Category: Nevin Manimala

Front Cell Dev Biol. 2025 Jul 23;13:1642539. doi: 10.3389/fcell.2025.1642539. eCollection 2025.

ABSTRACT

Although large language models (LLMs) show significant potential in clinical practice, accurate diagnosis and treatment planning in ophthalmology require multimodal integration of imaging, clinical history, and guideline-based knowledge. Current LLMs predominantly focus on unimodal language tasks and face limitations in specialized ophthalmic diagnosis due to domain knowledge gaps, hallucination risks, and inadequate alignment with clinical workflows. This study introduces a structured reasoning agent (ReasonAgent) that integrates a multimodal visual analysis module, a knowledge retrieval module, and a diagnostic reasoning module to address the limitations of current AI systems in ophthalmic decision-making. Validated on 30 real-world ophthalmic cases (27 common and 3 rare diseases), ReasonAgent demonstrated diagnostic accuracy comparable to ophthalmology residents (β = -0.07, p = 0.65). However, in treatment planning, it significantly outperformed both GPT-4o (β = 0.49, p = 0.01) and residents (β = 1.71, p < 0.001), particularly excelling in rare disease scenarios (all p < 0.05). While GPT-4o showed vulnerabilities in rare cases (90.48% low diagnostic scores), ReasonAgent’s hybrid design mitigated errors through structured reasoning. Statistical analysis identified significant case-level heterogeneity (diagnosis ICC = 0.28), highlighting the need for domain-specific AI solutions in complex clinical contexts. This framework establishes a novel paradigm for domain-specific AI in real-world clinical practice, demonstrating the potential of modularized architectures to advance decision fidelity through human-aligned reasoning pathways.

PMID:40772224 | PMC:PMC12325206 | DOI:10.3389/fcell.2025.1642539

Cureus. 2025 Jul 5;17(7):e87360. doi: 10.7759/cureus.87360. eCollection 2025 Jul.

ABSTRACT

Objectives This study set out to compare the mechanical behavior of graphene and zirconia in the context of their potential use in fixed dental prostheses. Specifically, we evaluated three critical properties: Rockwell hardness, to understand surface durability; compressive strength, to assess resistance to biting forces; and flexural strength, to examine performance under bending stress. To approximate real-world conditions, all samples were subjected to thermocycling, simulating the thermal changes typical of the oral cavity. The goal was to explore whether graphene could serve as a viable alternative to zirconia in restorative applications. Methods A systematic in vitro protocol was followed. Standardized specimens of graphene and zirconia were fabricated and subjected to 30,000 thermocycles between 5°C and 55°C. Mechanical tests were conducted using a universal testing machine. Rockwell hardness was measured using a standard durometer, while compressive and flexural strengths were evaluated through load-to-failure testing. Data were statistically analyzed using independent-sample t-tests, with significance defined at p<0.05. Results Zirconia showed markedly higher compressive strength compared to graphene, making it better suited for high-load areas of the mouth. Interestingly, the two materials performed similarly in Rockwell hardness, suggesting comparable surface durability. Flexural strength results were also close, with no significant difference, indicating that graphene may perform well under bending or tensile forces. These outcomes reaffirm zirconia’s status as a robust material for prosthodontics while also opening the door for graphene as a lightweight, structurally capable alternative. Conclusion While zirconia continues to outperform in terms of compressive strength, graphene demonstrates meaningful potential due to its comparable flexural strength and hardness, along with the added advantage of being significantly lighter. These findings support further investigation into graphene’s role in restorative dentistry, especially in cases where weight, design complexity, or aesthetics demand alternative materials. Future research should explore its biocompatibility, long-term performance, and integration with current dental systems.

PMID:40772214 | PMC:PMC12325734 | DOI:10.7759/cureus.87360

Cureus. 2025 Jul 6;17(7):e87389. doi: 10.7759/cureus.87389. eCollection 2025 Jul.

ABSTRACT

Background Pancreatic ductal adenocarcinoma (PDAC) remains a highly lethal malignancy with limited effective systemic therapies. Modified FOLFIRINOX (mFOLFIRINOX) and gemcitabine plus nab-paclitaxel (GN) are commonly used first-line regimens. The purpose of this study is to evaluate real-world efficacy (response rates, progression-free survival (PFS) and overall survival (OS)) and toxicity (grade 3/4 hematologic and non-hematologic toxicities) of first-line mFOLFIRINOX and gemcitabine plus nab-paclitaxel in patients with advanced pancreatic ductal adenocarcinoma. Methods We conducted a retrospective analysis of 64 patients with advanced PDAC treated between May 2023 and May 2025. Thirty patients received GN, and 34 received mFOLFIRINOX. Efficacy outcomes included overall response rate (ORR), clinical benefit rate (CBR), PFS, and OS. Toxicities were graded using Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Statistical analyses included Kaplan-Meier survival estimates and Cox regression modeling. Results The median age was 59 years (range: 32-75), with a predominance of male patients (68.2%). Most had Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0-1 (89.1%). Patients receiving mFOLFIRINOX were younger and more likely to have tumors in the pancreatic head, whereas elevated CA19-9 levels were more common in the GN group. ORR was 57% in the GN arm and 52.9% with mFOLFIRINOX (P=0.179), while CBR was comparable (77% vs. 76.5%, P=0.985). The median progression-free survival of patients receiving GN was 6.97 months and 8.5 months with FOLFIRINOX (HR: 1.14; 95% CI: 0.58 – 2.22; P=0.713). mFOLFIRINOX had a median overall survival benefit (HR: 1.352; 95% CI 0.63 – 2.90; P=0.428), but this did not reach statistical significance. One-year OS was higher with mFOLFIRINOX (91.6% vs. 82.4%), as was 1.5-year OS (76.3% vs. 55.0%). Paradoxically, one-year PFS favored GN (32.5% vs. 20.3%). Grade 3/4 hematologic toxicities were more frequent with mFOLFIRINOX (e.g., neutropenia: 20% vs. 8.8%, anemia: 20% vs. 5.9%). GN was associated with more grade 3/4 vomiting (38.2% vs. 10%, P=0.009), diarrhea (26.5% vs. 3.3%, P=0.011), and neuropathy (29.4% vs. 6.7%, P=0.02). Dose modifications and treatment delays were similar, though delays were more frequent in the mFOLFIRINOX arm. Conclusions Both mFOLFIRINOX and GN demonstrated comparable efficacy in real-world treatment of advanced PDAC. mFOLFIRINOX offered better long-term OS but carried a higher risk of hematologic toxicity, while GN was associated with greater gastrointestinal and neurological adverse effects. Treatment selection should be guided by patient-specific factors such as comorbidities and tolerance to toxicity. Sequential treatment planning, including access to second-line therapy, significantly impacts survival and should be integral to care strategies.

PMID:40772207 | PMC:PMC12324980 | DOI:10.7759/cureus.87389

Cureus. 2025 Jul 7;17(7):e87442. doi: 10.7759/cureus.87442. eCollection 2025 Jul.

ABSTRACT

BACKGROUND: Type 2 diabetes mellitus (T2DM) and depression commonly co-occur, and antidepressants are frequently prescribed. However, their potential impact on glycemic control remains unclear.

OBJECTIVE: This study aimed to evaluate the association between antidepressant use and hemoglobin A1c (HbA1c) levels among U.S. adults with comorbid T2DM and depression.

METHODS: This study used data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES). Adults with both T2DM and depression were included. Descriptive statistics and survey-weighted multivariable linear regression were used to assess the relationship between antidepressant use and HbA1c, adjusting for age, gender, race/ethnicity, and BMI.

RESULTS: Among 11,141,019 weighted individuals, 6.7% reported antidepressant use. No significant difference in HbA1c levels was found between users and non-users of antidepressants (adjusted beta (β) = 0.091, p = 0.118). Age was inversely associated with HbA1c, while BMI showed a modest positive relationship.

CONCLUSION: Antidepressant use was not significantly associated with HbA1c levels in U.S. adults with T2DM and depression. Further research is needed to explore the effects of specific antidepressant types and behavioral factors on glycemic control.

PMID:40772205 | PMC:PMC12327439 | DOI:10.7759/cureus.87442

Cureus. 2025 Jul 7;17(7):e87425. doi: 10.7759/cureus.87425. eCollection 2025 Jul.

ABSTRACT

OBJECTIVE: This study aimed to analyze pediatric firearm-related emergency department visits in Florida. We stratified the data by region, age group, and insurance status to identify demographic and geographic disparities and inform targeted public health interventions.

METHODS: Data were obtained from the Florida Agency for Health Care Administration for the years 2013 to 2018, focusing on ambulatory emergency department (ED) visits involving patients aged 19 years or younger with a principal diagnosis of firearm-related injury. These cases were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification, and the International Classification of Diseases, Tenth Revision, Clinical Modification, diagnostic codes. Florida was divided into 11 geographic regions based on the patient’s county of residence. Pediatric firearm injury visit rates were calculated per 10,000 population. The total number of ED visits for firearm-related injuries among pediatric patients from 2013 through 2018 was summed and divided by regional population estimates obtained from the Florida Community Health Assessment Resource Tool Set for the corresponding years. To assess statistically significant differences across regions and age groups, we employed the chi-square (χ²) test, considering a p value of ≤0.05 as statistically significant. Additionally, we examined the percentage distribution of pediatric firearm injuries by insurance status, categorized as Medicaid, self-pay, private insurance, other, and uninsured.

RESULTS: The highest rates of firearm-related injuries were observed among older children aged 15-19 years and among uninsured patients. Statistically significant differences in injury rates were identified across all geographic regions when stratified by age groups.

CONCLUSIONS: This study reinforces existing evidence that older children and uninsured older children are disproportionately affected by firearm injuries. These findings highlight the need for targeted public health interventions and further research focused on high-risk pediatric populations.

PMID:40772204 | PMC:PMC12326877 | DOI:10.7759/cureus.87425

Cureus. 2025 Jul 7;17(7):e87477. doi: 10.7759/cureus.87477. eCollection 2025 Jul.

ABSTRACT

Objective Type 2 diabetes mellitus (T2DM) is a chronic, non-communicable disease that is becoming increasingly prevalent around the world, particularly in low- and middle-income countries. Patient education plays a critical role in promoting the self-care behaviours that are essential for glycemic control and preventing complications. The aim of this study was to evaluate the effectiveness of a nurse-led educational intervention in improving diabetes knowledge in adults with T2DM, as measured by the Diabetes Knowledge Questionnaire (DKQ-24). Materials and methods A quasi-experimental pre-post study was conducted at the Medical Care and Research Centre in Mérida, Yucatán, Mexico, from April to May 2025. Thirty adult patients with confirmed T2DM and no prior structured diabetes education participated in a three-session educational programme delivered by trained nurses. The DKQ-24 was administered before and after the intervention. Descriptive statistics and paired t-tests were used to analyse changes in total and domain-specific knowledge scores. A Shapiro-Wilk test confirmed normality, with a significance level of p < 0.05 applied. Results The mean DKQ-24 score increased significantly from 24.1 ± 5.8 to 26.4 ± 4.5 (p = 0.0039). Notable improvements were seen in items addressing misconceptions about special diets, wound care, and insulin production. The most significant knowledge gains occurred in the disease control and complications domain. Nine out of 24 items showed statistically significant improvement post-intervention. Conclusion A brief educational intervention led by nurses significantly improved patients’ knowledge of diabetes, particularly by dispelling persistent myths. These findings highlight the important role of nurses in therapeutic education and support the incorporation of structured educational programmes into clinical diabetes care.

PMID:40772189 | PMC:PMC12328039 | DOI:10.7759/cureus.87477

Cureus. 2025 Jul 7;17(7):e87466. doi: 10.7759/cureus.87466. eCollection 2025 Jul.

ABSTRACT

BACKGROUND: Obsessive-compulsive disorder (OCD) is a prevalent psychiatric disorder that can significantly impair functioning and well-being. While OCD has been extensively studied in various populations, data on its prevalence among university students in the Tabuk region of Saudi Arabia remain limited.

OBJECTIVE: To determine the prevalence of obsessive-compulsive symptoms among students at Tabuk University and explore their association with demographic and academic characteristics.

METHODS: A cross-sectional study was conducted from August 2024 to December 2024 among 190 students at Tabuk University. Data were collected using an electronic questionnaire including socio-demographic information and the Arabic version of the Obsessive-Compulsive Inventory-Revised (OCI-R). Statistical analysis was performed using IBM SPSS Statistics, Version 30.0.

RESULTS: Among the participants, 41.6% showed probable OCD symptoms. Female students demonstrated a higher prevalence (45.3%) compared to males (36.9%). Students living alone or with roommates showed higher rates of probable OCD symptoms (54.2% and 50.0%, respectively) compared to those living with family (39.4%). Engineering and applied medical sciences students showed the highest rates of probable OCD symptoms (58.3% and 57.1%, respectively), while medical students showed the lowest (25.8%). Fifth-year students demonstrated the highest prevalence (77.8%).

CONCLUSION: A considerable proportion of Tabuk University students exhibit probable OCD symptoms, with variations across different demographic and academic characteristics. These findings highlight the need for targeted mental health interventions and support services within the university setting.

PMID:40772187 | PMC:PMC12327954 | DOI:10.7759/cureus.87466

Cureus. 2025 Jul 6;17(7):e87369. doi: 10.7759/cureus.87369. eCollection 2025 Jul.

ABSTRACT

Rotary instrumentation in primary teeth pulpectomy is gaining popularity due to its potential to improve procedural efficiency and clinical outcomes. While existing systematic reviews and meta-analyses (SRMAs) have explored rotary techniques, comparative evaluations of specific clinical endpoints, particularly cleaning effectiveness and postoperative pain, remain fragmented. This umbrella review synthesised evidence from SRMAs assessing rotary versus manual instrumentation in primary teeth, focusing on these two critical outcomes. A comprehensive literature search was conducted across six databases and grey literature until May 2025. Two eligible SRMAs were included: one addressed both cleaning effectiveness and postoperative pain, while the other focused solely on cleaning outcomes. Owing to clinical and statistical heterogeneity, meta-analysis was not feasible. Methodological quality appraisal using AMSTAR-2 rated one review as high confidence and the other as low confidence. According to the GRADE assessment, the certainty of evidence was low for cleaning effectiveness and moderate for postoperative pain, primarily due to inconsistency and imprecision. The findings suggest that rotary instrumentation may offer advantages in obturation quality and postoperative comfort in primary teeth. However, the limited number of high-confidence SRMAs and heterogeneity in outcome reporting underscore the need for standardised research protocols in pediatric endodontics.

PMID:40772175 | PMC:PMC12325778 | DOI:10.7759/cureus.87369

Cureus. 2025 Jul 7;17(7):e87451. doi: 10.7759/cureus.87451. eCollection 2025 Jul.

ABSTRACT

Aim To compare the functional outcomes of dynamic compression plating and intramedullary nailing in adolescents (12-19 years) with both-bone diaphyseal forearm fractures using the Grace and Eversmann scoring system. Materials and Methods Fifty-six adolescents (aged 12-19 years) with both-bone diaphyseal forearm fractures and meeting the inclusion criteria were enrolled in this study. Patients were assigned consecutive numbers; those with even numbers underwent intramedullary nailing, while those with odd numbers received dynamic compression plating. Functional outcomes were assessed at six months postoperatively using the Grace and Eversmann scoring system. Results Out of the 56 patients, the mean Grace and Eversmann score for the dynamic compression plating and intramedullary nailing groups was 9.79 and 9.75, respectively, at the final postoperative follow-up which was done after six months. An interpretation of the scores at the sixth month follow-up also revealed that in the dynamic compression plating group, 78.5% of patients achieved ‘EXCELLENT’ results and 21.5% achieved ‘GOOD’ results, whereas in the intramedullary nailing group, corresponding results were seen in 75% and 25% of the participants, respectively. Conclusion Both modalities were equally effective in the fixation of both-bone forearm fractures in adolescents aged 12-19 years, with no statistically significant difference in the functional outcome between the two groups.

PMID:40772173 | PMC:PMC12327928 | DOI:10.7759/cureus.87451

Cureus. 2025 Jul 7;17(7):e87452. doi: 10.7759/cureus.87452. eCollection 2025 Jul.

ABSTRACT

Introduction Vitiligo is a skin condition that appears as white blotches and is brought on by the epidermis losing melanocytes, the cells that give skin its color. Numerous theories have been proposed to explain it, but the exact cause is still unclear. Vitamin D3, an essential vitamin, plays a role in immunological response and may help regulate melanocyte activity. Vitiligo and other autoimmune diseases have been linked to low levels of this powerful immune-modulating vitamin. Moreover, vitamin D3 promotes tyrosinase activity and melanin formation via binding to the vitamin D receptor in melanocytes. The primary objective of the study is to determine if the vitamin D levels are impaired and different in vitiligo patients compared to those in healthy individuals, and the secondary objective is to ascertain the impact of this impairment on the severity and scope of the illness. Methodology This study is a prospective case-control design. Over a 12-month period from March 2024 to March 2025, patients visiting the dermatology outpatient department (OPD) at our tertiary care hospital diagnosed with vitiligo were randomly enrolled as cases. Age- and gender-matched healthy individuals attending the hospital were recruited as controls. There were 40 vitiligo sufferers and 40 control subjects in the study, who were taken as per the cases visiting our OPD. The Vitiligo Extent Tensity Index (VETI) score was used to evaluate the degree of skin involvement in vitiligo patients. In order to evaluate serum vitamin D3 levels using the chemiluminescence method, blood samples were obtained from both cases and controls after informed consent and clearance from the institutional ethical committee. Based on their vitamin D3 levels, individuals were divided into three groups: inadequate (<20 IU), insufficient (20-30 IU), and normal (>30 IU). The mean and standard deviation were computed based on the results. Results The age and gender distribution of the vitiligo patients and the control group in this study did not differ significantly. The gender distribution of the 40 cases and 40 controls was equal, with 50% of the participants being men and 50% being women. The largest percentage of participants (37.5%) were between the ages of 41 and 60, followed by those between the ages of 21 and 40 (35%), 11 and 20 (17.5%), one and 10 (10%). Vitiligo patients had a mean serum vitamin D level of 25.1 ± 10.6 ng/mL, while the control group had a significantly higher level of 37.9 ± 26.0 ng/mL (t value = -2.88 and p = 0.0057, statistically significant). Furthermore, chi-square value = 10.60 and p = 0.0314 indicated a statistically significant correlation between serum vitamin D levels and the degree of vitiligo as determined by the VETI score. The study showed that vitiligo patients had lower vitamin D levels compared to those of healthy subjects, and it also made clear how vitamin D deficiency may affect the severity and extent of vitiligo. Conclusion Vitiligo is recognized as a complex disorder with multiple factors. Melanocytes possess vitamin D receptors, which indicates that vitamin D might be involved in regulating their function. Thus, we investigated the role of vitamin D in the etiopathogenesis of vitiligo. The study indicates an inverse correlation of serum vitamin D3 levels with the degree of vitiligo.

PMID:40772169 | PMC:PMC12327571 | DOI:10.7759/cureus.87452