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

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)

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)

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)

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)

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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Atypical Presentation of Varicella-Zoster Virus Encephalitis in an Elderly Immunocompetent Adult: Early Diagnosis and Positive Outcome Following Treatment (2025)

Type of publication:

Journal article

Author(s):

*Adewoye, Oluwaseun G; Halim, Mohamed A; *Srinivasan, Meena; *Owolabi, Olasunkanmi H.

Citation:

Cureus. 17(7):e88535, 2025 Jul.

Abstract:

Varicella encephalitis following herpes zoster ophthalmicus (HZO) is a rare but serious complication that can occur due to the reactivation of the varicella-zoster virus (VZV). HZO involves the ophthalmic division of the trigeminal nerve, typically presenting with a dermatomal rash, and can lead to various ocular complications. In some cases, this reactivation can extend to the central nervous system, resulting in encephalitis, which can lead to significant morbidity and mortality, particularly in immunocompromised or elderly individuals. This report describes a case of VZV encephalitis complicating HZO in an elderly immunocompetent male who presented with altered mental status following an initial presentation of HZO in the absence of a dermatomal rash, with a tentative diagnosis of an acute ischemic stroke. Early diagnostic confirmation was achieved through cerebrospinal fluid analysis and polymerase chain reaction, which identified VZV central nervous system infection. The patient was administered intravenous acyclovir, leading to complete neurological recovery. This case underscores the necessity of including VZV encephalitis in the differential diagnosis of acute encephalopathy, even when typical dermatological signs are absent. Furthermore, it emphasizes the critical role of prompt antiviral therapy in ensuring favorable clinical outcomes. Additionally, this case illustrates that VZV encephalitis can mimic stroke-like symptoms, highlighting the potential for misdiagnosis and the importance of considering infectious etiologies in such presentations.

DOI: 10.7759/cureus.88535

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Practical Considerations in the Management of Frail Older People with Diabetes (2025)

Type of publication:

Journal article

Author(s):

*Abdelhafiz, Dima; Abdelhafiz, Ahmed.

Citation:

Diseases. 13(8), 2025 Aug 06.

Abstract:

With increasing life expectancy, the number of older people living with comorbid diabetes and frailty is increasing. The development of frailty accelerates diabetes-related adverse outcomes. Frailty is a multidimensional syndrome with physical, mental and social aspects which is associated with increased risk of hypoglycaemia, dementia and hospitalisation. Therefore, regular screening for all aspects of frailty should be an integrated part of the care plans of older people with diabetes. In addition, every effort should be made for prevention, which includes adequate nutrition combined with regular resistance exercise training. In already frail older people with diabetes, metabolic targets should be relaxed and hypoglycaemic agents should be of low hypoglycaemic risk potential. Furthermore, the metabolic phenotype of frailty should be considered when choosing hypoglycaemic agents and determining targets. With increasing severity of frailty, proactive chronological plans of de-escalation, palliation and end-of-life care should be considered. These plans should be undertaken in a shared decision-making manner which involves patients and their families. This ensures that patients' views, wishes and preferences are in the heart of these plans.

DOI: 10.3390/diseases13080249

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Quantifying association of early proteinuria and estimated glomerular filtration rate changes with long-term kidney failure in C3 glomerulopathy and immune-complex membranoproliferative glomerulonephritis using the United Kingdom RaDaR Registry (2025)

Type of publication:

Journal article

Author(s):

Downward L.; Proudfoot C.; Webb N.J.A.; Abat S.; Adalat S.; Agbonmwandolor J.; Ahmad Z.; Alejmi A.; Almasarwah R.; Annear N.; Araujo M.; Asgari E.; Ayers A.; Baharani J.; Balasubramaniam G.; Jo-Bamba Kpodo F.; Bailey L.; Bansal T.; Barratt A.; Barratt J.; Bates M.; Bayne N.; Bendle J.; Benyon S.; Bergmann C.; Bhandari S.; Bingham C.; Boddana P.; Bond S.; Braddon F.; Bramham K.; Branson A.; Brearey S.; Bridgett V.; Brocklebank V.; Budwal S.; Byrne C.; Cairns H.; Camilleri B.; Campbell G.; Capell A.; Carmody M.; Carson M.; Cathcart T.; Catley C.; Cesar K.; Chan M.; Chea H.; Chess J.; Cheung C.K.; Chick K.-J.; Chitalia N.; Christian M.; Chrysochou T.; Clark K.; Clayton C.; Clissold R.; Cockerill H.; Coelho J.; Colby E.; Colclough V.; Conway E.; Cook H.T.; Cook W.; Cooper T.; Coward R.J.; Crosbie S.; Cserep G.; Date A.; Davidson K.; Davies A.; Dhaun N.; Dhaygude A.; Diskin L.; Dixit A.; Doctolero E.A.; Dorey S.; Downard L.; Drayson M.; Dreyer G.; Dutt T.; Etuk K.; Evans D.; Finch J.; Flinter F.; Fotheringham J.; Francis L.; Gallagher H.; Game D.; Garcia E.L.; Gavrila M.; Gear S.; Geddes C.; Gilchrist M.; Gittus M.; Goggolidou P.; Goldsmith C.; Gooden P.; Goodlife A.; Goodwin P.; Grammatikopoulos T.; Gray B.; Griffith M.; Gumus S.; Gupta S.; Guzman R.; Hamilton P.; Hamrang-Yousefi S.; Harper L.; Harris T.; Haskell L.; Hayward S.; Hegde S.; Hendry B.; Hewins S.; Hewitson N.; Hillman K.; Hiremath M.; Howson A.; Htet Z.; Huish S.; Hull R.; Humphries A.; Hunt D.P.J.; Hunter K.; Hunter S.; Ijeomah-Orji M.; Inston N.; Jayne D.; Jenfa G.; Jenkins A.; Johnson S.; Jones C.A.; Jones C.; Jones A.; Jones R.; Kamesh L.; Kanigicherla D.; Frankl F.K.; Karim M.; Kaur A.; Kavanagh D.; Kearley K.; Kerecuk L.; Khwaja A.; King G.; Kislowska E.; Klata E.; Kokocinska M.; Koziell A.; Lambie M.; Lawless L.; Ledson T.; Lennon R.; Levine A.P.; Maggie Lai L.W.; Lipkin G.; Lovitt G.; Lyons P.; Mabillard H.; Mackintosh K.; Mahdi K.; Maher E.; Marchbank K.J.; Mark P.B.; Masoud S.; Masunda B.; Mavani Z.; Mayfair J.; McAdoo S.; Mckinnell J.; Melhem N.; Meyrick S.; Moochhala S.; Morgan P.; Morgan A.; Muhammad F.; Murray S.; Novobritskaya K.; Ong A.C.M.; Oni L.; Osmaston K.; Padmanabhan N.; Parkes S.; Patrick J.; Pattison J.; Paul R.; Percival R.; Perkins S.J.; Persu A.; Petchey W.G.; Pickering M.C.; Pinney J.; Pitcher D.; Plumb L.; Plummer Z.; Popoola J.; Post F.; Power A.; Pratt G.; Pusey C.; Pywell S.; Rabara R.; Rabuya M.; Raju T.; Javier C.; Roberts I.S.D.; Roufosse C.; Rumjon A.; Salama A.; Saleem M.; Sandford R.N.; *Sandu K.S.; Sarween N.; Sayer J.A.; Sebire N.; Selvaskandan H.; Shah S.; Sharma A.; Sharples E.J.; Sheerin N.; Shetty H.; Shroff R.; Simms R.; Sinha M.; Sinha S.; Smith K.; Smith L.; Srivastava S.; Steenkamp R.; Stott I.; Stroud K.; Swallow D.; Swift P.; Szklarzewicz J.; Tam F.; Tan K.; Taylor R.; Tischkowitz M.; Thomas K.; Tse Y.; Turnbull A.; Turner A.N.; Tyerman K.; Usher M.; Venkat-Raman G.; Walker A.; Walsh S.B.; Waters A.; Watt A.; Webster P.; Wechalekar A.; Welsh G.I.; West N.; Wheeler D.; Wiles K.; Willcocks L.; Williams A.; Williams E.; Williams K.; Wilson D.H.; Wilson P.D.; Winyard P.; Wong E.; Wong K.; Wood G.; Woodward E.; Woodward L.; Woolf A.; Wright D.; Wong E.K.S.; Gale D.P.

Citation:

Kidney International. 108(3) (pp 455-469), 2025. Date of Publication: 01 Sep 2025.

Abstract:

Introduction: C3 glomerulopathy (C3G) and immune-complex membranoproliferative glomerulonephritis (IC-MPGN) are rare disorders that frequently result in kidney failure over the long-term. Presently, there are no disease-specific treatments approved for these disorders, although there is much interest in the therapeutic potential of complement inhibition. However, the limited duration and necessarily small size of controlled trials means there is a need to quantify how well short-term changes in estimated glomerular filtration rate (eGFR) and proteinuria predict the clinically important outcome of kidney failure. Method(s): We address this using longitudinal data from the UK Registry of Rare Kidney Diseases (RaDaR) involving retrospective and prospective data collection with linkage to hospital laboratories via automated feeds of 371 patients. Analyses of kidney survival were conducted using Kaplan-Meier and Cox regression with eGFR slope estimated using linear mixed models. Result(s): In a median of 11.0 (inter quartile range 7.4-15.1) years follow-up, 148 patients (40%) reached kidney failure. There was no significant difference in progression to kidney failure between C3G and IC-MPGN groups. Baseline urine protein-creatinine ratio (UPCR), although high, was not associated with kidney failure in either group. Two-year eGFR slope had a modest association with kidney failure. In contrast, both 20%-50% and 50 mg/mmol reductions in UPCR between 0-12 months were associated with lower kidney failure risk in both groups. Notably, those with a UPCR under 100 mg/mmol at 12 months had a substantially lower risk of kidney failure (hazard ratio 0.10 (95% confidence interval 0.03-0.30). Conclusion(s): Overall, proteinuria a short time after diagnosis is strongly associated with long-term outcomes and a UPCR under 100 mg/mmol at one year is associated with a substantially lower kidney failure risk.

DOI: 10.1016/j.kint.2025.06.003

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Diagnostic Capabilities of MRI and CT in Evaluating Dizziness: A Systematic Review of Acute Cases in the ED (2025)

Type of publication:

Journal article

Author(s):

Ali Mohammed, Elsuha Elgassim; Alzain Ali, Mohamed Almogtaba Mohamed; Eltayeb, Ethar; Saidahmed Ahmed, Lobaba Mubarak; *Ahmed Dafaalla, *Dalia Hamdan; Mohammed Elsheikh, Mohammed Omer; M Osman, Hanady Me.

Citation:

Cureus. 17(7):e88057, 2025 Jul.

Abstract:

Dizziness is a common reason for ED visits, posing diagnostic challenges due to its broad range of potential causes, from benign vestibular conditions to critical cerebrovascular events. Although CT scans are often used to quickly assess for intracranial hemorrhage, MRI provides greater accuracy for identifying strokes in the posterior circulation. Differences in imaging practices and uncertainty about the most effective approach highlight the need for a thorough evaluation of these modalities. This narrative systematic review examined the diagnostic performance of MRI and CT in assessing patients presenting with acute dizziness in ED settings, focusing on detection rates and clinical considerations. A comprehensive literature search was conducted, and eight relevant studies were included. The methodological quality of the studies was assessed, and findings were synthesized narratively due to variability in study designs. Overall, MRI showed a higher detection rate for underlying causes of dizziness compared to CT, particularly for posterior circulation strokes. CT was mainly useful for ruling out hemorrhage, while MRI offered superior detection of ischemic events. Using clinical factors such as age, vascular risk, and neurological findings may help prioritize MRI use in patients with higher stroke risk, supporting targeted imaging strategies to improve diagnostic outcomes and resource utilization.

DOI: 10.7759/cureus.88057

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Association Between Stone Composition and Recurrence Rates Following Ureteroscopy: A Scoping Review (2025)

Type of publication:

Journal article

Author(s):

George, Althea O; Adefehinti, Mayowa; Lee, Minwook; Adebisi, Ajibola A; *Odedara, Ayodele; Omiko, Raymond; Akinwale, Mobolaji; Ndonga, Steven; Olalekan, Adeyeye; Yusuf, Abdulhameed; Ali, Sahar; Ononye, Reginald; Onobun, Daniel E.

Citation:

Cureus. 17(7):e87602, 2025 Jul.

Abstract:

Urolithiasis remains a significant global health burden, with high recurrence rates following intervention. Ureteroscopy is increasingly preferred due to its safety and efficacy; however, recurrence after ureteroscopy is common and may be influenced by stone composition. This scoping review aims to explore the relationship between stone composition and recurrence rates post-ureteroscopy and to identify gaps in current evidence that could inform clinical practice and research. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, we conducted a structured literature search (2014-2024) across PubMed, Scopus, MEDLINE, and Google Scholar. Studies were eligible if they reported on adult patients (>=18 years) undergoing ureteroscopy for renal or ureteric stones, provided stone composition data, and reported recurrence (defined radiologically, symptomatically, or via reintervention). Retrospective/prospective cohort studies, clinical trials, and case series (n >10) in English were included. Non-English, paediatric-only studies, case reports, and those lacking recurrence or composition data were excluded. In total, 13 studies met the inclusion criteria. Calcium oxalate was the most frequently reported stone type and appeared to be associated with higher recurrence rates. Reported recurrence ranged from 25.8% at 32 months to nearly 60% at 36 months, particularly in patients without metabolic follow-up. Reporting of uric acid, struvite, and cystine stones was inconsistent, limiting firm conclusions. The majority of studies were retrospective, small-scale, and lacked standardised definitions of recurrence, often conflating residual fragments with true recurrence. Language restriction and lack of granular metabolic data further limited synthesis. Stone composition appears to influence recurrence risk post-ureteroscopy, particularly for calcium-based stones. However, variability in study design, recurrence definitions, and underreporting of metabolic data reduce the strength of current evidence. Future prospective research with standardised reporting and broader linguistic inclusion is essential.

DOI: 10.7759/cureus.87602

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