Category: Nevin Manimala

J Pak Med Assoc. 2025 Aug;75(8):1320-1326. doi: 10.47391/JPMA.21001.

ABSTRACT

OBJECTIVE: To assess the frequency of anxiety and its coping mechanism among medical and engineering students.

METHODS: The comparative cross-sectional study was conducted from April to September 2023 in Faisalabad, Pakistan, and comprised students from two medical and two engineering education institutions. Within the two subsets, one was a public-sector institution and the other was in the private sector. Data was collected using Generalised Anxiety Disorder-7 and Brief Cope Inventory. Data was Analysed using SPSS 27.

RESULTS: Study subjects ranged between 17-26 years of age and 144(36%) of them were females. Of the 400 subjects, 200(50%) were medical students and the rest were engineering students uniformly representing all years of education. Also, 200(50%) responses were from private-sector institutions and the rest were from public-sector institutions. Mild anxiety was present in 220(55%) subjects, more in engineering students. Moderate anxiety was found in 98(24.5%) students, most in public-sector medical institutions. Minimal and severe anxiety were noted in 56(14%) and 26(6.50%) subjects, respectively. Medical and engineering students showed the same patterns of coping mechanisms, with planning (2.55±0.69) being the most adopted, and substance abuse (1.78±0.68) the least.

CONCLUSIONS: Except for mild anxiety, all other groups of anxiety levels were found to be higher among medical students. In terms of coping behaviour, there was no difference between medical and engineering students.

PMID:40851158 | DOI:10.47391/JPMA.21001

J Pak Med Assoc. 2025 Aug;75(8):1267-1270. doi: 10.47391/JPMA.20788.

ABSTRACT

The retrospective, observational study was planned to present the clinical manifestations of obstructive nephropathy secondary to urolithiasis, and its effect on long-term renal function. The sample comprised patients diagnosed with obstructive nephropathy secondary to stones admitted to the Department of Urology and Renal Transplant, Lahore General Hospital, Lahore, Pakistan, between January 1, 2018, and December 31, 2021. Data was analysed using SPSS 20. Of the 76 patients with a mean age of 50.06±13.42 years, 56(73.7%) were males and 20(26.3%) were females. The most frequent clinical cause was bilateral ureteric obstruction in 39 (51.3%) patients. The most common emergency procedure performed was unilateral percutaneous nephrostomy. It took an average of 10.8±2.3 days for patients to have a nadir value of creatinine. On follow-up, diabetes, presence of lower urinary tract symptoms and a higher value of creatinine at admission were significantly related to poorer outcomes (p<0.05).

PMID:40851138 | DOI:10.47391/JPMA.20788

J Pak Med Assoc. 2025 Aug;75(8):1218-1223. doi: 10.47391/JPMA.20611.

ABSTRACT

OBJECTIVES: To analyse prescribing patterns of cyclooxygenase-2 inhibitor for low-back pain patients with cardiovascular comorbidities in American outpatient settings.

METHODS: The data of this retrospective, cross-sectional study were from the 2007-2019 National Ambulatory Medical Care Survey except 2017 for which data were not available. Data related to low-back pain patients of either gender aged ≥20 years. Those having cardiovascular comorbidities were placed in group A, while those without such comorbidities were placed in group B. Descriptive statistics were employed to evaluate visit characteristics, stratified by cyclooxygenase-2 inhibitor use. Multivariable logistic regression analysis was utilised to assess factors associated with cyclooxygenase-2 inhibitor prescriptions. Data was analysed using R 4.1.2.

RESULTS: Of the 242.65 million patients with 107.19(44.2%) females, 76.83 million (31.7%) were in group A and 165.82 million (68.3%) in group B. Compared to group B patients, those in group A were older (62.0±14.1years vs 49.7±16.1 years, p<0.01) and had a higher prevalence of cyclooxygenase-2 inhibitor use (p=0.01). Overall, 5.2 million (2.14%) patients were prescribed cyclooxygenase-2 inhibitors. Those using cyclooxygenase-2 inhibitor exhibited a higher prevalence of cardiovascular comorbidities (p=0.01), especially hypertension (p=0.01), and were older in age (p<0.01). Older age (odds ratio = 1.019, 95% confidence interval: 1.003-1.035; p<0.05) and higher prevalence of cardiovascular comorbidities (odds ratio = 1.638, 95% CI: 1.017-2.637; p<0.05) were associated with increased likelihood of receiving cyclooxygenase-2 inhibitor prescriptions.

CONCLUSIONS: Cyclooxygenase-2 inhibitor use was positively correlated with age and cardiovascular comorbidities among low-back pain patients in American ambulatory care, suggesting potential contradiction to current medication guidelines and heightened risk of adverse cardiovascular events.

PMID:40851131 | DOI:10.47391/JPMA.20611

Sci Rep. 2025 Aug 24;15(1):31108. doi: 10.1038/s41598-025-17083-1.

ABSTRACT

Our study aimed to evaluate the survival impact of adjuvant radiotherapy (RT) following breast-conserving surgery (BCS) in elderly male patients with early-stage, low-risk breast cancer (node-negative, HR+), and to identify RT-benefiting subgroups using machine learning and causal inference approaches. We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) database (2000-2021), including 360 patients after propensity score matching (PSM). Patients were grouped by RT and non-RT (NRT) status, and a 1:3 nearest neighbor PSM was applied. Overall survival (OS), relative survival (RS), standardized mortality ratio (SMR), and transformed Cox regression were used to estimate RT benefit. Additionally, machine learning models, including random forest, support vector machines and causal forest model, were applied for survival prediction and validation. In early-stage, low-risk male breast cancer (MBC) patients treated with BCS, adjuvant RT did not demonstrate a significant survival advantage over NRT. After PSM, 15-year OS, RS, and SMR were 31.8%, 15.2%, and 2.14 for RT versus 34.1%, 21.5%, and 2.25 for NRT (p = 0.36, 0.68, and 0.81, respectively). The cumulative incidence of breast cancer-related death (BCRD) and non-BCRD also showed no statistically significant differences between groups (p = 0.06 and 0.75). Machine learning models (Cox, GBM, and XGBoost) confirmed the limited contribution of RT to survival prediction, with the Cox model demonstrating the best discrimination (C-index = 0.713). While RT was associated with a lower risk of death within the first 10 years, its benefit diminished over time. Causal forest analysis revealed notable heterogeneity in treatment effects across subgroups. Patients who were younger, diagnosed earlier, or had stage I disease showed relatively higher estimated benefit from RT, while older patients or those with more recent diagnoses demonstrated attenuated benefit. In elderly, low-risk MBC patients treated with BCS, adjuvant RT was not associated with improved long-term survival. While our findings suggest that RT may be safely omitted in selected individuals, this decision should be made cautiously in the absence of recurrence data. Model-based analyses underscore the importance of tailoring treatment to patient-specific risk profiles. Prospective studies dedicated to MBC are needed to support individualized de-escalation strategies.

PMID:40851101 | DOI:10.1038/s41598-025-17083-1

BMC Musculoskelet Disord. 2025 Aug 25;26(1):820. doi: 10.1186/s12891-025-09110-z.

ABSTRACT

OBJECTIVE: The posterior ligamentous complex (PLC) plays a crucial role in maintaining lumbar spine stability. PLC injuries have become a key factor in lumbar instability, with the increase in degenerative spinal conditions and surgical interventions. This study aimed to systematically quantify the impact of single and multi-ligament injuries on spinal stability and analyze their effects on lumbar biomechanical indices and intervertebral disc stress distribution.

METHODS: Finite element analysis (FEA) and experimental measurements were employed to examine the effects of 12 ligament resection combinations on lumbar range of motion (RoM) and intervertebral disc stress distribution. Detailed statistical analysis, including the Kruskal-Wallis Test, was used to evaluate the significance of observed differences. Functional contributions of individual ligaments and their combinations were analyzed to assess their roles in restricting spinal motion.

RESULTS: The results indicated that ligament resection combinations significantly impacted lumbar biomechanical indices (P = 0.016), with an effect size (η²) of 0.058, reflecting a moderate impact on segmental stability. The interspinous ligament (ISL) demonstrated the most significant role in restricting excessive spinal motion, followed by the ligamentum flavum (LF), while the supraspinous ligament (SSL) and facet joint capsules (FJC) had limited effects. Combined multi-ligament injuries, particularly ISL and LF resection, markedly increased spinal instability and altered intervertebral disc stress distribution. Despite significant stability loss from multi-ligament injuries, intact ligaments provided functional compensation, mitigating instability.

CONCLUSION: This study revealed the nonlinear cumulative effects of PLC damage on spinal stability, emphasizing the dominant roles of ISL and LF in maintaining biomechanical integrity. The findings provide critical quantitative insights for clinical decision-making, surgical planning, and postoperative rehabilitation strategies, highlighting the importance of preserving intact ligaments to leverage their compensatory capacity in mitigating instability.

PMID:40851096 | DOI:10.1186/s12891-025-09110-z

Sci Rep. 2025 Aug 24;15(1):31119. doi: 10.1038/s41598-025-17169-w.

ABSTRACT

This study aimed to explore the impact and the effectiveness of interventions based on the Interaction Model of Client Health Behavior on the self-care behavior of chronic heart failure patients. Using convenience sampling, 80 chronic heart failure patients who met the inclusion and exclusion criteria were selected from the Cardiovascular Department of a tertiary hospital in Henan Province from January to June 2023. The first and second wards were randomly assigned to control and intervention groups, with the first ward serving as the control group and the second ward as the intervention group, each consisting of 40 cases. The control group received routine care, and the intervention group was subjected to a self-care behavior intervention scheme based on Interaction Model of Client Health Behavior. The intervention lasted for three months. Then, various indicators of the patients were assessed. The intervention group had significantly higher self-care behavior levels than the control group, significantly lower levels of disease perception than the control group, and the quality of life scores of the intervention group was lower than that of the control group. The difference in readmission rates between the two groups was statistically significant. The intervention scheme based on Interaction Model of Client Health Behavior can enhance self-care behavior in chronic heart failure patients, improve their disease perception, ameliorate their quality of life, and further decline readmission due to disease recurrence or complications.

PMID:40851092 | DOI:10.1038/s41598-025-17169-w

Sci Rep. 2025 Aug 24;15(1):31091. doi: 10.1038/s41598-025-16169-0.

ABSTRACT

Accurately estimating blood loss is critical for managing hemorrhagic shock in prehospital and hospital settings. The Visual Estimation (VE) method is widely used, while the MAR method proposes using a fist measurement to estimate external blood on flat surfaces. A randomized, double-blind, parallel-group, controlled, and educational study was conducted involving 140 medical and paramedic students. The study compared the accuracy and duration of blood loss estimates made with the MAR and VE methods. The secondary objective was to assess whether MAR estimates varied by participants’ height, weight, or gender. Three simulated stations featured three different, non-absorbent, flat surfaces containing 75 mL, 150 mL, or 750 mL of blood. Participants were divided into two groups (Group 1: VE method, n₁ = 70; Group 2: MAR method, n₂ = 70) and asked to estimate blood loss using the assigned method at each of the three stations (Station 1 to Station 3). Analytical tests evaluated absolute differences and percentage errors in both intergroup and intragroup comparisons. In the intergroup analysis, comparisons were made between Group 1 using the VE method and Group 2 using the MAR method. In the intragroup analysis, Group 1 was compared using the VE method versus the MAR method. Given the non-normality, repeated measures were analyzed using F1 LD F1 and F2 LD F1 models via nparLD in R. Improvement in estimations after the MAR method was evidenced by a reduction in errors relative to the actual blood volumes, and this was statistically significant. It also reduced outlier estimates and took longer. The MAR volume estimates were not affected by participants’ phenotypic characteristics. In conclusion, incorporating the MAR method into structured clinical skills training for external bleeding management could be beneficial.Trial registration: ClinicalTrials.gov Identifier NCT06855472 (18/02/2025).

PMID:40851079 | DOI:10.1038/s41598-025-16169-0

J Chin Med Assoc. 2025 Aug 25. doi: 10.1097/JCMA.0000000000001284. Online ahead of print.

ABSTRACT

BACKGROUND: Goal-directed fluid therapy (GDFT) individualizes fluid administration to optimize oxygen delivery and tissue perfusion. Traditional static parameters, such as central venous and pulmonary artery wedge pressures, are inaccurate. Instead, GDFT employs dynamic variables like stroke volume variation (SVV) and pulse pressure variation (PPV) to assess preload responsiveness and guide fluid administration. However, the Trendelenburg position alters cardiovascular physiology, and the effects of different tilt angles on SVV, PPV, and other hemodynamic variables remain unclear.

METHODS: This single-center, observational study enrolled patients undergoing elective surgery. Following induction of general anesthesia, patients were positioned supine (0°) and then in the Trendelenburg position, with the angle adjusted to 5°, 10°, 15°, and 25°. Dynamic variables, including SVV, PPV, contractility (dP/dt), dynamic arterial elastance (Eadyn), and cardiac index (CI), at each angle were recorded and analyzed.

RESULTS: A total of 27 patients (mean age 66.7 ± 11.7 years, 79% male) were included. Increasing the Trendelenburg tilt angle from 0° to 25° was associated with a significant reduction in SVV (12.21 ± 4.26% at 0° to 6.94 ± 2.37% at 25°, p < 0.001) and PPV (13.47 ± 4.27% at 0° to 6.81 ± 3.20% at 25°, p < 0.001). SVV and PPV measured in the supine position correlated significantly with values obtained at 5°, 10°, 15°, and 25° (p < 0.001). dP/dt progressively declined from 711.85 ± 235.58 mmHg/s at 0° to 583.85 ± 166.19 mmHg/s at 25° (p < 0.001), and CI decreased from 2.51 ± 0.59 L/min/m² to 2.27 ± 0.60 L/min/m² (p = 0.001). Eadyn trended downward but did not reach statistical significance (p = 0.088).

CONCLUSION: The thresholds of SVV and PPV for predicting fluid responsiveness decrease with progressive Trendelenburg tilt. These variables should therefore be interpreted cautiously in relation to tilt angle when guiding fluid management.

PMID:40851077 | DOI:10.1097/JCMA.0000000000001284

BMC Musculoskelet Disord. 2025 Aug 25;26(1):817. doi: 10.1186/s12891-025-09082-0.

ABSTRACT

BACKGROUND: Isolated talonavicular arthritis is relatively uncommon and remains understudied. Furthermore, the alterations in plantar pressure distribution (PPD) following isolated talonavicular arthrodesis (TNA) have not been thoroughly investigated. This study aimed to evaluate PPD, clinical outcomes, and radiographic changes in patients undergoing unilateral isolated TNA. METHODS: Fifteen patients (63.2 ± 11.4 years) who underwent isolated unilateral TNA performed by a single surgeon were included. Postoperative PPD was evaluated across five foot regions at a mean follow-up of 33.3 ± 13.0 months, with comparisons made to the contralateral, unaffected foot. Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Foot Function Index (FFI). Radiographic evaluation included measurements of Meary’s angle (MA), talonavicular coverage angle (TCA), and talus-first metatarsal angle (T1MA). Preoperative and postoperative data for these variables were compared to analyze surgical outcomes. RESULTS: Compared with the unaffected foot, pressure-time integrals (PTIs) in the forefoot, medial sole, and the entire plantar surface were lower on the affected side, while PTIs in the lateral sole, hindfoot, and midfoot were higher, though none reached statistical significance (P > 0.05). Clinically, AOFAS midfoot scores improved from 27.0 ± 21.3 to 78.9 ± 21.0 (P < 0.001), hindfoot scores from 25.1 ± 23.8 to 77.9 ± 14.9 (P < 0.001), and FFI decreased from 54.0% ± 19.8-16.5% ± 15.9% (P < 0.001). Radiographically, the TCA decreased significantly from 12.3° ± 6.3° to 4.7° ± 5.2° (P = 0.002), while changes in MA and T1MA were not significant (P = 0.078 and P = 0.123, respectively). Pedobarographic results on affected sides showed no significant correlation with either preoperative or postoperative AOFAS scores or FFI. However, these scores showed significant correlations with changes in T1MA between preoperative and postoperative assessments. Preoperative T1MA and postoperative MA were significantly associated with PTIs in specific regions of the plantar surface on the affected side. Additionally, BMI was correlated not only with PTIs in certain plantar areas but also with postoperative FFI. CONCLUSIONS: Isolated TNA was associated with improved functional outcomes and trends toward symmetrical PPD during walking on both sides, though larger studies are needed to confirm these observations.

CLINICAL TRIAL NUMBER: Not applicable.

LEVEL OF EVIDENCE: Level IV.

PMID:40851068 | DOI:10.1186/s12891-025-09082-0

Radiologie (Heidelb). 2025 Aug 24. doi: 10.1007/s00117-025-01500-7. Online ahead of print.

ABSTRACT

BACKGROUND: Correct identification of the etiology and anatomical location of perforations is paramount for ensuring optimal therapeutic intervention and surgical planning in cases of gastrointestinal tract perforation.

PURPOSE: This study aimed to retrospectively evaluate the distinctive multidetector computed tomography (MDCT) findings of intraperitoneal and retro-/extraperitoneal perforation by comparing the locations of free air in the abdomen and other imaging findings.

MATERIAL AND METHODS: A total of 226 patients with acute abdominal pain who visited the emergency department and underwent contrast-enhanced CT between January 2016 and November 2023 were included. The study consisted of 146 male and 80 female patients with a median age of 53.5 years. Surgical findings determined the site of perforation in all cases. Two radiologists evaluated the CT images in a consensus blind to operative findings, assessing the presence of specific air distributions and strong predictors of gastrointestinal tract perforation.

RESULTS: The study included 192 intraperitoneal and 34 retro-/extraperitoneal perforation cases. Subphrenic free air and periportal free air were statistically significant in differentiating intraperitoneal gastrointestinal tract perforation among specific air distributions. Conversely, the presence of free air in the minor pelvis, right lower quadrant, left lower quadrant, and retroperitoneum was significant in differentiating retro-/extraperitoneal gastrointestinal tract perforation. Among strong imaging predictors, only ascites was statistically significant in differentiating intraperitoneal from retro-/extraperitoneal perforations.

CONCLUSION: Findings from MDCT may serve as predictive indicators for the precise localization of gastrointestinal tract perforations, which is crucial for appropriate management and surgical planning.

PMID:40851046 | DOI:10.1007/s00117-025-01500-7