Category: Nevin Manimala

Anemia. 2025 Feb 7;2025:5695022. doi: 10.1155/anem/5695022. eCollection 2025.

ABSTRACT

Background and Objective: IDA and chronic headache disorders such as migraines and tension-type headaches are common conditions that significantly affect quality of life. Emerging evidence suggests a bidirectional relationship between these two conditions. This systematic review and meta-analysis aimed to explore and quantify the association between iron deficiency anemia (IDA) and chronic headache disorders, with a focus on understanding the bidirectional nature of this relationship. Methods: A comprehensive literature search was conducted across PubMed, Embase, and Web of Science to identify relevant studies published up until August 10, 2024. Observational studies examining the prevalence, incidence, or association between IDA and chronic headache disorders were included. Data were extracted and assessed for quality using the Newcastle-Ottawa Scale. Meta-analyses were performed using a random-effects model to calculate pooled prevalence rates and risk ratios (RRs), with heterogeneity assessed via the I ² statistic and meta-regression. A sensitivity analysis was conducted using the leave-one-out approach, and publication bias was evaluated through a funnel plot. Results: The meta-analysis included 13 studies: five studies examined chronic headaches among patients with IDA, and eight studies examined IDA among patients with chronic headaches. The pooled prevalence of chronic headaches among patients with IDA was 38% (95% CI: 15%-69%). In addition, 20% (95% CI: 10%-35%) of patients with chronic headaches were found to have IDA. Anemic patients were found to have a 76% higher risk of developing chronic headaches compared to nonanemic individuals (RR: 1.76; 95% CI: 1.22-2.52). Significant heterogeneity was observed across the studies. Conclusion: This meta-analysis demonstrates a significant association between IDA and chronic headache disorders, with a pooled prevalence of 38% for chronic headaches in IDA patients and 20% for IDA in chronic headache patients. IDA was associated with a 76% higher risk of chronic headaches. Routine screening for IDA in high-risk populations may improve headache outcomes, but further longitudinal studies are needed to establish causality and refine management strategies.

PMID:39959849 | PMC:PMC11828653 | DOI:10.1155/anem/5695022

MedEdPORTAL. 2025 Feb 14;21:11499. doi: 10.15766/mep_2374-8265.11499. eCollection 2025.

ABSTRACT

INTRODUCTION: With increasing rates of fatal opioid overdoses and substance use disorders, discussing harm reduction strategies in undergraduate medical education is imperative. Medical students learn opioid pharmacology but often lack adequate training in recognizing and responding to opioid overdoses. Incorporating naloxone training into preclinical undergraduate medical education can be lifesaving.

METHODS: This educational activity trained second-year medical students in opioid overdose recognition and response. The 2-hour interactive session included an informative presentation on opioid use statistics, harm reduction, and opioid overdose; a case-based learning session; and hands-on practice on task trainers using an OSCE-style checklist. Student confidence in four areas was assessed through pre- and posttraining surveys on 5-point Likert scales. Data analysis was conducted using R (programming language), with exploratory analyses for sample size, normality, and variable selection. The Wilcoxon signed rank test evaluated changes in attitudes from pre- to posttest.

RESULTS: Eighty-six students participated, with 60 completing pre- and posttest surveys. Significant improvements were observed in confidence across all areas: assessing an opioid overdose (p < .001), administering naloxone (p < .001), continuing management after naloxone (p < .001), and training others on naloxone administration (p < .001).

DISCUSSION: Early training in opioid overdose management increased second-year medical students’ confidence in key areas, potentially enabling them to better combat the crisis during their clinical years and educate at-risk patients. Future activities should incorporate objective skill assessments to evaluate competency and explore long-term knowledge retention during clinical rotations.

PMID:39959842 | PMC:PMC11825861 | DOI:10.15766/mep_2374-8265.11499

PeerJ. 2025 Feb 11;13:e18873. doi: 10.7717/peerj.18873. eCollection 2025.

ABSTRACT

BACKGROUND: Acute myocardial infarction (AMI) significantly contributes to the progression of heart failure (HF). Standard treatment for HF has long been angiotensin-converting enzyme inhibitors (ACEIs), targeting the renin-angiotensin-aldosterone system (RAAS). Recent developments in HF management introduced sacubitril/valsartan (S/V), a novel angiotensin receptor-neprilysin inhibitor (ARNI), showing promising results in global trials. This study aimed to assess the efficacy of early S/V application compared to angiotensin-converting enzyme inhibitors (ACEIs) in reducing NT-proBNP levels and improving clinical outcomes, specifically focusing on dyspnea symptomatology, in Chinese patients with AMI complicated by HF.

METHODS: This single-center, mixed methods study was conducted at Tangshan Gongren Hospital from January to December 2021, including 88 patients diagnosed with AMI and HF. Patients were divided into two groups: 31 received S/V, while 57 were treated with ACEIs. Data collection encompassed baseline demographic, clinical, and biochemical variables, NT-proBNP levels, blood pressure measurements, and dyspnea symptom severity. Follow-up assessments were conducted 1 year post-discharge to evaluate NT-proBNP levels, and symptom progression. Statistical analyses, including t-tests, Wilcoxon rank-sum tests, and chi-square tests, were performed to compare outcomes between the two groups.

RESULTS: At baseline, no significant differences were observed between the two groups in terms of demographic, lifestyle, and medical history. Although patients in the S/V group presented with more severe baseline renal impairment and cardiac dysfunction, there was no significant difference in NT-proBNP levels from admission to discharge. 1-year follow-up showed a trend towards reduced NT-proBNP levels in the S/V group, though this difference did not reach statistical significance. All patients in both groups reported improvements in dyspnea at discharge and at follow-up, with no significant inter-group difference. Notably, the S/V group demonstrated a more significant reduction in both systolic and diastolic blood pressure from admission to discharge compared to the ACEIs group.

CONCLUSIONS: This study found that S/V had similar effects to ACEIs in reducing NT-proBNP levels among Chinese patients with AMI complicated by HF, though S/V was associated with greater reductions in blood pressure. These findings suggest that while S/V may offer additional benefits in blood pressure management, its impact on cardiac biomarkers in acute settings may not significantly differ from ACEIs. Given the study’s limitations, including its single-center design, small sample size, and baseline differences. Further multi-center, randomized controlled trials are warranted to validate these findings and explore tailored treatment strategies for AMI patients with concurrent HF.

PMID:39959840 | PMC:PMC11827574 | DOI:10.7717/peerj.18873

PeerJ. 2025 Feb 12;13:e18870. doi: 10.7717/peerj.18870. eCollection 2025.

ABSTRACT

BACKGROUND: Bladder cancer is a growing health concern, especially in developing countries like Türkiye. Intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is essential for reducing recurrence and progression in non-muscle invasive bladder cancer (NMIBC). However, it can cause local and systemic adverse effects linked to bacterial virulence, allergic reactions, or nosocomial infections. Data from randomized studies on BCG side effects are limited, with severe cases often reported in case studies. This study investigates the association between intravesical BCG immunotherapy and its adverse effects.

METHODS: A retrospective analysis was conducted on 239 patients who underwent BCG immunotherapy between 2017 and 2024. Detailed demographic, clinical, and laboratory data were collected, and the adverse effects that developed following BCG therapy were evaluated. Descriptive statistics, including medians, counts, and percentage distributions, were calculated, and logistic regression analysis was performed to identify factors influencing the development of adverse effects.

RESULTS: Adverse effects related to BCG immunotherapy were observed in 63.1% of the patients. The most common minor adverse effects were hematuria, dysuria, and cystitis, while major adverse effects included sepsis and lymphadenopathy. The analyses revealed that elevated aspartate aminotransferase (AST) levels and the presence of Escherichia coli and Enterococcus faecalis in urine cultures were significant risk factors for the development of adverse effects. Additionally, patients who underwent the 6th cycle of BCG therapy were found to have a higher risk of developing adverse effects compared to those who received fewer cycles.

CONCLUSION: BCG immunotherapy is an effective treatment method for NMIBC; however, the adverse effects that occur during treatment must be closely monitored. Elevated AST levels, the presence of specific pathogens in urine cultures, and the number of BCG doses administered are significant factors that increase the risk of adverse effects. These findings highlight the necessity for more careful monitoring throughout the treatment process.

PMID:39959825 | PMC:PMC11829628 | DOI:10.7717/peerj.18870

PeerJ. 2025 Feb 13;13:e18957. doi: 10.7717/peerj.18957. eCollection 2025.

ABSTRACT

BACKGROUND: The effects of visceral fat and body fat on osteoporosis (OP) have long been controversial. This study investigated the correlation between visceral fat and bone mineral density (BMD) in perimenopausal women aged 40-60. The goal was to evaluate the current state of BMD and its influencing factors, with the specific objective of establishing a foundation for preventing and treating osteoporosis in this demographic.

METHODS: This case-control study included female participants (n = 330), aged 40-60 years, from the Health Management Center of Guilin Medical College Affiliated Hospital, China, between January 2020 to August 2023. Their BMD was assessed using an ultrasound bone mineral density meter, and the visceral fat area was determined utilizing a body composition analyzer. Furthermore, past medical history, dietary habits, and lifestyle factors were collected through a telephonic questionnaire survey. Additionally, we analyzed the baseline characteristics of the population, bone status and visceral fat status, and the relationship between these variables.

RESULTS: Among perimenopausal women with varying bone mineral density statuses, there was no significant difference regarding body fat percentage (p = 0.359). In contrast, a statistically significant difference was observed regarding visceral fat area (p < 0.001) and vitamin D (p < 0.001). The visceral fat area exhibited an inverse correlation with bone density (r = -0.313, p < 0.001). Additionally, mediation analysis outcomes did not support the hypothesis that visceral fat affects bone density through its influence on vitamin D levels (p = 0.92).

CONCLUSIONS: Among perimenopausal women, visceral fat is negatively associated with bone density, suggesting that the distribution of body fat rather than the total amount plays a pivotal role in the development of osteoporosis. These findings suggest the significance of regular physical exercise and the abdominal fat distribution for perimenopausal women.

PMID:39959823 | PMC:PMC11830370 | DOI:10.7717/peerj.18957

Tanaffos. 2024 Feb;23(2):189-197.

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, disease coding significantly influenced national and international strategies for prevention, treatment, and control. This study aimed to assess the factors influencing COVID-19 records’ coding errors in teaching hospitals in South Khorasan province.

MATERIALS AND METHODS: In 2022, researchers conducted a cross-sectional study in South Khorasan Province, Iran. Data was gathered using a self-developed questionnaire distributed among medical coders in all hospitals. Descriptive statistics were employed in the data analysis using SPSS version 19.

RESULTS: The study’s results showed that non-observance of diagnostic principles by physicians (66 out of 92), a lack of specialized medical coding specialists (52 out of 92), and the use of ambiguous and non-standard abbreviations (51 out of 92) were the most significant factors affecting COVID-19 coding errors. Among the three main factors affecting COVID-19 records’ coding errors, factors related to the medical coder (47.66 out of 92), factors related to healthcare providers (29.8 out of 92), and organizational and environmental factors (21.4 out of 92) were the most significant.

CONCLUSION: This study revealed that multiple factors contribute to coding errors in COVID-19 records, with the most critical being physicians’ non-adherence to diagnostic principles, the shortage of medical coding specialists, the use of unclear and non-standard abbreviations, and the absence of COVID-19 coding continuing education. Therefore, we recommend conducting workshops on diagnosis and coding for medical coders, particularly emphasizing the precise coding of COVID-19 records.

PMID:39959802 | PMC:PMC11825067

Tanaffos. 2024 Feb;23(2):198-208.

ABSTRACT

BACKGROUND: Medication errors can lead to damage to patients with various disabilities or death. This study aims to identify factors affecting the incidence of medication error and its association with patient safety culture from the nurse’s perspective during the COVID-19 pandemic.

MATERIALS AND METHODS: This cross-sectional study was conducted among 340 employed in the hospitals affiliated with Shiraz University of Medical Sciences in 2021. Data were collected by applying a questionnaire for medication error and the standard questionnaire of the Hospital Survey on Patient Safety Culture. Descriptive statistics, the independent t-test, ANOVA, and Pearson correlation were applied using SPSS software version 23.

RESULTS: The main reasons for medication errors were fatigue due to the workload (3.13±1.16 out of 5), method of supervision in the hospital units (3.06±0.98 out of 5), and massive pile-up of duties (3.00±1.19 out of 5). Other results indicated a significant negative association between factors affecting medication error and patient safety culture (r=-0.574, p=0.002). A significant correlation was observed among factors affecting medication error and patient safety culture with demographic determinants of age and years of working experience (p<0.05). Significant differences were also observed among the two main studied variables, the number of monthly work shifts, and the number of patients (p<0.05).

CONCLUSION: Applying strategies for the reduction of physical fatigue and mental exhaustion along with balancing work shifts and managing the accumulative duties and massive tasks can help decrease the rates of medication errors.

PMID:39959792 | PMC:PMC11825077

Tanaffos. 2024 Feb;23(2):183-188.

ABSTRACT

BACKGROUND: Forecasting the longevity of patients’ immune stability could be the most effective approach to preventing illnesses. This study investigates immunoglobulin M (IgM) serum longevity, immunoglobulin G (IgG), and corresponding risk factors in the first phase seropositive patients in Mazandaran, Iran.

MATERIALS AND METHODS: This descriptive cross-sectional study aimed to assess IgM and IgG serum levels in a cohort of 184 seropositive patients during six months. The data analysis involved various statistical methods including descriptive statistics, the chi-square test, independent and paired t-tests, and single and multivariate logistic regression.

RESULTS: A total of 103 (56%) patients lacked the necessary antibodies, whereas 81 (44%) remained seropositive. According to the results of multivariable logistic regression, patients with a travel history, hospital admissions, and end-stage renal disease (ESRD) had 3.24 (P=0.04), 12.63 (P=0.018), and 9.79 (P=0.001) times higher chances of stable seropositivity, respectively. The average IgG and IgM serum levels fell by 4.5 and 3 units, respectively (P<0.001). In addition, serum levels of IgM and IgG increased by 12% and 12.5%, respectively, and dropped by 75.5% in both serums. There was no increase in either serum level for any of the patients.

CONCLUSION: The duration of immune serum stability in patients can significantly reduce disease mortality. The concurrent detection of IgM and IgG antibodies also assists in identifying the infectious stage.

PMID:39959791 | PMC:PMC11825069

Int J Womens Health. 2025 Feb 10;17:345-353. doi: 10.2147/IJWH.S503028. eCollection 2025.

ABSTRACT

BACKGROUND: The progression of high-grade cervical intraepithelial neoplasia (CIN) and cervical cancer is accompanied by a reduction in the immune response. The objectives of the study were to determine whether colposcopic lesion area is associated with serum levels of cytokines IL (interleukin) -1, IL-6, IL-8, IL-10, IL-12 and TNF-α in precursor lesions of cervical cancer.

METHODS: The study population comprised patients with high-grade squamous intraepithelial lesion who had undergone colposcopy, cervical biopsy, and measurements of serum cytokines by ELISA (Enzyme-Linked Immunosorbent Assay). Genotyping for HPV (human papillomavirus) 16, 18, 45 and 52 was performed by PCR (Polymerase Chain Reaction). ROC (Receiver Operating Characteristic) curves were calculated to determine whether there existed a cut-off value for serum cytokines in patients with colposcopic lesion area smaller vs larger than 1 cm². For cytokines with significant results, these cut-off values were used to perform the multivariable analysis.

RESULTS: There were 71 patients with CIN 2/3. ROC curves were calculated to verify a cut-off value for serum cytokine levels that could be used to distinguish between lesion areas <1 cm2 vs ≥1 cm2. Values with statistical significance were IL-1 >13.3 pg/mL and IL-12 ≤349.6 pg/mL. In the multivariable analysis, the independent variables associated with colposcopic lesion area greater than 1cm² were IL-1>13.3 pg/mL and IL-12 ≤349.6 pg/mL [OR (95% CI) = 10.10 (1.50-67.96); OR (95% CI)=10.70 (1.17-97.45), respectively].

CONCLUSION: Although CIN 2/3 is a local uterine cervix lesion, there is a systemic immunological response. Our results are unprecedented and could be the target of new important studies in public health and cervical cancer prevention.

PMID:39959756 | PMC:PMC11827493 | DOI:10.2147/IJWH.S503028

Nutr Res Pract. 2025 Feb;19(1):96-106. doi: 10.4162/nrp.2025.19.1.96. Epub 2025 Jan 15.

ABSTRACT

BACKGROUND/OBJECTIVES: Metabolic syndrome (MetS) is closely connected to dietary and lifestyle factors, with diet being one of the primary risk factors for MetS, acting as a key factor in both prevention and management. In this study, we analyzed the mediating effect of the Korean Healthy Eating Index (KHEI) on the relationship between lifestyle patterns and MetS in middle-aged Koreans using data from the 2019-2021 Korea National Health and Nutrition Examination Survey (KNHANES).

SUBJECTS/METHODS: This study examined data from 5,196 adults aged 40-64 yrs who participated in the eighth KNHANES. Data on 5 lifestyle factors-smoking, alcohol consumption, physical activity, sleep duration, and stress perception-were analyzed. The latent class analysis (LCA) was performed using Mplus 8.11, and SPSS PROCESS Macro v4.2 was used for statistical analysis to analyze the mediating effect of the KHEI.

RESULTS: The model categorized lifestyle factors into three into 3 clusters: ‘Low Activity Class,’ ‘Low Activity and Smoking Class,’ and ‘Multiple Risk Class.’ The KHEI mediation analysis showed significant effects: 0.0205 (95% confidence interval [CI], 0.0062-0.0363) in the ‘Low Activity and Smoke Class,’ and 0.0420 (95% CI, 0.0133-0.0726) in the ‘Multiple Risk Class.’ The mediating effect of the KHEI domain “adequacy” was significant in these groups, with effects of 0.0357 (95% CI, 0.0184-00563) and 0.0662 (95% CI, 0.0364-0.6491), for the respective groups. Balance of energy intake was significant in the group with ‘Multiple Risk Class’ (0.0189; 95% CI, 0.0044-0.0378).

CONCLUSION: The results suggest that a healthy diet improves health management and reduces risk factors for MetS. Nonetheless, better strategies for dietary improvement through a detailed analysis of KHEI components are warranted.

PMID:39959746 | PMC:PMC11821771 | DOI:10.4162/nrp.2025.19.1.96