Cureus最新文献

Background Patients undergoing hemodialysis for End-Stage Renal Disease (ESRD) are at risk for Hemodialysis Catheter-Related Bloodstream Infections (CRBSIs). This study evaluates the incidence, risk factors, organism types, and outcomes of CRBSI in adult patients on maintenance hemodialysis at King Faisal Hospital, Rwanda. Methods This was a prospective cohort study of adult patients with end-stage renal disease undergoing hemodialysis via central venous hemodialysis catheters at King Faisal Hospital, Rwanda. Upon receiving the IRB approval, 81 eligible patients, women, and men aged between 19 and 74, were enrolled. Restricted Mean Survival Time (RMST) analysis evaluated the risk factors for CRBSI. The statistical significance was determined using p-values, with a cut-off of 0.05. Results The incidence of CRBSI was found to be 0.78 episodes per 1,000 catheter-days. Acute hemodialysis catheter type and anemia were associated with increased risk for CRBSI, with a P-value less than 0.05. In addition, all CRBSI cases were due to bacteria, with 52.63% gram-negative and 47.37% gram-positive. Out of 19 CRBSI events, nine cases (47.37%) required hospitalization with a median duration of seven days. Approximately half of the CRBSIs required catheter removal. No metastatic infection or death was noted. Conclusion The present study demonstrated that our hemodialysis unit has an incidence of 0.78 episodes per 1,000 catheter-days. Catheter type and anemia were significantly associated with CRBSI.

This case shares the case of a post-menopausal woman who develops Philadelphia chromosome-positive B cell acute lymphoblastic leukemia (B-ALL) while receiving treatment for invasive ductal carcinoma (IDC) of the breast. The patient received a cyclin-dependent kinase (CDK) 4/6 inhibitor + aromatase inhibitor (AI) for the IDC; hyperfractionate cyclophosphamide, vincristine sulfate, doxorubicin hydrochloride (Adriamycin), methotrexate, and cytarabine (hyperCVAD), and the steroid hormone dexamethasone were added to treat the B-ALL. HyperCVAD combined with CDK 4/6 inhibitor + AI was very well tolerated. The CDK 4/6 inhibitor and AI were only held once in the treatment course due to adverse effect (AE) intolerance. The patient remains on a CDK 4/6 inhibitor and ponatinib with only low-grade fatigue as an AE. This case underscores the importance of a concurrent approach to managing hematologic and breast malignancies. The combined treatment regimens were effective and well-tolerated. Vigilant follow-up is essential for patients in remission from both malignancies, ensuring effective disease surveillance and treatment management. Integrated care remains pivotal for optimal outcomes.

A diagnosis of calciphylaxis is rare amongst the vulnerable population of patients with end-stage renal disease (ESRD); however, it has poor outcomes when it does present. With ineffective clearance due to reduced kidney function, calcium and phosphorus accumulate and deposit in the intimal layer of blood vessels and other soft tissues throughout the body. It can be proven using biopsy of skin lesions characteristic of the disease or with less invasive methods including X-ray and bone scintigraphy. Calciphylaxis is typically seen in middle-aged patients who have undergone prolonged dialysis treatment and has a devastating prognosis unless the patient can obtain a renal transplant. In this report, we present a case of a 30-year-old female patient with calciphylaxis and highlight the value of bone scintigraphy for diagnosis, while noting the importance of organ transplant for proper treatment.

Anxiety disorders are among the most common mental disorders worldwide. These conditions are characterized by excessive anxiety that is difficult to control. In most anxiety disorders, symptoms are triggered by exposure to specific objects or situations. This leads sufferers to avoid such exposures, leading to impaired social and occupational functioning and reduced quality of life. Therapies based on behavioral principles, either alone or in combination with cognitive techniques, are the most effective psychological interventions for anxiety disorders. However, the effectiveness of these therapies may be limited due to a lack of generalization from clinic to real-world settings. Augmented reality (AR) is a technology that provides an interactive experience by superimposing computer-generated content, often in multiple sensory modalities, on the real world. Emerging evidence suggests that AR may be useful in treating a broad range of mental disorders, including anxiety disorders. This review examines the evidence for the use of AR-based techniques as an aid to behavioral or cognitive-behavioral therapies for anxiety disorders. The available evidence suggests that this method may offer significant advantages over conventional therapies, particularly in the case of specific phobias, but also in social anxiety disorder. AR can also be combined with other novel technologies to monitor psychophysiological markers of anxiety and its reduction over the course of treatment. The advantages of AR could be related to its combination of real and simulated content, allowing for better generalization of the benefits of conventional exposure-based therapy. Though the safety, efficacy, and cost-effectiveness of this method need to be confirmed in larger samples, it could lead to a paradigm shift in the way behavioral therapies for anxiety disorders are conceptualized and delivered.

Stuttering is a complex speech disorder that is associated with a variety of etiologies, including psychological factors, metabolic disorders, and structural abnormalities. While stuttering is typically not caused by stroke, it is important to include it in the diagnostic evaluation, especially in patients with a history of neurological conditions. Of the clinical presentations of stroke-induced stuttering, transient stuttering following stroke has seldom been documented, as most patients who develop a stutter following a stroke end up developing permanent speech deficits. Additionally, as most cases of stroke-induced stuttering are part of a broader neurological presentation, stuttering generally does not present as an isolated symptom. Furthermore, although strokes of various sizes have been implicated in stuttering, it is quite uncommon for the affected lesion to be smaller than 1 cm. We present a rare case of transient, isolated stuttering following a subcentimeter stroke and a subsequent review of relevant literature. Our case report highlights the diversity of stroke-related speech disorders and the importance of considering even minor strokes in the differential diagnosis of stuttering.

Anti-Hu is the most commonly associated antibody in paraneoplastic syndromes (PNS) - mainly secondary to small cell lung cancer (SCLC), breast cancer, thymoma, and lymphoma. This case is about a 65-year-old female patient presenting with slurred speech, headache, and loss of balance for one day. On examination, she was found to have downbeat and bilateral gaze-evoked nystagmus, dysarthria, and bilateral intention tremors. The rest of the neurological examination was unremarkable. Upon investigation, a CT scan showed a pre-sacral mass and a PET scan showed a lobulated soft tissue mesenteric mass at L5/S1, thought to possibly be a gastrointestinal stromal tumour, and mediastinal lymph nodes including right lower pre-tracheal, subcarinal and right hilar lymph nodes. Additionally, paraneoplastic antibody testing was positive for anti-Hu antibodies. She was given a five-day course of intravenous immunoglobulin without significant clinical improvement. The patient was discharged on a fast-track pathway and did not undergo chemotherapy, radiotherapy or surgical resection as the primary tumour could not be diagnosed.  Paraneoplastic antibodies are a family of autoantibodies occurring as a result of malignancy that act to recognize antigens in the brain, resulting in a variety of neurological manifestations. Despite well-known literature on this entity, PNS is notoriously difficult to diagnose and manage. The first step in the management of PNS is to treat the underlying malignancy. Beyond this, the other key component of PNS treatment is immune modulation which may involve immunosuppression with high-dose corticosteroids, IV immunoglobulins, plasma exchange or plasmapheresis. It is therefore important for PNS to be diagnosed early and to adopt a comprehensive multidisciplinary approach to improve the outcomes of those presenting with PNS.

We present a case report of a 47-year-old male with an extensive tissue deficiency of the right lower leg. The patient was hospitalized for approximately one month in the intensive care unit following a motorcycle accident that resulted in polytrauma. He suffered a fracture of frontal and parietal bones, traumatic brain injury, intracerebral hematoma with a subarachnoid hemorrhage and thoracic trauma. At first, lower leg wound was treated with a negative pressure wound therapy vacuum-assisted closure (VAC) dressing. Afterwards, he was qualified for a surgical wound closure with synchronous use of two reverse flow flaps: a reverse sural flap (RSF) and a reverse hemisoleus muscle flap (RHMF). Both flaps were dissected, and the RHMF was used to cover the exposed bone and the fracture site while the RSF closed the distal part of the wound. Split-thickness skin graft was meshed in scale of 1:1.5 and used to cover the RHMF and the remaining lower leg wounds. In the following days, uneventful wound healing was observed and the patient was discharged on day 34. The patient was invited for a follow-up examination two years after the procedure. His quality of life was assessed using SF-36 and Lower Extremity Functional Scale. It was determined to be satisfactory when compared to patients with identical injuries. Ultrasound examination of the gradient and blood flow velocity showed preserved graft perfusion and no structural abnormalities were detected. Adequate wound preparation and the choice of surgical technique allowed rapid healing and, above all, salvage of the limb that was at high risk of amputation.

Introduction Amelanotic melanoma (AM) is a rare form of melanoma that lacks pigment. Although curable when diagnosed early, it is often missed or mistaken for other benign conditions. There has not been a study investigating the impact of demographic features on the diagnosis of stage 0-I (early-stage) versus stage IV AM. Objective This study addresses a gap in knowledge regarding demographic factors that influence the odds of early-stage vs. stage IV diagnosis of AM. Methods This study identified 684 patients from the National Cancer Database who were diagnosed with early-stage AM or stage IV AM from 2004 to 2020 and compared them based on age, sex, race, insurance, income, education, insurance status, rurality, facility type, geographic region, and Charleson-Deyo score. Socioeconomic and demographic features of patients with early-stage and stage IV were compared using the chi-squared test, the independent t-test, and multivariate logistic regression. Statistical significance was set at α = 0.05. Results Most cases analyzed were White (98.5%), male (57.7%), and lived in a metropolitan setting (86.7%). Males made up most of the early-stage and stage IV groups (55.0% vs. 45% and 66.5% vs. 33.5%, respectively, p < 0.05). Younger age is associated with decreased odds of stage IV disease (OR = 0.973, 95% CI = 0.952-0.993, p < 0.05). In addition, the female sex is associated with decreased odds of stage IV disease (OR = 0.584, 95% CI = 0.381-0.897, p < 0.05). Conclusions Age and sex are two variables that influence the odds of stage IV diagnosis in patients with AM, which is strongly associated with worse survival outcomes.

Mucormycosis is a rapidly progressive fungal infection that typically affects immunocompromised patients and diabetics. These fungi are found in soil and vegetation and can be easily inhaled by humans in day-to-day life; however, infection is rare unless specific risk factors are present. This case report presents a typical case of a 39-year-old male with poorly controlled type 1 diabetes mellitus. Initially presenting with a toothache in the upper molars, the infection quickly progressed to sinusitis, necrosis, and multiorgan failure. Based on our experience, prompt recognition of mucormycosis in risk-group patients is essential for improving future outcomes.

Henoch-Schönlein purpura (HSP) is a systemic vasculitis characterized by palpable purpura, arthralgia or arthritis, GI symptoms, and renal involvement. Superior mesenteric artery (SMA) syndrome, a rare condition, occurs when the third part of the duodenum is compressed between the aorta and the SMA, leading to upper intestinal obstruction. This case report describes the clinical presentation, diagnostic process, and management of an eight-year-old girl with HSP complicated by SMA syndrome. The patient initially presented with abdominal pain and vomiting, eventually developing the characteristic rash of HSP. While initial management was supportive, her condition deteriorated. Treatment with intravenous methylprednisolone resulted in significant symptom improvement and resolution of both SMA syndrome and HSP manifestations. This case highlights the need to recognize SMA syndrome as a potential complication of HSP and demonstrates the effectiveness of steroid therapy in managing this condition. Further research is needed to develop comprehensive treatment guidelines for HSP patients with SMA syndrome.