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

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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

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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)

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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)

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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)

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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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Implementing Quick Response (QR)-Coded Patient Information Leaflets to Reduce Environmental Impact in Urology Outpatient Clinics: A Pilot Study (2025)

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Type of publication:

Journal article

Author(s):

Matei, Ana; *Chin, Yew Fung; Hughes, Thomas; Mahmalji, Wasim.

Citation:

Cureus. 17(7):e87891, 2025 Jul.

Abstract:

Background and aim Patient information leaflets (PILs) printed in paper form are a commonly used adjunct tool in urology clinics. These help to facilitate the information transfer between doctor and patient. They are detrimental to the environment and costly. Quick response (QR) codes can be used as another option for delivering the leaflets and would reduce the environmental burden. The aim of this paper is to evaluate patient response to the introduction of QR codes as a replacement for paper-based PILs. Methods This pilot study followed the introduction of QR codes of commonly used leaflets sourced from the British Association of Urological Surgeons (BAUS). The study was conducted in a urology clinic at the Hereford County Hospital over a one-month period. The acceptability of the QR codes was recorded. Data such as patient demographics and the type of leaflet were also documented and tabulated. Results Thirty-one patients required PILs, out of which 80% agreed to PILs via QR codes. The mean age of the participating patients was 76. The replacement of paper with QR codes for the one-month period reflects an average estimated saving of 1.88 kg of carbon dioxide emissions and around 238 sheets of paper. Discussion The introduction of QR codes has seen an increase in most sectors, including, more recently, the medical industry. They can be used with a wide range of functions within the industry ranging from medical education to patient identification. These can also be more easily distributed in various forms to cater to all needs. Limitations, such as the currently limited variety of urology PILs available, also need to be considered. Conclusion QR codes of the PILs are a generally accepted alternative. The widespread introduction of QR codes reduces the total environmental impact of paper documents while also reducing production costs.

DOI: 10.7759/cureus.87891

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The 3,550 g Challenge: An Atypical Presentation of a 3.5 kg Seminoma Manifesting as Dry Skin (2025)

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Type of publication:

Journal article

Author(s):

Omorphos, Nicolas; Mohsin, Mohamed Shamil; *Mok, Spencer; Kitchen, Mark; Ho, Kuo J.

Citation:

Cureus. 17(7):e87174, 2025 Jul.

Abstract:

A 43-year-old male presented to the emergency department with a seven-year history of progressive left-sided scrotal swelling. On examination, a large mass was palpable in the left hemiscrotum, accompanied by eczema-like skin changes and a decubitus ulcer. Tumor markers were significantly elevated, particularly lactate dehydrogenase, and an urgent ultrasound confirmed the presence of a testicular tumor. CT revealed a scrotal mass originating from the left testis, along with bilateral inguinal lymphadenopathy. The patient underwent a left inguinal orchidectomy, and histopathological analysis confirmed a 3,550 g classical seminoma. He was subsequently referred to oncology for adjuvant chemotherapy.

DOI: 10.7759/cureus.87174

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Barriers to the safe discussion of the experience and management of menopausal symptoms: A systematic literature review (2025)

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Type of publication:

Journal article

Author(s):

Thavabalan, Karish; *Ovenell, Alistair; Pierce, Poppy; Sutaria, Aman; Parkhouse, Annabelle; Baydemir, Numan; Lally, Theodore.

Citation:

Maturitas. 201:108683, 2025 Aug 05.

Abstract:

As the number of women experiencing menopause continues to rise each year, the need for open and supportive discussions around the experience and management of menopausal symptoms becomes more imperative. Although research has identified numerous challenges women face during this life stage, many studies examine these barriers in isolated settings. Furthermore, how these challenges impact women's ability to safely discuss menopause remains poorly understood. This systematic literature review
sought to identify and synthesise the barriers that hinder safe discussions about the experience and management of menopausal symptoms. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, 21 qualitative studies were included. Six themes were identified regarding symptom experience: lack of support from friends and family, lack of workplace support, fear of menopause onset, variation in symptom experience, poor-quality information, and societal judgement. Two themes were identified regarding symptom management: perceived onus to endure symptoms and poor experiences with healthcare professionals. Notably, the themes revealed widespread shortcomings that collectively hinder safe discussions about menopause. Future work should prioritise intersectional approaches that tackle barriers across home, social, work, and healthcare settings. Proactive measures, such as placing a greater emphasis on menopause in medical education and developing culturally relevant resources, are crucial for fostering safe, informed discussions and improving care for all women.

DOI: 10.1016/j.maturitas.2025.108683

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Therapeutic Duel of Rifaximin Versus Lactulose in Hepatic Encephalopathy: A Systematic Review (2025)

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Type of publication:

Systematic Review

Author(s):

Oriko, David O; Khawaj, Zainab; Cheema, Muhammad Usairam; Talreja, Anjali; Tayyab, Muhammad Abbas; Zamir, Muhammad Hamza; Iqbal, Maheen; Farooq, Umer; *Ekomwereren, Osatohanmwen; Tariq, Muhammad M; Hasan, Abdul Haseeb.

Citation:

Cureus. 17(6):e86193, 2025 Jun.

Abstract:

This systematic review aimed to compare the clinical efficacy of rifaximinversus lactulose in the management of hepatic encephalopathy (HE) by analyzing evidence from randomized controlled trials (RCTs). A comprehensive search across major databases identified seven eligible RCTs encompassing 693 adult patients diagnosed with overt or minimal HE. Findings demonstrated that rifaximin is at least as effective as lactulose in reversing HE symptoms, with some studies reporting significantly higher HE reversal rates when rifaximin was used in combination with lactulose (e.g., 76% vs. 50.8%, p<0.004), reduced mortality (23.8% vs. 49.1%, p<0.05), and shorter hospital stays (5.8 vs. 8.2 days, p=0.001). While other trials reported similar efficacy between the two agents (e.g., HE improvement: 84.4% vs. 95.4%, p=0.315), rifaximin was generally associated with better tolerability and fewer gastrointestinal side effects. These results support rifaximin as an effective and well-tolerated therapeutic option, either as monotherapy or in combination with lactulose. Further large-scale, multicenter trials are warranted to assess long-term outcomes, recurrence rates, and cost-effectiveness.

DOI: 10.7759/cureus.86193

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