Category: Nevin Manimala

Neurosurg Rev. 2025 Sep 20;48(1):659. doi: 10.1007/s10143-025-03832-3.

ABSTRACT

Background Despite the increasing number of decompressive craniectomy (DC) in neurotrauma, the optimal timing for elective cranioplasty (CP) is still debated. Little is known about the CP complications related to surgery, implant material, and post-traumatic hydrocephalus. Objectives To explore the correlation between CP timing, implant material, and the incidence of postoperative complications in patients undergoing CP after DC for severe head injuries. Materials and methods A retrospective multicenter study was conducted from January 2010 to December 2021 across 9 European neurosurgical centers. A cohort of 4007 patients who underwent CP following DC for severe head injury was analyzed. Timing was categorized as: ultra-early (< 30 days), early (31-90 days), late (> 90 days). Complications were defined according to Clavien-Dindo classification, requiring revision surgery and/or hospital readmissions. Results Among the 4007 patients, 352 (8.8%) had ultra-early CP, 1627 (40.5%), and 2028 (51.7%) had early and late CP respectively. Cerebrospinal fluid (CSF) derangement was more frequently associated with large defects and the incidence of Sinking Skin Flap Syndrome (SSFS). SSFS was more frequently diagnosed in patients undergoing late surgery whereas hydrocephalus and epilepsy were less frequently encountered in the ultra-early and early groups (p < 0,05). The overall complication rate was 24.6% (985 patients) including internal hydrocephalus (20%), infection (18%), external hydrocephalus (15%), epilepsy (15%), acute extradural (14%) or subdural hematomas (10%), and subdural hygroma (8%). CP stabilized CSF derangement in 80% of cases, which did not progress into overt hydrocephalus, whereas 17% with definite diagnosis of post-traumatic hydrocephalus required a Ventriculo-Peritoneal shunt (VPS). Simultaneous CP and VPS led to infections in all cases, regardless of implant material. Conclusion Surgery timing has a greater impact on CP complications than implant material. CSF derangement represents the single most relevant factor influencing the clinical course of patients undergoing CP.

PMID:40974389 | DOI:10.1007/s10143-025-03832-3

Environ Monit Assess. 2025 Sep 20;197(10):1128. doi: 10.1007/s10661-025-14594-2.

ABSTRACT

Liverpool, a city with an industrial legacy and among the most socioeconomically deprived local authorities in the UK, faces a significant health challenge: the combined impact of air pollution and deprivation on children’s respiratory health. This study deploys a dense network of 52 air quality sensors, one of the most comprehensive in the UK, to monitor particulate matter in 2023. PM2.5 levels ranged from 4.78 to 18.15 µg/m³ (median 7.15 µg/m³), and PM10 from 11.21 to 43.14 µg/m³ (median 17.30 µg/m³), frequently exceeding WHO thresholds. High concentrations were found in northern wards with high deprivation. Hospital admission rates for under-18 s ranged from 0.2 to 2%, exceeding national averages. Linear regression showed Index of Multiple Deprivation (IMD) scores explained 16.1% of the variance in hospital admissions (R² = 0.1608, β = 0.023 to 0.025, p < 0.02), more than PM2.5 (6.6%) or PM10 (4.7%). Interaction terms suggested amplified pollution effects in deprived areas. Liverpool offers a valuable case study for understanding the intersection of environmental and social determinants of health as seen in many urban UK settings. Socioeconomic deprivation emerged as both a mediator, through factors like healthcare access, and a confounder in the pollution-health relationship. These findings underscore the need for targeted emission reductions and investment in disadvantaged communities. Future research with extended data could confirm these patterns and support broader policy action.

PMID:40974382 | DOI:10.1007/s10661-025-14594-2

Aliment Pharmacol Ther. 2025 Sep 20. doi: 10.1111/apt.70383. Online ahead of print.

ABSTRACT

BACKGROUND: Severe alcohol-associated hepatitis (sAH) is a life-threatening condition. Despite advances in clinical management, prognosis remains poor and long-term effectiveness of available therapies is uncertain. We conducted a systematic review and meta-analysis to evaluate short-term mortality (28, 60, and 90-day) trends in sAH over the past five decades.

METHODS: We searched PubMed, EMBASE, and Scopus from database inception to February 2024 for studies reporting 28, 60, and 90-day mortality in patients with sAH. Pooled mortality estimates were calculated using a random-effects meta-regression model. We assessed heterogeneity using the I² statistic and explored sources of heterogeneity through subgroup and meta-regression analyses. Separate Bayesian mixed-effects binomial models were used to estimate the posterior distribution of mortality probability, updated sequentially across calendar time.

RESULTS: 34 studies comprising 1586 patients with sAH were included. Pooled mortality rates were 26.8% (95% CI: 21.0%-33.5%) at 28 days, 35.1% (95% CI: 28.3%-42.5%) at 60 days, and 43.7% (95% CI: 34.6%-53.3%) at 90 days. Mortality increased steadily with follow-up time. Substantial heterogeneity was observed, as expected in pooled proportion meta-analysis (I² > 80%). Although cumulative Bayesian analysis showed that average 28-day mortality declined from over 50% in the 1970s to ~25% after 2000, a formal decade-based analysis indicated no statistically credible improvement in short-term mortality was detected overall in the past four decades. In multivariable models adjusting for follow-up time, the Model for End-Stage Liver Disease (MELD) score was significantly associated with mortality.

CONCLUSIONS: Short-term mortality in sAH remains high and has not improved in recent decades. These findings highlight the urgent need for effective therapies, improved patient selection for early liver transplantation, and better prognostic tools to guide clinical decision-making.

PMID:40974371 | DOI:10.1111/apt.70383

J Midwifery Womens Health. 2025 Sep 20. doi: 10.1111/jmwh.70029. Online ahead of print.

ABSTRACT

INTRODUCTION: Maternal morbidity and mortality rates in the United States and Georgia remain alarmingly high, exceeding those of many low-resource regions despite extensive interventions. Research highlights the role of competent midwifery care in addressing key contributing factors, such as limited health care access, insufficient prenatal care, and adverse social determinants of health. To expand the pool of qualified certified midwives and certified nurse-midwives, there is a pressing need for robust midwifery education programs, reliable and valid evaluation tools for student assessment, and documentation of skill development and confidence improvement among trainees.

PROCESS: To evaluate preparedness and competency, a quality improvement project was initiated to assess the effectiveness and efficiency of the intrapartum simulation laboratory. A modified version of the National League for Nursing Student Satisfaction and Self-Confidence in Learning tool was used. Third-semester midwifery students at Emory University School of Nursing in Atlanta, Georgia, completed pre- and postlaboratory surveys, which included a Likert scale to measure confidence in the simulation laboratory’s ability to meet their educational needs. Qualitative questions were incorporated to identify suggestions for laboratory improvements.

OUTCOMES: Statistically significant improvements were observed in midwifery students’ pre- and postlaboratory assessments, particularly in their confidence regarding the skills reviewed, the alignment of simulation and laboratory time with their learning styles, and their trust in faculty members’ ability to effectively teach essential midwifery practices.

DISCUSSION: The findings validate the effectiveness of intentional teaching strategies and innovative simulation technologies in enhancing midwifery education. Increasing the number of competent midwives in practice represents a critical step in addressing the persistently high maternal morbidity and mortality rates in the United States. These teaching approaches and technologies can also be applied to other midwifery simulation laboratories and adapted for use in other advanced practice registered nursing specialties.

PMID:40974338 | DOI:10.1111/jmwh.70029

Hum Brain Mapp. 2025 Oct 1;46(14):e70353. doi: 10.1002/hbm.70353.

ABSTRACT

Accelerated imaging in diffusion MRI has been widely used to reduce scan time. This can be particularly important in reducing the burden in patients, such as those with mild cognitive impairment (MCI). However, the impact on reliability is not fully understood. Moreover, the impact on effect sizes in group comparisons has not been examined. We conducted a test-retest study of the impact of simultaneous multislice (SMS, also called multiband) and in-plane acceleration (IPA, also called phase acceleration) on reliability and effect sizes in diffusion imaging in MCI, healthy older adults, and young adults. We evaluated diffusion tensor imaging measures (fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity) and neurite orientation and dispersion measures (orientation dispersion, isotropic volume fraction, intracellular volume fraction) under no acceleration (S1P1), SMS = 3 with no in-plane acceleration (S3P1), SMS = 3 with IPA = 2 (S3P2), S6P1, and S6P2, with scan times varying from over 20 min in S1P1 to under 4 min in S6P2. In white matter voxels, the ranking of the accelerations with respect to intraclass correlations (ICCs) was S1P1 $\approx$ S3P1 $\ge$ S3P2 $>$ S6P1 $>$ S6P2, with ICCs in the good range across most DWI measures in S1P1, S3P1, and S3P2, moderate to good in S6P1, and poor to moderate in S6P2. In-plane acceleration did not improve ICC in areas of high susceptibility distortion. Acceleration significantly impacted the values of white matter microstructure with an overall trend of increase in fractional anisotropy and decrease in orientation dispersion with increasing multiband acceleration. In group comparisons, effect sizes tended to be similar across S1P1, S3P1, S3P2, and S6P1, including medium effect sizes in MCI versus healthy older adults and large effect sizes in young versus healthy older adults. Our results provide guidance regarding the costs of acceleration (reduced ICC from high acceleration) while also characterizing the benefits (S3P1 has similar reliability as S1P1 while requiring one third of the acquisition time, ROI-level group comparisons similar between S1P1, S3P1, S3P2, and S6P1). The overall high reliability and medium effect sizes of white matter microstructure measures with a moderate SMS factor indicates accelerated DWI can be used in developing biomarkers of neurological decline.

PMID:40974302 | DOI:10.1002/hbm.70353

Ear Nose Throat J. 2025 Sep 20:1455613251377560. doi: 10.1177/01455613251377560. Online ahead of print.

ABSTRACT

OBJECTIVE: Carotid body tumors (CBTs) are rare neurogenic tumors that may indirectly affect cardiac autonomic regulation. This study aims to investigate the relationship between tumor size and electrocardiographic (ECG) findings, particularly the corrected QT (QTc) interval.

METHODS: This retrospective study included 21 patients with histologically or radiologically confirmed CBTs treated at a tertiary center between 2021 and 2025. Patients with comorbidities or medications affecting cardiac conduction were excluded. Tumor sizes were measured via contrast-enhanced computed tomography or magnetic resonance imaging. Preoperative ECGs were analyzed for heart rate, P wave, PR, QRS, T wave, and QTc intervals. The correlation between tumor size and ECG parameters was assessed using Spearman’s rank correlation.

RESULTS: A statistically significant and strong positive correlation was observed between tumor size and QTc interval (r = 0.940, P < .001). No other ECG parameter showed a significant association with tumor size. Tumor size explained 88.36% of the variance in QTc duration (r² = 0.8836).

CONCLUSION: This study demonstrates a strong correlation between CBT size and QTc prolongation, suggesting vagal overactivity as a possible mechanism. QTc may serve as a noninvasive marker of subclinical autonomic dysregulation in CBT patients. Larger prospective studies are warranted to validate this association and explore its clinical significance.

PMID:40974217 | DOI:10.1177/01455613251377560

Nurs Open. 2025 Sep;12(9):e70237. doi: 10.1002/nop2.70237.

ABSTRACT

AIMS: To analyse and discuss the basic conditions and related factors of transported patients’ PIs and attract the attention of healthcare providers to PIs.

DESIGN: Systematic review.

DATA SOURCES: Databases including CNKI, VIP, Wanfang Database, CBM, PubMed, Web of Science, EBSCO and Cochrane Library were used, and manual searches of reference lists were also performed. The search timeframe was from the inception of the databases up to December 2023.

METHODS: According to the PRISMA, a systematic review and meta-analysis was conducted. Data were combined using meta-analysis, and relevant factors were explored through descriptive analysis.

RESULTS: A total of eight articles were included, comprising 3512 participants. The prevalence of PIs among transported patients ranged from 5.2% to 7.92%, with an incidence rate of 9.4%. PIs were mainly classified as Stage 1 and Stage 2. Common sites included the sacrum, buttocks and heels. Risk factors included the duration and frequency of the transfer, equipment environment, age and BMI and patient source.

CONCLUSION: Patients during transport represent a special population at risk of developing PIs; healthcare providers and managers should increase their focus on PIs management for transported patients while ensuring the patients’ life conditions.

IMPACT: Current evidence indicates that transferred patients are at risk of developing PIs. High-quality studies are needed to validate these results to support healthcare providers in implementing precise and effective management.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution because of the review.

TRIAL REGISTRATION: PROSPERO registration number: CRD42023493742.

PMID:40974192 | DOI:10.1002/nop2.70237

J Prim Care Community Health. 2025 Jan-Dec;16:21501319251356768. doi: 10.1177/21501319251356768. Epub 2025 Sep 20.

ABSTRACT

OBJECTIVE: To investigate the experience of people experiencing unsheltered homelessness (PEUH) in meeting their basic needs for food, drinking water, toilet, hygiene, and healthcare in Los Angeles County.

METHODS: Cross-sectional, in-person health assessment survey (modified HOUSED BEDS instrument) from 2022 to 2023 among PEUH age 18+ years and initiating care with street medicine (N = 665).

RESULTS: Few participants reported access to a toilet (23%), shower (44%), primary care (7%), and food (x̅ = 8.3 meals per week ±5.7). Geographical area was associated with statistically significant differences in participant demographic characteristics, access to, and source type of basic resources.

CONCLUSIONS: Key gaps in access to basic resources for survival for PEUH continue to exist in an urban county where state and local government entities have prioritized addressing homelessness by heavily investing in housing solutions.

POLICY IMPLICATIONS: Pervasive unmet needs for basic resources among PEUH threatens wellbeing and holds important implications for public health, healthcare providers, and payers. Geographical differences in access to basic resources for PEUH suggests a need for heterogeneous services, resources, solutions, and policies to better support PEUH.

PMID:40974191 | DOI:10.1177/21501319251356768

J Sleep Res. 2025 Sep 20:e70196. doi: 10.1111/jsr.70196. Online ahead of print.

ABSTRACT

While Zepbound (Tirzepetide) is the only FDA-approved drug for obstructive sleep apnea (OSA), pharmacological options remain limited. Emerging data suggest sodium glucose co-transporter (SGLT-2) inhibitors may offer a novel therapeutic benefit in this population. Our meta-analysis aims to evaluate their efficacy based on current evidence. PubMed and Google Scholar were searched from inception to September 2024 for Randomised Controlled Trials (RCTs) and observational studies comparing SGLT-2 inhibitors to placebo in patients with OSA using continuous positive airway pressure (CPAP). After careful screening, 4 studies involving 686 patients were analysed using the random-effects model in RevMan 5.4.1, and mean differences (MD) were calculated. The addition of an SGLT-2 inhibitor showed a statistically significant reduction in the apnea-hypopnea index (AHI) [MD = -5.52 (95% CI: -9.72 to -1.32) (p = 0.01)], oxygen desaturation index [MD = -3.16 (95% CI: -5.33 to -0.99) (p = 0.004)], and Body Mass Index (BMI) [MD = -1.29 (95% CI: -2.20 to -0.39) (p = 0.005)]. However, they failed to show any significant improvement in daytime sleepiness [MD = -2.28 (95% CI: -4.92 to 0.37) (p = 0.90)] and Haemoglobin A1c [MD = 0.25 (95% CI: -0.32 to 0.82) (p = 0.88)]. Similarly, SGLT-2 inhibitors failed to depict any significant improvement in blood pressure or serum lipid levels. SGLT-2 inhibitors, along with significantly reducing AHI, also offer added cardiometabolic benefits in OSA patients. These findings support their role as a promising adjunct or alternative to existing therapeutic options. Further studies are warranted to define their place in OSA management.

PMID:40974185 | DOI:10.1111/jsr.70196

Am J Hum Biol. 2025 Sep;37(9):e70144. doi: 10.1002/ajhb.70144.

ABSTRACT

Arab adolescents are both racialized and invisible minorities in Canada and the United States (US), following the war on terror, incomplete ethnic categorization, Islamophobia, and anti-Arab racism. We conducted a scoping review of physical and psychological health in Arab adolescent populations living in the US and Canada. Inclusion criteria encompassed adolescents and emerging adults aged 10-24 who identified as Arab or having Arab identity and Southwest Asia and North Africa (SWANA) origins. Included scholarly literature reported at least one physical or psychological health outcome and was published in English or Arabic up until 2025. We identified over 200 relevant studies using PubMed, Web of Science, ResearchRabbit.ai, Google Scholar, and Undermind AI. We reviewed 50 total studies that met our inclusion criteria, highlighting the paucity of research on health and biopsychosocial variation among Arab adolescents in North America over a 30-year period. Despite heterogeneity in the health outcomes reported across studies, many focused on acculturative stress, ethnic identity formation, mental health, and discrimination. Few studies examined physical health and sexual and reproductive health; none examined pubertal, immunological, or linear growth outcomes. We discuss how biocultural and human biological research approaches can contribute to advancing a needed and more holistic understanding of health variation among Arab adolescent populations.

PMID:40974179 | DOI:10.1002/ajhb.70144