Nevin Manimala

F1000Res. 2025 Apr 25;13:1242. doi: 10.12688/f1000research.156703.2. eCollection 2024.

ABSTRACT

INTRODUCTION: Psoriasis is a chronic skin disease affecting quality of life and causing pruritus. The factors influencing itch and its impact on the quality of life in Thai psoriasis patients are unknown. We aimed to identify these factors and their effect on quality of life.

METHODS: In this questionnaire-based cross-sectional study, we included patients with psoriasis who received treatment at Chulabhorn Hospital in Thailand from January 2019 to July 2021. Interviewer is the non-dermatologist practician. The patient’s information was collected, including demographic data, Itch Numeric Rating Scale (Itch NRS) score, factors affecting itch, and score on the Thai version of the Dermatology Life Quality Index (DLQI). We performed descriptive statistics and logistic regression analysis.

RESULTS: Of 100 participants, most (99%) experienced itching, with a moderate degree of pruritus (mean Itch NRS score 6.5 ± 2.6) and a moderate effect on quality of life (mean DLQI score 9.4 ± 6.2). Factors associated with itch aggravation were dry skin (p-value = 0.003) and heat and humidity (p-value = 0.042). The results of binary logistic regression revealed that factors associated with moderate-to-extremely large DLQI scores were itch intensity (no-to-mild vs. moderate-to-severe itch: odds ratio [OR] = 13.33; 95% confidence interval [CI] = 2.72-65.32, p < 0.001; and adjusted odds ratio [AOR] = 31.17; 95% CI = 4.55-213.36; p < 0.001.

CONCLUSIONS: Our findings revealed that the quality of life among patients with psoriasis is their greatest concern. Eliminating the itch intensity that affects their quality of life is crucial but remains challenging in Thailand.

PMID:40416300 | PMC:PMC12103706 | DOI:10.12688/f1000research.156703.2

Cureus. 2025 Apr 24;17(4):e82944. doi: 10.7759/cureus.82944. eCollection 2025 Apr.

ABSTRACT

BACKGROUND: Dengue fever and enteric fever, two prevalent infectious diseases in tropical and subtropical regions, pose significant public health challenges due to their overlapping clinical manifestations and distinct therapeutic approaches. This study aims to evaluate hospitalization and management protocols for both illnesses, assessing their adherence to clinical guidelines and examining patient outcomes across diverse healthcare settings.

METHODOLOGY: A retrospective cross-sectional study was conducted by reviewing hospital records over a five-year period (April 2019-April 2024). A total of 218 individuals diagnosed with enteric fever (n=98) and dengue fever (n=120) were included in the study. Data were retrospectively collected using standardized forms from hospital records, laboratory reports, and discharge summaries to capture demographics, clinical presentations, lab findings, treatments, complications, and outcomes for patients with dengue or enteric fever. Statistical analysis was conducted using SPSS, Version 26 (IBM Corp., Armonk, NY), applying descriptive statistics, chi-square test, t-test, logistic regression, and Cox modeling to evaluate associations between treatment protocols and patient outcomes, with significance set at p<0.05.

RESULTS: Dengue and enteric fever showed distinct clinical patterns: rash and headache were more common in dengue fever, while abdominal pain and diarrhea predominated in enteric fever. Although demographic differences in age, sex, and residence were observed, they were not statistically significant. Improved outcomes in dengue fever were significantly associated with fluid replacement (n=110, 91.67%, p=0.02), reflecting the collective effect of standard supportive care measures. In contrast, antibiotic therapy (n=98, 100.00%, p=0.01) was central to favorable outcomes in enteric fever. Dengue fever was primarily diagnosed through serological testing (n=115, 95.83%), while enteric fever relied on blood cultures (n=78, 79.59%) (χ²=126.98, p<0.0001, OR=0.02). Hospitalization durations were significantly longer in enteric fever, patients staying ≥5 days compared to dengue fever patients (χ²=8.76, p=0.0031, OR=0.39). Recovery without complications was slightly more frequent in dengue fever (n=112, 93.33%) than in enteric fever (n=88, 89.80%), though this difference was not statistically significant (χ²=0.49, p=0.483, OR=0.60). These findings apply to general dengue fever cases only; patients with dengue hemorrhagic fever were managed separately due to differing clinical protocols.

CONCLUSION: This study highlights the necessity of tailored treatment protocols for enteric and dengue fever, emphasizing the importance of strict adherence to established clinical guidelines to optimize patient outcomes, particularly in resource-limited healthcare settings. While appropriate management, such as antibiotic therapy for enteric fever and supportive care for dengue, is well defined, differentiating between these conditions based solely on clinical presentation remains a significant challenge due to overlapping symptoms with other febrile illnesses. This diagnostic ambiguity underscores the urgent need for more robust, accessible, and rapid diagnostic tools. Furthermore, ongoing education and capacity building for healthcare professionals are essential to enhance clinical judgment, ensure early recognition, and improve compliance with evolving evidence-based practices in the management of febrile illnesses.

PMID:40416296 | PMC:PMC12103918 | DOI:10.7759/cureus.82944

Cureus. 2025 Apr 25;17(4):e82966. doi: 10.7759/cureus.82966. eCollection 2025 Apr.

ABSTRACT

Introduction This study aimed to analyze the costs of emergency department (ED) visits among patients aged 65 years and older, with a particular focus on the financial burden of recurrent admissions within a one-year period. Methods A retrospective cross-sectional study was conducted on 143,909 ED visits recorded between January 1, 2014, and December 31, 2014, at the Emergency Department of Ankara Atatürk Training and Research Hospital, Ankara, Turkey. Data for patients aged 65 and older were extracted from the Hospital Information Management System. Cost data were based on the Social Security Institution billing system and converted into US dollars (USD) using the 2014 exchange rate. Patients were categorized by age, gender, diagnosis, and visit frequency. Nonparametric statistical tests were used due to the non-normal distribution of cost variables. A p-value < 0.05 was considered statistically significant. Results A total of 21,458 (15.0%) ED visits were made by patients aged 65 and older. The median cost per visit in this group was $58.16. Costs increased with age: $42.90 for patients aged 65-74, $76.67 for those aged 75-84, and $96.42 for those aged ≥85 (Kruskal-Wallis H = 1,125.3, df = 2, p < 0.001). Among the 19,159 elderly patients who visited the ED, 1,951 (10.2%) had recurrent visits. Within this subgroup, internal medicine diagnoses were most common (1,345 visits, or 68.9%), followed by pulmonary (320, or 16.4%), cardiovascular (211, or 10.8%), and non-specific complaints (231, or 11.8%) as the leading causes. This diagnostic distribution differed significantly from that of single-visit patients (χ² = 42.7, df = 3, p < 0.001). Recurrence rates varied significantly by diagnostic category (χ² = 89.4, df = 5, p < 0.001): the highest recurrence was observed in patients with hematologic conditions (56/355, or 15.8%; adjusted OR = 1.72, 95% CI: 1.28-2.31), followed by psychiatric (8/57, or 14.0%; adjusted OR = 1.45, 95% CI: 0.99-2.12) and pulmonary diagnoses (320/2,358, or 13.6%; adjusted OR = 1.38, 95% CI: 1.22-1.57), all above the overall recurrence rate of 10.2%. The median cost of the first ED visit was significantly higher in the recurrent group ($72.13) compared to the non-recurrent group ($59.76) (Mann-Whitney U = 14.2 × 10⁶, p < 0.001, r = 0.14). Among recurrent cases, the mean cost of the first visit ($101.84) exceeded the average cost of subsequent visits ($93.98) (Wilcoxon T = 2.4 × 10⁵, p < 0.001, r = 0.09). Conclusion Older patients generate disproportionately higher ED costs in Turkey, particularly those with recurrent visits and chronic conditions. These findings support the implementation of geriatric-focused emergency care models and preventive strategies to optimize resource utilization in aging populations.

PMID:40416294 | PMC:PMC12103731 | DOI:10.7759/cureus.82966

Cureus. 2025 Apr 24;17(4):e82946. doi: 10.7759/cureus.82946. eCollection 2025 Apr.

ABSTRACT

Background Patient safety in pediatric care is a critical concern, as hospital environments pose unique risks for children, particularly falls. Despite advancements in healthcare, falls remain a common safety issue, emphasizing the need for effective preventive measures. Nurses play a vital role in reducing fall risks, but gaps in their knowledge, attitudes, and practices (KAP) can hinder the success of these efforts. This study evaluates the impact of targeted education on enhancing nursing officers’ KAP of fall prevention. Materials and methods A quasi-experimental pre-test and post-test design was conducted in the pediatric units of a tertiary care hospital in Bhopal. Nursing officers with at least one year of pediatric experience participated. KAP was assessed before a structured educational intervention, which included a workshop and educational materials. One week post-intervention, data were collected to measure changes. Statistical analysis was performed using SPSS Statistics version 26 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.), with paired t-tests assessing improvements in KAP and chi-square tests examining associations with demographic variables. Results A total of 64 nurses participated, with the majority being between 26 and 30 years old and holding a Bachelor of Science in Nursing degree. Pre-intervention knowledge levels indicated that most participants had average knowledge, which significantly improved post-intervention (mean score: 16.2 ± 4.20 to 24.0 ± 3.37, p<0.001). Attitudes toward fall prevention became more positive (mean score: 69.7 ± 6.07 to 73.5 ± 4.82, p<0.001), and preventive practices improved significantly (mean score: 10.7 ± 2.15 to 12.8 ± 1.50, p<0.001). Knowledge was significantly associated with age (p=0.029) and marital status (p=0.021), while attitudes and practices were linked to the department and the age group of the children in care. Conclusions Targeted educational interventions significantly improved nurses’ KAP of pediatric fall prevention. Although the intervention led to immediate improvements, further research is needed to assess long-term retention and sustainability. Continuous professional development, institutional policies, and interdisciplinary collaboration are essential to maintaining high standards of pediatric patient safety.

PMID:40416284 | PMC:PMC12103634 | DOI:10.7759/cureus.82946

Cureus. 2025 Apr 23;17(4):e82853. doi: 10.7759/cureus.82853. eCollection 2025 Apr.

ABSTRACT

Background Head and neck cancer (HNC) surrounds many malignancies that affect mucosal linings, lymphatic tissues, and salivary glands. The predominant subtypes include squamous cell carcinoma (SCC), Hodgkin lymphoma (HL), and pleomorphic adenoma (PA). One long non-coding RNA (lncRNA) known as B-cell lymphoma 1 (BCL1) has been observed to be a key regulator of tumor progression, metastasis, and resistance to chemotherapy. Objective This study aims to quantify the expression of BCL1 across HNC subtypes to evaluate its diagnostic and prognostic relevance. Materials and methodology A case-control study was conducted for nine months from February 2023 to October 2023. The study involved 160 HNC patients and 40 healthy controls. Blood samples were collected, and RNA extraction, cDNA synthesis, and RT-qPCR analysis were done afterward using BCL1-specific primers. Data were analyzed by using one-way analysis of variance (ANOVA) in SPSS v.26 (IBM Corp, Armonk, NY, US) with p<0.05 considered statistically significant. Results In patients with HNC, elevated relative gene fold levels of BCL1 highlighted malignancy in squamous cell carcinoma (SCC; 3.19±0.72), Hodgkin lymphoma (HL; 1.91±0.72), and pleomorphic adenoma (PA; 2.24±0.72), in comparison to the control group (1.07±0.72). SCC patients showed the highest expression, which correlated with advanced tumor stages (Stage IV: 60%). Conclusion There was an overexpression of BCL1 observed in HNC subtypes, which highlighted its role as an important biomarker for tumor aggressiveness and therapeutic resistance. This advocates its integration into frameworks of precision oncology.

PMID:40416279 | PMC:PMC12101792 | DOI:10.7759/cureus.82853

Cureus. 2025 Apr 23;17(4):e82879. doi: 10.7759/cureus.82879. eCollection 2025 Apr.

ABSTRACT

Introduction Complications such as acute rejection (AR) and acute tubular necrosis (ATN) following kidney transplantation can adversely affect graft function, complicating the treatment process and endangering patient health. Diffusion-weighted magnetic resonance imaging (DWI) has emerged as a promising imaging modality for detecting microscopic changes in renal tissue, particularly those affecting cellular structures. This study aims to evaluate the potential of DWI in detecting AR and ATN in kidney transplant patients. Methods A total of 24 patients who underwent kidney transplantation at the Department of Organ Transplantation, Ege University Faculty of Medicine, between January 2010 and December 2019 were included in the study. Fourteen patients with AR or ATN formed the study group, while the remaining 10 patients, who did not develop complications, constituted the control group. All patients underwent DWI using a 3 Tesla magnetic resonance imaging (MRI) device, and apparent diffusion coefficient (ADC) values were measured at different levels of the renal cortex and medulla. Results When evaluating the mean ADC values (×10⁻³ mm²/second) measured from the upper, middle, and lower poles of the kidneys, significantly lower values were observed in the study group compared to the control group. Statistically significant differences were found in all regions (p < 0.05). Conclusion In conclusion, this study highlights the potential utility of DWI as a non-invasive tool for assessing renal allograft function and detecting early graft injury in kidney transplant recipients.

PMID:40416269 | PMC:PMC12102636 | DOI:10.7759/cureus.82879

Cureus. 2025 Apr 23;17(4):e82845. doi: 10.7759/cureus.82845. eCollection 2025 Apr.

ABSTRACT

Psychogenic nonepileptic seizures (PNES), also referred to as functional seizures, are events that mimic epileptic seizures but are not triggered by abnormal electrical activity in the brain. According to the International Statistical Classification of Diseases (ICD)-11, PNES are classified as dissociative disorders. Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation therapy commonly used to treat major depression, particularly in cases where other treatments have not been effective. PNES has not been associated with TMS previously. Here, we describe a 52-year-old Caucasian male who presented to the acupuncture clinic with multiple episodes of sudden loss of consciousness following TMS for a long history of major depression. The episodes of unconsciousness occurred up to five times per day. During an electroencephalograph (EEG) session, the patient had an episode that included poor balance, “shaking,” head nodding, and a robotic/slowed voice, although no epileptic activity was captured on EEG. His illness was therefore diagnosed as PNES activity. He underwent treatment with body acupuncture and auricular acupressure and improved, with reduced number and duration of episodes. PNES following TMS has not been reported previously. A strong magnetic field can potentially disrupt normal neurotransmission and neuronal metabolism, resulting in PNES. The beneficial effects of acupuncture have been documented, but the mechanism of action has not been elucidated.

PMID:40416263 | PMC:PMC12102631 | DOI:10.7759/cureus.82845

Cureus. 2025 Apr 25;17(4):e82976. doi: 10.7759/cureus.82976. eCollection 2025 Apr.

ABSTRACT

Background Primary bladder neck obstruction (PBNO) in females is a rare condition with a tedious diagnostic process. The existing literature on bladder neck incision (BNI) to treat PBNO lacks a precise description of the surgical technique. Objective In this study, we provide a diagnostic protocol to streamline the evaluation of PBNO in females. We evaluate the outcomes of a precise surgical technique of BNI aimed at reducing the rates of known complications such as vesicovaginal fistula (VVF) and urinary incontinence. Methods This single-center prospective observational study, conducted over five years (2019-2024), included 20 patients diagnosed with PBNO who underwent BNI. Analyses included patient demographics, clinical presentation, treatment outcomes, and complications. Statistical analysis was performed using ANOVA, and univariate analysis was also conducted. Differences with P < 0.05 were considered statistically significant. Results At six months post-surgery, the mean maximum urinary flow rate (Qmax) increased from 6.49 ± 2.63 mL/sec to 12.41 ± 2.42 mL/sec (P = 0.0421). The mean post-void residual volume (PVR) decreased from 202.11 ± 70.20 mL to 53.11 ± 14.78 mL (P = 0.0152). The mean International Prostate Symptom Score (IPSS) decreased from 26.95 ± 2.84 to 14.74 ± 3.23 (P = 0.0325). The mean quality of life (QoL) score improved from 4.70 ± 0.80 to 1.60 ± 0.12 (P = 0.0067). None of the patients developed VVF or urinary incontinence in the post-operative period. One patient (5%) required re-surgery due to recurrence of bladder neck obstruction. Conclusion BNI for PBNO provides satisfactory results. A precise operative technique, with careful consideration of the depth and distal extent of the incision, helps avoid complications such as VVF and urinary incontinence.

PMID:40416261 | PMC:PMC12103814 | DOI:10.7759/cureus.82976

Cureus. 2025 Apr 25;17(4):e82965. doi: 10.7759/cureus.82965. eCollection 2025 Apr.

ABSTRACT

Introduction The anterior cruciate ligament (ACL) is essential for knee stability, and its injury significantly impacts athletic performance. Anterior cruciate ligament reconstruction (ACLR) is the standard treatment for active individuals, yet many fail to return to sport (RTS) due to factors like pain and kinesiophobia. This study explores these barriers in the Saudi Arabian population. Methodology This is a cross-sectional study using an online questionnaire targeting ACLR patients across five Saudi hospitals between 2017 and 2023. Tools included are the International Knee Documentation Committee’s (IKDC) scale and the Tampa Scale for Kinesiophobia (TSK-11) score. Data was analyzed using IBM SPSS Statistics software, version 29.0.0 (IBM Corp., Armonk, NY). Results Our study included 84 participants undergoing ACL reconstruction. Most were aged between 18 and 25 years (n=35, 41.7%), male (n=75, 89.3%), and employed (n=65, 77.4%). Only 44.0% (n=37) returned to their pre-injury level of sport. Moderate fear of re-injury was common (n=67, 79.8%), and fear significantly correlated with lower IKDC scores (r = -0.410, p < 0.001). Participants with minimal fear had the highest IKDC score (81.01 ± 9.47, p < 0.001). Functional limitation was significantly associated with RTS (p < 0.001); none with moderate/severe limitations returned. Lower pain scores (1.77 vs. 4.35, p = 0.005), lower TSK-11 scores (15.77 vs. 22.90, p < 0.001), and higher knee function (81.01 vs. 63.02, p < 0.001) were significantly linked to RTS. Height > 180 cm was also significantly associated with RTS (p = 0.011). Conclusion Our findings show that returning to sport after ACLR is strongly influenced by functional ability, pain severity, and fear of re-injury. Psychological readiness, particularly kinesiophobia, plays a critical role. Addressing both physical limitations and mental barriers is essential to improve RTS outcomes in post-ACLR patients.

PMID:40416260 | PMC:PMC12103728 | DOI:10.7759/cureus.82965

Cureus. 2025 Apr 24;17(4):e82955. doi: 10.7759/cureus.82955. eCollection 2025 Apr.

ABSTRACT

Polymerase chain reaction (PCR) tests are the gold standard for confirming COVID-19. Test results provide the cycle threshold (Ct) value, which is correlated to the patient’s viral load as well as hematological and biochemical parameters. The purpose of this study is to analyze the transmission dynamics of selected SARS-CoV-2 variants, both within hosts and between hosts, through statistics and data analysis of the Ct values and other metrics. Demographics data and Ct values from 1,041 patients with COVID-19 were collected and correlated with epidemiological indices, such as the positivity rate, hospitalizations, and deaths for each major wave of the pandemic, in Greece. The analysis showed that higher viral loads coincide with rising pandemic waves, while lower loads are observed during periods of decline. Notably, among all variants analyzed, the Delta variant, observed in mid-2021, exhibited the highest viral load values, which were associated with increased hospitalizations and mortality, despite a relatively low positivity rate. Consequently, variables associated with inter-host transmission dynamics show a significant correlation with those pertaining to intra-host dynamics. This correlation opens up the potential for predicting disease severity and forecasting the trajectory of the pandemic based on patient-related and other variables through data analysis. The analysis revealed that variations in Ct value yield valuable insights into the evolution of the pandemic and the risk stratification of patients. The study highlights that statistical measures derived from Ct values can provide insights into both intra-host and inter-host transmission dynamics, potentially supporting risk assessment and public health responses.

PMID:40416259 | PMC:PMC12103932 | DOI:10.7759/cureus.82955