Category: Nevin Manimala

Am J Mens Health. 2025 Mar-Apr;19(2):15579883251336056. doi: 10.1177/15579883251336056. Epub 2025 Apr 24.

ABSTRACT

Physical activity is associated with stress urinary incontinence (SUI). The genetic causality of this association remains unclear. This study used the Mendelian randomization (MR) method to explore the potential causal relationship between physical activity and SUI risk using heavy do-it-yourself (DIY), light DIY, strenuous sports, walking for pleasure, and other exercises as proxies. We selected single nucleotide polymorphisms associated with physical activity from published genome-wide association studies (GWAS). Statistics of SUI come from the GWAS database. MR estimation was performed using the inverse variance weighting method, the MR-Egger method, and the weighted median method. Sensitivity analyses were performed using Cochran’s Q test, MR-Egger intercept, MR-pleiotropy residuals, outlier methods, leave-one-out analysis, and funnel plots. The results showed that there was a causal relationship between heavy DIY and SUI (OR = 0.9712, 95% confidence interval [0.951, 0.9918], p = .006), while no significant causal relationship was found between other physical activities and SUI. These findings were robust across multiple sensitivity analyses. This MR study demonstrates the causal relationship between heavy DIY and SUI, helping doctors and researchers better recommend preventive and treatment measures to patients, while also providing specific directions for improving their lifestyle in men and women suffering from SUI.

PMID:40270342 | DOI:10.1177/15579883251336056

J Clin Hypertens (Greenwich). 2025 Apr;27(4):e70057. doi: 10.1111/jch.70057.

ABSTRACT

Emerging evidence links the Endothelial Activation and Stress Index (EASIX) and mortality risk in coronary artery disease, but its relevance in hypertensive patients remains unclear. This study examines the association between EASIX and all-cause and cardiovascular mortality in hypertensive individuals. The analysis included 6138 hypertensive patients from seven National Health and Nutrition Examination Survey (NHNES) cycles (2003-2016), with mortality data obtained from the National Death Index (NDI). Over a median follow-up of 98 months, 1435 (23.4%) participants died, including 400 (6.5%) from cardiovascular causes. Restricted cubic spline analysis revealed a positive association between EASIX and both all-cause and cardiovascular mortality. Weighted multivariable Cox regression indicated that each 1-unit increase in EASIX corresponding to a 25% and 23% rise in mortality risk, respectively. Based on the optimal cutoff value determined using the maximally selected rank statistics method, participants were stratified into higher (>0.79) and lower (≤0.79) EASIX groups. Higher EASIX was significantly associated with increased all-cause mortality risk (HR 1.46, 95% CI 1.23-1.73, p < 0.0001). Higher EASIX scores were associated with increased cardiovascular mortality, especially in former/current smokers and those with diabetes/prediabetes. Time-dependent receiver operating characteristic analysis assessed the predictive accuracy of EASIX, yielding area under the curve (AUC) for 1-, 3-, 5-, and 10-year survival of 0.71, 0.67, 0.67, and 0.67 for all-cause mortality and 0.79, 0.73, 0.73, and 0.71 for cardiovascular mortality. In conclusion, elevated EASIX is independently associated with increased all-cause and cardiovascular mortality in hypertensive patients, suggesting its potential as a predictive biomarker in clinical practice.

PMID:40270299 | DOI:10.1111/jch.70057

Tissue Barriers. 2025 Apr 24:2497101. doi: 10.1080/21688370.2025.2497101. Online ahead of print.

ABSTRACT

Several studies have focused on novel therapeutic strategies for extensive skin lesions aiming to improve healing quality and reduce treatment duration. In this context, the use of amniotic membrane (AM) and Wharton’s jelly (WJ) emerges as promising alternatives. Full-thickness dorsal skin wounds were created in 21 Wistar rats, randomly divided into three groups: control (C), AM – covered by AM and WJ – covered by WJ. Wound contraction rate was measured weekly. On day 28, histochemical (Picrosirius red) and immunohistochemical analyses matrix metalloproteinase-9 (MMP-9), transforming growth factor beta (TGF-β), and alpha-smooth muscle actin (α-SMA) were performed. On day seven, wound contraction rate was higher in the AM group (38.8%), followed by the WJ (27.4%) and control (26.5%) with statistically significance. During the first 14 days, the AM group maintained the highest contraction rate, followed by the control and WJ groups. However, by day 21, wound contraction rates increased in the order of WJ to AM to control groups (85.6%, 87.0%, and 91.1%) with statistically significance. Type I collagen predominated across all groups, without statistically significant differences among them. TGF-β expression significantly increased from WJ to AM to control groups (19.75%, 26.00%, and 36.56%) with statistically significance. MMP-9 and α-SMA expressions decreased from control to WJ to AM groups, but no significant differences were observed. Both AM and WJ enhanced early wound contraction and may support skin repair by attenuating fibrotic signaling. These findings highlight the potential of AM and WJ as biomaterials for promoting tissue regeneration at epithelial barriers.

PMID:40270293 | DOI:10.1080/21688370.2025.2497101

Glob Health Action. 2025 Dec;18(1):2490330. doi: 10.1080/16549716.2025.2490330. Epub 2025 Apr 24.

ABSTRACT

BACKGROUND: The Karamoja region in the East African drylands is a rural, impoverished setting where pastoralism is increasingly replaced by other livelihood strategies. Understanding the socioeconomic contexts as well as their local variations is key for sustainable development of communities.

OBJECTIVE: The aim of the present paper is to describe the baseline survey of the Drylands Transform project, its setting, methods and key findings.

METHODS: In June 2022, a survey was conducted with 944 randomly selected households at four study sites in the Karamoja border region of Kenya and Uganda. Data were analyzed using descriptive statistics.

RESULTS: Main livelihood forms were pastoralism and agropastoralism, while many households also relied on other sources of income. At some study sites, livestock keeping was abandoned by many residents due to cattle raiding and droughts. Only 4% of households were rated as food secure. The proportion of malnutrition among children aged 6-59 months varied across sites between 3% and 17% and was considerably higher among women.

CONCLUSIONS: Climate change, water shortage, social conflicts and marginalization pose barriers to food security and wellbeing for rural populations in the East African drylands. There are, however, opportunities for development through income diversification, the improvement of land health, the promotion of kitchen gardens and other measures of sustainable agriculture.

PMID:40270287 | DOI:10.1080/16549716.2025.2490330

Biomark Med. 2025 Apr 24:1-7. doi: 10.1080/17520363.2025.2496128. Online ahead of print.

ABSTRACT

INTRODUCTION: Coronary artery disease (CAD) is a multifactorial disorder influenced by both genetic and clinical risk factors. Lipid metabolism genes such as apolipoprotein B(APOB) (rs515135) and proprotein convertase subtilisin/kexin type 9 (PCSK9)(rs505151), have been associated with susceptibility to CAD. Study investigates the potential role of these genetic polymorphisms with risk of CAD in the Indian population.

MATERIALS AND METHODS: A case-control study including 150 CAD cases and 150 controls. Angiographically proven Cases were recruited from the Cardiology Unit, Department of Medicine, Era’s Lucknow Medical College. Genotyping was done using specific primers and restriction digestion; statistical analysis included t-tests, odds ratios, and haplotype analysis.

RESULTS: CAD cases(mean age 49.93 ± 9.13 years) had higher serum cholesterol and VLDL but lower systolic and diastolic BP compared to controls (mean age 56.47 ± 9.39 years). The APOB G allele showed a significant protective effect against CAD (OR: 0.431,p = 0.001).

CONCLUSION: The APOB G allele may serve as a protective factor against CAD, highlighting its potential role in genetic screening for lower disease risk. Further large-scale studies are required to confirm these findings.

PMID:40270278 | DOI:10.1080/17520363.2025.2496128

Stroke. 2025 Apr 24. doi: 10.1161/STROKEAHA.124.050045. Online ahead of print.

ABSTRACT

BACKGROUND: Acute symptomatic seizures (ASyS) increase the risk of epilepsy and mortality after a stroke. The impact of the timing and type of ASyS remains unclear.

METHODS: This multicenter cohort study included data from 9 centers between 2002 and 2018, with a final analysis in February 2024. The study included 4552 adults (2005 female; median age, 73 years) with ischemic stroke and no seizure history. Seizures were classified using International League Against Epilepsy definitions. We examined ASyS occurring within seven days after stroke. The main outcomes were all-cause mortality and epilepsy. Validation of the updated SeLECT score (SeLECT-ASyS) was performed in 3 independent cohorts (Switzerland, Argentina, and Japan) collected between 2012 and 2024, including 74 adults with ASyS.

RESULTS: The 10-year risk of poststroke epilepsy ranged from 41% to 94%, and mortality from 36% to 100%, depending on ASyS type and timing. ASyS on stroke onset day had a higher epilepsy risk (adjusted hazard ratio [aHR], 2.3 [95% CI, 1.3-4.0]; P=0.003) compared with later ASyS. Status epilepticus had the highest epilepsy risk (aHR, 9.6 [95% CI, 3.5-26.7]; P<0.001), followed by focal to bilateral tonic-clonic seizures (aHR, 3.4 [95% CI, 1.9-6.3]; P<0.001). Mortality was higher in those with ASyS presenting as focal to bilateral tonic-clonic seizures on day 0 (aHR, 2.8 [95% CI, 1.4-5.6]; P=0.004) and status epilepticus (aHR, 14.2 [95% CI, 3.5-58.8]; P<0.001). The updated SeLECT-ASyS model, available as an application, outperformed a previous model in the derivation cohort (concordance statistics, 0.68 versus 0.58; P=0.02) and in the validation cohort (0.70 versus 0.50; P=0.18).

CONCLUSIONS: ASyS timing and type significantly affect epilepsy and mortality risk after stroke, improving epilepsy prediction and guiding patient counseling.

PMID:40270248 | DOI:10.1161/STROKEAHA.124.050045

Palliat Support Care. 2025 Apr 24;23:e103. doi: 10.1017/S1478951525000422.

ABSTRACT

OBJECTIVES: Effective communication during specialist palliative care (PC) referral is linked to improved health outcomes. Initiating a conversation about PC is difficult and poor communication can lead to stigma. The aim of this descriptive phenomenological study was to explore the communication experiences of persons referred to specialist PC services and their carers and explore strategies to improve such experiences.

METHODS: Purposive sampling was used to recruit 17 participants who were either receiving specialist PC and/or caring for someone who was receiving specialist PC. Participants were recruited from a hospice. Inductive thematic analysis was conducted.

RESULTS: Four themes were identified: (i) The why, who, what, when, where, and how of PC referral; (ii) initial thoughts and feelings about referral to PC; (iii) enhancing the communication of PC referral; and (iv) addressing practical needs during PC referral. Participants were referred either through their general practitioner or oncologist. Initially, participants linked PC referral to death. This perception changed when participants started availing of the services. Compassion, empathy, hope, privacy, in-person communication, individualized referral, and information dosing were identified as building blocks for effective communication. Participants stressed the importance of raising public awareness of PC and addressing the practical needs of individuals being referred.

SIGNIFICANCE OF RESULTS: The communication of PC referral should be tailored to meet the individual needs of patients and carers. Delivering clear and simple information is important to help patients and carers understand and accept the referral.

PMID:40270246 | DOI:10.1017/S1478951525000422

Circ Heart Fail. 2025 Apr 24:e012446. doi: 10.1161/CIRCHEARTFAILURE.124.012446. Online ahead of print.

ABSTRACT

BACKGROUND: Peripheral microvascular dysfunction is a hallmark feature of both heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) pathophysiology, due partly to impairments in nitric oxide signaling secondary to tetrahydrobiopterin (BH₄) deficiency and oxidative stress.

METHODS: Using a randomized, double-blind, placebo-controlled crossover design, this study examined the impact of enteral BH₄ (10 mg/kg), an antioxidant cocktail (AOx), and coadministration of these 2 agents (BH₄+AOx) on microvascular function in patients with HFrEF (n=14, 64±10 years) and HFpEF (n=19, 74±9 years). Passive limb movement was utilized to assess locomotor muscle microvascular function, and biomarkers of inflammation and oxidative damage were measured.

RESULTS: Compared with placebo, the peak change in leg blood flow was not statistically different after AOx administration (HFrEF, P=0.60; HFpEF, P=0.61), but improved following BH₄ (P=0.033) and BH₄+AOx (P=0.019) in both HFrEF (placebo: 234±31; BH₄: 357±45; BH₄+AOx: 355±49 mL/min) and HFpEF (placebo: 269±33; BH₄: 367±47; BH₄+AOx: 394±65 mL/min). The total hyperemic response to passive limb movement (leg blood flow area under the curve) was not statistically different across treatments in patients with HFrEF (P=0.29), but increased following BH₄ (P=0.016) and BH₄+AOx (P=0.040) in the HFpEF group. CRP (C-reactive protein) was lower following BH₄ (P=0.007) and BH₄+AOx (P=0.007) in HFpEF (placebo: 4268±547; BH₄: 2721±391; BH₄+AOx: 2779±376 ng/mL), but was not statistically different in HFrEF (P=0.39).

CONCLUSIONS: Together, these results provide new evidence for the efficacy of acute BH₄ administration to improve some aspects of locomotor muscle microvascular function in patients with HFrEF and HFpEF, with no apparent benefit of AOx administration, alone or in combination with BH₄, in either group. These findings lend further conceptual support for the nitric oxide pathway as a modifiable target in the treatment of heart failure.

PMID:40270242 | DOI:10.1161/CIRCHEARTFAILURE.124.012446

Haematologica. 2025 Apr 24. doi: 10.3324/haematol.2024.287206. Online ahead of print.

ABSTRACT

Prophylactic and pre-emptive donor lymphocyte infusion (pro/preDLI) is used to prevent haematological relapse of AML and MDS after allogeneic stem cell transplantation. For lack of prospective trials, outcome reports, risk factor analyses and published recommendations for DLI administration had to rely on registry studies, frequently limited by inconsistent reporting and missing data. Therefore, we performed an extensive chart review on recipients of pro/preDLI in two German centers to investigate the clinical applicability of current guidelines in a well-defined cohort. Beyond, as outcome after pro/preDLI is unsatisfactorily described by conventional parameters, we constructed a model for treatment success, defined as leukaemia-free survival (LFS) without intensive immunosuppressive treatment for Graft-versus-Host-Disease (GvHD). Eighty-three patients had received proDLI (n=36), preDLI for incomplete chimerism (preDLIIC, n=27) or for persisting minimal residual disease/molecular relapse (preDLI-MRD, n=20). According to current guidelines concerning initial T cell doses and timing of DLI, 42% of patients had received DLI as recommended (standard-intensity), whereas 30%/28% had received DLI in lower/higher cell doses and/or at a later/earlier time point (low-/highintensity). Two-year rates of overall survival (OS), LFS, relapse incidence and non-relapse mortality within the entire cohort were 80%/67%/27%/8%. One-year rates of high-grade acute/chronic GvHD were 34%/27% among all patients and 53%/33% after high-intensity DLI. One-year treatment success rate were 72%/69% after low-/standard intensity, in contrast to 34% after high-intensity DLI. Apart from advanced disease at alloSCT, high-intensity DLI was the major risk factor for lower OS (HR=6.12), LFS (HR=5.43), higher aGvHD (HR=2.51), and lower treatment success (HR=0.41), supporting adherence to current recommendations.

PMID:40270206 | DOI:10.3324/haematol.2024.287206

Work. 2025 Apr 24:10519815251323988. doi: 10.1177/10519815251323988. Online ahead of print.

ABSTRACT

BackgroundToday, researchers try to recognize and improve the weaknesses of complex systems using resilience engineering (RE) principles.ObjectiveThis descriptive-analytical epidemiological study aims to evaluate the resilience performance of the hospital staff based on the principles of RE to enhance personnel performance.MethodA questionnaire containing 27 questions in four areas (anticipation, monitoring, response, and learning) was designed based on Hellangel’s model and field surveys to collect data from nurses and managers of various wards of five hospitals. The face validity and reliability of the questionnaire were confirmed by 16 professors and some individuals from the statistical sample.A hybrid approach utilizing entropy, TOPSIS, and DEA was employed in the Excel environment to process the collected data.ResultsThe results of the entropy method indicated that the responding and monitoring indicators, with values of 0.29 and 0.23, respectively, had the greatest impact on the resilience performance of the studied units. The outcomes of TOPSIS revealed that hospital D possesses the highest level of resilience. According to the DEA method, the first, second, and fifth efficient units were associated with hospital B.ConclusionBy evaluating the cornerstone of resilience, this study’s findings empower nurses and managers to mitigate the impacts of stress, emotional exhaustion, and burnout, fostering work interactions and improving their performance in the face of workplace challenges. The main limitation of the study was the spread of COVID-19, which impeded the training of personnel in the field of RE and its indicators, as well as the distribution, collection, and completion of questionnaires, along with challenging access to personnel.

PMID:40270181 | DOI:10.1177/10519815251323988