Tag: pubmed

Cureus. 2025 Jun 9;17(6):e85653. doi: 10.7759/cureus.85653. eCollection 2025 Jun.

ABSTRACT

Background Anticoagulation is commonly used to prevent thromboembolic events. Warfarin is a cost-effective, widely used anticoagulant that requires close monitoring due to its narrow therapeutic index. Time in therapeutic range (TTR) is a measure of international normalized ratio (INR) control. Using a retrospective approach, we evaluated the TTR of patients using warfarin for anticoagulation in our state-owned urban primary care clinic. Methods We conducted a retrospective chart review of adult patients on warfarin therapy followed at an urban Level 1 trauma center’s ambulatory clinic from January to December 2024. Patients with at least two contiguous INR visits over a two-month period were included. Data on warfarin dosing, INR values, anticoagulation visit history, and demographics were extracted from the electronic medical record. The primary outcome was TTR, calculated using the traditional method. Statistical analysis was performed using R-studio. Results Overall, 103 patients were analyzed in our clinic. The average TTR was 46.7% for this population. Around 17.5% of patients had a TTR >70%, and 30.1% had a TTR >60%. Approximately 29.1% of patients presented with high bleeding risk (INR >4.5) at least once during the measured time period, with 5.8% of patients requiring ED visits for significant elevations in INR. Variables such as gender, age, and insurance status did not significantly contribute to measured TTR. Conclusions The average TTR of our patient population was suboptimal. These findings highlight the need for more targeted quality improvement efforts to enhance anticoagulation management in our primary care clinic. Further evaluation of our current protocol with the help of pharmacists and the enhancement of patient education may be beneficial in achieving this goal.

PMID:40642722 | PMC:PMC12244846 | DOI:10.7759/cureus.85653

Cureus. 2025 Jun 9;17(6):e85661. doi: 10.7759/cureus.85661. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Tuberculosis (TB) remains a significant global health challenge, particularly in pediatric populations, where effective treatment with anti-tubercular therapy (ATT) is often complicated by adverse drug reactions. Drug-induced liver injury (DILI) is among the most serious complications of ATT, and identifying risk factors for DILI in children is essential for improving treatment safety and outcomes.

OBJECTIVE: This study aimed to determine the incidence of DILI in pediatric TB patients undergoing ATT and identify demographic and clinical factors associated with its development.

METHODS: A prospective observational study was conducted over 18 months at a tertiary care center in South India. Fifty children aged 1-14 years diagnosed with TB and initiated on ATT were enrolled. Liver function tests (LFTs) were performed at baseline, one month, and six months, and clinical parameters were monitored to identify DILI cases. Nutritional status was assessed using WHO growth standards, and statistical analyses were conducted to identify significant risk factors.

RESULTS: DILI was observed in 16 of 50 patients (32%). Malnutrition was present in 70% of DILI cases compared to 48% of non-DILI cases (p < 0.05). Female patients showed a higher incidence of DILI (56%) than males (44%). Baseline liver enzyme levels, specifically serum glutamic-oxaloacetic transaminase (SGOT) and serum glutamic-pyruvic transaminase (SGPT), were significantly higher in patients who developed DILI (p < 0.05). The most common clinical presentation of DILI was jaundice (50%), followed by anorexia and abdominal pain. Pulmonary TB accounted for 50% of DILI cases, while CNS TB represented 37.5%.

CONCLUSIONS: DILI is a common complication of ATT in pediatric TB patients, with malnutrition, female gender, and elevated baseline liver enzymes identified as significant risk factors. Routine liver function monitoring and nutritional interventions should be integral to TB management in children to mitigate the risk of DILI and improve treatment outcomes.

PMID:40642720 | PMC:PMC12244840 | DOI:10.7759/cureus.85661

Cureus. 2025 Jun 10;17(6):e85687. doi: 10.7759/cureus.85687. eCollection 2025 Jun.

ABSTRACT

Introduction Tribal populations in India face longstanding barriers to accessing formal healthcare due to economic, geographic, and cultural constraints. This study assessed the healthcare-seeking behaviour of tribal households in Palghar district, Maharashtra, and examined associated determinants. Methods A community-based cross-sectional study was conducted from August 2023 to March 2024 using multistage cluster random sampling in eight tribal villages located within a 25 km radius of the district hospital. A total of 80 households were selected, and 306 individuals were enumerated. Of these, 84 individuals (27.5%) who reported illness in the past three months were included in the analysis. Data were collected using a pretested structured questionnaire and analysed using R software (R Foundation for Statistical Computing, Vienna, Austria). Chi-square tests were applied to assess associations between healthcare-seeking behaviour and independent variables. Results Only 25 (29.8%) of the ill individuals sought formal healthcare, while 29 (34.5%) accessed informal providers, and 30 (35.7%) took no action. Among all variables analysed, only perceived severity of illness was significantly associated with formal healthcare utilization. Formal care was accessed by 13 of 14 (92.9%) individuals who perceived their illness as severe, compared to 11 of 40 (27.5%) with moderate and five of 30 (16.7%) with mild perception. No significant associations were found with age, gender, education, number of symptoms, or timing of illness. Conclusion The study highlights low formal healthcare utilization and a strong influence of perceived illness severity on care-seeking behaviour. Continued reliance on spiritual healers and non-action reflects persistent cultural and structural barriers. Interventions should include culturally sensitive health promotion, expansion of nearby healthcare services, and financial support mechanisms. Further qualitative research is needed to explore contextual factors influencing healthcare choices in tribal communities.

PMID:40642714 | PMC:PMC12243070 | DOI:10.7759/cureus.85687

Cureus. 2025 Jun 10;17(6):e85706. doi: 10.7759/cureus.85706. eCollection 2025 Jun.

ABSTRACT

INTRODUCTION: American football players face a higher risk of spine injuries due to the sport’s high-impact nature, especially in the lumbar and cervical spine regions. These injuries may require surgical interventions aimed at allowing athletes to return to the sport. However, the effects of these surgeries on players’ performance and career longevity have yet to be comprehensively studied.

OBJECTIVE: This study aims to evaluate the impact of spine surgeries on National Football League (NFL) players’ return-to-play rates and performance. We hypothesize that players undergoing lumbar surgeries would demonstrate greater performance improvement and return-to-play rates compared to those undergoing cervical surgeries, with differences influenced by player position and injury location. Study design and methods: This is a retrospective cohort study (III) for which NFL injury reports from 2005 to 2022 were reviewed to identify players who had undergone spine surgery. Data collected included player position, return-to-play, and years played following the procedure. Performance metrics were gathered using Super Bowl wins and Pro Football Focus (PFF) player performance ratings. Statistical analysis was conducted using Python version 3.10.12 (Python Software Foundation, Wilmington, DE, USA) to evaluate differences in return-to-play rates, performance changes, and career duration post-surgery.

RESULTS: The study identified 144 spine surgeries (77 lumbar, 67 cervical) among 136 players. Players who had lumbar surgery had a 61% return-to-play rate, with an average performance rating increase of 6.3%. In contrast, those who had cervical surgery had a 47% return-to-play rate and an average performance rating decrease of 5.8%. Lumbar surgeries were more common among linemen with higher BMIs, while cervical surgeries were more frequent in skill positions. Players with a history of lumbar surgeries were more likely to return to play than those without previous surgeries.

CONCLUSION: Spinal surgeries significantly impact the careers of NFL players. Lumbar surgeries show better outcomes in terms of return-to-play rates and performance improvements compared to cervical surgeries. The differences in surgical outcomes based on injury location and player position highlight the need for tailored rehabilitation protocols. This study provides valuable insights for medical practitioners, team management, and athletes, contributing to a broader understanding of the implications of spine surgeries in professional football.

PMID:40642713 | PMC:PMC12244281 | DOI:10.7759/cureus.85706

Cureus. 2025 Jun 10;17(6):e85689. doi: 10.7759/cureus.85689. eCollection 2025 Jun.

ABSTRACT

Introduction In recent years, the medical community has grown increasingly alarmed by the escalating rates of carbapenem resistance – a global concern that is also affecting the United Arab Emirates (UAE). This rise in antibiotic resistance poses a significant challenge to healthcare systems and necessitates urgent and comprehensive research. The primary objective of this study is to investigate the factors that influence the prognosis and outcomes of bacteremia caused by carbapenem-resistant Enterobacterales (CRE), managed with a combination of ceftazidime-avibactam (CAZ-AVI) and aztreonam (ATM). Understanding the determinants of treatment success may provide valuable insights into improving patient care and outcomes. Methods This retrospective observational chart review was conducted at Tawam Hospital, Al Ain, from 2020 to 2023. Seventeen adult patients (aged >18 years) with confirmed CRE bacteremia who received combination therapy with CAZ-AVI and ATM were included. Data were extracted from the SEHA electronic medical records, including demographics, clinical features, laboratory findings, and outcomes such as ICU admission, in-hospital mortality, and length of stay. Statistical analyses were performed using Excel, Meta-Chart, and SkyBlue Statistics. Given the small sample size, descriptive statistics were prioritized, and chi-square and unpaired t-tests were used to explore associations, recognizing limitations in statistical power. Results The incidence of CRE bacteremia treated with CAZ-AVI and ATM increased over the study period, with the highest number of cases recorded in 2023. Antimicrobial resistance remained consistently high across both beta-lactam and non-beta-lactam classes. The overall in-hospital mortality rate was 29.4%, with long-term four-year mortality reaching 53%. The median length of hospital stay was 19 days, and 17.6% of patients required intensive care. Poor outcomes were primarily associated with immunosuppression, prior hospitalizations, and multiple comorbidities. Conclusion This study highlights the increasing clinical burden of CRE bacteremia in the UAE. By identifying key prognostic factors and reporting high mortality and prolonged hospital stays despite combination therapy, it underscores the urgent need for timely intervention, improved antimicrobial stewardship, and enhanced diagnostic capacity. These findings contribute valuable regional data to the global effort to curb antimicrobial resistance.

PMID:40642711 | PMC:PMC12243072 | DOI:10.7759/cureus.85689

Cureus. 2025 Jun 10;17(6):e85677. doi: 10.7759/cureus.85677. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Caudal nerve blocks are commonly used for inguinal surgeries in children but can lead to complications, such as prolonged weakness. The ilioinguinal/iliohypogastric (ILIH) nerve block is an alternative that is used less frequently. This study aimed to compare the effectiveness of these techniques in pediatric patients (ages six months to 12 years) undergoing inguinal surgery.

METHODS: A double-blinded, randomized controlled trial was conducted with 20 pediatric patients undergoing inguinal surgery under general anesthesia. Group 1 (n = 8) received a caudal block, while Group 2 (n = 12) received an ILIH block. Pain was assessed using the Face, Legs, Activity, Cry and Consolability (FLACC) and Numeric Rating score (NRS). The primary outcomes included pain reduction and the use of rescue analgesia.

RESULTS: The mean age of Group 1 was 2.13 years (SD=1.356), while that of Group 2 was 3.67 years (SD=1.303). The pain scores were 1.75 (SD=2.235) and 1.25 (SD=1.658) (p=0.792) at 30 minutes post-surgery in the Post Anesthesia Care Unit (PACU), 0.50 (SD=0.756) versus 0.08 (SD=0.289) (p=0.792) at PACU discharge, a score of zero versus 0.58 (SD=0.900) (p=0.792) at two hours post-operation for Group 1 and Group 2 respectively. Pain scores were similar at three hours, six hours, and at ward discharge. On day two at home, Group 1 reported a score of 0.25 (SD=0.707) compared to 0.33 (SD=0.778) in Group 2 (p=0.792). The use of rescue analgesia was higher in the caudal group, but the difference was statistically insignificant (p=0.7055). The block to ward discharge time was similar: 283 (SD=102.182) minutes versus 309.83 (SD=79.409) minutes for Group 1 and Group 2, respectively (p=0.746).

CONCLUSION: Both caudal and ILIH blocks provided similar analgesic effects for pediatric inguinal surgery. More extensive studies are needed to confirm this conclusion.

PMID:40642709 | PMC:PMC12242709 | DOI:10.7759/cureus.85677

Cureus. 2025 Jun 9;17(6):e85664. doi: 10.7759/cureus.85664. eCollection 2025 Jun.

ABSTRACT

Introduction Compulsive buying disorder (CBD), also referred to as compulsive buying-shopping disorder, shopping addiction, oniomania, or pathological buying, is characterized by excessive and poorly controlled preoccupations, urges, or behaviors related to shopping and spending. Digitalization in e-commerce and payment systems has made indulgence in shopping easier than ever. CBD is a growing concern, especially in the younger generation. Aim To determine the prevalence of CBD and its associated factors among undergraduate medical students. Methodology A cross-sectional study was done among undergraduate medical students in a tertiary college in Chengalpattu district, Tamil Nadu, India. A total of 300 students participated in the study. A pretested semi-structured questionnaire was used to collect socio-demographic details and information on factors associated with CBD. A validated scale was used to assess CBD. Data analysis was done using IBM SPSS Statistics for Windows, Version 25 (IBM Corp., Armonk, NY). Results The prevalence of CBD was found to be 68/300 (22.6%) among the undergraduate medical students. A total of 26/103 (25.2%) males were affected compared to 42/197 (21.3%) female students. Being tempted to buy during deals and offers, social media influence, and not having a habit of saving money were found to be significantly associated with CBD. Conclusion CBD is an often-overlooked behavioral concern in academic settings, and its presence is highlighted in this study. These findings underscore the influence of social media, peers, and strategic deals by e-commerce services on students’ purchasing habits. Interventions to identify and treat CBD in the early stages are important to prevent long-term financial and psychological consequences.

PMID:40642701 | PMC:PMC12241713 | DOI:10.7759/cureus.85664

Cureus. 2025 Jun 10;17(6):e85679. doi: 10.7759/cureus.85679. eCollection 2025 Jun.

ABSTRACT

Background Pemphigus is a rare autoimmune blistering disorder characterized by involvement of the skin and mucous membranes, primarily due to autoantibodies targeting desmogleins. Emerging evidence has pointed to a potential pathogenic role of antimuscarinic acetylcholine receptor (anti-M-AChR) antibodies and reported a correlation between their titers and pemphigus disease activity. However, data on this association, particularly in relation to different phases of pulse therapy in the Indian context, remain limited. Aim This study aimed to evaluate the correlation between anti-M-AChR antibody titers and pemphigus disease activity at baseline and after Phase I of dexamethasone-cyclophosphamide/azathioprine pulse therapy. Materials and methods This prospective longitudinal observational study included newly diagnosed cases of pemphigus confirmed through histopathology and direct immunofluorescence from April 2019 to March 2021. Pemphigus Disease Area Index (PDAI) scores were recorded, and eligible patients received dexamethasone-cyclophosphamide or dexamethasone-azathioprine pulse therapy as appropriate. Results A total of 29 patients were enrolled: 23 (79%) with pemphigus vulgaris, five (17%) with pemphigus foliaceus, and one (3.4%) with pemphigus erythematosus. Patient ages ranged from 21 to 69 years, with a male-to-female ratio of 0.7:1. By the end of Phase I therapy, 20 patients (69%) completed follow-up. The mean baseline anti-M-AChR antibody titer was 76.48 ± 48.12 U/mL, which decreased to 53.61 ± 30.97 U/mL after Phase I. At that point, PDAI scores showed a moderate correlation with anti-M-AChR antibody levels (r = 0.51, p = 0.02). The reduction in antibody titers from baseline to the end of Phase I was statistically significant (p = 0.05). Conclusions While serum anti-M-AChR antibody titers may not reliably indicate disease activity at the time of diagnosis, their levels appear to reflect changes in disease activity following treatment. This suggests their potential use as a prognostic marker during the course of therapy.

PMID:40642697 | PMC:PMC12242711 | DOI:10.7759/cureus.85679

Cureus. 2025 Jun 9;17(6):e85666. doi: 10.7759/cureus.85666. eCollection 2025 Jun.

ABSTRACT

Introduction The COVID-19 pandemic has led to a high number of survivors with persistent symptoms, such as dyspnea, long after recovery. It is important to understand the association between the severity of the initial COVID-19 infection and the persistence of dyspnea to guide patient management and rehabilitation planning. Methods This cross-sectional analysis involved adult patients who had recovered from laboratory-confirmed COVID-19 infection. Patients were stratified into groups by the severity of their acute infection (mild, moderate, severe) based on the WHO Clinical Progression Scale. Persistent dyspnea was measured with a validated dyspnea scale. Statistical analysis was conducted to examine the association between COVID-19 severity and severity of dyspnea, adjusting for potential confounders. Results A total of 385 individuals took part in the study, where 217 people (56%) fell within the 30 to 39 years age bracket, while female participants constituted 52% (200 individuals). The respondents were primarily widowed people who had received secondary education (n = 119, 31%, and n = 118, 31% respectively). A total of 141 participants were current smokers, while 145 participants reported never smoking. Among the study participants, 73 experienced asthma (19%), and hypertension affected 68 individuals (18%). The COVID-19 severity of patients spanned from mild (n = 144, 37%) to critical (n = 78, 20%), and 51% of patients received hospital care (n = 197). Research findings indicated that dyspnea symptoms and advancement in the disease are closely linked (r = 0.521, p < 0.05). People who got oxygen therapy had higher clinical scores than those who did not (p = 0.01). When comparing the ICU patients to other patients, no important differences were noticed (p = 0.05). Recovery was felt very minimally in the results. According to regression analysis, changes in the patient’s clinical condition were highly associated with dyspnea, as shown by a β value of 0.521 and p < 0.001. Conclusion The intensity of COVID-19 infection strongly correlates with both the enduring nature and severity of dyspnea in adults who have recovered from the disease. Post-COVID follow-up and rehabilitation programs require strong evidence behind them to support patients who have experienced severe COVID-19 infections.

PMID:40642682 | PMC:PMC12241829 | DOI:10.7759/cureus.85666

BMC Psychol. 2025 Jul 10;13(1):769. doi: 10.1186/s40359-025-03122-z.

ABSTRACT

BACKGROUND: Globally, cancer is a complex disease that, if not detected and treated early, can lead to death. The diagnosis of cancer typically causes a profound crisis in the lives of those affected, leading to psychological challenges. People living with cancer tend to exhibit suicidal behaviours due to the difficult nature of the disease.

OBJECTIVE: The primary aim of this study was to determine the prevalence and factors influencing Suicidal behaviours among adults living with cancer at Korle Bu Teaching Hospital, Ghana.

METHOD: A convenience sampling method was employed to collect data from cancer patients at Korle Bu Teaching Hospital. Data were gathered using structured questionnaires and the Columbia-Suicide Severity Rating Scale (C-SSRS). Descriptive and inferential statistics, including frequency tables, percentages, and regression analysis with Stata 17, were used for data analysis.

RESULTS: The study found that 57.2% of participants reported suicidal ideation, 14.1% had attempted suicide, and 11.3% had planned suicide. Age, sex, educational level, income, occupational status, and marital status were significantly associated with suicidal behaviour (p-value < 0.001). Multivariate logistic regression results shows that patients who experienced recent significant life changes were 15 times more likely to experience suicidal ideation (AOR: 15.0, 95% CI: 9.1-22.9, p < 0.001), twice as likely to have a suicidal plan (AOR: 2.0, 95% CI: 1.0-3.1, p = 0.001), and over five times more likely to attempt suicide (AOR: 5.41, 95% CI: 2.22-6.07, p < 0.001) compared to those who did not experience significant life changes. In Addition, patients who believed they were a burden to others were over three times more likely to experience suicidal ideation (AOR: 3.3, 95% CI: 1.15-4.59, p < 0.001), five times more likely to have a suicidal plan (AOR: 5.0, 95% CI: 3.07-8.13, p < 0.001), and three times more likely to attempt suicide (AOR: 3.0, 95% CI: 2.1-5.3, p < 0.001) compared to those who did not feel this way.

CONCLUSION: This study reveals a high prevalence of suicidal behaviours among cancer patients, with many reporting suicidal ideation, attempts, and plans. Socio-demographic factors, including age, sex, educational level, income, occupational status, and marital status, were linked to higher suicide risk. To achieve SDG 3, particularly Target 3.4 (promoting mental health and well-being) and Target 3.8 (ensuring universal health coverage), the Ghana Health Service and the Ministry of Health should integrate mental health support into routine cancer care.

PMID:40640971 | DOI:10.1186/s40359-025-03122-z