Category: Nevin Manimala

J Surg Res. 2025 Dec 10;317:173-180. doi: 10.1016/j.jss.2025.11.018. Online ahead of print.

ABSTRACT

INTRODUCTION: Pediatric gunshot wounds to the head (GSWH) are among the most devastating injuries, with mortality rates ranging from 20% to 65%. Prognostic tools such as the St. Louis Score (SLS) and Rotterdam computed tomography (CT) Score have been studied, but data specific to pediatric populations are limited. This study aimed to identify factors predictive of mortality and functional outcomes in pediatric GSWH and evaluate the predictive accuracy of existing scoring systems.

METHODS: We retrospectively reviewed all 14 pediatric patients (≤18 y old) with GSWH at an urban, level 1 trauma center between 2010 and 2023. Patient demographics, injury characteristics, imaging findings, and outcomes were analyzed. Predictive tools were evaluated using receiver operator curve analysis, and statistical comparisons were conducted between survivors and nonsurvivors and between favorable (Glasgow Outcome Score ≥ 4) and unfavorable outcomes.

RESULTS: The overall mortality rate was 65%. Survivors had significantly higher admission Glasgow Coma Scale (11 versus 4, P = 0.008), lower international normalized ratio (1.1 versus 1.7, P = 0.015), lower serum glucose (138 versus 225, P = 0.021), and lower Rotterdam CT Scores (3 versus 5, P = 0.038). SLS and Rotterdam CT Score demonstrated poor predictive accuracy for mortality.

CONCLUSIONS: Survivors of pediatric GSWH exhibited distinct clinical and laboratory profiles on admission, including higher Glasgow Coma Scale and lower international normalized ratio and glucose levels. While the Rotterdam CT Score performed better than the SLS, both prognostic tools were suboptimal to predict favorable outcomes for this cohort. Larger studies are needed to refine predictive models and improve management strategies in pediatric GSWH.

PMID:41380225 | DOI:10.1016/j.jss.2025.11.018

Sleep Med. 2025 Dec 6;138:108708. doi: 10.1016/j.sleep.2025.108708. Online ahead of print.

ABSTRACT

Although sodium-glucose transporter 2 inhibitors (SGLT2is) are recommended medications for the treatment of type 2 diabetes mellitus (T2DM), conclusive evidence suggesting that they could alleviate the common complication of obstructive sleep apnea (OSA) in T2DM is lacking at present. Our objective is to systematically summarize the clinical evidence of SGLT2is for OSA in patients with T2DM by searching 12 databases and registers from the establishment to July 25, 2025. We included randomized controlled trials (RCTs) and non-randomized studies evaluating the use of SGLT2is for OSA in participants with T2DM. This analysis was registered on the PROSPERO website (CRD42024576637) and performed in accordance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Data were extracted by two investigators separately, and the meta-analysis of sleep-disordered breathing parameters, metabolic parameters, and adverse events outcomes was conducted using Review Manager 5.4 and Stata 15.0. Nine studies, including six RCTs and three non-RCTs, were included. The results demonstrated that the efficacy of SGLT2is in reducing the apnea-hypopnea index (AHI) (mean difference [MD] = -12.57, 95 % confidence interval [CI]: [-21.47, -3.66], P = 0.006, I² = 87 %) and increasing the lowest oxygen saturation (lowest SpO₂) was superior to that of the control interventions with other hypoglycemic drugs. Patients with T2DM showed a 50 % relative risk reduction for incident OSA when receiving SGLT2is in comparison with placebo. Furthermore, the adverse event rate in the SGLT2i group was comparable to that in the control group. Considering of the risk reduction for incident OSA and the enhanced metabolic parameters observed with SGLT2i administration, these drugs may be recommended as useful medication for the management of T2DM and OSA. However, Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessments rated the evidence quality as low to moderate because of inconsistency and indirectness. Given the weak strength of the evidence, further trials with sufficient statistical power are still needed to confirm efficacy and safety.

PMID:41380220 | DOI:10.1016/j.sleep.2025.108708

Burns. 2025 Dec 3;52(1):107819. doi: 10.1016/j.burns.2025.107819. Online ahead of print.

ABSTRACT

BACKGROUND: Hypertrophic scarring (HTS) is a major concern after burns. While conservative therapy is standard for superficial partial thickness burns and debridement for deep burns, the optimal treatment for intermediate depth burns remains unclear. This retrospective study assesses whether enzymatic debridement with Nexobrid® (EDNX) can reduce HTS in intermediate depth burns.

METHODS: Patients with intermediate depth burns (healing potential (HP) 14-21 days), assessed by laser Doppler imaging (LDI), were retrospectively analysed for HTS following conservative therapy or EDNX. Regions of interest (ROIs) were analysed for flux values, surface area, and wound closure time. HTS within ROIs was evaluated at 3-6, 6-12, and 12-24 months post-injury, independently by two burn specialists.

RESULTS: In total, 87 ROIs were analyzed in 62 patients, with 44 ROIs treated conservatively and 43 ROIs treated with EDNX. HTS was still present after 12 months in 13.6 % (6/44) of ROIs in the conservative group and 9.3 % (4/43) in the EDNX group, showing no statistically significant difference between the two groups (p = 0.186). The conservative group and EDNX group were comparable, with no statistically significant difference in flux values (346.41 ± 22.90 vs. 340.19 ± 20.75, p = 0.275) or wound closure time (22.70 ± 7.90 vs. 23.42 ± 7.47, p = 0.862). A statistically significant correlation was found between HTS formation and wound closure time (p = 0.001); however, no significant correlation was observed between HTS formation and flux values (p = 0.262).

CONCLUSION: The overall incidence of HTS after scar maturation was low in both the conservative group (13.6 %) and in the EDNX group (9.3 %). A small, but in significant difference was observed in HTS prevalence between intermediate depth burns treated conservatively and those treated with EDNX. These findings support conservative management through local wound care as the preferred approach for intermediate depth burns.

PMID:41380209 | DOI:10.1016/j.burns.2025.107819

Drug Alcohol Depend. 2025 Dec 5;278:112995. doi: 10.1016/j.drugalcdep.2025.112995. Online ahead of print.

ABSTRACT

BACKGROUND: Primary care settings tailored for persons with experience of homelessness (PEH) could enhance opioid use disorder treatment delivery, but evidence is lacking.

OBJECTIVE: To examine medication treatment for opioid use disorder (MOUD) among PEH who received homeless-tailored primary care in the Department of Veterans Affairs (VA).

METHODS: Receipt of MOUD was assessed from electronic health records among VA primary care patients with experience of homelessness and OUD in 2016-2020. We estimated the proportion who received MOUD over time and applied mixed effect Poisson models with entropy balance weighting to estimate differences in MOUD by primary care type (homeless-tailored vs. mainstream). Secondary analyses examined the consistency of findings across 18VA service regions.

FINDINGS: The percentage of eligible PEH (n = 45,864) receiving any MOUD rose from 42.1 % to 51.0 % over time. Half (51.3 %) of those initiating MOUD received > 30 days MOUD over one year. In unadjusted models, the proportion receiving MOUD was slightly higher in homeless-tailored primary care, compared to mainstream primary care (48.8 % vs 46.4 %, Unadjusted Incidence Rate Ratio=1.09, 95 % CI=1.03-1.16). After covariate adjustment, there was no statistical difference between groups (Adjusted IRR=0.97, CI=0.92-1.02). This proved broadly consistent across VA service regions.

CONCLUSIONS: Concomitant with a national VA initiative to tailor primary care services for PEH, half of diagnosed patients received MOUD. Yet evidence of durable treatment was low, and the homeless-tailored clinics did not outperform mainstream clinics. Efforts to tailor primary care for PEH may require specialized addiction staffing and implementation support to improve MOUD care in these settings.

PMID:41380198 | DOI:10.1016/j.drugalcdep.2025.112995

Appl Radiat Isot. 2025 Dec 8;229:112372. doi: 10.1016/j.apradiso.2025.112372. Online ahead of print.

ABSTRACT

BACKGROUND: Medical imaging is a major source of ionizing radiation exposure in healthcare. Effective radiation protection relies not only on facility design but also on healthcare staff knowledge, attitudes, and practices (KAP).

OBJECTIVE: To evaluate KAP related to radiation protection among staff at two nuclear medicine facilities such as Facility A and Facility B in Addis Ababa, Ethiopia, and assess relationships with occupational exposure and facility design.

METHODS: A cross-sectional study was conducted among 28 personnel using structured questionnaires, checklists, and interviews. KAP scores were calculated, with thresholds for satisfactory performance defined as ≥67 % for knowledge, attitude (corrected for misconceptions), and practice. Occupational doses were measured and compared with ICRP limits.

RESULTS: Eighty-five point seven percent of participants demonstrated satisfactory knowledge, while only 64.3 % had a good attitude after correcting misconceptions, such as the incorrect belief that dosimeters prevent all radiation. Seventy-five percent of personnel followed adequate radiation protection practices. The mean annual occupational dose was 0.33 ± 0.13 mSv, significantly below the ICRP limit of 20 mSv/year, indicating low actual exposure despite some gaps in understanding. Although education and occupation influenced practice, no statistically significant associations were found with overall knowledge, attitude, and practice (KAP) scores.

CONCLUSION: While personnel show adequate knowledge and practice, critical misconceptions about dosimeter function remain. Continuous training and education are necessary to correct these misconceptions. Occupational exposure levels are low, but improved safety culture and awareness are needed to maintain long-term protection. Future research should explore correlations between individual KAP scores and dose readings.

PMID:41380183 | DOI:10.1016/j.apradiso.2025.112372

J Acquir Immune Defic Syndr. 2026 Jan 1;101(1):95-102. doi: 10.1097/QAI.0000000000003765.

ABSTRACT

OBJECTIVE: To examine the association between mild kidney disease and coronary plaque parameters using coronary computed tomography angiography in people living with HIV (PWH) compared with people without HIV in Uganda.

DESIGN: Cross-sectional secondary analysis.

METHODS: We studied 165 participants aged >45 years with ≥1 cardiovascular risk factor (78 PWH on stable antiretroviral therapy, 87 HIV-negative). Kidney function was assessed using estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR). Coronary artery disease (CAD) was characterized by segment involvement score (SIS), segment stenosis score (SSS), and coronary artery calcium score. Multivariable Tobit regression assessed associations of kidney function measures with CAD parameters, testing for differences by HIV status.

RESULTS: The median (interquartile range) age was 57.0 (53-62) years, 62.4% of subjects were female, and 87.3% had hypertension. Among PWH, mildly impaired eGFR (<90 mL/min/1.73 m2) was associated with higher SIS [β 3.31, 95% confidence interval (CI): 0.41 to 6.21, P = 0.03] and SSS (β 5.95, 95% CI: 0.54 to 11.36, P = 0.03). The association with SIS remained significant after adjusting for age, gender, and 10-year ASCVD score (β 2.58, 95% CI: 0.10 to 5.06, P = 0.04). Associations of ACR with coronary plaque were not statistically significant for participants with or without HIV (all P > 0.07).

CONCLUSION: In PWH, mildly reduced eGFR was associated with greater coronary plaque burden (SIS, SSS) but not coronary artery calcium; ACR showed no associations with any CAD measures. Incorporating kidney function measures into cardiovascular risk assessment may be valuable in HIV care.

PMID:41380171 | DOI:10.1097/QAI.0000000000003765

J Addict Nurs. 2025 Dec 5. doi: 10.1097/JAN.0000000000000686. Online ahead of print.

ABSTRACT

BACKGROUND: Stigma is a key barrier to accessing or receiving substance use services. Those with substance use disorders (SUD) who seek health care services experience stigmatizing attitudes and behaviors from health care providers, including nurses. Integrating substance use-related content into core courses for advanced practice nursing students may help reduce stigma and prepare them to assist patients with SUDs across various specialties where advanced practice nurses work. This exploratory descriptive study assessed advanced practice nursing students’ attitudes and stigma perceptions related to caring for people with alcohol and drug use.

METHOD: An online survey was used to obtain demographic information and responses to three established measures focusing on substance use-related attitudes, perceptions, and stigma. Data were collected from students (baseline group) scheduled to take core required “3P” courses (Physical Assessment, Pathophysiology, and Pharmacotherapy) into which enhanced substance use-related content was infused. A separate group (postcourse) completed the measures after the enhanced courses. Descriptive statistics were obtained for demographic data, and means and standard deviations were calculated for subscales and total scores of the Person-Centered Drug and Drug Problems Perception Questionnaire, the Person-Centered Alcohol and Alcohol Problems Perception Questionnaire, and the Opening Minds Scale to examine differences before and after the enhanced content.

RESULTS: Eleven students completed the baseline survey and 12 completed the postcourse survey. Although statistical comparison was not possible, postcourse responses reflected more favorable attitudes toward people with SUD.

CONCLUSION: The more favorable attitudes following the 3P courses are promising. Future research should use more rigorous pre-post or longitudinal designs.

PMID:41380164 | DOI:10.1097/JAN.0000000000000686

Obstet Gynecol. 2025 Dec 11. doi: 10.1097/AOG.0000000000006147. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine preferences for human papillomavirus (HPV) specimen self-collection, and collection location, in a nationally representative sample of reproductive-aged women in the United States.

METHODS: This cross-sectional analysis used household population-based data from the National Survey of Family Growth (January 2022-December 2023) and was limited to women aged 21-49 years without a history of hysterectomy or cervical cancer (sample n=4,465). Survey weights and design variables were applied to generate nationally representative population frequencies and percentages of preference for HPV self-collection compared with clinician collection, and preference for collection location (ie, at home or in office).

RESULTS: Among eligible U.S. women, 42.9% preferred HPV self-collection, 28.5% preferred clinician collection, and 28.6% expressed no preference. An estimated 41.7 million (71.5%) U.S. women aged 21-49 years were open to HPV self-collection (either preferring it or having no preference), including 9.7 million women who were underscreened or never screened. Among women who were open to HPV self-collection, more than half (52.1%) preferred self-collection at home, 14.7% preferred to do self-collection in a doctor’s office, and 33.2% had no preference for location. More underscreened or never-screened women preferred HPV self-collection (54.0%) and at-home collection (59.3%) compared with those who were up to date with screening (40.3% and 50.2%, respectively, P<.001). Preference for self-collection also varied by race and Hispanic origin, education, income, parity, sexual orientation, and prior experience of nonvoluntary vaginal intercourse.

CONCLUSION: In this nationally representative study, more than 7 in 10 U.S. women aged 21-49 years were open to HPV self-collection for cervical cancer screening, with more than half favoring at-home collection. Preference was higher among women who were not up to date with screening. These findings provide timely evidence to inform future policy decisions and implementation strategies to improve access to cervical cancer screening.

PMID:41380156 | DOI:10.1097/AOG.0000000000006147

JMIR Mhealth Uhealth. 2025 Dec 11;13:e73512. doi: 10.2196/73512.

ABSTRACT

BACKGROUND: Approximately 1 out of 5 pregnant women develops depression. Internet-based cognitive behavioral therapy (iCBT) is an effective way to treat not only depression but also mild depressive symptoms or subthreshold depression. While numerous iCBT programs have been developed and tested through randomized controlled trials for various mental health conditions and specific populations, research on their effectiveness and application in the real world remains limited.

OBJECTIVE: This study aimed to examine the effectiveness of a previously developed iCBT program implemented in an existing app for improving depressive symptoms among pregnant women in a real-world setting.

METHODS: The previously developed iCBT program for preventing perinatal depression was already implemented in an existing app called Luna Luna Baby by MTI Ltd. The app aims to provide information to pregnant women about pregnancy and babies, and potential users can download it from the Japanese version of the Apple App Store or Google Play Store without any fee. The program does not require any additional fees. The log data stored on the app identified iCBT program users and nonusers, allowing us to conduct this retrospective cohort study. Data from September 2022 to September 2024 were extracted from the app after anonymous processing. The primary outcome was the score on the self-reported Edinburgh Postnatal Depression Scale (EPDS), which participants answer by themselves on the app. The exposure group was defined as completers of all 6 modules of the iCBT program. The nonexposure group was defined as users who did not use any module of the program and matched the baseline characteristics of the exposure group. The change in EPDS score before and after using the program was compared using effect sizes, and repeated 2-way ANOVA was conducted to test the difference between the exposure and nonexposure groups.

RESULTS: Data from 119 women who completed the iCBT program and 448 pair-matched controls were selected. The average EPDS scores at baseline were 7.24 (SD 5.30) in the exposure group and 7.25 (SD 5.18) in the nonexposure group. After using the iCBT program, the group mean EPDS scores changed by -0.69 (SD 4.92) and +0.99 (SD 5.56) over time in the exposure and nonexposure groups, respectively (Cohen d=0.31, 95% CI 0.11-0.51). The repeated 2-way ANOVA showed statistical significance in the interaction terms between the groups and the measurement time points (P=.04).

CONCLUSIONS: The previously developed iCBT program showed a significant effect with a modest effect size on decreasing depressive symptoms among pregnant women in a real-world setting. Future research should attempt to minimize dropouts and increase participation in the program.

PMID:41380149 | DOI:10.2196/73512

JMIR Mhealth Uhealth. 2025 Dec 11;13:e82465. doi: 10.2196/82465.

ABSTRACT

BACKGROUND: Sleep is essential for overall health and plays a critical role in the diagnosis of psychiatric disorders. Although polysomnography remains the gold standard for measuring sleep, its reliance on laboratory settings limits its feasibility for long-term, naturalistic monitoring, particularly for patients with mental disorders.

OBJECTIVE: This study assesses sleep-tracking reliability and alignment in healthy individuals and patients with mood disorders using wearables, nearables, and ecological momentary assessment, while examining measurement biases and the impact of seasonal and demographic factors on discrepancies across methods.

METHODS: We conducted a 14-day study in Finland and enrolled a total of 201 participants, comprising patients with a major depressive episode and healthy controls. Of these, 169 participants with sufficient observations were retained for further analyses. Participants’ sleep patterns (onset, offset, and total sleep time [TST]) were gathered daily from an actigraph (Actiwatch 2), a bed sensor (Murata SCA11H), mobile screen events, and a daily survey. The alignment between sleep measurement methods was evaluated using Bland-Altman plots and Pearson correlation. Linear mixed models were used to assess the effects of demographics, season, and disorder type on the sleep measures alignment.

RESULTS: Patients exhibited greater variability in sleep measures than healthy controls. For sleep onset, mean biases between devices were small and not statistically significant in either group, with moderate to strong correlations. In contrast, sleep offset showed significantly larger biases in patients: actigraph versus bed (+34.9 minutes; P=.01), smartphone versus bed (-45.3 minutes; P=.004), and actigraph versus smartphone (+78.7 minutes; P<.001), while controls exhibited minimal and nonsignificant differences. For TST, smartphone underestimates sleep compared to both bed sensors (-0.71 minutes; P<.001) and actigraphs (-1.35 minutes; P<.001). Across devices, TST correlations remained low, spanning r=0.12 (P=.58) to r=0.55 (P=.10) in controls and r=0.17 (P=.19) to r=0.43 (P=.002) in patients. Mixed models showed that older age was linked to better sleep offset alignment between actigraphy and bed sensors (β=-0.02, 95% CI -0.04 to 0.00; P=.048), as well as smartphone and bed sensor (β=-0.03, 95% CI -0.06 to 0.00; P=.03). Patients with bipolar/borderline personality disorder showed lower TST alignment, and alignment between smartphone and bed sensor was worse in females (β=-1.03, 95% CI -1.74 to -0.33, P=.004). Longer daylight duration was also associated with improved alignment in sleep offset and TST.

CONCLUSIONS: This study demonstrates the feasibility of using actigraphy, smartphone data, and bed sensors for sleep tracking in naturalistic settings with patients. It highlights measurement biases across devices, the impact of seasonal variations on sleep research in unique geographical regions like Finland, and key demographic factors influencing sleep measurement discrepancies.

PMID:41380148 | DOI:10.2196/82465