Category: Nevin Manimala

Microsc Microanal. 2025 Mar 17;31(2):ozaf008. doi: 10.1093/mam/ozaf008.

ABSTRACT

Lead is a common heavy metal used in a variety of products. We investigated the effect of lead-oxide nanoparticles (PbO-NPs) on the histological structure of the rat olfactory bulb (OB) and the potential therapeutic effect of stem cell-derived exosomes (EXOs). Forty male rats were included: 8 for EXO isolation and 32 were distributed into 4 groups: control, PbO-NPs group [intranasal (IN) 50 µL PbO-NPs/rat for 3 weeks], recovery group (PbO-NPs for 3 weeks and left for another 4 weeks), and PbO-NP-EXO (PbO-NPs for 3 weeks then IN EXO for another 3 weeks). After 7 weeks, olfactory behavioral tests were done before scarification. OBs were stained with hematoxylin and eosin, toluidine blue, and immunohistochemistry for synaptophysin (SYP), and ionized calcium-binding adaptor molecule-1 (Iba-1) and glial fibrillary acidic protein (GFAP). The results were confirmed by histomorphometry and statistical analysis. PbO-NPs and recovery groups showed a significant olfactory dysfunction, significant decrease in the thickness of OB layers and diameter of glomeruli, Nissl’s granules of mitral cells and SYP immunostaining, and a significant increase in Iba-1 and GFAP expression compared with control rats. In PbO-NP-EXO, notable regaining of OB structure and function was obvious with reversal of most of the behavioral and morphometric findings compared with the untreated groups. IN EXO administration improved the structure and function of PbO-NP-induced OB neurotoxicity.

PMID:40112249 | DOI:10.1093/mam/ozaf008

PLoS One. 2025 Mar 20;20(3):e0317182. doi: 10.1371/journal.pone.0317182. eCollection 2025.

ABSTRACT

Addressing the under-researched issue of weapon tolerance, the paper examines factors behind male knife and gun tolerance across four different cultures, seeking to rank them in terms of predictive power and shed light on relations between them. To this end, four regression and structural equation modelling analyses were conducted using samples from the US (n = 189), India (n = 196), England (n = 107) and Poland (n = 375). Each sample of male participants indicated their standing on several dimensions (i.e., predictors) derived from theory and related research (i.e., Psychoticism, Need for Respect, Aggressive Masculinity, Belief in Social Mobility and Doubt in Authority). All four regression models were statistically significant. The knife tolerance predictors were: Aggressive Masculinity (positive) in the US, Poland and England, Belief in Social Mobility (negative) in the US and England, Need for Respect (positive) in India and Psychoticism (positive) in Poland. The gun tolerance predictors were: Psychoticism (positive) in the US, India and Poland, Aggressive Masculinity (positive) in the US, England and Poland, and Belief in in Social Mobility (negative) in the US, Belief in Social Mobility (positive) and Doubt in Authority (negative) in Poland. The Structural Equation Weapon Tolerance Model (WTM) suggested an indirect effect for the latent factor Perceived Social Ecological Constraints via its positive relation with the latent factor Saving Face, both knife and gun tolerance were predicted by Psychoticism.

PMID:40112246 | DOI:10.1371/journal.pone.0317182

Neurology. 2025 Apr;104(7):e213442. doi: 10.1212/WNL.0000000000213442. Epub 2025 Mar 20.

ABSTRACT

BACKGROUND AND OBJECTIVES: There is uncertainty about whether patients with an anterior circulation large vessel occlusion (LVO) and a low NIH Stroke Scale (NIHSS) score (≤5) benefit from endovascular therapy (EVT) in the late time window (6-24 hours). We compared the clinical outcomes of these patients receiving EVT with those receiving medical management (MM).

METHODS: The CT for Late Endovascular Reperfusion multinational cohort study was conducted at 66 sites across 10 countries from January 2014 to May 2022. This subanalysis included consecutive patients with late-window stroke due to an anterior circulation LVO, defined as occlusion of the internal carotid artery or proximal middle cerebral artery (M1/M2 segments), and a baseline NIHSS score ≤5 who received EVT or MM alone. The primary end point was a 90-day ordinal shift in the modified Rankin Scale (mRS) score. Secondary outcomes were 90-day excellent outcome (defined as mRS scores 0-1 or return to baseline mRS score in patients with a prestroke mRS score >1) and favorable outcome (defined as mRS scores 0-2 or return to baseline mRS score in patients with prestroke mRS score >2). Safety outcomes were symptomatic intracranial hemorrhage and 90-day mortality. We used ordinal and binary logistic regression models to test for outcome differences.

RESULTS: Among 5,098 patients, 318 patients were included (median [interquartile range] age 67 [56-76] years; 149 [46.9%] were female; baseline NIHSS score was 4 [2-5]). A total of 202 patients (63.5%) received EVT and 116 MM (36.5%). There was no difference in favorable 90-day ordinal mRS score shift (adjusted common odds ratio [OR] 0.77, 95% CI 0.45-1.32), excellent outcome (adjusted OR 0.86, 95% CI 0.49-1.50), or favorable outcome (adjusted OR 0.72, 95% CI 0.35-1.50) in the EVT group compared with MM. Symptomatic intracranial hemorrhage risk (adjusted OR 3.40, 95% CI 0.84-13.73) and mortality at 90 days (adjusted OR 2.44, 95% CI 0.60-10.02) were not statistically different between treatment groups.

DISCUSSION: In patients with an anterior LVO and low NIHSS score in the 6-24-hour time window, there was no statistical difference in disability outcomes or intracranial bleeding risk between patients treated with EVT compared with MM. The retrospective and observational design limits our findings. Ongoing randomized controlled trials will provide further insight.

CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that in adult patients with anterior circulation LVO and low NIHSS score (≤5) presenting in the late time window (6-24 hours), EVT does not improve clinical outcome vs MM.

TRIAL REGISTRATION: This study was registered at clinicaltrials.gov under NCT04096248.

PMID:40112237 | DOI:10.1212/WNL.0000000000213442

Pharmacogenet Genomics. 2025 Mar 21. doi: 10.1097/FPC.0000000000000564. Online ahead of print.

ABSTRACT

OBJECTIVE: Optimizing antiplatelet therapy is crucial in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary interventions (PCIs). This study aimed to assess the prevalence of CYP2C19 loss-of-function (LOF) variants and evaluate the clinical outcome of ticagrelor, clopidogrel, and aspirin in patients with ACS-PCI.

METHODS: This study included patients from the southern part of India (predominantly Tamil Nadu) with coronary artery disease and PCI. They were categorized based on their CYP2C19 LOF variants. Patients were further divided into group 1 (continued ticagrelor) and group 2 (switched to clopidogrel) and followed up for 40 months. The primary and secondary outcomes were evaluated.

RESULTS: A total of 287 patients were genotyped, 36.2% were normal, 46.3% were intermediate, and 17.5% were poor metabolizers, the predominant allele being CYP2C19*2. After considering only patients who underwent PCI and received ticagrelor, 111 patients were recruited. Ticagrelor was switched to clopidogrel in 45.9% of patients. No statistically significant differences in major adverse cardiovascular events or individual outcomes were observed among different metabolizer groups and patients switched from ticagrelor to clopidogrel. Intermediate metabolizers (IMs) exhibited a trend favoring ticagrelor continuation. Notably, discontinuation of aspirin in IM was linked to increased target vessel reintervention (TVR) in the clopidogrel-only group.

CONCLUSION: Our study provides preliminary evidence on favoring ticagrelor continuation and increased TVR upon aspirin withdrawal in IM.

PMID:40112230 | DOI:10.1097/FPC.0000000000000564

Prim Care Companion CNS Disord. 2025 Mar 20;27(2):24m03833. doi: 10.4088/PCC.24m03833.

ABSTRACT

Objective: To assess the relationship of perceived social support and pregnancy related anxiety (PRA) among third trimester pregnant women.

Methods: This was a cross-sectional observational study. The data were collected from July 2021 to March 2022. Study participants included a total of 124 antenatal women who were in their third trimester. PRA was assessed with the Perinatal Anxiety Screening Scale and Pregnancy Anxiety Questionnaire Revised 2. Perceived social support was measured using the Multidimensional Scale for Perceived Social Support (MSPSS). Adequate statistical analysis was done.

Results: Frequency of PRA in the study population was 40.3%. The total MSPSS scores and all its domains were significantly lower in the anxious group (total: P = .002, significant other: P = .006, family: P = .031, and friends: P = .004). PRA was significantly associated with lower perceived social support (P= .002), higher education level (P= .028), and higher number of antenatal visits (P= .031).

Conclusion: Late-pregnancy anxiety is linked to perceived social support, and specific PRA themes (delivery, body shape, and child health) correlate with distinct perceived social support domains.

Prim Care Companion CNS Disord 2025;27(2):24m03833.

Author affiliations are listed at the end of this article.

PMID:40112212 | DOI:10.4088/PCC.24m03833

N Z Vet J. 2025 Mar 20:1-10. doi: 10.1080/00480169.2025.2473347. Online ahead of print.

ABSTRACT

AIMS: To describe the current capacity, resource limitations and challenges of cat and kitten rescue organisations (CKR) in New Zealand; to document the source and destination of the animals cared for; and to explore the role of foster programmes in cat rescue and rehoming in New Zealand.

METHODS: A national cross-sectional survey was administered to companion animal rescue organisations in New Zealand in May 2022. For those engaged in CKR, the survey included questions about types and numbers of cats cared for, facilities, locations, origins and outcomes of cats in care, reasons for owner surrender, whether the CKR had a foster programme, and foster programme capacity. Descriptive statistics were provided for all quantitative study variables and free-text comments were analysed for common themes.

RESULTS: Of the 64 organisations that indicated they cared for cats on the broader companion animal rescue survey, 50 (78%) completed the questions on CKR. At the time of the survey, these 50 organisations cared for an estimated total of 6,206 cats (median 39 (IQR 17-96) cats per CKR). The highest reported source of animals was strays (median of the CKR’s reported percentage: 72%; IQR 50-93%), followed by surrendered animals (median 14.5%; IQR 5-31%). The most common reasons for owners surrendering animals were unplanned litters, lack of pet-friendly accommodation, and inability to afford to care for the animal’s daily needs. An estimated median of 66% (IQR 60-80%) of cats under care in the previous year were subsequently rehomed. Most CKR were “usually” (26/50; 52%) or “always” (11/50; 22%) full to capacity. The majority of CKR that responded operated a fostering programme (40/50; 80%), with an estimated 59% (3,619/6,206) of all cats currently in the care of CKR located in foster homes. The availability of fosterers was identified by CKR as the most important factor affecting their ability to accept animals.

CONCLUSIONS AND CLINICAL RELEVANCE: These findings highlight that CKR in New Zealand currently handle a large volume of animals each year. Initiatives that focus on preventing unplanned litters, ensuring owned free-roaming cats have permanent identification through microchipping, and initiatives to prevent unnecessary owner relinquishment may help to reduce the number of animals entering care. With the majority of CKR relying on foster programmes, there is a need for further research to better understand how these operate and whether there may be opportunities to expand their capacity.

PMID:40111413 | DOI:10.1080/00480169.2025.2473347

Prim Health Care Res Dev. 2025 Mar 20;26:e29. doi: 10.1017/S1463423625000222.

ABSTRACT

AIM: This study aims to assess the effect of primary health care (PHC) service provision continuity on inpatient admissions for people with chronic diseases in Estonia.

BACKGROUND: Non-communicable diseases (NCDs) were collectively responsible for more than 7 out of 10 deaths worldwide in 2019. As the burden of NCDs increases, PHC has an increased role of coordinating care management. High-performing PHC can reduce unnecessary hospitalizations. Estonia has a strong PHC system focusing on multidisciplinary care. Yet it has not been evaluated for its effect on hospitalizations. Therefore, it is imperative to evaluate PHC continuity to improve care for NCD patients.

METHODS: This study used routinely collected electronic medical billing data of the Estonian population aged 15 years or older from 2005 to 2020 identifying patients with seven ambulatory care sensitive chronic (ACSC) conditions. We developed an indicator to describe the continuity of PHC. Charlson Comorbidity Index (CCI) was used to assess the impact of comorbidities and we controlled the patient’s age, gender, county of residency and socio-economic status. We estimated multilevel logistic regression models with family doctor patient list random effects to assess how the odds of hospitalization depend on continuity of care, allowing for confounders.

FINDINGS: We identified that 45% of the adult Estonian population had at least one of the target diagnoses. Among the target population, 96% had contact with their PHC providers. We found that there is a non-linear relationship between PHC continuity and patient outcomes. Any contact with PHC provider during the past 5 years decreases odds for hospitalization, but hospitalization risk is higher for people who are elderly and have higher CCI score. We found that after accounting for patient characteristics, differences among patient lists minimally impact outcomes. Further research should explore policies to better support family doctors in reducing hospitalizations for chronic patients.

PMID:40111407 | DOI:10.1017/S1463423625000222

J Prim Care Community Health. 2025 Jan-Dec;16:21501319251326750. doi: 10.1177/21501319251326750. Epub 2025 Mar 20.

ABSTRACT

OBJECTIVE: The Wrightington, Wigan, and Leigh NHS Teaching Hospitals Foundation Trust (WWL) developed a novel virtual ward (VW) service that integrated with community and primary care, supported healthcare throughout a patient’s journey, and had a clinical workflow that could step-up or step-down care as needed. We described their VW and evaluated clinical outcomes, adherence, safety, and patient satisfaction.

METHODS: Retrospective, single-center study of patients admitted to the WWL VW service from January 14, 2022 to January 31, 2024. Clinical data collected by WWL in their database for patients admitted to the VW, were matched to data captured automatically by the Current Health (CH) platform linked to the CH remote monitoring kits assigned to patients on the VW. The CH kits enabled the VW care at WWL and included a wearable device for continuous vital signs monitoring, a blood pressure cuff, and tablet. Evaluation metrics included clinical scope, clinical outcomes, adherence, safety, and patient satisfaction.

RESULTS: There were 1835 admissions and a 93% match rate between the clinical and CH databases. About 38% of referrals were step-up (31% ambulatory care and 7% primary care) and 62% of referrals were step-down (100% inpatients). Most specialty referrals were from thoracic and acute medicine (77%). The median length of stay on the VW was 8 days [IQR 5-13], 209 (12%) admissions were escalated to the hospital, 179 (11%) escalated to the emergency department out of hours, and 29 (2%) signposted to urgent medical services. Adherence to the wearable device was 92%. There were 38 minor safety incidents (typically hypersensitivity reactions or administrative errors) and 17 expected deaths. About 94% of admissions rated the VW experience as “excellent” or “good.” Results were similar between step-up and step-down referrals.

CONCLUSION: We have shown the VW service yielded acceptable clinical outcomes, was safe with no serious adverse events or negative impact on mortality rate. Patient adherence to the technology and satisfaction with the VW service were high. The VW service was innovative in its acceptance of a broad range of patients, expanding services beyond respiratory medicine, and in developing a step-up pathway, preventing some patients from ever taking up an acute bed in the hospital.

PMID:40111405 | DOI:10.1177/21501319251326750

J Prev Interv Community. 2025 Mar 20:1-24. doi: 10.1080/10852352.2025.2480455. Online ahead of print.

ABSTRACT

Hyperlipidemia, a major risk factor for cardiovascular disease, disproportionately affects racial and ethnic minority populations. This cross-sectional study examined the prevalence and risk factors for hyperlipidemia among middle-aged adults in the United States using data from the fifth wave of the Adolescent to Adult Health Study (Add Health). The study analyzed merged sociodemographic and biomarker data (N = 4,196) using descriptive statistics and binary logistic regression. The mean age was 37.14 years (SD = ±1.99), with a slightly higher proportion of males (50.38%). The overall prevalence of hyperlipidemia was 16.26%, with higher rates observed in males (20.1%) compared to females. Notably, Asian individuals had significantly higher odds of hyperlipidemia (OR = 2.70, 95% CI: 1.28-5.65), whereas Black/African Americans had a significantly lower risk (OR = 0.57, 95% CI: 0.34-0.94) compared to Whites. Chronic health conditions, including hypertension (OR = 2.46, 95% CI: 1.72-3.52) and diabetes (OR = 4.95, 95% CI: 3.08-7.97), were strong predictors of hyperlipidemia. Additionally, individuals with higher income levels had increased odds of hyperlipidemia (OR = 1.10, 95% CI: 1.01-1.19). Contrary to prior research, obesity was not significantly associated with hyperlipidemia risk. Physical activity was marginally protective, though the effect lost significance in the adjusted model. These findings highlight the importance of targeted cardiovascular health interventions, particularly for Asian populations and those with chronic conditions, to reduce disparities in hyperlipidemia and improve public health outcomes.

PMID:40111399 | DOI:10.1080/10852352.2025.2480455

JAMA Netw Open. 2025 Mar 3;8(3):e251186. doi: 10.1001/jamanetworkopen.2025.1186.

ABSTRACT

IMPORTANCE: Immune checkpoint inhibitors (ICIs) have been approved for treatment of microsatellite instable (MSI-H) metastatic colorectal cancer (mCRC), but factors associated with receipt and efficacy of ICIs in routine clinical practice remain largely unknown.

OBJECTIVE: To identify factors associated with receipt of ICIs and associated survival outcomes among patients with mCRC in routine clinical practice.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used deidentified data from a nationwide electronic health record-derived database to include 18 932 patients diagnosed with mCRC between January 2013 and June 2019. Population-based patients were diagnosed with de novo mCRC and had at least 2 documented clinical visits on or after the date of diagnosis. The study analyses were performed between September 2020 and April 2021.

EXPOSURE: Patients received ICI therapy and/or chemotherapy as part of a systemic treatment for mCRC.

MAIN OUTCOMES AND MEASURES: The outcomes were receipt of ICI therapy, overall survival (OS), and time to treatment discontinuation (TTD).

RESULTS: In this cohort study of 18 932 patients diagnosed with mCRC (10 537 [55.7%] male; 546 [2.9%] Asian, 2005 [10.6%] Black or African American, 1674 [8.8%] Hispanic, 12 338 [65.2%] White, 4043 [21.4%] unknown race or ethnicity; median [IQR] age at metastatic diagnosis, 64.6 [55.0-73.3] years), patients with MSI-H tumors had a significantly higher probability of receiving ICIs than those with microsatellite stable (MSS) tumors (odds ratio [OR], 22.66 [95% CI, 17.30-29.73]; P < .001), whereas patients initially diagnosed with synchronous mCRC had significantly lower odds of receiving ICIs than patients with metachronous mCRC (OR, 0.57 [95% CI, 0.45-0.73]; P < .001). Patients with MSI-H tumors who received ICIs as first line of therapy had significantly longer OS than those receiving chemotherapy only (HR, 0.37 [95% CI, 0.25-0.56]; P < .001). Among patients with MSS tumors, ICI-based therapy was associated with significantly longer OS for patients with high albumin level (vs low: HR, 0.28 [95% CI, 0.18-0.45]; P < .001) and antibiotic use (vs nonuse: HR, 0.43 [95% CI, 0.27-0.67]; P < .001), but a significantly shorter OS for patients with synchronous mCRC (vs metachronous: HR, 1.90 [95% CI, 1.24-2.89]; P = .003). In addition, 29 out of 235 patients with MSS tumors (12.3%) experienced durable responses on ICI-based therapy. Similar patterns of associations with TTD were observed.

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with mCRC, clinical characteristics were associated with different survival outcomes in patients treated with ICI-based therapy, with important clinical implications for patients with MSS tumors who are generally unresponsive to immunotherapy.

PMID:40111368 | DOI:10.1001/jamanetworkopen.2025.1186