Open access

STONE Score as a Triage Tool to Guide Computed Tomography of the Kidneys, Ureters, and Bladder (CT-KUB) Requests in Suspected Renal Colic: A Quality Improvement Initiative (2025)

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Type of publication:

Journal article

Author(s):

*Hassouba, Omar Nasr; Abdullah Omar, Abdulaziz Alsamani; Awan, Manahil; Ahmad, Shahzad; Taha, Mawada; Venkatachalapathi, Sharmila; Abouelsadat, Mohamed K; Mercy, Albina; Sahnon, Abdelrahman Sahnon Abaker; Shafique, Usama; *Herman, Dodi I.

Citation:

Cureus. 17(9):e92080, 2025 Sep.

Abstract:

Introduction Urolithiasis is a frequent cause of emergency department (ED) visits, with computed tomography (CT) being the gold standard for diagnosis. Excessive imaging increases radiation exposure and healthcare costs. The STONE score is a validated clinical prediction tool, designed to estimate the probability of ureteric stones and reduce unnecessary imaging. Objective The main objective of this study is to evaluate the diagnostic accuracy of the STONE score in patients presenting with flank pain. Methodology This is a cross-sectional retrospective review conducted at the Shrewsbury and Telford Hospital NHS Trust (SATH), Shrewsbury, England, over a four-month period from April 1, 2023, to July 31, 2023. This quality improvement initiative reviewed 81 eligible ED patients who underwent computed tomography of the kidneys, ureters, and bladder (CT-KUB) for suspected ureteric stones. Demographic, clinical, laboratory, and imaging data were collected. STONE scores were calculated for all patients. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis. Results The mean age was 38.5 +/- 16.1 years; 35 (43.2%) were male. Ureteric stones were confirmed in 15/19 (78.9%) high-risk, 9/45 (20%) moderate-risk, and 0/17 (0%) low-risk patients. The STONE score yielded an area under the curve (AUC) of 0.879, with a sensitivity of 91.7% and a specificity of 66.7%. Alternative diagnoses included gallbladder stones, appendicitis, cystitis, diverticulitis, hydronephrosis, renal angiomyolipoma, polycystic kidney disease (PCKD), pyelonephritis, and small bowel obstruction (SBO). Conclusion The STONE score demonstrates good diagnostic accuracy, particularly in high-risk patients, and may help reduce unnecessary CT imaging and radiation exposure in the ED.

DOI: 10.7759/cureus.92080

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A Joint Venture: Advancing Health Equity for Underserved Communities Through Integrated Dermatology-Rheumatology Clinics (2025)

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Type of publication:

Journal article

Author(s):

*Canteenwala, Zal; Thevathasan, Joseph; Baho, Heli George; Amin, Kunal; *Jain, Dimple; Amarasena, Roshan

Citation:

Cureus 17(10): e94590. doi:10.7759/cureus.94590

Abstract:

Background
Patients with immune-mediated disease often need both dermatology and rheumatology input. Separate appointments can increase travel and delay decisions, particularly in rural settings. We evaluated a monthly combined clinic in a rural UK catchment.

Methods
We conducted a prospective service evaluation (April-October 2022) of a consultant-led, co-located dermatology-rheumatology clinic. Forty-nine consecutive adult attendees completed an anonymous post-visit questionnaire on perceived usefulness, satisfaction, avoided appointments, travel costs, and prior time off work; free-text responses were thematically analysed by two reviewers. We report proportions with exact Clopper-Pearson 95% confidence intervals (CIs), with denominators varying due to item non-response.

Results
We analysed 49 questionnaires. All respondents viewed the joint appointment as a good idea (49/49; 100.0%; 95% CI 92.7-100.0), and all were satisfied (47/47; 100.0%; 95% CI 92.5-100.0). The clinic avoided an additional appointment for 44/46 (95.7%; 95% CI 85.2-99.5) and reduced out-of-pocket travel costs for 39/40 (97.5%; 95% CI 86.8-99.9). Among employed respondents, 19/36 (52.8%; 95% CI 35.5-69.6) reported previously needing time off work for separate specialty visits.

Conclusions
In a rural, cross-trust NHS setting, a combined dermatology-rheumatology clinic was feasible and associated with high patient-reported usefulness and satisfaction, fewer duplicate visits, and lower travel costs. Findings support continued provision and motivate comparative and economic evaluations using routine utilisation and cost data.

DOI: 10.7759/cureus.94590

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Bronchiolitis Obliterans in an Adult Male After Admission With Panton-Valentine Leucocidin Staphylococcal Pneumonia (2025)

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Type of publication:

Journal article

Author(s):

*Nadeem, Sabha; *Sargent, Georgina; *Wood, Gordon; *Ahmad, Nawaid.

Citation:

Cureus. 17(9):e91611, 2025 Sep.

Abstract:

A middle-aged man with no smoking or respiratory history presented with shortness of breath and facial swelling due to influenza. His condition deteriorated rapidly, and he required intensive care admission and intubation. He was found to have Panton-Valentine leucocidin (PVL) Staphylococcal pneumonia, with bilateral pneumothorax and subcutaneous emphysema. He responded well to antibiotics and chest drainage and was subsequently discharged. His follow-up radiology initially showed almost complete resolution. However, over the course of five years, he had multiple GP attendances and hospital admissions for recurrent infections with continued breathlessness on exertion. A follow-up CT suggested features of bronchiolitis obliterans (BO), which has not been previously recognised as associated with PVL Staphylococcal infections. Specialist teams have suggested active observation with consideration of transplantation in the event of deterioration. This case demonstrates that BO can be seen with previously unrecognised infectious aetiology and should be considered in any patient with appropriate symptomatology following a severe respiratory infection.

DOI: 10.7759/cureus.91611

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CT coronary angiography in the lipid clinic: a pilot study and lipidologist survey (2025)

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Type of publication:

Journal article

Author(s):

Graby, John; Sellek, James; Khavandi, Ali; Thompson, Dylan; Loughborough, Will W; Hudson, Benjamin J; Avades, Tony; Mbagaya, Wycliffe; Luva, Ahai; *Capps, Nigel; Shirodaria, Cheerag; Bayly, Graham; Antoniades, Charalambos; Downie, Paul F; Rodrigues, Jonathan C L.

Citation:

The International Journal of Cardiovascular Imaging. 2025 Oct 09. [epub ahead of print]

Abstract:

Guidelines recommend considering coronary calcium score (CCS) in asymptomatic patients to aid risk stratification. However, calcification occurs late in atherosclerosis. Coronary CT angiography (CCTA) can detect non-calcific plaque and inflammation before calcification develops, but impact on clinical management is not well documented. We compare coronary artery disease (CAD) detection and grading between CCS and CCTA, impact on management, and explore CCTA-derived inflammation biomarker (pericoronary fat attenuation index [FAI]) in the lipid clinic. Exploratory analysis of a prospectively maintained database of lipid clinic patients with CCS and CCTA (2018-2020). CCS grade was compared with CCTA stenosis, presence of high-risk plaque (HRP) and FAI-score analysis. UK Consultant Lipidologists completed an anonymised survey, documenting lipid target and management after sequential unblinding of CCS and CCTA data. In 45 asymptomatic patients (49% female, mean age 55 +/- 9), CCTA re-classified CAD presence in 22% (p = 0.002) and severity in 62% (p = 0.005) vs. CCS. HRP was observed in 20% (9/45), including 56% with CCS <= 100. Median LDL target with clinical vignette was 101 mg/dL (IQR 77-120), reducing to 89 mg/dL (77-120) after CCS, and 77 mg/dL (70-116) after CCTA unblinding. CCS altered LDL target in 12%, and CCTA a further 19% (chi2 57.0, p < 0.005). High FAI-score was demonstrated in 20%, including 22% of those with CCS <= 100 and 75% of those with <= mild CAD on CCTA. CCTA increased CAD prevalence and re-classified severity versus CCS, altering hypothetical management. High FAI-scores were observed across CCS and CCTA severity grades, including patients with no overt CAD.

DOI: 10.1007/s10554-025-03526-3

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Postoperative Outcomes of the Desarda Technique Versus Lichtenstein Mesh Repair for Inguinal Hernias: A Systematic Review and Meta-Analysis (2025)

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Type of publication:

Journal article

Author(s):

*Saeed, Jahanzaib; Jamal, Zohaib; Siddiqui, Asher; Muawaz, Muhammad; Saeed, Talha; *Jain, Rajesh K.

Citation:

Cureus. 17(9):e91388, 2025 Sep.

Abstract:

Inguinal hernias represent a prevalent surgical condition worldwide and constitute a significant proportion of elective general surgical procedures. While the Lichtenstein mesh repair has become the standard technique due to its tension-free approach, it is associated with several mesh-related complications, including chronic postoperative pain, seroma, scrotal edema, and foreign body sensation. To overcome these limitations, the Desarda technique was developed as a tissue-based, mesh-free alternative that reinforces the posterior wall of the inguinal canal using a strip of the external oblique aponeurosis. This systematic review compares postoperative complications between the Lichtenstein mesh repair and Desarda techniques to inform best practices in inguinal hernia repair. This systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed across PubMed, Cochrane Library, Excerpta Medica database (EMBASE), Emcare, Medical Literature Analysis and Retrieval System Online (MEDLINE), and Ovid, without language or date restrictions. Randomized controlled trials (RCTs) comparing Desarda and Lichtenstein mesh repair for primary inguinal hernia in adults were included. Data on postoperative complications were independently extracted by two reviewers. Risk of bias was assessed using the Risk of Bias 2 (ROB 2) tool (The Cochrane Collaboration, London, United Kingdom). Statistical analysis was performed using RevMan 5.4 (The Cochrane Collaboration, 2020), with risk ratios (RR) and 95% confidence intervals (CI) calculated for binary outcomes. Heterogeneity was assessed using the chi-square and I2 statistics. A total of 23 RCTs were included, comprising 2,425 patients, 1,201 of whom underwent the Desarda repair and 1,233 who underwent Lichtenstein mesh repair. The Desarda technique was associated with significantly lower rates of scrotal edema (RR = 0.52, 95% CI: 0.34-0.78, p = 0.002), seroma formation (RR = 0.68, 95% CI: 0.47-0.99, p = 0.04), foreign body sensation (RR = 0.61, 95% CI: 0.42-0.88, p = 0.009), and chronic postoperative pain (RR = 0.26, 95% CI: 0.15-0.45, p < 0.00001). While the Desarda group also showed lower rates of recurrence, wound infection, wound hematoma, and loss of sensation, these differences were not statistically significant and should be interpreted with caution. The findings suggest that the Desarda technique may be preferable to the Lichtenstein mesh repair for primary inguinal hernia, as it is associated with significantly lower rates of chronic postoperative pain, seroma, scrotal edema, and foreign body sensation. Although other complications, such as loss of sensation, recurrence, wound infection, and hematoma, were also less frequent with the Desarda technique, these differences were not statistically significant. Overall, the outcomes were largely comparable.

DOI: 10.7759/cureus.91388

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A Systematic Review of Long-Term Use of Proton Pump Inhibitors (PPIs) in Older Adults on Polypharmacy: Do PPIs Deplete Nutrients? (2025)

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Type of publication:

Systematic Review

Author(s):

Shahid, Muhammad Salman; Ahmed, Nouman; Kamal, Zeeshan; Nathaniel, Laibah; Singla, Bhavna; Singla, Shivam; Kumawat, Sunita; Batool, Munaza; *Ekomwereren, Osatohanmwen; Anika, Nabila N; Sahil, Muhammad.

Citation:

Cureus. 17(8):e90888, 2025 Aug.

Abstract:

Proton pump inhibitors (PPIs) are widely prescribed in older adults, often beyond recommended durations, raising concerns about nutrient depletion. This systematic review examined the impact of long-term PPI use (>=6 months) on micronutrient status in older adults receiving polypharmacy. A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) identified five eligible studies, including 693 participants. Results showed a 12-18% reduction in serum vitamin B12 over 12 months of PPI use. Calcium and parathyroid hormone levels declined significantly in a 12-month cohort, while bone turnover markers increased despite stable bone mineral density. Findings for magnesium were inconsistent, with results ranging from no change after 12 months to pharmacokinetic alterations without systemic depletion. Overall, the evidence consistently supports an association between prolonged PPI therapy and reductions in vitamin B12 and calcium, with conflicting results for magnesium. These deficiencies may contribute to cognitive decline, bone fragility, and increased fall risk in older adults. Routine nutritional monitoring, targeted supplementation, and deprescribing where appropriate should be considered to mitigate these risks, while further large-scale trials are needed in frail geriatric populations.

DOI: 10.7759/cureus.90888

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Patient-Reported Importance of Functional Benefit in Geographic Atrophy (2025)

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Type of publication:

Journal article

Author(s):

Dinah, Christiana; Enoch, Jamie; Ghulakhszian, Arevik; Sekhon, Mandeep; Salvatore, Serena; DeSalvo, Gabriella; Kumar, Praveen; Banerjee, Sanjiv; *Nayak, Devaki; Amoaku, Winfried; Shiew, Marianne; Osoba, Olayinka; Crabb, David P; Taylor, Deanna J.

Citation:

JAMA Ophthalmology. 2025 Sep 25. [epub ahead of print]

Abstract:

Importance: Intravitreal complement inhibitors injections (IVCIs) slowed progression of geographic atrophy (GA) lesions in several registration phase 3 trials although without benefit for prespecified secondary functional vision outcomes. Patient acceptability of these therapies needs further exploration.

Objective: To quantify the acceptability of IVCI therapy to United Kingdom patients with GA, assuming vision outcome benefits are expected.

Design, Setting, and Participants: This cross-sectional study took place at 9 geographically dispersed UK National Health Service centers from April 2023 to April 2024 among 153 participants with treatment-naive GA in at least 1 eye.

Exposures: GA in at least 1 eye.

Main Outcomes and Measures: Main outcomes were (1) acceptability of IVCI therapy based on completion of validated acceptability questionnaire. Participants were provided with a treatment information leaflet coproduced by a patients with lived experience of GA to inform them about the risks and benefits of IVCI for GA, assuming there were vision outcome benefits to this treatment and (2) response to the EuroQol 5-dimension with a vision bolt-on questionnaire to assess general health and vision-related quality of life. Spearman rank correlations and chi2 tests were used to explore associations between acceptability levels and specific ocular and sociodemographic characteristics.

Results: A total of 153 participants were recruited (93 [60%] women; mean [SD] age, 82 [7]), 57 (38%) of whom had bilateral foveal involvement. Median (IQR) visual acuity with habitual correction in the better-seeing eye and in eyes where neither eye was better or worse was logMAR, 0.30 (0.14-0.54; approximate Snellen equivalent, 20/40) and 0.47 (0.14-0.84; approximate Snellen equivalent, 20/63), respectively. Among the 153 participants, 81 (53%; 95% CI, 45-61) reported IVCIs were very much or extremely acceptable under the theoretical scenarios provided. The proportion finding IVCIs acceptable rose to 82% (95% CI, 76-88) when including those who rated prospective treatment as moderately acceptable. Belief in the perceived effectiveness of the treatment (rho, 0.52; 95% CI, 0.40-0.63; P < .001) and confidence in their ability to attend the eye clinic regularly (rho, 0.51; 95% CI, 0.38-0.62; P < .001) correlated with overall acceptability.

Conclusions and Relevance: IVCI therapy for GA may be acceptable to most UK patients with GA under the assumption that there are vision outcome benefits to this treatment. While current treatments do not result in vision outcome benefits, perceived effectiveness by patients was associated with acceptability, emphasizing the desire to quantify vision functional benefit concomitant with anatomical slowing of progression.

DOI: 10.1001/jamaophthalmol.2025.3264

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A Literature Review Assessing Whether the Use of Non-steroidal Anti-inflammatory Drugs (NSAIDs) Increases the Risk of Cardiovascular Events (2025)

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Type of publication:

Journal article

Author(s):

*Ahsan, Ammar; Sahu, Muhammad Arham.

Citation:

Cureus. 17(9):e92361, 2025 Sep.

Abstract:

Non-steroidal anti-inflammatory drugs (NSAIDs) are very useful due to their multiple properties, including analgesic, antipyretic, and anti-inflammatory effects. As a result, NSAIDs have become one of the most widely administered drugs in the world. The proposed function of this drug was to act like a steroid without its harmful and common side effects. However, like any other medication, NSAIDs come with their own set of side effects, notably their gastrointestinal and cardiovascular effects. With these known side effects and its ease of availability, it is concerning, and therefore further research was required to determine if there is a significant risk of cardiovascular events associated with NSAIDs. Guideline searches were performed using the following databases: National Institute for Health and Care Excellence (NICE), TRIP, SIGN, and AHRQ, which produced 22 results; however, after screening, only one guideline was included in this review. A literature search for systematic reviews was conducted using the following databases: MEDLINE, Cochrane, and PubMed, which yielded 711 results. However, after full screening, only three systematic reviews were included. The National Institute for Health and Care Excellence (NICE) guidelines are a source of evidence-based recommendations made for healthcare professionals in the diagnosis and management of their patients. The NICE guideline focusing on NSAIDs provides advice regarding the prescription of NSAIDs, including contraindications, dosage, and mechanism of action. Three systematic reviews assessed NSAIDs and their cardiovascular effects. All three systematic reviews found an association between NSAIDs and their cardiovascular effects with varying degrees of strength. In conclusion, this review demonstrates evidence of the cardiovascular side effects related to the use of NSAIDs and raises questions about an increase in events, such as stroke, myocardial infarction, and hypertension. Evaluating the systematic reviews, it was essential to determine whether there was a statistically significant risk of cardiovascular events. All three papers suggested a linked increase in cardiovascular events; however, further research is required in order to understand which specific NSAIDs cause this. As a result, guideline alterations may need to be followed.

DOI: 10.7759/cureus.92361

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Ultrasound shear wave elastography - a reliable protocol for the assessment of the stiffness of the supraspinatus tendon (2025)

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Type of publication:

Journal article

Author(s):

*Black, Martin; *Lumsden, Gordon; *Dodenhoff, Ron

Citation:

Shoulder And Elbow. 17585732251376351, 2025 Sep 15. [epub ahead of print]

Abstract:

Background: The continued evolution of shear wave elastography (SWE) in the measurement of supraspinatus tendon stiffness can assist in both rehabilitation and surgical monitoring with the potential to improve patient outcomes. It can provide non-invasive, quantitative data of elastic properties of tendons which are altered in the presence of pathological change. This study evaluates the inter- and intra-rater reliability of a standardised SWE assessment protocol of the supraspinatus
tendon.

Methods: Shear wave velocity (SWV, m/s) values of 52 healthy, asymptomatic supraspinatus tendons were recorded using SWE. Two raters scanned each tendon on two separate occasions, seven days apart, using a strict protocol.

Results: Intraclass correlation coefficient (ICC) for inter-rater reliability was 0.78. Intra-rater reliability was 0.81 for rater one and 0.89 for rater two, respectively. Minimal detectable change (MDC95) ranged between 1.28 and 1.82 m/s for intra- and inter-rater reliability. Mean SWV values (m/s) for rater one were 9.08 +/- 1.44 and 9.29 +/- 1.48; and for rater two 8.72 +/- 1.35 and 8.87 +/- 1.43, for trial one and two.

Conclusion: The results demonstrate reliable SWV measurements between and within raters in the supraspinatus tendon, providing normative values and a protocol which may be utilised clinically. Level of evidence: Level III Diagnostic Study.

DOI: 10.1177/17585732251376351

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Early Versus Delayed Diuretic Administration and Urine-Guided Strategies in Acute Decompensated Heart Failure: A Systematic Review of Clinical Outcomes (2025)

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Type of publication:

Systematic review

Author(s):

Muzammil, Rabeet; Mohammad, Ahmad; Hammad, Muhammad; Ahmed, Adeel; Hussain, Aadil; Rashid, Wardah; Yousaf, Rabia; Singla, Shivam; Singla, Bhavna; *Ekomwereren, Osatohanmwen; Asante Baadu, Francis; Irshad, Ahmad.

Citation:

Cureus. 17(8):e89408, 2025 Aug.

Abstract:

This systematic review explores the impact of diuretic timing and strategy on outcomes in patients with acute decompensated heart failure (ADHF). A total of seven studies were included, comprising randomized controlled trials (RCTs), pre-specified sub-analyses, and observational data. Early administration of intravenous loop diuretics, particularly within the first 60 to 90 minutes of hospital arrival, was generally associated with improved short-term outcomes, including reduced in-hospital and 30-day mortality. Furthermore, guided diuretic strategies using urine sodium or urinary biomarkers showed promise in enhancing decongestion efficiency and predicting therapeutic response, although long-term benefits remain uncertain. Despite some heterogeneity in study design, timing definitions, and outcome measures, this review underscores the clinical significance of prompt and tailored diuretic therapy. These findings highlight the need for timely intervention and more personalized management strategies in ADHF, while also identifying gaps for future large-scale trials.

DOI: 10.7759/cureus.89408

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