Nevin Manimala

Cureus. 2025 Dec 4;17(12):e98428. doi: 10.7759/cureus.98428. eCollection 2025 Dec.

ABSTRACT

Background Spinal cord injury (SCI) is a debilitating condition often associated with many complications, of which pressure injury (PI) is one of the most prevalent. Individuals with SCI are at an increased risk of developing PIs due to impaired protective sensations, dependence for mobility, and co-morbidities. Individuals with PIs often report an increase in morbidity, healthcare-related expenditure, and reduced quality of life (QoL). However, there is a paucity of data on PI-related risk factors and QoL outcomes in SCI individuals in developing countries like India. This study aimed to assess risk factors contributing to different stages of PI in individuals with SCI and to evaluate the impact of PI on their QoL. Methodology This was a cross-sectional observational study conducted over a period of 18 months at the All India Institute of Medical Sciences (AIIMS) Bhopal, India. A total of 134 individuals with SCI and PI were enrolled after considering all the inclusion and exclusion criteria. Data involving demographic profiling, physical examination, and hematological investigations were collected. Risk factors were assessed using the Braden Scale and Spinal Cord Injury Pressure Ulcer Scale (SCIPUS). Staging of PIs was done according to the Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System. Neurological level was classified using the American Spinal Injury Association (ASIA) Impairment Scale (AIS). QoL was determined using the World Health Organization Quality-of-Life Scale brief version (WHOQOL-BREF) questionnaire. Statistical analysis was done to assess the risk factors and their relation with SCI severity, PI stage, and QoL. Results The participants’ mean age was 38.65 years and 76.87% were men. Labourers were the most often affected (35.82%). Most participants were paraplegic (64.93%), and trauma was the most common cause of SCI etiology (66.42%). Stage 4 PI was observed (35.24%) more often than other stages and was followed by Stage 2 PI (34.46%). Complete SCI (American Spinal Injury Association (ASIA) Impairment Scale (AIS) A) was strongly associated with higher-stage PI. Risk factors such as limited mobility, moisture, and friction/shear were significantly linked to higher PI stages. Bed-bound individuals were more prone to Stage 3, while stage 4 PI was predominant in wheelchair-bound individuals. Braden and SCIPUS scores showed decreasing risk for PI from AIS A to D. WHOQOL-BREF revealed that all domains of QoL were adversely affected, but social relationship was reported as a major concern in our participants. However, no significant association was found between stage of PI and QoL scores. Conclusion This study highlights the strong correlation between complete SCI and higher-stage of PIs, with modifiable risk factors like moisture and friction having a substantial impact. PI considerably impairs all QoL domains, particularly social relationships. These findings emphasise the need for targeted preventive strategies and standard protocols to arrest PI progression and improve QoL of individuals with SCI. This is among the first such studies in central India, offering valuable insights for future clinical and rehabilitative planning.

PMID:41492628 | PMC:PMC12765511 | DOI:10.7759/cureus.98428

Cureus. 2025 Dec 5;17(12):e98526. doi: 10.7759/cureus.98526. eCollection 2025 Dec.

ABSTRACT

Background Intravesical administration of botulinum toxin type A (BoNT-A) is an established third-line intervention for patients with refractory overactive bladder (OAB). With BoNT-A therapy now widely adopted, ongoing audits remain important to capture real-world outcomes across different patient groups. This retrospective audit assessed the clinical outcomes of BoNT-A therapy in a heterogeneous patient population treated at a university-affiliated teaching hospital. Methodology We conducted a retrospective audit of 193 patients who received intravesical BoNT-A injections for OAB between January and December 2024. Patients underwent urodynamic testing to confirm diagnosis, and all cases were discussed in multidisciplinary team meetings where approval was given for BoNT-A treatment. Demographic data, treatment parameters, efficacy outcomes, adverse events, and catheterization requirements were systematically analyzed. Statistical analyses included chi-square tests and Fisher’s exact tests to evaluate associations between variables. Results The cohort included 164 (85%) females and 29 (15%) males, with a median age of 62 years. The primary indications for BoNT-A therapy were idiopathic detrusor overactivity (IDO, n = 149, 77.2%), neurogenic detrusor overactivity (NDO, n = 41, 21.2%), and sensory urgency (n = 3, 1.6%). Treatment success was observed in 82.4% (n = 159) of patients, with partial improvement in 4.1% (n = 8) and treatment failure in 11.9% (n = 23). The overall urinary tract infection (UTI) rate was 4.7% (n = 9), with diabetic patients exhibiting a three-fold increased risk (11.5% vs. 3.6%), but this did not reach statistical significance (χ² = 3.195, df = 1, p = 0.074; Fisher’s p = 0.105). Post-treatment catheterization was required in 29.5% (n = 57) of cases, predominantly among patients with NDO (n = 22, 53.7% vs. IDO, n=37, 25%). First-time BoNT-A administration occurred in 21.7% (n = 42) of patients, while the majority (n = 151, 78.3%) received repeat injections during the study period, with a mean of seven treatment cycles. The median duration of effect following intravesical BoNT‑A was six months (interquartile range = 5). The mean duration was 6.7 ± 4.0 months. Conclusions Intravesical BoNT-A demonstrates robust efficacy and an acceptable safety profile in the management of refractory OAB, with sustained therapeutic benefits necessitating repeat administration. Diabetic status may predispose patients to an increased risk of post-procedural UTIs, while those with NDO are more likely to require catheterization. These findings support BoNT-A as a valuable therapeutic option in the stepwise management of OAB, particularly when combined with appropriate patient selection and counseling.

PMID:41492626 | PMC:PMC12765457 | DOI:10.7759/cureus.98526

Cureus. 2025 Dec 5;17(12):e98511. doi: 10.7759/cureus.98511. eCollection 2025 Dec.

ABSTRACT

INTRODUCTION: Recurrent urinary tract infections (rUTIs) represent a significant clinical challenge, traditionally managed with long-term antibiotic prophylaxis. However, growing concerns regarding antimicrobial resistance have necessitated the exploration of alternative treatment modalities. Methenamine hippurate (MH), a urinary antiseptic with a unique mechanism of action, has emerged as a promising non-antibiotic option for rUTI prevention.

OBJECTIVE: This study aims to examine the effectiveness of MH in the prophylaxis of rUTI, with a specific focus on patients with structural or functional abnormalities of the urinary tract and those requiring catheterization to empty their bladder.

METHODS: A retrospective observational study was conducted on the first 150 patients prescribed MH in a University Hospital at a Local Health Board in South Wales from April 2020 to July 2022. Patient demographics, radiological findings, functional urological status, catheter use, and treatment outcomes were analyzed. Chi-square statistical tests were used to assess associations between categorical variables and treatment outcomes.

RESULTS: The cohort comprised 132 females (88%) with a median age of 60 years. After 12 weeks of treatment, 100 (66.7%) of patients showed improvement, with about half of these (n = 46) experiencing complete resolution of UTIs and a further third (n = 35) reporting reduced frequency or severity at six months follow-up. No statistically significant difference in long-term outcomes was observed based on radiological findings (χ² = 0.138, df = 2, p = 0.933). Similarly, there was no significant association between functional urological status and treatment outcome (χ² = 4.763, df = 2, p = 0.092), nor between catheter use and outcome (χ² = 4.226, df = 2, p = 0.121) Conclusions: MH demonstrates effectiveness for long-term management of rUTIs across diverse patient populations, including those with structural or functional urinary tract abnormalities and catheter users. These findings support the broader application of MH as a viable alternative to antibiotic prophylaxis, potentially reducing antimicrobial resistance while maintaining clinical efficacy.

PMID:41492622 | PMC:PMC12765357 | DOI:10.7759/cureus.98511

Cureus. 2025 Dec 5;17(12):e98536. doi: 10.7759/cureus.98536. eCollection 2025 Dec.

ABSTRACT

BACKGROUND: Pain management following lower extremity amputation remains a clinical challenge, particularly during inpatient rehabilitation. Although opioids are frequently used, their adverse effects and potential for prolonged use highlight the importance of multimodal pain strategies. This study investigated the relationship between specific non-opioid analgesics and reductions in opioid use among patients undergoing inpatient rehabilitation after major lower extremity amputation.

METHODS: A retrospective review was conducted at a single inpatient rehabilitation facility (IRF), examining opioid utilization measured in morphine milligram equivalents (MME) and the concurrent use of non-opioid agents, including acetaminophen, methocarbamol, gabapentin, pregabalin, and duloxetine. Eighty-one patients admitted between January 2021 and December 2023 were included. Admission and discharge opioid requirements were compared with daily non-opioid doses. Statistical analyses were performed using STATA version 3 (StataCorp LLC, College Station, TX).

RESULTS: Gabapentin use was associated with a significant decrease in MME from admission to discharge (p=0.04), with an average daily dose of 1000 mg corresponding to a reduction of 1 MME per day. In multivariable analysis incorporating all non-opioid medications, gabapentin and pregabalin both showed significant associations with reduced MME (p=0.021 and p=0.027, respectively).

CONCLUSION: Among patients recovering from lower extremity amputation during inpatient rehabilitation, gabapentin use was significantly associated with lower opioid requirements, with pregabalin demonstrating a similar pattern. Incorporating these agents into multimodal analgesic regimens may help optimize postoperative pain control and limit opioid exposure. Further research is warranted to explore the role of additional non-opioid options in this setting.

PMID:41492604 | PMC:PMC12765528 | DOI:10.7759/cureus.98536

Cureus. 2025 Dec 5;17(12):e98502. doi: 10.7759/cureus.98502. eCollection 2025 Dec.

ABSTRACT

INTRODUCTION: The systemic effects of capacitive and resistive energy transfer therapy (TECAR) and low-level laser therapy (LLLT) on hemodynamic parameters remain insufficiently documented. Although these procedures are known for their local impact on microcirculation, there is no solid clinical evidence regarding their influence on blood pressure. This study aims to describe the evolution of systolic and diastolic blood pressure during a standardized therapeutic protocol and to evaluate the safety of these interventions in patients with musculoskeletal disorders, including those with treated hypertension.

MATERIALS AND METHODS: A prospective observational study with repeated measurements was conducted across two clinical centers in Galați, Romania, between October 2023 and June 2025. A total of 268 patients with clinically and imaging-confirmed musculoskeletal disorders were included. Systolic and diastolic blood pressure were measured before and after TECAR and LLLT at three evaluation points (day 1, day 5, and day 10). Statistical analysis employed repeated-measures analysis of variance (ANOVA) and linear mixed models to compare responses between hypertensive and normotensive patients.

RESULTS: Statistical analyses revealed a discrete yet statistically significant reduction in systolic blood pressure at specific points within the therapeutic protocol. The Kolmogorov-Smirnov test indicated deviations from normality for post-procedure systolic values on days 1 and 5 following TECAR therapy (p = 0.010; p < 0.001), and on day 10 after LLLT (p = 0.044), suggesting increased variability in systolic responses at these stages. Comparisons between hypertensive and normotensive patients showed similar overall response patterns. Although initial sessions exhibited small group-dependent fluctuations, these differences progressively diminished, and systolic values converged by day 10, indicating a comparable hemodynamic profile and preserved safety across both categories. Diastolic blood pressure remained stable throughout the intervention, with no significant changes detected between pre- and post-session measurements. Repeated-measures ANOVA confirmed significant variations only in systolic values, while diastolic measurements showed no statistically relevant fluctuations.

CONCLUSION: This study showed that TECAR and LLLT are cardiovascularly well tolerated, producing only minimal and transient variations in blood pressure, with modest statistically significant reductions in systolic values and no significant changes in diastolic pressure. Responses were similar in hypertensive and normotensive patients, supporting an adequate safety profile. Controlled clinical studies are needed to further clarify any potential systemic hemodynamic effects of these therapies.

PMID:41492603 | PMC:PMC12765150 | DOI:10.7759/cureus.98502

Cureus. 2025 Dec 5;17(12):e98534. doi: 10.7759/cureus.98534. eCollection 2025 Dec.

ABSTRACT

BACKGROUND: Secondary hyperparathyroidism (SHPT) is a frequent complication in patients with end-stage renal disease (ESRD) undergoing hemodialysis. It results from imbalances in calcium, phosphate, and vitamin D metabolism due to impaired renal function.

OBJECTIVE: This study aimed to determine the frequency of SHPT among hemodialysis-dependent ESRD patients in a tertiary care hospital in Khyber Pakhtunkhwa.

METHODS: A cross-sectional study was conducted in the Nephrology Department of Lady Reading Hospital, Peshawar, from August 2023 to January 2024. A total of 127 patients between 18 and 75 years of age, undergoing maintenance hemodialysis for at least six months, were included. SHPT was defined in accordance with the Kidney Disease: Improving Global Outcomes (KDIGO) 2017 guidelines as an intact parathyroid hormone (iPTH) level greater than nine times the upper reference limit in hemodialysis patients. Data were analyzed using IBM SPSS Statistics for Windows, version 25, with stratification based on age, dialysis duration, diabetes status, and hypertension.

RESULTS: Out of 127 patients, 25 (19.7%) were found to have SHPT. The mean age of the study population was 51.8 ± 15 years, with 77 (60.6%) males and 50 (39.4%) females. Diabetes was present in 70 (55.1%) patients, while 83 (65.4%) were hypertensive. SHPT was observed more frequently among male patients, those with a longer duration of dialysis, and individuals with coexisting diabetes and hypertension.

CONCLUSION: SHPT was identified in nearly one-fifth of hemodialysis patients, with higher prevalence among males, diabetics, hypertensives, and those on prolonged dialysis. These findings highlight the importance of regular biochemical monitoring and early intervention to reduce SHPT-related complications and improve long-term outcomes in hemodialysis-dependent patients.

PMID:41492600 | PMC:PMC12765521 | DOI:10.7759/cureus.98534

Cureus. 2025 Dec 4;17(12):e98485. doi: 10.7759/cureus.98485. eCollection 2025 Dec.

ABSTRACT

​​​Introduction: Papillary thyroid carcinoma (PTC) is the most common thyroid cancer with multiple subtypes and accounts for the majority of thyroid malignancies worldwide. The tall cell subtype (TC-PTC) is recognised for its aggressive behaviour, poorer prognosis, and higher likelihood of extrathyroidal extension and distant metastasis. This study aimed to evaluate the prognostic validity of the revised WHO 2022 criteria for TC-PTC (≥30% of cells at least three times as tall as wide with dense eosinophilic cytoplasm and distinct cell membranes), compare clinicopathological features and outcomes of PTCs with any tall cell features (PTC-TCF) with classical PTC (cPTC), and determine whether less stringent morphological thresholds better identify clinically aggressive tumours.

METHODS: This retrospective comparative study was conducted in the Pathology Department of a tertiary care hospital in Kerala over four years (2015-2019) with a minimum five-year follow-up. Two groups were compared: PTC-TCF and cPTC, designated as cases and controls respectively. Based on distant metastasis proportions in TC-PTC and cPTC from an earlier study, with 95% confidence, 80% power, and a 1:4 ratio, the minimum required sample size was 66 cases and 264 controls (total of 330). Clinical and histopathological details were obtained from electronic medical records, and follow-up data from the institutional cancer registry. Archived H&E slides of cases with tall cell components were retrieved and reassessed for degree and percentage of tall cells. Statistical analysis was performed using IBM SPSS version 20.0 (IBM Corp., Armonk, NY, USA), with p < 0.05 considered statistically significant.

RESULTS: Of the 330 cases studied, 66 (20%) showed tall cell features. Compared with cPTC, PTC-TCF cases demonstrated significantly higher rates of extrathyroidal extension (ETE) (p < 0.001), advanced pathological T stage (p < 0.001), distant metastasis at presentation (p = 0.005), recurrence (p < 0.001), and mortality (p = 0.020). On multivariate analysis adjusted for tumour size and nodal status, T2 (HR = 12.70, p < 0.001) and T3 (HR = 17.40, p < 0.001) stages retained independent statistical significance. Tumour subtype (p < 0.001), tumour size (p = 0.043), modified American Thyroid Association (ATA) risk class (p = 0.006), proportion of cells with height twice as tall as width (2x) ≥ 30% (p = 0.003), T stage (p = 0.043), and M stage at presentation (p = 0.021) were found significant with respect to recurrence and death trends on univariate analysis. Categorising tumours using the WHO 2022 definition for tall cell subtype (≥ 30% of cells with height thrice as tall as width or 3x) did not yield significant correlation with recurrence or mortality rates (p = 0.197). After controlling for tumour focality, ETE, and lymphovascular invasion (LVI), presence of 2× tall cells in ≥ 30% retained significance (HR = 2.46, p = 0.048) with respect to prognostic outcomes on multivariate analysis.

CONCLUSION: In our study, the proportion of 2x tall cells with a cutoff of 30% showed statistical significance with respect to recurrence and mortality, which was retained even on multivariate analysis. This indicates that setting a criterion of 2x-3x tall cells for the diagnosis of tall cell PTC could better predict the prognosis.

PMID:41492599 | PMC:PMC12765030 | DOI:10.7759/cureus.98485

Cureus. 2025 Dec 5;17(12):e98532. doi: 10.7759/cureus.98532. eCollection 2025 Dec.

ABSTRACT

BACKGROUND: Polypharmacy in elderly patients significantly increases the risk of adverse drug reactions (ADRs), posing a challenge to safe outpatient care.

OBJECTIVE: To prospectively evaluate the frequency, nature, and clinical outcomes of ADRs associated with polypharmacy in elderly outpatients.

METHODOLOGY: A prospective observational study was conducted at the outpatient department of Azad Jammu and Kashmir Medical College (AJKMC), Muzaffarabad, over one year from June 2023 to May 2024. Through convenience sampling, 246 individuals who were at least 60 years old and using five or more drugs were included. Medical record reviews and structured patient interviews were used to gather data. The FDA Toxicity Grading Scale was used to classify ADRs according to their severity after they were evaluated using the FDA Toxicity Grading Scale. SPSS version 25.0 (IBM Corp., Armonk, NY) was used for the statistical analysis, and P < 0.05 was chosen as the significance level.

RESULTS: Of the 246 patients, 132 patients (53.66%) were male and 114 patients (46.34%) were female. The most common comorbidities were hypertension in 151 patients (61.38%), type 2 diabetes mellitus in 103 patients (41.87%), and ischemic heart disease in 89 patients (36.18%). Regarding polypharmacy, 94 patients (38.21%) were taking 5-6 medications, 87 patients (35.37%) were on 7-8 medications, and 65 patients (26.42%) were on 9 or more medications. A total of 76 patients (30.89%) experienced at least one ADR. The most frequently affected systems were gastrointestinal in 28 patients (11.38%) and dermatological in 17 patients (6.91%). ADRs were significantly more common in patients aged ≥80 years (16 out of 41, 39.02%), in those taking ≥9 medications (30 out of 65, 46.15%), and in those with two or more comorbidities (52 out of 121, 43.70%) (P < 0.05 for all comparisons).

CONCLUSIONS: Polypharmacy in elderly outpatients is strongly associated with clinically significant ADRs, warranting routine medication review and vigilant pharmacovigilance.

PMID:41492590 | PMC:PMC12765514 | DOI:10.7759/cureus.98532

Cureus. 2025 Dec 4;17(12):e98475. doi: 10.7759/cureus.98475. eCollection 2025 Dec.

ABSTRACT

Introduction Previous studies have identified morphological features in the bone and cartilage of knees with discoid lateral meniscus (DLM), but these investigations often depended on simple geometric variables like angles and linear dimensions. Three-dimensional (3D) bone and articular cartilage models can be used to obtain the volumes of knee structures. This study aimed to evaluate the volume of articular cartilage and epiphyseal bone in non-pathological knees and those with DLM and to assess their structural differences. Materials and methods This study included 19 magnetic resonance imaging (MRI) scans of knees in 16 patients with DLM and 31 MRI scans of non-pathological knees in 30 patients. Knee articular cartilage and epiphyseal bone segmentation were performed to obtain 3D reconstructed models. Subsequently, the cartilage and bone models were divided into five compartments for the femur (two-row (anterior and posterior) sections for the lateral and medial condyles and one section for the intercondylar region) and six compartments for the tibia (using a three-column (medial, intercondylar, and lateral) × two-row (anterior and posterior) grid), and the volumes of each compartment were calculated. Results The DLM knees had reduced volume in the lateral part of the articular cartilage and epiphyseal bone than those in the control group. Statistically significant differences between the two groups were observed in the volumes of the lateral tibial cartilage and lateral femoral epiphyseal bone. Conclusions Our study showed that the volume measurements of the knee articular cartilage and epiphyseal bone could facilitate the understanding of the structural differences between knees with DLM and non-pathological knees. The lateral compartment of the articular cartilage and bone is smaller in knees with DLM, and may be distinguishable from non-pathological knees.

PMID:41492588 | PMC:PMC12764399 | DOI:10.7759/cureus.98475

Cureus. 2025 Dec 4;17(12):e98439. doi: 10.7759/cureus.98439. eCollection 2025 Dec.

ABSTRACT

Introduction Traumatic limb fractures risk neurovascular (NV) compromise and require documented nerve-specific sensory, motor, and arterial assessments to support early detection and management. The British Orthopaedic Association Standards for Trauma (BOAST) mandate clear documentation of peripheral nerve function after injury, manipulation, cast fitting or surgery. This closed-loop audit measured current practice against the December 2021 BOAST guideline and tested whether a targeted educational intervention could improve NV documentation. Methods An audit for service evaluation and quality improvement at Russell Hall Hospital, UK, reviewed 97 adults admitted with acute upper- or lower-limb fractures across two cycles (49 patients, January 2024; 48 patients, July 2024). A single educational awareness presentation took place in May 2024. Data were extracted from Trauma & Orthopaedic (T&O) admission notes and benchmarked against BOAST criteria requiring specific nerve and arterial status. Median age and interquartile range (IQR) were reported; categorical comparisons used Pearson’s χ², and effect size was reported as phi (φ). Significance threshold was p < 0.05. Results Median age was 64 years (IQR: 34.5-79.5). The use of NV documentation rose from 87.8% to 97.9% following the intervention (χ² = 3.74, df = 1; p = 0.053). Detailed neurological recording increased from 38.8% to 54.2% (χ² = 2.31, p = 0.129; φ = 0.154). Detailed vascular recording improved from 26.5% to 45.8%, reaching statistical significance (χ² = 3.92, p = 0.048; φ = 0.201). Many entries continued to use the nonspecific phrase ‘NV intact’ rather than specific details. Conclusion Educational sessions within a closed-loop audit framework improved completion of an NV assessment and a significant rise in vascular details, while neurological details showed a slight increase. Continued adherence to BOAST guidance and structured feedback mechanisms should preserve high standards of NV assessment and improve patient safety.

PMID:41492587 | PMC:PMC12765522 | DOI:10.7759/cureus.98439