Cureus最新文献

{"title":"Adult-Onset Still's Disease Presenting as Antibiotic-Refractory Sepsis.","authors":"Mohammed Alnims, Ahmer A Longi, Misbah Fazlani, Arsheena Mohamed, Ahmed Saleh","doi":"10.7759/cureus.93933","DOIUrl":"10.7759/cureus.93933","url":null,"abstract":"<p><p>Adult-onset Still's disease (AOSD) is a rare autoinflammatory disorder typified by quotidian fevers, an evanescent salmon-colored rash, arthralgia, neutrophilic leukocytosis, and markedly elevated inflammatory markers. Diagnosis is clinical and by exclusion, supported by classification frameworks like the Yamaguchi criteria. A previously healthy lady in her 20s presented with fever above 39°C, severe generalized myalgia, pharyngitis, a transient salmon-colored rash, neutrophilic leukocytosis, and markedly elevated inflammatory markers. Competing infectious, autoimmune, and malignant etiologies were excluded. Based on clinical features and Yamaguchi criteria, AOSD was suspected. She improved rapidly with intravenous methylprednisolone pulse therapy. During steroid taper as an outpatient, she developed a biochemical flare with ferritin rising to 8,807 ng/ml; tocilizumab was initiated for disease control. This case underscores prompt recognition of AOSD after exclusion of mimics, the interpretive value of ferritin trends, and successful escalation to interleukin-6 (IL-6) blockade for relapse, consistent with emerging data emphasizing targeted cytokine inhibition.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 10","pages":"e93933"},"PeriodicalIF":1.3,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vertical Dimension in Prosthodontics Theory and Practice (Part II): A Comprehensive Review of Vertical Dimension Determination in Prosthodontics From Classical Methods to Digital Innovation.","authors":"Mostafa I Fayad, Rania Moussa, Nourhan A Ragheb, Yousra Ahmed, Sherif Sultan, Mahmoud R AbdulSalam, Hussein A Ismail, Mohamed O Elboraey, Mohammed H AbdElaziz, Mohamed A Helal","doi":"10.7759/cureus.93987","DOIUrl":"10.7759/cureus.93987","url":null,"abstract":"<p><p>The determination of vertical dimension of occlusion (VDO) represents one of the most challenging and critical aspects of prosthodontic treatment, particularly in edentulous patients. Accurate establishment of VDO is essential for optimal function, esthetics, and patient comfort in prosthetic rehabilitation. This comprehensive literature review aims to analyze the current evidence regarding various methods for determining vertical dimension (VD) in prosthodontic practice, examining their reliability, clinical applicability, and evolution from traditional to modern digital approaches. A search was conducted across multiple databases, including PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library. The search strategy included terms related to VD, prosthodontics, complete dentures, and measurement techniques. A total of 1,259 articles were initially identified, with 903 remaining after duplicates were removed. Following screening and quality assessment, 79 high-quality studies were included in this comprehensive review. The analysis identified two main categories of VDO determination: (a) pre-extraction record methods and (b) post-extraction assessment methods, the latter encompassing anthropometric/biometric approaches, physiological and functional techniques, mechanical methods, measurement devices, radiographic or imaging modalities, and esthetic evaluations. While traditional techniques hold historical value, their reliability and reproducibility remain limited. In contrast, contemporary digital methods offer greater precision and patient comfort, though their use demands advanced equipment and practitioner training. While no single method has emerged as universally superior, the integration of multiple assessment techniques with digital technology offers enhanced accuracy and reproducibility. Contemporary evidence supports a multifactorial approach combining traditional clinical judgment with digital precision and novel radiographic formulas for optimal VDO determination.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 10","pages":"e93987"},"PeriodicalIF":1.3,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Calcium as a Determinant of Fibroblast Growth Factor 23 Levels in Patients With Primary Hyperparathyroidism and Graves' Disease.","authors":"Hiroyuki Yamashita, Yusuke Mori, Yasuo Imanishi, Hisakazu Shindo, Daisuke Tatsushima, Seigo Tachibana, Takashi Fukuda, Hiroshi Takahashi, Yuji Nagayama, Shinya Satoh","doi":"10.7759/cureus.93972","DOIUrl":"10.7759/cureus.93972","url":null,"abstract":"<p><strong>Objective: </strong>Fibroblast growth factor 23 (FGF23) is a phosphate-regulating hormone with an emerging role in calcium homeostasis. However, its role in hypercalcemic conditions remains unclear. This study aimed to investigate the relationship between serum calcium and FGF23 levels in two hypercalcemic disorders: primary hyperparathyroidism (PHPT) and Graves' disease.</p><p><strong>Methods: </strong>A cross-sectional analysis was performed in 98 patients with PHPT and 45 patients with Graves' disease. Clinical and biochemical parameters, including parathyroid hormone (PTH), phosphate, and 1,25-dihydroxyvitamin D3 (1,25(OH)₂D), were analyzed.</p><p><strong>Results: </strong>In PHPT, serum calcium was the only independent determinant of FGF23 levels (P < 0.0001), whereas in Graves' disease, both serum calcium (P < 0.001) and 1,25(OH)₂D (P < 0.005) were independently associated with FGF23. A significant positive correlation between calcium and FGF23 was observed in both conditions. Interestingly, FGF23 levels were elevated despite different phosphate profiles: hypophosphatemia in PHPT and hyperphosphatemia in Graves' disease.</p><p><strong>Conclusions: </strong>These findings suggest that hypercalcemia may directly contribute to FGF23 elevation, independent of phosphate levels. However, the compensatory effect of FGF23 in modulating calcium homeostasis appears to be limited. This study provides new insights into the calcium sensitivity of FGF23 in endocrine disorders characterized by altered mineral metabolism.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 10","pages":"e93972"},"PeriodicalIF":1.3,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre- and Post-bronchodilator Spirometry in Asthmatic Smokers Versus Non-smokers: A Hospital-Based Cross-Sectional Study.","authors":"Yassine Wael Mohamed Elshammaa, Dana Mhd Nabil Bendakji, Sherif Elseedy, Mohammed Faeq, Mostafa Afifi, Ahmed Yehia Zakaria Khaled, Ali Abdallah, Basma Alleelwa, Toka Ghazy, Mohamed Nasr, Mohamed Ashraf Hussien Abdelhady, Naglaa Abdelsamea, Ahmed Mamdouh Elshafei Khaled, Afnan Elwafi, Mohsen Mosallam, Ibtihal Khider Fagir Salih, Nermeen Hassan, Marwa Harb, Mohamed Abdelfattah, Ahmed Mostafa, Abdulmabod Omar","doi":"10.7759/cureus.93986","DOIUrl":"10.7759/cureus.93986","url":null,"abstract":"<p><p>Background Cigarette smoking is a major risk factor for impaired lung function and the development of chronic respiratory diseases. Early detection of pulmonary changes using spirometry can help in timely intervention and prevention of long-term complications. Objective To compare spirometry parameters between smokers and non-smokers, and to evaluate the effect of bronchodilator administration on pulmonary function in both groups. Methods A cross-sectional study was conducted involving 60 participants (30 smokers and 30 non-smokers). Spirometry was performed before and after bronchodilator administration to measure vital capacity (VC%), forced vital capacity (FVC%), forced expiratory volume in the first second (FEV₁%), FEV₁/FVC ratio, forced expiratory flow over the middle one half of the FVC (FEF25-75%), maximal voluntary ventilation (MVV%), and expiratory time. Paired t-tests were used for within-group comparisons, and independent t-tests for between-group comparisons. A p-value < 0.05 was considered statistically significant. Results Smokers had significantly lower baseline spirometry values compared to non-smokers across all parameters (p < 0.001). Both groups showed statistically significant improvements post-bronchodilator (p < 0.001), with smokers exhibiting a smaller magnitude of improvement. Notably, FEV₁% increased from 47.2 ± 6.8 to 60.3 ± 11.5 in smokers and from 56.3 ± 7.1 to 73.3 ± 7.4 in non-smokers. The FEV₁/FVC ratio and other flow rates showed similar patterns. Expiratory time also increased post-bronchodilator in both groups. Conclusion Smoking is associated with marked reductions in lung function and diminished bronchodilator responsiveness. Early spirometric screening in smokers is essential to identify functional decline and guide smoking cessation and treatment strategies to prevent progression of pulmonary disease.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 10","pages":"e93986"},"PeriodicalIF":1.3,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the Sustainability of Urological Surgery: A Retrospective Analysis.","authors":"Rupert Vicary-Watts","doi":"10.7759/cureus.93904","DOIUrl":"10.7759/cureus.93904","url":null,"abstract":"<p><p>Climate change is the major health concern of the 21st century, and paradoxically, healthcare is one of the leading contributors to global warming. This study intends to investigate how urology can reduce its carbon footprint. A review of the literature highlighted how energy consumption - through air conditioning in particular - medical waste, and anaesthetic gases are the main causes of emissions from the theatre. A retrospective analysis of the number of general anaesthetics (GAs) and anaesthetic gases used for all urological procedures over one month was conducted using electronic records. A questionnaire was provided to 30 theatre staff, assessing their insight into the carbon footprint of the department. It investigated waste management and engagement with the issue of the climate crisis. An analysis of the current waste streams and the amount of waste produced was also conducted. Thirty-nine operations were done under GA, with sevoflurane used in 48% (n = 30) of all cases, and desflurane used in 3% (n = 7). Education and appropriate recycling facilities were identified as key areas within waste management that needed addressing. Clinical waste produced 850 tonnes per year at this Trust; domestic waste production was 725 tonnes per year; and recycling produced 160 tonnes of cardboard and 9 tonnes of plastic bottles. Discussion with the waste minimisation officer led to a planned introduction of a new waste stream into theatres. Poor staff knowledge on waste disposal and the new waste stream introduction was addressed with an in-person educational update on waste disposal. Second-cycle results showed a large improvement in staff scores prior to the new waste stream introduction. This study identifies simple measures that can be introduced to greatly reduce the carbon footprint of urological operations. Energy consumption can be reduced with efficient theatre management, air conditioning awareness, and appropriate waste streams. Furthermore, the implementation of a well-structured educational programme, and readily available recycling bins, addresses high levels of inappropriate waste disposal.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 10","pages":"e93904"},"PeriodicalIF":1.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12498003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Thoracotomy and Decortication in Pleural Empyema.","authors":"Arvind Kohli, Vishal V Bhende, Amit Chaudhary, Viral B Patel, Mathangi Krishnakumar, Swati Roy","doi":"10.7759/cureus.93879","DOIUrl":"10.7759/cureus.93879","url":null,"abstract":"<p><p>Background and aim Pleural empyema remains a serious complication of pulmonary infections, with high morbidity and mortality if not managed effectively. While antibiotics and drainage are sufficient in the early stages, chronic empyema often requires surgical intervention. This study evaluates the outcomes of early thoracotomy and decortication for pleural empyema at a tertiary cardiac center in India. Methods A retrospective observational study was conducted on nine patients who underwent early thoracotomy and decortication between 2018 and 2024. Demographics, radiological findings, etiology, complications, survival, and follow-up outcomes were analyzed. Survival and event-free survival were assessed using the Kaplan-Meier method. Results Six patients were female (66.7%), and three were male (33.3%). Four patients underwent right-sided, four left-sided, and one bilateral decortication. Six patients (66.7%) had moderate pleural fluid, three (33.3%) had large fluid collections, and all nine (100%) had pleural thickening ≥2 cm. Etiologies included non-tuberculosis (TB; n = 7; 77.8%) and TB (n = 2; 22.2%). Postoperative complications occurred in three patients (33.3%), including prolonged air leak (n = 2) and superficial wound infection (n = 1). One patient (11.1%) died from nosocomial pneumonia, acute respiratory distress syndrome, and septic shock. Kaplan-Meier estimated survival probability was 88.9% at 30 days and remained stable at 12 months. Event-free survival at 12 months was 66.7%. The median hospital stay was 12 days (range, 8-21). All survivors demonstrated satisfactory lung re-expansion with no recurrence during three to 12 months of follow-up. Conclusions Early thoracotomy and decortication is a safe and effective treatment for advanced-stage pleural empyema, yielding favorable survival and functional outcomes. Despite advances in minimally invasive surgery, thoracotomy remains indispensable for selected patients, particularly in TB-endemic regions.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 10","pages":"e93879"},"PeriodicalIF":1.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Ophthalmological Characteristics and Therapeutic Management of Patients With Sarcoidosis.","authors":"Karla I Llerenas-Aguirre, Bruno Taboada Moreno, Luis P Orozco Gómez","doi":"10.7759/cureus.93898","DOIUrl":"10.7759/cureus.93898","url":null,"abstract":"<p><p>Objective This study aimed to describe the clinical and ophthalmological characteristics, therapeutic management, and visual outcomes of patients with sarcoidosis at a tertiary referral center in Mexico over 10 years. Patients and methods This retrospective case series included patients diagnosed with sarcoidosis between 2015 and 2025 at Centro Médico Nacional \"20 de Noviembre.\" Diagnosis was based on clinical, radiological, and histopathological criteria aligned with the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) and the International Workshop on Ocular Sarcoidosis (IWOS) guidelines. Patients with complete records and at least one ophthalmologic evaluation were included. Data on demographics, systemic and ocular involvement, comorbidities, and treatments were collected and analyzed descriptively. Results Eight patients (75% female; median age: 67 years) were included, reflecting the rarity of sarcoidosis in our setting. Ocular involvement was present in five patients (62.5%). Keratoconjunctivitis sicca (KCS) was the most common manifestation, affecting four patients (50%), all bilaterally. Two patients (25%) presented with bilateral non-granulomatous anterior uveitis, one of whom progressed to panuveitis with peripheral chorioretinal lesions and uveitic macular edema. An asymptomatic solitary choroidal granuloma was identified in one patient (12.5%) through clinical examination and optical coherence tomography (OCT)-enhanced depth imaging (EDI). Visual acuity (VA) was assessed only in the five patients who underwent ophthalmologic evaluation; the remaining three were not assessed, as ophthalmologic consultation was not requested, likely due to the absence of ocular symptoms at presentation. Among evaluated patients, 37.5% had normal visual acuity, 25% had mild impairment, and one patient (12.5%) had severe visual loss. All patients received corticosteroids: 87.5% systemically and 25% via topical, periocular, or intravitreal routes. Immunosuppressive therapy was used in 75% (50% methotrexate, 25% azathioprine), and one patient (12.5%) received biologic therapy (adalimumab). Follow-up ranged from three to 10 years (median: five years), with two patients currently under active treatment for ocular sarcoidosis after three years of follow-up. Conclusions Ocular involvement was common in our cohort and, in some cases, represented the initial manifestation of sarcoidosis. KCS was the most frequently observed ocular finding. While quantitative VA data were limited, most evaluated patients maintained good visual function. Systemic corticosteroids were the mainstay of treatment, with immunosuppressants and biologics reserved for refractory cases. Given the potential for asymptomatic ocular disease, routine ophthalmologic evaluation is recommended for all patients with sarcoidosis, regardless of the presence of ocular symptoms.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 10","pages":"e93898"},"PeriodicalIF":1.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression and Anxiety as Predictors of Quality of Life in Osteoarthritis Patients.","authors":"Yashar Mashayekhi, Sara Baba-Aissa, Amanuel Kefyalew Assefa, Francis T Mutamba, Aamir Mohamed Nur, Zuhaib Y Shahid, Naheemat Mofolasayo Salimon, Ahmad Habahbeh, Niamat Ali, Ibrahim M Shandi, Racha Al Niazi, Fatima Habib","doi":"10.7759/cureus.93872","DOIUrl":"10.7759/cureus.93872","url":null,"abstract":"<p><strong>Background: </strong> Osteoarthritis (OA) is among the most common chronic joint disorders, which not only causes pain and disability, but also adversely impacts the psychological health and the quality of life (QoL). Depression and anxiety are commonly reported in OA patients, but their use as predictors of QoL has not been fully explored in Pakistan. The purpose of this study was to investigate whether depression and anxiety have a predictive effect on QoL in OA patients.</p><p><strong>Methods: </strong> A cross-sectional study was conducted between July and August 2025 among 300 adult OA patients recruited through community health centers, outpatient clinics in Sargodha and Lahore, Pakistan, and orthopaedic departments. The tools used to collect data were a structured questionnaire, consisting of the Hospital Anxiety and Depression Scale (HADS) and the Short Form-36 Health Survey (SF-36). Descriptive statistics, Pearson correlation, independent t-tests, one-way ANOVA, chi-square tests, and multiple linear regression were used to evaluate relationships between psychological and QoL.</p><p><strong>Findings: </strong>The study population consisted primarily of female patients (N = 240, 80%), with half being older than 65 years (N = 150, 50%). There was a significant correlation between anxiety and depression with lower QoL (r = -0.356 and r = -0.482, respectively; p < 0.001). Women were found to have average anxiety and depression and a low QoL score relative to that of men (p < 0.001). Older age was linked to greater depression and anxiety and less QoL (p < 0.001). Regression analysis revealed a significant predictor of poor QoL as depression (β = -0.245, p = 0.001), anxiety (β = -0.145, p = 0.003), older age, female gender, longer duration of disease, location of OA, and current treatment.</p><p><strong>Conclusion: </strong>Depression and anxiety became powerful predictors of poor QoL among OA patients, and depression had a more substantial effect. The results emphasise the need to integrate psychological evaluation and care into the regular OA treatment to enhance patient outcomes. Both physical and mental health care should be given on a holistic basis to improve the QoL of this population.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 10","pages":"e93872"},"PeriodicalIF":1.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12498169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Non-antibiotic Interventions for Preventing Urinary Tract Infections During Pregnancy: A Systematic Review.","authors":"Shivani Srivastava, Shreekar Roddam, Deepshikha Srivastava, Abdulmumini Shehu, Khyathi Krishna Gogineni, Ruchit Singla, Ahmed Owolabi, Basma Alleelwa, Aliyu O Olaniyi, Olabisi P Lawal","doi":"10.7759/cureus.93874","DOIUrl":"10.7759/cureus.93874","url":null,"abstract":"<p><p>Urinary tract infections (UTIs) are a common health concern in pregnancy and often require antibiotic therapy. Antimicrobial resistance (AMR) resulting from antibiotic misuse is a major public health challenge, and non-antibiotic interventions (NAIs) may provide a safer means of prevention. This systematic review evaluated non-antibiotic strategies for preventing UTIs during pregnancy as a way to reduce antibiotic prescribing and combat AMR. The review aims to evaluate the role of NAIs in preventing UTIs during pregnancy, with a focus on their potential to reduce antibiotic prescribing and AMR within the NHS care system. A systematic search of Ovid Medline, Web of Science, and Scopus identified studies that compared NAIs to a placebo, usual treatment, or no intervention. Eligible studies included randomised controlled trials, cohort studies, and other relevant designs. Study quality was assessed using established appraisal tools, and a narrative synthesis was conducted due to intervention heterogeneity. Eight studies met the inclusion criteria, examining cranberry products, Mediterranean diet, OM-89 (an oral immunostimulant also known as Uro-Vaxom), ascorbic acid, and knowledge-based interventions. Evidence from seven studies suggests that NAIs may reduce UTI incidence, but the findings are limited, and further research is needed to confirm their effectiveness during pregnancy. The review concludes that NAIs, particularly cranberry products and the Mediterranean diet, may reduce UTI incidence during pregnancy and offer a promising strategy to limit antibiotic use and AMR. However, given the methodological limitations and low quality of available evidence, further high-quality research is required to establish the safety, efficacy, and cost-effectiveness of these therapies in pregnant women.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 10","pages":"e93874"},"PeriodicalIF":1.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Vitamin D Level and Disease Activity in Patients With Systemic Lupus Erythematosus.","authors":"Aye Thin Zar Oo, Wint Thandar Oo, Kyaw L Tun, Aung K Myint, May Thu Zar Aye, Nandar E Khin, Khin Pyae Sone, Pyae Sonn","doi":"10.7759/cureus.93853","DOIUrl":"10.7759/cureus.93853","url":null,"abstract":"<p><strong>Introduction: </strong>Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with variable clinical manifestations and disease activity. Emerging evidence suggests that vitamin D may play a role in immune regulation and disease pathogenesis. This study aimed to investigate the association between serum vitamin D levels and disease activity in patients with SLE at Mandalay General Hospital.</p><p><strong>Methods: </strong>A cross-sectional study was conducted involving 60 patients diagnosed with SLE. Disease activity was assessed using the Systemic Lupus Activity Measure (SLAM) score. Serum vitamin D levels were measured using the enzyme-linked immunosorbent assay (ELISA) at the National Health Laboratory, Mandalay. Patients were categorized into active and inactive disease groups based on SLAM scores, and intergroup comparisons were made.</p><p><strong>Results: </strong>Among the 60 patients, the majority (43.3%) were aged 21-30 years, with a mean ± SD age of 25.77 ± 7.98 years. Female patients predominated (98.3%; female-to-male ratio 59:1). The mean SLAM score was 9.25 ± 2.94. Common clinical features included anaemia (56.7%), skin rash (33.3%), mucosal ulcers (16.7%), arthritis (16.7%), serositis (11.7%), vasculitis (11.7%), and neuropsychiatric lupus (5%). Patients with active disease had significantly lower serum vitamin D levels (12.2 ± 1.36 ng/mL) compared to those with inactive disease (26.1 ± 10.22 ng/mL; t = 5.55, p < 0.0001). A moderate inverse correlation was observed between SLAM scores and vitamin D levels (Pearson's r = -0.51, p < 0.0001), suggesting a clinically meaningful association between lower vitamin D levels and higher disease activity.</p><p><strong>Conclusion: </strong>This study demonstrates a moderate inverse relationship between serum vitamin D levels and SLE disease activity. These findings suggest that vitamin D may serve as a potential biomarker for disease monitoring. However, due to the cross-sectional design and relatively small sample size, causality cannot be established. Further longitudinal studies are recommended.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 10","pages":"e93853"},"PeriodicalIF":1.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}