Tag: pubmed

Cureus. 2026 Jun 11;18(6):e110691. doi: 10.7759/cureus.110691. eCollection 2026 Jun.

ABSTRACT

Background Caudal epidural analgesia is a widely used and effective regional anesthetic technique for pediatric infraumbilical surgeries. Although bupivacaine provides reliable analgesia, its relatively short duration has prompted the use of adjuvants to prolong postoperative pain relief. Dexmedetomidine, a selective α2-adrenergic agonist, and tramadol, a centrally acting analgesic, are commonly employed caudal adjuvants; however, their comparative effects when combined with bupivacaine remain incompletely defined. Methods This prospective, randomized, double-blind study included 60 pediatric patients aged two to eight years undergoing elective infraumbilical surgeries under general anesthesia. All patients received a caudal block with 0.25% bupivacaine (1 mL/kg) and were randomized into two groups: Group D received dexmedetomidine 0.5 µg/kg (n = 30), and Group T received tramadol 1 mg/kg (n = 30). Hemodynamic parameters, including heart rate (HR) and mean arterial pressure (MAP), were recorded intraoperatively and at extubation. The primary outcome was time to first rescue analgesia, defined as the time from skin closure to a Face, Legs, Activity, Cry, Consolability (FLACC) score >4. Data were analyzed using appropriate parametric tests, with p < 0.05 considered statistically significant. Results Demographic characteristics and duration of surgery were comparable between the groups. Mean age was 4.19 ± 1.91 years in Group D and 4.55 ± 2.10 years in Group T (p = 0.49), while mean body weight was 14.15 ± 4.00 kg and 15.16 ± 4.24 kg, respectively (p = 0.35). The duration of postoperative analgesia was significantly longer in the dexmedetomidine group compared with the tramadol group (812.70 ± 46.15 minutes vs. 605.53 ± 45.12 minutes; p < 0.0001). HR and MAP decreased gradually in both groups following induction, with lower values observed in the dexmedetomidine group; however, differences in HR at all measured time points were not statistically significant. MAP after extubation was significantly lower in Group D compared with Group T (66.73 ± 5.96 mmHg vs. 70.17 ± 6.86 mmHg; p = 0.04). No episodes of bradycardia or hypotension requiring intervention occurred in either group. Conclusion Dexmedetomidine (0.5 µg/kg) as an adjuvant to caudal bupivacaine provided significantly prolonged postoperative analgesia compared with tramadol (1 mg/kg) in pediatric infraumbilical surgeries. Both agents maintained stable perioperative hemodynamics without clinically significant adverse effects; however, dexmedetomidine demonstrated better attenuation of hemodynamic responses, particularly after extubation. Low-dose dexmedetomidine appears to be an effective and safe caudal adjuvant in pediatric patients undergoing infraumbilical surgical procedures.

PMID:42437239 | PMC:PMC13355903 | DOI:10.7759/cureus.110691

Cureus. 2026 Jun 11;18(6):e110643. doi: 10.7759/cureus.110643. eCollection 2026 Jun.

ABSTRACT

BACKGROUND: Acute pancreatitis is a common inflammatory disease with variable clinical outcomes. Diabetes mellitus may worsen the severity and increase complications in these patients. This study was conducted to evaluate the association of diabetes mellitus with severity, complications, and mortality in acute pancreatitis patients.

METHODS: This prospective observational study was conducted at Ayub Medical College, Abbottabad from April 2025 to September 2025. A total of 160 patients with confirmed acute pancreatitis were included through consecutive sampling. Patients were divided into diabetic and non-diabetic groups. Severity was assessed by the Revised Atlanta Classification. Demographic profile, laboratory findings, complications, ICU admission, hospital stay, and mortality were recorded. Data were analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2018; IBM Corp., Armonk, New York, United States). The chi-square test, independent sample t-test, and multivariable logistic regression analysis were applied. A p-value less than 0.05 was considered significant.

RESULTS: Out of 160 patients, 68 (42.5%) were diabetic, and 92 (57.5%) were non-diabetic. Severe acute pancreatitis was significantly more common in diabetic patients (30.9% vs 15.2%, p=0.017). Persistent organ failure (27.9% vs 13.0%, p=0.019), pancreatic necrosis (25.0% vs 12.0%, p=0.031), ICU admission (29.4% vs 14.1%, p=0.018), and mortality (16.2% vs 8.7%, p=0.041) were also higher among diabetic patients. Mean hospital stay was significantly prolonged in diabetics (8.7±3.9 vs 5.9±2.8 days, p<0.001). Multivariable analysis showed diabetes mellitus as an independent predictor of severe acute pancreatitis and mortality.

CONCLUSION: Diabetes mellitus was significantly associated with increased severity, complications, prolonged hospital stay, and mortality in acute pancreatitis. Early identification of diabetic patients may help improve clinical outcomes.

PMID:42437237 | PMC:PMC13355151 | DOI:10.7759/cureus.110643

Cureus. 2026 Jun 11;18(6):e110649. doi: 10.7759/cureus.110649. eCollection 2026 Jun.

ABSTRACT

Aim Chatbots are emerging as a new and valuable tool in healthcare, offering a wide range of applications. Their use as a tool in medical physics has immense future potential. This study aimed to evaluate the performance of three artificial intelligence (AI) chatbots – ChatGPT, DeepSeek, and Gemini – in response to questions or queries related to medical physics in oncology. Materials and methods A total of 11 questions from the field of medical physics pertaining to oncology were formulated by medical physics experts. These queries were presented to the AI chatbots – ChatGPT 5.2, DeepSeek V 3.2, and Gemini 3.0 – on a predetermined date. Responses were obtained by repeating the same question once for each chatbot. The initial responses were noted and evaluated by three experts based on their correctness, completeness, ease of understanding, reliability, and applicability in the national scenario. Results The mean correctness scores were 3.4, 3.81, and 3.09 for ChatGPT, DeepSeek, and Gemini, respectively. Regarding completeness, the DeepSeek gave the maximum responses, that is, 10 complete responses to the 11 questions. No statistically significant difference was foundin real-world applicability score for the three models. Conclusion In terms of performance metrics such as correctness, DeepSeek gave better results. None of the chatbots were seen to be good enough to replicate human intelligence in metrics such as correctness, completeness, or real-world applicability. A symbiotic collaboration between AI chatbots and medical professionals is essential for enhancing healthcare delivery.

PMID:42437234 | PMC:PMC13355276 | DOI:10.7759/cureus.110649

Cureus. 2026 Jun 11;18(6):e110673. doi: 10.7759/cureus.110673. eCollection 2026 Jun.

ABSTRACT

OBJECTIVE: The objective of this study is to assess the prevalence of migration intent among interns and residents at a tertiary care institution in Pakistan and to identify perception-based factors associated with this intent.

METHODOLOGY: A cross-sectional study was conducted at PNS Shifa Hospital using a structured, self-administered Google Form questionnaire (Google Inc., Mountain View, CA, USA). A total of 252 participants (house officers and postgraduate trainees) were recruited. Data were analyzed using IBM SPSS Statistics software, version 27 (IBM Corp., Armonk, NY, USA). Chi-square tests and binary logistic regression were applied to identify significant factors of migration intent.

RESULTS: Out of 252 participants, 52% expressed a preference for postgraduate training abroad, with the United Kingdom (54.2%), the Middle East (16.8%), and the United States (15.3%) being the most preferred destinations. Key push factors included low salary (65.6%), poor working conditions (53.4%), and unemployment (46.6%). Logistic regression analysis demonstrated that perception of better quality of life (OR = 1.91, p = 0.015), improved training opportunities (OR = 1.77, p = 0.024), and a better working environment (OR = 1.95, p = 0.010) were significant predictors of migration intent.

CONCLUSION: This study provides institution-level evidence on migration intent among early-career doctors, highlighting the role of perception-driven factors in shaping career decisions. A substantial proportion of participants expressed an intention to pursue postgraduate training abroad, primarily due to perceived socioeconomic and training-related advantages abroad. These findings may inform institutional-level retention strategies and highlight areas for further multicenter and longitudinal research.

PMID:42437233 | PMC:PMC13355848 | DOI:10.7759/cureus.110673

Cureus. 2026 Jun 11;18(6):e110655. doi: 10.7759/cureus.110655. eCollection 2026 Jun.

ABSTRACT

BACKGROUND: Drug-induced hepatotoxicity is a major adverse effect of first-line anti-tuberculosis (TB) therapy that can compromise treatment safety and outcomes.

OBJECTIVE: The objective of this study was to identify and evaluate clinical, laboratory, and nutritional factors associated with drug-induced hepatotoxicity in patients receiving first-line anti-TB therapy.

MATERIALS AND METHODS: A hospital-based prospective observational study was conducted at Lady Reading Hospital, Peshawar, Pakistan, from January 2023 to June 2024. A total of 220 adult patients with confirmed pulmonary or extrapulmonary TB receiving first-line anti-TB therapy comprising isoniazid, rifampicin, pyrazinamide, and ethambutol were included. Data included demographics, comorbidities, liver function tests (alanine aminotransferase (ALT), aspartate aminotransferase (AST)), and nutritional biomarkers (serum albumin, prealbumin, and total protein). Follow-up liver function tests and nutritional assessments were performed weekly during the first month and subsequently at week 6 and week 8. Drug-induced hepatotoxicity was defined as ALT/AST levels greater than three times the upper limit of normal (ULN) with symptoms or greater than five times ULN without symptoms. Statistical analysis included chi-square test, independent t-test, and multivariate logistic regression.

RESULTS: Drug-induced hepatotoxicity occurred in 38 of 220 patients (17.27%). Based on the severity of liver enzyme elevation and clinical presentation, 20 (9.09%) had mild hepatotoxicity, 12 (5.45%) had moderate hepatotoxicity, and six (2.73%) had severe hepatotoxicity. Comparisons were performed using pretreatment clinical, laboratory, and nutritional parameters measured before initiation of therapy, and outcomes were assessed during follow-up. Significant associated factors included age >45 years (47.37% vs 25.82%; adjusted OR (aOR) 2.15), female sex (57.89% vs 42.86%; aOR 1.87), alcohol use (31.58% vs 9.89%; aOR 3.42), and viral hepatitis (21.05% vs 3.85%; aOR 5.28). Nutritional factors associated with hepatotoxicity included low serum albumin (<3.5 g/dL; aOR 2.12) and low prealbumin (<20 mg/dL; aOR 2.45). Liver function test parameters measured at the time of hepatotoxicity diagnosis during follow-up were significantly higher in affected patients compared with those without hepatotoxicity.

CONCLUSION: Drug-induced hepatotoxicity during first-line anti-TB therapy is associated with specific clinical, laboratory, and nutritional risk factors that can help identify patients at higher risk for developing this adverse outcome. Future research should focus on validating these predictors in larger populations and developing targeted monitoring and prevention strategies to improve treatment safety and outcomes.

PMID:42437231 | PMC:PMC13355394 | DOI:10.7759/cureus.110655

Cureus. 2026 Jun 11;18(6):e110651. doi: 10.7759/cureus.110651. eCollection 2026 Jun.

ABSTRACT

BACKGROUND: Cancer continues to impose a significant global health burden, with metastatic disease being the leading cause of cancer-related mortality. Accurate detection and staging of metastases are essential for prognostication and treatment planning. Conventional imaging modalities, including contrast-enhanced computed tomography (CECT), have limitations in detecting early or subtle metastatic lesions. Whole-body magnetic resonance imaging (WB-MRI), particularly with diffusion-weighted imaging (DWI), has emerged as a radiation-free technique that enables comprehensive evaluation with high soft-tissue contrast. Therefore, this study aimed to evaluate the diagnostic performance of WB-MRI, including DWI, in detecting nodal, skeletal, and visceral metastases in patients with known malignancies and to compare its performance with CECT on a patient-based analysis.

METHODOLOGY: This analytical cross-sectional study was conducted in the Department of Radiodiagnosis at Aarupadai Veedu Medical College and Hospital, Puducherry, over a period of six months. Eighty patients aged 18-60 years with histopathologically confirmed malignancy were included. All participants underwent CECT of the neck, thorax, and abdomen, followed by WB-MRI using a 1.5-T system with diffusion-weighted sequences. Imaging findings were documented and, wherever feasible, correlated with histopathology or cytology. Data were analyzed using descriptive statistics and the chi-square test in Statistical Package for the Social Sciences, version 26.0 (IBM Corp., Armonk, NY; 2019). A p value of <0.05 was considered statistically significant.

RESULTS: The mean age of the participants was 53.39 ± 8.16 years, with a slight female predominance. Carcinoma of the cervix and breast carcinoma were the most common primary malignancies. WB-MRI demonstrated significantly higher sensitivity and specificity than CT in detecting nodal, skeletal, and visceral metastases. It showed excellent performance in detecting skeletal metastases and superior accuracy in identifying nodal and visceral involvement, with statistically significant differences compared to CT.

CONCLUSION: WB-MRI outperforms CT in the comprehensive detection of metastatic disease across multiple organ systems. Its high diagnostic accuracy, absence of ionizing radiation, and ability to detect early metastatic changes support its role as a reliable imaging modality for staging and follow-up in oncology.

PMID:42437229 | PMC:PMC13355307 | DOI:10.7759/cureus.110651

Cureus. 2026 Jun 11;18(6):e110645. doi: 10.7759/cureus.110645. eCollection 2026 Jun.

ABSTRACT

INTRODUCTION: Phase III clinical trials are essential for establishing the safety and efficacy of therapeutic interventions prior to regulatory approval. India has emerged as an important clinical research hub; however, long-term trends in phase III trials registered in the Clinical Trials Registry-India (CTRI) remain inadequately explored.

METHODS: A comprehensive analysis of phase III clinical trials registered in CTRI between 2007 and June 2025 was conducted. Trials were categorized into two periods, namely, 2007-2014 and 2015-2025, representing pre- and post-regulatory reform eras. Data regarding randomization, blinding, comparator type, intervention model, sponsorship, study site, intervention agents, geographic scope, and recruitment status were extracted and analyzed using descriptive statistics and chi-squared/Fisher’s exact tests.

RESULTS: A total of 1385 phase III clinical trials were analyzed. Randomized controlled trials significantly increased from 360 (88.7%) in 2007-2014 to 928 (94.8%) in 2015-2025 (p<0.001), while non-randomized studies declined. Active-controlled trials increased significantly (234 (57.6%) vs. 608 (62.1%); p=0.025), and parallel-group designs became more common (365 (89.9%) vs. 922 (94.2%); p=0.005). Industry-sponsored trials decreased from 374 (92.1%) to 799 (81.6%), accompanied by increased participation from educational and research institutions (p<0.001). Drug trials remained predominant, although vaccine and biologic/device-based studies increased significantly in the latter period. Recruitment status analysis demonstrated declining completed trials and increasing ongoing or “not yet recruiting” studies, likely reflecting stricter registration practices and pandemic-related disruptions.

CONCLUSION: Phase III clinical trials registered in CTRI demonstrated substantial improvements in methodological rigor, comparator selection, intervention design, sponsorship diversity, and reporting characteristics during 2015-2025 compared with 2007-2014. These favorable trends are temporally associated with the major Indian and international regulatory reforms, including the New Drugs and Clinical Trials (NDCT) Rules 2019, International Council for Harmonisation’s Guideline for Good Clinical Practice (ICH-GCP) updates, and strengthened ethical oversight. Nevertheless, persistent challenges related to trial completion and reporting transparency warrant continued regulatory strengthening.

PMID:42437223 | PMC:PMC13355154 | DOI:10.7759/cureus.110645

Cureus. 2026 Jun 11;18(6):e110688. doi: 10.7759/cureus.110688. eCollection 2026 Jun.

ABSTRACT

BACKGROUND: Cancer, one of the leading causes of mortality worldwide, is driven by genetic alterations promoting uncontrolled cell growth and metastasis. Among these genetic players, the insulin-like growth factor 2 (IGF2) gene has emerged as a significant factor in tumorigenesis. IGF2, a growth factor primarily produced in the liver, interacts with insulin and IGF receptors, influencing cell proliferation and survival. IGF2 is a known driver in fetal development and specific hepatic malignancies; its multi-omic diagnostic, prognostic, and immunological landscapes across diverse tissue barriers remain unmapped. This study presents a comprehensive pan-cancer analysis to systematically define the biomarker potential and epigenetic regulation of IGF2 across multiple human cancers.

METHODS: We utilized various bioinformatic platforms, including Tumor Immune Estimation Resource (TIMER), Gene Expression Profiling Interactive Analysis (GEPIA), UALCAN, and cBioPortal, to assess IGF2 gene expression and mutation profiles. Immune infiltration analysis evaluated IGF2’s role in tumor-immune interactions. Gene expression data from the Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression (GTEx) databases were analyzed, and findings were validated using the Gene Expression Omnibus (GEO). Kaplan-Meier survival analysis was applied to investigate the correlation between IGF2 expression and overall survival in different cancers.

RESULTS: IGF2 was significantly upregulated in cholangiocarcinoma (CHOL), liver hepatocellular carcinoma (LIHC), kidney chromophobe (KICH), and stomach adenocarcinoma (STAD) with P-values of 3.72E-05, 3.30-E08, 1.60E-03, and 1.43E-04, respectively. Survival analysis revealed that elevated IGF2 expression was associated with good prognosis in kidney renal papillary cell carcinoma (KIRP) (P = 7.2E-05). Immune infiltration analysis demonstrated a significant correlation between IGF2 expression and the presence of macrophages and CD4+ T cells in STAD (P = 1.30E-10, 2.61E-06, respectively), suggesting a role in modulating the tumor immune microenvironment. Genetic alterations in IGF2 were observed in multiple cancers, with missense mutations and deep deletions being the most prevalent. Patients with IGF2 mutations showed a trend toward poorer survival outcomes compared to those without mutations; however, the difference was not statistically significant (P = 0.384).

CONCLUSION: This study revealed that IGF2 plays a potential role as a diagnostic biomarker for CHOL, KICH, LIHC, and STAD and a prognostic biomarker role in KIRP.

PMID:42437219 | PMC:PMC13355938 | DOI:10.7759/cureus.110688

Cureus. 2026 Jun 11;18(6):e110648. doi: 10.7759/cureus.110648. eCollection 2026 Jun.

ABSTRACT

Background and aim Pseudoexfoliation syndrome (PXS) substantially elevates the technical complexity of cataract surgery through its twin mechanisms of restricted pupillary dilation and progressive zonular weakness. This study aimed to document the intraoperative complication spectrum and postoperative visual rehabilitation following small incision cataract surgery (SICS) with intraocular lens (IOL) implantation in eyes with concurrent PXS and to identify preoperative predictors of adverse surgical outcomes. Methods This prospective observational study enrolled 50 consecutive eyes of 50 patients with coexisting visually significant cataract and PXS at a tertiary ophthalmology center in Bihar, India. All patients underwent manual SICS with primary polymethyl methacrylate (PMMA) IOL implantation by a single surgeon, and outcomes were evaluated at three months. Preoperative pupillary dilation category was assessed as the primary predictor of intraoperative complications. Best-corrected visual acuity (BCVA) was recorded at baseline and at the three-month follow-up visit. Statistical associations were evaluated using chi-square and nonparametric tests, and a p-value <0.05 was considered significant. Results The cohort was predominantly male (31 (62%)) and elderly (29 (58%) aged above 70 years; mean age, 70.4 ± 8.6 years). Poor pharmacological mydriasis (pupil 3-5 mm) was recorded in 13 (26%) eyes. Intraoperative complications included difficulty with anterior capsulotomy in nine (18%) eyes, posterior capsular rent in five (10%), zonular dehiscence in four (8%), and vitreous loss in four (8%). All complication rates correlated significantly with inadequate pupillary dilation (p < 0.05). Postoperatively, 36 (72%) eyes attained a BCVA ≥ 6/18, representing a statistically significant improvement over the preoperative distribution (p < 0.001). Posterior capsular opacification in nine (18%) and cystoid macular edema in four (8%) were the leading causes of suboptimal visual rehabilitation. Conclusions Although PXS significantly amplifies surgical risk relative to routine cataract cases, structured preoperative planning, maximal pupillary dilation, and appropriate intraoperative adjuncts consistently yield visual outcomes comparable with published benchmarks. Preoperative pupillary dilation status is a robust, statistically significant predictor of intraoperative morbidity and should guide surgical strategy.

PMID:42437217 | PMC:PMC13355278 | DOI:10.7759/cureus.110648

Cureus. 2026 Jun 11;18(6):e110636. doi: 10.7759/cureus.110636. eCollection 2026 Jun.

ABSTRACT

Background Fluoride plays a critical role in public dental health, and its judicious use is central to caries prevention strategies worldwide. With the exponential growth of internet usage in the Arab world, dental websites in the Arabic language have become increasingly influential sources of health information. However, the accuracy, completeness, and scientific reliability of fluoride-related content on these platforms remain largely unexplored. This study aimed to assess and evaluate the quality and accuracy of fluoride information disseminated through Arabic-language websites. Methods A cross-sectional web-based study was conducted between January and April 2025. Arabic websites were systematically identified using Google, Bing, and Yahoo search engines with standardized Arabic search terms related to fluoride and dental health. Websites were evaluated using the DISCERN instrument, the Journal of the American Medical Association (JAMA) benchmark criteria, the Health on the Net (HON) code principles, and a custom fluoride-specific accuracy checklist developed from current evidence-based guidelines. A total of 120 websites met the inclusion criteria. Descriptive statistics, chi-square tests, and multivariate logistic regression were employed for data analysis. Results Of 120 eligible websites, 38 (31.7%) were classified as commercial, 29 (24.2%) as health information portals, 27 (22.5%) as governmental or academic, and 26 (21.7%) as social media-based or blog platforms. Overall website quality was rated poor to fair in 68.3% of assessed websites (n = 82). The mean DISCERN score was 38.4 out of 80 (SD = 11.2). Fluoride-specific accuracy scores revealed that only 44.2% of websites correctly described optimal fluoride concentration for drinking water, 52.5% accurately discussed fluoride toothpaste recommendations, and a mere 31.7% provided correct information regarding dental fluorosis. Governmental and academic websites demonstrated significantly higher quality scores compared to commercial and social media platforms (p < 0.001). Conclusion The majority of Arabic websites provide inadequate, inaccurate, or misleading fluoride-related health information. Significant quality disparities exist across different website categories, with governmental and academic websites outperforming commercial and social media platforms. There is an urgent need for standardized guidelines, regulatory oversight, and professional dental society engagement to improve the quality of fluoride information on Arabic dental websites.

PMID:42437215 | PMC:PMC13354934 | DOI:10.7759/cureus.110636