Tag: pubmed

Cureus. 2026 Jan 16;18(1):e101704. doi: 10.7759/cureus.101704. eCollection 2026 Jan.

ABSTRACT

Anterior shoulder instability, which includes dislocations and subluxations, is a significant concern in pediatric populations (≤19 years). Following an initial dislocation or subluxation, these patients often develop recurrent instability, which can result in long-term functional compromise. While timely and appropriate treatment is crucial, there remains a lack of consensus in the literature regarding the optimal management of pediatric shoulder instability. This systematic review aims to compare the efficacy of conservative and operative treatments for traumatic, isolated anterior shoulder instability in pediatric populations using recurrence of instability and return to play (RTP) at pre-injury levels as outcome measures. This study also provides a contemporary analysis that reflects evolving treatment strategies. This systematic review targeted studies published between 2013 and 2023 that evaluated pediatric patients (≤19 years), most between 13 and 19 years of age, who received conservative or operative treatment for a first-time or recurrent traumatic isolated anterior shoulder dislocation or subluxation. Statistical analysis was performed to compare rates of recurrence of instability and RTP within each group. Pooled effects (odds ratios) were estimated using fixed-effects models where heterogeneity was absent; otherwise, random-effects models were applied. A total of 1,459 patients (1,468 shoulders) met the inclusion criteria. Of these, 593 (40.4%) underwent conservative treatment, while 885 (60.3%) received operative interventions. Recurrence rates of instability were higher in the conservative group (236/543, 43.5%) compared to the primary operative group (182/875, 20.8%) and secondary operative group (2/26, 7.7%). RTP rates included 145/193 (75.1%) of conservatively treated patients, 380/480 (79.2%) of primary operative patients, and 8/11 (72.7%) of secondary operative patients returning to pre-injury levels. Among the four studies that directly compared conservative and primary operative treatments, the nonoperative group was more likely to have recurrence compared to the primary operative group (OR = 6.90; 95% CI, 2.28-20.91; p < 0.001). One of these studies was excluded due to methodological differences. A subsequent meta-analysis revealed a significantly higher likelihood of recurrent instability in conservatively treated patients (odds ratio (OR) = 9.55; 95% confidence interval (CI): 5.10-17.88; p < 0.001). In contrast, there was no statistically significant difference in RTP between groups (OR = 3.11; 95% CI: 0.31-30.97; p = 0.33). The findings support early surgical intervention in pediatric patients to reduce recurrence and improve functional outcomes. Conservative management, while recently shown to be successful for patients with less severe injuries such as subluxations, is still primarily associated with higher recurrence rates compared to operative treatment. Further studies are needed to refine treatment protocols by distinguishing effective strategies for subluxations versus dislocations. Future research should also explore the influence of factors such as sex, skeletal maturity, and activity level in determining optimal management strategies in pediatric patients.

PMID:41700290 | PMC:PMC12906957 | DOI:10.7759/cureus.101704

Cureus. 2026 Jan 16;18(1):e101672. doi: 10.7759/cureus.101672. eCollection 2026 Jan.

ABSTRACT

Developmental neurobiology indicates that baseline calibration of the hypothalamic-pituitary-adrenal (HPA) axis occurs predominantly during critical periods of plasticity (zero to five years). Early trauma may generate lifelong Allostatic Load, manifesting as a probable physiological substrate of psychosomatic disorders, treatment-resistant anxiety, and systemic dysfunctions, including chronic pain and metabolic sensitivities. Conventional therapies often operate via extinction mechanisms, which may suppress rather than modify the original fear trace. This article describes the RB7™ Protocol (Reconsolidation & Biology 7-Steps), a structured intervention designed to induce Memory Updating through interoceptive Mismatch Prediction Error. The methodology prioritizes biological validity over historical veracity (focusing on the functional engram regardless of factual accuracy). The protocol consists of seven sequential steps: (1) Hypothesis Mapping and Safety Calibration; (2) Vagal Modulation; (3) Engram Reactivation; (4) Heuristic Tracking using somatic bridging to bypass System 2; (5) Updating via Radical Reality; (6) Immediate Verification; and (7) Real-World Verification. This sequence aims to replicate the neurochemical conditions required for memory labilization. By utilizing somatic evidence of survival to overcome extinction-based barriers, the protocol presents a theoretically coherent mechanism for rewriting traumatic engrams. While current findings are based on preliminary multiple-case series, they suggest Affective Neutrality as a clinical marker of allostatic reversal. However, future randomized controlled trials (RCTs) are required to establish statistical generalizability.

PMID:41700288 | PMC:PMC12906688 | DOI:10.7759/cureus.101672

Cureus. 2026 Jan 15;18(1):e101625. doi: 10.7759/cureus.101625. eCollection 2026 Jan.

ABSTRACT

INTRODUCTION: Youth participation in mixed martial arts (MMA) has increased in recent years; however, the psychological impact of participation on mental health remains relatively unexplored. To date, no studies have specifically examined depression and resilience in youth MMA athletes. The objective of this study was to evaluate rates of depression and resilience among youth MMA participants.

METHODS: Youth MMA athletes aged 8-17 were surveyed from January to April 2024 using the validated Short Mood and Feelings Questionnaire (SMFQ) and the Connor-Davidson Resilience Scale (CD-RISC 2) to assess depression and resilience, respectively. Data were analyzed using descriptive statistics, Fisher’s exact tests, and ANOVA.

RESULTS: A total of 276 athletes were recruited via email and in person at a Youth National event. Of these, 108 participants completed the surveys fully (39% response rate). The mean SMFQ depression score was 1.26, with 4 athletes (3.7%) screening positive for depression using the SMFQ cutoff of 8. The mean CD-RISC 2 resilience score was 6.97. No significant differences in depression or resilience scores were observed based on age, gender, race, training hours, weight-cutting practices, parental coaching, injury history, or years of competition experience (p > 0.05).

CONCLUSION: This study provides baseline data on depression and resilience among youth MMA athletes. Compared with peers of similar age reported in the literature, youth MMA participants in this study had lower depression scores and higher resilience scores. Further large-scale longitudinal studies are warranted to guide mental health resources for youth MMA athletes as the sport continues to grow.

PMID:41700277 | PMC:PMC12906933 | DOI:10.7759/cureus.101625

Cureus. 2026 Jan 14;18(1):e101510. doi: 10.7759/cureus.101510. eCollection 2026 Jan.

ABSTRACT

Background Comprehensive genomic profiling (CGP) has become increasingly integrated into precision oncology; however, its real-world clinical utility in community hospitals outside the national cancer genomic core hospital network in Japan remains less studied. This study aimed to evaluate the implementation, feasibility, and clinical impact of CGP in a community-based hospital. Methods We retrospectively reviewed patients with unresectable or recurrent solid tumors who had not received systemic chemotherapy at our hospital between April 2021 and December 2025. Clinical outcomes, including the detection rate of druggable genomic alterations, the proportion of patients who received genomically matched therapy, and overall survival (OS), were compared between patients who underwent CGP and those who did not. Results Among 253 patients, 60 (24%) underwent CGP testing. Druggable genomic alterations were identified in 45 patients (75%), and seven patients (12%) received genomically matched therapy. Of these, 5% were treated within clinical trials, and 7% received approved targeted agents. Among patients who received matched therapy, the best overall response was complete response (CR) in two, partial response (PR) in two, stable disease (SD) in one, and progressive disease (PD) in two. Tumor-type-stratified analyses showed variability in actionable/druggable profiles and matched-therapy delivery across tumor types. No significant difference in OS was observed between the CGP and non-CGP groups (median OS: 22.9 vs. 23.0 months, P = 0.78). Within major tumor types, including colorectal, gastric, pancreatic, and biliary tract cancers, OS did not significantly differ according to CGP testing status. Among CGP patients, OS tended to be longer in those who received matched therapy, although the difference was not statistically significant. Conclusions Despite being conducted in a community hospital outside the cancer genomic core network, CGP testing was feasible and enabled a clinically meaningful proportion of patients to access genome-matched therapy at rates comparable to those reported from tertiary centers. Although CGP did not directly translate into improved OS, it provided valuable treatment opportunities and facilitated precision oncology in a regional care setting. Further expansion of accessible genome-guided therapies may enhance the clinical impact of CGP in community hospitals.

PMID:41700276 | PMC:PMC12906380 | DOI:10.7759/cureus.101510

Cureus. 2026 Jan 16;18(1):e101690. doi: 10.7759/cureus.101690. eCollection 2026 Jan.

ABSTRACT

INTRODUCTION AND AIM: Tobacco smoking remains a major public health concern worldwide and is associated with multiple preventable diseases, including cancer, cardiovascular disorders, and chronic respiratory conditions. Despite sustained global and regional tobacco control efforts, smoking prevalence remains high in Saudi Arabia. This study aimed to assess smoking frequency, awareness of smoking-related health risks, and cessation practices among hospitalized active smokers admitted to a tertiary care hospital in Jeddah.

METHODOLOGY: A cross-sectional descriptive survey was conducted between October 2024 and April 2025 among 250 actively smoking inpatients admitted to the Department of Medicine at King Fahad Armed Forces Hospital, Jeddah. Data were collected using a validated, Arabic-language translated electronic questionnaire that captured socio-demographic characteristics, smoking behaviors, awareness of health risks, and cessation practices. Statistical analysis was performed using SPSS version 24 (Armonk, NY: IBM Corp.), employing descriptive statistics and chi-square tests, with statistical significance set at p≤0.05.

RESULTS: The mean duration of smoking was 12.84±6.42 years, and the mean age at smoking initiation was 18.62±3.75 years. Cigarette smoking was the most prevalent form of tobacco use, reported by 191 participants (76.4%), followed by shisha use in 34 (13.6%) and dual use in 25 (10.0%). Awareness of smoking-related health risks was highest for lung cancer (212; 84.8%), whereas awareness of adverse pregnancy outcomes was comparatively low (94; 37.6%). More than half of the participants (139; 55.6%) reported at least one previous quit attempt; however, sustained abstinence for more than six months was achieved by only 34 (13.6%). Stratified analysis demonstrated significant associations between smoking behaviors and gender (p=0.021), age (p=0.034), marital status (p=0.013), and education level (p=0.033).

CONCLUSION: Hospital admission represents a critical window of opportunity to implement structured smoking cessation interventions, address gaps in risk awareness, and reduce socio-demographic disparities in smoking behaviors among active inpatient smokers.

PMID:41700261 | PMC:PMC12906823 | DOI:10.7759/cureus.101690

Cureus. 2026 Jan 15;18(1):e101582. doi: 10.7759/cureus.101582. eCollection 2026 Jan.

ABSTRACT

BACKGROUND: Vitamin D deficiency is a common global health problem and has been widely studied in relation to immune function and infectious diseases. Vitamin D receptors are expressed on multiple immune cells, suggesting a potential association between vitamin D status and immune-related parameters. However, comparative observational data examining age-related differences in immune markers and infection patterns among vitamin D-deficient individuals remain limited.

OBJECTIVE: The study aimed to describe and compare associations between vitamin D deficiency, selected immune markers, and reported infection patterns in pediatric and adult patients.

METHODS: This comparative cross-sectional observational study was conducted at a tertiary care hospital. Pediatric (1-18 years) and adult (≥19 years) patients with vitamin D deficiency were included. Serum 25-hydroxyvitamin D levels, immune markers (total lymphocyte count, immunoglobulin levels, C-reactive protein, and erythrocyte sedimentation rate), and reported respiratory and gastrointestinal infections over the preceding six months were assessed. Unadjusted comparisons between pediatric and adult groups were performed using appropriate statistical tests, and associations between vitamin D levels and immune markers were evaluated using correlation analysis.

RESULTS: A total of 120 participants were included, comprising 60 pediatric and 60 adult patients. Pediatric participants had lower measured serum vitamin D levels, lower total lymphocyte counts, and lower IgG levels compared to adult participants. Higher reported frequencies of respiratory and gastrointestinal infections were observed among children. A moderate positive correlation was observed between serum vitamin D levels and total lymphocyte counts across both age groups.

CONCLUSION: Vitamin D deficiency was associated with differences in selected immune markers and reported infection patterns between pediatric and adult patients. These findings represent descriptive associations observed at a single time point and do not establish causality or directionality. Further longitudinal and interventional studies are required to clarify temporal relationships and clinical significance.

PMID:41700250 | PMC:PMC12906915 | DOI:10.7759/cureus.101582

Cureus. 2026 Jan 15;18(1):e101616. doi: 10.7759/cureus.101616. eCollection 2026 Jan.

ABSTRACT

BACKGROUND: The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) supports shared decision-making about emergency and end-of-life care, while death verification and certification are essential legal and professional responsibilities for clinicians; however, many clinicians feel underprepared for these tasks.

AIM: This study aimed to identify gaps in confidence and training and to contribute to a more thoughtful and compassionate approach in preparing clinicians for some of the most challenging but deeply meaningful parts of their role. Methods: A cross-sectional online questionnaire-based survey was conducted amongst 109 medical doctors in active clinical roles from across the NHS trusts in the UK. A Cronbach’s alpha value of 0.84 indicated that the questionnaire is a reliable tool for measuring the intended constructs. The data were analysed using IBM SPSS Statistics Version 30.0 (IBM Corp., Armonk, USA). Results: There were 63 (57.8%) international medical graduates (IMGs) and 46 (42.2%) UK graduates. Time constraint (48.6%) and fear of causing distress (42.2%) were the most common challenges faced during ReSPECT discussions. The majority of the participants had not received any formal training in conducting ReSPECT discussions (74.3%) and death certification processes (60.6%). Workshops/seminars (56.0%) were reported to be the most effective type of training/support pertaining to death verification and certificate forms. Conclusion: A large proportion of clinicians did not receive proper training in the domains of ReSPECT and death verification. Therefore, greater emphasis should be placed on providing clinicians with appropriate formal training, clear guidelines and protocol, and ongoing support to help them feel more confident in initiating end-of-life discussions.

PMID:41700249 | PMC:PMC12906935 | DOI:10.7759/cureus.101616

Cureus. 2026 Jan 14;18(1):e101503. doi: 10.7759/cureus.101503. eCollection 2026 Jan.

ABSTRACT

BACKGROUND: Obesity is defined as an unhealthy accumulation of body fat that increases the risk of chronic diseases. Motivation is essential for weight loss. It can be due to intrinsic factors (e.g., enhanced health) or extrinsic factors (e.g., physical appearance or social approval). The aim of this study was to identify the motivational factors influencing weight loss in individuals with a history of obesity in 2025 at Al-Ahsa, Saudi Arabia.

METHODS: A descriptive, cross-sectional, questionnaire-based study was conducted to identify the motivational factors influencing weight loss in individuals with a history of obesity in 2025 at Al-Ahsa, Saudi Arabia. A stratified sample involved 367 participants who were obese and lost 5% or more of their weight in the last six months. IBM SPSS Statistics for Windows, Version 27.0 (IBM Corp., Armonk, New York, United States), was used to analyze the data, and the chi-squared test was used to correlate the motivational factors with sociodemographic characteristics.

RESULTS: The study included 367 participants: more than half of them were female (219, 59.7%), more than one-quarter (108, 29.4%) were aged between 30 and 40 years, more than half of them (218, 59.4%) had class I obesity, and an additional 149 (40.6%) had class II or III obesity. The mean motivational factors for weight loss among participants were as follows: enhance overall physical wellness (277, 75.5%), promote physical appearance (172, 46.9%), desire to fit into attire (143, 39%), and strengthen self-efficacy and self-image (134, 36.5%). The motivational factors for weight loss are significantly influenced by various sociodemographic characteristics.

CONCLUSION: This study concluded that obese adults in Al-Ahsa are primarily motivated to improve physical wellness, followed by physical appearance, fitting into attire, and self-esteem. These motivations are significantly influenced by sociodemographic factors. Therefore, focused, simple, and clear educational media campaigns are recommended to explain the benefits of weight loss in the community.

PMID:41700241 | PMC:PMC12906377 | DOI:10.7759/cureus.101503

Cureus. 2026 Jan 16;18(1):e101674. doi: 10.7759/cureus.101674. eCollection 2026 Jan.

ABSTRACT

INTRODUCTION: Peripheral artery disease (PAD) mainly compromises the lower limbs and may progress to chronic limb-threatening ischemia (CLTI); in this context, endovascular management has become a cornerstone of revascularization strategies. This study aimed to describe the epidemiologic, clinical, and procedural characteristics of patients with PAD treated in a Hemodynamics Unit in 2023 at a resource-limited hospital in Colombia.

METHODS: We conducted a retrospective observational descriptive study at a regional referral hospital in the Orinoquía region of Colombia. All adults who underwent an endovascular procedure for PAD between January 1 and December 31, 2023, were included. Patient-level variables were analyzed for 115 patients, and procedure-level variables for 152 PAD-related interventions. Demographic, clinical, and procedural data were extracted from electronic medical records. Descriptive statistics were performed, and exploratory chi-square tests were used to evaluate associations between clinical classifications, comorbidities, procedural outcomes, and limb amputations. Data analysis was performed using RStudio, Version 2024.12.1 + 563 (Posit PBC, Boston, MA, USA).

RESULTS: During the study period, 1,984 procedures were performed, of which 152 (7.7%) corresponded to PAD-related endovascular interventions in 115 patients. The majority of patients were male, comprising 68 (59.1%). The most common comorbidities were dyslipidemia in 93 (80.9%), hypertension in 84 (73.0%), and diabetes mellitus in 71 (61.7%) patients. Preoperative pharmacological treatment most frequently included antihypertensive therapy in 75 (65.2%) and high-intensity statins in 51 (44.25%) patients. CLTI was the main indication for intervention, documented in 89 (58.55%) cases. Complications of the procedures were found in 11 (7.24%) cases, and reinterventions were required in 23 (15.13%) cases. Among the observed statistical associations, clinically relevant findings included the association between insulin-dependent diabetes mellitus and limb amputation (χ² = 6.2805, p = 0.043), as well as the association between the Global Limb Anatomic Staging System (GLASS) and limb amputation (χ² = 30.078, p < 0.001). Another statistically significant association was observed between the Wound, Ischemia, foot Infection (WIfI) classification and procedural complications (χ² = 87.889, p < 0.001). Conclusions: PAD interventions were associated with low complication and reintervention rates, supporting the safety of endovascular management for this type of disease. Clinical classification systems showed significant associations with limb amputation, highlighting the importance of baseline disease severity determination. Additionally, this study provides a relevant epidemiological profile of PAD management within this regional context.

PMID:41700231 | PMC:PMC12906702 | DOI:10.7759/cureus.101674

Sisli Etfal Hastan Tip Bul. 2025 Oct 13;59(4):469-475. doi: 10.14744/SEMB.2025.40359. eCollection 2025.

ABSTRACT

OBJECTIVES: This study was conducted to evaluate the radiological and clinical results of platelet-rich plasma (PRP) therapy in degenerative meniscal lesions.

METHODS: Seventy patients with pain and grade 2 degenerative meniscal lesions on MRI (Magnetic Resonance Imaging) were included in the study. All patients underwent Knee Injury and Osteoarthritis Score (KOOS), Tegner-Lysholm, International Knee Documentation Committee Score (IKDC), Visual Analog Scale (VAS) clinical scores, and MRI scans before and 6 months after the injection.

RESULTS: There was a statistically significant increase in Tegner-Lysholm, KOOS, and IKDC scores after the procedure (p=0.001; p<0.01), and a statistically significant decrease in VAS score after the procedure (p=0.001; p<0.01). However, no statistically significant difference was observed in MRI parameters (p>0.05).

CONCLUSION: It has been shown that the use of intra-articular PRP in painful degenerative meniscal lesions improves knee functions and helps reduce pain. However, no significant difference was observed in MRI controls. The results of our study indicate that the use of intra-articular PRP injection in patients with grade 2 meniscus degeneration improves clinical scores but does not result in significant improvement in degeneration as measured by MRI.

PMID:41700211 | PMC:PMC12906876 | DOI:10.14744/SEMB.2025.40359