Category: Nevin Manimala

Kidney Res Clin Pract. 2025 Sep 9. doi: 10.23876/j.krcp.24.292. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic kidney disease (CKD) is a growing global health challenge, with smoking identified as a significant risk factor. This study investigates the long-term impact of adolescent smoking initiation on end-stage kidney disease (ESKD) development.

METHODS: A retrospective cohort study was conducted using data from the Korean National Health Insurance Service claims database. The cohort included 201,678 CKD patients aged ≥40 years with a documented smoking history. Patients were stratified by smoking initiation age (<20 years vs. ≥20 years) and cumulative smoking exposure (pack-year, PY). The primary outcome was ESKD incidence, defined as kidney replacement therapy initiation. Cox proportional hazards models assessed the relationship between smoking initiation age, smoking burden, and ESKD risk.

RESULTS: During a median 6.8-year follow-up period, 6,334 patients progressed to ESKD (incidence rate, 3.63 per 1,000 PYs). Those with higher PYs were older and had more comorbidities, such as hypertension and diabetes mellitus. Patients who began smoking before age 20 years and accumulated ≥20 PYs had a significantly higher risk of ESKD (hazard ratio, 1.26; 95% confidence interval, 1.16-1.38) compared to those with the same exposure but later smoking initiation. Increased cumulative smoking exposure further elevated the risk. When PYs were divided according to initiation age, a higher ratio was associated with an increased risk of ESKD.

CONCLUSION: Early smoking initiation during adolescence was associated with a significantly higher risk of progression to ESKD in patients with CKD, especially in those with higher cumulative smoking exposure. Public health interventions focusing on preventing adolescent smoking can mitigate the long-term burden of CKD progression.

PMID:40985140 | DOI:10.23876/j.krcp.24.292

Diabetes Technol Ther. 2025 Sep 23. doi: 10.1177/15209156251379505. Online ahead of print.

ABSTRACT

Objective: The CRISTAL trial indicated that advanced hybrid closed loop (AHCL) therapy with MiniMed™ 780G in type 1 diabetes pregnancy did not improve time in range (TIRp) compared with standard insulin therapy (SoC), but improved TIRp overnight and reduced time below range (TBRp). We aimed to evaluate the effect of AHCL therapy across different subgroups. Research Design and Methods: This secondary analysis of the CRISTAL randomized controlled trial compared glycemic outcomes (TIRp, TIRp overnight, TBRp, and TBRp overnight) averaged over the antenatal period (14-, 20-, 26-, and 33-weeks’ gestation) between the AHCL and SoC groups, within subgroups defined by baseline characteristics. Results: In women with baseline HbA1c <7.0%, the AHCL group (n = 35) had a significantly higher TIRp than SoC (n = 37), with a mean difference of 5.64% (95% confidence interval [95% CI]: 1.32-9.96), corresponding to 1 h 21 min more TIRp per day and 11.89% (95% CI: 7.01-16.76) higher TIRp overnight. In women without prior AHCL use, TIRp was 6.29% higher (95% CI: 0.90-11.68) and overnight TIRp 11.91% higher (95% CI: 5.65-18.16) in the AHCL group (n = 24) compared with SoC (n = 28). In women without higher education, AHCL users (n = 14) had a significantly higher TIRp compared with SoC (n = 14) with a difference of 7.33% (95% CI: 0.88-13.78). TBRp was significantly lower in AHCL users with baseline HbA1c <7.0% and in women without prior AHCL use. Conclusions: AHCL therapy improved glycemic management in pregnant women with baseline HbA1c <7.0%, in women without prior AHCL use, and in women without higher education, indicating that AHCL might particularly benefit these subgroups.

PMID:40985127 | DOI:10.1177/15209156251379505

Eur J Neurosci. 2025 Sep;62(6):e70245. doi: 10.1111/ejn.70245.

ABSTRACT

Studies evaluating cognitive functions in patients with obsessive-compulsive disorder (OCD) have yielded inconsistent results in various cognitive domains. One key reason for contradictory findings is the frequent occurrence of comorbid psychiatric disorders in OCD. Attention deficit hyperactivity disorder (ADHD), especially in childhood, is one of the most common comorbidities in OCD. The aim of the current study was to identify potential differences in cognitive functions caused by childhood ADHD in adult OCD patients while minimizing the effects of symptoms that frequently accompany OCD, such as anxiety, depression, and age. The study included 35 OCD patients with childhood ADHD (OCD + cADHD), 44 OCD patients without childhood ADHD (OCD-cADHD), and 40 healthy controls (HC). Hamilton Depression and Anxiety Scales were applied to all participants. Next, the Cambridge Neuropsychological Test Automated Battery (CANTAB) [Paired-Associate-Learning (PAL), Cambridge Gambling Task (CGT), Stop Signal Test (SST), and Intra-/Extra-Dimensional Set-Shifting Test (IED)] was administered. The OCD patients without childhood ADHD (OCD – cADHD) exhibited higher mean scores in CGT-Risk-Taking and Bet Ratio compared to the HC. However, OCD patients with childhood ADHD (OCD + cADHD) also showed higher mean scores in CGT-Bet Ratio compared to the HC. The mean number of IED-Total Errors and IED-Total Trials was higher in the OCD + cADHD group compared to the HC. The OCD + cADHD group had a higher mean number of SST-Direction Errors and Missed Trials than other groups. The results of the current study suggest that even when potential confounding factors such as depression and anxiety are neutralized, the presence of childhood ADHD in adult patients with OCD led to differences in cognitive domains related to decision-making, flexible thinking, and impulsivity.

PMID:40985125 | DOI:10.1111/ejn.70245

BJPsych Open. 2025 Sep 23;11(5):e220. doi: 10.1192/bjo.2025.10834.

ABSTRACT

BACKGROUND: First-episode psychosis (FEP) is a critical phase in psychotic disorders where early intervention significantly influences long-term outcomes. Catatonia, characterised by motor, behavioural, and psychological abnormalities, is an under-recognised aspect of FEP.

AIMS: This study examines catatonia prevalence in affective and non-affective FEP, its role as a severity indicator across psychopathological domains, its correlations with other symptoms and its association with clinical syndromes.

METHOD: A cross-sectional study was conducted with 58 FEP patients (38 females, 20 males) aged 15-55 years. Of those, 40 were antipsychotic-naive, and 18 had minimal prior antipsychotic exposure. Participants were recruited from acute psychiatric units. Catatonia was assessed using the Bush Francis Catatonia Rating Scale (BFCRS), while psychopathology was evaluated with the Positive and Negative Symptom Scale (PANSS), Calgary Depression Scale (CDS) and Young Mania Rating Scale (YMRS). Data analysis included descriptive statistics, t-tests, X² tests, and multivariable regression using SPSS version 25 for Windows.

RESULTS: Catatonic signs were identified in 22.4% of cases based on the Bush Francis Catatonia Screening Instrument (BFCSI) criteria (BFCSI-positive group, defined as ≥2 signs present for over 24 h), indicating potential catatonia. Prevalence varied by criteria: 13.8% (DSM-IV), 10.3% (Fink and Taylor), 10.38% (ICD-11) and 8.6% (DSM-5). Catatonic patients had more years of education and significantly higher PANSS totals, Emsley negative, disorganised, excited, and anxiety scores. Catatonic signs moderately correlated with Emsley disorganised scores. Regression analysis identified PANSS total and Emsley domain scores as significant predictors of catatonia severity.

CONCLUSIONS: Catatonia is notably prevalent in FEP and associated with severe psychopathology, particularly in negative and disorganised domains. These findings underscore the importance of improving recognition of catatonia in early psychosis. Larger longitudinal studies are needed to confirm these findings and explore treatment implications.

PMID:40985102 | DOI:10.1192/bjo.2025.10834

Acta Otorhinolaryngol Ital. 2025 Aug;45(4):280-286. doi: 10.14639/0392-100X-A731.

ABSTRACT

OBJECTIVE: Chronic kidney disease (CKD) is a global health problem with a significant impact on patients’ quality of life. Haemodialysis, a common treatment for advanced CKD, can profoundly affect vestibular function, which plays a critical role in maintaining balance and spatial orientation.

METHODS: This prospective study was conducted over a 6-month period at the Magna Graecia University and included 18 adult patients with CKD stage 5, undergoing haemodialysis. Vestibular function was assessed using the Visual Analogue Scale (VAS) for the symptom of unsteadiness and the video Head Impulse Test (vHIT) for the vestibulo-ocular reflex (VOR) gain.

RESULTS: Our results showed a statistically significant decrease in VOR gain from 0.99 at T0 to 0.92 at T1 (T-test p = 0.034 and Welch Test p = 0.037), accompanied by an increase in VAS instability scores, after the dialysis session. These results suggest a worsening of vestibular function as a result of haemodialysis.

CONCLUSIONS: These results highlight the need for early diagnosis and timely intervention, such as vestibular rehabilitation, to reduce the risk of falls and improve the quality of life in CKD patients undergoing haemodialysis. Future research should investigate the long-term effects of haemodialysis on vestibular function.

PMID:40985095 | DOI:10.14639/0392-100X-A731

Acta Otorhinolaryngol Ital. 2025 Aug;45(4):261-268. doi: 10.14639/0392-100X-N3125.

ABSTRACT

OBJECTIVE: To analyse the cost-effectiveness of unilateral cochlear implant (CI) surgery in Italian adults with post-lingual deafness, focusing on direct costs, Health Utilities Index (HUI), Quality-Adjusted Life Years (QALY), and Incremental Cost-Effectiveness Ratio (ICER).

METHODS: The analysis, from the Italian healthcare system perspective, included preoperative, surgical, hospitalisation, and postoperative costs. QALYs were estimated using the Italian Nijmegen Cochlear Implant Questionnaire (I-NCIQ) and Ontario Health Utilities Index Mark 3 (HUI-3). HUI-3 score changes were analysed with regression models in Stat View (v5.0.1, SAS Institute Inc). ICER was calculated as the incremental cost per QALY (in Euros/QALY) over the average patient’s lifetime.

RESULTS: CI significantly improved I-NCIQ (p < 0.001) and HUI-3 scores (p < 0.0001). Average life expectancy at surgery was 21.2 years; the degrade factor was 0.97, yielding a lifetime gain of 2.717 QALYs. Direct costs amount to €19,467.65. Cost-utility analysis showed €7,165.13 per QALY, below the €30,000/QALY ICER threshold.

CONCLUSIONS: CI surgery is cost-effective based on QALY analysis. Although cost-effectiveness decreases with age, quality of life and health benefits are comparable to younger patients.

PMID:40985093 | DOI:10.14639/0392-100X-N3125

Acta Otorhinolaryngol Ital. 2025 Aug;45(4):231-236. doi: 10.14639/0392-100X-N3165.

ABSTRACT

OBJECTIVE: The Host-index (H-index) is a value obtained using blood laboratory parameters. Elevated H-index is a negative prognostic factor in patients with head and neck squamous cell carcinoma (HNSCC). The purpose of our study was to assess the prognostic impact of the H-Index in patients with locally advanced tumours who underwent reconstructive surgery with free flaps.

METHODS: We performed a retrospective study on a cohort of patients referred to our center from January 2013 to October 2018. We assessed the prognostic role of H-index in terms of disease-free (DFS) and overall survival (OS).

RESULTS: A total of 99 patients were studied, with a median age of 66 years. After a median follow-up of 46.5 months (range, 1.4-121.9), 5-year OS was 59.6% (CI 29.3-57.5) and 5-year DFS 47.5% (CI 16.7-49.2). The H-index showed a statistically significant correlation with a shorter DFS (HR 1.2, 95% CI 1.1-1.4, p = 0.006). No correlations were found between surgical complications and the H-index.

CONCLUSIONS: This study confirmed that the H-index is an independent prognostic factor for DFS in patients with HNSCC undergoing microvascular reconstructive surgery and should be used to better stratify the risk of mortality and recurrence, with the aim of improving patient management.

PMID:40985089 | DOI:10.14639/0392-100X-N3165

J Intellect Disabil Res. 2025 Sep 23. doi: 10.1111/jir.70047. Online ahead of print.

ABSTRACT

INTRODUCTION: Outcomes for people with intellectual and developmental disabilities, particularly those with more severe and complex needs, depend on the quality of support they receive from staff. This paper explores staff perspectives on skilled support and relationships with training and experience.

METHODS: Questionnaires were received from 93 staff working in 28 supported accommodation services in which observations of the quality of support had also been conducted. Staff were asked about experience, training and views on skilled support. Content analysis was used to code written responses. Statistical analysis explored relationships between staff responses, and the quality of support was observed.

RESULTS: Staff perceived improving the quality of life of people they supported as key. All staff considered themselves as being at least partially skilled, with the majority associating being skilled with length of experience and attendance at training. Specific training was rarely mentioned, and receipt of training was not associated with the provision of better quality of support. Practice leadership was rarely mentioned.

CONCLUSIONS: In most cases, staff showed awareness of the principles set out in policy, but their reflections did not match observed practice.

PMID:40985050 | DOI:10.1111/jir.70047

Indian J Psychol Med. 2025 Sep 19:02537176251376317. doi: 10.1177/02537176251376317. Online ahead of print.

ABSTRACT

BACKGROUND: Alcohol use disorder (AUD) is accompanied by cognitive impairments, including attentional bias towards cues linked to alcohol. Most studies on attentional biases have focused on participants in intoxicated states, with limited research on differences between chronic and occasional users. This study aimed to examine attentional biases in chronic alcohol users compared to occasional users using eye-tracking.

METHODS: In this cross-sectional study, 71 male participants (36 chronic users and 35 occasional users) were recruited from a tertiary care center in India. Eye-tracking assessments were conducted using free-viewing of emotional and landscape images, and viewing of alcohol related stimuli. For each task, variables such as the number of fixations, fixation duration, scan path, and anti-saccade rates were calculated.

RESULTS: No statistically significant difference was found between chronic alcohol users and occasional users in fixation metrics, scan path length, or anti-saccade rates for emotional, landscape, or alcohol related stimuli. Chronic alcohol users had slightly longer fixation durations and greater scan path lengths on alcohol-related stimuli, but these differences were not significant (p > .05).

CONCLUSIONS: Our findings suggest that chronic alcohol users may not always display prominent attentional biases in a sober state. The prolonged abstinence duration (>2 months) contributed to the absence of significant biases in our study. The slightly longer scan path length for alcohol-related images among chronic users may indicate that they were possibly avoiding these images. The findings also highlight the need for a state-dependent approach and the importance of assessing variables like craving in future research.

PMID:40985043 | PMC:PMC12450205 | DOI:10.1177/02537176251376317

Indian J Psychol Med. 2025 Sep 20:02537176251371784. doi: 10.1177/02537176251371784. Online ahead of print.

ABSTRACT

BACKGROUND: The mental health (MH) treatment gap in India is particularly pronounced in underserved and rural areas. Community Health Officers (CHOs) play a crucial role in addressing this gap at the primary care level. A pan India digitally driven MH capacity-building program was designed to integrate MH care into primary care settings by training CHOs and supporting them through Collaborative Video Consultations (CVCs). We aimed to examine the profile of MH cases through CVCs by CHOs trained under a pan-India, digitally enabled MH capacity-building program, and to describe the diagnostic patterns and types of handholding provided across three Indian states.

METHODS: This cross-sectional study analyzed 591 CVC records from CHOs of Karnataka, Maharashtra and Bihar from November 15, 2022 to July 31, 2024, who underwent a six-session online training program on MH care, followed by real-time video consultations with MH professionals for case discussions and patient management. Descriptive statistics and crosstabulations were used for data analysis.

RESULTS: Most CVCs were from adult patients aged 19-60 years (79.69%), with women more frequently identified with common mental disorders (CMD) (25.42%) and men more commonly having severe mental disorders (SMD) (12.20%) and substance use disorders (SUD) (16.61%). Among states, Bihar had the highest number of CVCs (38.92%). CHOs provided handholding through referrals, counseling, and follow-ups.

CONCLUSIONS: The program demonstrated the effectiveness of CVCs in empowering CHOs to identify and manage MH conditions. The consultation-based collaborative model facilitated accurate diagnoses and timely interventions, bridging the MH treatment gap in rural and underserved regions. Continued investment in CHO training, digital infrastructure, and follow-up care is essential for sustaining the program’s impact on primary MH care.

PMID:40985042 | PMC:PMC12450207 | DOI:10.1177/02537176251371784