Cureus最新文献

Objectives: Hearing impairment during childhood is a widespread health issue. Prompt recognition and timely intervention are vital for the advancement of language skills. Insufficient parental knowledge can lead to a delay in diagnosing and treating a condition, which can have a negative impact on academic performance. The goals of our study were to assess the knowledge levels of parents regarding childhood hearing loss and to evaluate their attitudes toward the availability of hearing services.

Methods: A cross-sectional study was conducted using an online questionnaire. Participants, totaling 339, were recruited from various regions across Saudi Arabia through a stratified random sampling technique to ensure diverse representation. Recruitment was conducted via social media platforms, including Twitter, and WhatsApp. The data were examined using Microsoft Excel (Microsoft® Corp., Redmond, WA) and Statistical Product and Service Solutions (SPSS, version 26.0; IBM SPSS Statistics for Windows, Armonk, NY).

Result: This study consisted of 339 participants, of whom 295 (87.0%) were female. The 41-50 age group was the most represented at 35.7% (121/339). A total of 76.1% of the participants demonstrated inadequate knowledge regarding childhood hearing loss and its connection to developmental delay. Although the participants had limited knowledge, a significant majority of 82.9% expressed a favorable disposition toward hearing services.

Conclusions: This study emphasizes the existence of significant gaps in knowledge and diverse attitudes toward childhood hearing loss among caregivers. This underscores the urgent need for public health initiatives to tackle these gaps through educational and awareness campaigns. By promoting a well-informed and optimistic approach to hearing health, we can improve the results of early detection and intervention, thereby reducing the long-term effects on speech, language, and cognitive development.

Background: In surgically treated cases of head and neck squamous cell carcinoma (HNSCC), even pathological N0 (pN0) cases according to the Tumor, Node, and Metastasis (TNM) Classification, distant metastases can occur relatively early postoperatively. Therefore, we hypothesized that hematogenous distant metastasis may be related to the degree of venous invasion. Lymphatic invasion is considered to be a poor prognostic factor in HNSCC, but knowledge about venous invasion is scarce. We therefore investigated the association between venous invasion and distant metastasis, an important poor prognostic factor, in cases of HNSCC from our institution.

Subjects and methods: Between April 2020 and December 2023 (four years and nine months), there were 89 cases in which a postoperative pathological evaluation of microvascular invasion was conducted after HNSCC surgery at our institution. Of these, 73 were retrospectively reviewed, after excluding six cases with positive margins and 10 cases with extranodal extension of metastatic lymph nodes. The observation period ranged from 13 to 54 months (mean: 32.5 months). The correlations between the presence/absence of venous or lymphatic invasion at the primary site and distant metastasis were investigated.

Results: Among the 73 cases, venous invasion was found at 31 primary sites, and lymphatic invasion was observed in 38 cases. Distant metastases were found in 10 cases. All cases showed both venous out lymphatic invasion, and none of the cases where these were negative showed distant metastasis. There were significantly more distant metastases in both the venous invasion-positive group (p=0.001) and the lymphatic invasion-positive group (p=0.004).

Conclusion: The absence of distant metastasis in cases that were negative for venous invasion and venous invasion being present in all cases with distant metastasis indicated that venous invasion by the primary tumor is an important factor in distant metastasis. Venous invasion was also found to increase in frequency as the T and N stages progressed.

Exploratory laparotomies for blunt or penetrating trauma often result in significant morbidity. Despite advancements in resuscitation, surgical techniques, and antibiotics, intra-abdominal abscesses remain a serious complication, contributing to poor outcomes and extended hospital stays. Percutaneous computed tomography-guided drainage is the standard treatment for abscesses, offering high success rates and low morbidity. However, its efficacy depends on factors such as abscess location and radiologist expertise. In cases where drainage is inaccessible, open or laparoscopic surgery may be required, which carries substantial risks. In rare situations, administering tissue plasminogen activator (tPA) via an abdominal drain has been shown to resolve abscesses effectively. This report discusses a 37-year-old male patient with a gunshot wound to the left upper abdomen, resulting in hemoperitoneum, gastric injury, and lacerations to the kidney and pancreas. Following surgical repair and placement of a Jackson-Pratt drain, the patient developed sepsis and a subphrenic abscess that could not be accessed for interventional radiology drainage. After weighing the risks and benefits, tPA was administered via the Jackson-Pratt drain, leading to clinical improvement. This innovative approach may offer an alternative for managing difficult-to-drain intra-abdominal collections, potentially reducing surgical intervention and associated morbidity. Currently, no large-scale studies or consensus exist regarding tPA use and dosing for abdominal collections, highlighting the need for further research. Insights from intrapleural tPA application could inform its broader use in intra-abdominal treatments.

The increased cost and morbidity associated with diabetic foot ulcers (DFUs) place a substantial strain on the entire global healthcare system. In this trial, 24 subjects with a chronic DFU, Wagner grade 1 (University of Texas grade 1A), were treated with Standard of Care (SOC) therapy and randomized, one-half to receive advanced high-purity Type-I collagen-based skin substitute (HPTC; manufactured by Encoll Corp., Fremont, CA, USA), and the other half to receive a dehydrated human amnion/chorion membrane (dHACM) or viable cryopreserved human placental membrane (vCHPM). The primary study endpoint was percentage wound area reduction (PAR) over the five-week treatment period. Secondary endpoints included healing time, proportion of wounds closed, and mean number of graft applications. By four weeks post-randomization, the mean PAR for the HPTC group was 83.9 versus 71.3 for dHACM or vCHPM. By four weeks, 6/12 (50%) of wounds receiving HPTC healed, compared to 3/12 (25%) in the comparator group (dHACM or vCHPM). There were no adverse events reported in either group. The results of this study suggest that HPTC shows great promise in wound healing in people with DFUs, with the given limitations. We look forward to future studies that will confirm these encouraging results.

Background Chronic rhinosinusitis with nasal polyps (CRSwNP) significantly affects patients' quality of life, impacting both physical and psychological well-being. This study investigated the potential role of resilience in coping with CRSwNP and its relationship to disease severity and cellular proliferation. Methodology Between July 1, 2021, and June 30, 2022, 30 patients diagnosed with CRSwNP were enrolled in a study at Cardiomed Hospital in Cluj-Napoca, Romania. Resilience was assessed using the Connor-Davidson Resilience Scale (CD-RISC), while disease severity was evaluated through patient-reported outcomes (Sino-Nasal Outcome Test (SNOT-22)) and objective measures (Lund-Mackay score). Ki-67 expression was analyzed as a marker of cellular proliferation within nasal polyps. Results No significant correlation was observed between resilience and either SNOT-22 scores or Ki-67 expression. However, a strong positive correlation was found between SNOT-22 scores and Lund-Mackay scores, indicating that patients with more severe symptoms also exhibited greater objective disease burden. In addition, a moderate positive correlation was identified between Ki-67 expression and Lund-Mackay scores, suggesting a potential link between cellular proliferation and disease severity. Conclusion These findings suggest that resilience may not directly influence symptom severity or cellular proliferation in CRSwNP. Further research with larger sample sizes and longitudinal designs is needed to elucidate the complex interplay between resilience, disease pathophysiology, and patient outcomes in CRSwNP. This will ultimately inform the development of more targeted and effective interventions to improve the quality of life for individuals with this chronic condition.

Anticholinergic toxicity typically presents with symptoms of cutaneous vasodilation, delirium, mydriasis, urinary retention, hyperthermia, anhidrosis, and tachycardia. This case report presents a 68-year-old female patient who exhibited some of these signs and symptoms after ingesting an unknown quantity of dicyclomine. However, she displayed one notable exception to the classic toxidrome. On hospital day 2, the patient experienced multiple incidences of prolonged sinus pause, culminating in witnessed asystole lasting 5-10 seconds. The patient continued to have numerous episodes of sinus pause that lasted 5-10 seconds each over the next two days. Treatment involved placement of multiple temporary transvenous pacemakers until the episodes of sinus pause eventually self-resolved, facilitating discharge home on hospital day 6. The patient recovered without any known complications. After considering alternative diagnoses such as sick sinus syndrome, electrolyte derangements, and intracranial hypertension, multiple hospital medical services ultimately attributed the arrhythmia to anticholinergic toxicity. There are no other documented cases of intermittent sinus pause associated with anticholinergic overdose. While rare, clinicians should consider anticholinergic toxicity as a potential cause of intermittent sinus pause, especially in patients taking anticholinergic medications. Increased clinical vigilance could impact treatment decisions, including potentially avoiding unnecessary procedures such as permanent pacemaker placement, if symptoms resolve with cessation of the offending agent.

Papillary tumors of the pineal region (PTPR) are extremely rare malignancies that make up less than 0.1% of primary brain tumors. They are usually treated with surgery and adjuvant tumor bed radiotherapy (RT). We review the case of a man in his late 60s who presented with two weeks of confusion and ataxia. Imaging the head with computed tomography (CT) and magnetic resonance imaging (MRI) showed hydrocephalus and a 2 cm pineal region mass. We review the presenting symptoms, investigations, and differential diagnosis for patients with pineal region masses. The pathological features, initial hydrocephalus management, and curative treatment of his tumor with surgery and RT are discussed. We also review the PTPR literature, including prognostic features and the evidence for treatment modalities, and report adjuvant radiotherapy treatment planning volumes. The patient is symptom-free and without evidence of recurrent disease on follow-up MRI 18 months after treatment. PTPR has very high recurrence rates following treatment; less than 20% of patients have local control at 10 years, and further research is needed to find more effective interventions and improve patient outcomes.

Acute chest pain is one of the most common reasons for ED visits in the United States. Most patients are eventually admitted to the hospital to "rule out ACS" even when there are no significant EKG abnormalities or elevated cardiac enzymes. In addition to undergoing expensive tests while in the hospital, patients are also exposed to iatrogenic harm thereby worsening the overall healthcare costs. Meanwhile, the use of coronary computed tomography angiography (CTA) as a "gatekeeper" diagnostic test for patients with low to intermediate risk for coronary artery diseases (CADs) has significantly lowered hospital admissions and associated costs. However, coronary CTA may not be helpful for all classes of patients. Therefore, this study seeks to determine if the distribution of patients presenting to the ED with chest pain in an acute care facility will justify an investment in coronary CTA and contribute to lowering healthcare costs. Patients' data between July 2022 and June 2023 were considered in our analysis. Results revealed that a significant number of patients who presented to the ED for chest pain and were subsequently admitted to the hospital for further work-up would have benefited from coronary CTA screening without any need for further inpatient work-up. Also, cost analysis showed that the use of coronary CTA would have helped significantly lower healthcare costs in this facility.

We report the case of a four-month-old male infant diagnosed incidentally with bilateral congenital diaphragmatic hernias. Our patient was found to have chest asymmetry during an unrelated hospital visit and bilateral diaphragmatic defects were confirmed on cross-sectional imaging. Surgical repair of a right-sided Bochdalek hernia and a left-sided Morgagni hernia was performed with excellent outcomes. This case report documents the rare occurrence of a bilateral late-presenting congenital diaphragmatic hernia, augments the limited existing knowledge, and highlights the variability in clinical outcomes. It provides valuable perspectives on the potentially improved survival rates in the uncommon manifestations of this condition.

The bone tissue is a specialised connective tissue composed of several components that undergo constant remodelling. The balance between bone deposition and resorption is essential for maintaining a healthy bone structure. In case of a disruption in this remodelling process, which can lead to an imbalance between bone deposition and resorption, an increase in the opacity of a vertebral body may be observed in imaging studies, resulting in what is known as the "ivory vertebra sign". This condition can be present in many diseases such as Paget's disease, lymphomas, metastatic prostate or breast tumours and osteomyelitis. We present the case of a patient with an ivory vertebra, an uncommon radiological finding, which was related to another rare disease.