Cureus最新文献

Background and aim In 2019, a three-year internal medicine training (IMT) program replaced the two-year core medical training program in the United Kingdom, incorporating the first year of medical registrar (MR) training into the same curriculum. In light of the considerable evidence supporting the effectiveness of simulation-based education (SBE) and the challenges inherent in transitioning, the design and delivery of SBE are now ideally positioned to facilitate this transition process and assess its impact. However, trainees' perceptions regarding the effectiveness of SBE in the IMT curriculum for transitioning to the MR role are not well-documented. This study aimed to explore and examine trainees' views on SBE in the IMT curriculum to prepare them to transition to the role of the MR. It sought to identify the critical qualities and skills that IMT trainees believe SBE should address to enable them to successfully fulfill the MR role, as well as to assess the extent to which internal medicine year three trainees perceive that SBE in its current form within the IMT curriculum has prepared them for the role of MR. Methods This qualitative study employed focus groups to explore individuals' perspectives on SBE in the IMT curriculum and its role in preparing them for the transition to the MR position. Four focus groups were conducted, two with core trainees (CTs) and two with MRs. Sessions were recorded, transcribed verbatim, and analyzed using a thematic analysis approach. Results Eleven trainees participated in the study. Seven of them were CTs, with the remaining four in their first year as a MR. Six main themes emerged from the data, grouped into two main headings. The heading titled "Perceptions of SBE" included the themes "Valuable Teaching Tool," "A Squandered Resource," and "Avoid Over-Reliance." In contrast, the heading "Areas/Suggestions for Improving SBE" included the themes "Quantity and Scheduling," "Feedback," and "Draw on Others' Experiences." Conclusion The value of SBE was recognized, alongside the vital role of high-quality feedback. Other medical specialties and industries were highlighted for their effective implementation of SBE, offering a possible standard for educators involved in the IMT curriculum to pursue. There was a perception that SBE did not adequately support the ongoing maintenance of skills, placing considerable reliance on real-world clinical practice to fulfill this need. The limitations inherent in SBE were acknowledged, and educators are encouraged to explore ways to optimize the use of all educational tools at their disposal, which may include the formal introduction of a shadowing period for trainees.

Introduction This study evaluated the impact of Class II composite resin and amalgam restorations on alveolar bone loss in diabetic patients, a population more susceptible to periodontal complications. The main objective was to determine whether the choice of restorative material impacts periodontal health, providing insights to optimize dental care for this high-risk group. Materials and methods This observational, comparative. cross-sectional study included 64 diabetic patients, divided into two groups based on their Class II restorations. Group 1 had 32 patients with composite resin restorations, while Group 2 comprised 32 patients with amalgam restorations. Both groups were matched for age and diabetes duration to ensure comparability. Periodontal health, specifically alveolar bone loss, was assessed through clinical and radiographic evaluations. The study analyzed the impact of the two materials on alveolar bone levels. Results Data from 64 diabetic patients (32 in Group 1 and 32 in Group 2) were statistically analyzed using PASW Statistics for Windows, Version 18.0 (Released 2009; SPSS Inc., Chicago, United States). Three statistical tests, descriptive statistics, two-sample t-test, and analysis of covariance (ANCOVA), were used. The results showed significant differences between the two groups, with composite resin restorations linked to greater alveolar bone loss. Conclusion The choice of restorative material significantly influences periodontal health in diabetic patients. Composite resin restorations were associated with a higher risk of alveolar bone loss and periodontal disease, emphasizing the need for careful material selection and regular periodontal monitoring in diabetic patients.

Low serum potassium levels can precipitate a rare condition called hypokalemic periodic paralysis. A patient may be predisposed to this phenomenon through hereditary or acquired causes. We present a case of a 21-year-old female who presented with sudden-onset generalized weakness and hypokalemia, which was treated promptly in the Accident and Emergency department, which led to a quick resolution of symptoms. This case highlights the importance of prompt diagnosis and treatment at the time of presentation to prevent the progression of symptoms and further complications.

Atraumatic splenic rupture (ASR) is an unfamiliar entity that is potentially life-threatening if there is a delay in the diagnosis. Due to its rarity and its non-specific presentation, it can be a challenge to diagnose early. In this report, we present a case of a 42-year-old male patient who presented to the emergency department with nonspecific abdominal pain and had no past medical history. The patient presented abdominal pain associated with nausea, vomiting, and sweating. On examination, the patient was found to be tachycardic and mildly hypotensive, with mild left upper quadrant tenderness, and a lactate of 4 mmol/L on venous blood gas analysis. He was urgently transferred to the resuscitation area, where resuscitation commenced. Further investigations revealed significant anemia. The contrast-enhanced CT of the abdomen performed revealed a 13-cm splenic hemostasis suggestive of non-traumatic splenic rupture. The patient lacked any history of blunt trauma or family history that could account for the splenic rupture. The patient was taken to the theatre by the surgical team as he remained unstable. He received four units of blood in the theatre and underwent splenectomy due to the spleen being unsalvageable. Post-operatively, the patient was admitted to the high-dependency unit (HDU) for close monitoring. Histological examination of the splenic tissue revealed B-cell lymphoid hyperplasia and negative PCR for clonality. The patient was found to be IgG-positive for mumps and was not vaccinated for MMR. Surgeons believe it is the main cause of ASR, given that little literature available establishes the same. The case highlights the importance of consideration of ASR in patients presenting with unexplained abdominal pain and hemodynamic instability, even without evidence of trauma. Early imaging and operative intervention are lifesaving. The histologic findings indicate that there may be an associated hemopoietic disorder, and this case highlights the need for clinicians to consider splenic involvement in patients with mumps who present with abdominal pain or signs of hemodynamic instability.

Chronic pain, edema, and lipodystrophy are common issues in post-menopausal women, often linked to hormonal imbalances, metabolic dysfunctions, and chronic inflammation. Traditional treatments, such as hormone replacement therapy (HRT) and aesthetic procedures, frequently provide limited and temporary relief. This case series evaluates the effectiveness of radio electric asymmetric conveyor (REAC) technology specifically, the anti-cellulite treatment (ACT), circulatory optimization (CO), and metabolic optimization (MO) protocols in four post-menopausal women presenting with these conditions. Each patient underwent 18 sessions of ACT, CO, and MO protocols using the REAC Bio-Enhancer Neuro-Enhancer (BENE) 110 medical device (ASMED Srl, Scandicci Florence, Italy), with asymmetric conveyor probes (ACPs) symmetrically positioned on the quadriceps. The ACT protocol targeted skin and subcutaneous tissue biomechanical properties, the CO protocol focused on enhancing circulation and reducing edema, and the MO protocol aimed to restore metabolic balance. The results demonstrated significant improvements across all patients, with reductions in pain (9/10 to 3/10), edema, and lipodystrophy, as well as enhanced mood and overall well-being. Objective measures, such as reductions in thigh circumference and improvements in inflammatory markers, further supported the systemic benefits of REAC ACT, CO, and MO treatments. These findings suggest that REAC protocols offer a comprehensive and effective non-invasive treatment for chronic inflammatory and metabolic conditions in post-menopausal women.

Introduction Falls and fractures are major health challenges for older adults in England. Despite the advantages of anticoagulants, their use in the elderly is often restricted due to concerns about fall-related injuries. However, there is a lack of clear data on the risk of discontinuing anticoagulation therapy solely due to fall risk. NICE guidelines (2021) advise that anticoagulation should not be withheld solely based on age or fall risk. This study aims to assess the incidence of significant brain injuries or intracranial haemorrhages in patients on anticoagulant therapy, also comparing the independent risk factors for traumatic brain injury. Objective This study aims to assess the incidence of TBI following falls in patients on anticoagulant therapy, comparing outcomes between those using DOACs and Vitamin K antagonists. Methods A retrospective cohort study was conducted at Queen Alexandra Hospital, University Hospitals Portsmouth NHS Trust, from November 2023 to May 2024. Data were collected from 3,468 CT head scans performed on patients with a history of falls, including 801 on anticoagulation therapy. Results Of the 801 patients on anticoagulation, 763 (95.2%) were aged 65 or older, with a mean age of 83.1 years. Acute hemorrhage was detected in 3.1% (25/801) of patients. Patients on Warfarin and Dabigatran had significantly higher TBI risk compared to those on Apixaban (6.7%, p=0.02; and 7.6%, p=0.01, respectively), while Edoxaban and Rivaroxaban showed no significant difference. Also, older age (≥65 years) and higher frailty scores (CFS 6 and 7) were associated with increased TBI risk (p<0.05). All patients with acute hemorrhage received conservative management, and two patients experienced mortality within six months.  Discussion The study indicates that the risk of TBI following falls in anticoagulated patients is 3.1% relatively low, aligning with existing literature. This underscores the need for careful consideration before discontinuing anticoagulation therapy solely based on fall risk. Hence, discontinuation of anticoagulation should be a patient-specific decision that carefully considers the balance between the risk of traumatic brain injury (TBI) and the benefits of anticoagulation therapy. Factors such as age, frailty, and the type of anticoagulant should all be taken into account. Clinical judgment and selective CT imaging can help balance patient safety with healthcare costs.  Conclusion The incidence of adverse outcomes following head injury in patients on anticoagulant therapy is 3.1% and relatively low. Careful decision-making regarding the discontinuation of anticoagulation therapy, informed by patient background and presentation and selective CT imaging, is essential to manage risks effectively and optimize healthcare resource utilization.

Introduction The first tarsometatarsal joint (TMTJ) is often overlooked regarding foot pathology or a secondary measure in most studies, despite its heavy involvement in surgical procedures and foot stability. The primary aim of this study is to assess the effect of the first TMTJ morphology on the incidence of arthritis and post-operative complications following a Lapidus procedure. Materials and methods A total of 39 feet/subjects (19 left and 20 right) were assessed by two independent reviewers. The first TMTJ angle and articulating surface shape were measured, and relevant descriptive data was compiled. Statistical analysis was used to analyse variable outcomes via a logistical regression model and inter-rater reliability tests to determine the validity of the methods used.  Results A statistically significant relationship between first TMTJ angle and incidence of arthritis was revealed but not with articulating surface shape, or between either measure of first​​​​​​​ TMTJ morphology and post-operative complications. Inter-rater reliability tests showed a very strong correlation between inter-rater measurements.  Discussion The smaller the angle of the first​​​​​​​ TMTJ, the increased incidence of arthritis; therefore, it may be an early sign for clinicians to look for and implement prophylactic interventions sooner. Furthermore, it also signifies that conducting corrective surgeries at this joint will likely have a positive effect on decreasing arthritis pathology. The strong inter-rater reliability findings offer validity to the methods used in this study however can be improved using expert radiographers and AI software.  Conclusion The first​​​​​​​ TMTJ angle and shape of the articulating surface are both valuable predictors of the incidence of arthritis; however, this study cannot claim that they are good predictors for post-surgical complications. Further research is needed to address the limitations found in this study however it is a valuable initial step in identifying foot pathology early and initiating early management.

The global population is plagued by chronic illnesses of many types due to, in part, the activation of virulence of many latent microbes leading to chronic multi-system illness, stimulating the new term, multi-microbial activation syndrome (MMAS). Treatment-resistant infections across the entire microbial spectrum are now largely untreatable using the previously successful pharmaceutical and natural medicine options. The heavy-handed methods of long-term chemotherapeutic antibiotics, antifungals, and antiviral drugs, whose adverse effects could be worse than the original illness, are presently essentially useless in the long run, as microbes have developed rapid adaptive mutations, becoming drug-resistant. The introduction of induced native phage therapy opened a completely new treatment category that has the potential to complement or replace aggressive drug therapies of many classes. Since its introduction, many advancements have been made to the technology. The most recent development in this new treatment genre is the ability to formulate induced native phage cocktails that use a wide spectrum of induction signatures within the formulation to stimulate various types of beneficial phages already living within the phageome of the body, to target a wide range of pathogenic microbes and associated advantageous physiological targets. The ability to address the MMAS commonly seen in various chronic illnesses simultaneously within the same formulation enables greater clinical outcomes without harm to the microbiome or to the tissues and systems of the body.

Factor XI deficiency, a rare but significant coagulopathy, poses unique challenges in perioperative management, particularly in obstetric settings. This review provides an in-depth exploration of the pathophysiology, diagnosis, and anesthetic implications of factor XI deficiency, thereby emphasizing the useful role of anesthesiologists. The variable bleeding phenotype of the disorder necessitates a nuanced understanding and tailored management strategies to mitigate severe perioperative bleeding risks. Conventional coagulation tests, while useful, often fall short in predicting bleeding risks, underscoring the importance of advanced diagnostic tools, such as viscoelastic testing. Viscoelastic testing provides real-time data on clot stability, which allows for immediate intervention and more targeted therapeutic strategies compared to standard coagulation tests. A clinical case of a 25-year-old patient with factor XI deficiency undergoing emergency surgery for an ectopic pregnancy illustrates the application of viscoelastic testing in managing acute bleeding and optimizing patient outcomes and advocates for the development of standardized protocols, continuous monitoring techniques, and enhanced training programs to improve the perioperative care of patients with factor XI deficiency, providing anesthesiologists with the tools necessary to navigate the complexities of factor XI deficiency in the perioperative environment. Integrating these advanced diagnostic and therapeutic approaches could significantly improve patient safety and surgical outcomes in patients with complex coagulopathy.