Category: Nevin Manimala

Ther Adv Psychopharmacol. 2025 Sep 20;15:20451253251339378. doi: 10.1177/20451253251339378. eCollection 2025.

ABSTRACT

BACKGROUND: Postoperative delirium (POD) is associated with higher risks of postoperative complications ‌and‌ mortality (2- to 3-fold increase). Studies investigating the effect of intraoperative ketamine on POD risk have yielded conflicting results. This study aimed to assess the effects of intraoperative ketamine and its more potent version, esketamine, on POD.

DESIGN: Systematic review and meta-analysis.

OBJECTIVE: To evaluate the effect of intraoperative ketamine/esketamine on the incidence of POD.

METHODS: We adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and searched the PubMed, Embase, Medline (Ovid), Cochrane, Scopus, and Web of Science databases for the MeSH terms “ketamine” and “emergence delirium” from database inception to July 10, 2024. The primary outcome was POD incidence following general anesthesia. Data were analyzed using a common effects model, with between-study heterogeneity tested using the I ² statistic, and relative risk (RR) with 95% confidence intervals (CIs) for dichotomous data was used as the effect measure.

RESULTS: A total of 18 studies with a total of 1571 participants met eligibility criteria. A meta-analysis of all studies suggests that the intraoperative use of ketamine/esketamine may reduce the incidence of POD (RR = 0.71, 95% CI: 0.56, 0.90, p < 0.01). In the drug subgroup, esketamine demonstrated enhanced efficacy in preventing POD compared to ketamine (RR = 0.59, 95% CI: 0.38, 0.90, p = 0.02). In addition, subanesthetic doses of ketamine/esketamine (⩽0.5 mg/kg) contributed to POD prevention (RR = 0.52, 95% CI: 0.34, 0.79, p < 0.01), whereas higher doses (>0.5 mg/kg) showed no statistically significant effect (RR = 0.89, 95% CI: 0.66, 1.21, p = 0.46). Further analysis revealed additional benefits of ketamine/esketamine in reducing POD incidence in cardiac surgery (RR = 0.46, 95% CI: 0.31, 0.68, p < 0.01), in the elderly (RR = 0.68, 95% CI: 0.52, 0.91, p < 0.01), and in the first 24 h post-surgery (RR = 0.52, 95% CI: 0.29, 0.94, p = 0.03).

CONCLUSION: Our findings suggest that perioperative administration of ketamine/esketamine had a protective effect against the incidence of POD, with esketamine demonstrating superior efficacy compared to ketamine. The treatment effect exhibited a dose-response relationship, with subanesthetic doses showing greater efficacy. Furthermore, ketamine/esketamine may offer additional benefits for patients with specific risk factors.

PMID:40985036 | PMC:PMC12450268 | DOI:10.1177/20451253251339378

J Public Health Res. 2025 Sep 20;14(3):22799036251376881. doi: 10.1177/22799036251376881. eCollection 2025 Jul.

ABSTRACT

BACKGROUND: Dengue fever, a viral infection transmitted by Aedes mosquitoes, has emerged as a global public health concern according to the World Health Organization (WHO). Given the geographical proximity of Iran to countries that have reported outbreaks of this disease in recent years, this issue needs careful attention.

DESIGN AND METHODS: The present study aims to identify the knowledge, attitudes, and practices of rural populations concerning dengue fever in Fars Province, southern Iran.

METHODS: A cross-sectional study was conducted over 2 months, from October to December 2024, involving 17 rural regions and encompassing a total of 653 households. The data were collected using a questionnaire designed to assess knowledge, attitudes, and practices regarding dengue fever.

RESULTS: Of the 653 individuals participating in the study, 370 were male and 283 were female. The overall average scores, along with their standard deviations, for the rural population’s knowledge (10.76 ± 2.10 out of 15), attitude (13.65 ± 2.90 out of 20), and practice (8.24 ± 1.70 out of 12) regarding dengue fever were at moderate levels. Pearson’s correlation coefficient analysis indicated a direct and statistically significant relationship between knowledge, attitudes, and practices. The findings revealed a substantial positive association between the participants’ knowledge and their attitudes (r = 0.47, p < 0.001), as well as a strong direct relationship between knowledge and practices (r = 0.51, P<0.001). Furthermore, a notable positive correlation was observed between attitudinal variables and practical behaviors (r = 0.45, p < 0.001).

CONCLUSION: Overall, the knowledge, attitude, and practice of the rural population regarding dengue fever were found to be moderate. Therefore, it is recommended that health system policymakers should adopt suitable approaches, such as ensuring comprehensive public health education for all, creating educational materials, and enhancing awareness campaigns. Effective strategies for mitigating and controlling the spread of dengue fever depend on public knowledge and attitude changes, along with appropriate measures for successful disease control.

PMID:40985017 | PMC:PMC12450256 | DOI:10.1177/22799036251376881

Eur Heart J Digit Health. 2025 Jun 30;6(5):1084-1093. doi: 10.1093/ehjdh/ztaf075. eCollection 2025 Sep.

ABSTRACT

AIMS: Personalized risk assessment tools (PRTs) are recommended by cardiovascular guidelines to tailor prevention, diagnosis, and treatment. However, PRT implementation in clinical routine is poor. ACRIBiS (Advancing Cardiovascular Risk Identification with Structured Clinical Documentation and Biosignal Derived Phenotypes Synthesis) aims to establish interoperable infrastructures for standardized documentation of routine data and integration of high-resolution biosignals (HRBs) enabling data-based risk assessment.

METHODS AND RESULTS: Established cardiovascular risk scores were selected by their predictive performance and served as basis for building a core cardiovascular dataset with risk-relevant clinical routine information. Data items not yet represented in the Medical Informatics Inititative (MII) Core Dataset (CDS) FHIR profiles will be added to an extension module ‘Cardiology’ allowing for maximum interoperability. HRB integration will be implemented at each site through a modular infrastructure for electrocardiography (ECG) processing. Predictive performance of PRTs and their dynamic recalibration through HRB integration will be evaluated within the ACRIBiS cohort consisting of 5250 prospectively recruited patients at 15 German academic cardiology departments with 12-month follow-up. The potential of visualising these risks to improve patient education will also be assessed and supported by the development of a self-assessment app.

DISCUSSION: The ACRIBiS project presents an innovative concept to harmonize clinical data documentation and integrate ECG data, ultimately facilitating personalized risk assessment to improve patient empowerment and prognosis. Importantly, the consensus-based documentation and interoperability specifications developed will support the standardisation of routine patient data collection at the national and international levels, while the ACRIBiS cohort dataset will be available for broad secondary use.

TRIAL REGISTRATION: The study is registered at the German study registry (DRKS): #DRKS00034792.

PMID:40984993 | PMC:PMC12450505 | DOI:10.1093/ehjdh/ztaf075

Eur Heart J Digit Health. 2025 Jun 19;6(5):1015-1023. doi: 10.1093/ehjdh/ztaf071. eCollection 2025 Sep.

ABSTRACT

AIMS: Smartphone-based digital screening was shown to increase the detection rate of atrial fibrillation (AF) requiring oral anticoagulation (OAC) compared with usual care. In this pre-specified subgroup analysis of the eBRAVE-AF trial, we explored sex-specific differences in digital AF-screening.

METHODS AND RESULTS: In eBRAVE-AF (NCT04250220), participating policyholders of a German health insurance company were randomly assigned to a 6-month digital or conventional AF-screening strategy. For digital screening, participants used smartphone-based photoplethysmography (PPG) to detect pulse wave irregularities, which were confirmed using 14-day external ECG-recorders. The primary endpoint was newly diagnosed AF treated with OAC. After 6 months, participants were assigned to a second, cross-over study-phase. The efficacy of AF-screening in women and men was assessed by Cox-regression analysis. 5551 (31% females; 55% ≥ 65 years) of 67 488 invited policyholders free of AF participated in the study and were randomly assigned to digital screening (n = 2860) or usual care (n = 2691). Participation rate was significantly higher among men than women (8.7% vs. 7.3%; P < 0.001). Male sex was a significant predictor for reaching the primary endpoint (HR 1.74; 95% CI: 1.08-2.82, P = 0.023), which was pronounced in patients undergoing digital screening (HR 2.48; 95% CI: 1.52-4.05, P < 0.001). Digital screening did not significantly increase the detection rate of AF requiring OAC in women (HR 1.83; 95% CI: 0.74-4.54; P = 0.193; P-interaction = 0.563).

CONCLUSION: Men showed higher willingness to participate in this digital study and digital AF-screening was effective for them. While digital screening increased the detection rate of AF with OAC in women, the effect was not statistically significant, likely due to limited power.

PMID:40984986 | PMC:PMC12450515 | DOI:10.1093/ehjdh/ztaf071

Int J Gen Med. 2025 Sep 17;18:5581-5589. doi: 10.2147/IJGM.S513034. eCollection 2025.

ABSTRACT

OBJECTIVE: To investigate the predictive value of preoperative [¹⁸F]fluorodeoxyglucose ([¹⁸F]FDG) positron emission tomography/computed tomography (PET/CT)-derived heterogeneity index (HI) for occult lymph node metastasis (OLM) in clinical N0 gastric adenocarcinoma.

METHODS: This retrospective study included 83 patients with clinical N0 gastric adenocarcinoma who underwent [¹⁸F]FDG PET/CT scans before radical surgery between March 2018 and June 2024. Patients were classified as OLM-positive (n=40) or OLM-negative (n=43) based on postoperative pathology. Clinical characteristics, PET/CT metabolic parameters [maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), peak standardized uptake value (SUVpeak), tumor-to-liver ratio (TLR), metabolic tumor volume (MTV), and total lesion glycolysis (TLG)], and heterogeneity indices (HI-1 and HI-2) were analyzed. Univariate and multivariate logistic regression models were applied to identify independent predictors of OLM. ROC curve analysis was performed to assess diagnostic performance. Statistical analysis was conducted using SPSS version 26.0, with P<0.05 considered statistically significant.

RESULTS: Gender, tumor differentiation, and pathological T stage differed significantly between the two groups (P<0.05). HI-2 was significantly higher, while SUVmax, SUVmean, and HI-1 were significantly lower in the OLM-positive group (P<0.05). Multivariate analysis identified pathological T stage (T3-T4, OR=4.778, P=0.022) and HI-2 >4.959 (OR=6.887, P=0.002) as independent predictors of OLM. ROC analysis revealed that HI-2 had an AUC of 0.711 (95% CI: 0.596-0.824, P=0.001), with 52.5% sensitivity and 88.37% specificity at the optimal threshold.

CONCLUSION: HI-2 derived from preoperative [¹⁸F]FDG PET/CT is a significant independent predictor of OLM in clinical N0 gastric adenocarcinoma patients, alongside pathological T stage.

PMID:40984973 | PMC:PMC12450381 | DOI:10.2147/IJGM.S513034

Therap Adv Gastroenterol. 2025 Sep 20;18:17562848251378066. doi: 10.1177/17562848251378066. eCollection 2025.

ABSTRACT

BACKGROUND: Effective Helicobacter pylori (H. pylori) eradication depends on maintaining intragastric pH >6 and overcoming antibiotic resistance. High-dose dual therapy (HDDT) with a proton pump inhibitor (PPI) and amoxicillin has shown promising results.

OBJECTIVES: To compare the efficacy of 14-day vonoprazan-based (VA) and esomeprazole-based (EA) HDDT for H. pylori eradication and evaluate the impact of antibiotic resistance.

DESIGN: Randomized controlled trial (RCT).

METHODS: A total of 121 patients with confirmed H. pylori infection were randomized to receive either VA therapy (vonoprazan 20 mg twice daily plus amoxicillin 750 mg four times daily (QID)) or EA therapy (esomeprazole 40 mg three times daily plus amoxicillin 750 mg QID) for 14 days. Eradication was assessed by the ¹³C-urea breath test at week 8. Antibiotic susceptibility testing was performed on cultured isolates.

RESULTS: Baseline demographic and clinical characteristics were comparable between the VA and EA groups. In the intention-to-treat analysis, eradication rates were 86.9% (95% confidence interval (CI): 78.4%-95.4%) in the VA group and 81.7% (95% CI: 71.3%-89.4%) in the EA group (p = 0.430). Per-protocol (PP) analysis showed eradication rates of 93.0% (95% CI: 86.4%-99.6%) for VA and 84.5% (95% CI: 73.8%-92.1%) for EA (p = 0.150), indicating no statistically significant difference. Adverse events (AEs) were mild and similar between groups (5.3% in VA vs 5.2% in EA, p = 0.983), with constipation and diarrhea being the most reported. Both groups achieved 100% compliance. Antibiotic resistance patterns did not significantly affect outcomes.

CONCLUSION: Both VA and EA-HDDT regimens demonstrated comparable efficacy, excellent compliance, and minimal AEs. Although VA therapy achieved a >90% eradication rate in the PP analysis, our study was underpowered to confirm superiority. Therefore, larger, adequately powered RCTs are warranted to validate the potential superiority of VA.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT06811207.

PMID:40984972 | PMC:PMC12450270 | DOI:10.1177/17562848251378066

Cureus. 2025 Aug 22;17(8):e90717. doi: 10.7759/cureus.90717. eCollection 2025 Aug.

ABSTRACT

INTRODUCTION AND AIM: Diabetes mellitus is a metabolic disease characterized by hyperglycemia, leading to long-term organ damage and complications like foot ulcers. Aggressive management of diabetic foot ulcers can prevent complications and lower extremity amputations. This study aimed to assess the barriers faced by physicians in managing diabetic feet in primary care settings.

METHODS: This is a descriptive cross-sectional study conducted in primary healthcare settings in Al-Ahsa, Saudi Arabia, between 2024 and 2025, involving 220 participants through simple random sampling. The study used a structured, valid, pretested, and self-administered questionnaire to collect data. The Statistical Package for the Social Sciences (SPSS) version 27 (Armonk, NY: IBM Corp.) was used to analyze the data. Both descriptive and inferential statistics were used, with a p≤0.05 considered statistically significant.

RESULTS: This study included 220 physicians (mean age: 32.14±6.05 years, 53.6% male), 130 (59.0%) had practiced for less than five years, 97 (44.1%) reported less than five continuing medical education (CME) hours related to diabetes, and 132 (60.0%) reported no special training in diabetes mellitus (DM). A majority of them, 160 (72.7%), rated their knowledge as average; 197 (89.5%) reported educating patients on preventive foot care, and 189 (85.9%) reported recommending therapeutic footwear. Only 102 (46.4%) probe for bone exposure in open diabetic foot (DF) infections, and 93 (42.3%) request serial radiographs. More than half identified a lack of continuing education and knowledge as the main barriers to the effective diagnosis and management of diabetic foot infections. Further barriers reported by participants were the absence of a vascular medicine specialty and a lack of diabetic foot management guidelines. Furthermore, 140 (63.6%) reported a lack of access to foot examination tools, and 152 (69.1%) reported insufficient time for comprehensive foot examinations.

CONCLUSION: This study highlights significant gaps in knowledge, practice, and resources among healthcare professionals involved in diabetic foot management. The findings demonstrate the need for targeted interventions in Al-Ahsa to improve clinician competency, enhance resource availability, and address systemic challenges.

PMID:40984968 | PMC:PMC12450305 | DOI:10.7759/cureus.90717

Clinics (Sao Paulo). 2025 Sep 21;80:100795. doi: 10.1016/j.clinsp.2025.100795. Online ahead of print.

ABSTRACT

BACKGROUND: Myofascial Pain Syndrome (MPS) is regarded as an extremely common clinical disorder, but is not fully understood. Shoulder pain has a lifetime prevalence of up to 66.7% in the general population, and pain due to Myofascial Trigger Points (MTPs) located in the deltoid muscle is fairly common. Analyses of the correlations between innervation patterns and trigger point locations have been successful in other muscular groups.

OBJECTIVE: The objective of this study was to provide a mathematical analysis of the entry points of the axillary nerve into the deltoid muscle and correlate them with the described areas of myofascial pain.

METHOD: Ten cadavers were carefully dissected to measure a series of parameters in each deltoid muscle. The entry points of the axillary nerve into the deltoid muscle were placed in a cartesian graph created by dividing the deltoid muscle into 4-quadrants. Statistical analysis was carried out on the number of points in each quadrant.

RESULTS: Quadrant 1 had the largest number of axillary nerve entry sites, with a mean of 6.85 sites (63%), followed by quadrant 3 with 2.75 sites (25%), quadrant 2 with 1.15 sites (10%), and quadrant 4 with 0.25 sites (2%).

CONCLUSION: In accordance with the clinical literature, the branches of the axillary nerve in the deltoid muscle corresponded to the described areas of the MTPs. Anatomical correlations between MTPs may be useful tools for gaining a better understanding of the physiopathology of these disorders and providing a basis for their treatment.

PMID:40983051 | DOI:10.1016/j.clinsp.2025.100795

Clinics (Sao Paulo). 2025 Sep 21;80:100795. doi: 10.1016/j.clinsp.2025.100795. Online ahead of print.

ABSTRACT

BACKGROUND: Myofascial Pain Syndrome (MPS) is regarded as an extremely common clinical disorder, but is not fully understood. Shoulder pain has a lifetime prevalence of up to 66.7% in the general population, and pain due to Myofascial Trigger Points (MTPs) located in the deltoid muscle is fairly common. Analyses of the correlations between innervation patterns and trigger point locations have been successful in other muscular groups.

OBJECTIVE: The objective of this study was to provide a mathematical analysis of the entry points of the axillary nerve into the deltoid muscle and correlate them with the described areas of myofascial pain.

METHOD: Ten cadavers were carefully dissected to measure a series of parameters in each deltoid muscle. The entry points of the axillary nerve into the deltoid muscle were placed in a cartesian graph created by dividing the deltoid muscle into 4-quadrants. Statistical analysis was carried out on the number of points in each quadrant.

RESULTS: Quadrant 1 had the largest number of axillary nerve entry sites, with a mean of 6.85 sites (63%), followed by quadrant 3 with 2.75 sites (25%), quadrant 2 with 1.15 sites (10%), and quadrant 4 with 0.25 sites (2%).

CONCLUSION: In accordance with the clinical literature, the branches of the axillary nerve in the deltoid muscle corresponded to the described areas of the MTPs. Anatomical correlations between MTPs may be useful tools for gaining a better understanding of the physiopathology of these disorders and providing a basis for their treatment.

PMID:40983051 | DOI:10.1016/j.clinsp.2025.100795

Med Image Anal. 2025 Sep 20;107(Pt A):103814. doi: 10.1016/j.media.2025.103814. Online ahead of print.

ABSTRACT

Acquiring high-resolution Magnetic resonance (MR) images is challenging due to constraints such as hardware limitations and acquisition times. Super-resolution (SR) techniques offer a potential solution to enhance MR image quality without changing the magnetic resonance imaging (MRI) hardware. However, typical SR methods are designed for fixed upsampling scales and often produce over-smoothed images that lack fine textures and edge details. To address these issues, we propose a unified diffusion-based framework for arbitrary-scale in-plane MR image SR, dubbed Progressive Reconstruction and Denoising Diffusion Model (PRDDiff). Specifically, the forward diffusion process of PRDDiff gradually masks out high-frequency components and adds Gaussian noise to simulate the downsampling process in MRI. To reverse this process, we propose an Adaptive Resolution Restoration Network (ARRNet), which introduces a current step corresponding to the resolution of input MR image and an ending step corresponding to the target resolution. This design guide the ARRNet to recovering the clean MR image at the target resolution from input MR image. The SR process starts from an MR image at the initial resolution and gradually enhances them to higher resolution by progressively reconstructing high-frequency components and removing the noise based on the recovered MR image from ARRNet. Furthermore, we design a multi-stage SR strategy that incrementally enhances resolution through multiple sequential stages to further improve recovery accuracy. Each stage utilizes a set number of sampling steps from PRDDiff, guided by a specific ending step, to recover details pertinent to the predefined intermediate resolution. We conduct extensive experiments on fastMRI knee dataset, fastMRI brain dataset, our real-collected LR-HR brain dataset, and clinical pediatric cerebral palsy (CP) dataset, including T1-weighted and T2-weighted images for the brain and proton density-weighted images for the knee. The results demonstrate that PRDDiff outperforms previous MR image super-resolution methods in term of reconstruction accuracy, generalization, and downstream lesion segmentation accuracy and CP classification performance. The code is publicly available at https://github.com/Jiazhen-Wang/PRDDiff-main.

PMID:40983006 | DOI:10.1016/j.media.2025.103814