Tag: pubmed

Arch Esp Urol. 2025 Dec;78(10):1353-1361. doi: 10.56434/j.arch.esp.urol.20257810.177.

ABSTRACT

BACKGROUND: Percutaneous nephrolithotomy (PCNL) is the preferred technique for kidney stones larger than 20 mm in maximum diameter. The objective of this study is to evaluate the effect of the nephrostomy tube technique vs. that of the tubeless technique in patients undergoing supine PCNL, focusing on postoperative complications and hospital stay duration.

METHODS: This retrospective observational study was conducted from January 2018 to June 2024. A total of 243 patients underwent supine PCNL. Clinical, surgical and postoperative variables were compared between patients with and without nephrostomy tubes. Complications were classified into clinically relevant categories: Infectious (fever ≥38 °C), haemorrhagic (postoperative haemoglobin drop >1 g/dL within 48 h or the requirement for blood transfusion) and severe (including nephrectomy and mortality). A binary logistic regression model was used to identify independent predictors of complications. Stone-free status was assessed by noncontrast computed tomography (CT) at six weeks. All analyses were performed with IBM SPSS Statistics 26.0.

RESULTS: In 50% of patients, a nephrostomy tube was placed at the end of the procedure. The overall complication rate was 14.4% and was significantly higher in patients with nephrostomy tubes (22.9% vs. 6.7%; p < 0.001) than in those without. Hospital stay was longer in patients with nephrostomy tubes (median 3 days (interquartile range (IQR) 2-4) vs. 1 day (IQR 1-2); p < 0.001) than in those without. Stone-free rate was comparable between groups (80.9% vs. 77.8%; p = 0.529). In multivariate analysis, nephrostomy remained independently associated with complications (odds ratio 4.15; 95% confidence interval 1.72-10.02; p = 0.001).

CONCLUSIONS: In this retrospective series, tubeless PCNL was associated with significantly reduced overall complication rates, mainly as a result of a low number of bleeding events, and short hospital stay without compromising stone-free rates. These findings support the safety of a tubeless approach in appropriately selected patients.

PMID:41492665 | DOI:10.56434/j.arch.esp.urol.20257810.177

Lancet Reg Health Eur. 2025 Nov 20;60:101508. doi: 10.1016/j.lanepe.2025.101508. eCollection 2026 Jan.

ABSTRACT

BACKGROUND: To further reduce new HIV diagnoses in the Netherlands, individual and structural barriers hindering prevention must be addressed. We aimed to estimate the disproportional burden of new HIV diagnoses and explore how intersecting socio-demographic, socio-economic, and health-related factors jointly influence the risk of a new HIV diagnosis.

METHODS: We combined data from the ATHENA cohort, an ongoing nationwide HIV cohort, with registry data from Statistics Netherlands. We selected individuals with a new HIV diagnosis between 1 January 2012 and 31 December 2023 and matched them to individuals from the general population. We assessed determinants of a new HIV diagnosis using a multivariable generalized linear model. We used Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) to quantify the joint and individual contribution of intersecting variables.

FINDINGS: 6055 men and 1020 women were newly diagnosed with HIV. Having a migration background and a low to middle income or income below the poverty line was associated with a higher risk of a new HIV diagnosis for both men (low to middle: adjusted odd ratio (aOR) = 1.24, 95% confidence interval (CI) = 1.17-1.31; below the poverty line: aOR = 1.75, 95% CI = 1.62-1.89) and women (low to middle: aOR = 2.49, 95% CI = 2.05-3.01; below the poverty line: aOR = 4.71, 95% CI = 3.80-5.83). Use of mental health care (aOR = 1.14, 95% CI = 1.01-1.27) or antidepressants (aOR = 1.66, 95% CI = 1.50-1.84) also increased the risk among men; while receiving social welfare (aOR = 1.39, 95% CI = 1.15-1.67) and use of antipsychotic medication (aOR = 1.66, 95% CI = 1.21-2.28) increased the risk among women. Of all intersections identified in MAIHDA, men with a first-generation migration background, income below the poverty line, and who used antidepressants had the highest predicted probability of an HIV diagnosis (0.036%, 95% confidence interval (CI) = 0.025-0.052). Women with a first-generation background, income below the poverty line, who received social welfare, and who used antipsychotic medication had the highest predicted risk (0.019%, 95% CI = 0.011-0.035).

INTERPRETATION: A disproportionally higher burden of a new HIV diagnosis was observed for individuals with a migration background and economic and mental health vulnerabilities. HIV prevention and testing need to be reinforced in these groups.

FUNDING: Dutch Ministry of Health, Welfare and Sport; TKI Health Holland.

PMID:41492655 | PMC:PMC12765169 | DOI:10.1016/j.lanepe.2025.101508

Cancer Inform. 2026 Jan 3;25:11769351251411074. doi: 10.1177/11769351251411074. eCollection 2026.

ABSTRACT

BACKGROUND AND OBJECTIVES: Next-generation sequencing (NGS) is transforming clinical diagnostics by enabling the detection of genetic variation with unprecedented precision. However, successful implementation of NGS workflows necessitates stringent quality control. This study introduces Molecular Genetics Dashboard (MGDB), a novel bioinformatics tool designed to enhance quality control in clinical NGS workflows.

METHODS: Using the Python dash framework for visualizations and MySQL databases, we have developed a novel tool for variant-level monitoring of clinical NGS sequencing runs. MGDB uses a docker-compose containerization for improved portability and can flexibly include or exclude samples from accumulated statistics with notes from interpreters.

RESULTS: MGDB facilitates variant-level run-to-run monitoring, ensuring the consistency of variant detection across sequencing cycles. The tool provides an interactive platform for visualizing and assessing variant data, identifying potential inconsistencies or outliers and improving data management and interpretation compared to traditional methods. MGDB was tested using samples sequenced with Oncomine Focus/Comprehensive Plus assays on S5 sequencers and analyzed via IonReporter software.

CONCLUSIONS: MGDB offers a robust and user-friendly solution for enhancing quality control in clinical NGS workflows, contributing to greater accuracy and reliability in variant detection. The tool is freely available on GitHub: https://github.com/acri-nb/GeneticVariantsDB.

PMID:41492654 | PMC:PMC12764754 | DOI:10.1177/11769351251411074

Cureus. 2025 Dec 4;17(12):e98478. doi: 10.7759/cureus.98478. eCollection 2025 Dec.

ABSTRACT

AIM: To estimate the proportion of living kidney donors (completed one year post-donation) who have developed proteinuria, an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m², hypertension, or suboptimal renal compensation (defined as <70% of pre-donation glomerular filtration rate (GFR)) during post-donation follow-up. The study also aimed to evaluate the association between donor-related factors and clinical outcomes. To assess the emotional well-being and overall satisfaction of donors through structured, in-person interviews.

PATIENTS AND METHODS: A cross-sectional prospective study design was undertaken to contact all donors of recipients under regular review who had completed at least one year post-donation. Among approximately 250 living renal transplant recipients in active follow-up, about 200 corresponding donors had crossed the one-year post-donation period. Of these, 160 donors responded to the call for follow-up, and 140 completed a comprehensive clinical and laboratory assessment in accordance with the institutional follow-up protocol. Written informed consent was obtained from all participants, and pre-donation records were retrieved for comparative analysis. The emotional well-being and overall satisfaction of donors were assessed through structured, in-person (in formal) interviews. Results were analyzed with IBM SPSS Statistics Software, version 20.0 (IBM Corp., Armonk, New York, USA).

RESULTS: The mean age at donation was 45.4 ± 9.4 years (range: 20-69 years), and the mean age at follow-up was 51.5 ± 9.9 years. The median duration of follow-up was 7 ± 4 years (interquartile range (IQR): 1-23 years), with 30% (n = 42) of donors followed for more than 10 years post-donation. Female donors predominated (77.2%; n = 108), yielding a female-to-male ratio of approximately 3.4:1. Mothers constituted the largest donor subgroup (52.8%; n = 74). Perioperative complications occurred in 8% (n = 7) of donors. Hypertension was noted in 34 (24.3%). Proteinuria (protein-to-creatinine ratio (PCR) > 0.2) was seen in 34 donors (24.3%). Mean eGFR pre- and post-donation was 91.6 ± 16.0 ml/min and 80.3 ± 18.5 ml/min, with a decline of 11 ml/min. One hundred twenty-two donors (87.1%) have eGFR >60 ml/min/1.73 m². Overall, 84.3% (n = 118) achieved optimal and 15.7% (n = 22) showed suboptimal compensation. On multivariate analysis, only suboptimal renal compensation remained an independent predictor of eGFR < 60 ml/min (adjusted OR: 31.43; 95% CI: 7.19-137.2; p < 0.001). Neither donor age nor gender showed a significant association with outcomes such as proteinuria, hypertension, eGFR <60 mL/min/1.73 m²,and suboptimal compensation. A vast majority (91%, n = 127) expressed happiness and complete satisfaction with their decision to donate.

CONCLUSION: In this cohort, female predominance reflected persistent sociocultural patterns. The prevalence of hypertension was comparable to that of the general population. These findings reinforce that modest post-donation changes in proteinuria or eGFR should not discourage donation, given its profound benefits to recipients, donors, and society. Establishing dedicated renal donor clinics for structured, lifelong surveillance is vital to safeguard donor health.

PMID:41492638 | PMC:PMC12764397 | DOI:10.7759/cureus.98478

Cureus. 2025 Dec 3;17(12):e98424. doi: 10.7759/cureus.98424. eCollection 2025 Dec.

ABSTRACT

Background Maternal mortality remains a pressing health concern, especially in low‑ and middle‑income countries. Understanding the demographic, temporal, and contextual factors that lead to these deaths is essential for designing effective interventions. This study aimed to examine maternal mortality through the lens of the three delays model using data from Pakistan. Methods We conducted a retrospective analysis of the Pakistan Maternal Mortality Survey 2018‑2019, drawing on the Pakistan Demographic and Health Survey Verbal Autopsy dataset. Descriptive statistics and stratified analyses were used to profile maternal deaths by demographic characteristics, timing, and place of death. We also quantified delays in deciding to seek care, reaching a facility, and receiving treatment. Results Of the 1,177 maternal deaths analyzed, the mean age was 34 years. Most deaths occurred in health facilities and were classified as direct obstetric causes such as hemorrhage and sepsis. Women experienced an average delay of 3.8 days in deciding to seek care, 3.7 hours in reaching a facility, and 7.6 minutes in receiving treatment. More than half of the deaths occurred within 42 days postpartum. Financial hardship, geographic isolation, and limited resources emerged as prominent reasons for delay. Women who reached a health facility were less likely to die on the first day of admission than those who did not. Conclusions Maternal mortality in Pakistan reflects a web of sociodemographic inequalities and systemic shortcomings. Addressing these deaths requires more than clinical solutions. It calls for policies that improve the timeliness and quality of maternal health services, tackle financial and geographic barriers, and strengthen the healthcare system. Interventions grounded in the three delays framework could help reduce maternal mortality and advance maternal health equity in low‑resource settings.

PMID:41492636 | PMC:PMC12765515 | DOI:10.7759/cureus.98424

Cureus. 2025 Dec 5;17(12):e98524. doi: 10.7759/cureus.98524. eCollection 2025 Dec.

ABSTRACT

BACKGROUND: The role of the neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker for community-acquired pneumonia (CAP) has not been extensively studied in India. Therefore, we conducted this study to assess the role of the NLR in determining prognosis and severity among hospitalized CAP patients from Northeast India.

MATERIALS AND METHODS: This prospective observational study was conducted from October 2023 to November 2024 in a tertiary care hospital in southern Assam, Northeast India. A total of 162 adult patients with CAP were recruited for the study via consecutive sampling. Statistical analysis included descriptive statistics, chi-square tests, correlation analysis, and logistic regression to evaluate associations between NLR, severity scores (CURB-65), and patient outcomes.

RESULTS: A strong positive correlation (r = 0.72) was noted between the NLR and CURB-65 score. A level of NLR ≥ 9.5 anticipated the need for intensive care unit (ICU) admission (40.74%, n=66 out of 162), while NLR ≥ 16 was associated with a higher death rate (80%, n=16; out of 20 deaths) compared to NLR <16 (20%, n=4). Most patients (55%) were middle-aged men. Right middle zone pneumonia (22.8%) was the most frequent radiological finding, while 85.18% patients had sterile sputum culture. Both Klebsiella pneumoniae (6.2%) and Streptococcus pneumoniae (6.2%) were the most typical organisms noted in the culture specimen. Conclusion: An elevated NLR is a strong predictor of disease severity, ICU requirement and mortality amongst Indian CAP patients.

PMID:41492633 | PMC:PMC12765456 | DOI:10.7759/cureus.98524

Cureus. 2025 Dec 4;17(12):e98428. doi: 10.7759/cureus.98428. eCollection 2025 Dec.

ABSTRACT

Background Spinal cord injury (SCI) is a debilitating condition often associated with many complications, of which pressure injury (PI) is one of the most prevalent. Individuals with SCI are at an increased risk of developing PIs due to impaired protective sensations, dependence for mobility, and co-morbidities. Individuals with PIs often report an increase in morbidity, healthcare-related expenditure, and reduced quality of life (QoL). However, there is a paucity of data on PI-related risk factors and QoL outcomes in SCI individuals in developing countries like India. This study aimed to assess risk factors contributing to different stages of PI in individuals with SCI and to evaluate the impact of PI on their QoL. Methodology This was a cross-sectional observational study conducted over a period of 18 months at the All India Institute of Medical Sciences (AIIMS) Bhopal, India. A total of 134 individuals with SCI and PI were enrolled after considering all the inclusion and exclusion criteria. Data involving demographic profiling, physical examination, and hematological investigations were collected. Risk factors were assessed using the Braden Scale and Spinal Cord Injury Pressure Ulcer Scale (SCIPUS). Staging of PIs was done according to the Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System. Neurological level was classified using the American Spinal Injury Association (ASIA) Impairment Scale (AIS). QoL was determined using the World Health Organization Quality-of-Life Scale brief version (WHOQOL-BREF) questionnaire. Statistical analysis was done to assess the risk factors and their relation with SCI severity, PI stage, and QoL. Results The participants’ mean age was 38.65 years and 76.87% were men. Labourers were the most often affected (35.82%). Most participants were paraplegic (64.93%), and trauma was the most common cause of SCI etiology (66.42%). Stage 4 PI was observed (35.24%) more often than other stages and was followed by Stage 2 PI (34.46%). Complete SCI (American Spinal Injury Association (ASIA) Impairment Scale (AIS) A) was strongly associated with higher-stage PI. Risk factors such as limited mobility, moisture, and friction/shear were significantly linked to higher PI stages. Bed-bound individuals were more prone to Stage 3, while stage 4 PI was predominant in wheelchair-bound individuals. Braden and SCIPUS scores showed decreasing risk for PI from AIS A to D. WHOQOL-BREF revealed that all domains of QoL were adversely affected, but social relationship was reported as a major concern in our participants. However, no significant association was found between stage of PI and QoL scores. Conclusion This study highlights the strong correlation between complete SCI and higher-stage of PIs, with modifiable risk factors like moisture and friction having a substantial impact. PI considerably impairs all QoL domains, particularly social relationships. These findings emphasise the need for targeted preventive strategies and standard protocols to arrest PI progression and improve QoL of individuals with SCI. This is among the first such studies in central India, offering valuable insights for future clinical and rehabilitative planning.

PMID:41492628 | PMC:PMC12765511 | DOI:10.7759/cureus.98428

Cureus. 2025 Dec 5;17(12):e98526. doi: 10.7759/cureus.98526. eCollection 2025 Dec.

ABSTRACT

Background Intravesical administration of botulinum toxin type A (BoNT-A) is an established third-line intervention for patients with refractory overactive bladder (OAB). With BoNT-A therapy now widely adopted, ongoing audits remain important to capture real-world outcomes across different patient groups. This retrospective audit assessed the clinical outcomes of BoNT-A therapy in a heterogeneous patient population treated at a university-affiliated teaching hospital. Methodology We conducted a retrospective audit of 193 patients who received intravesical BoNT-A injections for OAB between January and December 2024. Patients underwent urodynamic testing to confirm diagnosis, and all cases were discussed in multidisciplinary team meetings where approval was given for BoNT-A treatment. Demographic data, treatment parameters, efficacy outcomes, adverse events, and catheterization requirements were systematically analyzed. Statistical analyses included chi-square tests and Fisher’s exact tests to evaluate associations between variables. Results The cohort included 164 (85%) females and 29 (15%) males, with a median age of 62 years. The primary indications for BoNT-A therapy were idiopathic detrusor overactivity (IDO, n = 149, 77.2%), neurogenic detrusor overactivity (NDO, n = 41, 21.2%), and sensory urgency (n = 3, 1.6%). Treatment success was observed in 82.4% (n = 159) of patients, with partial improvement in 4.1% (n = 8) and treatment failure in 11.9% (n = 23). The overall urinary tract infection (UTI) rate was 4.7% (n = 9), with diabetic patients exhibiting a three-fold increased risk (11.5% vs. 3.6%), but this did not reach statistical significance (χ² = 3.195, df = 1, p = 0.074; Fisher’s p = 0.105). Post-treatment catheterization was required in 29.5% (n = 57) of cases, predominantly among patients with NDO (n = 22, 53.7% vs. IDO, n=37, 25%). First-time BoNT-A administration occurred in 21.7% (n = 42) of patients, while the majority (n = 151, 78.3%) received repeat injections during the study period, with a mean of seven treatment cycles. The median duration of effect following intravesical BoNT‑A was six months (interquartile range = 5). The mean duration was 6.7 ± 4.0 months. Conclusions Intravesical BoNT-A demonstrates robust efficacy and an acceptable safety profile in the management of refractory OAB, with sustained therapeutic benefits necessitating repeat administration. Diabetic status may predispose patients to an increased risk of post-procedural UTIs, while those with NDO are more likely to require catheterization. These findings support BoNT-A as a valuable therapeutic option in the stepwise management of OAB, particularly when combined with appropriate patient selection and counseling.

PMID:41492626 | PMC:PMC12765457 | DOI:10.7759/cureus.98526

Cureus. 2025 Dec 5;17(12):e98511. doi: 10.7759/cureus.98511. eCollection 2025 Dec.

ABSTRACT

INTRODUCTION: Recurrent urinary tract infections (rUTIs) represent a significant clinical challenge, traditionally managed with long-term antibiotic prophylaxis. However, growing concerns regarding antimicrobial resistance have necessitated the exploration of alternative treatment modalities. Methenamine hippurate (MH), a urinary antiseptic with a unique mechanism of action, has emerged as a promising non-antibiotic option for rUTI prevention.

OBJECTIVE: This study aims to examine the effectiveness of MH in the prophylaxis of rUTI, with a specific focus on patients with structural or functional abnormalities of the urinary tract and those requiring catheterization to empty their bladder.

METHODS: A retrospective observational study was conducted on the first 150 patients prescribed MH in a University Hospital at a Local Health Board in South Wales from April 2020 to July 2022. Patient demographics, radiological findings, functional urological status, catheter use, and treatment outcomes were analyzed. Chi-square statistical tests were used to assess associations between categorical variables and treatment outcomes.

RESULTS: The cohort comprised 132 females (88%) with a median age of 60 years. After 12 weeks of treatment, 100 (66.7%) of patients showed improvement, with about half of these (n = 46) experiencing complete resolution of UTIs and a further third (n = 35) reporting reduced frequency or severity at six months follow-up. No statistically significant difference in long-term outcomes was observed based on radiological findings (χ² = 0.138, df = 2, p = 0.933). Similarly, there was no significant association between functional urological status and treatment outcome (χ² = 4.763, df = 2, p = 0.092), nor between catheter use and outcome (χ² = 4.226, df = 2, p = 0.121) Conclusions: MH demonstrates effectiveness for long-term management of rUTIs across diverse patient populations, including those with structural or functional urinary tract abnormalities and catheter users. These findings support the broader application of MH as a viable alternative to antibiotic prophylaxis, potentially reducing antimicrobial resistance while maintaining clinical efficacy.

PMID:41492622 | PMC:PMC12765357 | DOI:10.7759/cureus.98511

Cureus. 2025 Dec 5;17(12):e98536. doi: 10.7759/cureus.98536. eCollection 2025 Dec.

ABSTRACT

BACKGROUND: Pain management following lower extremity amputation remains a clinical challenge, particularly during inpatient rehabilitation. Although opioids are frequently used, their adverse effects and potential for prolonged use highlight the importance of multimodal pain strategies. This study investigated the relationship between specific non-opioid analgesics and reductions in opioid use among patients undergoing inpatient rehabilitation after major lower extremity amputation.

METHODS: A retrospective review was conducted at a single inpatient rehabilitation facility (IRF), examining opioid utilization measured in morphine milligram equivalents (MME) and the concurrent use of non-opioid agents, including acetaminophen, methocarbamol, gabapentin, pregabalin, and duloxetine. Eighty-one patients admitted between January 2021 and December 2023 were included. Admission and discharge opioid requirements were compared with daily non-opioid doses. Statistical analyses were performed using STATA version 3 (StataCorp LLC, College Station, TX).

RESULTS: Gabapentin use was associated with a significant decrease in MME from admission to discharge (p=0.04), with an average daily dose of 1000 mg corresponding to a reduction of 1 MME per day. In multivariable analysis incorporating all non-opioid medications, gabapentin and pregabalin both showed significant associations with reduced MME (p=0.021 and p=0.027, respectively).

CONCLUSION: Among patients recovering from lower extremity amputation during inpatient rehabilitation, gabapentin use was significantly associated with lower opioid requirements, with pregabalin demonstrating a similar pattern. Incorporating these agents into multimodal analgesic regimens may help optimize postoperative pain control and limit opioid exposure. Further research is warranted to explore the role of additional non-opioid options in this setting.

PMID:41492604 | PMC:PMC12765528 | DOI:10.7759/cureus.98536