Category: Nevin Manimala

Appl Health Econ Health Policy. 2025 Aug 30. doi: 10.1007/s40258-025-01001-7. Online ahead of print.

ABSTRACT

BACKGROUND: Antibiotic resistance (ABR) is a growing global health threat; reliable evidence on its impact is crucial for prioritising public health interventions.

OBJECTIVE: This study provides an updated, systematic review and meta-analysis to determine the true effect size of resistant infections on economic and clinical outcomes. It also evaluates methodologies used in ABR economic literature, offering recommendations for improving future research.

METHODS: Following PRISMA guidelines, 11,252 articles published between 2000 and 2022 were reviewed from several databases. Studies were included if they reported the economic costs of ABR in humans and compared resistant with susceptible infections. Meta-analyses were conducted using random intercept models; standardised mean difference (SMD) was used for length of stay, and odds ratio (OR) for mortality. The Mantel-Haenszel method was applied to obtain pooled estimates.

RESULTS: Results showed that 73% of the studies were conducted in high-income economies, the majority were performed at tertiary care settings (71%) and 67% employed only a hospital perspective. The available evidence indicated that the attributable cost of resistant infections ranged from EUR₂₀₂₂ – 21,629 to EUR₂₀₂₂ 74,452 per patient episode (with Pseudomonas spp. causing the highest costs). The majority of studies (93%) found that patients with ABR incurred higher costs than their susceptible counterparts (72% report statistically significantly higher costs). Results from meta-analysis indicated that, on average, the excess in hospital stay attributable to resistant infections was 8.72 days (95% confidence interval (CI) [6.42; 11.02], SMD = 0.91) and the odds of premature death were significantly higher in the resistance group, with a risk increase of 65% (OR 95% CI [1.44; 1.88]). Conclusion The findings of this study take the first steps in providing reliable evidence; they could be valuable to researchers, policymakers and clinicians involved in ABR control and health promotion across countries. Similarly, the reported estimates may prove useful for future modelling studies aimed at assessing the long-term economic impact of ABR.

PMID:40884690 | DOI:10.1007/s40258-025-01001-7

Clin Oral Investig. 2025 Aug 30;29(9):426. doi: 10.1007/s00784-025-06518-8.

ABSTRACT

OBJECTIVES: To investigate how surface treatment affects fracture force, flexural strength, and dynamic loading cycles until failure of 3D-printed restorations.

MATERIALS AND METHODS: Specimens (7 groups; n = 8 per group) were 3D-printed from an acrylate-based crown and bridge material. After cleaning and post-polymerization, specimens were treated with either silicon carbide paper (1000 grit; 1000/4000 grit) or blasting (Al₂O₃; 1 bar/125 µm; 2 bar/125 µm; 1 bar/250 µm) to simulate laboratory treatment. Surface roughness (Arithmetic mean Sa/maximum roughness height Sz; ISO 25178-2); fracture force (FF) and biaxial flexural strength (BFS; ISO 6872) were determined. The number of dynamic load cycles (LC) to failure was determined under cyclic loading in a BFS staircase approach.

STATISTICS: ANOVA, Bonferroni-test, Kaplan-Meier survival, Pearson correlation; α = 0.05.

RESULTS: BFS ranged between 94.4 MPa and 199.9 MPa, FF between 260.6 N and 428.6 N and Sa/Sz between 0.0/1.0 μm and 1.8/18.4 μm. BFS, FF and Sa/Sz showed significant differences between the treatments (p < 0.001) and individual groups (p ≤ 0.013). Mean LC ranged between 204,364 and 267,637 cycles. ANOVA comparisons (p = 0.706) and Log Rank test (Chi²: 10,835; p = 0.094; Fig. 2) revealed no significant differences between the loading cycles. Surface treatment with either silicon carbide papers or blasting protocols had a significant influence on FF, BFS, Sa, and Sz, but not on LC.

CONCLUSIONS: Surface treatment affected the fracture force and biaxial fracture strength of a 3D-printed crown. It showed no influence on the long-term dynamic behavior.

CLINICAL RELEVANCE: Smooth surfaces improve the stability of a restoration fabricated from 3D-printing resins. Extensive surface roughness treatment before cementation can reduce the stability of a crown.

PMID:40884683 | DOI:10.1007/s00784-025-06518-8

Int Urol Nephrol. 2025 Aug 30. doi: 10.1007/s11255-025-04750-5. Online ahead of print.

ABSTRACT

BACKGROUND: End-stage kidney disease (ESKD) requires lifelong kidney replacement therapy (KRT), which significantly influences patients’ quality of life (QoL). Primary KRT modalities include hemodialysis (HD), peritoneal dialysis (PD), and kidney transplant (KTX), each with varying impacts on QoL and clinical outcomes. Comparative data regarding these modalities in the local context, is limited.

OBJECTIVES: This study aims to evaluate and compare the QoL and biochemical profiles of patients undergoing different KRT modalities in Brunei Darussalam.

METHODS: A cross-sectional study was conducted in 2024 among 574 patients receiving HD, PD, or KTX across all government dialysis centers in Brunei. QoL was assessed using the validated SF-12 questionnaire, and biochemical parameters were collected from Brunei Darussalam Healthcare Information and Management System (BruHIMS). Sociodemographic and clinical data were used to profile and subgroups analysis.

RESULTS: KTX patients reported the highest QoL scores and most favorable biochemical profiles, reinforcing transplantation as the optimal modality when available. Among dialysis patients, PD was associated with higher physical health scores than HD, suggesting better QoL. KTX patients were generally younger, with higher educational and employment levels. Significant differences in biochemical parameters such as hemoglobin, albumin, creatinine, urea, phosphate, and cholesterol were observed across modalities, indicating modality-specific clinical impacts.

CONCLUSION: The findings suggest that PD may be associated with slightly better QoL outcomes compared to HD. However, these differences were not statistically significant and should be interpreted with caution, particularly given the potential for residual confounding inherent in observational study designs. Future research should focus on examining the long-term QoL trajectories among PD patients and identifying strategies to optimize its clinical benefits in the management of ESKD in Brunei.

PMID:40884617 | DOI:10.1007/s11255-025-04750-5

Eur Radiol. 2025 Aug 30. doi: 10.1007/s00330-025-11976-5. Online ahead of print.

ABSTRACT

OBJECTIVES: The rising global cancer burden underscores the need for efficient screening strategies. Whole-body magnetic resonance imaging (WB-MRI) has emerged as a promising modality for cancer screening, with growing use in research and commercial settings. This study aimed to evaluate the opportunistic cancer detection rate and the feasibility of WB-MRI in asymptomatic individuals.

MATERIALS AND METHODS: A systematic review and meta-analysis were conducted per PRISMA guidelines. A literature search was performed across multiple databases from January 2015 to April 2025. Eligible studies used WB-MRI for cancer detection in asymptomatic individuals. Studies were excluded if they combined WB-MRI with other imaging methods or included patients with active malignancy or comorbidities/genetic syndromes associated with increased cancer risk. Random-effects meta-analyses estimated pooled proportions of confirmed cancer diagnoses. Risk of bias was assessed using the ROBINS-I tool. Sensitivity and subgroup analyses, publication bias assessment, and meta-regression were performed.

RESULTS: Ten studies were included, comprising 9024 participants. The pooled detection rate for confirmed cancer was 1.57% (95% CI: 1.22-2.03%; I² = 31.3%). Results were robust in sensitivity and meta-regression analyses. No significant subgroup differences or publication bias were found. Most studies had a moderate to serious risk of bias.

CONCLUSION: Although WB-MRI shows potential as an opportunistic non-invasive cancer detection tool, modest detection rates, frequent incidental findings, unstandardized protocols, and lack of long-term outcome or cost-effectiveness data limit its current clinical utility.

KEY POINTS: Question Can whole-body magnetic resonance imaging (WB-MRI) serve as an effective cancer detection tool for asymptomatic individuals across various clinical and geographic settings? Findings This meta-analysis of over 9000 asymptomatic individuals found a lack of information on cost-effectiveness, unstandardized protocols, a modest cancer detection rate and high rates of incidental findings. Clinical relevance Despite the need for effective cancer screening tools and growing popularity in commercial and research centers, whole-body MRI lacks sufficient diagnostic yield, follow-up reports and standardization for opportunistic cancer detection in asymptomatic individuals and may lead to unnecessary investigations.

PMID:40884613 | DOI:10.1007/s00330-025-11976-5

Eur Radiol. 2025 Aug 30. doi: 10.1007/s00330-025-11931-4. Online ahead of print.

ABSTRACT

OBJECTIVE: T2 mapping allows for the classification of focal liver lesions, differentiating malignancies from the most common benign liver lesions, hemangiomas, and bile duct hamartomas (BDH). Partial volume (PV) due to the presence of liver and lesion within the same voxel confounds the classification of small lesions. Our objective is to develop a robust two-component T2 estimation technique (SEPG2-SP) to enable accurate T2 estimation in the presence of PV.

MATERIALS AND METHODS: T2 estimation accuracy was evaluated using computer simulations, physical phantom data, and in vivo in 27 subjects with focal liver lesions (16 males, 62.4 ± 14.3 years old; 11 females, 66.8 ± 5.8 years old) imaged at 1.5 T with a radial turbo spin-echo (RADTSE) technique. The SEPG2-SP model was compared to a single-component model, which does not account for PV. The area under the receiver operator characteristic curve (AUROC) was used to analyze lesion classification.

RESULTS: Phantom data showed that the SEPG2-SP model had a T2 estimation error of 2-9% while the single component model had a larger error of 9-23%. Analysis of in vivo data from 68 focal liver lesions (33 malignancies, 7 hemangiomas, and 28 BDH) showed that the SEPG2-SP model classified all lesions correctly (AUROC = 1), regardless of their size. On the other hand, with the single-component model, there was overlap between malignancies and benign lesions driven by misclassification of hemangiomas as malignancies (AUROC = 0.84).

CONCLUSIONS: The two-component T2 model improved the characterization of focal liver lesions affected by PV, yielding complete separation of malignancies from the most common benign liver lesions.

KEY POINTS: Question Partial volume effects result in T2 estimation errors that confound the classification of small focal liver lesions. Findings The proposed two-component T2 estimation technique improves T2 estimation accuracy and allows accurate characterization of focal liver lesions in the presence of partial volume. Clinical relevance The T2 mapping technique described here offers a practical and reliable approach for quantitatively classifying focal liver lesions. It enables differentiation between the most common benign liver lesions and malignancies, even in small tumors impacted by partial volume effects.

PMID:40884612 | DOI:10.1007/s00330-025-11931-4

Eur Radiol. 2025 Aug 30. doi: 10.1007/s00330-025-11928-z. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aims to explore the feasibility of employing generative adversarial networks (GAN) to generate synthetic contrast-enhanced ultrasound (CEUS) from grayscale ultrasound images of patients with thyroid nodules while dispensing with the need for ultrasound contrast agents injection.

MATERIALS AND METHODS: Patients who underwent preoperative thyroid CEUS examinations between January 2020 and July 2022 were collected retrospectively. The cycle-GAN framework integrated paired and unpaired learning modules was employed to develop the non-invasive image generation process. The synthetic CEUS images was generated in three phases: pre-arterial, plateau, and venous. The evaluation included quantitative similarity metrics, classification performance, and qualitative assessment by radiologists.

RESULTS: CEUS videos of 360 thyroid nodules from 314 patients (45 years ± 12 [SD]; 272 women) in the internal dataset and 202 thyroid nodules from 183 patients (46 years ± 13 [SD]; 148 women) in the external dataset were included. In the external testing dataset, quantitative analysis revealed a significant degree of similarity between real and synthetic CEUS images (structure similarity index, 0.89 ± 0.04; peak signal-to-noise ratio, 28.17 ± 2.42). Radiologists deemed 126 of 132 [95%] synthetic CEUS images diagnostically useful. The accuracy of radiologists in distinguishing between real and synthetic images was 55.6% (95% CI: 0.49, 0.63), with an AUC of 61.0% (95% CI: 0.65, 0.68). No statistically significant difference (p > 0.05) was observed when radiologists assessed peak intensity and enhancement patterns using real CEUS and synthetic CEUS.

CONCLUSION: Both quantitative analysis and radiologist evaluations exhibited that synthetic CEUS images generated by generative adversarial networks were similar to real CEUS images.

KEY POINTS: QuestionIt is feasible to generate synthetic thyroid contrast-enhanced ultrasound images using generative adversarial networks without ultrasound contrast agents injection. FindingsCompared to real contrast-enhanced ultrasound images, synthetic contrast-enhanced ultrasound images exhibited high similarity and image quality. Clinical relevanceThis non-invasive and intelligent transformation may reduce the requirement for ultrasound contrast agents in certain cases, particularly in scenarios where ultrasound contrast agents administration is contraindicated, such as in patients with allergies, poor tolerance, or limited access to resources.

PMID:40884611 | DOI:10.1007/s00330-025-11928-z

Eur Radiol. 2025 Aug 30. doi: 10.1007/s00330-025-11968-5. Online ahead of print.

ABSTRACT

OBJECTIVE: Massive haemoptysis due to central pulmonary artery (CPA) rupture in patients with advanced lung cancer is a fatal complication with limited early diagnostic tools. This study aimed to identify risk factors associated with pulmonary artery rupture and to propose a grading model to facilitate early diagnosis and timely endovascular intervention.

MATERIALS AND METHODS: This retrospective study included patients with advanced lung cancer who experienced in-hospital sudden haemoptysis-related death and received endovascular treatment for CPA abnormalities. Propensity score matching (PSM; 1:2) balanced covariates between haemoptysis-related and other in-hospital deaths. Following PSM, multivariable logistic regression was performed to identify independent risk factors. Patients were categorised into two cohorts: Group A (2012-2018) and Group B (2019-2024), the latter reflecting the implementation of early detection and endovascular management. Overall survival (OS) was compared using Kaplan-Meier analysis and log-rank testing.

RESULTS: Among 886 in-hospital deaths, sudden haemoptysis accounted for 4.63% (41/886), with 90.24% (37/41) exhibiting CPA abnormalities. CPA abnormalities, tumour necrosis, cavitation, and progressive bloody or malodorous sputum were identified as significant risk factors (p < 0.05). The haemoptysis group had significantly shorter OS than controls (p < 0.001). A three-tier grading system for pulmonary arterial blowout syndrome (PABS) was developed, with acute PABS being the most prevalent (67.26%). Patients in Group B demonstrated significantly improved OS compared with Group A (p < 0.001).

CONCLUSION: The PABS grading model enables risk stratification of life-threatening haemoptysis secondary to CPA rupture. Early identification and endovascular intervention may significantly improve clinical outcomes in advanced lung cancer.

KEY POINTS: Question What are the clinical characteristics and risk stratification criteria for life-threatening haemoptysis arising from CPA rupture in advanced lung cancer? Findings In-hospital sudden haemoptysis mortality was 4.63% and strongly associated with CPA abnormalities. A PABS grading model characterises this fatal condition. Clinical relevance The PABS grading system enables early recognition of high-risk CPA rupture in advanced lung cancer. Prompt identification and endovascular intervention may substantially improve patient outcomes.

PMID:40884610 | DOI:10.1007/s00330-025-11968-5

Eur J Orthop Surg Traumatol. 2025 Aug 30;35(1):368. doi: 10.1007/s00590-025-04496-x.

ABSTRACT

BACKGROUND: Shoulder instability is a common condition among young athletes, with high recurrence rates following conservative treatment. Bankart repair is a widely used surgical approach, but its failure rate remains significant, even for non-engaging defects. Combining Bankart repair with remplissage has been proposed to reduce recurrence rates.

METHODS: This retrospective, single-center study analyzed the long-term outcomes of young athletes (18-30 years old) who underwent Bankart repair combined with remplissage after a first anterior glenohumeral dislocation. Patients were evaluated at least five years postoperatively for recurrence rates, functional outcomes (Walch-Duplay, WOSI, Quick-DASH), return to sports, and the need for revision surgery.

RESULTS: Twenty-five patients were included, with an average follow-up of 81.4 months. The recurrence rate was 12% (3/25), with one patient requiring revision surgery. Functional scores were satisfactory (Walch-Duplay: 89.5, WOSI: 10.95, Quick-DASH: 14.30), and 84% of patients returned to sports at their previous level or higher. No significant complications were reported.

CONCLUSION: Bankart repair combined with remplissage appears to be an effective first-line treatment for young athletes with a first anterior shoulder dislocation, achieving a low recurrence rate and high return-to-sport levels. Further prospective, comparative studies are needed to validate these findings.

PMID:40884607 | DOI:10.1007/s00590-025-04496-x

CNS Drugs. 2025 Aug 30. doi: 10.1007/s40263-025-01221-4. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: The rising prescription rates and opioid-related harms in France highlight the need for local data. Evaluating this association may help identify vulnerable subgroups and guide safer prescribing practices. This study aimed to assess the association between opioid analgesic dispensation and the risk of suicide attempt in the French population. Secondary objectives included evaluation of a dose-response relationship and examination of the potential additive effects of co-prescriptions with benzodiazepines or gabapentinoids.

METHODS: We conducted a nationwide, population-based case-crossover study using data from the French National Health Insurance Database (Système National des Données de Santé, SNDS), covering 98.8% of the French population. Adults aged 18 years or older who were hospitalized for a first suicide attempt between 1 January 2013 and 31 December 2020, and who had received at least one opioid analgesic dispensation in the preceding year (excluding buprenorphine and methadone) were included. Opioid analgesic exposure during the 84 days before the attempt was compared with three earlier 84-day control periods.

RESULTS: Among 158,400 patients (mean age 47.0 years; 64.0% women), opioid analgesic dispensation was associated with a higher risk of suicide attempt (odds ratio [OR] = 1.26; 95% confidence interval 1.25-1.28). The risk was greater for strong opioid analgesics (OR = 1.73) and higher morphine-equivalent doses. Co-prescription with benzodiazepines or gabapentinoids further increased risk.

CONCLUSIONS: Opioid analgesic use, especially at higher doses or in combination with benzodiazepines or gabapentinoids, was associated with an increased risk of suicide attempt. Clinical vigilance is warranted when prescribing these medications.

TRIAL REGISTRATION: NCT04211077, registered 3 January 2020 (retrospectively registered).

PMID:40884605 | DOI:10.1007/s40263-025-01221-4

Bull Math Biol. 2025 Aug 30;87(10):138. doi: 10.1007/s11538-025-01518-x.

ABSTRACT

The community composition of vectors and hosts plays a critical role in determining risk of vector-borne disease transmission. Aedes aegypti and Aedes albopictus, two mosquito species that both transmit the viruses that cause dengue, chikungunya, and Zika, share habitat requirements and compete for resources at the larval stage. Ae. albopictus is generally considered a better competitor under many conditions, while Ae. aegypti is able to tolerate higher temperatures and is generally a more competent vector for many pathogens. We develop a stage-structured ordinary differential equation model that incorporates competition between the juvenile stages of two mosquito populations. We incorporate experimental constraints on competition coefficients for high and low quality food resources and explore differences in the potential outcomes of competition. We then incorporate temperature-dependent fecundity rates, juvenile development rates, and adult mortality rates for each species, and we explore competition outcomes as a function of temperature. We show that regions of coexistence and competitive exclusion depend on food quality and relative values of temperature-dependent life history parameters. Finally, we investigate the combined impacts of temperature and competition on the potential for dengue transmission, and we discuss our results in the context of present and future risk of mosquito-borne disease transmission.

PMID:40884588 | DOI:10.1007/s11538-025-01518-x