Category: Nevin Manimala

JAC Antimicrob Resist. 2025 Feb 8;7(1):dlaf008. doi: 10.1093/jacamr/dlaf008. eCollection 2025 Feb.

ABSTRACT

OBJECTIVE: To monitor the gut colonization by multidrug resistant (MDR) bacteria in residents of a single long-term care facility (LTCF) in relation to their clinical evolution, antibiotic consumption and mortality risk.

METHODS: In a total of 187 voluntarily enrolled residents, five rectal swabs samples were recovered over 1 year. Selective media were used to isolate MDR bacteria. Clinical data related to infections, antibiotic consumption and mortality were recovered. Mortality risk among residents who were MDR colonized and non-colonized was compared by Kaplan-Meier curves.

RESULTS: Globally, 25% of residents have gut colonization by ESBL-producing Escherichia coli with a lack of other pathogens such as Acinetobacter baumannii or Clostridioides difficile. Monitoring of ESBL-producing E. coli colonization for 1 year allowed to us to establish three categories among residents: 48.6% never colonized, 15.5% had a persistent colonization, and the remaining 35.8% presented intermittent colonization. The rates of mortality, infections and antibiotic exposure were comparable among ESBL-producing E. coli colonized and non-colonized residents, except for the intermittent colonization group in which a higher and statistically significant mortality rate was observed. As expected, urinary and respiratory tract infections were the most prevalent infectious pathologies in the LTCF, with amoxicillin/clavulanate and fluoroquinolones being the most prescribed antibiotics. A high percentage of ESBL-producing E. coli (28%), and fluoroquinolone resistance were detected in clinical samples.

CONCLUSIONS: The monitoring of gut colonization by MDR microorganisms in a single LTCF for 1 year demonstrated the predominance of ESBL-producing E. coli. Almost half of the residents were resistant to its colonization, whereas in 15.5% of them gut colonization was stable. Incidence of infectious episodes and antibiotic exposure were comparable between colonized and non-colonized subjects, but the group with the highest risk of mortality was that with intermittent colonization by ESBL-producing E. coli.

PMID:39927311 | PMC:PMC11806259 | DOI:10.1093/jacamr/dlaf008

JAC Antimicrob Resist. 2025 Feb 8;7(1):dlae219. doi: 10.1093/jacamr/dlae219. eCollection 2025 Feb.

ABSTRACT

OBJECTIVE: To audit the prescribing of antibiotics at a tertiary-level public hospital, in preparation for the implementation of an antimicrobial stewardship programme.

METHODS: A retrospective audit of antibiotic prescriptions for the period April 2020 to June 2020 was conducted to ascertain appropriate antibiotic prescribing based on a set of process measures, which included whether cultures were taken before the initiation of empirical antibiotics, the duration of antibiotic therapy, de-escalation to a narrower spectrum antibiotic, the concurrent use of four or more antibiotics, documented indication for antibiotic use, and parenteral to oral conversion. Statistics were calculated using Stata (Version 17).

RESULTS: A total of 380 patient medical charts were reviewed. It was noted that there were no standalone antibiotic charts, and antibiotics were prescribed alongside other medication in one prescription record. There was non-compliance to one or more of the process measures in two-thirds of antibiotic prescriptions audited. Excessive duration of therapy was evident in 3.16% (12) prescriptions. There were 18 (4.74%) instances in which de-escalation to a narrower spectrum antibiotic based on susceptibility results did not occur. Only a small proportion of patients were switched from parenteral to oral antibiotics (n = 12, 3.16%). Some of the additional findings included redundant antibiotic coverage (n = 137, 36.05%) and prescription of an antibiotic that did not align with the susceptibility results (n = 98, 25.79%).

CONCLUSIONS: Inappropriate antibiotic prescribing did occur in some cases. The results from this pre-implementation study highlight the importance of introducing antimicrobial stewardship interventions with process and outcome measures.

PMID:39927310 | PMC:PMC11806261 | DOI:10.1093/jacamr/dlae219

Open Access Emerg Med. 2025 Feb 4;17:67-83. doi: 10.2147/OAEM.S493878. eCollection 2025.

ABSTRACT

PURPOSE: This study investigates the predictive value of incorporating anemia, hyperglycemia, and left ventricular ejection fraction (LVEF) into the Global Registry of Acute Coronary Events (GRACE) score for in-hospital mortality in Acute Coronary Syndrome (ACS).

PATIENTS AND METHODS: We conducted a single-center, cross-sectional study involving 634 ACS patients admitted to Dr. Hasan Sadikin General Hospital between 2021 and 2023. Anemia was defined as hemoglobin <13 g/dL in men and <12 g/dL in women, while hyperglycemia was indicated with random blood glucose (RBG) ≥200 mg/dL at admission. Patients with LVEF <50% were classified as having reduced LVEF. The primary outcome was in-hospital mortality. Model goodness-of-fit was assessed using R² and the Hosmer-Lemeshow’s test. The predictive accuracy of the GRACE score alone and combined with these parameters were evaluated through receiver operating characteristic curve analysis, an area under the curve (AUC), and concordance (C)-statistics. Reclassification improvement was quantified using continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI).

RESULTS: Among 634 patients (mean age 58.10±11.08 years old; 80.3% male), anemia, hyperglycemia, and reduced LVEF were observed in 197 (31.1%), 123 (19.4%), and 364 (57.4%) patients, respectively. The in-hospital mortality rate was 6.6%. Regression analysis identified nine predictors of mortality, with anemia, hyperglycemia, and reduced LVEF confirmed as independent predictors. The GRACE score showed an AUC of 0.839 (95% confidence interval/CI 0.77-0.0.90). Incorporating anemia, hyperglycemia, and reduced LVEF increased the AUC to 0.862 (95% CI 0.81-0.91), enhancing predictive accuracy (p = 0.590). Combining these variables yielded an NRI of 0.075 (p = 0.070) and an IDI of 0.035 (p = 0.029).

CONCLUSION: Incorporating anemia, hyperglycemia, and reduced LVEF into the GRACE score improves its predictive capacity for in-hospital mortality in ACS patients. The modified GRACE score offers a more robust risk stratification tool for clinical practice and decision-making.

PMID:39927301 | PMC:PMC11806914 | DOI:10.2147/OAEM.S493878

Breast Cancer (Auckl). 2025 Feb 7;19:11782234251317070. doi: 10.1177/11782234251317070. eCollection 2025.

ABSTRACT

BACKGROUND: Breast cancer is the most common malignancy in women and the leading cause of cancer-related death. Although most early-stage patients are cured, 20% to 30% develop metastases, significantly reducing survival rates. Recent research highlights the role of iron in cancer progression, although its full impact on breast cancer metastasis is not yet fully understood.

OBJECTIVES: The aim of this study is to investigate the association between plasma iron levels at diagnosis of early-stage breast cancer and the risk of developing metastatic disease.

DESIGN: Retrospective single-center study.

METHODS: Patients with stage I to III breast cancer, diagnosed between 2007 and 2017, and with serum iron, transferrin saturation, and ferritin values available within 1.5 months before or after diagnosis were included. Cox proportional hazard models were applied to determine the association between iron levels and risk of metastasis.

RESULTS: In total, 1113 patients were included, 10% of them developed distant metastasis over a median follow-up period of 7 years. In multivariable analysis adjusting for age, stage, and subtype, transferrin saturation and serum iron were significantly associated with an increased risk of breast cancer metastasis. For each 10% increment of transferrin saturation at baseline, there was a 19% increase in metastatic risk (hazard ratio [HR] = 1.19; 95% confidence interval [CI] = [1.02-1.38]). Similarly, a serum iron increment of 10 µg/dL led to a 6% increase in risk (HR = 1.06; 95% CI = [1.01-1.12]). Ferritin was found not to be associated with metastatic risk (HR = 0.99; 95% CI = [0.98, 1.01]). There was no significant association with metastatic site or breast cancer subtype when adjusting for age and stage.

CONCLUSION: Elevated transferrin saturation and serum iron at early breast cancer diagnosis are associated with increased risk for metastatic disease but not with location of metastases or breast cancer subtype. Further research is needed to understand the underlying mechanisms and to explore the potential of iron-targeted therapies.

PMID:39927294 | PMC:PMC11806469 | DOI:10.1177/11782234251317070

Front Nutr. 2025 Jan 24;12:1451193. doi: 10.3389/fnut.2025.1451193. eCollection 2025.

ABSTRACT

BACKGROUND: Infant and Young Child Feeding significantly affect the health, development, and nutritional status of children under 2 years old, ultimately affecting their survival. The aim of this study is to determine the time to improvement in dietary diversity and associated factors in infants aged 6 to 12 months.

METHODS: The study used secondary data from the PMA Ethiopia longitudinal panel survey, involving pregnant women from January to March 2024. The data management and analysis were performed using Stata version 17. The Kaplan-Meier survival curve (KM) and the log-rank test method were implemented. A Cox proportional-hazard regression model was used to explore the association between independent variables and the outcome variable. The strength of the association was indicated by the adjusted hazard ratio (AHR) with a 95% confidence interval. The threshold of p < 0.05 was applied to determine the significance of an association.

RESULTS: The study found that the proportion of infants with improved dietary diversity aged 6-12 months was 22% (95% CI: 19.5, 25%). Factors associated with improved dietary diversity in infants aged 6 to 12 months were married women (AHR = 9.3, 95% CI = 1.19, 8.30), women with a secondary school (AHR = 1.9, 95% CI = 1.05, 3.51), women with technical and vocational (AHR = 2.0, 95% CI = 1.01, 4.05) and women with a university degree (AHR = 2.9, 95% CI = 1.51, 5.38). Moreover, women in the highest wealth quintile (AHR = 3.5, 95% CI = 1.31, 9.41), women visiting PNC (AHR = 1.7, 95% CI = 1.13, 2.62), women visiting ANC 1-3, and more than four times were (AHR = 2.4, 95% CI = 1.51, 3.74) and (AHR = 3.6, 95% CI = 2.28, 5.67) times higher for improving dietary diversity.

CONCLUSION: The findings of this study showed that the proportion of dietary diversity improvement was 22%. Which is relatively low. Marital status, educational status, wealth index, PNC, and ANC visits were identified as statistically significant factors associated with dietary diversity improvements. It suggests that public health interventions should focus on enhancing maternal knowledge and promoting regular healthcare visits to mitigate malnutrition and improve infant health outcomes in Ethiopia.

PMID:39927284 | PMC:PMC11802367 | DOI:10.3389/fnut.2025.1451193

Front Nutr. 2025 Jan 24;12:1515067. doi: 10.3389/fnut.2025.1515067. eCollection 2025.

ABSTRACT

BACKGROUND: Obesity is a major global health issue, driving high morbidity and mortality rates. The body roundness index (BRI), which includes waist circumference, offers a more accurate measure of visceral and total body fat. However, despite evidence of BRI’s effectiveness in predicting obesity-related diseases, national-level data, especially from non-Western populations like China, remain limited.

METHODS: This study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), a large, nationally representative cohort of Chinese adults, to examine the temporal trends of BRI, identify associated risk factors, and investigate the longitudinal associations between BRI and cardiovascular disease (CVD) outcomes. BRI was calculated using height and waist circumference measurements. Temporal trends and risk factors were analyzed cross-sectionally, while longitudinal associations were examined using Cox proportional hazards models adjusted for confounders. Mediation analyses were conducted to assess the role of intermediate factors such as hypertension and diabetes in the relationship between BRI and CVD.

RESULTS: A total of 12,902 participants were included for risk factor analysis, 10,525 for longitudinal analysis, and 7,310 for cumulative analysis. BRI continued to rise slowly across survey cycles but was higher in women, older adults, and urban residents. Multivariable analysis identified age, alcohol consumption, elevated blood pressure, and diabetes as positive predictors of BRI, while male sex, rural residence, and smoking were negatively associated. Higher baseline BRI was significantly associated with increased CVD risk (HR: 1.44, 95% CI: 1.22-1.69), stroke (HR: 1.49, 95% CI: 1.12-1.98), and heart disease (HR: 1.47, 95% CI: 1.22-1.77). Cumulative BRI similarly predicted increased risks of CVD, stroke, and heart disease. Mediation analysis showed that hypertension accounted for 20.69% of the association between BRI and CVD risk.

CONCLUSIONS: BRI is a robust predictor of CVD risk. Targeting hypertension and other metabolic conditions could mitigate the elevated CVD risk associated with high BRI in Chinese adults. These findings underscore the importance of incorporating BRI into public health strategies to better manage obesity-related health risks in China.

PMID:39927280 | PMC:PMC11804525 | DOI:10.3389/fnut.2025.1515067

Obes Pillars. 2025 Jan 10;13:100158. doi: 10.1016/j.obpill.2025.100158. eCollection 2025 Mar.

ABSTRACT

OBJECTIVE: Obesity, often associated with cardiometabolic risk factors such as hypertension, diabetes, and hyperlipidemia, is a predictor of major adverse cardiac and cerebrovascular events (MACCE) in hospitalized patients. However, in-hospital outcomes among young, metabolically healthy (MHO) Asians with obesity have not been explored.

METHODS: This was a retrospective cohort study that utilized 2019 National Inpatient Sample (NIS) database to identify hospitalizations of metabolically healthy young (18-44 years) Asian-Americans/Pacific Islanders (AA/API). Demographically matched cohorts of metabolically healthy Asians with obesity (MHO+) and Asians without obesity (MHO-) patients were compared for comorbidities and in-hospital outcomes using 1:1 propensity matching. Multivariable logistic regression analysis was conducted to identify predictors of MACCE in the MHO+ group.

RESULTS: Among 327,065 young AA/API hospitalizations, 7.8 % (n=25,470) were obese. Of which, 14315 were metabolically healthy after excluding encounters with concomitant cardiometabolic risk factors. Matched cohorts (MHO+ and MHO-, N = 14,200, median age 32 years, >84 % female) showed that the MHO + group had higher rates of depression, anxiety, tobacco use disorder, chronic pulmonary disease, and hypothyroidism, while the MHO- group had higher cancer and cannabis use disorder rates. The odds of MACCE (aOR 0.98, 95%CI 0.70-1.37, p = 0.886), and the odds of all-cause mortality (aOR 1.26, 95CI% 0.4-3.99, p = 0.690) were not of statistical significance. Males (aOR 10.18, 95%Cl 3.39-30.53), drug users (aOR 2.87, 95%Cl 1.05-7.86), cancer patients (aOR 9.70, 95%Cl 2.14-44.01), and those with congenital circulatory anomalies (aOR 21.77, 95%Cl 4.07-116.60) had significantly higher odds of MACCE. Depression (aOR 3.09, 95%Cl 0.86-11.08), elective admission (aOR 3.71, 95%Cl 0.74-18.58), and tobacco use (aOR 0.81, 95%Cl 0.26-2.60) were not statistically significant predictors.

CONCLUSION: Asian Americans males, drug users and cancer patients face elevated cardiovascular risk despite having a lower BMI, while overall odds of in-hospital cardiovascular event rates were not statistically significant compared to metabolically healthy cohorts with obesity.

PMID:39927248 | PMC:PMC11803883 | DOI:10.1016/j.obpill.2025.100158

Int J Psychol Res (Medellin). 2024 Apr 1;17(2):3-13. doi: 10.21500/20112084.7255. eCollection 2024 Jul-Dec.

ABSTRACT

Self-efficacy is related to the judgments and beliefs that a person has about him or her own capability to achieve goals, in which she or he also needs to be able of planning, organizing, and executing tasks to achieve that milestone. In this study, we are investigating if attention has a relevant role in self-efficacy. The participants were students at Institución Universitaria de Envigado (N=25), aged between 18 and 40 years old. They filled out the informed consent, the General Self-Efficacy Scale (GSS), Digits and Symbols (DS), the Brief Attention Test (BTA), and the Theta-Beta ratio (TBR) using EEG at points C3-C4 of the cerebral cortex. The results were as follows: mean GSS, 31.56 (SD=4.5) (max. 40 points); mean DS direct score, 45.16 (SD=8.6) (max. 120 points); mean total BTA, 9.4 (SD = 3.31) (max. 20 points); mean TBR C3 eyes open, 5.5 (SD = 1.7); TBR C4 eyes open, 5.2 (SD = 2). A negative correlation was found between the TBR C4 eyes open and the result of the Digits and Symbols DS test, which was statistically significant, using Spearman correlation, (-.529); however, there was no significant correlation between GSS self-efficacy and the three measures of attention (DS, BTA, QEEG). The conclusion of this study is that there is no clear statistically significant relationship between high self-efficacy and a high level of attention. However, a sig nificant negative correlation was found between the DS test and the QEEG measures, which indicates that the neurophysiological technique of attentional measurement is related to the psychometric measurement.

PMID:39927243 | PMC:PMC11804124 | DOI:10.21500/20112084.7255

Int J Psychol Res (Medellin). 2024 Sep 21;17(2):91-99. doi: 10.21500/20112084.7434. eCollection 2024 Jul-Dec.

ABSTRACT

Today, alcohol drinking frequently accompanies socialising as a routine activity in various groups of society. 84.0% of individuals aged 18 and above in the United States have drunk alcohol at some point in their life (National Institute on Alcohol Abuse & US, 2023). Similarly, 81.7% of Norwegians in the age group 16 to 79 have drunk alcohol in 2021 (Bye, 2018). Driving after the consumption of alcohol is a worldwide problem, causing a large number of deaths and injuries a year. This work proposes the first steps towards developing an electroencephalography (EEG)-based alcohol detector conceived with the idea to prevent people from driving under the influence of alcohol. This includes the design of an experimental protocol for EEG data collection, during which participants performed the Flanker task, and their blood alcohol concentration (BAC) was measured. The resulting data set consists of two sessions per participant, both while they are affected and not-affected by alcohol. Statistical analysis of the Flanker task indicated that participants were affected by alcohol and, therefore, their EEG signals were expected to be affected as well. The collected EEG signals were used as input for intra-subject and inter-subject models, both based on the EEGNet architecture. The intra-subject model obtained a mean classification accuracy of 90.7% and the inter-subject model a mean classification accuracy of 62.9%. The result suggest that alcohol can be detected with high accuracy when developing individual models and above the change accuracy when using a general model. Therefore, the work presented here could be used as the first steps towards the development of an EEG-based alcohol detector for drivers.

PMID:39927238 | PMC:PMC11804120 | DOI:10.21500/20112084.7434

Am J Sports Med. 2025 Feb 9:3635465251317509. doi: 10.1177/03635465251317509. Online ahead of print.

ABSTRACT

BACKGROUND: Pitchers with deficits in total shoulder rotation range of motion (ROM) are 2.6 times more likely to experience an elbow injury. Despite the effects of shoulder ROM on elbow injury, it is currently unclear whether specific tissue adaptations of the shoulder relate to the tissue adaptations of the elbow in baseball pitchers.

PURPOSE/HYPOTHESIS: The purpose was to evaluate the relationship between chronic structural adaptations of the shoulder (humeral retroversion [HR], posterior capsule thickness [PCT], infraspinatus/teres minor pennation angle, and muscle thickness) and chronic structural adaptations of the elbow (ulnar collateral ligament [UCL] thickness, ulnohumeral joint laxity with valgus stress, and ulnar nerve cross-sectional area) in professional baseball pitchers. It was hypothesized that chronic adaptations of HR and PCT would relate to structural adaptations of the elbow.

STUDY DESIGN: Cross-sectional study; Level of evidence, 3.

METHODS: Healthy minor league right-handed baseball pitchers from a single professional baseball organization were enrolled during 2022 preseason medical evaluations. Enrolled pitchers underwent bilateral shoulder ultrasound examination of HR, PCT, and posterior rotator cuff pennation angle and muscle thickness as well as bilateral elbow ultrasound examination of the ulnar nerve, UCL thickness, and ulnohumeral joint gapping using the Telos device. The difference in ulnohumeral joint gapping from stressed (150 N) to unstressed (ie, delta value) was calculated. Bilateral differences in every included measure were calculated and used for analysis to more closely isolate chronic adaptations. Multivariate stepwise regressions were performed to determine whether the chronic structural and clinical (strength and ROM) shoulder adaptations were related to structural adaptations of the elbow.

RESULTS: Overall, 40 right-handed professional baseball pitchers with a mean age of 22 ± 3 years were included. A significant positive relationship was observed between preseason structural adaptations of UCL thickness and PCT (R = 0.344; R² = 0.118; P = .030) as well as between chronic structural adaptations of ulnar nerve cross-sectional area and teres minor muscle thickness (R = 0.387; R² = 0.150; P = .020). No statistically significant relationships were found between chronic structural adaptations of the shoulder and delta ulnohumeral joint gapping (all P > .05) or between chronic adaptations in clinical measures (strength and ROM) of the shoulder and chronic structural adaptations of the elbow (all P > .05).

CONCLUSION: Positive relationships between chronic adaptations of UCL thickness and PCT, as well as between ulnar nerve cross-sectional area and teres minor MT, were observed in asymptomatic minor league pitchers. However, no significant relationships between adaptations in shoulder strength or ROM were related to chronic structural adaptations of the elbow.

PMID:39924652 | DOI:10.1177/03635465251317509