Category: Nevin Manimala

J Assoc Physicians India. 2025 Dec;73(12):e4-e7. doi: 10.59556/japi.73.1269.

ABSTRACT

BACKGROUND: The intensive care unit (ICU) is an area within a medical facility equipped with advanced technologies such as ventilators and personnel trained to provide intensive, advanced life-supportive care to critically ill patients. These units can be general or specialized. Intensive care beds are always in demand in any tertiary care center. Getting ICU beds is a challenging task. In 2008, the cost of critical care was 17-39% of hospital costs and 5.2-11% of the total healthcare budget. On one hand, where needy patients do not get ICU beds, there are instances when patients are kept just for observation in intensive care. So, we planned this study to analyze our status regarding the effective utilization of medical intensive care beds.

AIMS AND OBJECTIVES: To audit our admissions and discharges on the grounds of the criteria laid by the American Critical Care Medicine (ACCM) in the year 2016, and to strengthen our admission and discharge policies with standard protocols to make the best utilization for society.

MATERIALS AND METHODS: Retrospectively, we analyzed the medical records of 6 months (July 1-December 31, 2021). We analyze admission criteria and discharges in those patients. We recorded the sequential organ failure assessment (SOFA) score, the quick sequential organ failure assessment (qSOFA) score, the length of stay in ICU, the total length of stay, and the outcomes of the patients. The analysis was done with SPSS.

RESULTS: We collected records of 355 patients admitted in the medicine ICU during the defined period. There was a male preponderance in our study. The mean age of patients admitted was 54.75 ± 17.53 (range 16-82). Most patients were transferred in from the ward (53.5%), and the rest (46.5%) were directly from the emergency department. When we categorized the patients’ admission according to ACCM Guidelines, 39.4% of patients were in category I, 11.3% patients in category II, 36.6% in category III, 7% in category IV, and 5.6% in category V. When we compared the SOFA score along with the admissions category, there was no significant association. Mean ICU length of stay was 6.11 ± 4.99. There was no association found between the category of admission and the mean ICU length of stay. Overall, out of 355 patients, 255 patients (71.8%) transferred out, 20 patients (5.6%), and 80 patients (22.6%) could not be saved. In our study, 80.3% of transfers out were unplanned (this also includes the death of patients). There was a significant association between the admission category of patients and their outcome in the ICU.

CONCLUSION: The intensive care unit is an expensive setup. It is yet to be used in its maximum capacity for those who really need it. Triaging patients for the ICU is a must for better utilization of resources. Admissions and discharge policies should be followed stringently for optimum utilization of facilities.

PMID:41391086 | DOI:10.59556/japi.73.1269

J Assoc Physicians India. 2025 Dec;73(12):44-46. doi: 10.59556/japi.73.1275.

ABSTRACT

BACKGROUND: Heart failure (HF) is a major public health concern with increasing prevalence worldwide. Serum uric acid (SUA) has been proposed as a potential biomarker in HF, with its levels potentially correlating with the severity of systolic dysfunction. However, the relationship between SUA and left ventricular ejection fraction (LVEF) remains unclear.

METHODOLOGY: A cross-sectional study was conducted at DY Patil University School of Medicine, Navi Mumbai, involving 60 patients diagnosed with HF. Patients were categorized based on LVEF into HF with preserved ejection fraction (HFpEF), mid-range ejection fraction (HFmrEF), and reduced ejection fraction (HFrEF). SUA levels were measured, and patients were classified into hyperuricemia or normal uric acid level groups. Demographics, comorbidities, and clinical symptoms were also recorded. Statistical analysis was performed to determine the correlation between SUA and LVEF.

RESULTS: Of the 60 patients enrolled, 65% were female, with a mean age of 61-70 years. The majority had HFrEF (70%), followed by HFmrEF (26.67%) and HFpEF (3.3%). Hyperuricemia was observed in 38.3% of patients. A weak negative correlation was found between LVEF and SUA (r = -0.070), which was not statistically significant (p = 0.599). Although hyperuricemia was more prevalent in HFrEF, no significant relationship was established between SUA levels and severity of systolic dysfunction.

CONCLUSION: The study found a weak and statistically insignificant correlation between SUA levels and LVEF in HF patients. This suggests that SUA may not be a reliable biomarker for assessing the severity of systolic dysfunction. Further studies involving larger, more diverse populations are needed to clarify the prognostic role of SUA in HF.

PMID:41391081 | DOI:10.59556/japi.73.1275

J Assoc Physicians India. 2025 Dec;73(12):40-43. doi: 10.59556/japi.73.1263.

ABSTRACT

BACKGROUND: Sarcopenia is a frequent and prognostically significant complication of liver cirrhosis. Hand grip strength (HGS) has emerged as a simple, noninvasive tool for assessing muscle function, yet limited data exist on its utility in Indian cirrhotic populations.

AIM: To evaluate the association of HGS with established prognostic scores and biochemical parameters in Indian patients with cirrhosis.

MATERIALS AND METHODS: In this cross-sectional observational study, 100 adult cirrhotic patients were assessed between August 2022 and December 2023. HGS was measured using a validated hand-held dynamometer. Correlations between HGS and clinical scores of severity of cirrhosis [Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD)] and biochemical markers were analyzed using appropriate statistical methods.

RESULTS: Mean patient age was 59.2 ± 8.46 years; 85% were male. The most common etiologies were alcohol (46%) and viral hepatitis (26%). HGS declined significantly with increasing liver disease severity: CTP A (34.0 ± 1.48 kg), B (21.63 ± 1.07 kg), and C (13.5 ± 2.87 kg) (p < 0.0001). HGS was inversely correlated with MELD score (r = -0.820) and showed strong positive correlations with serum albumin (r = +0.872) and hemoglobin (r = +0.59). Age, international normalized ratio (INR), and bilirubin were negatively correlated with HGS.

CONCLUSION: HGS is strongly associated with liver disease severity and key biochemical indicators. As a bedside, radiation-free tool, it offers a practical method for assessing sarcopenia in cirrhosis, especially in resource-limited settings.

PMID:41391080 | DOI:10.59556/japi.73.1263

J Assoc Physicians India. 2025 Dec;73(12):37-39. doi: 10.59556/japi.73.1271.

ABSTRACT

OBJECTIVES: Surgical antimicrobial prophylaxis (SAP) is a critical component of postoperative infection prevention, but its misuse is a widespread global issue. This study aims to assess SAP utilization patterns and appropriateness of SAP in terms of choice, timing of administration, and duration of SAP, and to evaluate possible correlation of SAP compliance with reduction in surgical site infection (SSI) rates.

METHODS: A facility-based prospective cross-sectional study was conducted over a period of 6 months to evaluate the prescribing patterns of SAP and the incidence of SSIs. Prophylactic antimicrobial use was considered appropriate when the correct antimicrobial was administered for the appropriate indication, at the correct time, and for the recommended duration, in alignment with institutional protocols.

RESULTS: The findings suggest a general improvement in SAP adherence over the 6-month period, with a peak of 83% in May-24 coinciding with the lowest recorded SSI rate (0.64%). Conversely, the highest SSI rate (5.14%) in Jan-24 corresponded with the lowest adherence (60%), reinforcing the association between proper SAP compliance and reduced infection rates. SAP adherence improvement correlates with reduced SSI rates, but there is still a need to reduce prolonged SAP use.

CONCLUSION: The relationship between SAP adherence and SSI rates underscores the importance of evidence-based antimicrobial stewardship. Strengthening compliance with established protocols and aligning SAP practices with international guidelines will be critical in sustaining low SSI rates while minimizing antibiotic resistance risks. Further, assessing SAP using days of therapy/100 patient-days (DOT/100 PD) data could provide valuable insights into adherence trends and potential areas for improvement.

PMID:41391079 | DOI:10.59556/japi.73.1271

J Assoc Physicians India. 2025 Dec;73(12):17-22. doi: 10.59556/japi.73.1262.

ABSTRACT

BACKGROUND: Hydration plays a vital role in metabolic health, particularly in diabetes, where factors such as osmotic diuresis, polypharmacy, and comorbidities heighten the risk of dehydration. Effective management of fluid, electrolyte, and energy (FEE) deficits is crucial, yet gaps persist in current practices. This is the first study to assess the knowledge, attitude, and practices of cross-specialty healthcare professionals (HCPs) managing diabetes on such a unique issue in persons with diabetes.

OBJECTIVES: This study assessed the knowledge, attitudes, and practices (KAP) of 525 cross-specialty HCPs managing diabetes in India regarding FEE management in diabetic patients with acute nondiarrheal illnesses to identify gaps and inform interventions.

MATERIALS AND METHODS: An online cross-sectional survey evaluated physician perspectives on dehydration in diabetes using a 30-item questionnaire covering knowledge of dehydration in diabetes, attitudes toward the oral FEE formulations, and current practice.

RESULTS: Most respondents (90%) identified osmotic diuresis as a key driver of dehydration in diabetes, with 75% highlighting Sodium-glucose cotransporter 2 (SGLT-2) inhibitors as a risk factor. Despite widespread recognition of the adverse effects of dehydration and energy deficits (86%), only 46.5% routinely assessed hydration status during acute illnesses in persons with diabetes. Slow-release carbohydrates, such as isomaltulose, D-tagatose, and trehalose, were favored by 68.9% of respondents for their metabolic benefits to address energy deficits. 84.2% of HCPs perceived ready-to-drink (RTD) FEE formulations supporting rehydration and enhanced recovery, with an average impact on recovery time of 4.1 days.

CONCLUSION: This study highlights the gaps in understanding the role of hydration in persons with diabetes. It also underscores the need for standardized oral FEE management guidelines and innovative solutions, such as RTD FEE drinks, to improve outcomes in diabetic care.

PMID:41391075 | DOI:10.59556/japi.73.1262

Discov Oncol. 2025 Dec 14. doi: 10.1007/s12672-025-04287-0. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the clinicopathological characteristics of breast invasive micropapillary carcinoma (IMPC) and identify factors associated with recurrence and metastasis.

METHODS: The study retrospectively analyzed 401 cases of breast IMPC diagnosed between 2017 and 2021. The primary endpoint was recurrence and metastasis-free survival (RMFS). Secondary endpoints included locoregional recurrence-free survival (LRRFS) and distant metastasis-free survival (DMFS). Survival was estimated using the Kaplan-Meier method and compared with the log-rank test. Univariable and multivariable Cox regression analyses were performed to identify prognostic factors. Continuous variables were categorized using maximum log-rank statistics to optimize group stratification.

RESULTS: The median follow-up duration was 46.9 months (range, 1-92 months). The 5-year RMFS, LRRFS and DMFS rates were 86.0% (95% CI, 82.2%-90.0%), 97.5% (95% CI, 95.8%-99.3%) and 86.5% (95% CI, 82.8%-90.5%), respectively. Multivariable Cox analysis showed that maximum tumor diameter (≤ 1.7 cm vs. >1.7 cm, P = 0.018), the log odds of positive lymph nodes (LODDS) (≤ 0 vs. >0, P = 0.008), histological grade (I-II vs. III, P = 0.002), and receipt of neoadjuvant chemotherapy (P = 0.003) were independent predictors of recurrence and metastasis.

CONCLUSION: Breast IMPC carries a relatively high risk of recurrence and metastasis. Tumor size, LODDS, histologic grade, and neoadjuvant chemotherapy were independently associated with outcomes, underscoring the need for closer clinical monitoring and refined risk stratification in this subtype.

PMID:41391067 | DOI:10.1007/s12672-025-04287-0

Biomech Model Mechanobiol. 2025 Dec 14;25(1):6. doi: 10.1007/s10237-025-02036-4.

ABSTRACT

Simulating medical procedures requires accounting for inherent uncertainty in many numerical model parameters, such as material properties. Evaluating the impact of these uncertainties is crucial for identifying parameters needing precise definition and correctly interpreting simulation results. This study explores how uncertainties in modelling the aorta affect finite element outcomes of a thoracic endovascular aortic repair (TEVAR) procedure. Based on literature data, aortic wall thickness and mechanical properties were identified as the most uncertain. The aorta was modelled using shell elements with homogeneous thickness and assumed to behave as a linear elastic isotropic material. A design of experiments approach was used for uncertainty quantification and sensitivity analysis: wall thickness and Young’s modulus were varied over 11 levels in a full factorial design, resulting in 121 simulations. Uncertainty was quantified using statistical metrics such as mean, standard deviation, coefficient of variation, and 95% confidence intervals. Results indicate wall thickness significantly affects aortic wall stress (σ_aorta), with minimal influence on stent stress (σ_stent) and device opening area (OA). Conversely, Young’s modulus has limited impact on σ_aorta but affects σ_stent and OA to a greater extent. The highest uncertainty was observed in σ_aorta (~ 25% coefficient of variation), while σ_stent and OA showed lower variability (2.6% and 6.9%, respectively). These findings suggest that, in this model, accurate wall thickness definition is more critical than precise Young’s modulus for reducing uncertainty in wall stress predictions. Therefore, literature-based averages for Young’s modulus may be sufficient for simulating this procedure.

PMID:41391053 | DOI:10.1007/s10237-025-02036-4

Int J Psychiatry Clin Pract. 2025 Dec 14:1-9. doi: 10.1080/13651501.2025.2600083. Online ahead of print.

ABSTRACT

OBJECTIVE: The potential risk of diagnostic conversion from unipolar depression to bipolar disorder with antidepressant use, particularly serotonin-norepinephrine reuptake inhibitors (SNRIs) versus selective serotonin reuptake inhibitors (SSRIs), remains debated. This study aims to investigate the relationship between SSRI and SNRI use and the risk of diagnostic conversion.

METHODS: We conducted a retrospective cohort study using the Korean version of the Observational Medical Outcomes Partnership-Common Data Model (OMOP-CDM). The target cohort comprised patients prescribed SNRIs, while the comparator cohort included those prescribed SSRIs. The primary outcome was a new diagnosis of bipolar disorder occurring at least six months after antidepressant initiation.

RESULTS: After propensity score adjustment, no significant difference in the risk of diagnostic conversion was observed between SSRI and SNRI users. In the distributed network analysis, SNRI use was not significantly associated with an increased risk of diagnostic conversion compared to SSRI use after both 1:1 propensity score matching (hazard ratio [HR] = 1.28, 95% confidence interval [95% CI]: 0.90-1.82; I² = 24.1%) and 1:2 propensity score matching (HR = 1.16, 95% CI: 0.88-1.53, I² = 0%).

CONCLUSIONS: This study observed no significant difference in the risk of diagnostic conversion to bipolar disorder between SSRI and SNRI users.

PMID:41391041 | DOI:10.1080/13651501.2025.2600083

Mol Biol (Mosk). 2025 Sep-Oct;59(5):821-834. doi: 10.31857/S0026898425050075.

ABSTRACT

Breast cancer remains one of the leading causes of cancer mortality among women, and the study of epigenetic mechanisms is an important task of molecular oncology in breast cancer. In this study, we analyzed the expression levels of eight microRNAs (miR-125b-5p, -127-5p, -129-5p, -132-3p, -148a-3p, -193a- 5p, -24-2-5p, and -34b-3p) and methylation of promoter regions of seven microRNA genes in a representative set of 40 and 70 paired samples of tumor and normal breast tissue, respectively, and showed hypermethylation of promoter regions of seven genes and a statistically significant decrease in the expression levels of eight microRNAs in tumors. For three genes (MIR125B-1, MIR129-2, MIR148A), inverse relationships between methylation and expression (rs < -0.5) were revealed, indicating their possible epigenetic regulation. Statistically significant positive correlations of expression levels were revealed for seven pairwise combinations of miRNAs, suggesting their coordinated functioning. Indeed, for the pairs miR-127-5p/miR-125b-5p, miR-148a-3p/miR-125b-5p, miR-148a-3p/miR-132-3p, and miR-34b-3p/miR-193a-5p, common mRNA targets and involvement in biological processes, including pathways associated with epigenetic regulation, proliferation, and metastasis, were revealed. The miRNA-mRNA regulatory network constructed involving DNMTs and EZH2 highlights their potential role in breast cancer progression and demonstrates diagnostic and prognostic significance.

PMID:41391026 | DOI:10.31857/S0026898425050075

J Esthet Restor Dent. 2025 Dec 14. doi: 10.1111/jerd.70077. Online ahead of print.

ABSTRACT

INTRODUCTION: Ceramic laminate veneers (CLVs) play a vital role in esthetic dentistry; however, the impact of preparation design on clinical outcomes remains inconclusive.

OBJECTIVES: This prospective clinical study evaluated the clinical success of CLV restorations fabricated with different preparation techniques.

METHODS: CLVs (N = 110; 55 minimally invasive, 55 prepless) were placed in 12 patients (7 female and 5 male). After 1 year, restorations were assessed via United States Public Health Service (USPHS) criteria. Chewing pressure was measured; restorations were checked for fractures, cracks, or debonding. Periodontal health was evaluated by probing depths; patient satisfaction was recorded using the Visual Analog Scale (VAS). Statistical analysis used chi-square and Mann-Whitney U tests (p < 0.05).

RESULTS: No significant differences were observed in adaptation, color, form, or roughness (p > 0.05). Fractures were observed in 0% and 9.1% (n = 5), debonding in 0% and 1.8% (n = 1), and cracks in 3.6% (n = 2) and 0% of the minimally invasive and prepless groups, respectively. Fracture incidence differed significantly (p = 0.022). Chewing force showed no correlation with complications. Pocket depth changes were nonsignificant, and patient satisfaction was higher in the prepless group (median VAS = 10) than in the minimally invasive group (median = 9; p < 0.001).

CONCLUSIONS: Preparation type did not significantly affect esthetic or periodontal outcomes after 1 year. Complications were more common in prepless veneers, suggesting minimal prep might improve stability. Chewing forces did not significantly impact performance, indicating functional loads do not damage veneers.

CLINICAL SIGNIFICANCE: Both minimally invasive and prepless CLVs yield positive short-term outcomes. Yet, proper case selection and occlusal management are essential to prevent complications and secure long-term success.

PMID:41391014 | DOI:10.1111/jerd.70077