Category: Nevin Manimala

Indian J Med Res. 2025 Jul;162(1):66-73. doi: 10.25259/IJMR_2086_2024.

ABSTRACT

Background & objectives The role of behavioural therapies for alcohol use disorder (AUD) has been reported in patients with alcohol-related liver disease (ALD); however, that of pharmacological treatments is yet to be established. We conducted a systematic review and meta-analysis to study the use of these pharmacological interventions in ALD for liver-related and patient-important outcomes, including abstinence. Methods We conducted a systematic search of four major databases. Title and abstract screening, full-text review, risk of bias assessment, and data extraction were performed independently by two reviewers. Random-effects meta-analysis was used to calculate pooled effect estimates with 95 per cent confidence intervals (CI). The certainty of the evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) tool and categorised as high, moderate, low, or very low. Results Altogether, eleven studies (1 RCT and 10 cohort studies) were included in the systematic review and eight studies in the meta-analyses. Meta-analysis of two cohort studies (44813 participants) showed significantly lower odds of all-cause mortality with the use of AUD pharmacotherapy with acceptable statistical heterogeneity [Odds Ratio (OR) 0.86; 95% CI 0.79-0.93; I2 = 0%]. Meta-analysis of one RCT and three cohort studies (303 participants) for the outcome of abstinence revealed a pooled proportion of 47.5 per cent (95% CI, 42.1-52.9; I2 = 11.7%). The certainty in estimates was very low. Interpretation & conclusions The present systematic review and meta-analysis suggest that pharmacological therapies in ALD may reduce overall mortality and the incidence of hepatic decompensation. However, given the very low certainty of evidence, these findings should be interpreted with caution and underscore the need for well-designed trials.

PMID:40991211 | DOI:10.25259/IJMR_2086_2024

J Racial Ethn Health Disparities. 2025 Sep 24. doi: 10.1007/s40615-025-02655-8. Online ahead of print.

ABSTRACT

OBJECTIVES: Anxiety disorders have a chronic, more severe course among Black individuals. Racial and ethnic discrimination exacerbates anxiety among Black adults. Hope and mindfulness are positive resilience traits that correlate with lower anxiety levels. Protective factors against anxiety must be examined in culturally informed contexts. This study evaluates the unique associations of hope, mindfulness, discrimination, anxiety, and social anxiety among Black adults.

METHODS: Participants were 635 (133 men, 502 women) adults from a large southwestern United States university who identified as African American or Black. Ages ranged from 18 to 52 (M_age = 21.66 years). Participants completed a battery of self-report questionnaires on hope, mindfulness, anxiety, social anxiety, and discrimination.

RESULTS: Structural equation modeling analyses demonstrated that hope is associated with lower social fear when accounting for mindfulness and discrimination (β = – 0.14, C.I = – 0.24: – 0.03). Mindfulness is associated with lower anxiety (β = – 0.31, C.I = – 0.41: – 0.21), social fear (β = – 0.18, C.I = – 0.29: – 0.07), and social avoidance (β = – 0.22, C.I = – 0.34: – 0.10) when accounting for hope and discrimination. Discrimination is associated with higher anxiety (β = 0.28, C.I = 0.20:0.36), social fear (β = 0.31, C.I = 0.22:0.39), and social avoidance (β = 0.29, C.I = 0.20:0.37) when accounting for mindfulness and hope.

CONCLUSIONS: Mindfulness had more robust protective qualities in the context of discrimination for anxiety and social anxiety than hope. The maladaptive relationships between discrimination and anxiety remained despite the presence of hope and mindfulness. Additional research is needed to identify strength-based approaches to protecting against and healing from experiences with discrimination among Black adults.

PMID:40991199 | DOI:10.1007/s40615-025-02655-8

Int Urol Nephrol. 2025 Sep 24. doi: 10.1007/s11255-025-04777-8. Online ahead of print.

ABSTRACT

BACKGROUND: Continuous positive airway pressure (CPAP) therapy is the gold standard treatment for obstructive sleep apnea (OSA), but its impact on type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD), remains unclear. This study aimed to evaluate the effects of CPAP therapy on metabolic and renal parameters in patients with OSA, T2DM, and CKD for over 18 months.

MATERIAL AND METHODS: This prospective, non-randomized, single-centre cohort study enrolled 60 patients with moderate-to-severe OSA (AHI > 15 episodes/hour), CKD (eGFR 15-60 mL/min/1.73m²), and T2DM. The patients were divided into a CPAP therapy group (n = 30) and a usual care group (n = 30). CPAP adherence was defined as ≥ 4 h/night for at least 70% of monitored nights. The primary outcomes included changes in the urinary albumin-to-creatinine ratio (UACR) Secondary outcomes included changes in serum creatinine, estimated glomerular filtration rate (eGFR), HbA1c, homeostasis model assessment of insulin resistance (HOMA-IR), apnea-hypopnea index (AHI), and oxygen desaturation index (ODI). Statistical analyses included independent test, repeated measures of analysis of variance, and analysis of covariance (ANCOVA).

RESULTS: 8 (13%) patients were lost to follow-up, and therefore 52 patients (27 patients in CPAP group and 25 patients in usual care group) were included in per-protocol analysis. After 18 months, CPAP therapy significantly improved AHI (mean change: 8.96 ± 4.94, p = 0.001), HbA1c (mean change: 1.44 ± 0.46, p = 0.001), HOMA-IR (mean change: 1.85 ± 0.14, p = 0.001), UACR (mean change: 139.08 ± 85.27 mg/g, p = 0.015), and serum creatinine (mean change: 1.02 ± 0.34 mg/dL, p = 0.011). No significant changes were observed in eGFR (p = 0.513) levels.

CONCLUSION: CPAP therapy significantly improved metabolic and renal parameters, particularly albuminuria and insulin resistance, in patients with OSA, T2DM, and CKD. However, it did not significantly impact the eGFR over 18 months.

PMID:40991192 | DOI:10.1007/s11255-025-04777-8

Ir J Med Sci. 2025 Sep 24. doi: 10.1007/s11845-025-04097-x. Online ahead of print.

ABSTRACT

BACKGRAUND: Sleep disturbances and pain are common in the early postoperative period and can significantly impact recovery. Poor sleep quality may increase pain perception, while unmanaged pain can further disrupt sleep, creating a negative cycle that impairs healing. Understanding how these factors interact is essential to improving postoperative outcomes.

AIM: This study aims to examine the mediating role of pain in the relationship between sleep quality on the first postoperative night and the level of recovery.

METHODS: This descriptive and cross-sectional study was conducted with 250 patients who underwent laparoscopic cholecystectomy in the general surgery clinic of a university hospital. Data were collected using the Patient Information Form, the Richards-Campbell Sleep Questionnaire, the Quality of Recovery-40 Questionnaire, and the Visual Analogue Scale. For statistical analysis, Pearson correlation, regression, hierarchical regression, and bootstrap mediation analysis were performed.

RESULTS: Sleep quality was found to be a significant and positive predictor of recovery (β = 0.415, p < .001). However, when pain was included in the model, the effect of sleep quality decreased but remained significant (β = 0.130, p = .035). The results of the bootstrap mediation analysis confirmed that pain was a significant mediator in this relationship.

CONCLUSION: Sleep quality influences postoperative recovery both directly and indirectly through pain levels. The findings suggest that holistic approaches to sleep and pain management in postoperative care processes may optimise recovery.

PMID:40991188 | DOI:10.1007/s11845-025-04097-x

Eur J Health Econ. 2025 Sep 24. doi: 10.1007/s10198-025-01831-1. Online ahead of print.

ABSTRACT

BACKGROUND: Responses on health-related quality of life measured by disease-specific instruments can be mapped onto the EQ-5D to estimate utility values for economic evaluation. San Martin´s Quality of Life Scale (St. MQoL-S) is a preferred measure to obtain health outcomes in adults with cerebral palsy. Nevertheless, it lacks a preference-based health utility score for estimating quality-adjusted life years (QALYs).

OBJECTIVE: To develop algorithms for mapping from the St. MQoL-S to allow future prediction of the EQ-5D-5L, in adults with cerebral palsy, when utility data have not been collected.

METHODS: Direct mapping models were developed using ordinary least squares, a generalized linear model, and Tobit regression analysis to estimate EQ-5D-5L utilities, with St. MQoL-S total and domain scores as explanatory variables, in a cross-sectional study of adults with cerebral palsy in Spain. Goodness-of-fit was assessed using mean absolute error (MAE) and root mean square error (RMSE). Repeated k-fold cross-validation was employed to select the optimal mapping model demonstrating superior predictive performance.

RESULTS: The best-performing model for predicting EQ-5D-5L utilities, includes the St. MQoL-S total scores, age, gender, and types of cerebral palsy as explanatory variables in a stepwise ordinary least squares regression, making it the most robust model for use as a mapping algorithm with external data.

CONCLUSION: This is the first study to present mapping algorithms between the St. MQoL-S and EQ-5D-5L. The mapping functions preferred in this study seem adequate for estimating the utilities of the EQ-5D-5L for economic evaluation and to obtain QALYs in adults with cerebral palsy.

PMID:40991164 | DOI:10.1007/s10198-025-01831-1

Odontology. 2025 Sep 24. doi: 10.1007/s10266-025-01193-3. Online ahead of print.

ABSTRACT

This systematic review and network meta-analysis compared the efficacy of platelet concentrates with traditional bioactive capping materials on vital pulp treatment (VPT) healing outcomes in permanent human teeth. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist and a registered protocol (CRD42024614771), a search was conducted across PubMed, Web of Science, Scopus, ClinicalTrials.gov, and the Cochrane Library for studies published until March 31, 2025. Controlled clinical trials evaluating VPT success rates using platelet concentrates versus bioceramics in permanent teeth, with at least 6 months’ follow-up, were included. Data from the selected studies were analyzed using the MetaInsight tool to assess multiple comparisons, and the risk of bias was evaluated using the Cochrane RoB2 and ROBINS-I tools. Evidence quality was graded using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE). The search identified 1097 studies, with ten meeting the inclusion criteria, encompassing 437 patients and three treatment modalities. At 6 months, success rates for mature teeth showed no statistically significant differences: LPC (RR = 1.00; 95% CI: 0.96-1.04) and PRF (RR = 1.04; 95% CI: 0.96-1.12). For immature teeth, PRF demonstrated no significant effect (RR = 0.99; 95% CI: 0.92-1.06). At 12 months, outcomes remained non-significant for mature teeth with LPC (RR = 1.02; 95% CI: 0.90-1.15) and PRF (RR = 1.10; 95% CI: 0.94-1.28), and for immature teeth treated with PRF (RR = 1.00; 95% CI: 0.94-1.06). These findings suggest that while platelet concentrates may offer comparable outcomes, bioceramics should be considered the preferred option based on probabilistic analysis.PROSPERO registration number: CRD42024614771.

PMID:40991160 | DOI:10.1007/s10266-025-01193-3

Ophthalmol Ther. 2025 Sep 24. doi: 10.1007/s40123-025-01244-6. Online ahead of print.

ABSTRACT

INTRODUCTION: Vernal keratoconjunctivitis (VKC) is a chronic, recurrent ocular surface disease of childhood that often requires long-term anti-inflammatory therapy beyond topical corticosteroids. This study aimed to identify the clinical predictors of suboptimal treatment response with 0.1% cyclosporine A cationic emulsion (CsA CE) in a real-world pediatric cohort.

METHODS: This was a retrospective, single-center study including patients aged 4-18 years with moderate or severe VKC, evaluated at a multidisciplinary ophthalmology clinic between January 2021 and December 2024. All patients received 0.1% CsA CE (administered four times daily). Demographic, clinical, and anamnestic data were collected. Disease severity was assessed using the Bonini grading scale, which provides a semiquantitative evaluation of ocular signs and symptoms. Statistical analysis was performed using univariate and multivariate Cox regression. For significant parameters, ROC curves were generated and optimal cut-off values were identified using the Youden’s Index.

RESULTS: A total of 101 patients were included (mean age 8.86 ± 3.31 years; 27 females). Over a mean follow-up period of 1.44 ± 1.13 years, 18 patients (17.8%) required escalation to 1% CsA galenic eye drops, of whom seven were further switched to 0.1% tacrolimus galenic eye drops. On multivariate analysis, the baseline composite clinical score was the strongest predictor of suboptimal treatment response. Notably, the clinical signs score alone demonstrated superior discriminative ability (AUC 0.732) compared to the total score (AUC 0.714). Optimal cut-off values were identified as 7 for clinical signs and 15 for the overall score.

CONCLUSIONS: Baseline disease severity, particularly the score for clinical signs, is a reliable predictor of response to 0.1% CsA CE. In patients exceeding the identified thresholds, early therapeutic escalation may be warranted to improve disease control and prevent structural complications.

PMID:40991157 | DOI:10.1007/s40123-025-01244-6

J Neurogenet. 2025 Sep 24:1-10. doi: 10.1080/01677063.2025.2561589. Online ahead of print.

ABSTRACT

Previous studies have reported associations between risk of Alzheimer’s disease (AD) or dementia and rare coding variants in a number of genes. A two-stage strategy was used in which a previously released whole exome sequenced sample was used to prioritise 100 genes showing the strongest evidence for association with AD. These genes were then analysed in a newly released whole genome sequenced sample to identify those which showed statistically significant evidence for rare coding variant association. Association analysis of loss of function (LOF) and nonsynonymous variants was carried out in 18,998 protein-coding genes using 11,188 controls and 5,808 cases, with nonsynonymous variants being annotated using 45 different pathogenicity predictors. The 100 genes showing strongest evidence for association were then analysed in a new sample of 27,749 controls and 13,234 cases using only the pathogenicity predictor which had performed best in the first sample. Four genes were statistically significant after correction for multiple testing: ABCA7, PSEN1, SORL1 and TREM2. The association of different categories of variant with AD was characterised and the pattern was seen to vary between genes. This study quantifies the contribution of different types of variant within each gene to AD risk. In general, these variants are probably too rare to be clinically useful for assessing individual risk of AD. Further research into the mechanisms whereby the products of these genes affect AD pathogenesis may aid development of novel therapeutic strategies.

PMID:40990081 | DOI:10.1080/01677063.2025.2561589

Mil Med. 2025 Sep 24:usaf433. doi: 10.1093/milmed/usaf433. Online ahead of print.

ABSTRACT

INTRODUCTION: During interwar transition periods, military medical volume, particularly surgical volume, declines dramatically. The Knowledge, Skills, and Abilities (KSA) metric was developed to assess “readiness” and the ability of the Military Treatment Facilities (MTFs) to prepare active duty (AD) surgeons for deployment. The KSA metric, or threshold for readiness, has not been validated externally. We seek to provide that validation by comparing KSA statistics of the military neurosurgery community to those of civilian neurosurgeons at level 1 civilian trauma centers.

MATERIALS AND METHODS: The Carepoint Health Data base compiles KSA totals for each surgeon over a 12-month period for their current stationed MTF. Forty-six AD attending neurosurgeons were included for the 2022 calendar year. To determine reliability of the Carepoint database, we secondarily analyzed the 2023-2024 academic year case logs of every AD neurosurgeon at 2 individual MTFs (N = 11). Civilian neurosurgeon KSA data was compiled by evaluating the case logs of neurosurgeons from 4 level 1 trauma centers (N = 29). We additionally utilized the database to analyze local Purchased Care Markets for each of the neurosurgery supported MTFs during that year to explain the historically low case volumes at the MTFs.

RESULTS: In 2022, the average KSA per AD neurosurgeon per month was 393, extrapolated to 4,725 annually. Two of the 46 surgeons reached the KSA threshold. For the 2023-2024 academic year, the average AD military annual KSA was 3,192 (N = 9) and the average civilian KSA was 11,272 (N = 29) (P < .0001). Twenty-four of the 29 civilian surgeons met KSA goal 8,000; none of the AD surgeons met goal. Total neurosurgical KSA in Purchased Care was 3,01,535 compared to 1,39,005 for all MTFs. Operative cases were 7,324 deferred to the civilian sector compared to 2,286 performed at MTFs.

CONCLUSIONS: The KSA Metric is a reasonable and attainable readiness standard based on civilian level 1 trauma center statistics but does have its limitations. The current MTF neurosurgery case volume does not support wartime readiness as described by the KSA Metric.

PMID:40990067 | DOI:10.1093/milmed/usaf433

Mil Med. 2025 Sep 24:usaf459. doi: 10.1093/milmed/usaf459. Online ahead of print.

ABSTRACT

INTRODUCTION: Use of the upper limbs is often necessary for military and firefighter personnel who carry backpacks. Backpack straps can compress the brachial plexus nerves of the upper limb. It is known that carrying a backpack can lead to rucksack palsy, but it is unknown if effects of upper limb nerve compression from carrying a heavy backpack can be demonstrated after a single session of backpack use. Our study aimed to investigate the short-term effects of backpack carriage on upper limb nerve conduction.

MATERIALS AND METHODS: Thirty-six participants including 18 female (mean ± SD: age 24.3 ± 7.6 years; height 168.8 ± 9.4 cm; mass 73.1 ± 16.6 kg; BMI 25.4 ± 4.5 kg/m2) and 18 male (24.1 ± 5.8 years; 178.2 ± 9.4 cm; 80.2 ± 11.7 kg; BMI 25.0 ± 4.3 kg/m2) were recruited as a convenience sample and assessed by nerve conduction study (NCS) of the median nerve on the dominant upper limb. Skeletal muscle mass (SMM) and body mass index (BMI) were evaluated using bioelectric impedance. Nerve conduction study measurements were taken before (PRE), after 20 minutes of walking and while still wearing a military-style large frame backpack with hip belt loaded to 30% bodyweight (POST), and immediately after removing the backpack (DOFF). We analyzed comparisons statistically using mixed factor analysis of variance (ANOVA) with significance level of P < .05.

RESULTS: Motor nerve action potential amplitude significantly decreased when stimulation was at the axilla from PRE to POST (P = .025) and PRE to DOFF (P = .012). Motor nerve action potential latency was significantly increased PRE to POST and PRE to DOFF with stimulation at the elbow (P = .029 and P = .030, respectively). Latency was significantly longer for males as compared to females (P ≤ .008). Sensory nerve action potential amplitude decreased significantly between PRE and POST (P = .007). Significant correlation was determined between amount of SMM and percent difference PRE to POST in motor nerve action potential amplitude (r = 0.438, P < .01). Participants with lower SMM demonstrated greater difference in motor nerve action potential after backpack carriage with POST measurements lower than PRE measurements. Body mass index was significantly correlated with sensory baseline-to-peak amplitude percent difference PRE to POST (r = 0.428, P < .01) indicating that those with lower BMI had a larger negative impact on sensory nerve response after backpack carriage.

CONCLUSION: The results of this study reveal that walking for 20 minutes while carrying a 30% bodyweight backpack resulted in an increase in upper limb motor nerve latency and decrease in sensory and motor nerve action potential amplitude. The NCS findings indicate that SMM may have a protective effect and was therefore beneficial to maintaining upper limb nerve conduction after backpack carriage while lower BMI was a risk factor for reduced sensory nerve conduction. The demonstrated deficits in nerve conduction after backpack carriage could have implications for use of hands, especially the thumb, index, and middle finger, as they are innervated by the median nerve.

PMID:40990056 | DOI:10.1093/milmed/usaf459