Category: Nevin Manimala

Cureus. 2025 Apr 25;17(4):e82976. doi: 10.7759/cureus.82976. eCollection 2025 Apr.

ABSTRACT

Background Primary bladder neck obstruction (PBNO) in females is a rare condition with a tedious diagnostic process. The existing literature on bladder neck incision (BNI) to treat PBNO lacks a precise description of the surgical technique. Objective In this study, we provide a diagnostic protocol to streamline the evaluation of PBNO in females. We evaluate the outcomes of a precise surgical technique of BNI aimed at reducing the rates of known complications such as vesicovaginal fistula (VVF) and urinary incontinence. Methods This single-center prospective observational study, conducted over five years (2019-2024), included 20 patients diagnosed with PBNO who underwent BNI. Analyses included patient demographics, clinical presentation, treatment outcomes, and complications. Statistical analysis was performed using ANOVA, and univariate analysis was also conducted. Differences with P < 0.05 were considered statistically significant. Results At six months post-surgery, the mean maximum urinary flow rate (Qmax) increased from 6.49 ± 2.63 mL/sec to 12.41 ± 2.42 mL/sec (P = 0.0421). The mean post-void residual volume (PVR) decreased from 202.11 ± 70.20 mL to 53.11 ± 14.78 mL (P = 0.0152). The mean International Prostate Symptom Score (IPSS) decreased from 26.95 ± 2.84 to 14.74 ± 3.23 (P = 0.0325). The mean quality of life (QoL) score improved from 4.70 ± 0.80 to 1.60 ± 0.12 (P = 0.0067). None of the patients developed VVF or urinary incontinence in the post-operative period. One patient (5%) required re-surgery due to recurrence of bladder neck obstruction. Conclusion BNI for PBNO provides satisfactory results. A precise operative technique, with careful consideration of the depth and distal extent of the incision, helps avoid complications such as VVF and urinary incontinence.

PMID:40416261 | PMC:PMC12103814 | DOI:10.7759/cureus.82976

Cureus. 2025 Apr 25;17(4):e82965. doi: 10.7759/cureus.82965. eCollection 2025 Apr.

ABSTRACT

Introduction The anterior cruciate ligament (ACL) is essential for knee stability, and its injury significantly impacts athletic performance. Anterior cruciate ligament reconstruction (ACLR) is the standard treatment for active individuals, yet many fail to return to sport (RTS) due to factors like pain and kinesiophobia. This study explores these barriers in the Saudi Arabian population. Methodology This is a cross-sectional study using an online questionnaire targeting ACLR patients across five Saudi hospitals between 2017 and 2023. Tools included are the International Knee Documentation Committee’s (IKDC) scale and the Tampa Scale for Kinesiophobia (TSK-11) score. Data was analyzed using IBM SPSS Statistics software, version 29.0.0 (IBM Corp., Armonk, NY). Results Our study included 84 participants undergoing ACL reconstruction. Most were aged between 18 and 25 years (n=35, 41.7%), male (n=75, 89.3%), and employed (n=65, 77.4%). Only 44.0% (n=37) returned to their pre-injury level of sport. Moderate fear of re-injury was common (n=67, 79.8%), and fear significantly correlated with lower IKDC scores (r = -0.410, p < 0.001). Participants with minimal fear had the highest IKDC score (81.01 ± 9.47, p < 0.001). Functional limitation was significantly associated with RTS (p < 0.001); none with moderate/severe limitations returned. Lower pain scores (1.77 vs. 4.35, p = 0.005), lower TSK-11 scores (15.77 vs. 22.90, p < 0.001), and higher knee function (81.01 vs. 63.02, p < 0.001) were significantly linked to RTS. Height > 180 cm was also significantly associated with RTS (p = 0.011). Conclusion Our findings show that returning to sport after ACLR is strongly influenced by functional ability, pain severity, and fear of re-injury. Psychological readiness, particularly kinesiophobia, plays a critical role. Addressing both physical limitations and mental barriers is essential to improve RTS outcomes in post-ACLR patients.

PMID:40416260 | PMC:PMC12103728 | DOI:10.7759/cureus.82965

Cureus. 2025 Apr 24;17(4):e82955. doi: 10.7759/cureus.82955. eCollection 2025 Apr.

ABSTRACT

Polymerase chain reaction (PCR) tests are the gold standard for confirming COVID-19. Test results provide the cycle threshold (Ct) value, which is correlated to the patient’s viral load as well as hematological and biochemical parameters. The purpose of this study is to analyze the transmission dynamics of selected SARS-CoV-2 variants, both within hosts and between hosts, through statistics and data analysis of the Ct values and other metrics. Demographics data and Ct values from 1,041 patients with COVID-19 were collected and correlated with epidemiological indices, such as the positivity rate, hospitalizations, and deaths for each major wave of the pandemic, in Greece. The analysis showed that higher viral loads coincide with rising pandemic waves, while lower loads are observed during periods of decline. Notably, among all variants analyzed, the Delta variant, observed in mid-2021, exhibited the highest viral load values, which were associated with increased hospitalizations and mortality, despite a relatively low positivity rate. Consequently, variables associated with inter-host transmission dynamics show a significant correlation with those pertaining to intra-host dynamics. This correlation opens up the potential for predicting disease severity and forecasting the trajectory of the pandemic based on patient-related and other variables through data analysis. The analysis revealed that variations in Ct value yield valuable insights into the evolution of the pandemic and the risk stratification of patients. The study highlights that statistical measures derived from Ct values can provide insights into both intra-host and inter-host transmission dynamics, potentially supporting risk assessment and public health responses.

PMID:40416259 | PMC:PMC12103932 | DOI:10.7759/cureus.82955

Cureus. 2025 Apr 23;17(4):e82832. doi: 10.7759/cureus.82832. eCollection 2025 Apr.

ABSTRACT

Introduction Ebolaviruses are negative-stranded RNA viruses in the Filoviridae family. They are transmitted to humans through direct contact with the bodily fluids of infected individuals or animals, and they cause severe and often fatal hemorrhagic fever, with mortality rates ranging from 25% to 90%, depending on the outbreak and available healthcare resources. These viruses cause severe systemic disease with high mortality rates. Given the infectious nature of Ebola and the critical role of healthcare providers in managing outbreaks, educating nursing students on the virus’s transmission, prevention, and treatment is essential. Enhancing the knowledge of future healthcare professionals can improve healthcare system preparedness, ensuring effective response during outbreaks and reducing the virus’s impact. Methodology A quasi-experimental one-group pre-test post-test design was utilized to assess the effectiveness of a planned teaching program on Ebola virus knowledge among nursing students. A simple random sampling technique was employed to select participants from nursing colleges in Navi Mumbai. The teaching program, which covered Ebola virus transmission, prevention, and treatment, was administered to the selected students. A pre-test was conducted to assess baseline knowledge, followed by the teaching intervention, and a post-test was performed to measure knowledge gains. Data were analyzed using frequency and percentage distribution and paired t-tests to compare pre-test and post-test scores. Results A study was conducted with 50 second-year Bachelor of Science in Nursing students from MGM College of Nursing, Navi Mumbai, to assess the impact of an educational intervention. Participants included 41 females (82%) and nine males (18%), with most living in nuclear families (38 (76%)) and urban areas (45 (90%)). Before the intervention, the pre-test showed that participants’ knowledge levels varied: 10 (20%) had average knowledge, eight (16%) had poor knowledge, and 32 (64%) had good knowledge. After the intervention, there was a marked improvement: 32 participants (64%) exhibited excellent knowledge, 16 (32%) had good knowledge, and only two (4%) remained at the average level. This shift highlights the effectiveness of the intervention in enhancing participants’ understanding. Statistical analysis using paired t-tests confirmed a significant increase in knowledge, with no notable associations between demographic variables and pre-test scores. Conclusion The study concluded that the planned teaching program significantly enhanced the knowledge of nursing students regarding Ebola virus infection. A notable improvement was observed in the post-test, with most students demonstrating excellent and good knowledge compared to average and poor knowledge levels in the pre-test. These results suggest that targeted educational interventions are effective in improving healthcare students’ understanding of critical infectious diseases like Ebola. Furthermore, no significant associations were found between demographic variables and pre-test knowledge scores, indicating that the teaching program effectively reached all students. The findings underscore the importance of incorporating such teaching programs into nursing curricula to prepare students for managing future public health challenges.

PMID:40416252 | PMC:PMC12102646 | DOI:10.7759/cureus.82832

Cureus. 2025 Apr 23;17(4):e82820. doi: 10.7759/cureus.82820. eCollection 2025 Apr.

ABSTRACT

Introduction Pterygoid implants serve as an alternative for rehabilitating a posterior atrophic maxilla without requiring extensive bone grafting or sinus augmentation. This study aimed to evaluate the clinical outcomes and success rates of pterygoid implants over a one-year follow-up period and assess the influence of bone quality, complications, and other patient-related factors on implant success. Materials and methods A total of 34 patients with a posterior atrophic maxilla received 35 pterygoid implants. Preoperative cone-beam computed tomography (CBCT) was used to assess bone quality, and the implants were placed using a standardized surgical protocol. Clinical parameters, including primary stability, marginal bone loss, postoperative complications, and patient-reported outcomes, were recorded. Implant success was defined as the absence of pain, mobility, radiographic bone loss beyond 1.5 mm during one-year follow-up, or infection. Patient-reported outcomes were evaluated using the Oral Health Impact Profile (OHIP-14). Statistical analysis was conducted to determine the correlation between implant success and influencing factors such as bone density, complications, smoking history, age, and implant length. Results The overall success rate was 31 (88.57%) pterygoid implants within the one-year follow-up period. Bone quality significantly affected implant success, with D3 showing a higher failure rate than D2 (p = 0.029). Complications, including implant fracture, prosthetic failure, and nerve injury, were significantly associated with implant failure (p = 0.001). Marginal bone loss was higher in the failed implants, supporting its role as a predictive factor of long-term success. Patient age, sex, smoking history, and implant length did not significantly influence outcomes. OHIP-14 scores indicated that patients with successful implants reported improved function and quality of life. Conclusion The pterygoid implants demonstrated a high success rate and served as a viable treatment for posterior maxillary rehabilitation. Bone quality and complications were the key determinants of implant success, whereas age, sex, smoking history, and implant length had no significant impact. Marginal bone loss has emerged as a crucial factor for implant failure, highlighting the importance of postoperative monitoring.

PMID:40416251 | PMC:PMC12099467 | DOI:10.7759/cureus.82820

Cureus. 2025 Apr 23;17(4):e82824. doi: 10.7759/cureus.82824. eCollection 2025 Apr.

ABSTRACT

INTRODUCTION: Celiac disease (CD) is an autoimmune condition triggered by gluten ingestion. Limited data are available on its prevalence and characteristics in Yemen, a region facing socioeconomic challenges intensified by conflict. This study aimed to estimate the prevalence of CD and evaluate the demographic, clinical, and nutritional profiles of affected children.

METHODS: This five-year retrospective study analyzed data from 120 children diagnosed with CD at Al-Sabeen Hospital, Sana’a, Yemen, from January 2018 to December 2023. Children of any age and sex clinically suspected of having CD based on gastrointestinal (e.g., chronic diarrhea) and/or extraintestinal manifestations (e.g., failure to thrive) were included, with non-CD causes excluded via European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)-guided testing. Diagnosis followed the guidelines of the ESPGHAN guidelines, using transglutaminase 2 antibody (tTA-IgA) and endomysial antibody IgA (EMA IgA) levels, with biopsy recommended for tTA-IgA <10× the upper limit of normal. Data on demographics, nutritional status, clinical manifestations, and associations were collected via a structured questionnaire and analyzed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States), with chi-square tests assessing significance (p<0.05).

RESULTS: Among 3,570 admissions, CD prevalence was 3.4% (n=120), with a female predominance (58.3%, n=70) and 70% (n=84) diagnosed before the age of one year (mean 12 ± 3.5 months). Malnutrition affected 60.0% of cases, significantly associated with rural residency (p=0.015), low family income (p=0.001), unprotected water sources (p=0.030), and incomplete vaccination (p<0.001). Chronic diarrhea (85.0%) and pallor (81.7%) were the most common manifestations. No significant associations were found for sex (p=0.705) or animal contact (p=0.053).

CONCLUSIONS: CD prevalence in Yemeni children exceeds the global average, with malnutrition being a major comorbidity linked to socioeconomic and environmental factors. Targeted screening, biopsy-confirmed diagnosis for ambiguous cases, and nutritional interventions are critical in conflict-affected settings such as Yemen. Future multicenter studies with genetic testing are recommended to enhance our understanding and management.

PMID:40416247 | PMC:PMC12100572 | DOI:10.7759/cureus.82824

JACC Cardiovasc Interv. 2025 May 21:S1936-8798(25)01447-5. doi: 10.1016/j.jcin.2025.05.028. Online ahead of print.

ABSTRACT

BACKGROUND: Coronary microvascular dysfunction appears to play a major role in the pathogenesis of Takotsubo Syndrome (TTS). However, the prognostic value of microvascular function measured in the acute phase of TTS is unclear.

METHODS: In a collaborative, pooled analysis of individual patient data from nine prospective TTS cohorts, invasive assessment of coronary microvascular function was performed, including the index of microcirculatory resistance (IMR), coronary flow reserve (CFR), and microvascular resistance reserve (MRR). The primary endpoint was all-cause mortality. Secondary endpoints included major adverse cardiac and cerebrovascular events (MACCE) defined as the composite of all-cause death, recurrence of TTS, stroke, transient ischemic attack, or myocardial infarction.

RESULTS: One hundred and sixty six patients with TTS were included, in whom 130 (78%) had the typical (apical) TTS variant and 36 (22%) an atypical variant. During a median follow-up of 20.6 [4.3 – 60.0] months, all-cause mortality occurred in 17 patients (10.2%) and MACCE in 29 patients (17.5%). IMR, CFR, and MRR were associated with all-cause mortality. After adjustment for baseline differences, IMR was the only independent predictor of both all-cause mortality (aHR 3.9; 95% CI: 1.39-10.88, P = 0.010; c-statistic 0.817 (95% CI: 0.711-0.923)) and MACCE (aHR 2.6; 95% CI: 1.17-5.67; P = 0.018; c-statistic 0.719 (95% CI: 0.612-0.826)).

CONCLUSIONS: In this pooled analysis of individual patient data from nine prospective TTS cohorts, microvascular dysfunction measured in the acute phase, was associated with all-cause mortality. In particular, an elevated microvascular resistance, as assessed by IMR, was the only independent predictor of both mortality and MACCE.

PMID:40415182 | DOI:10.1016/j.jcin.2025.05.028

Alzheimers Dement. 2025 May;21(5):e70304. doi: 10.1002/alz.70304.

ABSTRACT

INTRODUCTION: We examined sex effects on amyloid positron emission tomography (PET) in a large cohort of patients evaluated for cognitive complaints in a “real-world” specialty setting.

METHODS: We analyzed 10,361 amyloid PET scans (51% females) from the Imaging Dementia-Evidence for Amyloid Scanning Study. Amyloid positivity was defined by either local visual read or central PET processing and quantification (≥ 24.4 Centiloids). Sex differences were examined using multilinear regression and logistic regression adjusted for age, comorbidities, and other demographic and clinical covariates.

RESULTS: Females had higher rates of positive amyloid PET visual reads (63% vs. 59%, P < 0.001) and higher Centiloids (CLs; median 48.7 vs. 36.8, p < 0.001). On logistic regression, females had higher odds ratios (ORs) for positive amyloid PET (visual read OR 1.20, 95% confidence interval [CI]: 1.11-1.31; CL threshold-based OR 1.37, 95% CI: 1.26-1.49; both p < 0.001).

DISCUSSION: Females with cognitive impairment showed higher amyloid PET positivity and greater amyloid burden. Further research is needed to explore mechanisms and treatment implications.

HIGHLIGHTS: Females exhibited higher rates of amyloid positron emission tomography (PET) positivity and higher amyloid burden than males. These sex effects were found in patients with both mild cognitive impairment (MCI) and dementia. Females also had higher rates of dementia and amnestic MCI, while males had higher rates of non-amnestic MCI and more cholinesterase inhibitor use.

PMID:40415175 | DOI:10.1002/alz.70304

J Sch Health. 2025 May 25. doi: 10.1111/josh.70016. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic triggered nationwide school closures in March 2020, putting millions of children in the United States who depended on subsidized school meals at risk of hunger. In response, the US Department of Agriculture activated the Summer Food Service Program (SFSP) and Seamless Summer Option (SSO) program to provide emergency free school meals. This study examined organizations’ experiences implementing these programs from March 2020 to September 2021.

METHODS: The study utilized a mixed-methods approach, which included: (1) conducting in-depth interviews with managers at program sponsor agencies responsible for meal distribution (n = 9), and (2) distributing a survey to meal site managers (n = 41). We conducted thematic analyses of interviews and descriptive statistics for survey items.

RESULTS: Thematic analyses revealed challenges related to families’ ability to access meal sites and communication gaps between organizations, hindering meal program implementation. Sponsors highlighted the benefits of federal waivers enabling grab-and-go options and extended pick-up hours, which enhanced operations and family participation. Survey findings also showed that most sites regularly offered fresh produce and whole grains during the pandemic.

CONCLUSIONS: Continuing meal program flexibilities could boost family participation and expand equitable access to school meals during summers or school closures.

PMID:40415168 | DOI:10.1111/josh.70016

Aging Clin Exp Res. 2025 May 26;37(1):166. doi: 10.1007/s40520-024-02893-6.

ABSTRACT

BACKGROUND & AIMS: Previous studies have shown that antioxidants may be associated with risk of Alzheimer’s disease (AD). However, some findings have failed to demonstrate a significant correlation. To rigorously evaluate this relationship, a comprehensive review and meta-analysis were conducted.

METHODS: All relevant cohort studies reporting association between antioxidants intake (diet and/or supplement use) and AD risk were searched in 9 electronic databases and 4 registration platforms from their inception up to March 15, 2023. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using either a fixed-effects or random-effects model. Heterogeneity was assessed using I² statistics. Furthermore, a dose-response meta-analysis was conducted to explore potential dose-response relationships.

RESULTS: Eleven cohort studies were included. The pooled HRs of AD were 0.90 (95% CI = 0.60-1.34) and 0.94 (95% CI = 0.75-1.17) for the dietary intake of vitamin E, 0.90 (95% CI = 0.76-1.07) for the vitamin E supplement use. The pooled HRs of AD were 0.84 (95% CI = 0.76-0.93) and 0.60 (95% CI = 0.35-1.02) for the dietary intake of vitamin C, 0.85 (95% CI = 0.72-1.00) for the vitamin C supplement use. The pooled HRs of AD were 1.02 (95% CI = 0.85-1.22) and 0.86 (95% CI = 0.68-1.07) for the dietary intake of beta-carotene. Notably, no significant dose-response relationship was observed.

CONCLUSIONS: A high dietary intake of vitamin C (≥ 75 mg/d) was found to have a statistically significant impact on reducing the risk of AD. However, no significant association was observed between dietary intake of vitamin E or beta-carotene, or the use of vitamin E or vitamin C supplement use, and the risk of AD.

PMID:40415164 | DOI:10.1007/s40520-024-02893-6