Nevin Manimala

Cureus. 2025 May 21;17(5):e84559. doi: 10.7759/cureus.84559. eCollection 2025 May.

ABSTRACT

BACKGROUND: To evaluate the efficiency of cotton (Apollo Sterilized Cotton Balls, Apollo Hospitals Enterprise Limited, Chennai, India), polytetrafluoroethylene (PTFE) tape (Holdtite Plus PTFE Tape, Pidilite Industries, Mumbai, India), and endo foam (Super Endo, Shenzhen Superline Technology Co., Ltd., Shenzhen, China) as an endodontic spacer material in combination with different intracanal medicaments.

MATERIALS AND METHODS: Ninety patients were randomized into three groups: Group I: cotton (n = 30), Group II: PTFE tape (n = 30), and Group III: endo foam (n = 30) after access opening and biomechanical preparation. Each group was further subdivided based on the intracanal medicament into subgroup A: sterile spacer (n = 10), subgroup B: spacer + calcium hydroxide (Ca(OH)₂) (Prime Dental Products Pvt. Ltd., Thane, India) (n = 10), and subgroup C: spacer + modified triple antibiotic paste (MTAP) (n = 10). Microbial load was assessed from samples collected from the access cavity at baseline (S₁) and again after seven days (S₂). Colony-forming units (CFUs) were determined after a 48-hour aerobic culture on brain-heart infusion (BHI) agar.

RESULTS: All three groups showed a statistically significant difference between the baseline and after seven-day mean values (p = 0.045, p = 0.049, p = 0.047). Intergroup comparison revealed a statistically significant difference in the mean values between the cotton and PTFE tape groups, as well as between the PTFE tape and endo foam groups. The mean difference values between the cotton and endo foam groups, however, did not differ in a way that was statistically significant.

CONCLUSION: Within the limitations of the study, it can be concluded that the PTFE tape and endo foam groups performed better than cotton.

PMID:40546637 | PMC:PMC12180776 | DOI:10.7759/cureus.84559

Cureus. 2025 May 21;17(5):e84530. doi: 10.7759/cureus.84530. eCollection 2025 May.

ABSTRACT

Background Exposure to nitrate through contaminated drinking water has been suggested as a potential risk factor for colorectal cancer (CRC). However, ecological evidence across the U.S. states remains limited. This study aims to examine the association between average nitrate concentrations and CRC incidence across 31 U.S. states. Methods An ecological analysis was conducted using data from the Centers for Disease Control and Prevention’s (CDC’s) Environmental Public Health Tracking Network and United States Cancer Statistics (2017-2021). Simple linear regression and Pearson correlation analyses were performed, stratified by gender. Results No significant associations were observed between nitrate concentrations and CRC incidence in both strata. Correlations were weak and non-significant. Conclusions In our study, state-level nitrate exposure was not significantly linked to CRC incidence. Further individual-level studies are recommended.

PMID:40546631 | PMC:PMC12179813 | DOI:10.7759/cureus.84530

Cureus. 2025 May 21;17(5):e84577. doi: 10.7759/cureus.84577. eCollection 2025 May.

ABSTRACT

BACKGROUND: The glomerular filtration rate (GFR) is considered the gold standard for assessing renal function. According to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, GFR estimation is often carried out using predictive equations that incorporate serum creatinine levels, along with demographic factors such as age, gender, race, and body size. However, these equations exhibit varying levels of accuracy across different populations, necessitating the evaluation of their performance and clinical relevance in diverse patient groups.

OBJECTIVES: This study aimed to evaluate the performance of three commonly used GFR estimation equations, the Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, along with their race-modified versions, by comparing them with measured 24-hour creatinine clearance (CrCl) in adult patients with chronic kidney disease (CKD).

METHODS: A cross-sectional descriptive study was conducted at Jos University Teaching Hospital (JUTH) between November 2019 and July 2020, involving 111 consecutively recruited CKD patients. Data collection included medical history, physical examination, laboratory investigations, calculation of CrCl, estimated glomerular filtration rate (eGFR) using different equations, and albumin-creatinine ratio (ACR). Statistical analysis was performed using SPSS version 20 (IBM Inc., Armonk, New York), with p-values <0.05 considered statistically significant.

RESULTS: The mean age of participants was 51.1±15.5 years. Diabetes mellitus was the most common cause of CKD, affecting 38% of the cohort. Among participants, 31% and 22% were classified as having stage 5 and stage 4 CKD, respectively. The median CrCl was 26 (9-56) mL/min. The median eGFR values across the equations were as follows: CG, 26 (11-60) mL/min/1.73m²; MDRD, 26 (11-60) mL/min/1.73m²; MDRD1, 22 (9-50) mL/min/1.73m²; CKD-EPI, 26 (10-62) mL/min/1.73m²; and CKD-EPI1, 22 (9-53) mL/min/1.73m². Strong positive correlations were observed between measured CrCl and the estimated GFR from each equation: CG (r=0.948, p=0.001), MDRD (r=0.940, p=0.001), MDRD1 (r=0.939, p=0.001), CKD-EPI (r=0.943, p=0.001), and CKD-EPI1 (r=0.942, p=0.001). Furthermore, significant correlations were found between the different GFR equations themselves, with the highest correlation observed between MDRD and CKD-EPI (r=0.999, p=0.001). The median ACR was 395.5 (45.3-2887.0) mg/g, and albuminuria was present in 82% of participants. All three GFR equations closely approximated the measured CrCl of 26 mL/min/1.73m². The equations performed optimally in patients with GFR values below 45 mL/min, with the CG equation exhibiting the least bias and the highest precision. Regression analysis revealed a significant association between albuminuria and all GFR equations and a notable association between age and CrCl, CG, and CKD-EPI estimates.

CONCLUSION: The CG, MDRD, and CKD-EPI equations demonstrated comparable accuracy to measured 24-hour CrCl in estimating GFR in Nigerian patients with CKD. These findings support the clinical use of these predictive equations for renal function assessment in CKD, though local validation in diverse populations is recommended for optimal clinical application.

PMID:40546627 | PMC:PMC12180909 | DOI:10.7759/cureus.84577

Cureus. 2025 May 23;17(5):e84659. doi: 10.7759/cureus.84659. eCollection 2025 May.

ABSTRACT

BACKGROUND: Chronic liver disease (CLD), traditionally considered a condition of older adults, has shown increasing mortality in younger US adults. Rising rates of alcohol-related liver disease and metabolic dysfunction-associated steatotic liver disease (MASLD) have shifted the demographic profile of CLD burden.

OBJECTIVE: This study aimed to identify significant trends and disparities in CLD mortality among US adults aged 25-44 years from 2000 to 2020, with analysis stratified by age subgroup, sex, and race/ethnicity.

MATERIALS AND METHODS: We conducted a retrospective analysis using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Underlying Cause of Death database. Deaths attributed to CLD were identified using International Classification of Diseases 10th Revision (ICD-10) codes K70 (alcoholic liver disease), K73 (chronic hepatitis), and K74 (fibrosis and cirrhosis). Data were stratified by age (25-34 and 35-44), sex, and race. Crude death rates per 100,000 were calculated. One-way analysis of variance (ANOVA) was performed to evaluate racial disparities within subgroups.

RESULTS: CLD mortality increased in all subgroups from 2000 to 2020. The highest rates were observed among men aged 35-44, particularly American Indian or Alaska Native (AI/AN) men, who reached an average of 19.4 deaths per 100,000. Black men and Hispanic women also experienced significant increases. ANOVA confirmed statistically significant racial disparities (p<0.0001) within all sex and age groups.

CONCLUSION: CLD mortality is rising among young US adults, with disproportionately high rates in AI/AN and Black populations. These findings underscore the need for earlier screening, expanded public health interventions, and targeted support for underserved communities.

PMID:40546619 | PMC:PMC12182956 | DOI:10.7759/cureus.84659

Cureus. 2025 May 20;17(5):e84515. doi: 10.7759/cureus.84515. eCollection 2025 May.

ABSTRACT

Background Assessing accurate fetal gestational age is vital in ascertaining the accurate growth of the fetus. Even if there are multiple ways to evaluate the fetal gestational age using ultrasonography, foot length measurement of the fetus can be utilized as an alternate tool to ascertain the age of gestation accurately. The length of the fetal femur and foot was estimated and recorded, and their ratio was calculated in this study. This parameter helps in distinguishing dysplastic short limbs from those shortened due to constitutional factors or due to intrauterine fetal growth retardation. Ultrasonography was used in this study to assess the association between gestational age and fetal foot length. The aim of the study is to derive normogram correlating gestational age (in weeks) with fetal foot length and to derive the femur-to-foot length ratio in women with 17-25 weeks of gestation. Materials and methods In our study, 150 healthy women with singleton pregnancy and 17-25 weeks of gestation underwent routine ultrasound examination in the Department of Radio Diagnosis, Meenakshi Medical College Hospital and Research Institute. In addition to the routine parameters, foot length and femur-to-foot length ratio were estimated. Results A strong correlation (positive) was observed in this study with Pearson’s correlation coefficient of 0.996 seen between gestational age and foot length, and 0.930 between foot length and femur length, both with a statistically significant p value < 0.0001. The femur-to-foot length ratio ranged from 0.9 to 1 in all cases. Conclusion The study revealed a robust correlation, which was linear, between gestational age and foot length, thereby supporting the use of fetal foot length as an added biometric measure to estimate gestational age. Additionally, the study highlights that the femur-to-foot length ratio approximates 1, with a ratio below 0.92 serving as a reliable indicator for detecting most cases of dysplasia.

PMID:40546615 | PMC:PMC12179565 | DOI:10.7759/cureus.84515

Cureus. 2025 May 22;17(5):e84610. doi: 10.7759/cureus.84610. eCollection 2025 May.

ABSTRACT

BACKGROUND: Obesity is a well-established risk factor for various cancers, contributing to significant public health burdens. Disparities in obesity-associated cancer incidence exist across racial, age, and geographic groups, necessitating targeted prevention and intervention strategies.

OBJECTIVE: The aim of this study is to analyze the incidence rates of obesity-associated cancers across different racial, age, and geographic groups in the United States from 2017 to 2021, identifying key disparities to inform public health interventions.

METHODS: A retrospective analysis of cancer incidence data from national registries was conducted. Age-adjusted incidence rates (per 100,000 population) were calculated across racial/ethnic groups, age cohorts, and US states. Descriptive statistics and confidence intervals were used to assess disparities.

RESULTS: Black, non-Hispanic individuals had the highest obesity-associated cancer incidence (184.8 per 100,000), followed by American Indian/Alaska Native populations (179.3 per 100,000). Incidence rates increased with age, peaking at 75-79 years (788.7 per 100,000 overall). Geographically, Midwestern and Southern states exhibited higher incidence rates, with West Virginia reporting the highest (188.3 per 100,000) and Nevada the lowest (149.5 per 100,000). These findings highlight significant racial, age, and regional disparities.

CONCLUSION: The study underscores the need for targeted public health strategies, including enhanced screening, culturally tailored interventions, and policy-driven approaches to address obesity and its related cancer risks. Future research should explore individual-level risk factors and effective interventions to promote equitable healthcare access and improved cancer outcomes.

PMID:40546611 | PMC:PMC12181978 | DOI:10.7759/cureus.84610

Cureus. 2025 May 21;17(5):e84580. doi: 10.7759/cureus.84580. eCollection 2025 May.

ABSTRACT

Psychiatric nosology, traditionally represented by the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM), is based on categorical diagnoses that have not met the current needs of clinicians. The so-called transdiagnostic approach appears to offer promise for classifying mental disorders. In the present study, our objective was to conduct a descriptive analysis of this approach in psychiatry based on the current literature. This study is a narrative review that utilized a bibliographic search for original and review articles on the transdiagnostic approach in psychiatry. The following keywords were used: “transdiagnostic”, “psychiatry”, “diagnosis”, “approach”, and “classification.” Searches were conducted in PubMed, ScienceDirect, Scielo, the Cochrane Library, PsycINFO, Lilacs, and Hinari. Articles in English and Spanish with publication dates between 2003 and 2024 were included. A total of 261 records were identified for screening, and 104 were retrieved for full review. The DSM and ICD are systems that define aspects of our conceptualization of mental health. More recently, however, transdiagnostic perspectives have gained prominence, particularly through frameworks such as the RDoC (Research Domain Criteria) and HiTOP (Hierarchical Taxonomy of Psychopathology). The RDoC stands out for guiding research on the neurobiological bases of psychopathology. HiTOP is based on data and a hierarchy that conceptualizes psychopathology as a set of transdiagnostic dimensions and spectra. Both approaches, with their strengths and weaknesses, could be an interface and the basis for a new nosology in psychiatry. There is consensus on the need for a new operational framework for classification. The transdiagnostic approach could be the contemporary answer to this premise. The challenge is to develop further research and standardize the definition of the construct.

PMID:40546608 | PMC:PMC12181037 | DOI:10.7759/cureus.84580

Cureus. 2025 May 20;17(5):e84487. doi: 10.7759/cureus.84487. eCollection 2025 May.

ABSTRACT

Introduction Hepatocellular carcinoma (HCC) remains a significant global health concern, ranking as the third leading cause of cancer-related mortality worldwide. The risk factors for HCC include chronic hepatitis B and C, alcohol-associated liver disease, and non-alcoholic fatty liver disease (NAFLD). The aim of this study was to evaluate trends in HCC incidence in the United States from 2000 to 2020 using the Surveillance, Epidemiology, and End Results (SEER) database, with stratification by age, sex, and race/ethnicity to identify demographic differences in temporal patterns. Methods Incidence rates of HCC per 100,000 population (age-adjusted) from 2000 to 2020 were calculated utilizing a population-based cancer registry, SEER*Stat (version 8.4.3). HCC cases were identified by the International Classification of Diseases for Oncology, third edition (ICD-O-3) site code C22.0 and histology codes 8170-8175, including only histologically confirmed malignancies. We utilized the Joinpoint Regression Program version 5.0.1 to report time-trends expressed as annual percentage change (APC). Cases with missing age, sex, or race data were excluded from stratified analyses. Statistical significance was set at a p-value less than 0.05. Results There were a total of 242,769 cases of HCC recorded from 2000 to 2020. Since 2015, HCC incidence has declined across all age groups, with the most significant reductions observed in individuals aged 45-54 years (APC, -8.22; p < 0.05) and 55-64 years (APC, -7.03%; p < 0.05). Among racial and ethnic groups, Black individuals experienced the most pronounced decline between 2018 and 2020 (APC, -10.64%; p < 0.05), followed by Hispanics (APC, -8.25%; p < 0.05) and Asians (APC, -8.06%; p < 0.05). With regards to sex, there was a greater decline among males (APC, -7.28%; p < 0.05) from 2018 to 2020 compared to females (APC, -2.4%; p < 0.05) from 2014 to 2020. Conclusions These findings reflect encouraging trends likely due to improved prevention and treatment of chronic liver diseases and are consistent with declining HCC incidence observed in other high-income countries. However, reliance on histologically confirmed diagnoses may underestimate the true incidence. Persistent disparities, potentially driven by differences in access to care and socioeconomic status, indicate a need for targeted interventions addressing underlying risk factors of HCC, such as obesity, alcohol, and viral hepatitis. With continued efforts focused on prevention, early detection, and treatment, the burden of HCC will continue to decline.

PMID:40546598 | PMC:PMC12178839 | DOI:10.7759/cureus.84487

Cureus. 2025 May 22;17(5):e84623. doi: 10.7759/cureus.84623. eCollection 2025 May.

ABSTRACT

Objectives The misuse of antibiotics fuels antimicrobial resistance (AMR), rendering treatments ineffective, increasing healthcare costs, and increasing mortality. This study estimated the prevalence, patterns, and drivers of self-medication with antibiotics (SMA) among adults, alongside exploring the reasons behind this practice. Methodology This community-based mixed-method study ran from January 2023 to June 2024. Simple random sampling selected 250 participants for the quantitative component, and purposive sampling chose 19 participants for the qualitative component. Descriptive statistics, cross-tabulation, and logistic regression were executed using SPSS (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp). Thematic analysis of focus group discussions (FGDs) was done using NVivo 14 (Lumivero 2023, NVivo Version 14, Denver). Results The prevalence of SMA was 36.4%(95% confidence interval (CI): 31.4-41.4), with 63 (69.2%) participants self-medicating at least once in the past three months, primarily for cold and flu-like symptoms (29, 31.86%) and fever (27, 29.69%). Key predictors of SMA were marital status, religion, education level, socioeconomic class, presence of chronic disease, knowledge, and attitude. Four (4.4%) participants experienced adverse drug reactions, 167 (66.8%) had inadequate knowledge about antibiotics, with only 13 (5.2%) aware of AMR, 142 (56.8%) had a favorable attitude towards SMA, and 171 (68.4%) followed appropriate practices. FGDs identified convenience, trust in local chemists, economic constraints, misinformation, long waiting times, limited healthcare access, and community acceptance as SMA drivers. Conclusion The study found that the prevalence of SMA in South-East Delhi surpasses rates in other regions of the country and signals a critical public health concern. To address SMA and mitigate AMR, authorities should enforce stricter regulations on over-the-counter antibiotic sales and implement targeted community education programs to enhance awareness of rational antibiotic use and AMR risks. These interventions, by improving regulatory oversight and knowledge, can effectively reduce SMA and safeguard antibiotic efficacy.

PMID:40546587 | PMC:PMC12182256 | DOI:10.7759/cureus.84623

Cureus. 2025 May 23;17(5):e84657. doi: 10.7759/cureus.84657. eCollection 2025 May.

ABSTRACT

BACKGROUND: Hodgkin lymphoma (HL) is a type of cancer that affects lymphatic tissues and is marked by the presence of Reed-Sternberg cells, which are large, abnormal lymphocytes. Involvement of the head and neck region is a prominent feature in HL, often serving as the initial clinical presentation of the disease.

OBJECTIVE: The main objective of the study is to find the incidence, mortality rate, and risk factors for HL in the Pakistani population.

METHODS: A retrospective study was conducted with 50 patients diagnosed with HL across three cancer treatment centers in Pakistan. Data were collected from medical records and structured patient interviews, examining demographic factors, clinical stage, treatment types, and risk factors, including Epstein-Barr virus (EBV) infection. Statistical analyses assessed correlations between risk factors, disease stage, and mortality.

RESULTS: The highest incidence was observed in young adults (18-30 years), with males representing 65% of cases. Mortality was significantly higher among patients diagnosed at advanced stages (stage III and IV), particularly in rural areas with limited access to treatment. EBV infection and low socioeconomic status were associated with late-stage diagnosis and poorer survival rates. Patients receiving combined chemotherapy and radiotherapy showed better one-year survival outcomes.

CONCLUSION: HL in Pakistan is characterized by late-stage diagnosis, high mortality, and socioeconomic disparities affecting access to care. Addressing these challenges through improved awareness, early screening, and accessible treatment could reduce mortality and improve outcomes.

PMID:40546577 | PMC:PMC12182637 | DOI:10.7759/cureus.84657