Nevin Manimala

Clin Ter. 2026 Jan-Feb;177(1):130-138. doi: 10.7417/CT.2026.1984.

ABSTRACT

BACKGROUND: Osteoarthritis (OA) is a pathological condition widely prevalent throughout the world. The inability to perform some physical functions was the main symptom of OA and it impacted the quality of life (QOL) of patients. Therefore, TKR surgery was necessary to improve their QOL. However, to our knowledge, no study addressed the assessment of physical health and improvement in QOL before and after TKA in Saudi Arabia.

OBJECTIVE: To assess the QOL of patients before and after TKA.

METHODS: A cross-sectional study included 139 TKR patients with a mean age of 63.8±6.2 years. Data on sociodemographic characteristics, date of TKR surgery, and body mass index (BMI) were recorded. QOL was assessed (before TKR surgery and from 6 months to 3 years after surgery). The WOMAC, SF-12, and SF-36 physical health and QOL assessment scale questionnaires were sent to the participants and the results were obtained. Data and relationships were analyzed with SPSS, t-test, and ANOVA.

RESULTS: The mean WOMAC and SF-12 total scores after TKR surgery showed significant improvement compared to before surgery (14.3±5.7 vs. 61±6.1, p=0.001) and (56±4.8 vs. 38.5±7.4, p= 0.02) respectively. There was statistical significance for mean gender, educational level, date of surgery, and BMI with QOL scales.

CONCLUSIONS: Our results suggest that patients who had undergone TKR surgery at least six months prior reported improvements in physical health status and QOL according to the study scales WOMAC, SF-12, and SF-36, which are considered the most appropriate scales to evaluate the QOL of TKR patients.

PMID:41525123 | DOI:10.7417/CT.2026.1984

Clin Ter. 2026 Jan-Feb;177(1):123-129. doi: 10.7417/CT.2026.1983.

ABSTRACT

BACKGROUND: Polycystic ovary syndrome (PCOS) is a multifactorial endocrine disorder with both reproductive and metabolic manifestations. Subclinical hypothyroidism (SCH), is defined by elevated thyroid-stimulating hormone (TSH) with normal free thyroxine levels, is increasingly recognized in women with PCOS, yet its clinical impact remains debated. This study intended to explore the prevalence of SCH in PCOS and examine its influence on metabolic, hormonal, and anthropometric profiles in an Indian population.

METHODS: A cross-sectional study was conducted between January 2023 and January 2025 at a tertiary care center in South India. A total of 368 women with PCOS, diagnosed according to Rotterdam criteria, were enrolled and classified as either euthyroid (n = 316) or having SCH (n = 52). Comprehensive evaluations included anthropometry, blood pressure, glycemic indices, lipid profile, insulin resistance via HOMA-IR, and reproductive hormone levels. Statistical analyses included t-tests and Spearman correlation.

RESULTS: The prevalence of SCH among women (with PCOS) was 14.13%. Compared with the euthyroid group, SCH-PCOS patients exhibited significantly higher BMI, fasting blood glucose, HbA1c, serum insulin, HOMA-IR, and adverse lipid profiles (p < 0.05). No significant diffe-rences were observed in LH, FSH, or testosterone levels. TSH demonstrated positive correlations with BMI, Glycemic markers, and HOMA-IR, underscoring its association with metabolic risk.

CONCLUSION: SCH is a common and metabolically relevant comorbidity in women with PCOS, aggravating insulin resistance and dyslipi-demia without significantly affecting reproductive hormones. These findings highlight the need for routine thyroid function screening in PCOS management, especially among those with metabolic syndrome features. Further longitudinal studies are warranted to evaluate the benefits of targeted thyroid intervention in this subgroup.

PMID:41525122 | DOI:10.7417/CT.2026.1983

Clin Ter. 2026 Jan-Feb;177(1):100-103. doi: 10.7417/CT.2026.1980.

ABSTRACT

BACKGROUND: Hypertension is a major risk factor for cardiovascular disease. Despite pharmacologic interventions, a substantial proportion of patients exhibit poor blood pressure (BP) control. High sodium intake is a modifiable contributor to uncontrolled hypertension. This study eva-luates 24-hour urinary sodium excretion as an objective biomarker for sodium intake in controlled versus uncontrolled hypertensive patients.

OBJECTIVES: To compare 24-hour urinary sodium excretion between hypertensive patients with controlled and uncontrolled BP, and to assess its association with treatment response.

METHODS: This cross-sectional study was conducted at VMKV Medical College and Hospital, Salem, over 15 months. A total of 100 hypertensive patients aged 45-65 years were recruited and grouped into controlled (n=50) and uncontrolled (n=50) based on JNC VIII BP criteria. Data on demographics, clinical history, and 24-hour urine collections were analyzed. Sodium, potassium, and albumin levels were measured. Independent t-tests and Chi-square tests were used for statistical comparisons.

RESULTS: Mean 24-hour urinary sodium was significantly higher in the uncontrolled group (174.5 ± 32.1 mmol/day) compared to the controlled group (142.7 ± 28.3 mmol/day; p < 0.001). No significant differences were noted in urinary potassium levels (p = 0.42) or microalbuminuria prevalence (p = 0.31) between the groups.

CONCLUSION: Higher urinary sodium excretion is significantly associated with poor BP control, underscoring the importance of dietary sodium reduction even in patients under antihypertensive therapy. 24-hour urine sodium measurement can serve as a reliable biomarker in clinical management.

PMID:41525119 | DOI:10.7417/CT.2026.1980

Clin Ter. 2026 Jan-Feb;177(1):93-99. doi: 10.7417/CT.2026.1979.

ABSTRACT

INTRODUCTION: Women are vulnerable to depression, with evidence of MAO-A and HTTP gene variations’ impact. We studied depression in women at a UAE hospital to analyze hormonal changes, psychological symptoms severity, and gene variations related to MAO and HTTP promoter region polymorphism.

METHODS: This prospective analytical study included 100 participants (50 depressed, 50 non-depressed women aged 18-60 years). Women with thyroid diseases, abnormal mammograms, organic causes, cardiovascular diseases, or atherosclerotic conditions were excluded. Depression severity was assessed using Beck Depression Inventory. Cortisol, serotonin, and leptin levels were measured using ELISA kits. Saliva samples were collected for DNA polymorphism detection using PCR and gel electrophoresis. Statistical analysis used SPSS software.

RESULTS: Participants showed simple depression (20%), moderate (13%), severe (10%), and very severe (7%). HTTP cases were L/L (41%), L/S (39%), and S/S (20%). MSP distributions were SA/SG (32%), SA/SA (29%), LA/SA (25%), and SA/LG(14%); MAO were 3/4 (57%), 3/3 (32%), and 4/4 (11%).

CONCLUSION: This UAE study demonstrates hormones and gene variations’ influence. HTTP genotyping revealed three groups: S/S, S/L, and L/L alleles. MAO variants were 3/4, 3/3 and 4/4. Genetic factors can guide treatment planning for severe depression.

PMID:41525118 | DOI:10.7417/CT.2026.1979

Clin Ter. 2026 Jan-Feb;177(1):74-82. doi: 10.7417/CT.2026.1977.

ABSTRACT

BACKGROUND: Dynamic contrast enhancement-magnetic resonance imaging (DCE-MRI) is becoming increasingly significant for identifying and characterizing breast lesions. It can also provide insight into functional parameters, such as enhancement kinetics and tissue perfusion parameters, including Ktrans, Ve, and Kep.

AIM: This study explores the role of both qualitative and quantitative analyses of DCE-MRI in enhancing diagnostic accuracy for distin-guishing between benign and malignant breast lesions, contributing to more precise breast cancer diagnosis and management.

MATERIALS AND METHODS: This single-center cross-sectional study was performed on 47 patients with breast lesions. MRI Breast was performed on a closed 3T MRI scanner equipped with a dedicated 18-channel breast coil. MRI study protocol included conventional Breast MRI and DCE sequences. Statistical analysis was performed using the SPSS statistics software package version 28.0.

RESULTS: A total of 47 patients, with an age range of 17 to 70 years old, were included in the study. The sensitivity of kinetic curve analysis was 94.74 %, specificity of 75%, positive predictive value of 72 %, and negative predictive value of 95.45 % to distinguish benign and mali-gnant breast lesions. The mean Ktrans value of benign breast lesions was 0.447+1.55/min and 0.496+1.08 / min (p-value <0.04) for malignant lesions. The mean Kep value of benign breast lesions was 2.984+8.27/ min, and for malignant lesions was 3.424+8.70/ min (p-value <0.008). The mean Ve value did not show a significant value in distinguishing benign and malignant breast lesions (p-value <0.386). Kep cut-off value at 0.279 and Ktrans cut-off value at 0.73 depicted the highest area under the curve (AUC).

CONCLUSIONS: Integrating qualitative and quantitative data provides a more comprehensive understanding of breast lesions, ultimately leading to more accurate diagnoses and tailored treatment strategies.

PMID:41525116 | DOI:10.7417/CT.2026.1977

Clin Ter. 2026 Jan-Feb;177(1):45-54. doi: 10.7417/CT.2026.1974.

ABSTRACT

OBJECTIVE: To evaluate the osteogenic potential of dental pulp mesenchymal stem cells in extraction sockets of mandibular third molars by objective assessment of bone density and resorption.

MATERIALS AND METHODS: This human study, a randomized clinical trial included twenty bilaterally symmetrical impacted third molars on each side of the lower jaw. The cohorts were divided in to two groups. Group A in which stem cells extracted from the pulp chamber were placed in the extraction socket. The stem cells were wrapped with a collagen membrane in a ependorph tube and roiled on a dental vibrator. In Group B, the extraction socket was closed without the placement of stem cells. CBCT was performed on the day of the surgery and 6 months post-surgery. CBCT data was analyzed by 2 radiologists individualistically, determining bone density and bone resorption post extraction and 6 months thereafter.

RESULTS: The response variable were bone density and bone resorption. Bone density variable BDD for Group A by radiologist 1 and radiologist 2 was 136 and 136.50(Median Inter quartile range) with p value (0.0001) and for Group B by radiologist 1 and 2 was 47.0 and 52.0(Median Interquartile range) with p value (0.0001). Bone resorption variable (BRV) for Group A by radiologist 1 and radiologist 2 was -0.885 and -0.845(Median IQR) with p value (0.001) and for Group B it was -0.325 and -0.330(Median IQR) with p value (0.001). With a p value less than 0.05 our results were statistically significant.

CONCLUSION: The results of our study suggest an increase in bone density and reduced bone resorption in the extraction sockets that were infused with dental pulp stem cells before closure, as opposed to the controls.

PMID:41525113 | DOI:10.7417/CT.2026.1974

Clin Ter. 2026 Jan-Feb;177(1):38-44. doi: 10.7417/CT.2026.1973.

ABSTRACT

BACKGROUND: Upper gastrointestinal endoscopy (UGIE) is a widely used procedure for the diagnosis and treatment of upper gastrointestinal diseases. The use of lidocaine as a topical pharyngeal anesthetic has been shown to facilitate endoscopy intubation and reduce pharyngeal mucosa injury. Lidocaine gel and spray are two common forms of topical pharyngeal anesthesia used to reduce discomfort and pain during these procedures.

METHODS: In This prospective, randomized, single-blinded clinical trial, 180 patients eligible for UGIE were randomly allocated into 2 groups. The first Group S (Lidocaine Spray) received 6 puffs of 10% lidocaine spray each puff delivering 10mg of lidocaine, sprayed to the pharynx distributed as 2 puffs in left, right and middle portion after tongue depression in 2 consecutive 30-second intervals. After each spray, patients were asked to swallow to maximize the anesthetic effect on the hypopharynx. The second Group G (Lidocaine Gel) received 10g of 2% lidocaine gel (gently applied 3-5 minutes before the endoscopy at three consecutive 30-second intervals on the palate and peritonsillar areas. Patients were informed to spread the gel within their mouth by the tongue and then swallow it to cover the oropharynx and esophagus. Outcome parameters included incidence of gag reflex as a primary outcome with the ease of esophageal entrance during endoscopy were com-pared. onset of numbness, Total propofol consumption, recovery time, Endoscopist and Patient Satisfaction and complications as a secondary outcome during UGIE.

RESULTS: Comparison between the groups studied regarding the outcome parameters. The Lidocaine gel groups achieved better performance and better scores in reducing gag reflex (6.67%) compared to (21.11%) Spray group, and ease of 1st attempt esophageal intubation is statisti-cally significant better (96.67%) compared to (85.56%) in spray group as well as reducing total patient number of propofol needs 8/90 (8.89%) compared to 23/90 (25.56%) in Spray group as well as increase patient and endoscopist satisfaction.

CONCLUSION: Lidocaine Gel is considered safe, suitable and effective option and exhibiting better performance in reducing the incidence of gag reflex, with the ease of esophageal entrance shortening recovery time and improving patient and endoscopist satisfaction. Decrease total propofol consumption in patients undergoing UGIE compared to lidocaine spray.

PMID:41525112 | DOI:10.7417/CT.2026.1973

Clin Ter. 2025 Jan-Feb;177(1):23-30. doi: 10.7417/CT.2026.1971.

ABSTRACT

PURPOSE: This study examines how demographic factors such as parental age, education, occupation, intervention training, family income, and psychotropic drug use impact Autism Spectrum Disorder (ASD) intervention outcomes in southern Vietnam. Identifying significant demographic influences can help clinicians personalize treatment plans, potentially improving the effectiveness of interventions for ASD.

APPROACH: Sixty-three children with ASD were analyzed using DSM-5 criteria. Intervention outcomes were measured through the Childhood Autism Rating Scale (CARS), Autism Treatment Evaluation Checklist (ATEC), Vineland Adaptive Behavior Scales-II (VABS-II), and Communication Matrix (CM). Statistical analyses used the General Linear Model to assess associations between demographic factors and intervention effectiveness.

FINDINGS: Results show that specific factors, particularly paternal age, occupation, family income, and psychotropic drug usage, correlate significantly with certain intervention outcomes. Notably, psychotropic drugs positively affected communication, while other variables like paternal age and income impacted adaptive behaviors.

ORIGINALITY/VALUE: This study emphasizes the value of demographic-informed, tailored intervention approaches for ASD. These findings highlight how specific demographic factors can serve as predictors of treatment response, providing insights for developing more personalized ASD intervention strategies.

PMID:41525110 | DOI:10.7417/CT.2026.1971

JMIR Form Res. 2025 Dec 29. doi: 10.2196/81499. Online ahead of print.

ABSTRACT

BACKGROUND: Suicide is the second leading cause of death for children and adolescents aged 6 to 18 years old. Pediatric suicidality is underreported, which poses significant challenges for effective intervention and prevention strategies. Identifying populations at risk for suicidality can provide critical benefits in terms of study cohort selection, prevalence estimation, and clinical resource allocation.

OBJECTIVE: This study sought to (1) measure the prevalence of mental health comorbidities in pediatric suicidality, and (2) identify undiagnosed high-risk suicidality cases by matching patients with similar mental health comorbidity burden.

METHODS: Electronic health record data from a large academic pediatric hospital in Boston, Massachusetts, were analyzed for patients aged 6-18 years old presenting to the emergency department between June 1, 2016, and June 1, 2022. Suicidality cases were defined using ICD-10 codes for three suicidality subtypes: suicidal ideation, self-harm, and suicide attempt. Comorbidities of suicidality were calculated as the conditional probability of ICD-10 code pairs. After multiple hypothesis corrections, statistically significant comorbidities and patient encounter demographics were input as covariates into a propensity score matching (PSM) model. Accuracy of the PSM model was validated against chart review by two independent subject matter experts.

RESULTS: In total, 2,638 ED encounters met an ICD-10-based case definition of suicidality during the study period. The prevalence of suicidality (2.9%) by subtype was ideation (2.5%), self-harm (1.1%), and attempt (0.2%). Suicidality prevalence was more common for female sex (4.2%) than male sex (1.7%). Comorbidities of suicidality were statistically significant for 55 frequently co-occurring ICD-10 codes. Nearly half of these comorbidities (26/55) were not present in DSM-5, and nearly a quarter (12/55) consisted of ICD-10 codes for accidental rather than intentional self-harm. Increased probability of suicidality was observed for patients with personality disorder (44%), gender dysphoria (43%), bipolar disorder (36%), depression (33%), and schizophrenia spectrum disorders (32%). Based on gold standard chart review, 53.4% of propensity matched non-cases were unrecognized suicidality cases.

CONCLUSIONS: Propensity score matching using comorbidity profiles is an effective approach for identifying suicidality cases that lack ICD-10 codes for suicidality.

PMID:41525105 | DOI:10.2196/81499

J Refract Surg. 2026 Jan;42(1):e31-e40. doi: 10.3928/1081597X-20251124-03. Epub 2026 Jan 1.

ABSTRACT

PURPOSE: To compare the visual quality and stereopsis after bilateral implantation of the zonal refractive multifocal intraocular lens (IOL) LS-313 MF15 (Oculentis) and enhanced monofocal IOL TECNIS Eyhance ICB00 (AMO).

METHODS: In this retrospective case series at The Second Hospital of Jilin University, patients underwent bilateral phacoemulsification with implantation of either enhanced monofocal (Tecnis Eyhance ICB00) or zonal refractive (LS-313 MF15) IOLs. Postoperative evaluations at 3 months included visual quality and stereopsis parameters: uncorrected distance, intermediate, and near visual acuity; corrected distance visual acuity; defocus curves; higher order aberrations; Strehl ratio; modulation transfer function; stereoacuity with correlation analysis; Visual Function Index-14 (VF-14) score; and spectacle independence rate.

RESULTS: Sixty patients (120 eyes) were included, with 30 patients (60 eyes) per group completing follow-up assessments. At the 3-month follow-up visit, the LS-313 MF15 group showed superior near visual acuity and stereopsis versus the Eyhance ICB00, with stereopsis positively correlating with binocular near visual acuity. The LS-313 MF15 demonstrated smoother defocus curves, broader landing zones, and superior near vision performance versus the Eyhance ICB00. The LS-313 MF15 group demonstrated lower spherical aberration but higher coma, trefoil, and total higher order aberrations compared to the Eyhance ICB00 group. No statistically significant differences were observed between the two groups in SR, MTF curve area, VF-14 questionnaire scores, or spectacle independence rates.

CONCLUSIONS: For patients with intermediate-vision requirements, both IOLs represent viable options, whereas the LS-313 MF15 may be preferable for those requiring enhanced near vision and stereopsis. The Eyhance ICB00 appears more suitable for patients with suboptimal ocular conditions.

PMID:41525097 | DOI:10.3928/1081597X-20251124-03