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Muacevic A, Adler JR, Wool KJ, Elmarzooky Z, Kondapaneni V. An Unusual Case of Impending Paradoxical Embolism Through a Patent Foramen Ovale in Renal Cell Carcinoma. Cureus 2023; 15:e34964. [PMID: 36819953 PMCID: PMC9931375 DOI: 10.7759/cureus.34964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 02/16/2023] Open
Abstract
Impending paradoxical embolism (IPDE) is a clinical emergency with adverse outcomes. Due to its rarity, larger research cannot be obtained to provide definitive therapy alternatives. We report a case of a tumor embolus from a renal cell carcinoma (RCC) that caused a right atrial mass, pulmonary embolus, and impending paradoxical embolus via a patent foramen ovale (PFO) and its management.
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Muacevic A, Adler JR. Behavioral Seizure in a Patient With a Cavernous Malformation Finding in CT: A Case Report. Cureus 2023; 15:e34731. [PMID: 36755771 PMCID: PMC9904422 DOI: 10.7759/cureus.34731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
Behavioral epileptic seizures (BES) are a unique type of seizure that can be presented with or without the classic limb movements of epilepsy. This type of seizure is commonly associated with the frontal and temporal lobes of the brain. Symptoms consist of anxiety, smiling, crying, fear, aggression, irritability, and change in awareness or activity. We report a case of unusual seizure presentation of jerky movements followed by intense fear and crying caused by a right parietal cavernous malformation with chronic bleeding.
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Muacevic A, Adler JR. Bilateral Lateral Rectus Recession in Duane Retraction Syndrome Type II: A Case Report. Cureus 2023; 15:e35351. [PMID: 36846636 PMCID: PMC9957553 DOI: 10.7759/cureus.35351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 02/25/2023] Open
Abstract
A two year presented to the clinic with abnormal head posture and right-sided face turn since birth. On examination, he showed a large right face turn of 40° while concentrating on a near target. His ocular motility assessment showed a -4 limitation of adduction in the left eye with 40 prism diopters (PD) exotropia and grade 1 globe retraction of the left eye. He was diagnosed with type II Duane retraction syndrome (DRS) in the left eye and planned for lateral rectus recession of both eyes. Postoperatively, the patient was orthotropic at distance and near in primary gaze with resolved face turn and improvement of limitation of adduction to -2, but some limitation of abduction -1 in the left eye was observed. Herein, we discuss the clinical features, etiologies, tailored evaluation, and management for type II DRS patient.
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Muacevic A, Adler JR. Complicated Diverticulitis: Age Distribution, Management and Burden on Health Care. Cureus 2023; 15:e34482. [PMID: 36733440 PMCID: PMC9890077 DOI: 10.7759/cureus.34482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Acute diverticulitis represents a common surgical condition and one of the leading gastrointestinal causes of hospital admissions in Western societies. The aim of the study is to examine the distribution, management and cost to healthcare of complicated diverticulitis and compare those to uncomplicated diverticulitis. METHODS The case-control study was performed for patients with acute diverticulitis in Lyell McEwin Hospital in Adelaide, South Australia. Data were collected for patients presented from January 2015 to December 2017. Consecutive patients with acute diverticulitis confirmed by computed tomography were included in the study. Patients recruited for the study were divided into two groups. Patients presenting with Hinchey Ia diverticulitis were classified as 'uncomplicated diverticulitis'. Patients who presented with Hinchey Ib, II, III or IV diverticulitis were classified as 'complicated diverticulitis'. The Hinchey classification was based on the radiological reports of CT scans. RESULTS From 2015-2017, 116 cases were screened for the study, 10 of which were excluded due to not having CT diagnosis. A total of 106 consecutive cases of acute diverticulitis were recruited for the study. Forty-four cases had complicated diverticulitis. Sixty-two cases with uncomplicated diverticulitis were allocated as a control group. The distribution of cases spanned through all age groups. There were nine cases (20.9%) in the 30-39 age group in the complicated diverticulitis compared to eight cases (12.9%) in the uncomplicated group with odds ratio 1.7 (0.61-4.92). The mean length of stay of the complicated diverticulitis group was 7.74 days compared to 3.93 days of the uncomplicated group with a p value of 0.000235. Nine (20%) cases of the 44 complicated diverticulitis cases were managed operatively, while 35 (80%) of the complicated diverticulitis group and all of the uncomplicated (control) group were managed conservatively. Localized perforations were 24 cases (54.5%) of the complicated diverticulitis group and collections were 18 cases (40.8%). Those cases collectively represented the majority of the complicated group. CONCLUSION Complicated diverticulitis increases the length of stay significantly in acute diverticulitis cases that are requiring hospital admission despite conservative management in 80% of the cases. Younger age groups represent a significant percentage of both complicated and uncomplicated diverticulitis. In the study population, the percentage of the younger age group was higher in complicated diverticulitis compared to uncomplicated diverticulitis, although this increased risk did not reach statistical significance. This will need to be further investigated in future studies.
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Muacevic A, Adler JR. Effect of COVID-19 on Glycemic Control, Insulin Resistance, and pH in Elderly Patients With Type 2 Diabetes. Cureus 2023; 15:e35390. [PMID: 36846644 PMCID: PMC9954760 DOI: 10.7759/cureus.35390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 03/01/2023] Open
Abstract
Background The coronavirus disease of 2019 (COVID-19) was spread all over the world, while diabetes mellitus (DM) remains the most prevalent chronic disease worldwide. Aims This study aims to investigate the effect of COVID-19 on glycemic control, insulin resistance (IR), and pH in elderly patients with type 2 diabetes. Methods A retrospective study was conducted on patients with type 2 DM who were diagnosed with COVID-19 infection in the central hospitals of the Tabuk region. Patient data were collected from September 2021 to August 2022. Four non-insulin-based insulin resistance indexes were calculated for patients: the triglyceride-glucose (TyG) index, the triglyceride glucose-body mass index (TyG-BMI) index, the triglyceride to high-density lipoprotein cholesterol (TG/HDL) ratio, and the metabolic score for insulin resistance (METS-IR). Results Patients showed increased serum fasting glucose and blood HbA1c associated with a high TyG index, TyG-BMI index, TG/HDL ratio, and METS-IR as compared with results before COVID-19. Moreover, during COVID-19, patients revealed a reduction in pH, associated with a reduction in cBase and bicarbonate, and an elevation in PaCO2 as compared with their results before COVID-19. After complete remission, all patients' results turn back to their level before COVID-19. Conclusions Patients with type 2 DM who catch the COVID-19 infection suffer from dysregulation of glycemic control and elevated insulin resistance associated with a significant reduction in their pH.
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Muacevic A, Adler JR. Reaffirming a Positive Correlation Between Number of Vaccine Doses and Infant Mortality Rates: A Response to Critics. Cureus 2023; 15:e34566. [PMID: 36751569 PMCID: PMC9897596 DOI: 10.7759/cureus.34566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction In 2011, we published a study that found a counterintuitive, positive correlation, r = 0.70 (p < .0001), demonstrating that among the most highly developed nations (n = 30), those that require more vaccines for their infants tend to have higher infant mortality rates (IMRs). Critics of the paper recently claimed that this finding is due to "inappropriate data exclusion," i.e., the failure to analyze the "full dataset" of all 185 nations. Objective In the present study, we examine various claims postulated by these critics and the validity of their scientific methods, and we perform several investigations to assess the reliability of our original findings. Methods The critics select 185 nations and use linear regression to report a correlation between the number of vaccine doses and IMRs. They also perform multiple linear regression analyses of the Human Development Index (HDI) vs. IMR with additional predictors and investigate IMR vs. percentage vaccination rates for eight different vaccines. We perform odds ratio, sensitivity, and replication analyses. Results The critics' reanalysis combines 185 developed and Third World nations that have varying rates of vaccination and socioeconomic disparities. Despite the presence of inherent confounding variables, a small, statistically significant positive correlation of r = 0.16 (p < .03) is reported that corroborates the positive trend in our study. Multiple linear regression analyses report high correlations between IMR and HDI, but the number of vaccine doses as an additional predictor is not statistically significant. This finding is a likely consequence of known misclassification errors in HDI. Linear regression of IMR as a function of percentage vaccination rates reports statistically significant inverse correlations for 7 of 8 vaccines. However, several anomalies in the scatter plots of the data suggest that the chosen linear model is problematic. Our odds ratio analysis conducted on the original dataset controlled for several variables. None of these variables lowered the correlation below 0.62, thus robustly confirming our findings. Our sensitivity analysis reported statistically significant positive correlations between the number of vaccine doses and IMR when we expanded our original analysis from the top 30 to the 46 nations with the best IMRs. Additionally, a replication of our original study using updated 2019 data corroborated the trend we found in our first paper (r = 0.45, p = .002). Conclusions A positive correlation between the number of vaccine doses and IMRs is detectable in the most highly developed nations but attenuated in the background noise of nations with heterogeneous socioeconomic variables that contribute to high rates of infant mortality, such as malnutrition, poverty, and substandard health care.
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Muacevic A, Adler JR. Focal Crescentic Glomerulonephritis Following COVID-19 Viral Vector Vaccination. Cureus 2023; 15:e35305. [PMID: 36846637 PMCID: PMC9945812 DOI: 10.7759/cureus.35305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 02/24/2023] Open
Abstract
Vaccination is a vital tool aimed at curbing the COVID-19 pandemic, and the FDA has authorized several vaccines for emergency use to combat COVID-19. Our patient presented with acute kidney injury two weeks after receiving the first dose of the COVID-19 Janssen (Johnson & Johnson) vaccine. Renal biopsy confirmed focal crescentic glomerulonephritis. The patient has been unable to achieve remission after diagnosis and is now a candidate for a kidney transplant. In conclusion, this case report provides insight into the possible relationship between glomerular disease following COVID-19 Janssen (Johnson & Johnson) vaccination. Based on this presented case, new-onset or relapse of glomerular diseases presenting post-COVID-19 vaccination should be observed as a possible adverse event to large-scale COVID-19 vaccination.
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Muacevic A, Adler JR. Correction: Anesthetic Challenges During Whole Lung Lavage: A Case Report. Cureus 2023. [PMID: 36865646 PMCID: PMC9972502 DOI: 10.7759/cureus.c103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
[This corrects the article DOI: 10.7759/cureus.33659.].
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Muacevic A, Adler JR. Pericentric Inversion of Chromosome 9 in Twins With Cyclopia: A Rare Entity. Cureus 2023; 15:e34562. [PMID: 36743908 PMCID: PMC9894573 DOI: 10.7759/cureus.34562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Pericentric inversion of chromosome 9 (inv(9)) is one of the most common variants seen in a normal human karyotype that occurs during meiosis. Despite being categorized as a normal variant, some studies using classical cytogenetics have recently shown that inv(9) could be associated with azoospermia, congenital anomalies, growth retardation, and rarely with abnormal karyotype. However, there is no reported association with cyclopia. Interestingly this genetic variant involves twin fetuses. A 36-year-old multiparous lady with dichorionic diamniotic twin pregnancy presented to the fetomaternal unit with fetal growth restriction at 34 weeks of gestation. An ultrasound scan revealed both have microcephaly, fisting hands, holoprosencephaly, and proboscis suspicious of Patau syndrome. Amniocentesis was not issued due to late pregnancy and guarded prognosis. The mother presented with pre-eclampsia at 35 weeks of gestation. The pregnancy managed to prolong up to 36 weeks after which caesarean section was performed due to the leading twin being in a transverse lie. Two baby twin girls were born 3 minutes apart with microcephaly and cyclops appearance. Chromosomal analysis of both twins revealed similar karyotypes of 46, XX, inv(9)(p11,q13). Pericentric inversion of chromosome 9 is regarded as a normal chromosomal variation in the general population, but in twins with cyclops is considered rare. Early referral to a tertiary hospital for twin management is highly required. It may identify fetuses with such abnormalities and counsel the parents with appropriate management.
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Muacevic A, Adler JR. Kikuchi's Disease Diagnosed by an Excisional Biopsy in a Patient With COVID-19. Cureus 2023; 15:e35251. [PMID: 36825075 PMCID: PMC9942247 DOI: 10.7759/cureus.35251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 02/23/2023] Open
Abstract
COVID-19 is an ongoing pandemic caused by the novel coronavirus SARS-CoV-2. The clinical features of COVID-19 are myriad. Though it is a multisystem illness, it predominantly involves the respiratory system. There have been case reports on rare manifestations of COVID-19, of which COVID-19-related Kikuchi's disease is one of them. To our knowledge, this is the third reported case in the world. We report a lady in her late 60s with COVID-19 infection and secondary bacterial pneumonia, which necessitated ICU admission, having ongoing fever spikes with high inflammatory markers and leukopenia. She was also found to have tender cervical lymphadenopathy on the third week of illness, whose biopsy revealed histiocytic necrotizing lymphadenitis in keeping with Kikuchi's disease. The patient had an uneventful recovery in two weeks without any intervention. The pathophysiology of COVID-19-related Kikuchi's disease is unclear. However, COVID-19 is a viral illness that involves changes in interleukins. The latter is postulated in Kikuchi's disease.
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Muacevic A, Adler JR. Correction: Behavioral Seizure in a Patient With a Cavernous Malformation Finding in CT: A Case Report. Cureus 2023; 15:c104. [PMID: 36874303 PMCID: PMC9975975 DOI: 10.7759/cureus.c104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
[This corrects the article DOI: 10.7759/cureus.34731.].
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Muacevic A, Adler JR. Efficacy of Harmonic Scalpel Versus Bipolar Diathermy in Hemorrhoidectomy: A Systematic Review and Meta-Analysis of Nine Randomized Controlled Trials. Cureus 2023; 15:e34734. [PMID: 36755770 PMCID: PMC9904392 DOI: 10.7759/cureus.34734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
Hemorrhoidectomy is one of the most common surgical interventions to remove the third and fourth degrees of prolapse hemorrhoid. We carried out this systematic review and meta-analysis of the randomized controlled trials (RCTs) to comprehensively evaluate the efficacy of harmonic scalpel (HS) versus bipolar diathermy (BD) methods in terms of decreasing intraoperative and postoperative morbidities among patients undergoing hemorrhoidectomy. Suitable citations were found utilizing digital medical sources, including the CENTRAL, Web of Science, PubMed, Scopus, and Google Scholar, from inception until December 2022. Only RCTs that matched the inclusion requirements were selected. We used the updated Cochrane risk of bias (ROB) tool (version 2) to assess the quality of the involved citations. The Review Manager (version 5.4 for Windows) was used to perform the pooled analysis. Data were pooled and reported as mean difference (MD) or risk ratio (RR) with a 95% confidence interval (CI) in random-effects models. Overall, there was no significant difference between HS and BD in terms of decreasing intraoperative morbidities like operative time, intraoperative blood loss, mean duration of hospital stay, and mean duration of first bowel movement (P>0.05). Similarly, the rate of postoperative complications like pain, bleeding, urinary retention, anal stenosis, flatus incontinence, and wound edema; was similar in both groups with no significant difference (P>0.05). In conclusion, our pooled analysis revealed there was no substantial difference between HS and BD in terms of intraoperative and postoperative endpoints. Additional RCTs with larger sample sizes are needed to consolidate the power and quality of the presented evidence.
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Muacevic A, Adler JR. Assessment of Uncarboxylated Osteocalcin Levels in Type 2 Diabetes Mellitus. Cureus 2023; 15:e35297. [PMID: 36846642 PMCID: PMC9945018 DOI: 10.7759/cureus.35297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 02/24/2023] Open
Abstract
Osteocalcin is one of the main organic components of the bone matrix and consists of 49 amino acids excreted from osteoblastic cells in carboxylated and uncarboxylated forms. Carboxylated Osteocalcin belongs to the bone matrix, whereas uncarboxylated osteocalcin (ucOC) is an important enzyme of osteocalcin in the circulatory system. It is an essential protein for balancing the minerals in bones, binding with calcium, and regulating body glucose levels. In this review, we point out the assessment of ucOC levels in type 2 diabetes mellitus. The experimental results that show ucOC controls glucose metabolism are significant because they relate to the current obesity, diabetes, and cardiovascular disease. To confirm that, low serum levels of ucOC were a risk factor for poor glucose metabolism, and further clinical studies are required.
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Muacevic A, Adler JR. A Comparative Study on the Efficacy and Safety of Dose Escalation of Luseogliflozin in Type 2 Diabetes Mellitus Patients With Poor Glycemic Control. Cureus 2023; 15:e35393. [PMID: 36846645 PMCID: PMC9950847 DOI: 10.7759/cureus.35393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/01/2023] Open
Abstract
Objective In this study, we aimed to assess the safety and efficacy of the dose escalation of luseogliflozin (LUSEO) in type 2 diabetes mellitus (T2DM) patients with poor glycemic control. To that end, we compared two groups assigned to two different doses of luseogliflozin (LUSEO) for 12 weeks. Methods Patients with a hemoglobin A1c (HbA1c) level of 7% or higher already on treatment with luseogliflozin 2.5 mg/day for 12 weeks or longer were randomly assigned to either the 2.5-mg/day group (control group) or the 5-mg/day group (dose-escalation group) of luseogliflozin through the envelope method and were treated for 12 weeks. Blood and urine samples were collected at two different time points: at weeks 0 and 12 after randomization. The primary outcome was the change in HbA1c from the baseline to 12 weeks. The secondary outcomes were changes in the body mass index (BMI), body weight (BW), blood pressure (BP), fasting plasma glucose (FPG), lipid parameters, hepatic function, or renal function from the baseline to 12 weeks. Results Based on our findings, HbA1c levels significantly decreased in the dose-escalation group when compared to the control group (p<0.001) at week 12. Conclusion For T2DM patients with poor glycemic control under treatment with LUSEO at a dose of 2.5 mg, dose escalation of LUSEO to 5 mg safely improved glycemic control, and this might prove to be an effective and safe treatment option.
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Muacevic A, Adler JR. Thyrotoxic Periodic Paralysis With Severe Hypokalemia Precipitated by Acute Alcohol Intoxication in a Patient With Graves' Disease. Cureus 2023; 15:e35548. [PMID: 36860822 PMCID: PMC9970111 DOI: 10.7759/cureus.35548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/01/2023] Open
Abstract
We present a case of a 29-year-old male who presented with thyrotoxic periodic paralysis (TPP) precipitated by acute alcohol intoxication. TPP is an endocrine emergency that presents with an episode of acute flaccid paralysis with hypokalemia in the setting of thyrotoxicosis. Individuals who present with TPP are thought to have an underlying genetic predisposition. Overactivation of the Na+/K+ ATPase channel leads to large-scale intracellular shifts in potassium, leading to low serum levels and the clinical manifestations of TPP. Severe hypokalemia can lead to life-threatening complications such as ventricular arrhythmias and respiratory failure. Therefore, timely recognition and management are essential in cases of TPP. In addition, understanding the precipitating factors is necessary for adequate counseling of these patients to prevent further episodes.
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Muacevic A, Adler JR. Is Disrupted Mitophagy a Central Player to Parkinson's Disease Pathology? Cureus 2023; 15:e35458. [PMID: 36860818 PMCID: PMC9969326 DOI: 10.7759/cureus.35458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2023] [Indexed: 02/27/2023] Open
Abstract
Whilst the pathophysiology at a cellular level has been defined, the cause of Parkinson's disease (PD) remains poorly understood. This neurodegenerative disorder is associated with impaired dopamine transmission in the substantia nigra, and protein accumulations known as Lewy bodies are visible in affected neurons. Cell culture models of PD have indicated impaired mitochondrial function, so the focus of this paper is on the quality control processes involved in and around mitochondria. Mitochondrial autophagy (mitophagy) is the process through which defective mitochondria are removed from the cell by internalisation into autophagosomes which fuse with a lysosome. This process involves many proteins, notably including PINK1 and parkin, both of which are known to be coded on genes associated with PD. Normally in healthy individuals, PINK1 associates with the outer mitochondrial membrane, which then recruits parkin, activating it to attach ubiquitin proteins to the mitochondrial membrane. PINK1, parkin, and ubiquitin cooperate to form a positive feedback system which accelerates the deposition of ubiquitin on dysfunctional mitochondria, resulting in mitophagy. However, in hereditary PD, the genes encoding PINK1 and parkin are mutated, resulting in proteins that are less efficient at removing poorly performing mitochondria, leaving cells more vulnerable to oxidative stress and ubiquitinated inclusion bodies, such as Lewy bodies. Current research that looks into the connection between mitophagy and PD is promising, already yielding potentially therapeutic compounds; until now, pharmacological support for the mitophagy process has not been part of the therapeutic arsenal. Continued research in this area is warranted.
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Muacevic A, Adler JR, Utlu E, Güvey H, Kahyaoğlu İ, Neşelioğlu S, Erel Ö, Akar S, Engin-Üstün Y. Serum and Follicular Fluid Thiol/Disulfide Homeostasis in Diminished Ovarian Reserve Patients Undergoing In Vitro Fertilization/Intracytoplasmic Sperm Injection Treatment. Cureus 2023; 15:e35476. [PMID: 36855584 PMCID: PMC9968409 DOI: 10.7759/cureus.35476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 02/27/2023] Open
Abstract
INTRODUCTION The etiologies of diminished ovarian reserve (DOR) are still poorly understood, and many factors such as age, autoimmunity, genetics, idiopathicity, iatrogenesis, and oxidative stress (OS) play a role. Oxidative cellular damage increases following reactive oxygen species (ROS)-induced aging. This is the first study to evaluate the serum and follicular fluid (FF) thiol/disulfide homeostasis in patients under 35 years of age with DOR undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). METHODS In this study, DOR was defined by the Poseidon criteria, and Poseidon group 3 women were selected as the study group (n = 40). The control group was composed of patients with the diagnosis of mild-moderate male factor infertility (n = 30). RESULTS The FF and serum native and total thiol levels, the markers of the antioxidant system, were significantly decreased in the DOR group compared with the control group (p = 0.021) (p = 0.037) (p = 0.029) (p = 0.04). On the other hand, we found no significant differences in the oxidant parameters between the groups (p > 0.05). CONCLUSIONS An intrinsic deficiency of antioxidants can play an important role in the etiology of DOR. The dietary addition of antioxidants could be beneficial in DOR patients.
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Muacevic A, Adler JR. ChatGPT Output Regarding Compulsory Vaccination and COVID-19 Vaccine Conspiracy: A Descriptive Study at the Outset of a Paradigm Shift in Online Search for Information. Cureus 2023; 15:e35029. [PMID: 36819954 PMCID: PMC9931398 DOI: 10.7759/cureus.35029] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Being on the verge of a revolutionary approach to gathering information, ChatGPT (an artificial intelligence (AI)-based language model developed by OpenAI, and capable of producing human-like text) could be the prime motive of a paradigm shift on how humans will acquire information. Despite the concerns related to the use of such a promising tool in relation to the future of the quality of education, this technology will soon be incorporated into web search engines mandating the need to evaluate the output of such a tool. Previous studies showed that dependence on some sources of online information (e.g., social media platforms) was associated with higher rates of vaccination hesitancy. Therefore, the aim of the current study was to describe the output of ChatGPT regarding coronavirus disease 2019 (COVID-19) vaccine conspiracy beliefs. and compulsory vaccination. METHODS The current descriptive study was conducted on January 14, 2023 using the ChatGPT from OpenAI (OpenAI, L.L.C., San Francisco, CA, USA). The output was evaluated by two authors and the degree of agreement regarding the correctness, clarity, conciseness, and bias was evaluated using Cohen's kappa. RESULTS The ChatGPT responses were dismissive of conspiratorial ideas about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) origins labeling it as non-credible and lacking scientific evidence. Additionally, ChatGPT responses were totally against COVID-19 vaccine conspiracy statements. Regarding compulsory vaccination, ChatGPT responses were neutral citing the following as advantages of this strategy: protecting public health, maintaining herd immunity, reducing the spread of disease, cost-effectiveness, and legal obligation, and on the other hand, it cited the following as disadvantages of compulsory vaccination: ethical and legal concerns, mistrust and resistance, logistical challenges, and limited resources and knowledge. CONCLUSIONS The current study showed that ChatGPT could be a source of information to challenge COVID-19 vaccine conspiracies. For compulsory vaccination, ChatGPT resonated with the divided opinion in the scientific community toward such a strategy; nevertheless, it detailed the pros and cons of this approach. As it currently stands, the judicious use of ChatGPT could be utilized as a user-friendly source of COVID-19 vaccine information that could challenge conspiracy ideas with clear, concise, and non-biased content. However, ChatGPT content cannot be used as an alternative to the original reliable sources of vaccine information (e.g., the World Health Organization [WHO] and the Centers for Disease Control and Prevention [CDC]).
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Muacevic A, Adler JR. The Importance of Diaphragmatic Function in Neuromuscular Expression in Patients With Chronic Heart Failure. Cureus 2023; 15:e34629. [PMID: 36751571 PMCID: PMC9899102 DOI: 10.7759/cureus.34629] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 02/05/2023] Open
Abstract
Chronic heart failure (CHF) is a set of symptoms and physical manifestations caused by the inability of the heart to perform its normal contractile function and satisfy the blood needs of all organs. This dysfunction leads to a non-physiological adaptation of all body systems, including the skeletal muscles and the diaphragm. The myopathy found in patients brings symptoms such as fatigue and intolerance to exercise, with an entity not always attributable to cardiac function. Neuromuscular incoordination is one of the symptoms related to CHF, causing an increased risk of mortality and hospitalization. The article reviews diaphragmatic adaptation in the presence of CHF and seeks to emphasize the importance of the diaphragm in understanding skeletal muscle incoordination in patients.
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Liegl R, Schmelter V, Fuerweger C, Ehret F, Priglinger S, Muacevic A, Foerster P. Robotic CyberKnife Radiosurgery for the Treatment of Choroidal and Ciliary Body Melanoma. Am J Ophthalmol 2023; 250:177-185. [PMID: 36642391 DOI: 10.1016/j.ajo.2022.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 11/15/2022] [Accepted: 12/16/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE To present the results of robotic-assisted radiosurgery in choroidal and ciliary body melanomas treated at the Department of Ophthalmology of Ludwig-Maximilians-University and the European CyberKnife Center in Munich, Germany. DESIGN Interventional case series METHODS: This retrospective study included 594 consecutive patients referred to our clinic for the treatment of choroidal and ciliary body melanomas with robotic radiosurgery (CyberKnife) from 2005 to 2019. Eye retention, local control and disease-specific survival rates were calculated as Kaplan-Meier and actuarial estimates. The impact of prescription dose, tumor size, and ciliary body involvement was assessed by likelihood ratio tests and Cox regression. RESULTS Among all patients who were staged according to the TNM classification system (8th edition), 22.7% were I, 57.9% were II, 18.9% were III, and 0.5% were IV. Median apical tumor height and base diameter were 5.8 and 11.4 mm. The mean follow-up was 41.7 months. Local control after 3 and 5 years was 92.0% (95% CI = 88.2%-94.7%) and 84.3% (95% CI = 77.9%-89.0%), respectively, for 21 to 22 Gy and 86.9% (95% CI = 79.7%-91.7%) and 77.7% (95% CI = 68.5%-84.6%), respectively, when treated with 20 Gy or less. Eye retention was achieved in 89.9% and 81.0% after 3 and 5 years with 21 to 22 Gy and 85.9% and 80.0% for 20 Gy or less. Disease-specific survival rates were 93.1% (95% CI = 90.2%-95.2%) after 3 years, 89.8% (95% CI = 86.0%-92.6%) after 5 years, and 87.8% (95% CI = 82.8%-91.4%) after 7 years. CONCLUSIONS This is the largest series of patients treated for choroidal and ciliary body melanomas with CyberKnife. Our results reflect an improvement in the outcome of CyberKnife therapy for patients with choroidal and ciliary body melanoma treated with single-session radiosurgery in the last decade.
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Muacevic A, Adler JR, Alharbi M, Alzahrani RS, Almutairi MF. Chromosome 2 Interstitial Deletion (del(2)(q14.1q22.1) Syndrome With Novel Skeletal and Central Nervous System Features. Cureus 2023; 15:e33586. [PMID: 36636524 PMCID: PMC9830841 DOI: 10.7759/cureus.33586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
In this report, we present the case of a Saudi baby boy with a rare de novo interstitial deletion of chromosome 2q14.1-q22.1. His karyotype was confirmed as 46,XY 1(?)q14.2-1q21.3) but further investigation using chromosomal microarray analysis yielded the deletion breakpoints as 2q14.1q22.1. To date, only 10 cases have been reported within or spanning the deletion of the 2q13-2q22.1 region. In comparison to the established cases, our proband shares similar features, such as bitemporal narrowing, deep vein thrombosis, and horseshoe kidney. However, our proband presented with new features which included congenital knee dislocation, congenital vertical talus, bilateral hip dislocation, and myelomeningocele. Moreover, all the reported cases share GLI2 deletion which may reflect the phenotypic features in patients with the deletion of 2q14.1q22.1.
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Muacevic A, Adler JR, Ide Y, Kawai K, Futani H, Shibahara H. Extraskeletal Myxoid Chondrosarcoma of the Vulva: A Case Report. Cureus 2023; 15:e33601. [PMID: 36636521 PMCID: PMC9831112 DOI: 10.7759/cureus.33601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
Extraskeletal myxoid chondrosarcoma (EMC) of the vulva is extremely rare. We report our experience with a case of disease control by radiation therapy to a localized lesion of EMC. A 41-year-old woman presented to our clinic with a vulvar mass. Magnetic resonance imaging showed a 15 cm mass between the perineum and the medial thigh muscle. It was the "adductor magnus muscle." After the needle biopsy, a histopathological diagnosis of EMC was made. Tissue genomic analysis detected the EWSR1-NR4A3 fusion gene. A joint operation by the Department of Orthopedics, Gynecology, and Plastic Surgery was performed, which included a wide excision of the perineum, partial excision of the medial thigh muscle, and rectus abdominis valvuloplasty. Intraoperatively, pubic infiltration was detected. Postoperative pelvic radiotherapy was administered as adjuvant therapy. Recurrent common iliac lymph node metastases outside the irradiation field and multiple lung metastases were observed. Pazopanib was administered as adjuvant therapy. Pulmonary metastases were controlled, but the pelvic tumor had spread, so the patient underwent radiation therapy. After second-line chemotherapy with doxorubicin, left pleural effusion and mediastinal lymph node metastasis appeared, and third-line chemotherapy with eribulin mesylate was administered. The pleural effusion improved, but the patient developed cough again, and trabectedin was administered as the fourth chemotherapy. In this case, there was no local recurrence for three years after radiotherapy, suggesting the effectiveness of radiotherapy in local control.
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Muacevic A, Adler JR, Toyoshima I. Whole-Exome Sequencing Identified a Novel DYRK1A Variant in a Patient With Intellectual Developmental Disorder, Autosomal Dominant 7. Cureus 2023; 15:e33379. [PMID: 36628390 PMCID: PMC9822525 DOI: 10.7759/cureus.33379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/06/2023] Open
Abstract
Intellectual developmental disorder, autosomal dominant 7 (MRD7; OMIM 614104) is a rare disease characterized by microcephaly, intellectual disability, speech delay, feeding difficulties, and facial dysmorphisms. This disorder is caused by pathogenic/likely pathogenic variants of the DYRK1A gene, which encodes dual-specificity tyrosine-phosphorylation-regulated kinase 1A. Here, we report a case of MRD7 that was diagnosed using Face2Gene and whole-exome sequencing (WES). A 22-year-old man presented with microcephaly, intellectual disability, slender body, long slender fingers, and facial dysmorphisms. He was previously diagnosed with Cornelia de Lange syndrome (CdLS) at four years of age. However, his CdLS clinical diagnostic score was low at 22 years of age. The Face2Gene application introduced several candidate diseases including MRD7. Finally, by utilizing WES and Sanger sequencing analysis of cloned cDNA, we identified a novel heterozygous duplication variant (c.848dup, p.(Asn283LysfsTer6)) in the DYRK1A gene, which introduces a premature stop codon. This report provides more information about the phenotypic spectrum of a young adult patient with MRD7. Face2Gene helped us introduce candidate diseases of the patient. Registering further genetically confirmed cases with MRD7 will improve the accuracy of the diagnostic recommendations in Face2Gene. Moreover, WES is a powerful tool for diagnosing rare genetic diseases, such as MRD7.
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Muacevic A, Adler JR, Braud S, Komberg J, Mansour SA, Becker H. An Update on Tissue Contraction in Immediate Breast Reconstruction Using an Adjustable Implant Partially Filled With Air. Cureus 2023; 15:e33463. [PMID: 36628399 PMCID: PMC9822785 DOI: 10.7759/cureus.33463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/09/2023] Open
Abstract
Background With the use of nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) techniques, utilizing a prepectoral underfilled adjustable saline implant allows for tissue contraction and thickening of the flap. This procedure allows for immediate reconstruction using an adjustable implant as a spacer with less risk of skin flap compromise and improves cosmetic outcomes. Methods A retrospective chart review of patients presenting to a single surgeon from September 2013 to September 2021 for breast reconstruction utilizing an underfilled prepectoral adjustable implant following SSM or NSM was performed. Baseline patient demographics, clinical information, postoperative complications, conversion to silicone implant, and contraction distance were recorded and analyzed. Results Fifty-four patients underwent prepectoral breast reconstruction using a Spectrum™ adjustable implant following an NSM or SSM. Tissue contraction and skin flap elevation were observed in all patients. The amount of tissue contraction averaged 4.4 cm (mean). Seven patients (12.96%) developed seromas. Four patients (7.41%) developed hematomas in the early postoperative period. Two patients (3.67%) developed capsular contracture. Two patients (3.67%) had a displaced port. After converting the air to saline, 25 patients (46.29%) opted for a secondary reconstructive procedure to exchange the saline implants for silicone gel implants. Conclusion Tissue contraction reduces the need for skin excision in ptotic breasts undergoing reconstruction procedures following NSM or SSM. The partially filled implant initially functions as a spacer to prevent flap adherence to the pectoral muscle and minimizes tension on the flap to promote flap thickening, elevation around the underfilled implant, and maximizes breast projection and overall aesthetic outcome.
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Muacevic A, Adler JR. Sudden Gross Visual Deterioration: Importance of Examining the Whole Eye. Cureus 2023; 15:e34374. [PMID: 36726769 PMCID: PMC9885514 DOI: 10.7759/cureus.34374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2023] [Indexed: 02/03/2023] Open
Abstract
A 75-year-old caucasian female presented with sudden severe visual deterioration in one eye reduced from 6/9 to counting fingers (CF), with second eye reduction in vision from 6/9 to CF three months later. Past medical history included a background of proliferative diabetic retinopathy, uncontrolled blood pressure, and a 44-year history of poorly controlled type 1 diabetes mellitus (T1DM). Previous ocular history included bilateral pan-retinal photocoagulation for proliferative diabetic retinopathy, followed by bilateral vitrectomies, with subsequent bilateral cataract surgery with intraocular lens implants. A diagnosis of anterior ischemic optic neuropathy (AION) was thought to be the most likely diagnosis due to sudden visual loss, pale discs, and previous long-term history of diabetes and blood pressure with variable control in the absence of a raised erythrocyte sedimentation rate (ESR). However, at the time of the second eye visual loss, the inferior peripheral retina examination revealed bilateral pseudophakic intraocular lens dislocations. With spectacle correction of +11.50/-1.00 x 75 right eye and +11.50/-1.00 x 65 left eye, her visual acuities were 6/12 right eye and 6/9 left eye, and subsequent secondary intraocular lens insertion was planned. This case highlights the importance of a careful review of the whole eye to ensure that remediable causes of visual loss are not missed.
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