Category: Nevin Manimala

Medicine (Baltimore). 2026 May 1;105(18):e48146. doi: 10.1097/MD.0000000000048146.

ABSTRACT

Pharmaceutical Care (PC) has emerged as a vital component of the healthcare system, involving the provision of medication therapy to achieve specific outcomes that enhance a patient’s quality of life. Therefore, this study aims to evaluate PharmD interns’ self-reported attitudes, perceptions of the skills required to provide PC using multiple domains (technical, psychosocial, communication, and administrative aspects) and perceived barriers to implementing PC, and recommendations. A cross-sectional study was conducted between May and December 2023, utilizing pretested questionnaires with PharmD interns at Saudi universities in Riyadh, Saudi Arabia. The questionnaire included sociodemographic information, attitudes (13 items), perceptions (24 items), importance (19 items), barriers (17 items) toward PC, and recommendations (4 items). To find out the association between variables chi-square, Analysis of Variance, and Spearman correlation were used to examine differences in perceptions and correlations between attitude and perception scores, with a P value < .05 considered statistically significant. A total of 216 PharmD interns participated, with 59.7% being male, 94.9% Saudi nationals, and a mean age of 24.08 ± 0.98 years. The majority (72.7%) were 24 years old. Participants were from public (57.9%) and private (42.1%) universities in Riyadh. The mean attitude score towards PC was 51.25 ± 9.38, and the mean perception score was 106.67 ± 16.01. Attitude scores were significantly associated with gender and university type (P < .001), while perception scores showed significant associations with gender, age, and university type (P < .01). The results of the Spearman correlation analysis indicated a moderate, statistically significant positive correlation between mean attitude and mean perception scores (R = 0.345, P < .01). Most interns agreed that pharmacists should prevent and solve medication-related problems (86.6%) and provide PC (85.7%). However, 43.5% believed that PC is not worth the additional workload. The most frequently reported barriers were lack of financial compensation (65.8%), inadequate staffing (62.5%), limited private counseling areas (60.7%). Most of the PharmD interns have a positive attitude towards PC but face structural and educational barriers to PC implementation. Future research should focus on overcoming these barriers and promoting Interprofessional healthcare courses to enhance patient outcomes.

PMID:42065214 | DOI:10.1097/MD.0000000000048146

Medicine (Baltimore). 2026 May 1;105(18):e48537. doi: 10.1097/MD.0000000000048537.

ABSTRACT

Unintentional poisoning and exposure to harmful substances involving illicit drugs, medications other than those taken as prescribed, and biological substances have emerged as a leading cause of preventable death in the United States. The increase in drug-specific toxicity, particularly from synthetic opioids, has accelerated during the COVID-19 pandemic, thus highlighting a need for national surveillance to monitor emerging demographic and geographic patterns. The CDC WONDER Multiple Cause of Death database provided mortality data from 1999 to 2023. Deaths with accidental poisoning (International Statistical Classification of Diseases and Health-Related Problems-10th Revision codes X40-X49) coded as the underlying cause and poisoning due to drugs (T36-T50) as multiple causes were considered. Age-adjusted mortality rates were extracted from the SEER database (number of deaths per 100,000 individuals). They were analyzed according to sex, age strata, race/ethnicity, and geographic region via Joinpoint regression for estimation of annual percentage change and average annual percentage change, with statistical significance set at P < .05. From 1999 to 2023, all-ages age-adjusted mortality rates more than sextupled, from 4.8 (95% confidence interval: 4.7-4.9) to 30.8 (95% confidence interval: 30.6-31.0). The consistently higher male mortality culminated in 2022, where men had a crude mortality of 45.3 per million compared with 18.2 per million in women. The largest increase was from 2019 to 2020, after the start of the COVID-19 pandemic. It is most severe among middle-aged adults (ages 45-64) and is characterized by geographic disparities in mortality, with clustering in counties across the Appalachian region and Southern United States. Non-Hispanic Black and American Indian/Alaska Native people experienced the latest spikes in mortality. The ongoing rise in drug-related accidental poisonings indicates a growing, evolving epidemic in the United States. The findings identified a need for focused equity-based interventions targeting substance use treatment, social determinants of health, and enhanced surveillance to address the escalating burden of mortality due to drug toxicity.

PMID:42065199 | DOI:10.1097/MD.0000000000048537

Medicine (Baltimore). 2026 May 1;105(18):e48545. doi: 10.1097/MD.0000000000048545.

ABSTRACT

Early detection of cognitive dysfunction through reliable biomarkers remains a critical challenge in geriatric medicine. While conventional peripheral blood parameters offer convenient and cost-effective biomarker potential, previous studies have been limited by their focus on isolated cell populations. This study investigates both individual blood cell parameters and their derived ratios to comprehensively evaluate their relationship with cognitive function. In this cross-sectional conducted from 2022 to 2024, we enrolled 109 participants (51 with cognitive impairment and 58 controls) from the Haikou City Community Health Service Center. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). We analyzed 26 blood parameters, including traditional metrics and calculated indices such as lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio, and systemic immune-inflammation index (SII). The relationship between these parameters and cognitive domains was evaluated using comprehensive statistical analyses. Fifteen parameters showed significant differences between groups. Binary logistic regression identified SII as a risk factor (OR: 1.008, 95% CI: 1.003-1.012, P = .002). The receiver operating characteristic curve analysis indicated that the diagnostic accuracy of SII (AUC = 0.911, 95% CI: 0.856-0.966) was significantly superior to that of the sole parameter, the number of lymphocyte count (AUC = 0.702, 95% CI: 0.604-0.801). Our findings suggest that lower lymphocyte counts and elevated SII levels are associated with increased risk of cognitive impairment. These results provide new insights into the relationship between systemic inflammation and cognitive decline, with potential implications for clinical practice.

PMID:42065191 | DOI:10.1097/MD.0000000000048545

Medicine (Baltimore). 2026 May 1;105(18):e48510. doi: 10.1097/MD.0000000000048510.

ABSTRACT

The link between salt intake and the risk of gastric cancer remains uncertain, and a causal relationship has not been established. Therefore, clarifying the causal effect of salt intake on the risk of gastric cancer using reliable causal inference methods is necessary. The aim of this study was to assess the causal association between salt intake and cancer by integrating summary-level genome-wide association study (GWAS) data. Two-sample Mendelian randomization (MR) analyses were performed using summary statistics from a GWAS. Inverse-variance weighted (IVW) regression, Mendelian randomization-Egger (MR-Egger) regression, and weighted median analyses were used to evaluate the causal relationship between salt intake and gastric cancer. Moreover, Mendelian Randomization Pleiotropy RESidual Sum of Squares and Outliers and MR-Egger analyses were used to evaluate the level of multipotency, and “leave-one-out” sensitivity analysis was assessed. The IVW method estimate indicated that salt intake was not correlated with gastric cancer incidence. The IVW (β = 0.1008, standard error [SE] = 0.1510, odds ratio [OR] = 1.1061, 95% confidence interval [CI], 0.82-1.48, P = .5042), MR-Egger regression (β = 0.059, SE = 0.5318, OR = 1.0612, 95% CI, 0.37-3.01, P = .9111), and weighted median (β = 0.2639, SE = 0.2298, OR = 1.3020, 95% CI, 0.82-2.04, P = .2508) analyses revealed no causal relationship between salt intake and gastric cancer risk (P > .05). In addition, the funnel plot and MR-Egger analysis (P = .6694 > .05) did not indicate horizontal pleiotropy or heterogeneity. GWAS data from public databases were used in this study, and the causal relationship between salt intake and gastric cancer risk was analyzed via a two-sample MR method. The results revealed no genetic causal relationship between salt intake and gastric cancer.

PMID:42065187 | DOI:10.1097/MD.0000000000048510

Medicine (Baltimore). 2026 May 1;105(18):e48373. doi: 10.1097/MD.0000000000048373.

ABSTRACT

BACKGROUND: Epicanthus, a prevalent aesthetic concern in Asian populations, can be surgically corrected using various techniques. The skin redraping method and Z-plasty are 2 widely adopted approaches. This study aimed to conduct a systematic meta-analysis to comprehensively compare the clinical efficacy and outcomes of these 2 dominant surgical methods for epicanthus correction.

METHODS: A systematic literature search was performed across PubMed, Embase, China National Knowledge Infrastructure, Wanfang, and VIP databases from their inception through December 2025. Randomized controlled trials (RCTs) and cohort studies directly comparing skin redraping and Z-plasty for congenital epicanthus were eligible. Primary outcomes included postoperative change in intercanthal distance (ICD), scar assessment via the Vancouver Scar Scale at 6 months, patient satisfaction, recurrence rate, and incidence of complications. Study quality was assessed using the Cochrane Risk of Bias tool for RCTs and the Newcastle-Ottawa Scale for cohort studies. Statistical synthesis was performed using Review Manager 5.4 and R metafor package, employing fixed-effect or random-effects models based on heterogeneity (I2 statistic).

RESULTS: Fourteen studies (1539 patients) were included. All included studies were published in Chinese. Meta-analysis showed no significant difference in postoperative ICD reduction (mean difference = 0.56 mm, 95% confidence interval [CI]: -1.20 to 2.33, P = .53, I2 = 98%). Z-plasty yielded significantly better 6-month Vancouver Scar Scale scores (mean difference = 0.44, 95% CI: 0.31-0.57, P < .00001) and higher patient satisfaction (odds ratio [OR] = 0.39, 95% CI: 0.18-0.84, P = .02). Recurrence was significantly lower with Z-plasty (OR = 13.73, 95% CI: 2.53-74.49, P = .002), although this analysis was based on only 3 studies. Complication rates were similar (OR = 1.45, 95% CI: 0.65-3.23, P = .36).

CONCLUSION: Both techniques effectively reduce ICD with comparable safety. Within the limited follow-up period of the included studies (up to 6 months), Z-plasty was associated with better scar appearance, higher satisfaction, and lower recurrence. The high heterogeneity and exclusive inclusion of Chinese studies necessitate cautious interpretation. Future multicenter RCTs with longer follow-up and standardized technique reporting are warranted.

PMID:42065185 | DOI:10.1097/MD.0000000000048373

Medicine (Baltimore). 2026 May 1;105(18):e48553. doi: 10.1097/MD.0000000000048553.

ABSTRACT

We performed a single-center observational cohort study on patients with COVID-19. We retrospectively analyzed 54 patients with confirmed SARS-CoV-2 infection, diagnosed as critically ill. Severely ill patients have a poor prognosis and it is a matter of great interest to identify these cases for an adequate management. Current findings revealed that altered levels of some blood markers might be linked with the degree of severity and mortality of patients with COVID-19. Our study aimed to assess the relationship between inflammation and coagulation in SARS-CoV-2 infection and to find out if pro-inflammatory markers are correlated with coagulation parameters in COVID-19. Pro-inflammatory markers included leptin and classical biomarkers. This paper highlights the results obtained. We found statistically significant associations between blood levels of various biomarkers including leptin, IL-6, ferritin, neutrophil-lymphocyte ratio, C-reactive protein, fibrinogen, erythrocyte sedimentation rate and lactate dehydrogenase and the presence of coagulopathy, as indicated by the Pearson Chi-Square and Likelihood Ratio tests. The relationships are not linear, as indicated by the nonsignificant Linear-by-Linear Association test. The correlations between some biomarkers such as leptin, IL-6, ferritin, neutrophil-lymphocyte ratio, C-reactive protein, fibrinogen, erythrocyte sedimentation rate and lactate dehydrogenase and coagulopathy are weak and not statistically significant and the correlation between IL-6 levels and coagulopathy is very weak and negative and not statistically significant. Different crosstabulations between serum leptin levels and D-dimers, Prothrombin time, Prothrombin activity, International-normalized-ratio and activated partial thromboplastin time have been performed including the analysis of a potentional correlation. There are statistically significant associations between serum leptin levels and coagulation parameters, including D-dimers, prothrombin time, prothrombin activity and activated partial thromboplastin time, as indicated by the Pearson Chi-Square test. There is also a statistically significant association between serum leptin levels and international-normalized ratio (INR) as indicated by the Pearson Chi-Square test. The Linear-by-Linear Association test indicates a significant linear relationship between Leptin levels and international-normalized ratio. Pearson R shows a moderate positive correlation, which is statistically significant.

PMID:42065184 | DOI:10.1097/MD.0000000000048553

Medicine (Baltimore). 2026 May 1;105(18):e48549. doi: 10.1097/MD.0000000000048549.

ABSTRACT

The efficacy and adverse reactions of Maren Runchang Pills among patients of different genders remain unclear. This study aims to analyze the efficacy and safety differences of Maren Runchang Pills in patients of different genders, providing a basis for the implementation of gender-precise treatment in clinical practice. Gender-stratified analysis was adopted to include constipation-predominant irritable bowel syndrome (IBS-C) patients who met the syndrome of intestinal heat and accumulation. The efficacy and safety of Maren Runchang Pills were evaluated after 4 weeks of treatment. The main evaluation indicators include the complete spontaneous bowel movement response rates, visual analogue scale scores for abdominal pain and distension, traditional Chinese medicine syndrome scores, irritable bowel syndrome-symptom severity scale/irritable bowel syndrome-quality of life scale scores, and safety indicators. A total of 126 patients were included, among whom 101 were female and 25 were male. After 4 weeks of treatment, the proportion of female patients with a complete spontaneous bowel movement response rate of ≥75% was significantly higher than that of male patients (71.29% vs 48%, P = .0270), and the improvement in abdominal distension visual analogue scale score was also significantly better in females (decrease of 2.78 points vs 1.84 points, P = .0199). However, the total score of traditional Chinese medicine syndromes in male patients was higher than that in female patients (7.08 points vs 5.09 points, P = .0341). There were no statistically significant differences in the scores of the irritable bowel syndrome-symptom severity scale, irritable bowel syndrome-quality of life scale and safety indicators between the 2 groups. Maren Runchang Pills can effectively alleviate the constipation symptoms of patients with IBS-C, and the therapeutic effect is even better in female patients. The research results support considering gender factors in the clinical treatment of IBS-C to achieve individualized and precise intervention.

PMID:42065180 | DOI:10.1097/MD.0000000000048549

Medicine (Baltimore). 2026 May 1;105(18):e48582. doi: 10.1097/MD.0000000000048582.

ABSTRACT

This study aimed to comprehensively assess the prognostic value of routinely obtained blood-based systemic inflammatory indices in predicting all-cause mortality among individuals with chronic obstructive pulmonary disease (COPD). This retrospective cohort study analyzed data from the National Health and Nutrition Examination Survey (NHANES) cycles 2007-2010. A total of 1109 eligible adults with COPD were included, with 333 deaths recorded during the follow-up period. Eleven systemic inflammatory indices were derived from baseline hematological parameters. The associations between these indices and all-cause mortality were initially evaluated using multivariate Cox proportional hazards models. To manage high-dimensional data and identify complex patterns not captured by conventional statistical methods, machine learning (ML) algorithms were applied for feature selection, model development, and performance evaluation. Model discrimination and clinical utility were assessed using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis. Among the 1109 participants (mean age 57.9 ± 15.5 years, 52.2% male), non-survivors (n = 333) were significantly older and had a higher baseline burden of comorbidities. After full adjustment for covariates, several inflammatory indices showed statistically significant associations with all-cause mortality. The neutrophil percentage-to-albumin ratio (NPAR) and neutrophil-to-lymphocyte ratio exhibited the strongest associations, with HRs of 2.46 (95% CI: 1.64-3.69) and 2.14 (95% CI: 1.42-3.22), respectively, in the highest quartile (Q4) compared to the lowest (Q1). The neutrophil-to- high-density lipoprotein ratio also demonstrated a significant positive association (HR for Q4 vs Q1: 1.79, 95% CI: 1.18-2.70). In contrast, higher levels of the C-reactive protein-albumin-lymphocyte index index were associated with reduced risk, indicating a protective effect (HR for Q4 vs Q1: 0.49, 95% CI: 0.33-0.72). The ML-derived NPARTEST model, based on the NPAR index, achieved an AUC of 0.828 for predicting all-cause mortality, demonstrating good discriminative performance and clinical utility. Systemic inflammatory indices, particularly the NPAR and neutrophil-to- high-density lipoprotein ratio, are independently associated with all-cause mortality in patients with COPD, often exhibiting nonlinear relationships. The ML-based NPARTEST model demonstrates promising predictive performance. These findings underscore the potential of cost-effective, routinely measured blood-based biomarkers to enhance risk stratification in COPD management. External validation in diverse populations is warranted to confirm the generalizability of these results.

PMID:42065179 | DOI:10.1097/MD.0000000000048582

Medicine (Baltimore). 2026 May 1;105(18):e48381. doi: 10.1097/MD.0000000000048381.

ABSTRACT

To explore the risk factors and predictive value of Mycoplasma pneumoniae (MP) infection in children. A total of 2042 children with suspected Mycoplasma pneumoniae infection who were treated for the first time at Civil Aviation General Hospital from October 2023 to December 2023 were selected as the study subjects. Among them, 1637 cases were confirmed as Mycoplasma pneumonia-infected and were included in the pneumonia group, while the remaining 405 cases were non-Mycoplasma pneumonia-infected and were included in the non-Mycoplasma pneumonia group. The clinical data of the 2 groups of children (including gender, age, initial symptoms, laboratory indicators, etc) and the risk factors of MP infection in children were compared, and the receiver operating characteristic curve was analyzed. This study showed that the percentage of neutrophils in the non-MP infection group was significantly lower than that in the MP infection group, and the difference was statistically significant (P < .001). When comparing the percentages of lymphocyte percentage (LY) and hemoglobin in the 2 groups of children, the Mycoplasma pneumonia-infected group was lower than the non-Mycoplasma pneumonia-infected group, and the differences were both statistically significant (P < .05). Logistic regression analysis revealed that white blood cell and neutrophil-to-lymphocyte ratio (NLR) might be valuable markers for predicting MP infection. The Spearman correlation indicated that LY was collinear with the occurrence of MP infection, and Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis demonstrated that both LY and NLR might be valuable markers for predicting MP infection (P < .05). Receiver operating characteristic curve analysis revealed that the area under the curve of the NLR for diagnosing MP infection was 0.624, with a cutoff value of 1.36 (sensitivity of 0.798 and specificity of 0.558). In the diagnosis of MP infection, the consistency between the RNA method and the immunogold colloidal method was poor (Kappa = 0.108, P < .05). The consistency between the RNA method and the immunogold colloidal method in the diagnosis of MP infection is poor. Both the white blood cell and NLR are valuable markers for MP infection.

PMID:42065166 | DOI:10.1097/MD.0000000000048381

Medicine (Baltimore). 2026 May 1;105(18):e48424. doi: 10.1097/MD.0000000000048424.

ABSTRACT

BACKGROUND: Dry eye disease (DED) is a multifactorial ocular surface disorder characterized by tear film instability and inflammation. Rebamipide 2% ophthalmic suspension, a mucin secretagogue, has been investigated as a potential treatment due to its unique mechanism targeting mucin deficiency and ocular surface repair.

METHODS: A systematic search of PubMed, Embase, and Cochrane Library was conducted for studies published between January 2013 and March 2025. Non-randomized and randomized controlled trials evaluating topical 2% rebamipide in patients with DED were included. Outcomes assessed included tear breakup time, Schirmer I test, fluorescein staining scores, ocular surface disease index, and adverse events. Data were synthesized using standard meta-analytic techniques and subgroup analyses.

RESULTS: Thirteen studies, including both randomized and non-randomized trials, were analyzed, comprising a total of 575 participants. Meta-analysis showed that rebamipide nonsignificantly increased tear breakup time at 2 weeks (standardized mean difference [SMD] = 1.04; 95% confidence interval (CI):-0.94 to 3.03; P = .30; I2 = 89.3%), significant at 4 weeks (SMD = 1.19; 95% CI: 0.74-1.64; P < .0001; I2 = 85%) and nonsignificant at 12 weeks (SMD = 0.97; 95% CI:-0.15 to 2.08; P = .09; I2 = 80.1%) indicating enhanced tear film stability. Schirmer I test values showed no significant improvement (SMD = 0.04; 95% CI: -0.35-0.43; P = .83), suggesting limited effect on aqueous tear production. Fluorescein staining scores showed a reduction approaching statistical significance (SMD = -0.68; P = .051), while symptom scores measured by ocular surface disease index trended toward improvement, also approaching significance (SMD = -1.17; P = .055). Subgroup analyses revealed greater efficacy in contact lens wearers and postsurgical patients. Safety analysis indicated excellent tolerability, with a high adherence rate (96.8%) and only mild adverse effects such as dysgeusia and nasopharyngitis.

CONCLUSION: Rebamipide 2% ophthalmic suspension improves tear stability and ocular surface health in mucin-deficient DED with a favorable safety profile. Further high-quality trials in diverse populations are warranted to confirm its role in global clinical practice.

PMID:42065158 | DOI:10.1097/MD.0000000000048424