Nevin Manimala

Cureus. 2025 Mar 11;17(3):e80428. doi: 10.7759/cureus.80428. eCollection 2025 Mar.

ABSTRACT

Both microscopic and endoscopic transsphenoidal approaches can be utilized to treat pituitary adenomas or pituitary neuroendocrine tumors (PitNETs). While both techniques have shown comparable beneficial outcomes, challenges remain, and definitive long-term data are lacking. A comprehensive study could help optimize surgical strategies for pituitary tumor management, ultimately improving patient outcomes. This retrospective study compares the outcomes of microscopic and endoscopic transsphenoidal surgeries for treating pituitary tumors. Fifty-two patients (23 men and 29 women) who underwent surgery between January 2012 and December 2018 were included. Patients were classified into two groups based on the surgical approach: 26 underwent microscopic surgery and 26 underwent endoscopic surgery. Preoperative and postoperative MRI scans, tumor size, and hormone levels were analyzed. The primary outcomes evaluated included the extent of tumor resection, complication rates, hormonal remission, and improvements in visual symptoms. The results showed no statistically significant difference in tumor resection between the two groups, with total radiological remission achieved in 65.4% of patients in both the microscopic and endoscopic groups. The hormonal remission rate was 81.3% in the microscopic group and 86.6% in the endoscopic group. Complications included transient diabetes insipidus in 25% of patients and rhinorrhea in 9.6%, and no surgical mortality was observed. The endoscopic approach offered advantages such as reduced mucosal trauma and improved visualization, while challenges included the need for a bloodless surgical field. Despite these differences, both techniques demonstrated comparable outcomes regarding tumor resection, complication rates, and hormonal remission.

PMID:40213724 | PMC:PMC11985159 | DOI:10.7759/cureus.80428

Cureus. 2025 Mar 11;17(3):e80408. doi: 10.7759/cureus.80408. eCollection 2025 Mar.

ABSTRACT

Background Coronary artery disease (CAD) is the leading cause of death and premature disability worldwide. Secreted frizzled-related protein 5 (SFRP5), a recently identified adipokine, acts as an antagonist of Wingless-type family member 5A (WNT5A) signaling. Since WNT5A triggers inflammation in endothelial cells, the anti-inflammatory properties of SFRP5 play a crucial role in counteracting this effect. Lower SFRP5 levels contribute to the chronic inflammatory conditions associated with CAD by promoting WNT5A signaling. Aim This study aimed to assess serum SFRP5 levels in CAD patients and compare them with those in non-CAD patients at a tertiary care hospital. Materials and methods The study sample included 40 angiographically confirmed CAD patients as cases and 40 non-CAD patients as controls. Serum SFRP5 levels and lipid profiles were measured and compared between the two groups. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, NY, USA), employing descriptive statistics, normality tests, t-tests, chi-square tests, and correlation analyses. A p-value of <0.05 was considered statistically significant. Results Serum SFRP5 levels were significantly lower in CAD patients (1.25 ± 0.35) compared to controls (2.46 ± 0.96) (p < 0.01). Additionally, SFRP5 showed a significant negative correlation with triglycerides and low-density lipoprotein cholesterol (p < 0.05). Conclusions This study demonstrated that serum SFRP5 levels were significantly lower in CAD patients compared to controls. Therefore, serum SFRP5 may serve as a novel biomarker for the early prediction of CAD.

PMID:40213711 | PMC:PMC11984588 | DOI:10.7759/cureus.80408

Cureus. 2025 Mar 11;17(3):e80393. doi: 10.7759/cureus.80393. eCollection 2025 Mar.

ABSTRACT

Introduction Transplant renal artery stenosis (TRAS) is a potentially treatable posttransplant complication, primarily presenting with arterial hypertension and allograft dysfunction. Its prevalence in children with posttransplant hypertension ranges from 5% to 15%. Diagnosis is typically made through invasive angiography following suspicion raised by echo Doppler findings. Treatment options include medical therapy, percutaneous transluminal angioplasty (PTA)/stenting, and surgical revascularization. This study aimed to assess the efficacy, complications, and outcomes of PTA/stenting procedures in children with TRAS. Methods We reviewed all pediatric patients who underwent renal transplantation in Serbia between June 2001 and February 2023 to identify cases of TRAS treated with PTA. Statistical analysis was performed to compare pre- and post-intervention arterial vessel diameters, serum creatinine levels, estimated glomerular filtration rate (eGFR), mean blood pressure, systolic and diastolic blood pressure indices, and the number of antihypertensive medications used. Results Seven patients underwent PTA with or without stent placement for TRAS. None were treated solely with medical therapy or surgical intervention. The overall prevalence of TRAS was 6.32%, higher in cadaveric transplants (11.11%) compared to living-related transplants (3.39%). Of the seven patients, five underwent PTA alone, while two required stent placement. Two of the five PTA patients required re-interventions, resulting in a total of seven angioplasty procedures. No complications occurred following the procedures. After a mean follow-up of 56.86 ± 45.76 months, patients demonstrated improved blood pressure control and reduced use of antihypertensive medications. While the mean eGFR showed a nonsignificant improvement, one patient with severe concomitant cytomegalovirus disease progressed to grade IV chronic kidney disease. Conclusions PTA, with or without stenting, appears to be an effective and safe treatment for TRAS in children, with immediate and intermediate-term results comparable to those reported in the literature. Stent placement may be particularly suitable for adolescents who have completed their growth phase.

PMID:40213709 | PMC:PMC11984333 | DOI:10.7759/cureus.80393

Cureus. 2025 Mar 10;17(3):e80353. doi: 10.7759/cureus.80353. eCollection 2025 Mar.

ABSTRACT

Background Patients undergoing dialysis require intensive treatment and supportive care, which affects their caregivers physically, socially, economically, and psychologically. However, this topic has been largely underexplored. Objectives This study aimed to examine the socio-economic and psychological burdens experienced by primary caregivers of patients undergoing dialysis. Method This cross-sectional study was conducted over 12 weeks using purposive sampling of primary caregivers of patients undergoing dialysis at two public and two private dialysis centers in Trinidad and Tobago. The questionnaire collected data on socio-demographics, economics, and selected psychological issues. Selected global health status questions adapted from the World Health Organization Quality of Life Brief Version were included. Participants were assured of confidentiality and anonymity. Verbal consent was obtained by completing an online questionnaire. The collected data were entered into a Statistical Package for the Social Sciences spreadsheet. Data analysis included hypothesis testing at a 5% level of significance using chi-square tests of association and analysis of variance. Results The final sample comprised 150 participants (response rate: 100%). The majority of caregivers were aged 46-55 (n = 44, 29.3%), women (n =82, 54.7%), and had attained tertiary-level education (n = 82, 54.7%). Most caregivers were the patient’s son or daughter (n = 53, 35.3%), lived with the patient (n = 83, 55.3%), and were employed full time (n = 104, 69.3%). More than half (n = 79, 52.7%) reported having at least one health condition, with 40% (n = 61) reporting “getting sick easily” after becoming a caregiver. The majority experienced psychological symptoms of feeling nervous, anxious, or on edge (n = 115, 76.7%). Caregivers reported feeling depressed (n = 49, 32.7%), experiencing burnout (n = 101, 67.8%), and having suicidal thoughts (n = 10, 6.7%). Caregivers spent between one (n = 4, 2.7%) and four (n = 30, 20.0%) days a week taking patients for dialysis treatments, with the majority (n = 80, 53.3%) spending three days weekly. Travel time to dialysis centers ranged from 45 minutes (n = 46, 30.7%) to three hours (n = 5, 3.0%). Most caregivers also reported difficulty having a good work-life balance (n = 106, 70.7%), inability to attend social events (n = 93, 62.0%), reduced personal time (n = 86, 57.3%), and the need to adjust their work hours (n = 99, 66.0%). The majority also experienced economic hardships such as worrying about finances (n = 102, 68.0%). Caregivers also wished other family members contributed financially to patient care (n = 107, 71.3%), especially because the majority (n = 99, 66.0%) were unable to afford to send the patient to a nursing home. Nearly half (n = 66, 44%) of caregivers rated their quality of life (QoL) as “less than good”and more than half (n = 99, 66%) felt that their life lacked meaning. Conclusion Caregivers spend a considerable amount of time with patients, which affects them biologically, socially, economically, and psychologically. More than half of caregivers had challenges in maintaining a work-life balance. The majority were worried about finances (n = 102, 68.0%). Participants experienced anxiety (n = 116, 76.7%), burnout (n = 102, 68.0%), depression (n = 49, 32.7%), and suicidal thoughts (n = 10, 6.7%). These findings underscore the need for targeted intervention to support caregivers and improve their overall QoL.

PMID:40213708 | PMC:PMC11984004 | DOI:10.7759/cureus.80353

Front Pharmacol. 2025 Mar 27;16:1504230. doi: 10.3389/fphar.2025.1504230. eCollection 2025.

ABSTRACT

One-class modeling is a supervised multivariate botanical identification method based on principal component analysis (PCA) that constructs a model based only on the characteristics of the reference samples and uses the Q statistic as a combined metric. Test samples are judged to be similar (authentic) if their combined metric falls within the model limits or different (adulterated or contaminated) if the metric falls outside the model limits. This review initially considers three major factors affecting identification: the number of variables (univariate versus multivariate), the number of classes (one-class versus multi-class), and the type of analysis (quantitative versus qualitative). Multivariate analysis is commonly used for identification, providing a broader coverage of the identity specifications of the samples. With a combined metric, multivariate methods are analogous to univariate methods. One-class modeling and multi-class modeling employ different approaches for identification with one-class modeling being more flexible. While most methods to date have had a quantitative basis, qualitative methods are possible. This review focuses on multivariate, one-class modeling based on PCA. Examples are presented for the application of one-class modeling to identification of American ginseng (Panax quinquefolius), Echinacea purpurea, Black Cohosh (Actaea racemosa), and Maca (Lepidium meyenii). These examples demonstrate the utility and flexibility of one-class modeling.

PMID:40213685 | PMC:PMC11983402 | DOI:10.3389/fphar.2025.1504230

Adv Biomed Res. 2025 Jan 30;14:8. doi: 10.4103/abr.abr_313_24. eCollection 2025.

ABSTRACT

BACKGROUND: One of the major drawbacks of cone beam computed tomography (cone beam CT) is that unlike CT, the gray density values obtained from cone beam CT are relative, and not absolute as obtained in the case of CT. The present study was conducted with the intent to perform a comparative bone densitometric analysis using cone beam CT and CT and to determine if there was a mathematical correlation between the two.

MATERIALS AND METHODS: The present in-vitro study included CT and cone beam CT scans of 30 dry mandibles wherein the gray density values from well-demarcated, precise anatomical areas were obtained, analyzed, and compared. Also, the dependent t-test and Pearson’s correlation coefficient test were used for statistical analysis, while probability values (P values) < 0.05 were contemplated as being statistically significant.

RESULTS: Pearson’s correlation between the gray density values for different combinations of point(s)/group(s) as derived on CT and cone beam CT images revealed the results to be statistically significant for each of the imaging methods used, individually and when compared in between the two methods, in all the cases (P < 0.001) when analyzed at 5% level of significance.

CONCLUSIONS: The mean gray density values obtained with cone beam CT were found to be significantly higher than the ones derived from CT in the present study, though, a linear correlation was observed between the values obtained from cone beam CT and CT, which can be used to convert the relative values obtained with cone beam CT into absolute values derived with CT.

PMID:40213598 | PMC:PMC11981036 | DOI:10.4103/abr.abr_313_24

Adv Biomed Res. 2025 Jan 30;14:6. doi: 10.4103/abr.abr_283_24. eCollection 2025.

ABSTRACT

BACKGROUND: Diffusion-weighted imaging with background body signal suppression (DWIBS) is a new imaging tool for the diagnosis of breast lesions. This study aims to compare DWIBS with contrast-enhanced magnetic resonance imaging (CE-MRI) sequences.

MATERIALS AND METHODS: Eighty consecutive patients underwent both CE-MRI and DWIBS images. DWIBS was assessed qualitatively and quantitatively using the apparent diffusion coefficient mapping. A threshold of 1.44 × 10^-3 mm²/s was considered as a cutoff value between malignant and benign lesions. CE-MRI images were evaluated based on a combination of kinetic and morphological information and reported using Breast Imaging Reporting and Data System lexicon. Statistical analysis was performed for both sequences based on pathologic findings as a gold standard.

RESULTS: Fifty-five out of 80 lesions (69%) were benign, and 25 malignant lesions (31%) have been reported. The sensitivity, specificity, positive predictive value, and negative predictive value for CE-MRI were 100, 38, 42, and 100%, respectively, and those for DWIBS were 77, 70, 53, and 87%, respectively. By comparing DWIBS and CE-MRI data, no statistically significant difference was reported.

CONCLUSION: DWIBS can be used as an effective alternative for breast CE-MRI in cases of contradictions of IV contrast injection.

PMID:40213596 | PMC:PMC11981034 | DOI:10.4103/abr.abr_283_24

Afr J Emerg Med. 2025 Jun;15(2):577-583. doi: 10.1016/j.afjem.2025.02.006. Epub 2025 Mar 21.

ABSTRACT

BACKGROUND: Mental illness and substance use are major global challenges, with their impact on Emergency Centres becoming evident, especially in South Africa. Patients facing these issues require significant resources from both hospital and community services. However, there is a lack of local data regarding the prevalence of concurrent mental health and substance use disorders. This study aims to evaluate the extent of psychoactive substance use within the psychiatric population at a District Hospital in Cape Town, South Africa.

METHODS: This study is a single-centre, retrospective descriptive analysis. It includes all patients referred to the inpatient psychiatric service over six months, recorded in an electronic database. Data were statistically analysed, considering the following variables: urine drug test results to identify specific substance (s) used, sex, age, diagnosis, and repeat visits.

RESULTS: A total of 597 patient visits were analysed. Fifty-nine percent tested positive for at least one substance. The patients’ average age was 34 years. A greater percentage of visits were for males (58 %), with males exhibiting a higher rate of positive test results (64 %) than females (51 %). Among the 146 repeat visits, a significant association was found between the number of visits and positive test results, with 73 % of patients with ≥2 repeat visits testing positive for substances (p < 0.001). Cannabis (60 %), methamphetamines (47 %), benzodiazepines (26 %), opioids (7 %), and cocaine (1 %) were the substances most frequently reported.

CONCLUSIONS: Emergency Centres in South Africa are impacted by individuals seeking mental health care, and substance use significantly exacerbates these challenges. Substance use creates serious physical, mental, and social implications for patients. As emergency care practitioners and members of the broader healthcare system, we play vital roles in addressing these issues. This study provides valuable insights into the complexities of the situation and suggests potential approaches for intervention.

PMID:40213582 | PMC:PMC11982960 | DOI:10.1016/j.afjem.2025.02.006

Front Immunol. 2025 Mar 27;16:1570502. doi: 10.3389/fimmu.2025.1570502. eCollection 2025.

ABSTRACT

BACKGROUND AND OBJECTIVE: This study aims to explore the relationship between melanocortin-1 receptor (MC1R) expression levels and clinical pathological parameters of melanoma, as well as its potential as a prognostic biomarker.

METHODS: This retrospective study included 99 melanoma patients in our hospital from June 2017 to July 2023. MC1R expression was assessed by immunohistochemistry assays. Histochemistry score (H-score) determined the level of MC1R immunohistochemistry expression in melanoma. The relationships among MC1R expression, clinical pathological parameters in melanoma patients were assessed using Chi-square and Fisher’s precision probability tests. Kaplan-Meier assay and log-rank test were utilized to estimate survival curves. Potential independent factors among the enrolled patients were investigated using COX regression analysis.

RESULTS: According to median value of H-score, 38 cases with low MC1R expression and 61 cases with high MC1R expression in melanoma tumor tissues were observed. Patients with high MC1R expression in melanoma tissues exhibited a worse prognosis compared to patients with low MC1R expression. The survival time difference was statistically significant [MC1R expression in melanoma tumor tissue (MC1RT): median DFS, 12.83 vs. 17.53 months, χ2 = 5.395, P=0.0202; median OS, 16.47 vs. 21.77 months, χ2 = 5.082, P=0.0243. MC1R expression in normal adjacent to melanoma tissue (MC1RN): median DFS, 12.03 vs. 14.29 months, χ2 = 6.864, P=0.0088; median OS, 16.73 vs. 21.77 months, χ2 = 5.649, P=0.0175]. Multivariate COX regression model analysis indicated that MC1RN, MC1RT, sex, ESR, tumor site, targeted therapy, and immunotherapy were potential prognostic factors for the DFS. Furthermore, MC1RN, MC1RT, sex, tumor site, TLN, PLN, and immunotherapy were potential prognostic factors for the OS. Calibration curve indicated the predicted probabilities of nomogram models were in accordance with the actual probabilities, and the prediction accuracy was relatively high at one year and three years following surgery. The decision clinical curve revealed that the nomogram models had better predictive performance for DFS and OS than the MC1RT or MC1RN thresholds.

CONCLUSIONS: Low MC1R expression in melanoma tumor tissues and adjacent normal tissue might be beneficial for the prognosis of melanoma patients. MC1R was a predictive factor for the prognosis of melanoma patients. Nomogram models based on MC1R demonstrated good prediction ability.

PMID:40213552 | PMC:PMC11983465 | DOI:10.3389/fimmu.2025.1570502

JAAD Int. 2024 Jan 13;20:23-30. doi: 10.1016/j.jdin.2023.12.010. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: There are multiple topical agents for papulopustular rosacea (PPR), but the most effective for the management of moderate-to-severe PPR remains unknown.

OBJECTIVE: To compare the efficacy and safety of topical agents for moderate-to-severe PPR.

METHODS: Medline, Embase, and CENTRAL databases were searched. The efficacy of topical agents was explored through frequentist network meta-analysis using random-effects model. Treatments were ranked using net rank function, yielding P scores.

RESULTS: Nineteen randomized control trials (RCTs) that enrolled and 8208 participants were deemed eligible. Azelaic acid 20% yielded the highest effect size (OR = 8.54, 95% CI: 2.48-29.45) and highest P-score (P score = 0.97) with respect to improvement in investigator global assessment (IGA) score. Azelaic acid 15%, Metronidazole 0.75%, and Ivermectin 1% yielded comparable effect sizes. Azelaic acid 15% yielded statistically significant odds ratio (OR = 1.95, 95% CI: 1.30-2.93, P score = 0.14) for adverse events. Adverse event risk for other topical agents was not significant.

LIMITATION: The sample size was limited for some of the topical agents. Also, many clinically important outcomes were overlooked by most of the included RCTs.

CONCLUSION: Azelaic acid 20% was the most effective in improving IGA score for moderate-to-severe PPR and azelaic acid 15% as having the highest adverse event profile.

PMID:40213532 | PMC:PMC11979399 | DOI:10.1016/j.jdin.2023.12.010