Category: Nevin Manimala

Clin Neurol Neurosurg. 2025 Apr 14;253:108893. doi: 10.1016/j.clineuro.2025.108893. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Traumatic brain injury (TBI) is characterized by a wide range in severity. This variation presents a challenge for predicting outcomes and making management decisions, particularly for patients sustaining less severe injury. We present a novel statistical model for the prediction of hospital outcomes in two propensity-matched cohorts to optimize TBI patient management and counseling.

METHODS: Hospitalized patients diagnosed with TBI were selected from the Nationwide Readmissions Database (NRD) from 2010 to 2019 using ICD-9 and ICD-10 codes. Using propensity score matching for baseline characteristics, patients were sorted by GCS score into two cohorts: 1188 patients with mild to moderate TBI (mTBI, GCS > 8) and 1219 patients with severe TBI (sTBI, GCS ≤ 8). Mixed-effects modeling was implemented, and model performance was evaluated using the Area Under the Curve (AUC). Any variance in ROC model prediction between cohorts was compared using DeLong’s test.

RESULTS: After bivariate analysis, the mean length of stay (LOS), hospital cost, and mortality were significantly lower in the mTBI cohort relative to sTBI. GCS scores within the range of 9-15 were predictive of LOS (p < 0.01), with a trend towards significance in the prediction of non-routine discharge (p = 0.06).

CONCLUSION: Using an advanced mixed-effects model, our study found that GCS is an accurate predictor of hospital outcomes after a TBI diagnosis. These results provide insight that may aid in the development of preventative strategies, management decisions, and patient counseling to ensure a safe return to daily life for patients diagnosed with concussion.

PMID:40273479 | DOI:10.1016/j.clineuro.2025.108893

Gen Hosp Psychiatry. 2025 Apr 18;95:44-51. doi: 10.1016/j.genhosppsych.2025.04.004. Online ahead of print.

ABSTRACT

OBJECTIVE: Veterans with schizophrenia or bipolar disorder (SZ/BP) experience excess mortality due to several reasons, including cancer. We evaluated whether disparities exist in stage of non-small-cell lung cancer (NSCLC) diagnosis and survival between Veterans Health Administration (VHA) patients with and without SZ/BP.

METHOD: This retrospective evaluation used VHA data to identify patients newly diagnosed with NSCLC from 2005 to 2014. Bivariate analyses compared NSCLC stage at diagnosis by SZ/BP status. Kaplan-Meier and adjusted Cox proportional hazards regression analyses examined differences in survival by SZ/BP status. Meaningful differences were assessed using statistical significance, p < .01, and effect sizes of least 0.2 less/greater than 1.

RESULTS: The cohort included 64,269 VHA patients with newly diagnosed NSCLC. These included 1605 (2.5 %) patients with schizophrenia and 1099 (1.7 %) with bipolar disorder. Stage at diagnosis did not meaningfully differ between patients with and without SZ/BP. After adjusting for stage of diagnosis and other factors, schizophrenia, but not bipolar disorder, was associated with an increased risk of five-year all-cause mortality compared to no SZ/BP (schizophrenia: HR 1.22, 95 % CI 1.14-1.30; bipolar: HR 1.01, 95 % CI 0.94-1.10).

CONCLUSIONS: VHA patients diagnosed with NSCLC who had schizophrenia experienced greater mortality compared to those without SZ/BP, despite no meaningful differences between the two groups in stage of NSCLC at diagnosis. Further work to understand drivers of this difference (e.g., access to NSCLC treatment) and subsequent interventions are needed.

PMID:40273476 | DOI:10.1016/j.genhosppsych.2025.04.004

Rev Med Inst Mex Seguro Soc. 2025 Mar 3;63(2):e6353. doi: 10.5281/zenodo.14617070.

ABSTRACT

BACKGROUND: SARS-CoV-2 is associated with the activation of innate immunity, with an observed increase in neutrophils, mononuclear phagocytes, and natural killer cells, as well as a decrease in T cells. Interferon plays important roles in restricting viruses and is crucial because it participates in both innate and adaptive immunity. Gamma interferon (IFN-γ) is a cytokine that plays a fundamental role in maintaining homeostasis in the body, both in vitro and in vivo.

OBJECTIVE: An immunological study was conducted to measure the concentrations of IFN-γ in severe SARS-CoV-2-positive patients.

MATERIAL AND METHODS: Around 500 sera from patients with similar respiratory comorbidities at the onset of the disease were analyzed, using healthy patients as controls. The sera from SARS-CoV-2-positive individuals were processed using the ELISA technique, and the statistical treatment of the data involved creating a database with the absorbance readings, which were then converted into concentrations in pg/ml.

RESULTS: We can infer that the amount of IFN-γ expression depends on the patient’s condition; the more severe the patient’s condition, the higher the expression of this cytokine compared to their baseline levels, ranging from 0 to 0.5 μg/ml.

CONCLUSION: It is suggested that the IFN-γ response plays an important role in controlling the disease, and effective therapies are recommended for the treatment of Covid-19, which will lead to the implementation of therapeutic approaches aimed at counteracting the immune system, especially in the more severe forms of the disease.

PMID:40273463 | DOI:10.5281/zenodo.14617070

JMIR Res Protoc. 2025 Apr 24;14:e71867. doi: 10.2196/71867.

ABSTRACT

BACKGROUND: Probation officers and other professionals who work with youth in the legal system often experience high chronic workplace stress, which can contribute over time to elevations in anxiety, depression, and workplace burnout. Emotion dysregulation appears to function as a common mechanism underlying these elevations, and growing evidence suggests it can be improved with mindfulness meditation. Implemented successfully, app-based meditation programs could provide professionals with real-time tools for mitigating the effects of chronic workplace stress.

OBJECTIVE: This paper describes the protocol for a hybrid type 2 effectiveness-implementation pilot randomized controlled trial (RCT) of Bodhi AIM+, a meditation app adapted with and for professionals who work with youth in the legal system. The adaptation process and implementation plan, as well as the pilot RCT design, were guided by theoretically driven implementation science frameworks. The primary outcome of the pilot RCT is app adherence (ie, ongoing app usage per objective analytics data).

METHODS: The RCT will be fully remote. Officers and other professionals who work with youth in the legal system (N=50) will be individually randomized to use the meditation app or an active control app matched for time and structure. All participants will be asked to follow a 30-day path of brief audio- or video-guided content and invited to use additional app features as desired. In-app analytics will capture the objective usage of each feature. An adaptive engagement design will be employed to engage nonusers of both apps, whereby analytics data indicating nonuse will trigger additional support (eg, text messages promoting engagement). Mental health outcomes and potential moderators and covariates will be self-reported at baseline, posttest, and 6 months. Participants will also complete 1-week bursts of ecological momentary assessment (EMA) at baseline and over the last week of the intervention to capture the mechanistic target (ie, emotion regulation) in real time. All participants will be invited to complete qualitative posttest interviews. Descriptive statistics will be calculated for quantitative data. Qualitative data will be analyzed using a combined deductive-inductive approach. The quantitative and qualitative data will be incorporated into a mixed methods triangulation design, allowing for the evaluation of app adherence and other implementation outcomes as well as related barriers and facilitators to implementation.

RESULTS: Enrollment into the trial started in December 2024 and is currently underway. Study results are anticipated to be available in 2026.

CONCLUSIONS: Completion of this pilot trial will inform a future, fully powered RCT to formally evaluate the effectiveness and implementation of Bodhi AIM+. Its use of implementation science methods, coupled with digital technology, positions the present study not only to help make meditation tools available to an important workforce at scale but also to inform broader efforts at implementing and evaluating health apps within workplace settings.

TRIAL REGISTRATION: ClincialTrials.gov NCT06555172; https://clinicaltrials.gov/study/NCT06555172.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/71867.

PMID:40273446 | DOI:10.2196/71867

Rev Med Inst Mex Seguro Soc. 2025 Mar 3;63(2):e6591. doi: 10.5281/zenodo.14617002.

ABSTRACT

BACKGROUND: Area strain evaluates the longitudinal and circumferential deformation simultaneously. There are not estudies that support its benefit in predicting functional recovering in myocardial infarction.

OBJECTIVE: The aim was establish the prognostic value of the area strain measured within the first 7 days after succesful angioplasty to predicting functional recovering.

MATERAIL AND METHODS: A prospective cohort study was performed during 3-month follow-up. Patients with myocardial infarction treated with succesful angioplasty were enrolled. The area strain was perfomed within the first 7 days. Functional recovering was defined as an improvement of the ejection fraction ≥ 10% at 3-months follow-up.

RESULTS: A total of 52 patients were enrolled. An area strain of ≤ -24.2 % appeared in the 45.5% of the patients with functional recovering, RR 16.25 (IC 95%: 2.55-103, p = 0.003). In the multivariate analyses the area strain of ≤ -24.2 % was the only variable with statistical significance with an OR of 13.15 (IC 95%: 1.83-94, p = 0.010) when was adjusted to hypertension, OR of 12.7 (IC 95%: 1.88-85.9, p = 0.009) adjusted to reperfusion time of ≤ 120 minutes and the OR was of 11.87 (IC 95%: 1.66-84.5, p = 0.013) adjusted to smoking.

CONCLUSIONS: An area strain of ≤ – 24.2% is a prognostic factor of improvement of ejection fraction of ≥ 10% at 3-months follow-up in patients with myocardial infarction and succesful angioplasty.

PMID:40273433 | DOI:10.5281/zenodo.14617002

Invest Radiol. 2025 Apr 25. doi: 10.1097/RLI.0000000000001196. Online ahead of print.

ABSTRACT

OBJECTIVES: Deuterium (2H) metabolic imaging (DMI) is an emerging magnetic resonance technique to non-invasively map human brain glucose (Glc) uptake and downstream metabolism following oral or intravenous administration of 2H-labeled Glc. The achievable spatial resolution is limited due to inherently low sensitivity of DMI. This hinders potential clinical translation. The purpose of this study was to improve the signal-to-noise ratio (SNR) of 3D DMI via a balanced steady-state free precession (bSSFP) acquisition scheme combined with fast non-Cartesian spatial-spectral sampling to enable high-resolution dynamic imaging of neural Glc uptake and glutamate+glutamine (Glx) synthesis of the human brain at 7T.

MATERIALS AND METHODS: Six healthy volunteers (2 f/4 m) were scanned after oral administration of 0.8 g/kg [6,6′]-2H-Glc using a novel density-weighted bSSFP acquisition scheme combined with fast 3D concentric ring trajectory (CRT) k-space sampling at 7T. Time-resolved whole brain DMI datasets were acquired for approximately 80 minutes (7 minutes per dataset) after oral 2H-labeled Glc administration with 0.75 mL and 0.36 mL isotropic spatial resolution and results were compared to conventional spoiled Free Induction Decay (FID) 2H-MRSI with CRT readout at matched nominal spatial resolution. Dynamic DMI measurements of the brain were accompanied by simultaneous systemic Glc measurements of the interstitial fluid using a continuous Glc monitoring (CGM) sensor (on the upper arm). The correlation between brain and interstitial Glc levels was analyzed using linear mixed models.

RESULTS: The bSSFP-CRT approach achieved SNRs that were up to 3-fold higher than conventional spoiled FID-CRT 2H-MRSI. This enabled a 2-fold higher spatial resolution. Seventy minutes after oral tracer uptake comparable 2H-Glc, 2H-Glx, and 2H-water concentrations were detected using both acquisition schemes at both, regular and high spatial resolutions (0.75 ml and 0.36 mL isotropic). The mean Areas Under the Curve (AUC) for interstitial fluid Glc measurements obtained using a CGM sensor was 509 ± 65 mM·min. This is 3.4 times higher than the mean AUC of brain Glc measurements of 149 ± 43 mM·min obtained via DMI. The linear mixed models fitted to assess the relationship between CGM measures and brain 2H-Glc yielded statistically significant slope estimates in both GM (β1 = 0.47, P = 0.01) and WM (β1 = 0.36, P = 0.03).

CONCLUSIONS: In this study we successfully implemented a balanced steady-state free precession (bSSFP) acquisition scheme for dynamic whole-brain human DMI at 7T. A 3-fold SNR increase compared to conventional spoiled acquisition allowed us to double the spatial resolution achieved using conventional FID-CRT DMI. Systemic continuous glucose measurements, combined with dynamic DMI, demonstrate significant potential for clinical applications. This could help improve our understanding of brain glucose metabolism by linking it to time-resolved peripheral glucose levels. Importantly, these measurements are conducted in a minimally invasive and physiological manner.

PMID:40273422 | DOI:10.1097/RLI.0000000000001196

Can Urol Assoc J. 2025 Apr 17. doi: 10.5489/cuaj.9077. Online ahead of print.

ABSTRACT

INTRODUCTION: The majority (97.5%) of men with prostate cancer (PCa) live for at least five years after diagnosis. The health-related quality of life (HRQoL) of such men is affected by the adverse effects of treatment. Men living in remote areas of Canada have difficulty accessing specialized medical resources and psychological support. This constitutes an additional burden that weighs heavily on their HRQoL. Regular physical activity (PA) has a direct benefit, or an effect mediated by emotional distress, on the HRQoL of such individuals. In Canada, and elsewhere in the world, there is a poor uptake of PA-related recommendations.

METHOD: We conducted a cross-sectional, observational study among 85 participants between May 2023 and September 2023. We then explored, through mediation analyses, the association between PA and HRQoL, taking into account the potential mediating effect of emotional distress.

RESULTS: Most participants (61.2%) engaged in a high level of PA; however, their physical and mental HRQoL scores were low (mean scores of 41.99±6.09 and 52.40±4.86, respectively). Participants self-reported low levels of stress (mean score of 3.18±2.62). Very few participants (5.9%) displayed symptoms consistent with depression. In contrast, the majority of participants (92.9%) displayed symptoms of anxiety. No significant statistical association was observed between the level of PA and HRQoL.

CONCLUSIONS: This lack of association may be explained by the short-term, seasonal nature of certain types of PA, which prevents such PA from having a positive effect on the HRQoL.

PMID:40273413 | DOI:10.5489/cuaj.9077

Can Urol Assoc J. 2025 Apr 17. doi: 10.5489/cuaj.9121. Online ahead of print.

ABSTRACT

INTRODUCTION: We aimed to assess early and late continence rates post-robot-assisted radical prostatectomy (RARP), comparing posterior reconstruction (PR) urethrovesical anastomosis (UVA) to conventional urethrovesical anastomosis (C-UVA).

METHODS: Consecutive patients with clinically localized prostate cancer undergoing RARP underwent simple randomization to PR-UVA or C-UVA. Return to continence outcomes were assessed using a validated questionnaire (Expanded Prostate Cancer Index Composite [EPIC] Short Form-26) at baseline, two-, three-, four-, six-, eight-, and 12-month followups. Five-year outcomes were assessed by frequency of undergoing continence-improving procedures.

RESULTS: A total of 163 patients were randomized 1:1 to PR-UVA or C-UVA from April 2014 to July 2015, and 140 patients completed followup. There were no significant clinical or functional differences between groups preoperatively. Using a continence definition of 0-1 pads/day, the continence rates for PR-UVA vs. C-UVA were 39% vs. 38% at two months, respectively (p=1.0), and 93% vs. 86%, respectively, at 12 months (p=0.3). Frequency of urine leak, quantity of pad use, subjective urinary control, and overall bother improved significantly in all patients during the 12-month study period (p<0.001); however, no difference was demonstrated between groups. Five-year results showed no statistically significant difference in the number of patients undergoing a continence-improving procedure (hazard ratio 1.21, 95% confidence interval 0.40-3.65, p=0.7).

CONCLUSIONS: PR-UVA failed to show a benefit in short-term return to urinary continence or need for an incontinence-improving procedure five years post-RARP.

PMID:40273410 | DOI:10.5489/cuaj.9121

JMIR Public Health Surveill. 2025 Apr 24;11:e68355. doi: 10.2196/68355.

ABSTRACT

BACKGROUND: Early diagnosis and treatment initiation for tuberculosis (TB) not only improve individual patient outcomes but also reduce circulation within communities. Active case-finding (ACF), a cornerstone of TB control programs, aims to achieve this by targeting symptom screening and laboratory testing for individuals at high risk of infection. However, its efficiency is dependent on the ability to accurately identify such high-risk individuals and communities. The socioeconomic determinants of TB include difficulties in accessing health care and high within-household contact rates. These two determinants are common in the poorest neighborhoods of many sub-Saharan cities, where household crowding and lack of health-care access often coincide with malnutrition and HIV infection, further contributing to the TB burden.

OBJECTIVE: In this study, we propose a new approach to enhance the efficacy of ACF with focused interventions that target subpopulations at high risk. In particular, we focus on densely inhabited urban areas, where the proximity of individuals represents a proxy for poorer neighborhoods with enhanced contact rates.

METHODS: To this end, we used satellite imagery of the city of Kigali, Rwanda, and computer-vision algorithms to identify areas with a high density of small residential buildings. We subsequently screened 10,423 people living in these areas for TB exposure and symptoms and referred patients with a higher risk score for polymerase chain reaction testing.

RESULTS: We found autocorrelation in questionnaire scores for adjacent areas up to 782 meters. We removed the effects of this autocorrelation by aggregating the results based on H3 hexagons with a long diagonal of 1062 meters. Out of 324 people with high questionnaire scores, 202 underwent polymerase chain reaction testing, and 9 people had positive test results. We observed a weak but statistically significant correlation (r=0.28; P=.04) between the mean questionnaire score and the mean urban density of each hexagonal area.

CONCLUSIONS: Nine previously undiagnosed individuals had positive test results through this screening program. This limited number may be due to low TB incidence in Kigali, Rwanda, during the study period. However, our results suggest that analyzing satellite imagery may allow the identification of urban areas where inhabitants are at higher risk of TB. These findings could be used to efficiently guide targeted ACF interventions.

PMID:40273403 | DOI:10.2196/68355

Eur J Prev Cardiol. 2025 Apr 24:zwaf239. doi: 10.1093/eurjpc/zwaf239. Online ahead of print.

ABSTRACT

AIMS: Which cardiometabolic risk factors (CMRFs) primarily mediate the association between long-term fine particulate matter (PM2.5) exposure and coronary artery disease (CAD) incidence, and whether participants with high genetic risks of CMRFs are more susceptible remains unclear.

METHODS: This study was based on the project of Prediction for Atherosclerotic Cardiovascular Disease Risk in China. Long-term PM2.5 concentration was assessed by satellite-based spatiotemporal model at 1km resolution. Mediation analyses were conducted to assess the mediating contribution of CMRFs for PM2.5 and CAD, and then stratified by genetic risk of CMRFs. Additive interaction was additionally evaluated on modification of genetic risk for PM2.5 and CAD.

RESULTS: During a median follow-up of 11.15 years, 941 CAD cases of 34,481 participants were recorded. Each 10 μg/m3 increase in PM2.5 exposure was associated with a 28% increased risk of CAD (hazard ratio: 1.28; 95% confidence interval [CI]: 1.19, 1.37). Systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-C) emerged as the primary mediators, with mediating proportions of 13.02% (95%CI:4.63,21.42) and 9.23% (95%CI:0.34,18.12), respectively. Notably, individuals with high genetic risk exhibited greater mediating proportions at 18.99% (95%CI:6.43,31.55) and 16.30% (95%CI:5.11,27.52) then those with low genetic risk at 2.42% (95%CI: -16.80,21.64) and 6.15% (95%CI: -8.13,20.43). Meanwhile, the genetic risks of SBP and LDL-C also significantly exacerbated CAD risk related to PM2.5 exposure, demonstrating additive interaction (P<0.05).

CONCLUSIONS: This study provided a combination of conventional and genetic evidence to underscore the importance of integrated management targeting BP and blood cholesterol to mitigate CAD burden when PM2.5 exposure is unavoidable.

PMID:40273389 | DOI:10.1093/eurjpc/zwaf239