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Cureus Apr 2024Propylthiouracil (PTU) has been identified as a known cause of anti-neutrophil cytoplasmic antibodies-associated vasculitis. However, the association between PTU and...
Propylthiouracil (PTU) has been identified as a known cause of anti-neutrophil cytoplasmic antibodies-associated vasculitis. However, the association between PTU and immunoglobulin A (IgA) vasculitis remains uncertain due to its rarity and diverse clinical presentation. Here, we report the case of a 57-year-old female with a past medical history of chronic leukopenia and Graves' disease treated with PTU that presented with pancytopenia and widespread non-blanching ecchymoses on the bilateral legs. A punch biopsy of the medial leg demonstrated IgA vasculitis and autoimmune antibody analysis revealed increased levels of anti-proteinase 3 antibodies compared to anti-myeloperoxidase antibodies. These findings led to the diagnosis of PTU-induced IgA vasculitis. Following the discontinuation of PTU, there was marked improvement in the appearance of the patient's cutaneous manifestations and hematological indices.
PubMed: 38957824
DOI: 10.7759/cureus.58535 -
Cureus Apr 2024Background Spinal metastatic disease is a silent progressive cancer complication with an increasing prevalence worldwide. The spine is the third most common site where...
Background Spinal metastatic disease is a silent progressive cancer complication with an increasing prevalence worldwide. The spine is the third most common site where solid tumors metastasize. Complications involved in spinal metastasis include root or spinal cord compression, progressing to a declining quality of life as patient autonomy reduces and pain increases. The main objective of this study is to report the incidence of patients and typology of spinal metastases in three reference centers in Mexico. Methodology Retrospective cohorts of patients diagnosed with spinal metastases from January 2010 to February 2017 at the National Cancer Institute, National Rehabilitation Institute, and the Traumatology and Orthopedics Hospital "Lomas Verdes" in Mexico City were analyzed. Results A total of 326 patients (56% males) with spinal metastases were reported. The mean age was 58.06 ± 14.05 years. The main sources of spinal metastases were tumors of unknown origin in 53 (16.25%) cases, breast cancer in 67 (20.5%) cases, prostate cancer in 59 (18%) cases, myeloma in 24 (7.4%) cases, and lung cancer in 23 (7.1%) cases. Conclusions The data obtained in this analysis delivers an updated standpoint on Mexico, providing the opportunity to distinguish the current data from global references. Collecting more epidemiological information for better recording of cancer and its associated complications, as well as further studies on them, is necessary.
PubMed: 38957823
DOI: 10.7759/cureus.58546 -
Cureus Apr 2024Appendicectomy is the most frequent emergency general surgical procedure. Prior research highlights the importance of histopathology analysis after appendicectomy which...
INTRODUCTION
Appendicectomy is the most frequent emergency general surgical procedure. Prior research highlights the importance of histopathology analysis after appendicectomy which is the practice in many countries including the United Kingdom (UK), aiming to prevent any oversight of vital findings and the avoidance of potential delays in patient care. Our primary objective was to audit the extent to which surgeons adhere to the NHS England patient safety guidelines from 2016 when it comes to timely reviewing and effectively communicating histopathology results to patients and/or their general practitioners following appendicectomy procedures. Our secondary objective was to amend practice, if deemed necessary, following the implementation of agreed-upon protocols, with the expected improvements being observable in the second cycle of the audit.
METHODS
In our two-cycle audit, we performed a retrospective analysis using online patient records from a single centre in the UK. The initial cycle involved cases of emergency appendectomies carried out consecutively for suspected appendicitis from April 2018 to June 2019. Following the clinical governance meeting and the implementation of recommendations, the second audit cycle covered cases between September 2020 and October 2020.
RESULTS
In the first cycle, among 418 laparoscopic appendectomies, 207 (49.52%) and 47 reports (11.24%) were reviewed within a 15-day and a 16-30-day window, respectively, following the online availability of histopathology results. Notably, 116 reports (27.75%) remained unreviewed by surgeons, and only 67 (16.02%) of these reports documented communication with patients and/or their general practitioners. In the second cycle, involving 49 patients, 38 reports (77.55%) were reviewed within the first 15 days, and 10 reports (20.4%) were reviewed between 16-30 days. Among these, 16 reports (32.65%) documented communication with patients and/or their general practitioners.
CONCLUSIONS
Our adherence to the aforementioned guidance was poor prior to this audit. This two-cycle audit highlighted the need for improvement in the timely review and communication of histopathology reports following appendectomy at our centre. The second cycle showed promising progress, suggesting that changes implemented between the cycles had a positive impact. Nevertheless, continuous efforts may be required to enhance and sustain adherence to these vital patient safety guidelines.
PubMed: 38957822
DOI: 10.7759/cureus.58539 -
Cureus Apr 2024Invasive disease due to group A infection results in a large spectrum of clinical manifestations. In the neonatal period, the occurrence is rare and potentially...
Invasive disease due to group A infection results in a large spectrum of clinical manifestations. In the neonatal period, the occurrence is rare and potentially serious. We present a case of a term male newborn on the 9th day of life who was admitted to the emergency room with moaning and poor feeding. The patient was hemodynamically unstable needing mechanical ventilation and inotropic support. Mother and father had clinical symptoms of pharyngitis. Blood samples revealed high serum C-reactive protein and procalcitonin, leucopenia, thrombocytopenia, hyponatremia, hepatic cytolysis, and cholestasis. He started on IV ampicillin, gentamicin, and cefotaxime. Due to an abdominal distension, an ultrasound was done showing a heterogenous hepatic lobe. A color Doppler scan completed the study revealing a left hepatic thrombosis. Enoxaparin was started. The newborn's blood culture and mother's milk were positive for the same strain of group A Intravenous immunoglobulin and clindamycin were added to the treatment. On day 5 of treatment, inotropic support was ceased and extubation took place on day 6. Neonatologists should be aware of rare complications of group A infection such as thrombotic events.
PubMed: 38957821
DOI: 10.7759/cureus.58520 -
Cureus Apr 2024Background Due to the emergence of new COVID-19 mutations and an increase in re-infection rates, it has become an important priority for the medical community to...
Background Due to the emergence of new COVID-19 mutations and an increase in re-infection rates, it has become an important priority for the medical community to identify the factors affecting the short- and long-term survival of patients. This study aimed to determine the risk factors of short- and long-term survival in patients with COVID-19 based on mixture and non-mixture cure models. Methodology In this study, the data of 880 patients with COVID-19 confirmed with polymerase chain reaction in Fereydunshahr city (Isfahan, Iran) from February 20, 2020, to December 21, 2021, were gathered, and the vital status of these patients was followed for at least one year. Due to the high rate of censoring, mixture and non-mixture cure models were applied to estimate the survival. Akaike information criterion values were used to evaluate the fit of the models. Results In this study, the mean age of the patients was 48.9 ± 21.23 years, and the estimated survival rates on the first day, the fourth day, the first week, the first month, and at one year were 0.997, 0.982, 0.973, 0.936, and 0.928, respectively. Among the parametric models, the log-logistic mixed cure model with the logit link, which showed the lowest Akaike information criterion value, demonstrated the best fit. The variables of age and prescribed medication type were significant predictors of long-term survival, while occupation was influential in the short-term survival of patients. Conclusions According to the results of this study, it can be concluded that elderly patients should observe health protocols more strictly and consider receiving booster vaccine doses. The log-logistic cure model with a logit link can be used for survival analysis in COVID-19 patients, a fraction of whom have long-term survival.
PubMed: 38957820
DOI: 10.7759/cureus.58550 -
Cureus Apr 2024Metanephric adenoma (MA) is a rare embryonal epithelial tumor that is often diagnosed incidentally. A definitive diagnosis can only be made postoperatively based on the...
Metanephric adenoma (MA) is a rare embryonal epithelial tumor that is often diagnosed incidentally. A definitive diagnosis can only be made postoperatively based on the pathological findings. This case report discusses the rare occurrence of a metanephric adenoma, the symptoms it can present with, and the diagnosis, treatment, and immunological staining needed to differentiate metanephric adenoma from other types of renal tumors. In this study, a 37-year-old female presented to the emergency room for vague right lower quadrant pain (RLQ) and underwent imaging that showed a lesion on the lower pole of the left kidney. A subsequent biopsy of the lesion showed a low-grade renal epithelial neoplasm favoring metanephric adenoma. The patient successfully underwent a left partial nephrectomy to remove the tumor, which required no further treatment after resection. Due to the rarity of the tumor, it requires immunohistology to differentiate from other renal tumors such as Wilm's tumor and renal cell carcinoma. This case report aims to recognize proper workup, diagnosis, and treatment to achieve a positive outcome in the setting of this rare tumor.
PubMed: 38957819
DOI: 10.7759/cureus.58545 -
Cureus Apr 2024Among the patient population in Basrah, Iraq, prolactinoma is the most commonly found pituitary tumor. Impulse control disorders (ICDs) were reportedly associated with...
BACKGROUND
Among the patient population in Basrah, Iraq, prolactinoma is the most commonly found pituitary tumor. Impulse control disorders (ICDs) were reportedly associated with these patients being treated with cabergoline. This study aimed to assess the prevalence of ICDs in cabergoline-treated prolactinoma patients versus healthy, matched controls.
METHODS
This cross-sectional case-control study was conducted at the Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) in Basrah, southern Iraq, from January 2023 to May 2023. It included 30 cabergoline-treated prolactinoma patients and 30 healthy, matched controls. The questionnaire for ICDs in Parkinson's disease was used as a screening tool. Following this, positively screened patients were evaluated using validated criteria accordingly to diagnose impulse control disorders.
RESULTS
The ICDs were diagnosed in nine (30%) cabergoline-treated prolactinoma patients versus two (6.7%) in control (p = 0.02). The most frequent ICD types were hypersexuality and binge eating, while no patient reported pathological gambling. Three patients reported multiple types of ICDs. The patients' sociodemographic characteristics, prolactinoma duration and size, and cabergoline dose did not correlate significantly with ICD diagnosis.
CONCLUSIONS
Treatment with cabergoline is associated with the development of ICDs. Therefore, clinicians should be aware of this disabling side effect to ensure its early detection and treatment.
PubMed: 38957818
DOI: 10.7759/cureus.58516 -
Cureus Apr 2024Metastatic cervical carcinoma from an unknown primary source poses a diagnostic and therapeutic challenge, as it involves the spread of cancer to the neck lymph nodes...
Metastatic cervical carcinoma from an unknown primary source poses a diagnostic and therapeutic challenge, as it involves the spread of cancer to the neck lymph nodes without a discernible primary tumor despite thorough investigation. While the diagnosis and treatment of this uncommon condition lack definitive evidence, a review of existing literature offers some clinical guidance. A comprehensive diagnostic evaluation, which includes multiple imaging and endoscopic studies, is essential. Surgery is preferred whenever feasible due to its ability to offer more precise staging. This treatment entails an excisional biopsy, neck dissection, and tonsillectomy, but advanced cases necessitate a combination of treatments. This case report underscores this complexity, where, despite radical neck dissection on the affected side, recurrence manifested after two months with no discernible primary site. We emphasize the urgency for continued research and innovative approaches to enhance the diagnosis and management of metastatic cervical carcinoma from an unknown primary source.
PubMed: 38957817
DOI: 10.7759/cureus.58537 -
Cureus Apr 2024Klippel-Feil syndrome (KFS) is a rare congenital disorder characterized by the fusion of cervical vertebrae, limiting neck mobility, and often presenting with clinical...
Klippel-Feil syndrome (KFS) is a rare congenital disorder characterized by the fusion of cervical vertebrae, limiting neck mobility, and often presenting with clinical manifestations such as neck pain, stiffness, and neurological deficits. While the classical presentation of KFS includes a "clinical triad" comprising a shortened neck, a low posterior hairline, and limited cervical motion, not all patients exhibit all three features. This case report presents an 81-year-old male with the complete KFS triad and underscores the diagnostic challenges and management strategies associated with this condition. Despite the rarity of KFS, understanding it is crucial for clinicians due to its profound implications on patient management and quality of life. This case emphasizes the importance of clinical suspicion in Internal Medicine, showcasing how an isolated presentation may often be a manifestation of an underlying congenital condition.
PubMed: 38957816
DOI: 10.7759/cureus.58538 -
Cureus Apr 2024Knowledge of anatomical landmarks is crucial for effective dental treatments, especially in surgical procedures. The mental nerve (MN), a branch of the inferior alveolar...
INTRODUCTION
Knowledge of anatomical landmarks is crucial for effective dental treatments, especially in surgical procedures. The mental nerve (MN), a branch of the inferior alveolar nerve, features a critical landmark known as the anterior loop (AL), often overlooked by surgeons. This study aims to assess the occurrence of the MN AL, its type, and its length within a sample of the Jordanian population by utilizing cone beam computed tomography (CBCT) scans.
METHODS
This retrospective observational study included the acquisition of CBCT images from a total of randomly selected 268 patients who sought treatment for a range of dental conditions (such as tooth extraction, orthodontic therapy, and dental implants) at hospitals affiliated with the Jordanian Royal Medical Services. Reformatted images were utilized to detect the AL type, length, and the association between the nerve type and mental foramen (MF) position.
RESULTS
This study involved 268 patients. The distribution of MF positions and the characteristics of the inferior dental nerve were evaluated, with no significant gender differences observed. The predominant location for the MF in both males and females in both sides was position IV, with 52% of females and 56-59% (left-right sides) of males presenting this trait. The inferior dental nerve types also showed no significant gender variation, with 42-43% (left-right sides) of females having type III and a similar distribution among males. Measurements of the midline-mental foramen and inter-foramen distances revealed slight variations between genders, with significant differences noted in the right AL length for type III nerves, favoring males (p=0.034). A notable correlation was found between the type of inferior dental nerve and the MF position, particularly with type I nerves predominantly associating with position IV mental foramina (p≤0.004).
CONCLUSION
CBCT scans are essential in the precise evaluation of the AL, aiding in the prevention of nerve injuries during dental procedures. Our results highlight the diversity of the AL in the Jordanian population and the importance of individualized treatment plans. Future research with larger cohorts is advised to refine these insights, aiming to improve treatment outcomes and patient care.
PubMed: 38957815
DOI: 10.7759/cureus.58519