Pub Date : 2024-09-13eCollection Date: 2024-09-01DOI: 10.7759/cureus.69349
Abdulrahman M Alamri, Saeed A Alsareii, Nadia A Isaway, Saleh H Alshaiban, Saleh Y Alyami, Mustafa T Alsaid
Background Obesity is a significant health concern among older adults, leading to various comorbidities and reduced quality of life. Bariatric surgery (BS) has emerged as a potential intervention, but its efficacy in geriatric populations, particularly in Saudi Arabia, is not well-established. Aims This retrospective study aims to evaluate the impact of BS on weight reduction and comorbidity resolution in Saudi Arabian geriatric populations. Methods A retrospective cohort study was conducted at King Khalid Hospital, Saudi Arabia, involving geriatric patients aged 60 and above who underwent BS between January 2018 and December 2022. Data were collected from medical records and analyzed using descriptive statistics, chi-square tests, t-tests, and multivariate regression analysis. Results The study included a total of 26 patients with a mean age of 64 years. Of these, 18 (69.3%) were females, while eight (30.7%) were males, and 23 (87%) underwent sleeve gastrectomy (SG), while three (13%) had Roux-en-Y gastric bypass (RYGB). Preoperative comorbidities majorly included diabetes (17, 35.42%), hypertension (11, 22.92%), and anemia (four, 8.33%). The average body mass index (BMI) of the patients decreased significantly from 45.12 to 37.29 at three months and further to 31.36 at six months post surgery. Total weight loss (TWL) was 19.92% at three months and 35.15% at six months, while the percentage of excess weight loss (%EWL) was 33.42% at three months and 57.85% at six months. Results also showed a significant reduction in the number of comorbidities postoperatively. A significant association with gender, preoperative weight, and preoperative height at three and six months and a significant association with preoperative BMI and comorbidity status at six months were recorded. Conclusion The study suggests that bariatric surgery is effective in achieving significant weight loss and improving comorbidities in geriatric patients. Few demographic and clinical features affect the outcome of the weight loss.
{"title":"The Impact of Bariatric Surgery on Weight Reduction and the Resolution of Comorbidities in Older Geriatric Populations of Saudi Arabia: A Retrospective Study.","authors":"Abdulrahman M Alamri, Saeed A Alsareii, Nadia A Isaway, Saleh H Alshaiban, Saleh Y Alyami, Mustafa T Alsaid","doi":"10.7759/cureus.69349","DOIUrl":"https://doi.org/10.7759/cureus.69349","url":null,"abstract":"<p><p>Background Obesity is a significant health concern among older adults, leading to various comorbidities and reduced quality of life. Bariatric surgery (BS) has emerged as a potential intervention, but its efficacy in geriatric populations, particularly in Saudi Arabia, is not well-established. Aims This retrospective study aims to evaluate the impact of BS on weight reduction and comorbidity resolution in Saudi Arabian geriatric populations. Methods A retrospective cohort study was conducted at King Khalid Hospital, Saudi Arabia, involving geriatric patients aged 60 and above who underwent BS between January 2018 and December 2022. Data were collected from medical records and analyzed using descriptive statistics, chi-square tests, t-tests, and multivariate regression analysis. Results The study included a total of 26 patients with a mean age of 64 years. Of these, 18 (69.3%) were females, while eight (30.7%) were males, and 23 (87%) underwent sleeve gastrectomy (SG), while three (13%) had Roux-en-Y gastric bypass (RYGB). Preoperative comorbidities majorly included diabetes (17, 35.42%), hypertension (11, 22.92%), and anemia (four, 8.33%). The average body mass index (BMI) of the patients decreased significantly from 45.12 to 37.29 at three months and further to 31.36 at six months post surgery. Total weight loss (TWL) was 19.92% at three months and 35.15% at six months, while the percentage of excess weight loss (%EWL) was 33.42% at three months and 57.85% at six months. Results also showed a significant reduction in the number of comorbidities postoperatively. A significant association with gender, preoperative weight, and preoperative height at three and six months and a significant association with preoperative BMI and comorbidity status at six months were recorded. Conclusion The study suggests that bariatric surgery is effective in achieving significant weight loss and improving comorbidities in geriatric patients. Few demographic and clinical features affect the outcome of the weight loss.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142304507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-13eCollection Date: 2024-09-01DOI: 10.7759/cureus.69327
Rubén Neris, Ali Kimyaghalam, Kuldeep Singh
Background Duplex ultrasonography (DUS) is readily available and often used as the first diagnostic test for patients with peripheral artery diseases (PADs). PAD is a disease that affects the general population but more commonly affects diabetics. To date, the role of DUS in the assessment of tibial vessel disease is inconclusive at best. The goal of our study is to assess the validity of DUS in characterizing the presence and severity of tibial diseases via comparison with digital subtraction angiography (DSA) findings. Methods This is a single-center retrospective cohort study analyzing three arterial segments (anterior tibial, posterior tibial, and fibular arteries) in patients who received a duplex study followed by DSA within a 30-day period. All arterial segments were graded from normal (Grade 0) to occluded (Grade 4), based on duplex interpretation and directly compared to direct visualization findings from DSA. Using statistical methods, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of DUS were determined. Results A total of 171 tibial vessel segments from 57 enrolled subjects with critical limb ischemia symptoms were analyzed in this study. The agreement between both modalities was poor (Kappa=0.19, p < 0.05), with DUS demonstrating a significant underestimation of vessel pathologies. This is also reflected by the overall sub-optimal sensitivity (23%), specificity (84%), PPV (69%), and NPV (41%) in DUS when compared to DSA results as the gold standard. Conclusion Significant disagreements were noted in this study between DUS and DSA findings, primarily significant underestimation of tibial vessel disease by the DUS when compared with the DSA. Caution is advised in the clinical application of DUS in patients with chronic limb-threatening ischemia (CLTI) symptoms and multi-segment tibial vessels due to its demonstrated limitations in this study.
背景 双反射超声波检查(DUS)很容易获得,通常用作外周动脉疾病(PAD)患者的首次诊断检查。PAD 是一种影响普通人群的疾病,但更常见于糖尿病患者。迄今为止,DUS 在评估胫骨血管疾病中的作用充其量只能说是尚无定论。我们的研究旨在通过与数字减影血管造影(DSA)结果的比较,评估 DUS 在描述胫骨血管疾病的存在和严重程度方面的有效性。方法 这是一项单中心回顾性队列研究,分析了 30 天内接受双工检查和 DSA 的患者的三个动脉段(胫前动脉、胫后动脉和腓动脉)。所有动脉段都根据双工分析结果从正常(0 级)到闭塞(4 级)进行了分级,并与 DSA 的直接显像结果进行了直接比较。使用统计方法确定了 DUS 的敏感性、特异性、阳性预测值 (PPV)、阴性预测值 (NPV) 和准确性。结果 本研究共分析了 57 名有严重肢体缺血症状的受试者的 171 个胫骨血管节段。两种模式之间的一致性很差(Kappa=0.19,p < 0.05),DUS 明显低估了血管的病变。与作为金标准的 DSA 结果相比,DUS 的灵敏度(23%)、特异性(84%)、PPV(69%)和 NPV(41%)均未达到最佳水平,这也反映了这一点。结论 在本研究中,DUS 和 DSA 结果之间存在显著差异,主要是 DUS 与 DSA 相比明显低估了胫骨血管疾病。由于 DUS 在本研究中的局限性,建议对有慢性肢体缺血(CLTI)症状和多节胫骨血管的患者临床应用 DUS 时要谨慎。
{"title":"Comparison of Duplex Ultrasound and Digital Subtraction Angiography for Assessing Tibial Vessel Disease.","authors":"Rubén Neris, Ali Kimyaghalam, Kuldeep Singh","doi":"10.7759/cureus.69327","DOIUrl":"https://doi.org/10.7759/cureus.69327","url":null,"abstract":"<p><p>Background Duplex ultrasonography (DUS) is readily available and often used as the first diagnostic test for patients with peripheral artery diseases (PADs). PAD is a disease that affects the general population but more commonly affects diabetics. To date, the role of DUS in the assessment of tibial vessel disease is inconclusive at best. The goal of our study is to assess the validity of DUS in characterizing the presence and severity of tibial diseases via comparison with digital subtraction angiography (DSA) findings. Methods This is a single-center retrospective cohort study analyzing three arterial segments (anterior tibial, posterior tibial, and fibular arteries) in patients who received a duplex study followed by DSA within a 30-day period. All arterial segments were graded from normal (Grade 0) to occluded (Grade 4), based on duplex interpretation and directly compared to direct visualization findings from DSA. Using statistical methods, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of DUS were determined. Results A total of 171 tibial vessel segments from 57 enrolled subjects with critical limb ischemia symptoms were analyzed in this study. The agreement between both modalities was poor (Kappa=0.19, p < 0.05), with DUS demonstrating a significant underestimation of vessel pathologies. This is also reflected by the overall sub-optimal sensitivity (23%), specificity (84%), PPV (69%), and NPV (41%) in DUS when compared to DSA results as the gold standard. Conclusion Significant disagreements were noted in this study between DUS and DSA findings, primarily significant underestimation of tibial vessel disease by the DUS when compared with the DSA. Caution is advised in the clinical application of DUS in patients with chronic limb-threatening ischemia (CLTI) symptoms and multi-segment tibial vessels due to its demonstrated limitations in this study.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11401628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142304402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nitrous oxide (N2O) has a lengthy history of use as an anesthetic and has recently found popularity as a recreational euphoric hallucinogen. The odorless, colorless, non-flammable gas interferes with Vitamin B12 resulting in a cascade of effects, including hyperhomocysteinemia. It has long been proposed that hyperhomocysteinemia adversely affects the cardiovascular system, producing atherogenic and prothrombotic diseases. In this case vignette, we describe a case in which a healthy patient presented with venous thromboembolism (VTE) that we suspect could have been precipitated by daily and significant recreational use of N2O. Anticoagulation therapy was given, and there was a significant improvement in the pulmonary emboli. As recreational use of N2O increases, it is essential to recognize that hyperhomocysteinemia may also produce a thrombotic state.
{"title":"Nitrous Oxide Use Precipitates Pulmonary Embolism: A Case Report.","authors":"Nancy Nguyen, Jessica Cao, Deborah Carlson, Lynn Kong, Graal Diaz","doi":"10.7759/cureus.69347","DOIUrl":"https://doi.org/10.7759/cureus.69347","url":null,"abstract":"<p><p>Nitrous oxide (N2O) has a lengthy history of use as an anesthetic and has recently found popularity as a recreational euphoric hallucinogen. The odorless, colorless, non-flammable gas interferes with Vitamin B12 resulting in a cascade of effects, including hyperhomocysteinemia. It has long been proposed that hyperhomocysteinemia adversely affects the cardiovascular system, producing atherogenic and prothrombotic diseases. In this case vignette, we describe a case in which a healthy patient presented with venous thromboembolism (VTE) that we suspect could have been precipitated by daily and significant recreational use of N2O. Anticoagulation therapy was given, and there was a significant improvement in the pulmonary emboli. As recreational use of N2O increases, it is essential to recognize that hyperhomocysteinemia may also produce a thrombotic state.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142304451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-13eCollection Date: 2024-09-01DOI: 10.7759/cureus.69328
Bryan A Morales Eslava, Julio E Suástegui Mares, Gonzalo A Chuc Baeza, Ana Sánchez Arzate
The Macklin effect is a rare but potentially serious complication of pneumomediastinum, caused by the dissemination of air from the lungs into the subcutaneous tissue and mediastinum after severe chest trauma or invasive manipulation. Early recognition is crucial for proper management of the patient. A 33-year-old male skidded while riding a motorcycle, lost control of the vehicle, and crashed into a utility pole with a thoracic contusion. He was admitted to the hospital; a computed tomography (CT) of the chest and abdomen was requested, which ruled out the presence of fractures and showed air in the mediastinum and subcutaneous cellular tissue, with features suggestive of the Macklin phenomenon. After 72 hours of inpatient monitoring, the patient was discharged to the general surgery outpatient clinic. The Macklin phenomenon occurs as a result of airway rupture due to negative pressure caused by trauma or invasive mechanical ventilation. Risk factors include a higher prevalence in young males, a slender stature and above-average height, and an age range of 12 to 35 years. Early detection of the Macklin phenomenon is crucial to recognize and prevent further complications. This case demonstrated the importance of considering the Macklin effect as a cause of pneumomediastinum in patients with severe chest trauma. Diagnostic imaging plays a key role in confirming the diagnosis and planning treatment.
{"title":"The Macklin Effect: An Underestimated Cause of Pneumomediastinum.","authors":"Bryan A Morales Eslava, Julio E Suástegui Mares, Gonzalo A Chuc Baeza, Ana Sánchez Arzate","doi":"10.7759/cureus.69328","DOIUrl":"https://doi.org/10.7759/cureus.69328","url":null,"abstract":"<p><p>The Macklin effect is a rare but potentially serious complication of pneumomediastinum, caused by the dissemination of air from the lungs into the subcutaneous tissue and mediastinum after severe chest trauma or invasive manipulation. Early recognition is crucial for proper management of the patient. A 33-year-old male skidded while riding a motorcycle, lost control of the vehicle, and crashed into a utility pole with a thoracic contusion. He was admitted to the hospital; a computed tomography (CT) of the chest and abdomen was requested, which ruled out the presence of fractures and showed air in the mediastinum and subcutaneous cellular tissue, with features suggestive of the Macklin phenomenon. After 72 hours of inpatient monitoring, the patient was discharged to the general surgery outpatient clinic. The Macklin phenomenon occurs as a result of airway rupture due to negative pressure caused by trauma or invasive mechanical ventilation. Risk factors include a higher prevalence in young males, a slender stature and above-average height, and an age range of 12 to 35 years. Early detection of the Macklin phenomenon is crucial to recognize and prevent further complications. This case demonstrated the importance of considering the Macklin effect as a cause of pneumomediastinum in patients with severe chest trauma. Diagnostic imaging plays a key role in confirming the diagnosis and planning treatment.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11395196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142304509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12eCollection Date: 2024-09-01DOI: 10.7759/cureus.69263
Palmer H Ford, Eric Carbo, Andrew Rennie, Richard Virgilio
Cauda equina syndrome (CES) is a rare condition describing the constellation of symptoms resulting from the compression of the cauda equina. Metastatic lesions are a common cause of CES, with lung lesions often implicated as the primary source. A particularly rare cause of CES is leptomeningeal metastasis (LM) from primary solid tumors. In this case, a 63-year-old male presented with urinary and fecal retention, as well as altered sensation in the genitalia. The clinical diagnosis of CES was based on the constellation of symptoms. Computed tomography (CT) imaging demonstrated a metastatic lesion in the S2 and S3 sacral vertebral bodies, with extension into the right piriformis muscle. Magnetic resonance imaging (MRI) revealed an intramedullary lesion at L2 and leptomeningeal enhancement, indicative of metastasis. Further imaging identified a primary lesion in the right lower lobe of the lung, with additional metastases to the brain and liver. A pathological diagnosis of metastatic neuroendocrine carcinoma (NEC) was confirmed following a supraclavicular lymph node biopsy. The patient received steroid therapy, chemotherapy, and radiation to the pelvis. This case provides an important perspective on CES evaluation due to the scarcity of literature highlighting spinal metastases as the primary presentation in patients with NEC of the lung. The clinical diagnosis of CES should raise suspicion for metastasis and warrant further investigation.
马尾综合征(CES)是一种罕见的病症,描述的是马尾受压引起的一系列症状。转移性病变是马尾综合征的常见病因,肺部病变通常是主要病因。CES的一个特别罕见的病因是原发性实体瘤的脑膜转移(LM)。在本病例中,一名63岁的男性出现了尿潴留和大便潴留,以及生殖器感觉改变。根据症状表现,临床诊断为 CES。计算机断层扫描(CT)成像显示,S2和S3骶椎体有转移性病变,并延伸至右侧梨状肌。磁共振成像(MRI)显示,L2椎体存在髓内病变,并伴有显示转移的脑膜强化。进一步的影像学检查发现,原发病灶位于右肺下叶,另外还有脑和肝转移。锁骨上淋巴结活检后,病理诊断证实为转移性神经内分泌癌(NEC)。患者接受了类固醇治疗、化疗和盆腔放疗。该病例为 CES 评估提供了一个重要的视角,因为很少有文献强调脊柱转移是肺部 NEC 患者的主要表现。临床诊断为CES时应怀疑肿瘤转移,并进行进一步检查。
{"title":"A Rare Cause of Cauda Equina Syndrome: Neuroendocrine Carcinoma of the Lung.","authors":"Palmer H Ford, Eric Carbo, Andrew Rennie, Richard Virgilio","doi":"10.7759/cureus.69263","DOIUrl":"https://doi.org/10.7759/cureus.69263","url":null,"abstract":"<p><p>Cauda equina syndrome (CES) is a rare condition describing the constellation of symptoms resulting from the compression of the cauda equina. Metastatic lesions are a common cause of CES, with lung lesions often implicated as the primary source. A particularly rare cause of CES is leptomeningeal metastasis (LM) from primary solid tumors. In this case, a 63-year-old male presented with urinary and fecal retention, as well as altered sensation in the genitalia. The clinical diagnosis of CES was based on the constellation of symptoms. Computed tomography (CT) imaging demonstrated a metastatic lesion in the S2 and S3 sacral vertebral bodies, with extension into the right piriformis muscle. Magnetic resonance imaging (MRI) revealed an intramedullary lesion at L2 and leptomeningeal enhancement, indicative of metastasis. Further imaging identified a primary lesion in the right lower lobe of the lung, with additional metastases to the brain and liver. A pathological diagnosis of metastatic neuroendocrine carcinoma (NEC) was confirmed following a supraclavicular lymph node biopsy. The patient received steroid therapy, chemotherapy, and radiation to the pelvis. This case provides an important perspective on CES evaluation due to the scarcity of literature highlighting spinal metastases as the primary presentation in patients with NEC of the lung. The clinical diagnosis of CES should raise suspicion for metastasis and warrant further investigation.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142304483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12eCollection Date: 2024-09-01DOI: 10.7759/cureus.69287
Amal G Jamjoom
This review examines platelet-rich fibrin (PRF) efficacy in periodontal plastic surgery, highlighting its crucial role in promoting periodontal regeneration and healing. Various forms of PRF are discussed, like leukocyte- and platelet-rich fibrin, advanced PRF, and injectable PRF, in addition to their application in different periodontal procedures such as root coverage and increasing the width of keratinized tissue surrounding the teeth. This review emphasizes the biological benefits of PRF, such as faster wound healing, reduced postsurgical pain, and better management of bleeding. The presence of growth factors, cytokines, and leukocytes in PRF significantly aids in promoting tissue regeneration, thereby improving the clinical outcomes of periodontal therapy. This review also provides recommendations for further research using standardized PRF protocols to optimize the benefits of PRF in clinical practice.
{"title":"From Healing to Regeneration: A Comprehensive Review of the Efficacy of Platelet-Rich Fibrin in Periodontal Plastic Surgery Procedures.","authors":"Amal G Jamjoom","doi":"10.7759/cureus.69287","DOIUrl":"https://doi.org/10.7759/cureus.69287","url":null,"abstract":"<p><p>This review examines platelet-rich fibrin (PRF) efficacy in periodontal plastic surgery, highlighting its crucial role in promoting periodontal regeneration and healing. Various forms of PRF are discussed, like leukocyte- and platelet-rich fibrin, advanced PRF, and injectable PRF, in addition to their application in different periodontal procedures such as root coverage and increasing the width of keratinized tissue surrounding the teeth. This review emphasizes the biological benefits of PRF, such as faster wound healing, reduced postsurgical pain, and better management of bleeding. The presence of growth factors, cytokines, and leukocytes in PRF significantly aids in promoting tissue regeneration, thereby improving the clinical outcomes of periodontal therapy. This review also provides recommendations for further research using standardized PRF protocols to optimize the benefits of PRF in clinical practice.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11392565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142304423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12eCollection Date: 2024-09-01DOI: 10.7759/cureus.69247
Omar Basubrain
Background Despite clear definitions of brain death, students and medical professionals may have varying understandings. This study investigated the knowledge and attitudes of medical students regarding brain death. Methods A cross-sectional survey was administered to 142 fourth-year medical students at Umm Al-Qura University. The survey used single-choice and Likert scale questions to assess knowledge of brain death definition, diagnosis procedures, and student attitudes. Prior to administration, the questionnaire underwent content validation by experts in medicine, ethics, and public health. Results A significant proportion of students lacked knowledge of the legal definition of brain death in Saudi Arabia (26.1%), brain death diagnostic procedures (43.7%), and prerequisites for declaring brain death (38%). While some students expressed confidence in diagnosing brain death, concerns about misdiagnosis were also present. Conclusion Fourth-year medical students in this study demonstrated significant knowledge gaps regarding brain death. Medical education programs may need to be revised to provide more comprehensive training on brain death and its implications. Additionally, public awareness campaigns could improve understanding and facilitate informed decision-making about organ donation. Further research, including multicenter studies, is warranted to confirm these findings and guide educational interventions.
{"title":"Brain Death Knowledge and Attitudes Among Fourth-Year Medical Students at Umm Al-Qura University.","authors":"Omar Basubrain","doi":"10.7759/cureus.69247","DOIUrl":"https://doi.org/10.7759/cureus.69247","url":null,"abstract":"<p><p>Background Despite clear definitions of brain death, students and medical professionals may have varying understandings. This study investigated the knowledge and attitudes of medical students regarding brain death. Methods A cross-sectional survey was administered to 142 fourth-year medical students at Umm Al-Qura University. The survey used single-choice and Likert scale questions to assess knowledge of brain death definition, diagnosis procedures, and student attitudes. Prior to administration, the questionnaire underwent content validation by experts in medicine, ethics, and public health. Results A significant proportion of students lacked knowledge of the legal definition of brain death in Saudi Arabia (26.1%), brain death diagnostic procedures (43.7%), and prerequisites for declaring brain death (38%). While some students expressed confidence in diagnosing brain death, concerns about misdiagnosis were also present. Conclusion Fourth-year medical students in this study demonstrated significant knowledge gaps regarding brain death. Medical education programs may need to be revised to provide more comprehensive training on brain death and its implications. Additionally, public awareness campaigns could improve understanding and facilitate informed decision-making about organ donation. Further research, including multicenter studies, is warranted to confirm these findings and guide educational interventions.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142304398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12eCollection Date: 2024-09-01DOI: 10.7759/cureus.69286
Luis A Areiza, Juan F Rodriguez, David Rodriguez
Background Left atrial appendage closure (LAAC) has emerged as an alternative approach for mitigating thrombotic risk in nonvalvular atrial fibrillation patients. However, existing registries often lack representation of the Hispanic population, motivating this study to elucidate the demographic, clinical, and procedural characteristics, specifically among Hispanic patients undergoing this procedure. Methods Adult patients who underwent percutaneous LAAC between June 2017 and July 2022 at a high-complexity hospital in Bogotá, COL, were included. Baseline and procedural characteristics are reported. For patients with available follow-up data, major bleeding, thromboembolic events, and cardiovascular mortality were assessed. A subgroup analysis was conducted for patients with end-stage renal disease on dialysis. Results We included 33 patients. Follow-up data were available for 27 patients, with a mean follow-up period of 12.4 months. The median age of the cohort was 70 years (SD 9), with 58% being women. The median CHADS2 and HAS-BLED scores were 3 points (IQR 2 to 4) and 4 points (IQR 3 to 4), respectively. The 90-day cardiovascular mortality rate was 3.7%, whereas cardioembolic episodes and major bleeding events were reported at rates of 10.8 and 14.4 per 100 patient years, respectively. The long-term outcomes of patients on dialysis were comparable to those of nondialysis patients. Conclusions Our study reinforces existing evidence supporting the safety of LAAC, particularly in a multimorbid patient population with elevated bleeding and thrombotic risks. In this high-risk cohort, LAAC emerges as a feasible alternative for reducing thromboembolic risk. Notably, patients on dialysis demonstrated comparable long-term outcomes, suggesting the procedure's viability in this subgroup as well.
{"title":"Left Atrial Appendage Closure: A Single-Center Experience in a Population With a High Prevalence of End-Stage Renal Disease.","authors":"Luis A Areiza, Juan F Rodriguez, David Rodriguez","doi":"10.7759/cureus.69286","DOIUrl":"https://doi.org/10.7759/cureus.69286","url":null,"abstract":"<p><p>Background Left atrial appendage closure (LAAC) has emerged as an alternative approach for mitigating thrombotic risk in nonvalvular atrial fibrillation patients. However, existing registries often lack representation of the Hispanic population, motivating this study to elucidate the demographic, clinical, and procedural characteristics, specifically among Hispanic patients undergoing this procedure. Methods Adult patients who underwent percutaneous LAAC between June 2017 and July 2022 at a high-complexity hospital in Bogotá, COL, were included. Baseline and procedural characteristics are reported. For patients with available follow-up data, major bleeding, thromboembolic events, and cardiovascular mortality were assessed. A subgroup analysis was conducted for patients with end-stage renal disease on dialysis. Results We included 33 patients. Follow-up data were available for 27 patients, with a mean follow-up period of 12.4 months. The median age of the cohort was 70 years (SD 9), with 58% being women. The median CHADS2 and HAS-BLED scores were 3 points (IQR 2 to 4) and 4 points (IQR 3 to 4), respectively. The 90-day cardiovascular mortality rate was 3.7%, whereas cardioembolic episodes and major bleeding events were reported at rates of 10.8 and 14.4 per 100 patient years, respectively. The long-term outcomes of patients on dialysis were comparable to those of nondialysis patients. Conclusions Our study reinforces existing evidence supporting the safety of LAAC, particularly in a multimorbid patient population with elevated bleeding and thrombotic risks. In this high-risk cohort, LAAC emerges as a feasible alternative for reducing thromboembolic risk. Notably, patients on dialysis demonstrated comparable long-term outcomes, suggesting the procedure's viability in this subgroup as well.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11393381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142304446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12eCollection Date: 2024-09-01DOI: 10.7759/cureus.69249
Irfan B Gunes
Introduction: Previous studies have shown that isolated eyelid myokymia (EM) is usually caused by stress, fatigue, and caffeine consumption. The purpose of this study was to evaluate the association between EM and digital screen time, uncorrected refractive error, intraocular pressure (IOP), and blood electrolyte levels.
Methods: Between February 2023 and June 2024, 103 eyes of 103 patients who applied to the ophthalmology outpatient clinic with complaints of eyelid twitching lasting for more than two weeks and 103 eyes of 103 healthy individuals as a control group were included in the study. All participants were asked to record their daily time spent with digital screens for two weeks. Cycloplegic refractive error, IOP, optic nerve head cup/disc (C/D) ratio, and blood calcium, sodium, potassium, and magnesium levels were recorded and compared between the two groups.
Results: Mean digital screen time was 4.84±1.74 hours in the control group and 6.88±2.01 hours in the EM group. It was found that digital screen time was significantly higher in the EM group compared to the control group (p<0.001). There was a strong positive correlation between the duration of eyelid twitching and the time spent in front of digital screens (p<0.001, r=0.670). There was no significant difference in cycloplegic refractive error, IOP, C/D ratio, and blood electrolyte levels between the two groups (p>0.05).
Conclusion: Prolonged digital screen time might play a role in the development of EM. On the other hand, no relationship was found between eyelid twitching and uncorrected refractive error, glaucoma, or blood electrolyte levels.
{"title":"Association Between Eyelid Twitching and Digital Screen Time, Uncorrected Refractive Error, Intraocular Pressure, and Blood Electrolyte Imbalances.","authors":"Irfan B Gunes","doi":"10.7759/cureus.69249","DOIUrl":"https://doi.org/10.7759/cureus.69249","url":null,"abstract":"<p><strong>Introduction: </strong> Previous studies have shown that isolated eyelid myokymia (EM) is usually caused by stress, fatigue, and caffeine consumption. The purpose of this study was to evaluate the association between EM and digital screen time, uncorrected refractive error, intraocular pressure (IOP), and blood electrolyte levels.</p><p><strong>Methods: </strong>Between February 2023 and June 2024, 103 eyes of 103 patients who applied to the ophthalmology outpatient clinic with complaints of eyelid twitching lasting for more than two weeks and 103 eyes of 103 healthy individuals as a control group were included in the study. All participants were asked to record their daily time spent with digital screens for two weeks. Cycloplegic refractive error, IOP, optic nerve head cup/disc (C/D) ratio, and blood calcium, sodium, potassium, and magnesium levels were recorded and compared between the two groups.</p><p><strong>Results: </strong>Mean digital screen time was 4.84±1.74 hours in the control group and 6.88±2.01 hours in the EM group. It was found that digital screen time was significantly higher in the EM group compared to the control group (p<0.001). There was a strong positive correlation between the duration of eyelid twitching and the time spent in front of digital screens (p<0.001, r=0.670). There was no significant difference in cycloplegic refractive error, IOP, C/D ratio, and blood electrolyte levels between the two groups (p>0.05).</p><p><strong>Conclusion: </strong>Prolonged digital screen time might play a role in the development of EM. On the other hand, no relationship was found between eyelid twitching and uncorrected refractive error, glaucoma, or blood electrolyte levels.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142304494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}