Tag: pubmed

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

Adv Clin Exp Med. 2026 Jan 5. doi: 10.17219/acem/203217. Online ahead of print.

ABSTRACT

BACKGROUND: Acute cholecystitis (AC) is a common biliary disorder, most often caused by gallstones obstructing the cystic duct and leading to gallbladder inflammation.

OBJECTIVES: This study aimed to compare the therapeutic efficacy and complication rates of laparoscopic cholecystectomy (LC) performed using the Calot’s triangle approach vs traditional LC techniques in the treatment of AC.

MATERIAL AND METHODS: A retrospective analysis was conducted on 120 patients diagnosed with AC, with 60 patients undergoing LC using the Calot’s triangle approach (study group) and 60 patients treated with traditional LC techniques (control group). Surgical parameters, including operation time, intraoperative hemorrhage, postoperative recovery times, and 30-day postoperative complications were recorded. Intraoperative adhesion formation was evaluated through direct visualization and graded based on severity. Postoperative pain was assessed using the visual analogue scale (VAS).

RESULTS: There was no statistically significant difference in the baseline characteristics between the 2 groups, confirming their comparability. The study group (Calot’s triangle approach) demonstrated significantly shorter average operation time, postoperative exhaust time, and diet recovery time compared to the control group. Additionally, patients in the study group had significantly lower intraoperative bleeding, lower VAS pain scores at 24 h and 72 h postoperatively, and a lower overall complication rate compared to the control group (p < 0.05).

CONCLUSIONS: The LC Calot’s triangle approach demonstrated shorter operation times and lower rates of certain complications compared with traditional LC techniques. However, the absence of statistically significant differences in some key outcomes highlights the need for further research to fully evaluate its clinical advantages and long-term benefits.

PMID:41489865 | DOI:10.17219/acem/203217

Adv Clin Exp Med. 2026 Jan 5. doi: 10.17219/acem/203397. Online ahead of print.

ABSTRACT

BACKGROUND: Noninvasive ventilation (NIV) is an important treatment modality in the management of chronic obstructive pulmonary disease (COPD) by reducing respiratory distress, improving gas exchange and reducing exacerbations without the need for intubation and invasive airways.

OBJECTIVES: To synthesize data from randomized controlled trials (RCTs) and perform a meta-analysis to understand the beneficial effects of NIV across different COPD stages.

MATERIAL AND METHODS: A systematic literature review was performed using MEDLINE (PubMed) and Cochrane Register of Controlled Trials (CENTRAL) al databases for RCTs that involved the administration of NIV vs usual treatment (oxygen supplementation, pharmacological agents, nasal cannulation) in patients with stable COPD, acute exacerbations of COPD (AECOPD), and post-exacerbation COPD (PECOPD). Mortality, exacerbation and intubation rates, and arterial blood gases (PaCO2 and PaO2 levels) were assessed in both groups. RevMan software was used to assess the risk of bias and calculate the pooled odds ratio (OR), mean differences (MDs) and subgroup analyses with a random-effects model.

RESULTS: A total of 51 RCTs were included in the meta-analysis with information from 3,775 patients. Meta-analysis of the data showed that there was a significant decrease in mortality outcomes (p < 0.001), intubation frequency (p < 0.001) and PaCO2 levels (p < 0.001) but no significant improvement in exacerbation frequency (p = 0.12) and PaO2 levels (p = 0.69). Subgroup analyses demonstrated no significant difference between COPD stage on mortality outcomes (p = 0.32), PaCO2 level (p = 0.12) and PaO2 level (p = 0.64). There was a significant decrease in intubation rate in AECOPD patients receiving NIV and a statistically nonsignificant difference in exacerbation frequency in stable COPD patients using NIV.

CONCLUSION: The findings of this meta-analysis indicate a substantial overall enhancement in the frequency of exacerbations and intubations, mortality outcomes, and arterial gas levels among patients in various stages of COPD. Consequently, it is imperative to identify patients with COPD that are most likely to benefit from the use of NIV.

PMID:41489863 | DOI:10.17219/acem/203397

Adv Clin Exp Med. 2026 Jan 5. doi: 10.17219/acem/203504. Online ahead of print.

ABSTRACT

BACKGROUND: Hyperlipidemia is a major risk factor for cardiovascular diseases and is associated with complications such as atherosclerosis and tendon injury. Though atorvastatin reduces cholesterol, genetic variants (CYP2D6-4, SULT1A1, CYP2C192) affect its response. These genetic variations influence atorvastatin metabolism, thereby affecting its therapeutic effectiveness.

OBJECTIVES: To advance personalized therapeutic drug monitoring and improve lipid profile management, this study aims to develop a robust and LC-MS/MS method for quantifying atorvastatin levels in human plasma. Additionally, to investigate the influence of genetic polymorphisms – particularly CYP2D6-4-on plasma concentrations of atorvastatin in patients with hyperlipidemia.

MATERIAL AND METHODS: Ethical approval for the study was obtained from the appropriate institutional review boards, and written informed consent was obtained from all participants. Atorvastatin was measured using LC-MS/MS. PCR-based methods were used for genotyping. Statistical analyses were performed to evaluate relationships between plasma atorvastatin levels and genetic variants.

RESULTS: The LC-MS/MS method demonstrated excellent linearity, accuracy, precision, and stability, for the quantification of atorvastatin in human plasma. Higher atorvastatin concentrations were tied to CYP2D6-4. Furthermore, the study validated the analytical method for consistent and reliable measurement of atorvastatin levels in clinical samples.

CONCLUSIONS: This study successfully developed and validated a straightforward and reliable LC-MS/MS method for quantifying atorvastatin levels in human plasma. Significant CYP2D64 – atorvastatin links highlight the value of pharmacogenetic dosing. Integrating pharmacogenetics – especially in the Jordanian population – may enhance the safety, efficacy, and individualization of atorvastatin therapy.

PMID:41489862 | DOI:10.17219/acem/203504

AIDS Behav. 2026 Jan 5. doi: 10.1007/s10461-025-04941-2. Online ahead of print.

ABSTRACT

While urban refugee youth face HIV vulnerabilities spanning socio-ecological levels, knowledge gaps persist in HIV prevention outcomes. We conducted a baseline analysis of a cohort enrolled in Tushirikiane-4-Uthabiti, an intervention focused on HIV testing practices among urban refugee youth aged 16-24 in Kampala, Uganda (N = 330). Using regression models, we examined the societal, community, and interpersonal factors associated with condom use self-efficacy [CUSE], consistent condom use, HIV self-testing [HIVST] kit access, and recent HIV testing. Most participants were women (53.3%), with a mean age of 21.3 years (SD = 2.9). One-fifth reported consistent condom use (19.1%), over half accessed HIVST kits (56.4%), and recent HIV testing (50.6%). Statistically significant results showed that higher education (β = 0.18, p < 0.001) and financial resilience (β = 0.18, p < 0.001) were positively associated with CUSE, whereas food insecurity (β = – 0.21, p < 0.05) was negatively associated with CUSE. Being in a casual relationship (adjusted odds ratio [aOR] 3.33, p < 0.05) and CUSE (aOR 1.12, p < 0.010) were associated with increased odds of consistent condom use. Higher education (aOR 2.45, p < 0.001), adolescent sexual and reproductive health stigma (aOR 1.16, p < 0.010), and perceived HIV stigma (aOR 1.05, p < 0.05) were associated with increased odds of recent HIVST kit access. Financial resilience (aOR 1.05, p < 0.010) and young parenthood (aOR = 2.32, p < 0.010) were associated with increased odds of recent last year HIV testing. The findings demonstrate suboptimal HIV prevention outcomes and highlight the need for tailored multilevel interventions to improve the sexual health of urban refugee youth.

PMID:41489850 | DOI:10.1007/s10461-025-04941-2