Category: Nevin Manimala

Orphanet J Rare Dis. 2025 Apr 18;20(1):188. doi: 10.1186/s13023-025-03722-3.

ABSTRACT

BACKGROUND: Primary hypertrophic osteoarthropathy (PHO) is a rare genetic disorder classified into clinical subtypes and genetic subtypes. Previous clinical studies have primarily focused on case reports and family analyses, largely characterizing the genetic subtypes. However, there remains a long-standing gap in understanding the characteristics of the different clinical subtypes of PHO. This study aimed to determine the distribution of the three clinical subtypes of PHO and compare their clinical characteristics using a large global sample.

METHODS: A systematic literature search was conducted in multiple databases to categorize cases into complete form (CO), incomplete form (IN), and fruste form (FR). Statistical analyses were performed to assess clinical differences in a retrospective study design.

RESULTS: Males predominated across all subtypes, whereas females were most prevalent in IN patients (51.1%). IN patients had the highest family history rate (62.1%). Age at onset peaked in adolescence for CO and FR patients, while IN patients exhibited bimodal peaks in early childhood and adolescence. Congenital diseases were more frequent in IN patients (7.8%, P = 0.021), while CO patients had a higher prevalence of digestive system diseases (12.2%, P = 0.007). Urinary prostaglandin E2 (PGE2) and PGE Metabolite (PGEM) were consistently elevated in CO and FR patients. In IN patients, urinary PGE2 levels were also increased, but the urinary PGEM levels showed equal proportions of elevation and reduction. Genetic analysis revealed that solute carrier organic anion transporter family member 2A1 (SLCO2A1) mutations were predominant in CO (95 cases, 73.1%) and FR (22 cases, 57.9%) patients, whereas hydroxyprostaglandin dehydrogenase (HPGD) mutations were most frequently associated with IN (25 cases, 73.5%).

CONCLUSIONS: The three clinical subtypes of PHO exhibited distinct characteristics with no clear correlation between clinical and genetic subtypes. These findings highlighted the clinical significance of PHO typing and provided valuable insights for diagnosis, differential diagnosis and subtype-specific management strategies.

PMID:40251683 | DOI:10.1186/s13023-025-03722-3

J Orthop Surg Res. 2025 Apr 19;20(1):391. doi: 10.1186/s13018-025-05803-2.

ABSTRACT

PURPOSE: The dynamic hip screw (DHS) is a widely used method for hip fracture stabilisation, but conventional DHS (CHDS) fixations may be limited by longer surgical duration and delayed recovery compared to minimally invasive DHS (MIDHS) fixations. We describe a novel low-cost surgical method that reduces intraoperative time, peri-operative complications, and improves overall patient outcomes.

METHODS: A prospective double-blinded study included 15 patients who underwent surgical fixation of IT hip fractures using a 4-hole DHS system. All surgeries were performed at a tertiary referral hospital between January 2019 and April 2023 by surgeons with similar levels of experience. Main outcome measurements included tip-apex distance (TAD), surgery duration, haemoglobin loss, and hospital stay duration. Two independent assessors measured TAD using the post-operative anteroposterior and lateral radiographs. Kyle’s classification was used to categorize the IT fractures. IBM SPSS Statistics 26.0 for Mac (SPSS, Chicago, IL, USA) was used for the statistical analysis. Statistically significant difference was defined as p-value < 0.05.

RESULTS: Both groups had similar baseline characteristics (p > 0.05). Both groups had similar complexity in fractures, but the mean surgical duration was significantly shorter (p = 0.019) (43.8 ± 12.3 min) compared to the CDHS group (73.4 ± 18.2 min). Postoperatively, there was no significant difference (p > 0.05) in hospital stay duration, haemoglobin (Hb) loss, or TAD.

CONCLUSIONS: MIDHS group had shorter surgical duration compared to CDHS group, with no significant difference in TAD, haemoglobin loss and hospital stay duration.

PMID:40251666 | DOI:10.1186/s13018-025-05803-2

Cardiovasc Diabetol. 2025 Apr 18;24(1):172. doi: 10.1186/s12933-025-02717-5.

ABSTRACT

BACKGROUND: Type 2 diabetes is a stronger risk factor for cardiovascular disease (CVD) in women compared with men possibly due to higher susceptibility to develop myocardial microvascular dysfunction. We investigated sex-dependent effects of risk factors on myocardial blood flow (MBF) and myocardial flow reserve (MFR) in individuals with type 2 diabetes without overt CVD.

METHODS: Cross-sectional analysis of a prospective study including 901 individuals recruited between 2020 and 2023. All participants underwent a cardiac 82-Rubidium positron emission tomography/computed tomography scan to quantify MBF at rest and during pharmacologically induced stress, allowing for calculation of MFR. Linear regression, with/without interaction terms for sex, was used to test whether sex modified the association between MFR/MBF and risk factors.

RESULTS: Mean (SD) age was 65 (8.9) years, diabetes duration was 14 (8.4) years, and 266 (29.5%) were women. Women had higher MBF at rest and stress but had lower MFR (mean (SD) 2.44 (0.67) vs. 2.59 (0.77), p = 0.003) than men. A similar proportion of men and women (21.1% vs. 23.7%) had an MFR < 2. The decline in predicted MFR with age differed between sexes. At age 55, women had a mean MFR that was 0.29 lower than men (95% CI: – 0.44 to – 0.14), but by age 75, this difference had nearly disappeared (- 0.04, 95% CI: – 0.19 to 0.11). However, after adjustment for other risk factors, the interaction between sex and age was not statistically significant (p = 0.057). No other risk factors exhibited significant sex-dependent interactions.

CONCLUSIONS: In individuals with type 2 diabetes without overt CVD, women exhibited lower MFR than men, primarily due to higher MBF at rest, suggesting sex-related differences. While MFR declined in both sexes, the sex difference was more pronounced in younger individuals and diminished over time. These findings underscore the need for further research into sex-specific thresholds for MFR in cardiovascular risk stratification.

PMID:40251660 | DOI:10.1186/s12933-025-02717-5

Int Breastfeed J. 2025 Apr 18;20(1):32. doi: 10.1186/s13006-025-00724-6.

ABSTRACT

BACKGROUND: Breastfeeding offers critical benefits in disasters but faces significant barriers. In this study, we aimed to determine the association between experiencing the 2023 Türkiye earthquake and breastfeeding problems.

METHOD: This cross-sectional descriptive study was conducted in pediatric clinics in eight different provinces of Türkiye, three earthquake-affected provinces and five earthquake-unaffected provinces, between April and July 2023. Breastfeeding mothers and their 0-23 month infants were included in the study. A structured questionnaire was applied to mothers face-to-face. Multivariate logistic regression analysis was performed to determine independent parameters associated with breastfeeding problems.

RESULTS: A total of 761 mother-child pairs participated in the study. Among these mothers, 49% (n = 373) were living in the earthquake-affected region, and 51% (n = 388) were not. Breastfeeding problems were more common in the earthquake-affected mother-child pairs (48.8%) compared to unaffected pairs (28.6%). Perceived insufficient milk supply was the most common breastfeeding problem, reported by 33.0% in earthquake-affected regions and 11.1% in unaffected region. Breastfeeding problems were 2.01 times more common in mothers from earthquake-affected region (95% CI: 1.45, 2.77) and 1.66 times more common in those who bottle-fed their infants (95% CI: 1.45, 2.37). Perceived insufficient milk supply was 4.12 times more prevalent in earthquake-affected regions (95% CI: 2.73, 6.22) and 1.78 times higher in bottle-feeding mothers (95% CI: 1.23, 2.57). The likelihood of perceived insufficient milk supply was lower in mothers receiving mental health support (AOR: 0.53, 95% CI: 0.33, 0.84) and nutritional support (AOR: 0.49, 95% CI: 0.27, 0.89).

CONCLUSION: Perceived insufficient milk supply is the most common breastfeeding challenge reported by mothers affected by earthquakes, occurring more frequently than among mothers who were not affected. This issue is associated with increased bottle feeding, limited mental health support, and inadequate nutritional support. Addressing this issue through adherence to the International Code of Marketing of Breast-milk Substitutes, controlling donation and distribution of commercial milk formula to discourage bottle feeding, alongside ensuring nutritional and mental health support for mothers, could significantly mitigate breastfeeding difficulties during disasters.

PMID:40251658 | DOI:10.1186/s13006-025-00724-6

Eur J Med Res. 2025 Apr 19;30(1):310. doi: 10.1186/s40001-025-02583-7.

ABSTRACT

BACKGROUND: Identifying the risk of stroke in patients with atrial fibrillation (AF) presents a challenge, as existing tools such as the CHA2DS2-VASc score primarily emphasize medical history, affording relatively less attention to the electrocardiogram (ECG). Exploring HRV (heart rate-related variability) parameters could help refine risk prediction for thromboembolic ischemic stroke and enhance personalized management. This paper investigates how HRV parameters may inform the risk of acute ischemic stroke in atrial fibrillation patients.

METHODS: Data were retrospectively collected from Zhongnan Hospital’s electronic registry for patients with atrial fibrillation admitted in 2022. The sample was sorted into cases and controls based on specific inclusion and criteria. The outcome was the onset of acute ischemic stroke (AIS) in recurrent paroxysmal non-valvular atrial fibrillation. Cases and control data were analyzed using different statistical methods based on distribution, and the association between HRV parameters and the risk of stroke in paroxysmal atrial fibrillation was assessed. Binary logistic regression was utilized to assess a predictive model for stroke risk based on heart rate variability (HRV) parameters.

RESULTS: A total of 3218 medical records with atrial fibrillation were retrieved. Out of 3218 medical records with atrial fibrillation, 192 were selected after screening, including 93 cases and 99 controls. The cohort comprised 93 females (50 cases) and 99 males (43 cases). Mean ages were 68.67 ± 1.95 for cases and 68.35 ± 1.19 for controls, with no significant difference (P > 0.05). Hypertension history was significantly more common in cases (P = 0.006), indicating a dependency between hypertension and acute ischemic stroke in non-valvular paroxysmal AF. SDNN mean rank was significantly lower in cases (P = 0.024), and LF was significantly reduced (P = 0.044). Other HRV parameters showed lower values in cases, but differences were not statistically significant. We found that AVTD (abnormal variation in the time domain) alone was significantly associated with acute ischemic stroke in non-valvular paroxysmal AF. While AVFD (abnormal variation in frequency domain) and AVA (abnormal variation in arrhythmogenicity) were not individually significant, a combined variable (CDV) from AVTD, AVFD, and AVA was also statistically significant (P = 0.029). In this model, SDNN, AVTD, history of hypertension, as well as the CHA2DS2-VASc score and the use of novel anticoagulant medicines (NOACS), were significant predictors in both univariate and multivariate analyses. At the same time, CDV was significant only in univariate analysis. These findings may suggest that HRV parameters may provide clues to the risk of acute ischemic stroke in non-valvular paroxysmal AF.

CONCLUSION: This study found that abnormal variation in HRV parameters was more observed in patients with acute ischemic stroke. Then, unlike previous research, this study uniquely integrated multiple HRV parameters to develop novel indices such as AVTD, AVFD, AVA, and CDV, which somehow demonstrated a significant association with the risk of AIS. These new metrics, combined with conventional risk factors and CHA2DS2-VASc score, brought great improvement to the model prediction for AIS risk.

PMID:40251653 | DOI:10.1186/s40001-025-02583-7

BMC Rheumatol. 2025 Apr 18;9(1):44. doi: 10.1186/s41927-025-00498-8.

ABSTRACT

OBJECTIVES: Fatigue is a prominent symptom in patients with psoriatic arthritis (PsA). There was a wide variety of statistics previously reported on fatigue prevalence in patients. This systematic review examined the current literature to derive the overall prevalence of fatigue and risk factors in PsA patients.

METHODS: A systematic review of the literature with subsequent meta-analyses was conducted. Publications assessing fatigue severity and prevalence in patients with PsA using validated measurement scores were identified from seven online databases (Cochrane, CINAHL, EMBASE, Google Scholar, MEDLINE, PubMed, and Web of Science), from inception until January 2024. Employing a random effects model, we calculated the pooled fatigue prevalence. Quality assessment of included studies was performed utilising the Joanna Briggs Critical Appraisal Tool.

RESULTS: The final analysis included 15 studies with 6482 PsA patients. Pooled fatigue prevalence was 0.51 (95% CI: 0.41, 0.61; I2 = 97.4%). There was substantial heterogenicity across the studies, with biologics use and geographical location in terms of Western versus Eastern countries being possible sources of heterogeneity. Age, disease duration, gender, tender joint count, swollen joint and enthesitis count are among the most commonly reported risk factors for fatigue in multivariate logistic regressions.

CONCLUSIONS: Approximately half of the patients with PsA experienced fatigue. Biologics use and geographical location of the study were possible sources of heterogeneity in the subgroup analysis.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40251651 | DOI:10.1186/s41927-025-00498-8

J Cardiothorac Surg. 2025 Apr 18;20(1):209. doi: 10.1186/s13019-025-03421-x.

ABSTRACT

BACKGROUND: Acetaminophen (APAP) is widely used in the treatment of patients after surgery, but the prognosis of patients with coronary artery bypass grafting (CABG)-related acute respiratory distress syndrome (CABG-ARDS) is still unclear. This study aims to explore the role of APAP in the management of CABG related ARDS.

METHODS: We collected clinical data on patients with CABG-ARDS from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. The primary outcome was early mortality after ARDS, and the secondary outcomes were length of hospital stay and duration of mechanical ventilation (MV). Multivariate logistic regression and Cox regression models were used for statistical analysis, and inverse probability processing weighting (IPTW), overlap weighting (OW) and propensity score matching (PSM) were used to explore the robustness of the outcomes.

RESULTS: A total of 5459 patients were enrolled in the analysis. Multivariate logistic regression analysis revealed that the 14-day mortality in APAP group was significantly lower than that in non-APAP group (0.5% vs. 2.7%, OR = 0.301; 95% CI, 0.170-0.531; P < 0.001). The APAP group also showed a significant advantage in Cox regression analysis (0.5% vs. 2.7%, HR = 0.329; 95% CI, 0.187-0.577; P < 0.001). IPTW, OW, and PSM analyses were conducted between the two groups, and the differences remained significant. These results were consistent in 30-, 60-, and 90-day mortality analyses. Meanwhile, exposure to APAP was associated with a shorter length of hospital stay and a reduced duration of MV (P < 0.001).

CONCLUSION: The administration of APAP was associated with reduced early mortality in patients with CABG-ARDS, as well as shorter length of hospital stay and duration of MV.

PMID:40251639 | DOI:10.1186/s13019-025-03421-x

BMC Psychol. 2025 Apr 18;13(1):401. doi: 10.1186/s40359-025-02676-2.

ABSTRACT

From a holistic perspective of positive psychology, there is a dearth of knowledge regarding how its three underlying factors (i.e., positive subjective experience, positive individual traits, and positive collective institutions) co-shape learners’ willingness to communicate (WTC), a critical facilitator of foreign language learning achievement. This research gap is particularly evident for learners in multi-ethnic regions who have been underrepresented in foreign language education in China. This issue may constrain our understanding of the contributions of positive psychology to the field of applied linguistics, since the role of positive psychological factors in influencing WTC may be distinct across diverse ethnic populations. Besides, the relative importance of these three factors in predicting WTC has yet to be investigated in latent models. Given that different pedagogical approaches may engender disparate perceptions and attitudes among learners, it is of the utmost importance to ascertain which factor should be prioritized in classroom psychological interventions, as well as in teacher training programs. To address these gaps, this study addressed the joint effect of positive subjective experience (foreign language peace of mind, FLPOM), positive individual trait (language-specific grit), and positive collective institution (classroom environment) on WTC using structural modeling analysis. Furthermore, the study employed latent dominance analysis to ascertain the relative importance of these three factors in promoting WTC. The sample consisted of 643 multi-ethnic foreign language students from five provinces in Western China. The findings suggested that FLPOM, grit, and classroom environment collectively stimulate learners’ WTC. Notably, FLPOM, a factor that has not previously been examined in relation to in-class or face-to-face WTC, emerged as the most statistically significant predictor of WTC. Therefore, it is imperative that foreign language practitioners and learners recognize the significance of FLPOM in language learning and teaching in Chinese multi-ethnic regions.

PMID:40251638 | DOI:10.1186/s40359-025-02676-2

BMC Med. 2025 Apr 18;23(1):228. doi: 10.1186/s12916-025-04060-8.

ABSTRACT

BACKGROUND: Environmental access to exercise opportunities plays a crucial role in determining the level of physical activity within a population. However, it is unclear how environmental factors contribute to disparities in physical activity and health outcomes. We explored the associations between county-level access to exercise opportunities and cardiovascular disease (CVD) mortality across US counties.

METHODS: We conducted an ecological analysis using aggregated data from two primary sources: the County Health Rankings and Roadmaps data and CDC WONDER mortality data. We compared county-level age-adjusted CVD mortality across county-level quartiles of access to exercise opportunities and physical inactivity. Stratification was performed based on age, sex, race, and urbanization variables. The rate ratio (RR) for CVD mortality was also calculated using generalized linear models.

RESULTS: We observed significant variations in CVD mortality across different levels of exercise opportunities access and physical inactivity, which was consistent across all demographic subgroups (P < 0.001). Access to exercise opportunities was significantly associated with a reduced risk of CVD mortality (RR = 0.93 [0.91-0.95]), and the association was most pronounced for acute myocardial infarction (AMI) mortality (RR, 0.80 [0.76-0.85]). The county-level physical inactivity was significantly associated with an increased risk of CVD mortality (RR, 1.16 [1.14-1.17]), especially for ischemic heart disease (IHD) (RR, 1.35 [1.31-1.38]) and AMI (RR, 1.32 [1.25-1.38]). All demographic subgroups demonstrated similar benefits in reducing the risk of CVD by improving the county-level indicators of physical activity.

CONCLUSIONS: Counties have the potential to make significant environmental strides in improving the cardiovascular health of their populations by enhancing access to exercise opportunities in the context of urbanization.

PMID:40251637 | DOI:10.1186/s12916-025-04060-8

BMC Med Educ. 2025 Apr 18;25(1):572. doi: 10.1186/s12909-025-07176-w.

ABSTRACT

BACKGROUND: Artificial Intelligence (AI) Chatbots (e.g., ChatGPT, Microsoft Bing, and Google Bard) can emulate human interaction and may support physiotherapy education. Despite growing interest, physiotherapy students’ perspectives remain unexplored. This study investigated Italian physiotherapy students’ knowledge, use, and perception of the benefits and limitations of AI Chatbots.

METHODS: A cross-sectional study was conducted through Survey Monkey from February to June 2024. One thousand five hundred and thirty-one physiotherapy students from 10 universities were involved. The survey consisted of 23 questions investigating: (a) respondent characteristics, (b) AI Chatbot knowledge and use, (c) perceived benefits, and (d) limitations. Multiple-choice and Likert-scale-based questions were adopted. Factors associated with knowledge, use, and perceptions of AI were explored using logistic regression models.

RESULTS: Of 589 students (38%) that completed the survey, most were male (n = 317; 53.8%) with a mean age of 22 years (SD = 3.88). Nearly all (n = 561; 95.3%) had heard of AI Chatbots, but 53.7% (n = 316) never used these tools for academic purposes. Among users, learning support was the most common purpose (n = 187; 31.8%), while only 9.9% (n = 58) declared Chatbot use during internships. Students agreed that Chatbots have limitations in performing complex tasks and may generate inaccurate results (median = 3 out of 4). However, they neither agreed nor disagreed about Chatbots’ impact on academic performance, emotional intelligence, bias, and fairness (median = 2 out of 4). The students agreed to identify the risk of misinformation as a primary barrier (median = 3 out of 4). In contrast, they neither agreed nor disagreed on content validity, plagiarism, privacy, and impacts on critical thinking and creativity (median = 2 out of 4). Young students had 11% more odds of being familiar with Chatbots than older students (OR = 0.89; 95%CI 0.84-0.95; p = < 0.01), whereas female students had 39% lesser odds than males to have used Chatbots for academic purposes (OR = 0.61; 95%CI 0.44-0.85; p = < 0.01).

CONCLUSIONS: While most students recognize the potential of AI Chatbots, they express caution about their use in academia. Targeted training for students and faculty, supported by institutional and national guidelines, could guarantee a responsible integration of these technologies into physiotherapy education.

TRIAL REGISTRATION: Not applicable.

PMID:40251635 | DOI:10.1186/s12909-025-07176-w