Cureus最新文献

Asthma is a common obstructive airway disease associated with significant functional impairment and morbidity. Osteopathic manipulative treatment (OMT) has been proposed as an adjunctive therapy to address musculoskeletal and respiratory mechanical dysfunctions associated with asthma; however, supporting evidence remains limited. This systematic review evaluates whether OMT, compared with sham treatment or usual care, improves pulmonary function outcomes in patients with asthma, as measured by peak expiratory flow (PEF) and spirometric indices including forced expiratory volume in 1 second (FEV₁) and forced vital capacity (FVC). A systematic literature search of MEDLINE/PubMed, Google Scholar, Cochrane Library, and Semantic Scholar databases was conducted to identify clinical studies evaluating OMT in patients with asthma. Five clinical studies met the inclusion criteria and were included in the qualitative synthesis. Sample sizes were small across studies, and there was substantial heterogeneity in study design, intervention protocols, and outcome measures. While some studies reported improvements in pulmonary function following OMT, the overall risk of bias was moderate, and the certainty of evidence was low to moderate. In conclusion, available evidence suggests that OMT may be associated with improvements in pulmonary function in patients with asthma; however, these findings should be interpreted cautiously due to limited sample sizes, heterogeneity, and methodological limitations. Larger, well-designed randomized controlled trials are needed to more definitively determine the role of OMT in the management of asthma.

[This corrects the article DOI: 10.7759/cureus.96126.].

Introduction: Sarcopenia is highly prevalent in patients with liver cirrhosis and is associated with increased morbidity, hospitalization, and mortality. However, routine screening is not consistently performed in clinical practice. The strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire is a simple tool that may facilitate early identification of sarcopenia risk.

Methods: This cross-sectional study included adult patients with cirrhosis attending a tertiary government hospital in Bahrain between January 1, 2024, and December 31, 2025. Sarcopenia risk was assessed using the SARC-F questionnaire, with a score ≥4 indicating high risk. Clinical and laboratory data were collected. Multivariable logistic regression was used to identify independent predictors of sarcopenia risk.

Results: A total of 362 patients were included (mean age 56.8 ± 11.9 years; 221 (61.0%) males). High sarcopenia risk (SARC-F ≥4) was identified in 129 patients (35.6%). Patients with high risk were older (60.2 vs 54.9 years, p < 0.001), had higher model for end-stage liver disease (MELD) scores (14.6 vs 11.2, p < 0.001), and more frequent ascites (75 (58.1%) vs 80 (34.5%), p < 0.001). They also had higher rates of hospitalization (55 (42.6%) vs 54 (23.3%), p < 0.001). On multivariable analysis, age (adjusted odds ratio (aOR): 1.05; 95% CI: 1.02-1.07), MELD score (aOR: 1.09; 95% CI: 1.04-1.14), and ascites (aOR: 1.87; 95% CI: 1.18-2.95) were independently associated with sarcopenia risk.

Conclusions: Sarcopenia risk appears to be common among patients with cirrhosis and is associated with markers of disease severity. The SARC-F questionnaire may serve as a simple screening tool to identify patients at higher risk in routine clinical practice.

Background Dermal fillers used with minimally invasive techniques have currently achieved an important role in regenerative medicine and in alleviating skin damage over the years. Objectives To evaluate clinical results after the use of the Polydioxanone Collagen Biostimulator Ultra V® UltraCol 200 (Ultracol), commonly referred to as PDO microspheres, with the addition of organic silicon to enhance Ultracol biostimulation, using the adipostructuring technique in a group of older patients who consulted to improve the quality of their skin. Materials and methods The study included 20 patients (3 men and 17 women), aged 40 to 80 years. We used Ultracol plus organic silicon. Injections were performed using the facial adipostructuring technique, with a 22-gauge, 50-mm cannula, injecting 2.5 mL per hemiface in a single session. We evaluated results at 10 days and 2 months after the procedure using photography and parameters selected by a blinded evaluator, along with a satisfaction survey. Results Clinical evaluation demonstrated noticeable improvement in facial tridimensionality, with enhanced volumetric projection and contour definition. A reduction in nasolabial fold depth was observed, along with improved vertical positioning of the malar region. Additionally, better definition of the infraorbital area was noted, accompanied by a subtle increase in supraperiosteal volume. Overall, these changes were considered favorable outcomes in this treated older patient group. Conclusion Ultracol plus organic silicon, using the facial adipostructuring technique in a group of older patients, can be considered a suitable and safe therapeutic alternative.

Background Postoperative pneumonia remains a frequent and clinically consequential complication following adult cardiac surgery with cardiopulmonary bypass (CPB), contributing to prolonged ventilatory dependency and increased intensive care resource utilization. Identification of perioperative determinants may inform targeted prevention strategies. Methods We conducted a single-center retrospective observational cohort study including 50 consecutive adults undergoing cardiac surgery with CPB between January 2022 and December 2023. Postoperative pneumonia occurring within seven postoperative days was defined using combined clinical, radiologic, and microbiological criteria. Baseline characteristics, intraoperative variables, and early postoperative outcomes were compared between patients with and without pneumonia. Results Postoperative pneumonia developed in 11 of 50 patients (22%). Patients with pneumonia more frequently required prolonged mechanical ventilation (>24 hours) compared with those without pneumonia (64% vs 23%) and had higher reintubation rates (27% vs 5%). Intensive care unit length of stay was substantially longer among pneumonia patients (mean±SD, 7.8±3.1 vs 3.9±1.7 days). Cardiopulmonary bypass duration was longer, and diabetes mellitus was more prevalent in patients who developed pneumonia. Conclusions In this real-world cohort, postoperative pneumonia was common and consistently associated with sustained ventilatory dependence and increased ICU utilization. These findings underscore the clinical and resource burden of postoperative pulmonary complications and support risk-stratified perioperative strategies emphasizing early extubation readiness, pulmonary-protective management, and structured postoperative surveillance.

Ovarian tuberculosis is a rare manifestation of extrapulmonary tuberculosis and may closely resemble advanced ovarian carcinoma due to overlapping clinical, biochemical, and radiological features. We report the case of an 18-year-old female who presented with progressive abdominal distension, severe hypogastric pain, and unintentional weight loss. Imaging revealed a left adnexal mass with ascites and retroperitoneal lymphadenopathy suggestive of stage IIIC ovarian carcinoma. Serum CA-125 was markedly elevated (637.4 U/mL). Prior to initiation of chemotherapy, an image-guided TRUCUT biopsy demonstrated chronic granulomatous inflammation with acid-fast bacilli. Ziehl-Neelsen staining was positive, QuantiFERON-TB Gold assay was positive, and culture of the adnexal lesion confirmed Mycobacterium tuberculosis. The patient was treated with first-line anti-tuberculous therapy and showed clinical and radiological improvement. This case highlights the importance of considering tuberculosis in the differential diagnosis of adnexal masses with elevated CA-125, particularly in endemic regions, and emphasizes the value of histopathological confirmation to prevent misdiagnosis and avoid unnecessary oncologic treatment.

Background Testicular germ cell tumors (TGCTs) are the most common solid malignancies in young adult men and typically have excellent outcomes with modern therapy. Tumor lysis syndrome (TLS) is a rare but potentially fatal complication in TGCTs, particularly when it occurs spontaneously in the absence of cytotoxic treatment. Data describing spontaneous TLS in this setting remain limited. Methods We report a case series of six patients who presented with spontaneous TLS secondary to TGCTs. Clinical features, imaging findings, laboratory results, management strategies, and outcomes were reviewed retrospectively from the electronic medical records. TLS was diagnosed based on characteristic biochemical abnormalities, including hyperuricemia, hyperphosphatemia, hyperkalemia, hypocalcemia, and acute kidney injury (AKI). Results Most patients had seminomatous histology, and all demonstrated extensive tumor burden on imaging. TLS was identified prior to the initiation of chemotherapy in all cases. Management included aggressive intravenous hydration, urate-lowering therapy with rasburicase and/or allopurinol, and renal replacement therapy for refractory metabolic disturbances. Chemotherapy was initiated with individualized dosing strategies to minimize further metabolic complications. Despite early recognition and multidisciplinary management, mortality was substantial, largely due to renal failure and infectious complications. Conclusions Spontaneous TLS is a rare but life-threatening complication of TGCTs, particularly in patients with bulky disease. Tumor burden appears to be a key risk factor regardless of histological subtype. Increased clinical awareness, early diagnosis, aggressive supportive care, and tailored chemotherapy approaches are critical to reducing morbidity and mortality in this high-risk population.

Immune checkpoint inhibitors (ICIs), including pembrolizumab, are widely used to treat advanced non-small cell lung cancer; however, they are associated with immune-related adverse events, including immune-mediated hepatitis. Although systemic corticosteroids are recommended as first-line therapy for severe immune-mediated hepatitis, the optimal initial dose remains unclear, and current guidelines specify a wide range of doses. Herein, we report the case of a 76-year-old man with lung adenocarcinoma, a history of resolved hepatitis B virus infection, ulcerative colitis in long-term remission, and latent hereditary spherocytosis who developed grade 3 immune-mediated hepatitis during pembrolizumab monotherapy. Liver biopsy revealed moderate lobular necroinflammation consistent with immune-mediated hepatitis. Based on these histopathological findings, prednisolone at 0.3 mg/kg/day was initiated. Liver enzyme levels improved rapidly, and pembrolizumab was subsequently resumed without recurrence of immune-mediated hepatitis. This case highlights the diagnostic and therapeutic value of liver biopsy in patients with severe immune-mediated hepatitis. Histopathological assessment of inflammatory severity and bile duct involvement may contribute to individualized corticosteroid dosing, promote early recovery, and support safe ICI rechallenge.

Sporadic vestibular schwannomas are typically slow-growing, unilateral cerebellopontine angle benign tumors that occur in middle-aged and older adults and rarely present in individuals younger than 30 years. We describe the case of a 21-year-old man who presented with progressive unilateral hearing loss and tinnitus and was found to have a large vestibular schwannoma causing brainstem compression and obstructive hydrocephalus. Tumor analysis demonstrated a somatic mutation in neurofibromatosis type 2 (NF2), confined to the tumor, supporting a diagnosis of sporadic vestibular schwannoma in the absence of NF2 features. This case highlights the importance of early neuroimaging in patients with persistent or progressive unilateral audiovestibular symptoms.

Clostridioides difficile infection (CDI) is a significant cause of morbidity and mortality worldwide, and its treatment is often challenging in patients with complex medication regimens. We report a case of refractory CDI in a 70-year-old woman with Hurley stage II hidradenitis suppurativa (HS) involving the right axilla and perianal region. Her HS was managed with chronic antibiotic use (clindamycin) and anti-tumor necrosis factor (TNF) biologics, initially infliximab (5 mg/kg every eight weeks) followed by adalimumab (40 mg every two weeks) due to inadequate response to infliximab. Despite multiple hospitalizations and treatment with vancomycin and fidaxomicin, the patient experienced recurrent CDI with systemic manifestations including fever, tachycardia, and altered mental status. This case illustrates how chronic antibiotic-induced dysbiosis combined with immunosuppressive therapy can create treatment-resistant CDI requiring multidisciplinary management beyond standard antibiotic protocols.