Cureus最新文献

Background Non-attendance at outpatient clinics compromises continuity of care, clinic efficiency, and health equity. In Australia, these challenges are amplified in remote settings and among Aboriginal and Torres Strait Islander peoples, yet data on surgical outpatient attendance in such contexts are limited. Methods A retrospective cohort study was conducted of all adult patients scheduled for appointments at a surgical outpatient clinic in Mount Isa, Queensland, Australia, between January 1, 2022, and December 31, 2024. Demographic, geographic, and appointment-related variables were analyzed. Geographic access was assessed using collapsed Modified Monash Model (MMM) categories and distance to clinic. Univariable logistic regression identified predictors of non-attendance, followed by multivariable logistic regression to estimate adjusted associations. Two multivariable models were constructed, incorporating either the MMM category or the distance. Results A total of 6,267 appointments for 2,792 patients were analyzed, with an overall non-attendance rate of 18.3%. In multivariable analysis, Indigenous status was the strongest independent predictor for non-attendance (adjusted OR 3.72, 95% CI 3.22-4.29, p < 0.001). Increasing age was associated with improved attendance (adjusted OR 0.97 per year, p < 0.001). Geographic remoteness and greater travel distance were both associated with higher odds of non-attendance. Telephone (adjusted OR 0.57, 95% CI 0.45-0.71, p < 0.001) and telehealth consultations (adjusted OR 0.62, 95% CI 0.47-0.82, p = 0.001) were associated with reduced non-attendance after adjustment. Female gender showed a reversal from higher unadjusted odds to lower adjusted odds of non-attendance. Conclusion Non-attendance at surgical outpatient clinics in remote Australia is common and is associated with Indigenous status, geographic access, age, and appointment modality. Systemic and logistical barriers to healthcare access continue to disproportionately affect Indigenous patients and those residing further from care, resulting in an unequal burden of missed appointments. Telehealth and telephone consultations are associated with improved attendance and represent important tools that may help mitigate geographic barriers.

[This corrects the article DOI: 10.7759/cureus.101075.].

[This retracts the article DOI: 10.7759/cureus.103212.].

Hydrofluoric acid (HF) is a highly corrosive and toxic chemical capable of causing deep tissue injury and life-threatening systemic electrolyte disturbances. This study systematically reviews reported cases of dermal HF burns over the past decade, with emphasis on immediate management, systemic toxicity, surgical intervention, and clinical outcomes. A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Thirteen studies comprising individual case reports and one retrospective case series (N=29 patients) were included. HF concentrations ranged from dilute household preparations to highly concentrated industrial exposures, with total body surface area (TBSA) involvement ranging from <5% to 91%. Mild exposures were successfully managed with topical calcium gluconate gel or soaking techniques without significant systemic complications. Severe cases were associated with profound hypocalcemia, hypomagnesemia, hyperkalemia, ventricular dysrhythmias, metabolic acidosis, and shock. Surgical intervention, including debridement and skin grafting, was necessary primarily in patients with extensive or delayed-recognition injuries. Mortality was reported in two cases involving significant TBSA and systemic toxicity. Continued systematic reporting is necessary to refine treatment strategies and improve clinical outcomes.

Rugby is a globally expanding sport for women, yet research on female-specific health and safety issues remains limited. While orthopedic injuries are the most common and are a concern, the differences in physiology, anatomy, and social context between men and women call for a broader and more gender-informed approach to player health, safety, and welfare. There is a need for gender-specific injury surveillance, which includes not only orthopedic injuries, but also breast injuries, pelvic floor dysfunction, and postpartum effects that impair playing. Strengthening research funding and integrating sex-specific findings into practice are essential to ensure safe, equitable participation and optimal performance for women rugby players.

Orthodontic treatments for maxillary canine retraction often extend over long durations, affecting patient comfort and compliance and leading to growing interest in using physical modalities such as low-level laser therapy (LLLT), mechanical vibration, and electromagnetic fields to accelerate tooth movement. This study systematically evaluates and compares the effectiveness of these physical methods in increasing the rate of upper canine retraction in fixed-appliance orthodontic patients. A comprehensive electronic search of six databases was conducted through July 5, 2025, to identify randomized controlled trials (RCTs) evaluating LLLT, mechanical vibration, or electromagnetic interventions for maxillary canine retraction. Eligible studies compared these modalities with standard orthodontic controls and reported the rate of upper canine retraction (mm/month) as the primary outcome, alongside secondary outcomes including canine angulation, rotation, anchorage loss, and root resorption. Risk of bias was assessed using the Cochrane RoB2 tool, and meta-analyses were performed to calculate mean differences (MDs), p-values, and heterogeneity (I²). Sixteen RCTs with 322 participants were included, revealing that LLLT significantly increased the retraction rate (MD = 0.43 mm/month, p = 0.007; I² = 97%), which, after sensitivity analysis, became MD = 0.26 mm/month (I² = 48%). Mechanical vibration also significantly increased retraction (MD = 0.36 mm/month, p < 0.00001), with no heterogeneity (I² = 0%). Evidence for electromagnetic fields was limited but still positive. For secondary outcomes, no significant adverse effects were noted for angulation, rotation, anchorage, or root integrity, although one study reported minimal, nonsignificant root resorption. In conclusion, physical modalities - particularly LLLT and mechanical vibration - can moderately accelerate upper canine retraction without detectable adverse effects. However, due to variability in protocols and limited long-term data, further high-quality RCTs with standardized methodologies are warranted before routine clinical application.

Background: Atrial fibrillation (AF) is a significant driver of cardiovascular mortality and stroke. While the safety and efficacy of the direct oral anticoagulant (DOAC) edoxaban are well-established in global trials, there is limited real-world evidence within the Filipino population. This study evaluated the safety and bleeding rates of edoxaban in routine clinical practice among Filipino patients with non-valvular atrial fibrillation (NVAF). The safety profile of edoxaban is of particular interest in the context of the "East Asian Paradox", where Asian patients exhibit a higher risk of bleeding complications on traditional anticoagulants compared to Western populations.

Methods: This was a multicenter, prospective, observational post-marketing surveillance study conducted at six sites in the Philippines, namely, Davao Doctors Hospital, St. Luke's Medical Center (Quezon City and Global City), Makati Medical Center, the Philippine General Hospital, and the Philippine Heart Center, between March 2022 and December 2024. Adult patients (≥21 years) with NVAF and a CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years (doubled), diabetes mellitus, stroke/transient ischemic attack (TIA)/thromboembolism (doubled), vascular disease, age 65-74 years, and sex category (female)) score of ≥1 were prescribed edoxaban (30 mg or 60 mg daily) at the clinician's discretion. Patients were followed for 180 days. The primary endpoints were adverse events (AEs), adverse drug reactions (ADRs), and major bleeding.

Results: A total of 72 patients were enrolled; however, one patient (1.4%) did not receive the treatment and was excluded, resulting in a safety analysis population of 71 (mean age: 68.5±10.1 years). The majority of participants were female (50.7%; n=36). Comorbidities were highly prevalent, including hypertension (100%; n=71), coronary artery disease (25.4%; n=18), and heart failure (23.9%; n=17). In this cohort, 35.2% (n=25) were prescribed the 30 mg dose, while 64.8% (n=46) received the 60 mg dose. Over the 180-day observation period, no major bleeding, as well as bleeding requiring medical intervention but not meeting the major criteria, occurred (0%; 95% CI: 0-4.2%). The overall incidence of AEs was low (7%; n=5). One fatal serious AE (acute myocardial infarction) was reported but was determined to be unrelated to the study drug.

Conclusion: In this real-world Filipino cohort, edoxaban demonstrated a favorable safety profile with zero major bleeding events over six months of therapy. Despite a high-risk profile and significant comorbidities, these findings align with global phase III and post-marketing data, supporting edoxaban as a safe anticoagulation option for Filipino patients with NVAF.

Neurodiversity encompasses natural variations in brain function, including autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), dyslexia, and dyspraxia. These differences influence cognitive processing, communication, and sensory perception, shaping how individuals engage with demanding clinical environments. In medicine, junior doctors face intense workloads and high emotional demands, which may amplify difficulties associated with neurodivergent traits. This editorial highlights the challenges experienced by neurodiverse junior doctors and reflects on the need for inclusive clinical and educational practices. Drawing on professional guidance from bodies such as the General Medical Council and the National Institute for Health and Care Excellence (NICE), this article discusses systemic gaps in recognition, limited accommodations, and persistent stigma within medical training. It emphasizes practical strategies, including structured mentorship, predictable scheduling, assistive technologies, and organizational awareness programs, and underscores institutional responsibilities and policy implications. By adopting inclusive frameworks aligned with established professional standards, healthcare organizations can better support neurodiverse clinicians, improve retention, and enhance patient-care quality.

BRASH syndrome is defined as a clinical condition in which bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia interact to form a self-perpetuating negative spiral. Geriatric practitioners are increasingly likely to encounter elderly patients with this syndrome who are taking AV nodal blocking agents, such as calcium channel blockers (CCBs) or β-blockers. However, it remains unclear how the heart failure (HF) pandemic and coronavirus disease 2019 (COVID-19) have influenced the incidence, triggers, management, and clinical course of BRASH syndrome. Therefore, open-access databases were searched for publications from 1980 to 2025, identifying 41 eligible articles reporting a total of 54 patients with BRASH syndrome. The mean age of affected patients was 69.0 ± 15.1 years. Hypertension (HTN, 74%), chronic kidney disease (CKD, 61%), and diabetes (54%) were the most common comorbidities. More than half of the patients (52%) were prescribed angiotensin-suppressing agents (angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), or angiotensin receptor-neprilysin inhibitors (ARNI)) for HTN or HF. Two elderly patients were diagnosed with BRASH syndrome triggered by COVID-19. This literature review clarifies that BRASH syndrome commonly occurs in elderly patients with HTN or CKD and is often associated with everyday clinical events such as anorexia, vomiting, diarrhea, bleeding, and infection, including COVID-19. Our database search supports recognizing BRASH syndrome as an important clinical entity in geriatric emergency medicine. Geriatric practitioners should be aware of this condition to enable early diagnosis and appropriate management in the modern HF and post-COVID-19 era.

Background: In regions such as North India, where anemia is prevalent, interpretation of the erythrocyte sedimentation rate (ESR) in rheumatoid arthritis (RA) may be challenging. We evaluated the independent associations of inflammation, autoantibody status, and anemia with ESR elevation and examined morphologic anemia patterns in this cohort.

Methods: We conducted a retrospective cross-sectional analysis of 152 RA patients attending a tertiary care center. Multivariate logistic regression identified independent predictors of elevated ESR and of anemia after adjustment for covariates. Seropositivity was defined by rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP) positivity. Among anemic patients, anemia was classified morphologically as microcytic or normocytic based on mean corpuscular volume (MCV), and inflammatory markers were compared across groups. Missing laboratory data were addressed using multiple imputation by chained equations (MICE).

Results: The cohort was predominantly female (133/152, 87.5%), and seropositive RA accounted for 75.7% (115/152) of cases. In the ESR model, C-reactive protein (CRP) positivity was the strongest independent predictor (adjusted odds ratio [aOR] 7.81, p<0.001), whereas anemia was not independently associated after adjustment (aOR 1.45, p=0.305). In a separate model predicting anemia, seropositive RA remained independently associated (aOR 2.12, p=0.024). Among anemic patients (n=89), 87 had available morphologic data; of these, 47 (54%) were normocytic and 40 (46%) microcytic. The normocytic group demonstrated significantly higher ESR and CRP values than other groups (p<0.001).

Conclusion: ESR elevation was independently associated with CRP-defined inflammatory activity after multivariate adjustment, whereas anemia did not demonstrate an independent association. These findings suggest that ESR retains clinical relevance in reflecting inflammatory burden when interpreted in conjunction with complementary laboratory parameters.