Category: Nevin Manimala

Pancreas. 2025 Aug 21. doi: 10.1097/MPA.0000000000002556. Online ahead of print.

ABSTRACT

INTRODUCTION: Schwannomas, paragangliomas, and gangliocytic paragangliomas are rare tumors of the pancreas and peripancreas. Diagnosis and management of these tumors remain challenging.

METHODS: A retrospective review was conducted at a single institution. Nineteen cases were identified from 1990 to 2022. Descriptive statistics summarized the demographic, clinicopathologic, and long-term outcome data.

RESULTS: Schwannomas were encountered within the pancreatic parenchyma, whereas half of the paragangliomas were intraparenchymal and the other half were in the peripancreatic connective tissue. Symptoms varied and occurred in half of the patients encountered. Imaging characteristics were nonspecific. When obtained, EUS-FNA (n=16) and nuclear imaging (n=3) assisted with making a preoperative diagnosis. Intraparenchymal tumors were predominantly managed with a pancreatectomy (n=12) while tumors in the peripancreatic connective tissue were managed with tumor resection without a pancreatectomy (n=4). The median follow-up for Schwannomas and gangliocytic paragangliomas was 66.8 and 13.6 months, respectively, during which time zero recurrences occurred. Paraganglioma patients had a median follow-up of 21.4 months, and tumor recurrence was encountered in 50% of patients.

CONCLUSION: Schwannomas and gangliocytic paragangliomas are benign tumors. Paragangliomas have malignant potential and should be managed with an oncologic resection. Accurate preoperative diagnosis using EUS-FNA and nuclear imaging is crucial for recommending the appropriate surgical intervention and minimizing surgical morbidity.

PMID:40834354 | DOI:10.1097/MPA.0000000000002556

Neurology. 2025 Sep 9;105(5):e213984. doi: 10.1212/WNL.0000000000213984. Epub 2025 Aug 20.

ABSTRACT

BACKGROUND AND OBJECTIVES: The most common cause of convexity subarachnoid hemorrhage (cSAH) in younger patients (younger than 60 years) is reversible cerebral vasoconstriction syndrome (RCVS). Evidence on the long-term outcomes of future vascular events and functional outcome after cSAH due to RCVS is limited. We aimed to assess the rates and baseline predictors of our primary outcomes (cSAH, intracerebral hemorrhage (ICH), and ischemic stroke), functional outcome, and mortality after cSAH attributed to RCVS.

METHODS: Individual patient data pooled analysis in patients with cSAH attributed to RCVS. A systematic literature search was conducted in PubMed and EMBASE. Two independent reviewers screened studies and extracted data. Quality assessment was assessed using the Newcastle-Ottawa Scale. Early events during the accepted time frame of an RCVS episode (<3 months) were classified as progression rather than recurrence. Follow-up was truncated at 5 years. Primary outcomes were recurrent cSAH, ICH, and ischemic stroke. Secondary outcomes were mortality and functional status measured by modified Rankin Score (mRS).

RESULTS: We identified 21 eligible cohorts finally including 138 patients from 9 collaborative centers, which provided individual patient data. The mean age was 49.3 ± 12.1 years, and 110 (79.7%) were female. During a mean follow-up of 1.8 years, annual rates were cSAH recurrence 0.81% (95% CI 0.1-2.91), ICH 0.81% (95% CI 0.1-2.91), and ischemic stroke 0.81% (95% CI 0.1-2.91). Progression during the initial episode (shortly after admission) occurred in 10 patients for cSAH, 2 for ICH, and 8 for ischemic stroke, respectively. Of 106 patients (76.8%) with available outcome data, 100 (94.3%) achieve a mRS of ≤1 at follow-up, indicating no significant disability. Two patients died (annual rate 0.5%, 95% CI 0.09-2.9): one within 10 days and the other within 2 months of the cSAH.

DISCUSSION: Our data suggest a favorable prognosis for most patients after RCVS-associated cSAH with low rates of recurrent events and a high proportion achieving functional independence. Major limitations include retrospective data collection and potential selection bias from centers providing individual patient data. Nevertheless, these findings provide prognostic information to inform clinical practice.

PMID:40834342 | DOI:10.1212/WNL.0000000000213984

Prehosp Emerg Care. 2025 Aug 20:1-16. doi: 10.1080/10903127.2025.2547651. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate video-assisted dispatcher cardiopulmonary resuscitation (CPR) versus audio-assisted dispatcher CPR effects on compression quality in simulated out-of-hospital cardiac arrest (OHCA) scenarios.

METHODS: Network meta-analysis of randomized controlled trials (RCTs) comparing video-assisted dispatcher CPR (V-DACPR) versus audio-assisted dispatcher CPR (A-DACPR) and control. Primary outcome was compression rate; secondary outcomes included compression depth, time to first compression, and interruption time. Network meta-analysis of randomized controlled trials comparing dispatcher-guided CPR with video feedback versus telephone-only instructions in simulated out-of-hospital cardiac arrest scenarios using high-fidelity manikins. Three intervention arms were compared: video-assisted CPR, audio-assisted CPR, and unguided CPR (control). Standardized mean differences (SMD) and Surface Under the Cumulative Ranking curve (SUCRA) were calculated using Bayesian network meta-analysis methodology. Primary outcome was compression rate; secondary outcomes included compression depth, time to first compression, and interruption time.

RESULTS: Fifteen trials (n = 1,556) were analyzed. V-DACPR showed superior compression rates versus A-DACPR (effect size: -21.37, 95% CI: -36.10, -7.41) and control (-43.04, 95% CI: -63.05, -22.52). V-DACPR demonstrated better time to first compression versus control (-42.23, 95% CI: -83.31, -1.42) and favorable trends in compression depth (-5.06, 95% CI: -12.40 to 2.12) and interruption time, though several comparisons between V-DACPR and A-DACPR did not reach statistical significance. Heterogeneity was low to moderate (I²=12-63%). CINeMA assessment supported moderate to high-quality evidence.

CONCLUSIONS: Video-assisted dispatcher cardiopulmonary resuscitation (CPR) demonstrated significant advantages in compression rate in simulated scenarios, with favorable trends in other quality metrics compared to A-DACPR. These findings support the potential for video assistance technology in dispatcher-guided CPR, particularly for optimizing compression rates. However, these results were observed in simulation studies and require validation in real-world clinical settings to determine their impact on patient outcomes.

PMID:40834332 | DOI:10.1080/10903127.2025.2547651

JCO Precis Oncol. 2025 Aug;9:e2500406. doi: 10.1200/PO-25-00406. Epub 2025 Aug 20.

ABSTRACT

PURPOSE: Biopsy tissue-based genomic classifiers (GCs) for prostate cancer are commercially available tools to enhance prognostication. They may corroborate candidacy for active surveillance/watchful waiting (AS/WW) or identify men who are more likely to benefit from radiotherapy (RT) with androgen deprivation therapy (ADT). We analyze real-world use of GC and associations with clinical decision making.

PATIENTS AND METHODS: We examined US commercial (n = 134,561) and Medicare (n = 68,431) insurance claims of men with newly diagnosed, localized prostate cancer between 2013 and 2022. We evaluated utilization of GCs over time and compared use of AS/WW, RT with or without ADT, radical prostatectomy (RP), or focal ablative therapy (FT) based on the receipt and type of GC.

RESULTS: GC utilization increased from <1% to 17% in 8 years with a median payment of $3,001 (IQR, $0-3,873). Younger age, higher median household income, and high-deductible health insurance were associated with higher odds of receiving a GC (all P < .001). Patients with GC were more likely to pursue AS/WW than treatment (odds ratio, 2.00 [95% CI, 1.85 to 2.1]; P < .001). Patients receiving OncotypeDX, Prolaris, and Decipher were most likely to pursue AS/WW, RP, and RT with ADT, respectively (all P < .001). Prolaris was ordered more than three times as often in Detroit as in any other city, whereas OncotypeDx was ordered more than twice as often in New York City as in any other city.

CONCLUSION: We show contemporary, real-world GC utilization trends, costs, and associations with treatment patterns. Prospective trials are ongoing to validate GC-informed treatment, but US uptake has expanded and management is associated with the use and type of GC.

PMID:40834325 | DOI:10.1200/PO-25-00406

J Econ Entomol. 2025 Aug 20:toaf210. doi: 10.1093/jee/toaf210. Online ahead of print.

ABSTRACT

Dietary-administered probiotics may address poor health and performance in honey bees (Apis mellifera L. [Hymenoptera: Apidae]). Human-grade probiotics are an affordable source of general probiotics. We examined the effects of human-grade probiotics by comparing colony and individual level health and performance between colonies administered a probiotic every other week, and those not given probiotic supplementation (control treatment group). We found that probiotics did not statistically increase individual honey bee health and performance as measured by body lipid level, tibial length, and weight of bees, nor colony performance as measured by monthly assessments of brood area, colony weight, and Varroa destructor Anderson and Trueman (Mesostigmata: Varroidae) mite infestation rate.

PMID:40834321 | DOI:10.1093/jee/toaf210

N Engl J Med. 2025 Aug 21;393(8):764-773. doi: 10.1056/NEJMoa2410542.

ABSTRACT

BACKGROUND: Autoimmune pulmonary alveolar proteinosis (aPAP) is a rare disease characterized by progressive surfactant accumulation and hypoxemia caused by autoantibodies against granulocyte-macrophage colony-stimulating factor (GM-CSF), which alveolar macrophages require to clear surfactant. Molgramostim is a formulation of inhaled recombinant human GM-CSF, but its efficacy and safety in patients with aPAP have not been studied sufficiently.

METHODS: In this phase 3, double-blind, placebo-controlled trial, we randomly assigned patients with aPAP to receive molgramostim at a dose of 300 μg or placebo once daily for 48 weeks. The primary end point was the change from baseline to week 24 in the diffusing capacity of the lungs for carbon monoxide (DLCO), which was adjusted for hemoglobin concentration and expressed as a percentage of the predicted value. Secondary end points adjusted for multiplicity were the change from baseline in DLCO at 48 weeks and the change from baseline in the St. George’s Respiratory Questionnaire total (SGRQ-T) and activity (SGRQ-A) scores (scores range from 0 to 100, with lower scores indicating better quality of life) and in exercise capacity at 24 and 48 weeks.

RESULTS: A total of 164 patients underwent randomization: 81 were assigned to receive molgramostim and 83 to receive placebo. The least-squares mean change in DLCO from baseline to week 24 was 9.8 percentage points (95% confidence interval [CI], 7.3 to 12.3) with molgramostim and 3.8 percentage points (95% CI, 1.4 to 6.3) with placebo (estimated treatment difference, 6.0 percentage points; 95% CI, 2.5 to 9.4; P<0.001). The least-squares mean change in DLCO from baseline to week 48 was 11.6 percentage points (95% CI, 8.7 to 14.5) with molgramostim and 4.7 percentage points (95% CI, 1.8 to 7.6) with placebo (P<0.001), and the least-squares mean change in the SGRQ-T score at week 24 was -11.5 points (95% CI, -15.0 to -8.0) and -4.9 points (95% CI, -8.3 to -1.5), respectively (P = 0.007). No significant between-group difference in the change in SGRQ-A score was observed at 24 weeks, so no statistical inference was drawn with respect to subsequent secondary end points. The percentage of patients with at least one adverse event and the percentage with at least one serious adverse event were similar in the two groups.

CONCLUSIONS: Once-daily inhaled molgramostim led to a greater increase in pulmonary gas transfer than placebo in patients with aPAP. (Funded by Savara; IMPALA-2 ClinicalTrials.gov number, NCT04544293; European Union Clinical Trials Information System number, 2024-511052-41-00.).

PMID:40834301 | DOI:10.1056/NEJMoa2410542

Arch Endocrinol Metab. 2025 Aug 20;69(4):e250098. doi: 10.20945/2359-4292-2025-0098.

ABSTRACT

OBJECTIVE: To investigate the practices of Brazilian endocrinologists in educating patients with adrenal insufficiency about stress-induced glucocorticoid adjustments.

METHODS: This was a cross-sectional online survey carried out with 280 endocrinologists across Brazil. The survey included demographic questions and ten clinical vignettes assessing knowledge of appropriate glucocorticoid adjustments during various stressful situations. All participants provided informed consent, and the study protocol was approved by the local Ethics Committee. Statistical analysis compared responses based on physician demographics and practice settings.

RESULTS: The mean percentage of correct answers was 63.3%. A significant proportion of respondents (41.1%) incorrectly believed that patients should not self-administer intramuscular hydrocortisone during an adrenal crisis. Older physicians tended to provide more conservative (and potentially harmful) glucocorticoid dosing recommendations in certain scenarios. Physicians working in both outpatient and hospital settings demonstrated better knowledge of patient education and emergency glucocorticoid administration.

CONCLUSION: The results of this study revealed moderate adherence to guidelines among Brazilian endocrinologists regarding adrenal insufficiency management and patient education. There is a need for improved education on glucocorticoid self-administration and targeted interventions to address knowledge gaps across different clinical scenarios. Further research is needed to evaluate the impact of these findings on patient outcomes and develop strategies to optimize the management of adrenal insufficiency in Brazil.

PMID:40834281 | DOI:10.20945/2359-4292-2025-0098

Am J Primatol. 2025 Aug;87(8):e70068. doi: 10.1002/ajp.70068.

ABSTRACT

Assessing body weight is common practice for monitoring health in common marmosets (Callithrix jacchus). Body composition analysis via quantitative magnetic resonance (QMR) is a more in-depth assessment allowing measurements of lean and fat mass, but it is expensive and remains unavailable to most. Alternatively, body condition scoring (BCS) is an instrument-free method for visually inspecting and palpating lean and fat tissue. Animals are rated for lean and fat mass abundance, using an ordinal scale with species-specific descriptions as reference. However, modified BCS systems developed for other species are being used, because no BCS system has been fully validated for marmosets. The accuracy of BCS in identifying marmosets with poor body condition or obesity remains unknown. We assessed an adapted BCS for marmosets (n = 68, 2-16 years). Objectives were to (1) determine whether BCS predicts body weight and body composition, and (2) evaluate the performance of BCS as a screening test for low body condition and obesity in marmosets, in comparison to QMR body composition analysis. BCS predicted body weight and body composition (F(15, 166) = 7.51, Wilks’ Λ = 0.240, p < 0.001), and was better at predicting low lean mass and obesity, than at predicting low adiposity. Marmosets with low BCS had higher odds of low lean mass (B = 3.37, (95% CI, 0.95-5.78), OR = 29.0, p = 0.006). Marmosets with excessively high BCS had higher odds of obesity (B = 2.72, (95% CI, 1.07-4.38), OR = 15.23, p = 0.001). The accuracy rates of BCS in identifying low body condition (79.4%-91.2%) and obesity (77.9%) suggest that it can serve as an instrument-free screening method in marmosets.

PMID:40834231 | DOI:10.1002/ajp.70068

Rev Col Bras Cir. 2025 Aug 18;52:e20253812. doi: 10.1590/0100-6991e-20253812-en. eCollection 2025.

ABSTRACT

INTRODUCTION: Patients who undergo to gastroplasty present massive weight loss and the plastic surgery represents an important play in the treatment. The aim of this study is to present the profile of patients who underwent plastic surgery after bariatric surgery performed at the Reference Public Hospital in West-Center of Brazil.

METHODS: A descriptive, analytical and retrospective study was performed in a single public hospital on patients who underwent post-bariatric plastic surgery from January 2011 to December 2023. Three hundred and sixteen patients who underwent plastic surgery following Roux-Y gastroplasty were studied. Measures included BMI (body mass index) before gastroplasty and before plastic surgery, medical complications and comorbidities.

RESULTS: 316 patients (297 female, 19 male) with a mean age of 43 years underwent 268 separated operations. The average BMI at the time of plastic surgery was 27,39kg/m2 . Average weight loss was 47,44kg and mean pre-weight loss BMI (max BMI) was 45,5kg/m2 .The most important preplastic comorbities were: arterial hypertension (12,7%), degenerative artrophaty (7,0%), diabete melito (5,7%) and methabolic syndrom (4,4%). From 316 patients operated, 75,7% were underwent abdominoplasty followed by mammaplasy (41,4%), ritidoplasty (12,0%), and brachioplasty (12,0%). Thirty-nine (12,3%) patients had hernia repair in combination with abdominoplasty. The complication rate was 31,3%.

CONCLUSION: Epidemiological profile of postbariatric patients who underwent body contour surgery showed peculiar clinical, anthropometric and surgical aspects, specially the low prevelence of comorbidities, the low number of associated surgeries and rate of postoperative complications in the group studied.

PMID:40834225 | DOI:10.1590/0100-6991e-20253812-en

J Neuroophthalmol. 2024 Dec 13;45(3):343-349. doi: 10.1097/WNO.0000000000002275.

ABSTRACT

BACKGROUND: Concussions are mild traumatic brain injuries that often cause vision problems. They have significant impacts on everyday life, cognitive capacity, and sports performance, and may affect injury prevalence in fast contact sports such as ice hockey. A functional vision questionnaire specifically designed for sports was used here to study the correlation between vision problems and concussion history.

METHODS: In this national cross-sectional concussion study, 860 Finnish elite-level male adolescent ice hockey players (aged 13-21 years) answered a functional vision questionnaire and performed a computerized neurocognitive test, ImPACT. Totally 265 athletes reported a history of at least 1 concussion. All data were statistically compared with age-matched athletes with no concussion history (n = 595). For further analysis, athletes were divided into subgroups by age and number of previous concussions.

RESULTS: Previously concussed athletes reported more general and eye-specific symptoms than their healthy controls. Increases in eye fatigue, frontal headaches, and blinking were statistically significant. Also statistically more problems with depth perception and evaluating distances, concentration problems, blurred vision, and losing the object in sight were observed among athletes with concussion history.

CONCLUSIONS: Concussion history reflects an increase in the prevalence of vision deficits, as determined by multiple disturbances in the near triad. The significant number of vision problems in the concussion history groups strongly suggests that functional vision should routinely be evaluated in athletes. The vision problems observed in the athletes with concussion history may indicate an increased injury risk that should be addressed.

PMID:40833794 | DOI:10.1097/WNO.0000000000002275