Tag: pubmed

Biomed Res Int. 2025 Dec 17;2025:9923869. doi: 10.1155/bmri/9923869. eCollection 2025.

ABSTRACT

BACKGROUND: Despite the increasing incidence of cancer worldwide, the knowledge about the trend of cancer incidence in Ethiopia is limited. The paucity of core cancer diagnostic services like pathology, diagnostic imaging technology, and the absence of a comprehensive national cancer registry masked the exact magnitude of cancer incidence in Ethiopia in general and the Wolaita area in particular. This study is aimed at filling the gap by analyzing diagnostic data from a referral clinic. The clinic used to serve as a primary diagnostic center for patients referred from over 25 healthcare facilities in the region.

METHODS: A pathology sample retrospective analysis-based prevalence study was conducted for the period between December 2017 and February 2022. Records saved in computers were subjected to analysis by using Statistical Package for Social Sciences (SPSS) software Version 22. The data were used to analyze the types and distribution of cancers in the region across age, sex, and diagnosis.

RESULTS AND DISCUSSIONS: The results showed notable gender disparities, with women experiencing a greater prevalence of breast cancer and men mostly receiving diagnoses for soft tissue sarcomas. The most prevalent forms of cancer were determined, along with the locations of each. The study also emphasized how different referral facilities, such as general hospitals, primary hospitals, and medium-sized clinics, had varying cancer incidence rates. Although generalizability may be limited by the study’s clinic-based design, its relevance to comparable healthcare settings in Ethiopia and other low-resource locations is strengthened by the large and diverse sample drawn from a variety of referral institutions. This study emphasizes the necessity of focused screening programs and greater cancer awareness in Wolaita Zone, particularly in rural regions. The results also suggest possible directions for future investigation, such as population-based studies to confirm and build upon these findings.

CONCLUSIONS: This study provides crucial insights into the cancer burden in Wolaita Zone and emphasizes the importance of improving diagnostic and preventive measures. Further research, including broader, population-based studies, is necessary to confirm these findings and inform regional cancer control strategies.

PMID:41416348 | PMC:PMC12709645 | DOI:10.1155/bmri/9923869

Cureus. 2025 Nov 17;17(11):e97096. doi: 10.7759/cureus.97096. eCollection 2025 Nov.

ABSTRACT

BACKGROUND: Rapid cycle deliberate practice (RCDP) is a form of simulation debriefing that incorporates repeated cycles of hands-on practice, characterized by within-simulation directed feedback and repeated practice with the goal of mastering a skill. RCDP debriefing has been shown to improve immediate performance; however, evidence of improved retention and superiority to traditional styles of debriefing is lacking.

OBJECTIVES: To compare RCDP and traditional debriefing for knowledge and skills acquisition and retention as part of a longitudinal residency simulation curriculum.

DESIGN: Participants were first-year pediatrics residents who underwent two simulation scenarios, focusing on basic airway and cardiac arrest management, at the beginning of their intern year. Participants were block randomized to either the RCDP or the traditional debriefing arm. Knowledge was assessed in a pre-post format at time 0 and at 12 months using a multiple-choice quiz. All interns received a repeat simulation teaching session at three, six, nine, or 12 months, remaining in their RCDP or traditional debriefing arm. Skills were assessed via a video-recorded simulated scenario prior to an initial simulation session (RCDP vs. traditional debriefing) at time 0 and three, six, nine, and 12 months, and before and after their repeat simulation teaching session. Videos were scored by two pediatric emergency medicine physicians using a resuscitation skills assessment tool.

RESULTS: There was no statistical difference in overall knowledge (via paired t-test) or skills acquisition (via linear mixed effects model) between residents who received traditional debriefing and those who received RCDP debriefing. The RCDP group showed significant improvement in skills when compared with the traditional group for those who received repeat education at three months; however, there was no difference in the other time groups. There was no difference between groups in skills retention at three months after the repeat teaching session, as assessed via the ANOVA analysis.

CONCLUSION: Overall, we demonstrated similar knowledge and skills gain and retention in traditional debriefing and RCDP groups, with the exception of those residents who received repeat teaching at the three-month time point. This may indicate that a three-month time interval could be the most appropriate timing for repeated RCDP resuscitation teaching. Higher power randomized controlled trials comparing RCDP to traditional simulation and/or qualitative studies assessing the efficacy of RCDP would add to current evidence.

PMID:41416338 | PMC:PMC12711249 | DOI:10.7759/cureus.97096

Cureus. 2025 Nov 17;17(11):e97084. doi: 10.7759/cureus.97084. eCollection 2025 Nov.

ABSTRACT

Pantoprazole is a proton pump inhibitor commonly used to treat gastroesophageal reflux disease (GERD) by reducing stomach acid production. Although widely used for gastrointestinal issues, its effects on embryonic development remain underexplored. This study investigated the impact of pantoprazole on neural tube closure using a chick embryo model. Fertilised chicken eggs were divided into groups and treated with varying doses of pantoprazole. All embryos were collected on the eighth day of incubation. Both macroscopic and microscopic examinations were conducted to assess developmental abnormalities. Macroscopic analysis revealed malformations, particularly in embryos exposed to medium and high doses of pantoprazole. These groups exhibited statistically significant developmental delays compared to controls. Microscopic examination further demonstrated that high-dose pantoprazole resulted in delayed vertebral lamina ossification and midline closure defects-key indicators of neural tube defects. Overall, the study concluded that high levels of pantoprazole exposure during embryonic development can lead to structural malformations and delayed growth. Specifically, neural tube defects were identified, indicating a risk to early neural development. These findings suggest that pantoprazole use during pregnancy may pose teratogenic risks and should be approached with caution. This research highlights the need for further studies on the safety of commonly used medications like pantoprazole during pregnancy, as their use may adversely affect embryonic development, particularly neural tube formation.

PMID:41416336 | PMC:PMC12710982 | DOI:10.7759/cureus.97084

Cureus. 2025 Nov 17;17(11):e97097. doi: 10.7759/cureus.97097. eCollection 2025 Nov.

ABSTRACT

Background Patients presenting with neck-of-femur (NOF) fractures often require urgent surgery, as prolonged delays beyond 36 hours are associated with increased morbidity, mortality, and length of hospital stay, whereas shorter time-to-surgery intervals have been shown to improve outcomes. Many of these patients are elderly and on anticoagulant therapy; therefore, making accurate International Normalized Ratio (INR) assessment is crucial for determining surgical readiness and anaesthetic safety. The INR reflects the extrinsic pathway of coagulation and is prolonged in patients on warfarin or who have underlying coagulopathies. Inaccurate or rejected INR samples delay operative clearance, prolong fasting, and increase bed occupancy and cost of treatment. A frequent pre-analytical cause of INR rejection is underfilling of sodium citrate tubes, which alters the required 9:1 blood-to-anticoagulant ratio. Objective To improve the rejection rate of INR samples through a simple phlebotomy intervention involving staff education and the appropriate use of a discard tube before citrate collection. Methods A retrospective two-cycle closed-loop audit was conducted at Heartlands Hospital, part of the University Hospitals Birmingham (UHB) NHS Foundation Trust. The first cycle included NOF fracture patients admitted between July and August 2023, during which 399 INR samples were analysed. Of these, 66 (16.5%) were rejected, 62 (94%) due to underfilling and four (6%) due to haemolysis. Following targeted interventions, including staff education on correct discard-tube use with butterfly systems and the introduction of shorter-tubing blood collection sets, a second audit cycle was performed and included NOF patients admitted between July and August 2025. In this cycle, 261 INR samples were reviewed, of which 29 (11.1%) were rejected, 27 (93%) for underfilling and two (7%) for haemolysis. Rejection proportions were compared between cycles, and absolute and relative changes were calculated. Statistical significance of the observed difference was assessed using a two-proportion z-test (two-sided, α = 0.05). Data collection and review were performed using the UHB trust Prescribing Information and Communication System (PICS) electronic system. Results INR sample rejection rate decreased from 16.5% in cycle 1 to 11.1% in cycle 2, an absolute reduction of 5.4% and relative reduction of ~33% (p ≈ 0.11). Among patients taking some form of blood thinner (e.g. warfarin, direct oral anticoagulants, low molecular weight heparin), 132 (33%) in cycle 1 and 56 (25%) in cycle 2, INR rejection occurred in 17.4% and 19.6%, respectively. Most rejections were due to underfilling the INR sample tube. Conclusions In trauma patients, particularly those awaiting urgent NOF surgery, preventing INR sample rejection can significantly reduce avoidable operative delays. This closed-loop audit demonstrated that a simple, low-cost intervention focused on correct tube filling, discard-tube use, and appropriate equipment selection led to a clinically meaningful reduction in INR sample rejection rates. Most remaining rejections remain preventable, underscoring the importance of continuous education, reinforcement of best practice, and regular re-audit to sustain long-term improvement.

PMID:41416323 | PMC:PMC12711245 | DOI:10.7759/cureus.97097

Cureus. 2025 Nov 16;17(11):e96972. doi: 10.7759/cureus.96972. eCollection 2025 Nov.

ABSTRACT

Background Diffusion tensor imaging (DTI) is a sensitive neuroimaging modality that evaluates white matter microstructure by measuring parameters such as fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD). Alterations in these metrics can indicate myelin disruption, axonal injury, or generalized microstructural changes. This study aimed to assess white matter integrity in children with developmental delay and evaluate the diagnostic performance of DTI metrics using receiver operating characteristic (ROC) analysis. Methods A hospital-based observational study was conducted on pediatric subjects with neurodevelopmental abnormalities. DTI was performed, and FA, MD, RD, and AD were quantified across major tracts, including the genu and splenium of the corpus callosum, anterior and posterior limbs of the internal capsule, superior longitudinal fasciculus (SLF), inferior fronto-occipital fasciculus (IFOF), and frontal and parietal white matter. Age-matched controls served as the comparison group. Statistical analysis included group comparisons and ROC curve evaluation for diagnostic accuracy. Results Significant reductions in FA were observed in the genu of the corpus callosum (0.34±0.07), frontal white matter (0.31±0.06), parietal white matter (0.33±0.05), SLF (0.35±0.06), and IFOF (0.37±0.05) (p<0.01 vs. controls). RD was significantly elevated in these regions (0.92-0.97×10⁻³ mm²/s; p<0.01), consistent with demyelination or delayed myelination. MD values were diffusely elevated (1.06-1.12×10⁻³ mm²/s), supporting generalized microstructural disruption, whereas AD showed mild but non-significant changes. ROC analysis demonstrated that FA had the highest diagnostic accuracy: genu of the corpus callosum (AUC 0.89), frontal white matter (AUC 0.91), and SLF (AUC 0.88). RD and MD also showed strong discriminatory ability, while AD performed less robustly. Conclusion Reduced FA, along with elevated RD and MD, reliably reflects white matter microstructural injury in pediatric populations. ROC analysis confirmed FA as the most sensitive biomarker, with high sensitivity and specificity. DTI metrics hold strong clinical potential for the early detection of neurodevelopmental white matter abnormalities.

PMID:41416317 | PMC:PMC12709428 | DOI:10.7759/cureus.96972

Cureus. 2025 Nov 17;17(11):e97048. doi: 10.7759/cureus.97048. eCollection 2025 Nov.

ABSTRACT

Introduction Laparoscopic cholecystectomy (LC) is traditionally performed under general anesthesia (GA). However, thoracic segmental spinal anesthesia (TSSA), where low doses of local anesthetics (LA), often with adjuvants, are used at thoracic spinal levels, is also being explored by some researchers. Shoulder pain is a common issue during LC, adversely impacting the patient’s perioperative experience. A combination of hypobaric and isobaric LA at the thoracic level has been described to mitigate this complication. The primary objective of the study was to compare the efficacy of a combination of hypobaric and isobaric bupivacaine versus isobaric bupivacaine alone during TSSA in LC in reducing intraoperative shoulder pain. The secondary objectives were to assess the incidence of adverse effects (hypotension, bradycardia, nausea, vomiting, etc.) and to evaluate patient and surgeon satisfaction. Methods This randomized, controlled, open-label study was conducted at a tertiary care center after receiving ethical approval and registration at the Clinical Trial Registry of India. A total of 90 patients were recruited, with 45 participants in each group, aged 20-70 years, with ASA Physical Status I-II, scheduled for elective LC. Exclusion criteria included BMI > 35, contraindications to regional anesthesia, allergy to study drugs, spinal deformity, and previous abdominal surgery. Patients were randomly assigned to two groups using computer-generated random numbers. Anesthesia was provided by a senior consultant proficient in TSSA. Group 2 received hypobaric and isobaric bupivacaine, and Group 1 received only isobaric bupivacaine. Both groups received 11 mg bupivacaine with 5 μg dexmedetomidine in TSSA. Data were collected using Microsoft Excel (Microsoft® Corp., Redmond, WA, USA) and analyzed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, NY, USA). Continuous variables were expressed as means ± SD and analyzed using an independent t-test or the Mann-Whitney U-test, depending on the distribution of data. Categorical variables were compared using the Chi-square or Fisher’s exact test. A p-value of <0.05 was considered statistically significant. Results All 90 patients in both groups successfully underwent LC under TSSA with no conversion to GA. The mean age of the participants was 49.11 ± 7.4 years with 58 (64.4%) females. Both groups were comparable in terms of demographic parameters. Intraoperative clinical parameters were comparable in both groups, without any statistically significant differences. Six (13.3%) patients in Group 1 and five (11.1%) patients in Group 2 had hypotension, which was easily corrected with a fluid bolus and a single 6 mg dose of intravenous mephentermine. Six (13.3%) patients in Group 1 reported shoulder pain, whereas in Group 2 only one (2.2%) patient had shoulder pain intraoperatively. Patient and surgeon satisfaction scores were better in Group 2, which was statistically significant. The number needed to treat (NNT) of nine indicates that approximately nine patients would need to receive the hypobaric + isobaric regimen to prevent one case of intraoperative shoulder pain. Conclusions LC can be performed successfully under TSSA with stable hemodynamics. The addition of hypobaric bupivacaine to isobaric bupivacaine provided better shoulder-tip pain control and fewer postoperative complications. Further studies with larger sample sizes are needed to validate these findings.

PMID:41416305 | PMC:PMC12709560 | DOI:10.7759/cureus.97048

Cureus. 2025 Nov 16;17(11):e97010. doi: 10.7759/cureus.97010. eCollection 2025 Nov.

ABSTRACT

Acne vulgaris is a multifactorial inflammatory skin disorder influenced by hormonal activity, microbial imbalance, and immune dysregulation. While conventional treatments such as antibiotics and retinoids remain effective, their long-term use is often limited by side effects, resistance, and poor adherence. This meta-analysis evaluated the efficacy of probiotics as an adjunct or alternative therapy for acne management. Four randomized controlled trials involving 227 participants were analyzed, showing that probiotic supplementation reduced acne severity scores (OR 0.48; 95% CI 0.29-0.79) and non-inflammatory lesion counts (mean difference (MD) -4.62; 95% CI -8.10 to -1.15) compared with controls. A trend toward improvement in inflammatory lesions was observed (MD -2.03; 95% CI -5.46 to 1.41) but was not statistically significant. Heterogeneity across studies ranged from moderate to high, reflecting variation in probiotic strains, formulations, and treatment durations. While these findings suggest a potential benefit of probiotics, the limited number and quality of trials warrant cautious interpretation. Larger, standardized clinical studies are needed to confirm efficacy and identify optimal probiotic regimens for acne management.

PMID:41416302 | PMC:PMC12709052 | DOI:10.7759/cureus.97010

Cureus. 2025 Nov 17;17(11):e97076. doi: 10.7759/cureus.97076. eCollection 2025 Nov.

ABSTRACT

Background Ankle fractures are common and place a substantial burden on services. Contemporary guidance generally permits weight-bearing as tolerated after stable fixation with early outpatient review. Recent randomised evidence suggests that beginning weight-bearing at around two weeks after open reduction and internal fixation (ORIF) can achieve at least comparable functional outcomes without increased complications and may be resource-efficient. Despite this, the adoption of early weight-bearing remains variable. We evaluated our centre’s timing to first weight-bearing and early safety in the year following the dissemination of new evidence. Methods We conducted a single-centre retrospective cohort study at a UK major trauma centre (September 2024-August 2025). Adults (≥18 years) undergoing ankle ORIF were included; exclusions were hindfoot nails, tibial plafond (pilon) fractures, open fractures, or missing follow-up. Data sources were the local trauma database, operative notes, discharge summaries, fracture-clinic letters, imaging, and general practitioner records. Variables included age, sex, length of inpatient stay (LOS), fracture pattern (unimalleolar/bimalleolar/trimalleolar), posterior malleolus fixation (yes/no), syndesmosis fixation (none/screw/suture-button), and discharge device (cast/boot). The primary outcome was time to first weight-bearing (bands: at 2 weeks, 2-6 weeks, >6 weeks; sub-bands 6-8 and >8 weeks). Safety within eight weeks comprised unplanned emergency department/clinic contact, re-operation, and radiographic loss of reduction. Analyses used descriptive statistics (mean/standard deviation (SD); median/interquartile range (IQR)); between-group comparisons employed Kruskal-Wallis or Mann-Whitney U for days to weight-bearing and chi-square for proportions >6 weeks (two-sided p<0.05). Continuous outcomes (LOS, days to first weight-bearing) were non-normally distributed (Shapiro-Wilk p<0.001); hence, non-parametric tests were used. Results Forty-two patients were included. The mean age was 51.1 years (SD 16.5), with a median age of 49.5 years (IQR 39.2-62.5). LOS had a mean of 7.0 days (SD 7.9) and a median of 3.5 days (IQR 1.0-13.0). Time to first weight-bearing: at 2 weeks 2/42 (4.8%), 2-6 weeks 9/42 (21.4%), >6 weeks 31/42 (73.8%) (including 6-8 weeks 21/42 (50.0%), >8 weeks 10/42 (23.8%)). Safety ≤8 weeks in the 6-week or longer group showed unplanned contact 1/42 (2.4%), re-operation 0/42, loss of reduction 0/42, and delayed union 2/42 (4.8%). Safety margins in the 2-week group did not show any complications (0/42 in all parameters). Days to first weight-bearing did not differ significantly by fracture pattern (p=0.066) or syndesmosis fixation (p=0.383); posterior malleolus fixation was associated with longer time (Mann-Whitney p=0.036). Proportions exceeding six weeks did not differ significantly across subgroups. Conclusions Early weight-bearing after ankle ORIF was seldom implemented locally, with most patients first weight-bearing at ≥6 weeks despite reassuring short-term safety. In light of the recent clinical guidance, a default “weight-bearing as tolerated from two weeks” pathway (with clearly defined exceptions), standardised discharge/clinic instructions, and planned re-audit may improve implementation without compromising safety.

PMID:41416288 | PMC:PMC12710795 | DOI:10.7759/cureus.97076

Cureus. 2025 Nov 16;17(11):e97018. doi: 10.7759/cureus.97018. eCollection 2025 Nov.

ABSTRACT

Background and objective The restoration of bowel continuity after temporary intestinal stoma formation is a routine general surgical procedure. However, stoma reversal is associated with significant postoperative morbidity and mortality. Surgeons may face challenges such as dense adhesions, iatrogenic bowel injury, or even procedure abandonment, as well as postoperative complications such as surgical site infection (SSI), anastomotic leak, intra-abdominal sepsis, and death. This study aimed to identify common complications and their risk factors to facilitate strategies for optimizing surgical outcomes. Specifically, it sought to determine the incidence and pattern of early (within 30 days) postoperative complications, grade their severity using the Clavien-Dindo classification, and analyze the risk factors associated with complications following intestinal stoma reversal. Methods A prospective observational study was conducted in the Department of General Surgery at a tertiary care medical college hospital. All consenting adult patients undergoing reversal of a temporary intestinal stoma were included. Demographic, clinical, and operative variables – including age, sex, comorbidities, stoma type, indication, local pathology, interval between stoma creation and closure, preoperative chemo- or radiotherapy, hemoglobin, serum albumin, surgical technique, and use of postoperative nutritional support – were recorded. Outcome measures included intraoperative technical difficulty, iatrogenic bowel injury, postoperative complications, SSI, anastomotic leak, and mortality. Statistical analysis was performed using the Chi-square or Fisher’s exact test for categorical data and the t-test for continuous data. A p-value <0.05 was considered statistically significant. Results Seventy patients undergoing stoma reversal were included. Technical difficulty and iatrogenic bowel injury occurred in 23 (32.8%) patients and were significantly associated with colostomy reversal (p=0.002) and end stoma reversal (p=0.0059). Postoperative complications occurred in 32 patients (45.7%). The most common complication was SSI in 26 (37.1%), followed by anastomotic leak in six (8.6% ), intra-abdominal abscess in four (5.7%), abdominal wall dehiscence in four (5.7%), and enterocutaneous fistula in three (4.2%). There were four deaths (5.7%), all due to sepsis following anastomotic leak in patients with comorbidities. Preoperative serum albumin <3.5 g/dL was significantly associated with mortality (p=0.0007), while postoperative nutritional support significantly reduced complications (p=0.001). Conclusions Stoma reversal is linked to considerable morbidity and mortality; hence, the decision to create a diverting stoma should be made judiciously. Ileostomy reversal is technically easier and safer than colostomy or Hartmann’s reversal and may be preferred when diversion is indicated. Delayed reversal beyond three months, optimization of comorbidities, correction of hypoalbuminemia (>3.5 g/dL), and postoperative nutritional support are recommended to minimize complications and improve outcomes.

PMID:41416276 | PMC:PMC12709135 | DOI:10.7759/cureus.97018

Cureus. 2025 Nov 17;17(11):e97061. doi: 10.7759/cureus.97061. eCollection 2025 Nov.

ABSTRACT

Background Terson syndrome (TS), an intraocular hemorrhage secondary to aneurysmal subarachnoid hemorrhage (aSAH), has a high incidence rate. Clinically, patients with aSAH often present with concomitant TS; however, owing to the difficulty in performing ophthalmic examinations in critically ill patients, many cases may be missed. This study aimed to develop and evaluate a CT-based diagnostic model incorporating posterior globe thickness to predict TS in patients with aSAH. Materials and methods This was a retrospective study on patients who underwent direct surgery or endovascular treatment for ruptured cerebral aneurysms at our institution between January 1, 2018, and August 31, 2025 (analyzed by eye). We extracted data from eyes definitively diagnosed with TS via ophthalmic examination. In addition to collecting epidemiological and clinical data, posterior globe thickness was measured for each eye. Statistical analyses included the Mann-Whitney U test, chi-square test, generalized estimating equation (GEE) logistic regression analysis, and receiver operating characteristic (ROC) analysis. Statistical significance was set at p < 0.05. Results A total of 177 patients (354 eyes) received aSAH treatment, of whom 26 individuals (52 eyes) underwent ophthalmic examination, and within this subgroup, 11 patients (17 eyes) were diagnosed with TS. In the univariate GEE logistic regression analysis, the presence of TS was significantly correlated with age (p=0.005), World Federation of Neurosurgical Societies (WFNS) grade (p=0.021), complaints of visual and visual field impairment (p=0.021), and posterior globe thickness (p=0.038). The multivariate GEE logistic regression analysis demonstrated that age and posterior globe thickness significantly influenced the risk of developing TS. In this final multivariate model, the odds of having TS decreased by a factor of 0.85 for every one-year increase in age (p=0.007), whereas the odds increased by a factor of 13.74 for every 1 mm increase in posterior globe thickness (p=0.027). ROC analysis, performed using this final multivariate model, yielded a calculation to determine the age-dependent cutoff for posterior globe thickness: Cutoff(mm)≈-1.295+0.0637×Age (years), which showed a sensitivity and specificity of 82.4% and 82.9%, respectively. Conclusion This study proposes a noninvasive prediction model for estimating TS based on CT measurements of posterior globe thickness. Serving as a practical triage tool, these findings suggest that incorporating age significantly enhances the diagnostic utility. To ensure broad generalizability and facilitate its application in clinical practice, prospective multicenter trials are necessary to validate these results.

PMID:41416274 | PMC:PMC12710446 | DOI:10.7759/cureus.97061