Background/Objectives: Hartmann’s procedure is commonly employed to manage complications of acute sigmoid diverticulitis, such as perforation or abscess formation. However, determining the optimal timing for colostomy reversal remains a topic of debate. This study aims to evaluate the effect of early versus delayed colostomy reversal on postoperative outcomes, focusing on complications, hospital stay duration, and readmission rates. Methods: A retrospective cohort study was conducted on 148 patients who underwent Hartmann’s procedure for acute sigmoid diverticulitis at a single tertiary care center between 2014 and 2023. Participants were grouped based on the timing of colostomy reversal: early (45–120 days), intermediate (121–180 days), and late (>180 days). Data on complications, hospital stay length, and readmissions were analyzed. Results: Early reversal was associated with fewer postoperative complications, shorter hospital stays, and reduced readmissions compared to delayed reversal. The late reversal group had higher rates of complications, longer hospital stays, and a higher need for reintervention. Advanced age and comorbidities, such as cardiovascular disease and diabetes, were significant predictors of poor outcomes, contributing to delayed reversal. Logistic regression analysis indicated that late reversal was independently associated with higher complication rates. Conclusions: Early colostomy reversal within 45–120 days following Hartmann’s procedure is associated with improved postoperative outcomes, including fewer complications and a shorter hospital stay. The timing of colostomy reversal should be individualized based on patient health status, with early reversal preferred for those without significant comorbidities. Further prospective research is needed to confirm these findings and refine guidelines for optimal reversal timing.
Dental phobia is a disabling yet underdiagnosed condition that prevents many patients from seeking essential oral healthcare, leading to avoidable pain, disease progression, and reduced quality of life. Cognitive Behavioral Therapy (CBT) is the most widely supported psychological intervention for specific phobias and has demonstrated significant efficacy in reducing dental anxiety and avoidance. This narrative review synthesizes recent evidence on CBT applications for phobia management, with particular emphasis on dental settings. In addition to reviewing established mechanisms of CBT, this paper highlights emerging adjunctive approaches such as virtual reality, eye movement desensitization and reprocessing (EMDR), and hypnosis. Special attention is given to pediatric populations, trauma-exposed individuals, and patients with neurodevelopmental disorders, who are often underrepresented in clinical research. The findings underscore the central role of CBT in addressing dental phobia while identifying gaps in standardized protocols, long-term outcomes, and accessibility across diverse healthcare contexts. Future research should prioritize controlled trials, cultural adaptations, and the integration of psychological training into dental curricula to enhance the translation of evidence into everyday practice.
Background: Dentophobia, a significant barrier to dental healthcare, may be influenced by an increased dependency on digital technology and internet addiction, particularly among younger populations. This study aimed to assess the effectiveness of Virtual Reality Exposure Therapy (VRET) compared to traditional methods in managing dentophobia, particularly among individuals exhibiting high levels of internet dependency. Methods: A comparative study involving two groups, each consisting of 50 young adults aged 18–30 years, diagnosed with dentophobia, was conducted. Group A participants, who exhibited high familiarity and borderline addictive behavior towards digital technologies, received VRET using VR-BOX glasses across four specific dental scenarios: dental chair positioning, oral examination, anesthesia administration, and dental drilling procedures. Group B received traditional “tell–show–do” management without VR assistance. Anxiety levels were evaluated using the Modified Dental Anxiety Scale (MDAS) before and after interventions and at follow-up intervals of one week, three months, and six months. Results: Both groups showed significant reductions in anxiety scores across all follow-up periods. Mild to phobic anxiety scores demonstrated no significant differences between VRET and traditional method groups. The average MDAS scores post-intervention were similar, indicating comparable effectiveness between both treatment modalities. Conclusions: Virtual Reality Exposure Therapy effectively reduces dentophobia among young adults, particularly those with significant internet dependency. Although VRET’s effectiveness was similar to conventional methods, it holds considerable promise for improving treatment adherence and comfort among digitally dependent individuals.
Background: Colonic obstructions present a serious medical emergency that requires prompt surgical intervention to prevent life-threatening complications. Cecostomy, a procedure involving the creation of an opening in the cecum to decompress the colon, serves as one surgical approach for managing these obstructions. The aim of this review is to evaluate the effectiveness and benefits of cecostomies in emergency surgical settings, with a focus on recent clinical studies and case reports. Cecostomy is highlighted as a bridge procedure in cases such as obstructive carcinomas, providing data on success rates, relative survival, and clinical effectiveness. The importance of the patient’s condition and surgeon expertise in selecting cecostomy as a procedure is emphasized. Further comparative research is suggested to optimize the selection criteria, providing a strong, clinically oriented conclusion. Methods: A comprehensive literature review was conducted to identify studies and case reports focusing on the application of cecostomies in cases of acute colonic obstruction. Articles were selected based on their relevance to emergency surgery, the effectiveness of cecostomies, and patient outcomes in various clinical scenarios, including obstructive carcinomas and colonic pseudo-obstructions. Results: The analysis reveals that cecostomies provide rapid decompression and effective relief from colonic obstruction, particularly when immediate intervention is needed to prevent bowel perforation or ischemia. In several cases, cecostomies act as a bridge to more definitive surgical treatments, such as resection and anastomosis, and are associated with reduced morbidity and mortality. The selection of cecostomy as a preferred procedure depends on the patient’s condition, location of the obstruction, and surgeon expertise. Conclusions: Cecostomies play a crucial role in the emergency management of colonic obstructions, offering a viable and sometimes lifesaving alternative for rapid decompression. Understanding the indications and appropriate use of cecostomies can enhance patient outcomes and provide surgeons with effective strategies for managing acute colonic obstructions. Further research is warranted to refine selection criteria and to compare outcomes between cecostomies and other decompressive techniques in emergency settings.
Background: Continuous glucose monitoring (CGM) systems have significantly improved glycemic management in patients with type 1 diabetes mellitus and are generally considered safe. However, transcutaneous sensor insertion disrupts the skin barrier and, in susceptible individuals, may contribute to infectious complications. Severe soft tissue infections occurring in temporal association with CGM use are exceedingly rare. Case Presentation: We report a fatal case of necrotizing soft tissue infection in a 54-year-old male with long-standing type 1 diabetes mellitus occurring in temporal association with CGM use. The patient initially developed localized inflammation at a prior sensor insertion site that failed to fully resolve. Over subsequent weeks, he experienced progressive systemic symptoms and worsening local findings, culminating in advanced necrotizing infection. Despite emergency surgical debridement, broad-spectrum antimicrobial therapy, and intensive care support, the clinical course was complicated by septic shock and multiorgan failure, resulting in death. Discussion: This case highlights the role of patient-specific vulnerability, persistent insertion-site inflammation, and delayed clinical recognition in the progression from localized skin changes to life-threatening infection. Importantly, this report does not establish a direct causal relationship between CGM use and necrotizing soft tissue infection but underscores the need for heightened vigilance in high-risk individuals. Conclusions: Although CGM systems have a favorable safety profile, careful inspection of insertion sites, avoidance of sensor reapplication over incompletely healed tissue, and early evaluation of persistent or progressive symptoms are essential to minimize the risk of severe outcomes in susceptible patients.