Category: Nevin Manimala

Nurs Crit Care. 2025 Mar;30(2):e13289. doi: 10.1111/nicc.13289.

ABSTRACT

BACKGROUND: Oral care is critical for preventing ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients. ICU nurses play a key role in delivering this care but often encounter challenges stemming from knowledge gaps and inconsistent practices.

AIM: To assess ICU nurses’ knowledge, attitudes and practices (KAP) in oral care for VAP prevention and identify demographic factors influencing these variations using random forest analysis.

STUDY DESIGN: A multi-centre cross-sectional study was conducted. Between April and June 2023, 291 ICU nurses from five ICUs across three public tertiary hospitals in Ganzhou City were surveyed using proportionate stratified sampling. Likert-scale questionnaires evaluated KAP, and statistical analyses, including t-tests, analysis of variance and random forest models, were used to determine demographic predictors of KAP scores.

RESULTS: The average KAP scores were as follows: knowledge 27.34 (±4.53), attitudes 31.89 (±4.24), and practices 43.13 (±9.0). Significant predictors of KAP included academic titles, professional positions, gender, ICU tenure and department. Common barriers to effective oral care included lack of formal training, time constraints and limited resources.

CONCLUSIONS: ICU nurses demonstrate positive attitudes towards VAP prevention, but significant gaps in knowledge and practice remain. Targeted education, especially for less-experienced and lower qualified nurses, and standardized protocols are essential to improve adherence to oral care practices and reduce VAP incidence.

RELEVANCE TO CLINICAL PRACTICE: The findings highlight the need for tailored educational interventions to address knowledge gaps, particularly among male, less-experienced and lower qualified nurses. Implementing standardized training protocols can enhance oral care practices, improve patient outcomes and reduce VAP incidence.

PMID:39996334 | DOI:10.1111/nicc.13289

Ann Surg. 2025 Feb 25. doi: 10.1097/SLA.0000000000006679. Online ahead of print.

ABSTRACT

OBJECTIVE: To design and validate a questionnaire-based scoring system that measures distress and quality of life implications related to specific bowel function symptoms and consequences.

SUMMARY OF BACKGROUND DATA: The Patient Reported Outcomes after Pouch Surgery Delphi consensus study identified symptoms and consequences that were utilized to previously create a pouch severity score. The existing score does not specifically evaluate patients’ accommodations to pouch function or their perceived distress related to bowel-related quality of life over time.

METHODS: Pouch patients were recruited at inflammatory bowel disease centers and via patient advocacy websites. They were administered a questionnaire-based survey eliciting responses regarding the frequency of a variety of bowel symptoms identified in the prior Delphi consensus study. For each item, participants also responded to the question “How much does having this symptom (or consequence) bother you?”. Participants also reported on their quality of life. The responses were used to generate the Ileoanal Pouch Syndrome Distress index. Test-retest validity, convergent validity, and clinical validity were evaluated.

RESULTS: The distress index was calculated by adding the patient’s scores for all 16 items. The possible scores range from 0 to 64, ranked from least to most bothersome symptoms. With increasing distress index scores, a higher proportion of patients reported poor quality of life. The receiver operating characteristic area under the curve for the distress score prediction of poor quality of life was calculated at 0.871. The distress index showed excellent correlation with bowel function scores and measures of clinical validity.

CONCLUSIONS: The distress index represents a step forward in the patient-centered management of ileoanal pouch function. When used in combination with the severity score and longitudinally over time, it will allow surgeons and gastroenterologists to take a nuanced approach to optimizing bowel function for a population of highly complex gastrointestinal patients, while accounting for symptom accommodation over time.

PMID:39996315 | DOI:10.1097/SLA.0000000000006679

Mol Ecol. 2025 Feb 25:e17702. doi: 10.1111/mec.17702. Online ahead of print.

ABSTRACT

Polyploidisation is a significant reproductive barrier, yet genetic evidence indicates that interploidy admixture is more common than previously thought. Theoretical models and controlled crosses support the ‘triploid bridge’ hypothesis, proposing that hybrids of intermediate ploidy facilitate gene flow. However, comprehensive evidence combining experimental and genetic data from natural mixed-ploidy species is missing. Here, we investigated the rates and directionality of gene flow within a diploid-autotetraploid contact zone of Cardamine amara, a species with abundant natural triploids. We cytotyped over 400 individuals in the field, conducted reciprocal interploidy crosses, and inferred gene flow based on genome-wide sequencing of 84 individuals. Triploids represent a conspicuous entity in mixed-ploidy populations (5%), yet only part of them arose through interploidy hybridisation. Despite being rarely formed, triploid hybrids can backcross with their parental cytotypes, producing viable offspring that are often euploid (in 42% of cases). In correspondence, D-statistics and coalescent simulations documented a significant genome-wide signal of bidirectional gene flow in sympatric but not allopatric populations. Triploids, though rare, thus seem to play a key role in overcoming polyploidy-related reproductive barriers in C. amara. In sum, we present integrative evidence for interploidy gene flow mediated by a triploid bridge in natural populations.

PMID:39996298 | DOI:10.1111/mec.17702

Cureus. 2025 Jan 24;17(1):e77935. doi: 10.7759/cureus.77935. eCollection 2025 Jan.

ABSTRACT

Introduction Many medical students do not have access to hands-on surgical experience throughout the pre-clinical curriculum. To address this issue, we developed a low-cost abdominal surgery simulator for use during instructive years and tested its efficacy through a proof-of-concept, randomized controlled trial. Our goal is to help medical students integrate foundational anatomy with surgical pathology, enhancing their understanding and translating to academic success on board-relevant topics. Methods Second-year students at Edward Via College of Osteopathic Medicine-Carolinas Campus (VCOM-CC) were split into two groups. The control group utilized the traditional curriculum, while the experimental group used the curriculum along with the simulator in instructive and integrative sessions. We created pre- and post-assessments comprised of gastrointestinal anatomy relevant to United States Medical Licensing Examination (USMLE) Step 1 and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1 medical licensing examinations and compared the groups’ outcomes using statistical analysis. Results Statistical analysis was performed on the average change between the pre-assessment and post-assessment scores. This trial revealed an average change of -0.267, a standard deviation of 3.90 for the experimental group (n = 15), and an average change of -1.375, a standard deviation of 2.93 for the control group (n = 16). A two-sample t-test at 95% confidence interval yielded a p-value of 0.3246. Conclusion Although this trial did not demonstrate a statistically significant difference in the average score change, the increased exposure to both surgical and anatomical concepts provides a relevant learning experience for students before their clinical curriculum. In the future, we aim to integrate our simulator into pre-clinical medical education. Furthermore, we plan to evaluate the impact of our simulator on the performance of the two groups during surgical rotations as part of our ongoing research.

PMID:39996231 | PMC:PMC11848221 | DOI:10.7759/cureus.77935

Cureus. 2025 Jan 25;17(1):e77949. doi: 10.7759/cureus.77949. eCollection 2025 Jan.

ABSTRACT

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the world’s most serious healthcare issues, causing morbidity, mortality, and high healthcare costs, making effective treatment strategies essential. This meta-analysis assessed the comparative effectiveness and safety of ceftaroline, linezolid, and vancomycin in treating MRSA infections. Searches were undertaken across major electronic databases, including PubMed, Cochrane CENTRAL, Embase, and Web of Science, from 2000 to 2024. A total of 24 studies (17 randomized controlled trials (RCTs) and seven observational studies) involving 11,332 patients met the inclusion criteria. Patients on vancomycin treatment were more likely to have lower odds of being cured than controls (OR 0.68; 95% CI (0.58, 0.81), p < 0.0001), especially when compared to linezolid (OR 0.61; 95% CI (0.49, 0.74), p < 0.00001). Furthermore, mortality rates were significantly higher in vancomycin-treated patients than in controls (OR 1.25; 95% CI (1.00, 1.56), p = 0.05) and more precisely than in linezolid (OR 1.29; 95% CI (1.03, 1.62), p = 0.03). Microbiological eradication rates were not statistically different between vancomycin and the comparators (OR, 0.82; 95% CI (0.63, 1.07), p = 0.14). Safety analysis demonstrated comparable adverse event profiles between vancomycin and linezolid for thrombocytopenia, anemia, and hepatotoxicity. Although vancomycin remains a viable option owing to its accessibility and cost-effectiveness, our findings suggest that newer alternatives, particularly linezolid, may offer superior clinical outcomes in specific MRSA infections, especially in cases of pneumonia or high-risk patients. These results have important implications for clinical practice and antimicrobial stewardship programs and support a more nuanced approach to MRSA treatment based on patient-specific factors, infection characteristics, and local resources.

PMID:39996230 | PMC:PMC11848488 | DOI:10.7759/cureus.77949

Cureus. 2025 Jan 24;17(1):e77936. doi: 10.7759/cureus.77936. eCollection 2025 Jan.

ABSTRACT

BACKGROUND: Long-term prescribing of benzodiazepine receptor agonists (BZRAs) is a problem worldwide, but there are no detailed reports on the effects or side effects of reducing or discontinuing the dose. We retrospectively investigated the efficacy and safety of discontinuing or reducing the dose of BZRAs hypnotics after long-term use.

METHODS: Between April 2018 and May 2019, patients with insomnia after long-term use of BZRA hypnotics had BZRA hypnotics discontinued or their dose reduced, and their sleep conditions and anxiety symptoms were assessed. Insomnia severity (primary endpoint) was assessed as the change from baseline after discontinuation or reduction of BZRA hypnotics using the Insomnia Severity Index Japanese version (ISI-J). Changes from baseline in sleep quality and anxiety symptoms (secondary endpoint) from baseline were assessed using the Pittsburgh Sleep Quality Index Japanese version (PSQI-J) and Generalized Anxiety Disorder-7 (GAD-7), respectively. The adverse events were recorded during the study period. Statistical analysis was performed using the Wilcoxon matched-pairs signed rank test for changes in BZRA and concomitant medication dose, PSQI-J and GAD-7, and the paired t-test for changes in ISI-J.

RESULTS: The changes in ISI-J (discontinuation group: p = 0.07, reduction group: p = 0.91), PSQI-J (discontinuation group: p = 0.19, reduction group: p = 0.19), and GAD-7 scores (discontinuation group, p = 0.27; reduction group, p = 0.81) were not significant after the BZRA hypnotics were discontinued or reduced. Concomitant medications (antipsychotics and antidepressants) did not change from the baseline. The incidence of each adverse event did not change during the study period.

CONCLUSION: BZRA hypnotics can be discontinued or their dose reduced after long-term use without worsening sleep conditions and anxiety symptoms. Our results may provide a basis for the safe and effective discontinuation or dose reduction of long-term benzodiazepine hypnotics use.

PMID:39996227 | PMC:PMC11847632 | DOI:10.7759/cureus.77936

Cureus. 2025 Jan 24;17(1):e77904. doi: 10.7759/cureus.77904. eCollection 2025 Jan.

ABSTRACT

BACKGROUND: The use of peripherally inserted central catheters (PICC) in neonates has been established for numerous years, with significant advancements and enhancements observed in PICC technology over time. The objective of this study is to investigate the application trend of PICC over a 10-year period in a single-center neonatal intensive care unit (NICU).

METHODOLOGY: A retrospective analysis was conducted on the infants admitted between January 2012 and October 2021 who underwent PICC catheterization. Data pertaining to gestational age, birth weight, catheter weight, placement site, and indwelling time, as well as the occurrence of infection and complications, were collected. The data was collated, and statistical analysis was performed using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, New York, United States).

RESULTS: Out of the 1928 enrolled infants who underwent PICC catheterization, 1033 (53.58%) were males, and 895 (46.42%) were females. On the day of placement, their mean gestational age was 30.49±0.70 weeks, and their mean weight was 1398.26±14.05 g. Over the past 10 years, the number of PICC has consistently increased. The majority of cases were due to lower and right limb catheterization, with 1749 (90.72%) lower limb cases and 1477 (76.61%) right limb cases. The duration of catheter indwelling was 19.35±0.27 days. There were 297 cases (15.40%) of catheter-related complications, which included 107 cases (5.55%) of phlebitis, 71 cases (3.68%) of catheter obstruction, and 51 cases (2.65%) of catheter-related bloodstream infection (CRBSI). The binary logistic regression analysis revealed that the catheter site (upper extremity/lower extremity) (OR=0.612; 95% CI: 0.414-0.905; p=0.014) and catheter tip position (OR=1.903; 95% CI: 1.200-3.017; p=0.006) were associated with catheter complications.

CONCLUSIONS: During neonatal PICC catheterization in the NICU, the preferred approach is to perform venous catheterization of the lower extremities and ensure that the catheter tip remains positioned within the vena cava. This technique is associated with a reduction in catheter-related complications.

PMID:39996223 | PMC:PMC11848227 | DOI:10.7759/cureus.77904

Cureus. 2025 Jan 25;17(1):e77963. doi: 10.7759/cureus.77963. eCollection 2025 Jan.

ABSTRACT

BACKGROUND: Anemia is a significant public health issue in rural India, with a very big impact on health and productivity. This study investigates the prevalence and severity of anemia stratified by age and gender in a village in Southern India, using different guidelines.

METHODS: Retrospective data (n=3523) from a 2023 anemia survey done in the field area at Chirravuru under the Centre for Rural Health AIIMS (CRHA), Primary Health Centre (PHC), Nutakki (a peripheral unit of All India Institute of Medical Sciences {AIIMS}, Mangalagiri) covering 90% of the estimated population of the village was taken for the study. The hemoglobin levels were estimated from capillary blood, from where anemia severity was determined. Analysis was carried out to evaluate variations by age and gender to obtain statistical inferences. Results: Prevalence of anemia in the whole population was 79.3% (n=2792) with 32.9% (n=1159) of it being mild, 41.07% (n=1447) moderate, and 5.3% (n=186) severely anemic. Men had higher anemia of milder forms (43.3%) (n=746) than women (23.0%) (n=413), whereas women presented with a more severe form (7.8%) (n=140) compared to men (2.7%) (n=46). Moderate anemia tended to be similar in prevalence across both genders and was commoner among children under five (60%) (n=12) and adolescents (46.6%) (n=41) in comparison with adults (40.7%) (n=1350). Severe anemia was more frequent in adults (5.4%) (n=184).

CONCLUSIONS: Our findings revealed a relatively higher burden of anemia among women and children in Chirravuru. Similar areas of our country need targeted interventions to improve the hemoglobin status of adults and children through nutritional supplementation and health education.

PMID:39996221 | PMC:PMC11849579 | DOI:10.7759/cureus.77963

Cureus. 2025 Jan 22;17(1):e77856. doi: 10.7759/cureus.77856. eCollection 2025 Jan.

ABSTRACT

The choice of treatment of two modalities, open surgical or endovascular, in posterior cerebral artery (PCA) intracranial aneurysms must be taken based on their special characteristics. The objective of this study is to assess the potential superiority in outcomes, operative mortality, and clinical improvement after microsurgical and endovascular management repair in PCA intracranial aneurysms. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we created this study, performing a systematic investigation on the PubMed database, with the last search carried out on June 12, 2016. The eligibility limitations were that only full text was used in the English language, and double-checking was applied. Extracted data was organized on a standard table form, including first author, publication year, general number of patients and patients at follow-up, mortality rate (with 30 days from the selecting treatment), improvement (showing postoperatively at the clinical progress (muscle strength, thinking ability, and disorientation, due to ischemic infarctions following parent vessel occlusion) for the patients of both modalities. There were eight articles that matched our study criteria. The total study population included 8,863 patients with an aneurysm, 184 (2.07%) of which had an aneurysm at the different segments of the PCA. The pooled results revealed no statistically significant difference between the two groups, in terms of mortality, but with substantial statistical results concerning clinical improvement. We concluded that the aneurysmal site and size do not influence the treatment outcome. However, clinical improvement was a statistically significant factor, demonstrating the superiority of open surgical management over endovascular treatment (EVT) for PCA aneurysms. The selection of the appropriate procedure for every case must be done based on its special characteristics.

PMID:39996215 | PMC:PMC11848699 | DOI:10.7759/cureus.77856

Cureus. 2025 Jan 25;17(1):e77960. doi: 10.7759/cureus.77960. eCollection 2025 Jan.

ABSTRACT

Spontaneous intracranial hypotension (SIH) is a rare condition typically caused by a CSF leak at the level of the spine, leading to a reduction in intracranial pressure (ICP). This case describes a 55-year-old man who presented with visual disturbance, intermittent occipital headaches, nausea, altered hearing, and unsteady gait. The initial MRI of the head showed shallow bilateral subdural hematomas, which were believed to be secondary to the stretching of subdural veins. A diagnosis of probable intracranial hypotension was made and further radiological imaging of the spine was carried out to look for the presence of a CSF leak. A CT myelogram identified a CSF leak in the anterior part of the dura at the T1/T2 level, which was believed to be secondary to a bony spur. There are no well-defined statistics on the incidence of the causes of SIH. After a multidisciplinary discussion, a targeted CT-guided epidural blood patch was planned; however, the patient reported improvement in symptoms, so the procedure was abandoned, with serial follow-ups advised.

PMID:39996213 | PMC:PMC11849439 | DOI:10.7759/cureus.77960