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Apocrine Hidrocystoma of Foreskin: A Rare Benign Cystic Lesion (2026)

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Type of publication:

Journal article

Author(s):

Han, Lin Aung; *Potter, Laura; *Bardapure, Mallikarjun.

Citation:

Cureus. 18(4):e107284, 2026 Apr.

Abstract:

Apocrine hidrocystoma is a benign cystic tumour arising from apocrine sweat glands. Its occurrence on the penile foreskin is exceedingly rare, representing an uncommon lesion of the external genitalia. A review of the literature suggests that only a limited number of cases -- approximately 13 involving external genitalia -- have been reported worldwide. We present the case of a 50-year-old gentleman who was referred to the urology service with a gradually enlarging, multiloculated, non-proliferative cyst arising from the foreskin. Patient underwent excisional biopsy with complete circumcision under local anaesthesia. Histopathology examination confirmed the diagnosis of apocrine hidrocystoma. Apocrine hidrocystomas are mostly located in the head and neck region, particularly the periorbital area, external auditory meatus, and axilla, with genital involvement being exceptionally uncommon. Complete surgical excision is both diagnostic and curative with a low risk of recurrence. Reports of apocrine hidrocystoma involving the foreskin remain scarce in the literature. To our knowledge, this represents the first reported case from Royal Shrewsbury Hospital.

DOI: 10.7759/cureus.107284

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An Electromyographic Study Comparing Muscle Function During Supination and Pronation of the Forearm (2026)

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Type of publication:

Journal article

Author(s):

Kondi, Suresh; *Murugesan, Thivagar; Postans, Neil; Thumri, Paavana; Kantamaneni, Ketan; Ansari, Shahbaz; Pickard, Simon.

Citation:

Cureus. 18(1):e101255, 2026 Jan.

Abstract:

BACKGROUND: Forearm pronation and supination are fundamental movements essential for daily activities and clinical applications. While supinator and biceps brachii contribute to supination, and pronator quadratus and pronator teres facilitate pronation, the precise activation patterns and torque-dependent recruitment strategies of these muscles remain incompletely understood. Conflicting evidence exists regarding muscle contribution at varying load conditions, with implications for rehabilitation protocols, surgical planning, and prosthetic design.

PURPOSE: This study aimed to quantify and compare the electromyographic (EMG) activity of forearm rotator muscles during isometric contraction under progressively increasing torque loads during both supination and pronation movements.

METHODS: Four healthy right-handed subjects (3 males, 1 female; mean age 32.5 years) underwent simultaneous EMG and motion capture recording. Surface electrodes captured activity from biceps brachii, triceps, pronator teres, and pronator quadratus, while fine-wire electrodes measured supinator muscle activity. Participants maintained a neutral forearm position against applied loads of 1 kilogram positioned at increasing distances (10-35 cm) from the supination axis, creating progressively higher torques. EMG signals were filtered, rectified, normalized, and analyzed using root mean square values across three trials per loading condition.

RESULTS: During supination resistance, the supinator demonstrated higher activation at lower torques compared to the biceps brachii. As applied torque increased, the biceps brachii activity increased proportionally more than the supinator, indicating load-dependent recruitment. Triceps showed increased co-activation for joint stability. During pronation resistance, the pronator quadratus exhibited greater activity at lower torques relative to the pronator teres. With increasing torque, the pronator teres demonstrated relatively greater activation increases than the pronator quadratus. Both movement patterns demonstrated progressive recruitment of multi-joint muscles as torque demands increased.

CONCLUSIONS: This pilot EMG study (n=4) provides preliminary descriptive evidence suggesting that supinator and pronator quadratus primarily govern low-torque forearm rotation, while biceps brachii and pronator teres become increasingly dominant during high-torque demands. These observed patterns are consistent with a hierarchical muscle recruitment strategy optimized for mechanical efficiency and joint stability. Understanding these activation patterns may have potential clinical applications for rehabilitation protocol design following nerve injury or tendon rupture, surgical planning for nerve transfer procedures, and development of myoelectric prosthetic control algorithms.

DOI: 10.7759/cureus.101255

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A multicentered retrospective cohort study comparing JAK inhibitor therapies in moderate-to-severe ulcerative colitis (2026)

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Type of publication:

Journal article

Author(s):

Kumar, Aditi; Baxter, Joshua; Rimmer, Peter; Noble, Ben; Bower, Joshua; Makki, Mujeeb Ullah; Hatta, Ayiesha; Chikhlia, Anmol; Cheesbrough, Jonathan; Disney, Ben; *Muir, Josh; *Karova, Mariya; *Butterworth, Jeffrey; Sagar, Nidhi; Al-Talib, Ismaeel; Nahal, Jasbir; Ali, Nasima; Sagar, Vandana; Varyani, Fumi; Smith, Sam; Bourne, Stephanie; Hsu, Yu-Kai; Eltahir, Almoiez; de Silva, Shanika; Harvey, Philip.

Citation:

Crohn's & Colitis 360. 8(2):otag045, 2026 Apr.

Abstract:

Background: Tofacitinib, filgotinib, and upadacitinib are Janus kinase inhibitors (JAKi) that have demonstrated efficacy in ulcerative colitis (UC) against placebo. This study aims to compare the clinical efficacy between these drugs.

Methods: This is a multicentered, retrospective cohort study. Patients with UC starting a JAKi were recruited between 2018 and 2024 when starting their first JAKi. Clinical remission and response, based on clinical scores, calprotectin, and endoscopic measurement, were assessed at 3 and 6 months. Both independent and combined variable outcomes were analyzed.

Results: Two hundred and seventy patients were included in the analysis, of which 70 (26%) were on upadacitinib, 51 (19%) on filgotinib, and 149 (55%) on tofacitinib. Clinical, biochemical, and endoscopic remission at 6 months was 91%, 71%, and 80% for upadacitinib; 78%, 67%, and 50% for filgotinib; 73%, 51%, and 44% for tofacitinib. Upadacitinib demonstrated significantly greater clinical response (P = .027) and remission (P = .037) rates at 6 months than tofacitinib. Drug persistence at 12 months was 86% for upadacitinib, 72% for filgotinib, and 69% for tofacitinib. Upadacitinib demonstrated significantly greater 6-month remission rates compared to tofacitinib in the bio-exposed cohort (71% vs 52%, P = .022) and in the bio-naive cohort (93% vs 50%, P = .009). The incidence rates for hospital admissions were 10.2, 21.9, and 14.1 and for colectomies were 6.7, 10.0, and 5.0 per 1000 patient-months at risk for upadacitinib, filgotinib and tofacitinib, respectively.

Conclusion: This study demonstrates that upadacitinib is more likely to achieve 6-month response and remission compared to tofacitinib. In both bio-naive and bio-exposed patients, upadacitinib was more likely to achieve remission at 6 months. The efficacy of JAKi does not appear diminished by prior biologic use.

DOI: 10.1093/crocol/otag045

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Intranetwork variation in neoadjuvant therapy delivery for borderline resectable and locally advanced pancreatic cancer: a UK multicentre cohort study (2026)

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Type of publication:

Journal article

Author(s):

Labib, P L; Alarabiyat, M; Powell-Brett, S; Hall, L; Rehman, S; Edwards, D; Ma, Y T; Sivakumar, S; Good, J; Candish, C; Nagy, A; Tsalic, M; Hafeez, T; Kunene, V; *Chatterjee, A; Roberts, K J; Chatzizacharias, N.

Citation:

Annals of the Royal College of Surgeons of England. 2026 Apr 09.

Abstract:

INTRODUCTION: Pancreatic cancer (PC) treatment in the UK is coordinated via regional referral networks, but formal neoadjuvant chemotherapy (NAC) pathways for borderline resectable and locally advanced PC (BR/LAPC) are rare. This cohort study assessed intranetwork variation in access to diagnostics, time to treatment and patient outcomes following NAC for BR/LAPC in our network.

METHODS: All patients with BR/LAPC referred from regional network hospitals between 2017 and 2021 were reviewed. Data were collected on time from first diagnostic computed tomography scan to endoscopy, commencement of NAC, NAC regimens administered and patient outcomes.

RESULTS: In the 155 patients who commenced NAC, there were significant differences in median time to biliary drainage and endoscopic ultrasound between referral hospitals. Time from decision to treat to first administration of NAC was long (median 64 days). There were significant differences in the proportion of patients commenced on mFOLFIRINOX (0-100%, p<0.001) and the proportion completing NAC (0-100%, p=0.012). The likelihood of proceeding to surgical resection was similar between centres.

CONCLUSIONS: There is significant intranetwork variation in access to interventional endoscopy and choice of NAC regimen. Centralised tracking of patients receiving NAC, development of locally agreed treatment protocols and an update to national guidelines are needed to standardise NAC pathways for BR/LAPC.

DOI: 10.1308/rcsann.2026.0023

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Optimising Performance Through Sleep: An Evidence-Based Review (2026)

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Type of publication:

Journal article

Author(s):

*Bastock, Daniel; Amarnani, Raj.

Citation:

Cureus. 18(7):e111990, 2026 Jul.

Abstract:

Sleep is increasingly being recognised as an important factor influencing athletic performance, recovery and overall health. This narrative review aims to discuss the factors that can affect sleep in athletes and how sleep can affect performance. Traditionally, athlete well-being has focused on training and nutrition; however, new evidence and initiatives now highlight sleep as an important element of performance. This review examines current evidence on sleep duration, sleep quality and sleep disturbances in athletic populations, with a particular focus on the effects related to competition. Athletes often report shorter sleep durations than non-athletes, despite experiencing less sleep fragmentation and quicker sleep onset. One study found that on nights before a competition day, athletes went to bed earlier (22:56 hr +/- 49.2 min), woke up later (8:12 hr +/- 58.6 min) and slept for longer (7:57 hr +/- 60.9 min). A significant number of athletes face poor sleep quality, difficulty falling asleep, and excessive daytime sleepiness. Sleep disruptions are also common around competitions, with post-competition nights showing reductions in total sleep time and sleep quality compared to pre-competition nights. Factors contributing to this include late competition times, heightened physiological and psychological arousal, increased caffeine intake, travel demands and use of technology. Overall, these findings demonstrate that inadequate and disturbed sleep is widespread among athletes, especially during competition periods, which may impact recovery, cognitive function and emotional stability.

DOI: 10.1002/wjs.70558

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Interventions to Reduce Surgical Site Infection in Transmetatarsal Forefoot Amputations: A Feasibility Survey (2026)

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Type of publication:

Journal article

Author(s):

*Alawattegama, Lakna Harindi; Al-Saadi, Nina; Bosanquet, David; Chetter, Ian; Fabre, Ismay; Garnham, Andrew; Gwilym, Brenig; Hitchman, Louise; Long, Judith; Magill, Laura; Worrallo, Katie; Pinkney, Thomas; Popplewell, Matthew; Wall, Michael.

Citation:

International Wound Journal. 23(4):e70846, 2026 Apr.

Abstract:

Surgical site infection (SSI) following transmetatarsal amputation (TMA) is common and associated with significant morbidity. However, there is limited evidence to guide perioperative strategies for SSI prevention in this population. A prospective, cross-sectional survey was conducted among vascular specialists. The questionnaire assessed current practice in SSI prevention for TMA, perceptions of evidence gaps, and willingness to participate in future research. Responses were analysed descriptively. Eighty-four valid responses were analysed, with 64.3% from consultant vascular surgeons and 84.5% from UK centres. Most respondents (84.5%) considered SSI after TMA to be a significant issue. The majority preferred primary closure in clean wounds (78.6%) and commonly used short-course antibiotics and interrupted sutures. Over 70% agreed no clear best practice exists, and 65.5% felt high-quality randomised trials are needed. Ninety-three percent expressed willingness to engage in future studies. Equipoise existed regarding interventions including antibiotic duration, wound adjuncts, and closure techniques. Opinion varied regarding whether TMA and major lower limb amputation should be pooled when undertaking research into SSI prevention. Current practice in SSI prevention for TMA is highly variable. This survey demonstrates broad support for rigorous trials to establish effective strategies and highlights the feasibility of future research in this area.

DOI: 10.1111/iwj.70846

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Continuous Infusion and Sequential Nephron Blockade Versus Bolus Furosemide in Acute Heart Failure: A Systematic Review (2026)

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Type of publication:

Systematic review

Author(s):

Ahmed Mohamed, Leena Awad Alkareem; *Abozaid, Khalid; Mohammed Ahmed Hassan, Hala Fakhri; Ali, Yasir; Hussein Abdalla, Nibras Elfatih; Ibrahim, Mohamed Samir Yasin; Ahmed Mohammed, Weam Mohammed; Babikir Omer, Ahmed Mohammed; Awad, Alaa.

Citation:

Cureus. 18(6):e111063, 2026 Jun.

Abstract:

Acute heart failure (AHF) is a leading cause of hospitalization worldwide, with congestion as its central pathophysiologic feature. Loop diuretics, particularly furosemide, remain the cornerstone of decongestive therapy, yet the optimal administration strategy, continuous infusion versus bolus dosing, remains debated. Furthermore, sequential nephron blockade through the addition of distal tubule-acting diuretics or sodium-glucose cotransporter-2 (SGLT2) inhibitors has emerged as a strategy to overcome diuretic resistance. This systematic review had two primary objectives: first, to compare continuous infusion versus bolus dosing of furosemide; second, to evaluate the efficacy and safety of adjunctive sequential nephron blockade (SGLT2 inhibitors, thiazides, and acetazolamide) added to loop diuretics within the context of the ongoing debate over optimal decongestion in AHF. A systematic literature search was conducted in PubMed, Scopus, Web of Science, the Cochrane Library, and ClinicalTrials.gov for studies published between 2021 and 2025. Eligible studies included randomized controlled trials (RCTs) and prospective observational studies evaluating either continuous furosemide infusion versus bolus furosemide or adjunctive sequential nephron blockade (added to loop diuretics) versus placebo, usual care, or, in one case, an active diuretic comparator. The Cochrane Risk of Bias 2 (RoB 2) tool was used for RCTs, and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool was used for the nonrandomized study. A narrative synthesis was performed because of substantial clinical and methodological heterogeneity. Ten studies (nine RCTs and one prospective observational study) comprising 2,972 patients were included. Continuous furosemide infusion consistently improved surrogate measures of decongestion (urine output and weight loss) compared with bolus dosing. However, these benefits did not reliably translate into improved symptoms or shorter hospital stays, and one large study reported increased renal injury and adverse events, highlighting a potential efficacy-safety trade-off. Sequential nephron blockade with SGLT2 inhibitors enhanced diuresis with favorable renal and electrolyte safety profiles and a nonsignificant trend toward lower mortality (the studies were not powered for mortality). Thiazide-based strategies achieved potent diuresis but significantly increased the risks of acute kidney injury and electrolyte disturbances without a mortality benefit. Acetazolamide improved decongestion safely but did not reduce mortality or readmissions. No single decongestive strategy is universally superior. However, direct comparisons across strategies are limited by substantial heterogeneity in study design, patient populations (e.g., renal function and congestion severity), and outcome definitions. Continuous furosemide infusion offers enhanced diuresis but inconsistent clinical benefits and potential renal harm. Based largely on surrogate outcomes from heterogeneous studies not designed to detect differences in mortality or readmissions, definitive clinical recommendations remain limited. SGLT2 inhibitors represent a promising but not yet proven adjunct in AHF, pending larger, adequately powered trials. Thiazide-based sequential blockade should be reserved for refractory cases with close monitoring. Treatment should be individualized based on baseline renal function, congestion severity, and electrolyte status.

DOI: 10.7759/cureus.111063

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Fecal Microbiota Transplantation (FMT) in the Management of Ulcerative Colitis: A Comprehensive Systematic Review and Meta-Analysis of Randomized Controlled Trials (RCTs) (2026)

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Type of publication:

Systematic review

Author(s):

Ahad, Amal; Kumar, Sandeep; Kolomar, Hugh; Williams, Jada; Abdallah, Abrar I; Sadeghzadegan, Amirali; *Yateem, Dana; Kharel, Punam; Chowdhury, Dristy; Alnajar, Fahad; Ali, Muqaddas.

Citation:

Cureus. 18(6):e111804, 2026 Jun.

Abstract:

Ulcerative colitis (UC) is a chronic inflammatory disorder of the colon with increasing global prevalence, particularly in newly industrialized countries. Fecal microbiota transplantation (FMT) has worked as an effective therapeutic strategy aimed at restoring immune homeostasis and gut microbial balance. However, a lack of standardized protocols and comprehensive safety data necessitates further evaluation. This meta-analysis aims to comprehensively analyze the efficacy of FMT in inducing clinical remission in UC, incorporating the latest randomized controlled trials (RCTs). A systematic review and meta-analysis of RCTs investigating FMT in UC were conducted. The primary outcomes were clinical and endoscopic remission, while adverse events (AEs) were assessed as secondary outcomes. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated, and heterogeneity was analyzed using the I2 statistic and Cochran's Q test. Overall, FMT demonstrated a significant benefit in inducing clinical remission compared with placebo (RR 1.55; 95% CI 1.22-1.96; p = 0.0003). For endoscopic remission, FMT showed a significant overall effect (RR 1.68; 95% CI 1.15-2.46; p = 0.007). The incidence of AEs was comparable between the FMT and control groups (RR 0.88; 95% CI 0.77-1.00; p = 0.06). This meta-analysis gives strong confirmation for the efficacy of FMT in inducing both clinical and endoscopic remission in UC patients, with a favorable safety profile. Multi-donor FMT and oral capsule administration appear to be particularly promising. Future research should focus on standardizing protocols, elucidating mechanisms of action, and conducting larger, long-term trials to optimize FMT for UC.

DOI: 10.7759/cureus.111804

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Coexistence of Elevated Mean Platelet Volume and Bleeding Symptoms in Chronic Kidney Disease: A Discordant Hemostatic Profile (2026)

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Type of publication:

Journal article

Author(s):

Adeyeye, Ayomide; Abdul Sattar, Tehzeeb; Mani Tripathi, Kaushalendra; Ali, Sahil; Samuel, Paul Sunday; Uzzaman, Gkm Rashik; *Oso, Ayodeji; Abughazal, Mahmoud Am; Shreen, Sibgha

Citation:

Cureus. 18(6):e111383, 2026 Jun.

Abstract:

BACKGROUND: Hemostasis in chronic kidney disease (CKD) is currently becoming a complicated and disturbed process, not a simple bleeding disorder. Recent evidence suggests that the combination of elevated mean platelet volume (MPV) and bleeding, particularly during the initial phases of the disease, is a discordant hemostatic profile.

OBJECTIVE: To examine the association between mean platelet volume (MPV) and bleeding symptoms among patients with chronic kidney disease (CKD) and to evaluate the utility of platelet indices in characterizing a discordant hemostatic profile.

METHODS: This analytical cross-sectional study recruited 527 patients with CKD from tertiary care centers. Bleeding was measured on a questionnaire that included typical bleeding symptoms and a bleeding score. Platelet indices, such as mean platelet volume (MPV), platelet distribution width (PDW), and platelet count, were provided in the medical records. Data were evaluated using nonparametric tests, logistic regression, and receiver operating characteristic (ROC) curves.

RESULTS: Bleeding symptoms were observed in 298 patients (56.5%). Bleeding participants had increased MPV, which increased with increasing CKD stages. Multivariate analysis showed MPV was significantly associated with bleeding symptoms (OR = 2.88, p < 0.001). ROC curves indicated moderate discriminative ability (area under the curve (AUC) = 0.730), but poor performance of PDW and non-predictive value of platelet count.

CONCLUSION: CKD is associated with a discordant hemostatic profile of elevated MPV alongside bleeding symptoms. MPV may serve as a potential marker associated with bleeding symptoms in patients with CKD.

DOI: 10.7759/cureus.111383

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Trochanteric Buttress Plate Augmentation of the Proximal Femoral Nail for Unstable Intertrochanteric Fractures: A Randomized Controlled Trial (2026)

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Type of publication:

Randomised controlled trial

Author(s):

*Abdelaty Shalaby, Mohamed H; *Khafagy, Doaa G; Hosny, Mohamed M; Eltantawy, Ahmed E; Omran, Ali M.

Citation:

Cureus. 18(2):e104235, 2026 Feb.

Abstract:

BACKGROUND: Unstable intertrochanteric (IT) fractures pose a significant challenge in orthopedic surgery.

OBJECTIVE: To investigate the effectiveness of combining a trochanteric buttress plate (TBP) with a proximal femoral nail (PFN) for managing unstable IT fractures.

METHODS: This randomized controlled open-label study was performed on 90 patients with recent unstable IT fractures (Evans types 1c, 1d, 1e, or 2). Patients were randomly divided into two groups: Group A was treated with standard PFN fixation. Group B was treated with PFN integrated with TBP augmentation. Assessments were conducted at two weeks and monthly for six months. Functional outcomes were assessed using the modified Harris Hip Score (mHHS).

RESULTS: Operative time and blood loss were significantly higher in Group B (PFN+TBP) than in Group A (standard PFN) (P = 0.005 and 0.006, respectively). Postoperative mHHS was significantly higher in Group B at all follow-up intervals from two weeks to six months (P < 0.05).

CONCLUSIONS: The integration of the TBP with PFN for unstable IT fractures significantly improves functional outcomes without increasing major complications, despite a modest increase in operative time and blood loss.

DOI: 10.7759/cureus.104235

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