Category: Nevin Manimala

Epilepsia Open. 2025 Mar 2. doi: 10.1002/epi4.13130. Online ahead of print.

ABSTRACT

OBJECTIVE: Psychogenic non-epileptic seizures (PNES) are functional neurological disorders that are often misdiagnosed and treated as epileptic seizures (ES). Video-electroencephalography (v-EEG) is the gold standard for differentiating ES from PNES. However, blood biomarkers provide a faster and more accessible methodology, particularly for unwitnessed events. Ubiquitin C-terminal hydrolase L1 (UCH-L1) and protein S100B are key biomarkers released following neuronal and glial damage. Previous experimental and clinical studies have shown increased postictal serum and cerebrospinal fluid (CSF) levels of UCH-L1 and S100B in patients with ES.

METHODS: This prospective cohort pilot study compared postictal serum levels of UCH-L1 and S100B proteins in subjects with ES to those with PNES, aiming to identify specific biomarkers for distinguishing these conditions. To exclude confounding factors, the inclusion criteria required normal magnetic resonance (MR) findings of the brain. Strict timing of blood sampling and v-EEG monitoring were used for diagnosing PNES. The study included 32 subjects with epilepsy, 36 with PNES, and 30 healthy controls.

RESULTS: A significant difference in postictal UCH-L1 levels was observed among the groups. Subjects with ES had significantly higher postictal UCH-L1 levels (pg/mL) compared to those with PNES (p = 0.049) and healthy controls (p = 0.029). No significant differences were found between PNES subjects and healthy controls (p = 0.756). Postictal protein S100B levels did not differ significantly between the groups (p = 0.515).

SIGNIFICANCE: This study confirms the potential of postictal UCH-L1 levels as a biomarker for distinguishing ES from PNES. However, it also raises questions about the utility of protein S100B as a biomarker in epilepsy. Given the pilot nature of this study, UCH-L1 cannot yet be adopted for clinical use due to the small sample size, as statistical significance may have been driven by a subset of eight patients.

PLAIN LANGUAGE SUMMARY: This study evaluated two potential biomarkers, UCH-L1 and S100B, to differentiate ES from PNES in clinical practice. Our findings showed elevated postictal UCH-L1 levels in subjects with epilepsy compared to those with PNES, while no significant differences in S100B levels were observed among the groups.

PMID:40025842 | DOI:10.1002/epi4.13130

Clin Transl Sci. 2025 Mar;18(3):e70183. doi: 10.1111/cts.70183.

ABSTRACT

Despite interest in clinical trials with decentralized elements (DCTs), analysis of their trends in trial registries is lacking due to heterogeneous designs and unstandardized terms. We explored Llama 3, an open-source large language model, to efficiently evaluate these trends. Trial data were sourced from Aggregate Analysis of ClinicalTrials.gov, focusing on drug trials conducted between 2018 and 2023. We utilized three Llama 3 models with a different number of parameters: 8b (model 1), fine-tuned 8b (model 2) with curated data, and 70b (model 3). Prompt engineering enabled sophisticated tasks such as classification of DCTs with explanations and extracting decentralized elements. Model performance, evaluated on a 3-month exploratory test dataset, demonstrated that sensitivity could be improved after fine-tuning from 0.0357 to 0.5385. Low positive predictive value in the fine-tuned model 2 could be improved by focusing on trials with DCT-associated expressions from 0.5385 to 0.9167. However, the extraction of decentralized elements was only properly performed by model 3, which had a larger number of parameters. Based on the results, we screened the entire 6-year dataset after applying DCT-associated expressions. After the subsequent application of models 2 and 3, we identified 692 DCTs. We found that a total of 213 trials were classified as phase 2, followed by 162 phase 4 trials, 112 phase 3 trials, and 92 phase 1 trials. In conclusion, our study demonstrated the potential of large language models for analyzing clinical trial information not structured in a machine-readable format. Managing potential biases during model application is crucial.

PMID:40025837 | DOI:10.1111/cts.70183

Ren Fail. 2025 Dec;47(1):2472037. doi: 10.1080/0886022X.2025.2472037. Epub 2025 Mar 2.

ABSTRACT

PURPOSE: Cardiorenal syndrome (CRS) is a complex clinical condition characterized by the simultaneous dysfunction of the heart and kidneys. The atherogenic index of plasma (AIP), calculated as the logarithm of the ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C), has emerged as a potential biomarker for cardiovascular risk. This study investigates the association between AIP and CRS, aiming to explore the potential linkage between AIP and CRS.

METHODS: Data were sourced from the National Health and Nutrition Examination Survey spanning 2005-2018, involving 35,365 participants after applying exclusion criteria. The primary exposure variable was AIP, categorized into quartiles, while the primary outcome variable was CRS, defined by the coexistence of cardiovascular disease (CVD) and chronic kidney disease (CKD). Statistical analyses, considering sample weights, included ANOVA, Chi-square tests, logistic regression models, and restricted cubic spline (RCS) analysis to examine nonlinear relationships.

RESULTS: The weighted logistic regression analysis showed a positive correlation between AIP and CRS across all models. In the fully adjusted model, the highest AIP quartile had a significantly increased odds ratio (OR) for CRS (Q4: OR = 1.62; 95% CI: 1.21-2.15). RCS analysis confirmed a positive correlation between AIP and CRS, with TG positively and HDL-C negatively correlated with CRS. Subgroup analysis indicated a significant interaction with hypertension, showing a stronger association in non-hypertensive individuals.

CONCLUSION: Higher AIP levels are associated with an increased prevalence of CRS, with a notable hypertension-specific interaction indicating a higher effect in individuals without hypertension.

PMID:40025821 | DOI:10.1080/0886022X.2025.2472037

Aging Ment Health. 2025 Mar 2:1-10. doi: 10.1080/13607863.2025.2472888. Online ahead of print.

ABSTRACT

OBJECTIVES: We evaluated the association between two measures of social connection prior to COVID-19-social isolation and functional social support-and loneliness during the pandemic.

METHOD: The study was a retrospective longitudinal analysis of 20,129 middle-aged and older adults enrolled in the Canadian Longitudinal Study on Aging (CLSA). We drew upon two waves of CLSA data spanning three years and the supplemental COVID-19 Questionnaire Study of eight months to conduct our analysis.

RESULTS: Social isolation prior to COVID-19 was associated with loneliness during COVID-19 only among persons who were lonely before the pandemic (adjusted odds ratio [aOR]: 1.17; 95% confidence interval [CI]: 1.02, 1.35). Higher functional social support prior to COVID-19 was inversely associated with loneliness during the pandemic, when adjusting for pre-COVID-19 loneliness (aOR: 0.37; 95%CI: 0.34, 0.41) and when assessing incident loneliness during the pandemic (adjusted relative risk: 0.59; 95% CI: 0.55, 0.63).

CONCLUSION: Policies are needed to identify people who are both socially isolated and lonely, and provide them with functional social support, to prevent worsening loneliness during public health crises.

PMID:40025804 | DOI:10.1080/13607863.2025.2472888

Pediatr Transplant. 2025 May;29(3):e70058. doi: 10.1111/petr.70058.

ABSTRACT

BACKGROUND: Toxoplasma gondii can cause opportunistic infections leading to life-threatening disseminated disease after organ transplantation. However, there is a paucity of pediatric-specific data to guide recommendations for the prevention of toxoplasmosis after solid organ transplantation.

METHODS: To assess current practices, international pediatric transplant providers were surveyed.

RESULTS: Considerable variability in both screening and prophylaxis strategies was found across centers and organ types, with heart transplant programs performing more screening and prophylaxis. Trimethoprim/sulfamethoxazole was the preferred prophylaxis agent for each graft; no toxoplasmosis cases were recalled while patients received prophylaxis.

CONCLUSION: More research is needed to clarify and standardize the optimal toxoplasmosis prevention strategy.

PMID:40025782 | DOI:10.1111/petr.70058

Ophthalmic Epidemiol. 2025 Mar 2:1-9. doi: 10.1080/09286586.2025.2473721. Online ahead of print.

ABSTRACT

PURPOSE: Open Globe Injuries are one of the leading causes of preventable, trauma-related blindness. There is some literature studying the effects of demographic factors as they relate to hospital outcomes. This study characterises trends of Open Globe Injury (OGI) and hospital outcomes based on demographic information utilising the National Trauma Data Bank (NTDB).

METHODS: Using Python programming software, the NTDB was queried for International Classification of Diseases 9th Revision diagnosis codes related to OGI based on the Birmingham Eye Trauma Terminology system. Descriptive statistics were calculated utilising chi-square tests, multivariable adjusted logistic regressions, and ANOVA to process adjusted odds ratio (OR) and means of comparison groups.

RESULTS: The final analysis included 21,481 patients. Mean age of OGI was lower for Black (40.01 [40.53-41.49]), American Indian (39.08 [37.15-41.00]), and Hispanic (38.24 [37.70-38.77]) populations. OR for Black patients was lower for work-related OGI (0.36 [0.30-0.44]), but higher for drug-positive OGI (1.51 [1.35-1.69]). Black and American Indian patients had increased odds for assault-related injuries and decreased odds for accident-related injuries. Race and ethnicity had little to no effect on mortality, or discharge to home with service, ICU, or step-down unit. Mean age of fall on the same level injuries was (71.28 [70.49-72.07]); all other mechanisms of injury had a mean age < 42.

CONCLUSIONS: Our research offers a unique perspective on OGI utilising the NTDB. The trends identify at-risk populations not previously reported and suggests potential racial effects of public safety, work safety and precautions for open globe injuries.

PMID:40025628 | DOI:10.1080/09286586.2025.2473721

BMC Psychol. 2025 Mar 2;13(1):181. doi: 10.1186/s40359-025-02542-1.

ABSTRACT

BACKGROUND: Wars profoundly impact mental health with growing long lasting consequences. This study assessed the prevalence of post-traumatic stress disorder (PTSD) and well-being among Sudanese affected by the ongoing conflict, with a specific focus on healthcare workers (HCWs).

METHODS: A cross-sectional study was conducted between April 1 and June 30, 2024, using the validated Arabic versions of PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (PCL-5) and the World Health Organization (WHO)-5 Well-Being Index.

RESULTS: A total of 1022 participants were included, and 44% were recruitted through online questionnaire and face-to-face interviews. Their mean age was 31.4 ± 12.5 years, 63.4% were females, 16.3% were HCWs and 83.3% were displaced due to conflict. The mean score of PTSD was 35 ± 21.3 with 56.9% having PTSD. The mean well-being score was 55.0 ± 23.9 with 40% reporting poor well-being. Among HCWs, 60.5% suffered from PTSD and 27.5% experienced poor well-being. A significant negative correlation was observed between PTSD and well-being scores (r=-0.273, p < 0.001). Predictors of PTSD were being male [β = -10.91, 95% confidence interval (CI) (-13.44, -8.38); p < 0.001], urban area resident [β = -10.38, 95%CI (-18.78, -1.98); p = 0.016], non-medical profession [β = 5.07, 95%CI (1.46, 8.67); p = 0.006], living with 2 to 10 households [β = 6.69, 95%CI (0.46, 12.91); p = 0.035], living with more than 20 households [β = 13.20, 95%CI (4.17, 22.23); p = 0.004], insufficient income [β = 4.32, 95% CI (1.84,6.81); p = 0.001], living in conflict zones [β = 13.38 95%CI (8.83,17.92); p < 0.001], refugee resettlement [β = 13.18, 95%CI (9.98,16.38); p < 0.001], and well-being score [β = -0.20, 95%CI (-0.25, -0.15); p < 0.001]. Predictors of well-being scores were living with more than 20 households [β = -17.44, 95%CI (-28.83, -6.04); p = 0.003], being a HCW [β =-6.22, 95%CI (-11.87, -0.57); p = 0.031], being a student [β = -7.55, 95%CI (-12.94, -2.16), p = 0.006, insufficient income [β = -5.04, 95%CI (-8.17, -1.90); p = 0.002], and living in conflict zones [β = -8.22, 95%CI (-13.96, -2.48); p = 0.005].

CONCLUSIONS: The study highlights an alarmingly high prevalence of PTSD among Sudanese including HCWs, with significant mental health consequences. These findings emphasize the urgent need for mental health interventions and humanitarian support to mitigate the psychological challenges faced by the conflict affected population.

PMID:40025606 | DOI:10.1186/s40359-025-02542-1

J Orthop Surg Res. 2025 Mar 1;20(1):223. doi: 10.1186/s13018-025-05649-8.

ABSTRACT

OBJECTIVES: Foot postural alignment is linked to changes in gait patterns. This review aimed to compare spatiotemporal and kinematic parameters of the lower extremities in individuals with and without flexible flatfoot.

METHODS: Under PRISMA guidelines, a systematic review and meta-analysis were conducted by searching PubMed, Scopus, Web of Science, and Google Scholar databases for original and peer-reviewed articles with selected keywords from inception to November 2024. The quality of the included studies was assessed using the Joanna Briggs Institute checklist. Statistical analysis was conducted with Comprehensive Meta-Analysis software version 3. To evaluate data heterogeneity, the Q-test and I² statistic were applied. Egger’s test was used to assess publication bias.

RESULTS: After searching the mentioned databases, 5309 articles were found. Finally, sixteen articles were included in the current review. A significant difference was found between the two groups in ankle inversion (effect size; 0.291, 95% CI = 0.053_0.053, P = 0.017), eversion (effect size; -0.568, 95% CI= -0.784_-0.352, P = 0.001), and hip flexion (effect size; -0.348, 95% CI= -0.576_-0.120, P = 0.003). Also, stride length (effect size; 0.658, 95% CI = 0.184_1.133, P = 0.007) and gait speed (effect size; 0.447, 95% CI = 0.120_0.774, P = 0.007) significantly differed between the two groups.

CONCLUSION: This study indicated that subjects with flatfoot exhibited alterations in the inversion, eversion, hip flexion, stride length, and walking speed compared to neutral foot participants and demonstrated a distinct gait pattern throughout the entire gait cycle. Health specialists are advised to consider these findings when prescribing prevention and rehabilitation programs for musculoskeletal deformities in individuals with flexible flatfoot.

PMID:40025605 | DOI:10.1186/s13018-025-05649-8

Ir Vet J. 2025 Mar 1;78(1):7. doi: 10.1186/s13620-025-00294-3.

ABSTRACT

Foals commonly experience diarrhoea in the first weeks of life. Although this condition is rarely life-threatening, it can have significant health consequences. This study investigated whether new-born foals can benefit from a dietary supplement of nucleotides, as already demonstrated in other species. Dietary nucleotides have positive effects on rapidly proliferating tissues and are considered “semi-essential nutrients” since cells have only a limited capacity to synthesize these compounds. The aim of this study was to investigate whether providing foals with a dietary nucleotide supplementation, in the form of an oral paste, was able to affect diarrhoea incidence, systemic immunity, intestinal microbiota and volatile fatty acid production. Thirty new-born standardbred foals, from 3 different premises within the same area, were equally distributed between two groups: one group received an oral paste containing dietary nucleotides (NUCL group), while the other received a placebo paste (CTRL group). Faecal and blood samples were collected on days 1 and 35 after birth. No statistical differences in cytokines (TNF-α, IFN-γ, IL-6, IL-12) or faecal calprotectin levels were found between the two groups, suggesting that the level of nucleotide supplementation used in this study did not have significant effects on the systemic immune system and on the levels of faecal calprotectin. However, the NUCL group showed a lower relative frequency of number of days with diarrhoea (6.12% vs 13.33%; p < 0.001) and greater weight gain compared with the CTRL group (50.3 ± 5.65 kg vs 44.0 ± 8.65 kg; p < 0.05). Total volatile fatty acids, branched volatile fatty acids, acetic acid, propionic acid, butyric acid, succinic acid and iso-butyric acids in faecal samples were all higher in the NUCL group compared with the CTRL group. This outcome may explain an earlier establishment of a gut microbiota in the foals of the NUCL group that was closer to that typical of an adult horse, characterised by predominant fibrolytic populations. Volatile fatty acid production (especially butyric acid) has also been shown to correlate with the intestinal well-being of the horse, supporting the use of dietary nucleotide supplements for improved health and well-being in new-born foals. Although we noted no clear differences in the faecal microbial communities between the two groups, dietary nucleotide supplementation did appear to have a positive clinical outcome, reducing the number of days of diarrhoea and increasing the levels of volatile fatty acids.

PMID:40025599 | DOI:10.1186/s13620-025-00294-3

Adv Simul (Lond). 2025 Mar 1;10(1):6. doi: 10.1186/s41077-025-00338-2.

ABSTRACT

INTRODUCTION: Neonatal mortality is high in middle- and low-income countries, including Tanzania. Most of these deaths are preventable and linked to suboptimal quality of care. In this study, we assessed neonatal resuscitation skills acquisition after a 1-day Helping Babies Breathe (HBB) simulation training using improved tools and associated factors among healthcare providers in 12 facilities in Tanzania.

METHODS: A cross-sectional study was conducted among healthcare providers working in the labor wards in selected health facilities. The training was conducted in situ using the HBB second edition curriculum with improved simulation tools (Neonatalie Live simulator, NeoBeat heart rate meter, and Upright resuscitator). After training, skills acquisition was evaluated using Objectively Structured Clinical Evaluation. Participants who scored an average of 75% or above were considered passing. Descriptive statistics were used to determine the proportion of staff who passed the evaluation by different demographic categories. One-way analysis of variance was used to compare mean scores among demographic categories. Factors associated with neonatal resuscitation skills acquisition were analyzed using modified Poisson regression.

RESULTS: A total of 481 participants were enrolled in the study. Among these, 420 (87.3%) passed the skills evaluation on the first attempt. The overall mean skills score was 92.4%. In bivariable analysis, health facility level, region, age, and experience working in the labor ward were associated with passing skills evaluation on the first attempt. However, after controlling other variables in a multivariable model, none of the factors showed a statistically significant association.

CONCLUSION: In-situ, HBB simulation training using improved training tools effectively imparts neonatal resuscitation skills among healthcare providers. Participants learned skills similarly regardless of their different demographic characteristics, including level of education and working experience. Due to its potential to impart skills, frequent simulation training using improved tools may be considered for scaling up in other health facilities.

PMID:40025598 | DOI:10.1186/s41077-025-00338-2