the 21 caregivers who provided consent to participate in this study. The demographic variables of the caregivers and care recipients revealed that the caregivers were predominantly female (typical spouses). Most PWDs were diagnosed with atopic disease. No significant correlations were found between the short Japanese version of the Zarit Burden Interview (J-ZBI_8) and the following measures: caregiving years, activities of daily living (ADL), the 14-item Short-Memory Questionnaire (SMQ), caregiving time, the Caregiving Gratification Scale (CGS), total caregiving tasks, sleep time, walking steps, or conversation time. Caregiver burden was significantly associated with caregiving experience and continued caregiving. We observed no significant differences in the average HR for pre- and post-caregiving tasks. Significant differences were found in the maximum pre- and post-caregiving HR. While caregiver burden showed a high-scoring trend and positive perception showed a low-scoring trend, none of the variables differed according to the presence or absence of PWDs. Conclusions These results indicate that subjective appraisal of caregiver burden was not significantly associated with HR change during caregiving tasks. No differences were observed in the behaviors of caregivers with or without dementia. It is necessary to measure subjective and objective appraisals using wearable sensors to better understand caregivers' situations.

Roux-en-Y gastric bypass (RYGB) is a bariatric surgical procedure commonly performed in adults to treat severe obesity. While RYGB is generally safe, it occasionally leads to rare but significant complications, including intussusception, a form of bowel obstruction caused by the invagination of an intestine segment from the proximal to the adjacent distal portion. We report a case of intussusception in a 74-year-old female patient who underwent RYGB 12 years prior. A computed tomography (CT) scan revealed jejunal intussusception accompanied by internal herniation, which was subsequently confirmed through exploratory laparotomy. The segments in intussusception were successfully reduced without any complications. Postoperative follow-up demonstrated the absence of recurrence or any additional complications.

[This corrects the article DOI: 10.7759/cureus.76294.].

We present a case of a 46-year-old woman with recurrent breast abscess resistant to conventional treatments. Initial diagnosis of mastitis led to antibiotic therapy; however, abscess formation recurred. Subsequent interventions, including incision, drainage, and various antibiotics, were insufficient because of recurrent infections. Due to the side effects of long-term antibiotic use, the patient was referred to the Kampo medicine department to address the premenstrual symptoms and recurrent infections. Treatment with Kampo medicines resulted in significant symptom reduction within a month. After treatment, the patient experienced mild symptoms, and breast abscess recurrence was prevented for more than two years. This case highlights the potential role of Kampo medicine in the management of refractory breast abscesses associated with premenstrual symptoms. Further research is required to explore the efficacy and mechanisms of action of Kampo medicines in similar cases.

Background Laparoscopic appendicectomy is a commonly used approach for the surgical management of acute appendicitis. If complications arise, a blood transfusion may be necessary for patients undergoing emergency appendicectomy. The need for routine group and save (G&S) sampling prior to emergency laparoscopic appendicectomy remains a subject of ongoing discussion. The aim of this study was to evaluate whether routine G&S sampling is needed prior to emergency laparoscopic appendicectomy. Methods The present study retrospectively reviewed G&S sampling for emergency laparoscopic appendicectomy cases over a six-month period at two hospital sites in the United Kingdom: Croydon University Hospital (June 1, 2024, to November 30, 2024) and Tunbridge Wells Hospital (October 1, 2023, to April 30, 2024). A total of 304 patients across both sites were included in the review. Results In 2023, 23 procedures (7.6%) were performed, while 279 procedures (92.4%) occurred in 2024. The patient population consisted of 46.4% males (n = 141) and 53.6% females (n = 163), with a mean age of 37.1 years (median 33, range 6-84). A total of 406 G&S samples were collected, of which 351 (86.5%) were processed and 55 (13.5%) were rejected by the blood bank. From the sample size, only one patient received a blood transfusion prior to surgery due to a low hemoglobin level of 72 g/L, likely resulting from the delayed presentation of a perforated appendix. Conclusion This study suggests that omitting routine G&S sampling is safe for patients undergoing emergency laparoscopic appendicectomy. Hence, an individualized risk assessment approach should be used to identify high-risk patients requiring preoperative G&S sampling.

Integrating artificial intelligence (AI) into oncology can revolutionize decision-making by providing accurate information. This study evaluates the performance of ChatGPT-4o (OpenAI, San Francisco, CA) Oncology Expert, in addressing open-ended clinical oncology questions. Thirty-seven treatment-related questions on solid organ tumors were selected from a hematology-oncology textbook. Responses from ChatGPT-4o Oncology Expert and the textbook were anonymized and independently evaluated by two medical oncologists using a structured scoring system focused on accuracy and clinical justification. Statistical analysis, including paired t-tests, was conducted to compare scores, and interrater reliability was assessed using Cohen's Kappa. Oncology Expert achieved a significantly higher average score of 7.83 compared to the textbook's 7.0 (p < 0.01). In 10 cases, Oncology Expert provided more accurate and updated answers, demonstrating its ability to integrate recent medical knowledge. In 26 cases, both sources provided equally relevant answers, but the Oncology Expert's responses were clearer and easier to understand. Cohen's Kappa indicated almost perfect agreement (κ = 0.93). Both sources included outdated information for bladder cancer treatment, underscoring the need for regular updates. ChatGPT-4o Oncology Expert shows significant potential as a clinical tool in oncology by offering precise, up-to-date, and user-friendly responses. It could transform oncology practice by enhancing decision-making efficiency, improving educational tools, and serving as a reliable adjunct to clinical workflows. However, its integration requires regular updates, expert validation, and a collaborative approach to ensure reliability and relevance in the rapidly evolving field of oncology.

Background The relationship between physical activity and incident pancreatic cancer is poorly defined, and the evidence to date is inconsistent, largely due to small sample sizes and insufficient incident outcomes. Using the UK Biobank cohort dataset, the association between physical activity levels at recruitment and incident pancreatic ductal adenocarcinoma (PDAC) at follow-up was analysed. Method Physical activity, the key exposure, was quantified using Metabolic Equivalent Task (MET) values and categorised into walking, moderate, and vigorous activity. These categories were each analysed in quartiles. Summed activity was analysed both in quartiles and using International Physical Activity Questionnaire (IPAQ) activity levels (low, moderate, high). Univariate hazard ratios (HRs) and multivariable-adjusted HRs (aHRs) with 95% confidence intervals (CIs) were calculated using Cox regression analyses. Results A total of 542 incident PDAC cases and 2,139 controls (1:4 matching for age and sex) with a median (IQR) follow-up of 6.8 (1.7) years were analysed. No significant association was found in walking, moderate, and vigorous activities. In summed activity, only the 3rd quartile showed a statistically significant inverse association with PDAC risk (aHR 0.67, 95% CI 0.52-0.86, p<0.01). For IPAQ activity, the moderate and high activity groups showed borderline statistically significant associations with incident PDAC (aHR 0.80, 95% CI 0.63-1.00, p=0.05, and aHR 0.80, 95% CI 0.64-1.01, p=0.06, respectively). Conclusion The large UK Biobank cohort study did not show a strong association between physical activity levels and the development of incident PDAC.