Category: Nevin Manimala

Ear Nose Throat J. 2025 Oct 5:1455613251378726. doi: 10.1177/01455613251378726. Online ahead of print.

ABSTRACT

BACKGROUND: Laryngopharyngeal reflux (LPR), allergic rhinitis (AR), and asthma are common airway disorders that often coexist, suggesting shared inflammatory mechanisms. LPR involves gastric reflux into the laryngopharynx, while AR and asthma are linked by the “united airway” hypothesis. Evidence indicates LPR may contribute to AR and asthma exacerbation, yet their interactions remain unclear. Understanding their interaction may enhance clinical outcomes.

OBJECTIVE: This systematic review aimed to evaluate the associations between LPR, AR, and asthma by analyzing studies that examined these conditions in various patient populations.

METHODOLOGY: A comprehensive search of electronic databases, including PubMed, Scopus, and Google Scholar, was conducted for studies published up until 2024. Eligible studies were selected based on predefined inclusion criteria, and data on the prevalence, diagnostic methods, and associations between LPR, AR, and asthma were extracted. This systematic review was conducted and registered in PROSPERO (CRD42024588367). Statistical analysis was performed to determine the strength of the associations between these conditions.

RESULTS: The review identified significant associations between LPR and both AR and asthma. Multiple studies confirmed a positive correlation between LPR and AR, with worse AR symptoms observed in patients with more severe LPR. Additionally, a strong association between LPR and asthma was observed, particularly in patients with poorly-controlled asthma. The analysis also revealed a robust relationship between AR and asthma, consistent with the “united airway” hypothesis, which posits that the upper and lower airways share common inflammatory pathways. These findings suggest that the coexistence of these conditions may exacerbate symptoms and complicate management.

CONCLUSION: This systematic review highlights the significant associations between LPR, AR, and asthma, emphasizing the importance of recognizing and addressing these comorbidities in clinical practice. The findings suggest that managing 1 condition may have a beneficial effect on the others, supporting a multidisciplinary approach to diagnosis and treatment.

PMID:41046361 | DOI:10.1177/01455613251378726

J Sex Med. 2025 Oct 5;22(10):1750-1756. doi: 10.1093/jsxmed/qdaf182.

ABSTRACT

BACKGROUND: Erectile dysfunction (ED) is a known precursor and sequela of cardiovascular disease (CVD), with ED severity predicting CVD severity.

AIM: This study aimed to evaluate the utility of ceramide levels in patients with ED.

METHODS: We initiated ceramide testing in all patients with ED. We retrospectively analyzed ceramide levels from electronic records and stratified by severity of symptoms using the erectile function domain of the International Index of Erectile Function (IIEF).

OUTCOMES: The study aimed to determine whether abnormal ceramide levels were associated with ED severity and increased cardiovascular risk.

RESULTS: Three hundred and fifty-four patients were reviewed, of whom 253 (71.5%) had moderate or higher ED. A statistically significant difference in abnormal ceramide values was found in patients with moderate to severe symptoms, and the odds of getting an abnormal ceramide test were increased based on the IIEF scoring alone (odds ratio [OR] 2.3 [1.04-5.12]; P-value = .034).

CLINICAL IMPLICATIONS: Serum ceramide testing could be beneficial in identifying cardiovascular risk in men with ED, potentially prompting cardiac referrals and lifestyle modifications.

STRENGTHS AND LIMITATIONS: The strengths of this study include a large sample size and the use of a well-established scale, while the limitations include the retrospective nature of the study and the need for further research to validate the findings.

CONCLUSION: Patients undergoing management for ED may benefit from serum ceramide testing and subsequent cardiac referral.

PMID:41046349 | DOI:10.1093/jsxmed/qdaf182

Cancer Rep (Hoboken). 2025 Oct;8(10):e70357. doi: 10.1002/cnr2.70357.

ABSTRACT

PURPOSE: Acinic cell carcinoma (ACC) of the breast is a very rare, primary salivary gland-type breast malignancy, with ~100 reported cases in the literature. Limited information about the clinical features and outcomes of patients with ACC is available.

METHODS: We utilized the Surveillance, Epidemiology, and End Results (SEER) database to identify ACC patients. For comparison, we also examined a cohort of invasive breast carcinomas of no special type (NST).

RESULTS: Thirty ACC patients were identified among the more than 248 000 invasive breast carcinoma NST patients. ACCs were predominantly grade 3 carcinomas (44%) and were diagnosed at an earlier stage (67%). Hormone receptor (HR) and HER2 status data were available for only 13 patients, revealing molecular heterogeneity: HR-/HER2- (four patients), HR-/HER2+ (two patients), HR+/HER2- (four patients), and HR+/HER2+ (three patients). The median survival time for ACC patients was 19 months vs. 48 months for NST patients (p < 0.001). A complete-case approach was utilized for the adjusted analyses, restricting the sample to 46 257 patients without missing data on all relevant covariates. The adjusted Kaplan-Meier analysis indicated a more pronounced decline in survival probabilities among patients with ACC compared to those with NST, with the number at risk in the ACC group diminishing to four patients by the 30-month mark. In contrast, NST patients exhibited a more gradual decrease. In the multivariable Cox regression, which adjusted for age, TNM stage, HR/HER2, and chemotherapy, ACC histology was correlated with a 1.69-fold increase in the hazard of death (HR: 1.69; 95% CI: 0.63-4.56), although this result was not statistically significant. Age and advanced stage continued to be strong predictors of poor survival, and the inclusion of an age-time interaction enhanced the model fit.

CONCLUSION: Acinic cell carcinoma of the breast is a very rare primary breast malignancy. Our study indicates potentially aggressive clinical behavior in mammary ACC; however, findings must be interpreted cautiously given inherent SEER limitations, especially regarding histologic and molecular subtyping accuracy. Further centralized studies are urgently needed for the accurate characterization of this rare entity.

PMID:41046342 | DOI:10.1002/cnr2.70357

Clin Oral Implants Res. 2025 Oct 4. doi: 10.1111/clr.70053. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the impact of the marginal fit of implant-supported prostheses (ISP) on peri-implant bone levels. Additionally, the study aimed to determine a clinically relevant threshold for the radiographic vertical misfit gap at the ISP, when present, and to identify potential risk factors associated with changes in bone levels.

METHODS: This study involved subjects who received ISPs for tooth replacement therapy. Standardized intraoral periapical radiographs were taken 10 years after loading to assess the radiographic distance between the implant shoulder and the most coronal point of crestal bone (DIB). ISP marginal gaps were categorized as no gap or gap, with vertical dimensions categorized as 0 mm, > 0- < 0.1 mm, and ≥ 0.1 mm. A multivariable linear mixed-effect model was applied to control for potential confounders.

RESULTS: A total of 301 patients and 505 implants with a 10.6 ± 0.7 years follow-up were analyzed. ISPs without gaps exhibited statistically significantly lower DIB values (3.22 ± 0.8 mm) than those with gaps (3.43 ± 0.6 mm; p = 0.001). Gaps ≥ 0.1 mm were associated with statistically significantly higher DIB values (3.45 ± 0.7 mm; p = 0.001) compared with gaps between > 0 and < 0.1 mm (3.36 ± 0.5 mm; p = 0.001), or no gaps (3.22 ± 0.7 mm; p = 0.001). Each increment of 0.1 mm in the vertical crestal gap corresponded to a significant increase in DIB values (0.08 mm; p = 0.03). Finally, smoking and a history of periodontitis were independent risk factors for increased DIB.

CONCLUSIONS: Marginal misfit of ISP affects peri-implant bone stability, with gaps ≥ 0.1 mm linked to higher DIB. Smoking and periodontitis are independent risk factors for increased DIB.

PMID:41046331 | DOI:10.1111/clr.70053

BMC Oral Health. 2025 Oct 4;25(1):1527. doi: 10.1186/s12903-025-06884-5.

ABSTRACT

OBJECTIVE: Oral health is a neglected aspect of healthcare, especially among prison inmates who face barriers in accessing dental services. Dental caries is a prevalent and preventable disease that affects inmates’ general health and quality of life. This study evaluated dental caries and its predictors among inmates in the Eastern Province of Saudi Arabia.

METHODS: This cross-sectional study was conducted as part of an ongoing oral health program by the College of Dentistry, Imam Abdulrahman Bin Faisal University(IAU), Dammam, targeting inmates in prisons across Dammam, Khobar, Dhahran, Jubail, and AlHasa in the Eastern Province of Saudi Arabia. This prison outreach program is conducted annually from January to April. Male and female inmates who voluntarily consented were included without exclusion criteria. Data collection involved oral examinations using the DMFT index and Simplified Oral Hygiene Index (OHI-S), following World Health Organization’s (WHO) criteria, and structured interviews based on the WHO Oral Health Questionnaire for Adults. Calibrated examiners performed the examinations using portable dental units. Statistical analysis included t-tests, ANOVA, Pearson correlation, and multiple linear regression analysis.

RESULTS: The sample consisted of 230 participants with 86.1% males and 13.9% females. In the study, 98.3% of the sample had untreated decay and 99.1% of participants had DMFT score ranging from 1 to 28, with a mean score of 14.41 ± 7.89. About 25.2% of participants never cleaned their teeth using any tool, 23.5% did not use toothpaste, and 23.5% consumed soft drinks several times a day. Dental attendance, defined as being seen by a dentist at prison, within the last year was reported by 37% of participants and 15.2% never received dental care. Most participants (85.2%) reported dental pain during the last year. The study showed a statistically significant correlation between the simplified oral hygiene index and the mean decayed score (r = 0.456, P < 0.001). The mean DMFT of the sample significantly increased with advancing age (P = 0.023). Male participants (15.12 ± 7.94) demonstrated significantly higher mean DMFT score than females (10.03 ± 6.05) (P = 0.001). Similarly, significantly higher DMFT was found in Saudi (15.74 ± 7.91) versus non-Saudi participants (10.45 ± 6.41) (P < 0.001). Those who used toothpaste (12.82 ± 6.95) had significantly lower mean DMFT score than those who did not use toothpaste (19.59 ± 8.58) (P = 0.006). A statistically significant relationship was observed between soft drink consumption and caries experience (P = 0.043).

CONCLUSION: Untreated decay was highly prevalent among inmates in this study. A statistically significant correlation was found between oral hygiene and caries experience, with advancing age, male gender, Saudi nationality, and frequent soft drink consumption being significantly associated with higher caries levels. These findings highlight the urgent need for targeted oral health promotion strategies and improved access to dental care within correctional facilities. Policy implications include the integration of oral health education into prison health programs and the establishment of routine dental screenings. Future research should explore the effectiveness of mobile dental services and behavioral interventions tailored to this high-risk population.

PMID:41046304 | DOI:10.1186/s12903-025-06884-5

Eur Radiol. 2025 Oct 4. doi: 10.1007/s00330-025-12040-y. Online ahead of print.

ABSTRACT

OBJECTIVES: To develop a predictive model incorporating both clinical and imaging findings to predict early progression in patients with advanced hepatocellular carcinoma (HCC) undergoing atezolizumab plus bevacizumab (Atezo-Bev) therapy.

MATERIALS AND METHODS: A total of 140 consecutive patients with HCC who initiated Atezo-Bev therapy between January 2020 and May 2022 at two tertiary care centres were retrospectively enrolled. Early progression was defined as progressive disease in the first response evaluation conducted at 4 weeks and 12 weeks after treatment initiation using dynamic CT or MRI. Images were reviewed by two radiologists. Logistic regression analysis was performed to determine the early progression scores.

RESULTS: The first response evaluation of Atezo-Bev therapy was conducted at a median of 56 days (interquartile range, 42-64 days) after treatment initiation. Approximately 40% (56/140) of patients with HCC showed early progression. The early progression score was defined as follows: (age < 60 years; 1 point) + (serum alpha-fetoprotein level ≥ 300 ng/mL; 3 points) + (neutrophil-to-lymphocyte ratio ≥ 2.8; 1 point) + (infiltrative appearance; 2 points). At a score of 3 or higher, the early progression score showed sensitivity of 91.1% (95% confidence interval [CI]: 83.6-98.5%) and a specificity of 53.6% (95% CI: 42.9-64.2%). At a score of 6 or higher, the score demonstrated a sensitivity of 55.4% (95% CI: 42.3-68.4%) and a specificity of 91.7% (95% CI: 85.8-97.6%).

CONCLUSION: We developed an early progression score that integrates clinical and imaging factors with high specificity to accurately predict early progression in patients with advanced HCC undergoing Atezo-Bev therapy.

KEY POINTS: Question No validated imaging-based tool currently exists to predict early progression to Atezo-Bev therapy in advanced HCC. Findings Infiltrative tumour appearance, high AFP, high neutrophil-to-lymphocyte ratio, and younger age were significantly associated with early progression. Clinical relevance A composite early progression score integrating clinical and imaging features showed high diagnostic accuracy for predicting treatment failure.

PMID:41046297 | DOI:10.1007/s00330-025-12040-y

Ann Surg Oncol. 2025 Oct 4. doi: 10.1245/s10434-025-18423-1. Online ahead of print.

ABSTRACT

BACKGROUND: Complete cytoreductive surgery is crucial in advanced ovarian cancer (OC) treatment. Diaphragmatic surgery, including stripping (DS) and resection (DR), is often necessary for optimal cytoreduction. However, postoperative complications and the timing of adjuvant chemotherapy initiation remain critical concerns. This study evaluates the impact of DR and DS on surgical outcomes, chemotherapy timing, and survival.

PATIENTS AND METHODS: This retrospective, monocentric study analyzed 215 patients with International Federation of Gynecology and Obstetrics (FIGO) stage III-IV OC undergoing DS or DR between 2011 and 2023. Clinical, surgical, and survival data were collected; complications were graded using the Clavien-Dindo system. Statistical analysis included contingency and survival tests.

RESULTS: A total of 215 patients underwent diaphragmatic surgery: 122 patients (56.7%) underwent DR and 93 (43.3%) DS. No significant differences existed between groups regarding age, body mass index (BMI), histological subtype, American Society of Anesthesiologists (ASA) score, or primary/interval debulking surgery distribution (p = 0.122). DR was more common in patients with greater peritoneal disease (p = 0.003), higher pleural involvement (p = 0.002), and longer operative times (p = 0.018). Postoperatively, DR was associated with increased thoracic complications (87.7% versus 52.7%, p < 0.001), greater oxygen supplementation needs (55.7% versus 35.5%, p = 0.003), and elevated liver enzymes. However, no significant differences emerged in severe complications (p = 0.077), reoperation rates (p = 0.227), or time to chemotherapy initiation (p = 0.742). A decreasing trend in thoracostomy tube placement was observed since 2018. Progression-free and overall survival were similar between groups.

CONCLUSIONS: Despite requiring greater intraoperative effort and resulting in higher postoperative morbidity, DR is not associated with an increased incidence of severe complications (grade 3+) or delayed chemotherapy initiation compared with DS. These findings support the feasibility of DR for achieving complete cytoreduction in advanced OC.

PMID:41046296 | DOI:10.1245/s10434-025-18423-1

Lung. 2025 Oct 4;203(1):97. doi: 10.1007/s00408-025-00853-z.

ABSTRACT

BACKGROUND: Refractory chronic cough (RCC) significantly impairs patient quality of life and poses a major challenge in clinical management. However, little is known about the healthcare resource utilization (HRU) of patients with RCC.

OBJECTIVE: The goal of our study is to describe the HRU and associated costs of RCC patients and those with non-refractory chronic cough (non-RCC).

METHODS: Patients with chronic cough were prospectively recruited from 6 centers in France. At 6 months, the patients were classified as having RCC or no RCC. A retrospective analysis was made using the French National Health Insurance Database (SNDS) in order to determine healthcare utilization for the one-year period preceding inclusion at the site and for the one-year period thereafter.

RESULTS: Sixty-eight patients were included. Among them, 32 (47%) patients had RCC. There was no difference between groups regarding clinical data apart from cough duration (56.8 ± 59.5 months in the no RCC group vs. 139.3 ± 123.8 months in the RCC group, p = 0.002). Within 1 year prior to inclusion, there was no difference in terms of drug dispensations between the 2 groups. During the 1-year post-inclusion period, a significantly higher proportion of patients with RCC received at least one dispensation of opioids and amitriptyline compared to those with no RCC (8 (25%) vs. 2 (6%) for opioids, p = 0.038 and 14 (44%) vs. 3 (8%) for amitriptyline, p = 0.0015, respectively). Within 1 year after inclusion, more patients with RCC had attended speech pathologist visits in comparison to patients with no RCC (14 (44%) patients vs. 10 (28%) patients, p = 0.21, respectively). Total costs within 12 months prior to inclusion were 3,878€ [2,498 – 5,755€] for patients with no RCC and 5,159€ [3,426 – 7,138€] with RCC, but the difference was not significant. No change occurred in the 1-year period following inclusion.

CONCLUSION: RCC has a high healthcare utilization with substantial costs.

PMID:41046288 | DOI:10.1007/s00408-025-00853-z

Pediatr Surg Int. 2025 Oct 4;41(1):310. doi: 10.1007/s00383-025-06216-2.

ABSTRACT

PURPOSE: To evaluate the relationship between nutritional status and surgical outcomes in patients with esophageal atresia (EA) from the Turkish Esophageal Atresia Registry (TEAR).

METHODS: Between 2015 and 2024, 713 patients with the complete data of neonatal period and first year of life were included. According to FENTON, growth charts and patients were grouped as small for gestational age (SGA, < 10 percentiles), medium SGA (percentiles = 10-20), appropriate for gestational age (AGA, percentiles = 20-90) and large for gestational age (LGA, percentiles > 90) at birth. The z scores for height-for-weight were reevaluated at 6th and 12th months of age.

RESULTS: Among 713 patients, 56% were boys. 23.7% of patients were SGA. There was no difference among groups for demographic features, outcomes, and mortality (p > 0.05). Patients with SGA had a higher rate of karyotype anomalies (23.1%, p < 0.05). At the 6th month, 20% of patients had improved nutritional status, 46.2% unchanged, and 33.5% worsened. At the 12th month, it was 31.6%, 50.2%, and 18.3%, respectively. 32.8% of the SGA patients had severe malnutrition at the 6th month, while this rate decreased to 10.2% at the end of the first year of life. Patients with worsened nutritional status had a significantly higher rate of mortality (10.2%) than patients with unchanged and improved nutritional status (3.7%, 2%, respectively, p < 0.05). There was no statistical difference between nutritional status and surgical outcomes at the 6th and 12th months (p > 0.05).

CONCLUSIONS: The incidence of SGA was significantly higher in EA patients with karyotype anomalies. While 20% of patients improved nutritional status at the 6th month, only one-third of patients improved nutritional status at the end of the first year. Closer follow-up is needed in patients with EA to avoid malnutrition, which can lead to poor growth, developmental delay, and impaired immune function.

PMID:41046286 | DOI:10.1007/s00383-025-06216-2

BMC Oral Health. 2025 Oct 4;25(1):1526. doi: 10.1186/s12903-025-06530-0.

ABSTRACT

BACKGROUND: This study aimed to investigate the association between taurodontism and maternal-child characteristics, as well as its relationship with other dental anomalies including hypodontia, hyperdontia, and pyramidal molars.

METHODS: Panoramic radiographs were obtained from 815 patients aged 9 to 15 years. A total of 62 children with taurodontism and their mothers agreed to participate. Other dental anomalies and taurodontism types were also recorded. Mothers completed a questionnaire that included the mother and child’s demographic characteristics and potential etiological factors. The collected data were subjected to statistical analysis.

RESULTS: The most common form of taurodontism was hypotaurodontism, most frequently affecting the right maxillary first molar (43.5%). Heart disease (n = 5) was the most frequently observed systemic condition among children with taurodontism. A statistically significant association was observed between the number of taurodontic teeth and the presence of pyramidal molars (p < 0.05). Regression analysis revealed significant associations (p < 0.05) between the presence of more than two taurodontic teeth and several factors, including maternal smoking during pregnancy, a higher number of siblings, female sex, and consanguineous marriage. These findings may assist in identifying at-risk pediatric populations and underscore the importance of considering these variables in the clinical assessment of dental anomalies.

CONCLUSIONS: Evaluating taurodontism in children with heart disease or pyramidal molars may contribute to early diagnosis and more effective management. The findings of this study highlight the need for increased clinician awareness and further research with larger sample sizes and healthy control groups to better understand the risk factors associated with taurodontism.

PMID:41046282 | DOI:10.1186/s12903-025-06530-0