Category: Nevin Manimala

Niger J Clin Pract. 2025 Sep 1;28(9):1020-1026. doi: 10.4103/njcp.njcp_354_25. Epub 2025 Sep 27.

ABSTRACT

BACKGROUND: Urinary retention (UR) can lead to both anatomical and functional derangement in the urinary system. Chronic kidney disease occurs when there is renal damage.

AIM: This study aims to determine the relationship between chronic UR (CUR), retained urine volume, and renal function among men with chronic and acute-on-chronic UR.

METHODS: The study was a hospital-based prospective study of Nigerian men presenting with chronic or acute-on-chronic UR. Diagnosis of UR was made based on history and physical examination. The estimated glomerular filtration rate (eGFR) was calculated using the serum creatinine level. Retained urine volume was measured after an aseptic urethral catheterization. Spearman’s rank correlation test was used for correlation analysis between CUR, retained urine volume, and renal function. A P value of < 0.05 was accepted as statistically significant.

RESULTS: Fifty-six men met the inclusion criteria. Most of the patients were in the age range of 80-89 years. A total of 20 (35.7%) had acute-on-chronic UR, while 36 (64.3%) had CUR. The mean retained urine volume was 1500 ± 748.0 mL and 1100 ± 515.0 mL for the chronic and acute-on-chronic UR groups, respectively. Obstructive nephropathy occurred in 88.6% of the participants with CUR. There was a significant negative relationship between the eGFR and the volume of retained urine (r = -0.397, P = 0.002).

CONCLUSION: A high prevalence of obstructive nephropathy was observed among men with chronic and acute-on-chronic UR in this study.

PMID:41014526 | DOI:10.4103/njcp.njcp_354_25

Niger J Clin Pract. 2025 Sep 1;28(9):995-1003. doi: 10.4103/njcp.njcp_254_25. Epub 2025 Sep 27.

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) and the need for renal replacement therapy (RRT) are major complications in critically ill patients. The C-reactive protein (CRP)/albumin ratio (CAR) is a readily available biomarker reflecting systemic inflammation and nutritional status, but its predictive value for renal outcomes in the intensive care unit (ICU) remains uncertain.

AIMS: To assess whether the CAR measured within the first 12 hours of ICU admission can predict the development of AKI and the need for RRT in critically ill patients.

METHODS: This retrospective observational study was conducted in a tertiary intensive care unit and included 204 ICU patients without acute or chronic kidney failure at admission. CRP and albumin levels were measured within 12 hours of ICU admission. Patients with conditions affecting albumin levels were excluded. AKI and RRT development during ICU stay were recorded. Statistical analyses included the Mann-Whitney U test, Chi-square test, receiver operating characteristic (ROC) analysis for diagnostic performance, and multivariate logistic regression for independent predictors.

RESULTS: AKI occurred in 55.9% and RRT was required in 21.6% of patients. Patients requiring RRT had lower albumin levels and higher acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores. Although CAR was slightly elevated in patients with AKI or RRT, it was not independently associated with these outcomes (RRT: OR 0.97, AUC 0.575; AKI: OR 1.03, AUC 0.643).

CONCLUSIONS: The CRP/albumin ratio was not an independent predictor of AKI or RRT. Its clinical usefulness may improve, when combined with established illness severity scores for renal risk stratification in ICU patients.

PMID:41014523 | DOI:10.4103/njcp.njcp_254_25

Health Technol Assess. 2025 Sep;29(47):1-150. doi: 10.3310/DWKT1327.

ABSTRACT

BACKGROUND: Surgical reconstruction to close a severe pressure ulcer has not been evaluated.

AIM AND OBJECTIVES: We aimed to investigate the feasibility of research to evaluate surgical reconstruction for severe pressure ulcers by: systematically reviewing evidence about: the effectiveness of surgical reconstruction for severe pressure ulcers; the impact of pressure ulceration on health-related quality-of-life (review 2) surveying primary and secondary care healthcare professionals about surgical referrals of patients with severe pressure ulcers and severe pressure ulcer management, including surgical reconstruction describing patients with incident pressure ulcers and with severe pressure ulcers having surgical reconstruction comparing outcomes in patients with severe pressure ulcers having/not having surgical reconstruction seeking consensus about treatments and management strategies for severe pressure ulcers.

DESIGN: Systematic reviews; surveys; binary choice experiment; retrospective cohort studies using routine data; consensus meeting.

PARTICIPANTS: General practitioners; nurses; and surgeons managing pressure ulcers; people with incident pressure ulcers and hospitalised with severe pressure ulcers.

INTERVENTION: Surgical reconstruction.

COMPARATOR: No surgical reconstruction.

OUTCOMES: Surgical reconstruction, time to next admission with a severe pressure ulcer time to next admission, hospital stay, all-cause mortality, surgical reconstruction after discharge.

RESULTS: Review 1 included three studies comparing different surgical reconstruction techniques. None reported wound-free time. Recurrence occurred in ≈ 20%. Review 2 included three randomised controlled trials measuring health-related quality of life, but none observed benefits of interventions evaluated. Among primary care survey respondents, 54% did not know surgical reconstruction can treat severe pressure ulcers; > 50% had never referred a patient to a surgeon. Among nurses, 72% had considered surgical reconstruction for a severe pressure ulcer; 54% believed surgical reconstruction should be more available. Among surgeons, 39% had never offered surgical reconstruction and 52% offered surgical reconstruction to < 50%; 68% believed surgical reconstruction should be more available. Routine data recorded 367,884 admissions with severe pressure ulcer diagnoses in England over 7.5 years; surgical reconstructions were performed in at least 404 and at most 1018 admissions. Twenty English hospitals performed > 70% of the surgical reconstructions. Comparing surgical reconstruction (n = 325) versus no surgical reconstruction (n = 1474) patients, time to next admission with a severe pressure ulcer was longer in patients having surgical reconstruction (hazard ratio = 0.79, 95% confidence interval 0.61 to 1.03; p = 0.07). Estimated pressure ulcer incidence in primary care was ≈ 5/10,000, but the true incidence was believed to be ≈ 7 times higher. Episodes of pressure ulcer care could not be identified. There was consensus about a referral pathway for severe pressure ulcer patients wanting surgical reconstruction, including both community-led and surgically led multidisciplinary team meetings, and about the influence of several patient and severe pressure ulcer characteristics on suitability for surgical reconstruction.

LIMITATIONS: Surveys only considered factors one by one. Analyses of the Hospital Episode Statistics cohort depended on coding accuracy. For the comparison of surgical reconstruction and no surgical reconstruction, the no surgical reconstruction group had to be admitted. Routine data do not record wound healing outcomes. Primary care data underestimated pressure ulcer incidence; pressure ulcer care episodes could not be identified. The consensus meeting did not include surgeons. The COVID-19 pandemic caused delays, made team members unavailable and restricted face-to-face meetings.

CONCLUSIONS: There is insufficient evidence to determine the effectiveness of surgical reconstruction on health-related quality of life or wound healing for severe pressure ulcers. Too few procedures are carried out to enable a randomised controlled trial to be feasible.

FUTURE WORK: We identified three areas: qualitative research on the acceptability of surgical reconstruction and the impact of a SPU on a patient’s quality-of-life; a core outcome set for interventions to treat pressure ulcers; and economic modelling of surgical reconstruction cost-effectiveness.

STUDY REGISTRATION: This study is registered as PROSPERO 2019 CRD42019156436, 2019 CRD42019156450; ISRCTN13292620.

FUNDING: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR127850) and is published in full in Health Technology Assessment; Vol. 29, No. 47. See the NIHR Funding and Awards website for further award information.

PMID:41014516 | DOI:10.3310/DWKT1327

Age Ageing. 2025 Aug 29;54(9):afaf273. doi: 10.1093/ageing/afaf273.

ABSTRACT

BACKGROUND: The association between pre-existing frailty and increased mortality in stroke survivors remains unclear, with prior studies reporting inconsistent findings. This meta-analysis aimed to evaluate the impact of pre-stroke frailty on all-cause mortality in this population.

METHODS: We systematically searched PubMed, Embase, Web of Science, Cochrane Library, CINAHL, PsycINFO, CNKI, Wanfang, VIP, and SinoMed databases up to November 12, 2024. Study selection and data extraction were independently performed by two investigators. Studies using validated frailty assessment tools and reporting adjusted hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were included.

RESULTS: Sixteen studies involving 55,897 patients met the inclusion criteria. The prevalence of frailty among stroke survivors ranged from 11.2% to 75.3%. Meta-analysis showed that pre-stroke frailty was significantly associated with increased all-cause mortality (pooled HR = 2.19, 95% CI: 1.44-3.34; pooled OR for continuous frailty scores = 1.26, 95% CI: 1.14-1.38). Dose-response analysis revealed a linear relationship, with each one-point increase in frailty score associated with a 6.4% higher risk of death (HR = 1.064, 95% CI: 1.031-1.098). Subgroup analyses indicated that the association was particularly strong in acute ischemic stroke populations (OR = 3.43, 95% CI: 1.81-6.51). The type of frailty assessment tool and study sample size were identified as potential sources of heterogeneity.

CONCLUSION: Pre-stroke frailty independently predicts all-cause mortality in stroke survivors. Even mild increases in frailty burden are associated with worse outcomes, highlighting the clinical importance of incorporating frailty assessment into prognostic evaluation.

PMID:41014508 | DOI:10.1093/ageing/afaf273

J Anim Sci. 2025 Sep 27:skaf334. doi: 10.1093/jas/skaf334. Online ahead of print.

ABSTRACT

The application of heat in dietary processing is known to influence nutrient digestibility. Novel pet food formats with differing processing methods are gaining popularity, but few studies have examined their digestibility. Most research evaluating dietary processing type on nutrient digestibility has tested commercial foods that were vastly different regarding ingredient inclusion and macronutrient content, making it difficult to determine the processing influences. To address this research question, the current study aimed to determine amino acid (AA) digestibility and nitrogen-corrected true metabolizable energy (TMEn) of diets having the same ingredient formulations and nutrient concentrations but manufactured using different processing methods. Five diets were manufactured using the following processing methods: retort (RT), mildly cooked [sous vide (SV) and steamed (ST)], and raw [high-pressure processing (HPP) and freeze-drying (FD)]. Those diets were compared against the raw ingredient batch (RAW) that served as a control. Two precision-fed rooster assays utilizing Single Comb White Leghorn (1.5 to 2.5 y old, 2.5 to 3 kg body weight) were conducted to determine the standardized AA digestibility (30 cecectomized roosters; n = 5) and TMEn content (30 conventional roosters; n = 5) of the six pet foods. Prior to feeding, wet diets (RT, SV, ST, HPP, and RAW) were freeze-dried, and all diets were ground. Following crop intubation, excreta were collected for 48 h and analyzed, and then AA digestibility and TMEn calculations were performed. Data were analyzed using the Mixed Models procedure of SAS with P < 0.05 accepted as statistically significant and P < 0.10 a trend. The digestibility of 6 indispensable AA were affected by processing. The SV and ST diets had greater (P < 0.05) histidine digestibilities than all other diets. For valine, methionine, leucine, phenylalanine, and isoleucine, the RAW diet tended to have greater (P < 0.10) digestibility than the RT diet. The RT diet had lower (P < 0.05) aspartic acid digestibility than ST, HPP, FD, and RAW diets. Dietary TMEn was higher (P < 0.05) for the SV and ST diets than the RT, HPP, and FD diets, suggesting that those cooking methods are less damaging to macronutrients. Overall, the RT diet had lower indispensable digestible AA concentrations than RAW, likely due to the high heat of processing. Future research should test differences in these diet types in the target species (ie, dog) to evaluate how they perform.

PMID:41014493 | DOI:10.1093/jas/skaf334

J Endocrinol Invest. 2025 Sep 27. doi: 10.1007/s40618-025-02708-z. Online ahead of print.

ABSTRACT

PURPOSE: To identify clinical and sociodemographic factors that predict follow-up discontinuation and rehospitalisation after multidisciplinary residential rehabilitation for severe obesity, thereby defining high-risk patient profiles and guiding tailored retention strategies.

METHODS: We retrospectively followed 1,851 adults with obesity discharged from a multidisciplinary residential programme between 2015 and 2018 (median BMI 42 kg m⁻²). Dropout, defined as more than twelve months without contact, was studied with discrete-time survival models; time to rehospitalisation was analysed with Cox regression.

RESULTS: Within twelve months 1,513 patients (87%) discontinued follow-up. Each five-year increase in age lowered drop-out risk (HR 0.97, 95% CI 0.94-0.99, p = 0.004); diabetes had a similar protective effect (HR 0.89, 0.79-1.00, p = 0.0455). Rehospitalisation occurred in 591 patients (32%). Risk increased with age (5-years increment; HR = 1.05, 95% CI 1.01-1.09, p = 0.0191), baseline BMI (HR = 1.04, 95% CI 1.03-1.05, p < 0.0001), diabetes (HR = 1.22, 95% CI 1.02-1.30, p = 0.0306) and eating disorders (HR = 1.48, 95% CI 1.07-2.05, p = 0.0193).

DISCUSSION: Maintaining the benefits of residential rehabilitation is important. In our cohort, 87% of patients dropped out of follow-up within one year and 32% were readmitted. Two distinct profiles emerged: younger and non-diabetic subjects were prone to dropout, while patients with higher BMI, diabetes, or eating disorders were at higher risk of rehospitalization. Early identification of these groups may suggest flexible, technology-assisted follow-up for working-age patients and integrated metabolic-psychiatric care for complex cases, safeguarding outcomes and optimizing resources.

PMID:41014476 | DOI:10.1007/s40618-025-02708-z

J Med Ultrason (2001). 2025 Sep 27. doi: 10.1007/s10396-025-01579-4. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the technical feasibility and performance of automatic image-based registration (IBR) for liver fusion imaging and to identify clinical and anatomical factors affecting registration success.

MATERIALS AND METHODS: This prospective study included 84 patients undergoing liver fusion imaging using an ultrasound system with IBR. Three operators with 5, 10, and 25 years of experience (junior, intermediate, and senior), respectively, independently performed IBR. Fusion time and registration error were recorded. Fusion success was defined both globally (success by all or at least one operator) and individually (registration error < 10 mm). Clinical and anatomical factors were assessed. Predictors of failure were identified using multivariable logistic regression with Firth’s correction.

RESULTS: IBR was successful in all three operators in 86.9% of cases and by at least one operator in 96.4%. The most experienced operator achieved significantly shorter fusion times (median: 15.0 s) and smaller fusion errors (median: 6.0 mm) compared to the less experienced operators. Operator-specific success rates defined as registration error < 10 mm were 45.2%, 60.7%, and 79.8%, respectively (p < 0.001). Subcutaneous tissue depth was the only independent predictor of fusion failure in both multivariable models (OR = 1.13 for all failed, p = 0.033; OR = 0.88 for partial success, p = 0.012). Other clinical factors were not statistically significant.

CONCLUSION: IBR is a highly feasible method that reduces operator dependency in liver fusion imaging compared to conventional methods, though registration accuracy still varies with operator experience.

CLINICAL IMPACT: IBR enables consistent and simplified fusion imaging regardless of operator experience. Its broad applicability may support safer and more efficient ultrasound-guided interventions, especially in resource-limited or time-sensitive settings.

PMID:41014474 | DOI:10.1007/s10396-025-01579-4

Eye (Lond). 2025 Sep 26. doi: 10.1038/s41433-025-04036-1. Online ahead of print.

ABSTRACT

BACKGROUND: This study evaluated the long-term structural, functional, and microvascular outcomes in school-aged children with a history of laser photocoagulation (LP) therapy for the treatment of type 1 retinopathy of prematurity (ROP). The macular integrity, retinal sensitivity, fixation stability, and microvascular parameters were assessed using microperimetry and optical coherence tomography angiography (OCT-A).

METHODS: This retrospective cross-sectional study included children aged 10-15 who underwent detailed ophthalmologic examinations. Participants were divided into three groups: (1) children who had received LP for the treatment of ROP in infancy, (2) prematurely born infants without any ROP diagnosis, and (3) full-term controls. Statistical analysis was conducted to compare fixation stability, foveal avascular zone (FAZ) area, and vascular density (VD).

RESULTS: A significant difference was found in fixation stability among the groups, demonstrating more stable fixation in term-born children compared to preterm groups and significantly eccentric fixation in laser-treated infants (p = 0.019 and p < 0.001, respectively). Furthermore, FAZ areas were substantially smaller, and VD values were higher in laser-treated infants (p < 0.001 for both). A negative correlation was identified between fixation instability and FAZ size (p = 0.016 and p = 0.015), suggesting a relationship between fixation behaviour and foveal microvascular integrity.

CONCLUSION: The diagnosis and treatment of ROP can significantly affect long-term visual functions, fixation behaviours, and macular vascular development. These findings emphasise the importance of long-term follow-up for preterm infants and the need for further studies to investigate the relationship between fixation stability and retinal microvasculature.

PMID:41006681 | DOI:10.1038/s41433-025-04036-1

Sci Rep. 2025 Sep 26;15(1):33010. doi: 10.1038/s41598-025-18390-3.

ABSTRACT

Knowing the predictors of pregnancy outcomes in patients with recurrent spontaneous abortion (RSA) is extremely critical. Accordingly, we aimed to determine the effects of the difference between mean gestational sac diameter and crown-rump length (mGSD-CRL) on the pregnancy outcomes in patients with RSA at 6-10 gestational weeks, as well as to explore its significance in predicting the pregnancy outcomes of patients with RSA. This retrospective cohort study included 256 pregnant women at 6-10 weeks of gestation and with RSA who had visited our hospital from January 2020 to March 2023. The patients were allocated to three groups based on the mGSD-CRL difference: Group A: mGSD-CRL ≤ 10 mm, Group B: 10 mm < mGSD-CRL ≤ 15 mm, and Group C: mGSD-CRL > 15 mm. The pregnancy failure rate in Group A was 22%, which was higher than those that in Group B (5.5%) and Group C (9.4%), with statistically significant differences (P < 0.05). Binary logistic regression analysis revealed that the mGSD (odd ratio [OR] = 1.14, 95% confidence interval [CI] = 1.06-1.23, P = 0.001), the CRL (OR = 1.16, 95% CI = 1.05-1.28, P = 0.004), and mGSD-CRL (OR = 1.12, 95% CI = 1.01-1.24, P = 0.026) were independent risk factors affecting the pregnancy outcome of patients with RSA. However, the uterine artery peak systolic value to end-diastolic value (UtA-S/D), D-dimer (DD), adenosine diphosphate (ADP), and arachidonic acid (AA) were not related (P > 0.05). The area under the receiver operator characteristic (ROC) curve of mGSD-CRL at 6-10 weeks of pregnancy was 0.566, with a cutoff value of 9.50 mm. The sensitivity and specificity were 90% and 36%, respectively. Compared with their prediction value, the combined prediction of mGSD-CRL, mGSD, and CRL exhibited a higher value (AUC = 0.718) in predicting pregnancy outcomes. A weak negative correlation was detected between ADP and mGSD-CRL difference (r = – 0.165, P = 0.025). In patients with RSA, mGSD-CRL acts as an independent risk factor affecting pregnancy outcomes, thereby effectively predicting the early pregnancy outcomes of patients with RSA. Thus, a low mGSD-CRL difference signifies the heightened probability of miscarriage, thereby urgently requiring clinicians to pay timely attention. Trial registration: The study is registered at ClinincalTrails.gov (Trial registration number: NCT06081556, October 13, 2023).

PMID:41006676 | DOI:10.1038/s41598-025-18390-3

Nat Neurosci. 2025 Sep 26. doi: 10.1038/s41593-025-02066-2. Online ahead of print.

ABSTRACT

Gonadal hormone receptors are widely distributed across the brain, yet their influence on brain structure remains understudied. Here, using precision imaging, we examined four females, including one with endometriosis and one using oral contraceptives (OC), across a monthly period. Whole-brain analyses revealed spatiotemporal patterns of brain volume changes, with substantial variations across the monthly period. In typical cycles, spatiotemporal patterns were associated with serum progesterone levels, while in cycles with endometriosis and during OC intake, patterns were associated with serum estradiol levels. The volume changes were widely distributed rather than region-specific, suggesting a widespread but coordinated influence of hormonal fluctuations. These findings underscore the importance of considering diverse hormonal milieus beyond typical menstrual cycles in understanding structural brain dynamics and suggest that hormonal rhythms may drive widespread structural brain changes.

PMID:41006668 | DOI:10.1038/s41593-025-02066-2