Category: Nevin Manimala

Medicine (Baltimore). 2025 Jan 24;104(4):e41265. doi: 10.1097/MD.0000000000041265.

ABSTRACT

BACKGROUND: This study investigates the therapeutic efficacy of dynamic neuromuscular stabilization (DNS) technology paired with Kinesio Taping in patients with persistent nonspecific low back pain, as well as the effect on neuromuscular function and pain self-efficacy.

METHODS: A randomized controlled clinical study was conducted to collect clinical data on DNS combined with KT for the treatment of chronic nonspecific low back pain from November 2023 to April 2024. The inclusion criteria were patients with chronic nonspecific lower back pain, aged between 18 and 30 years old, and without serious underlying medical conditions, such as cardiac disease, hypertension, and diabetes. The control group received Kinesio Tape therapy, and the experimental group received a combination of Kinesio Tape therapy and DNS technology. The treatment lasted for 6 weeks, 3 times a week. Patients were examined before and after treatment using the Visual Analog Rating Scale, Oswestry Dysfunction Score, and Pain Self-Efficacy Questionnaire. Multifidus and transversus abdominis muscle strength was tested using surface electromyography signals, and the patient’s joint mobility, maximal isometric muscle strength, and muscular endurance were tested using the Davy Spine Rehabilitation System. Internal lumbar and abdominal pressures were assessed using stabilizer pressure biofeedback.

RESULTS: A total of 32 subjects (17 males and 15 females) were enrolled, of which 16 were in the experimental group and 16 in the control group. After the treatment, the patients in both groups showed significant improvements in the visual analogue scale, Oswestry disability index, Chinese version of Pain Self-Efficacy Questionnaire (PSEQ), joint mobility, maximum isometric strength, muscle endurance, abdominal pressure, transverse abdominal muscle and multifidus muscle scales compared with the pretreatment results. (Chinese version of Pain Self-Efficacy Questionnaire) scales were significantly improved compared with the pretreatment; joint mobility, maximal isometric muscle strength, muscular endurance, intra-abdominal pressure, transversus abdominis and multifidus AEMG (average electromyography) were more significantly improved, and the differences were statistically significant (P < .05). The experimental group showed more significant improvement than the control group (P < .05).

CONCLUSION: DNS technology paired with Kinesio Taping can considerably improve neuromuscular function and enhance pain self-efficacy in chronic nonspecific low back pain patients, reducing discomfort and improving dysfunction.

PMID:39854745 | DOI:10.1097/MD.0000000000041265

Medicine (Baltimore). 2025 Jan 24;104(4):e41353. doi: 10.1097/MD.0000000000041353.

ABSTRACT

This study assesses the effect of carotid sinus blockade applied with a local anesthetic on hemodynamic parameters during carotid endarterectomy (CEA) operations performed under general anesthesia. The medical records of patients who underwent CEA under general anesthesia between January 2020 and December 2022, were retrospectively reviewed. It was recorded whether the patients received carotid sinus block with 2 mL of 2% prilocaine. Intraoperative and 48-hour postoperative hemodynamic data were examined in the patients included in the study. A total of 129 patients were evaluated in the study, with 70 patients who received carotid sinus blockade (Group I) and 59 patients who did not receive blockade (Group II) during CEA. The comparison of heart rate variability immediately before clamping, immediately after clamping, and at 5, 10, and 20 minutes post-clamping indicated a significantly greater reduction in Group II compared to Group I (P < .05). In the postoperative period, the total dose of glyceryl trinitrate administered was 40.8 ± 31.9 mg in Group I and 53 ± 17.2 mg in Group II, showing a statistically significant difference (P = .001). Additionally, blood pressure measurements during this period were significantly higher in Group II than in Group I (P < .05). While the application of a local anesthetic during CEA appears to provide better intraoperative heart rate and postoperative blood pressure control, attributing these results solely to local anesthesia may not be entirely accurate. Hemodynamic instability observed during and after CEA is influenced by various factors.

PMID:39854738 | DOI:10.1097/MD.0000000000041353

Medicine (Baltimore). 2025 Jan 24;104(4):e41268. doi: 10.1097/MD.0000000000041268.

ABSTRACT

This study aimed to investigate the direct association between domestic violence and the indirect association of exposure through pregnancy, delivery, and neonatal risk factors with severe maternal morbidity (SMM). The target population of this case-control study included all women who gave birth in the hospitals of the Torbat Heidarieh University of Medical Science from June 2018 to May 2020. A total of 123 mothers with SMM according to the World Health Organization criteria were selected as cases, and 127 mothers who did not meet the World Health Organization criteria were included in the control group. Data were analyzed using Stata 14 and mediation packages with a counterfactual approach. The odds ratio of the pure direct effect of physical violence on SMM through pregnancy and neonatal risk factors is 2.26 and 2.29, respectively. The odds ratio of the pure direct effect of social violence on SMM through pregnancy, delivery, and neonatal risk factors was 2.54, 2.67, and 2.57, respectively, and that for economic violence through neonatal risk factors was 1.99. Additionally, the interaction between physical and social violence and pregnancy risk factors increased the risk of severe maternal morbidity by 394.6% and 360%, respectively. Domestic violence against women is directly associated with severe maternal morbidity. Physical and social violence showed a significant interaction with severe maternal morbidity. A preventive program for domestic violence should be considered an effective intervention to prevent severe maternal morbidity and improve the health of mothers by implementing control strategies.

PMID:39854735 | DOI:10.1097/MD.0000000000041268

J Med Internet Res. 2025 Jan 24;27:e52043. doi: 10.2196/52043.

ABSTRACT

BACKGROUND: Results on parental burden during the COVID-19 pandemic are predominantly available from nonrepresentative samples. Although sample selection can significantly influence results, the effects of sampling strategies have been largely underexplored.

OBJECTIVE: This study aimed to investigate how sampling strategy may impact study results. Specifically, we aimed to (1) investigate if outcomes on parental health and child maltreatment during the COVID-19 pandemic from a convenience sample differ from those of a specific representative sample and (2) investigate reasons for differences in the results.

METHODS: In 2020, we simultaneously conducted 2 studies: (1) a web-based survey using a convenience sample of 4967 parents of underage children, primarily recruited via social media, and (2) a study using a quota sample representative of the German adult population with underage children (N=1024), recruited through a combination of telephone interviews and computer-assisted web interviews. In both studies, the same questionnaire was used. To evaluate the impact of sampling, we compared the results on outcomes (parental stress, subjective health, parental mental health, general stress, pandemic-related stress, and the occurrence of child maltreatment) between the 2 samples. To explain differences in the results between the 2 studies, we controlled for sociodemographic data, parent-related risk factors, and COVID-19-related experiences.

RESULTS: Compared to parents from the quota sample, parents from the convenience sample reported significantly more parental stress (η²=0.024); decreased subjective health (η²=0.016); more anxiety and depression symptoms (η²=0.055); more general stress (η²=0.044); more occurrences of verbal emotional abuse (VEA; φ=0.12), witnessing domestic violence (WDV; φ=0.13), nonverbal emotional abuse (NEA; φ=0.03), physical abuse (φ=0.10), and emotional neglect (φ=0.06); and an increase of child maltreatment (VEA: exp(B)=2.95; WDV: exp(B)=3.19; NEA: exp(B)=1.65). Sociodemographic data, parent-related risk factors, and COVID-19-related experiences explained the differences in parental stress (remaining difference between samples after controlling for covariates: η²=0.002) and subjective health (remaining difference between samples after controlling for covariates: η²=0.004) and partially explained differences in parental mental health (remaining: η²=0.016), general stress (remaining: η²=0.014), and child maltreatment (remaining: VEA: exp(B)=2.05 and WDV: exp(B)=2.02) between the 2 samples. The covariates could not explain the difference in NEA (exp(B)=1.70). We discuss further factors that may explain the unexplained differences.

CONCLUSIONS: Results of studies can be heavily impacted by the sampling strategy. Scientists are advised to collect relevant explaining variables (covariates) that are possibly related to sample selection and the outcome under investigation. This approach enables us to identify the individuals to whom the results apply and to combine findings from different studies. Furthermore, if data on the distribution of these explanatory variables in the population are available, it becomes possible to adjust for sample selection bias.

PMID:39854726 | DOI:10.2196/52043

Endocr Connect. 2025 Jan 1:EC-24-0522. doi: 10.1530/EC-24-0522. Online ahead of print.

ABSTRACT

BACKGROUND: The aim is to develop age-specific anti-Müllerian hormone screening criteria for polycystic ovary syndrome to facilitate the early detection and diagnosis of the condition, and to subsequently evaluate the screening criteria.

METHODS: A retrospective analysis was performed on patient data from Hangzhou Women’s Hospital between July 2021 and August 2024. The use of restricted cubic spline analysis helped identify age-related inflection points, which were crucial for segmenting the patient population. Statistical analysis was conducted using SPSS software, and the receiver operating characteristic curve was employed to determine the area under the curve, optimal anti-Müllerian hormone screening thresholds, sensitivity, specificity, Youden index, correct diagnosis rate, positive likelihood ratio, and negative likelihood ratio. The established age-related anti-Müllerian hormone screening criteria for polycystic ovary syndrome were then validated using a separate validation group. The consistency of the polycystic ovary syndrome age-related anti-Müllerian hormone screening test with the 2003 Rotterdam polycystic ovary syndrome diagnostic criteria was assessed using the Kappa statistic.

RESULTS: The derived age-specific anti-Müllerian hormone screening thresholds for polycystic ovary syndrome were as follows: ≥5.65 ng/ml (20-27-year-old), ≥5.06 ng/ml (28-30-year-old), and ≥4.19 ng/ml (31-39-year-old).

CONCLUSION: The age-stratified anti-Müllerian hormone screening criteria demonstrated high sensitivity, specificity, and accuracy in identifying polycystic ovary syndrome, indicating a strong predictive value. However, the development of more robust and universally applicable diagnostic criteria for polycystic ovary syndrome will require additional multicenter, prospective clinical trials for further validation.

PMID:39854723 | DOI:10.1530/EC-24-0522

J Neurosurg. 2025 Jan 24:1-10. doi: 10.3171/2024.8.JNS241097. Online ahead of print.

ABSTRACT

OBJECTIVE: An MRI protocol for germinoma surveillance after complete remission has not been established. Moreover, the standard treatment for recurrent or refractory germinoma has not been determined. In this study, the authors explored the imaging characteristics of recurrent germinoma and discuss their institution’s experience with multidisciplinary treatment of this malignancy.

METHODS: The medical records of 16 patients (14 male, 2 female) with recurrent germinoma and 62 patients (52 male, 10 female) without recurrence who were treated at the authors’ institution between 1989 and 2023 were retrospectively examined. Data including diagnostic imaging, tumor markers, treatment at diagnosis and recurrence, and overall survival were collected from patients’ medical records and statistically analyzed.

RESULTS: No patients with recurrence received craniospinal irradiation (CSI) as an initial therapy, and local irradiation was a significant risk factor of recurrence (p = 0.0072). The period between the start of first-line treatment and confirmation of the first recurrence ranged from 4.2 to 272 months (median 66.8 months). Among the recurrences, 13 tumors occurred outside the radiation field, including 6 cases of spinal cord/canal recurrence. One-third of patients did not exhibit elevated tumor marker levels in the serum. Fourteen patients had contrast-enhanced recurrent lesions. In the 2 patients with non-contrast-enhanced lesions, recurrence was detected by high signal intensity on diffusion-weighted imaging (DWI) and elevated tumor marker levels in CSF. Fifteen patients received chemotherapy for the first recurrence, and 14 received radiation therapy, with 9 receiving CSI. The patients who received CSI survived without further recurrence during the study period. However, the median progression-free survival and overall survival after the first recurrence among patients who did not undergo CSI were 12.2 and 37.4 months, respectively, which were shorter than those for patients treated with CSI (both p < 0.01, log-rank test).

CONCLUSIONS: Spinal MRI for surveillance in patients with recurrent germinoma, especially for those who do not receive CSI, is recommended. DWI might be useful for detecting recurrent germinoma. Aggressive treatment at the time of recurrence is crucial, and even if remission is achieved with chemotherapy, CSI for consolidation is important to prevent further recurrence.

PMID:39854721 | DOI:10.3171/2024.8.JNS241097

J Neurosurg Spine. 2025 Jan 24:1-10. doi: 10.3171/2024.9.SPINE24639. Online ahead of print.

ABSTRACT

OBJECTIVE: Smartphones and wearable devices can be effective tools to objectively assess patient mobility and well-being before and after spine surgery. In this retrospective observational study, the authors investigated the relationship between these longitudinal perioperative patient activity data and socioeconomic and demographic correlates, assessing whether smartphone-captured metrics may allow neurosurgeons to distinguish intergroup patterns.

METHODS: A multi-institutional retrospective study of patients who underwent spinal decompression with and without fusion between 2017 and 2021 was conducted. Patients’ home zip codes were used to determine each patient’s Area Deprivation Index (ADI)-an independently validated composite measure of the socioeconomic health of a specific neighborhood relative to the entire United States. Activity data, including steps-taken-per-day across a 2-year perioperative period, were extracted from patient smartphones and statistically normalized to enable interpatient comparisons. Multivariate regression was performed to identify relationships between ADI and patient mobility, while controlling for confounders including age and obesity.

RESULTS: The study included 49 patients. The preoperative activity level of patients living in neighborhoods with an ADI score below the 80th percentile nationally was significantly greater than that of patients living in neighborhoods above the 80th percentile (p = 0.011). A direct positive correlation existed between patients’ ADI scores and the number of days with below-average steps-taken-per-day during the preoperative period (adjusted r2 = 0.822, p = 0.049). Postoperatively, patients with ADI scores above the 80th percentile had significantly greater documented activity levels (p = 0.031).

CONCLUSIONS: The authors’ study demonstrates that individuals living in neighborhoods with an ADI score below the 80th percentile had higher preoperative activity than patients in neighborhoods above the 80th percentile; this disparity diminishes after spine surgery. Though these findings are not generalizable, the authors hypothesized that the relatively faster postoperative recovery of patients living in wealthier neighborhoods is likely multifactorial, possibly due to sustained activity in the preoperative and likely symptomatic period of patients in lower-income neighborhoods, as well as enhanced access to postoperative care for patients in higher-income neighborhoods. Overall, the findings from the authors’ study demonstrate that smartphone-captured activity may be utilized as a metric to study socioeconomic disparities in surgical outcomes. Future studies must specifically isolate socioeconomic variables as potential causal factors to inform improvements in healthcare delivery after surgery.

PMID:39854717 | DOI:10.3171/2024.9.SPINE24639

J Neurosurg. 2025 Jan 24:1-10. doi: 10.3171/2024.9.JNS241208. Online ahead of print.

ABSTRACT

OBJECTIVE: The complex mix of factors, including hemodynamic forces and wall remodeling mechanisms, that drive intracranial aneurysm growth is unclear. This study focuses on the specific regions within aneurysm walls where growth occurs and their relationship to the prevalent hemodynamic conditions to reveal critical mechanisms leading to enlargement.

METHODS: The authors examined hemodynamic models of 67 longitudinally followed aneurysms, identifying 88 growth regions. These regions (of enlargement) were pinpointed through alignment and distance mapping between baseline and follow-up models. Aneurysm wall subdivisions were created based on saccular anatomy and flow-related characteristics, which were used to assess local hemodynamics. The distribution of growing regions across these subdivisions was then studied and stratified by aneurysm location and morphology to reveal distinct growth patterns. Statistical significance was evaluated using the Kruskal-Wallis and Mann-Whitney tests.

RESULTS: Growth predominantly occurred in the body (p < 0.0001) of aneurysms, with anterior communicating artery (ACom) (p < 0.0001) and lateral (p = 0.002) aneurysms showing a significantly greater tendency for growth in this region. In comparison, middle cerebral artery (MCA) (p < 0.0001) and bifurcation (p = 0.0001) aneurysms demonstrated growth in both the dome and the body. Notable differences in growth distribution across saccular regions included ACom versus MCA (neck, p = 0.038), bifurcation versus lateral (neck, p = 0.008), and so forth. The central flow region saw the most growth (p < 0.0001); although not significant, ACom (p = 0.196) and lateral (p = 0.218) aneurysms showed a tendency for growth in inflow and central zones, while MCA (p = 0.001) and bifurcation (p < 0.0001) aneurysms were more likely to grow in the central flow region.

CONCLUSIONS: Two primary mechanisms seem to influence aneurysm growth: high-flow impingement jets in the neck, body, and inflow zones leading to wall degeneration/thinning, mainly in ACom aneurysms; and slow, oscillatory flow conditions in the dome and central flow zones promoting wall remodeling/thickening, mainly in MCA aneurysms. This latter mechanism is also observed as secondary flows in ACom aneurysms. These findings emphasize the need to understand the distinct and sometimes concurrent mechanisms of aneurysm growth, advocating for targeted monitoring and interventions that mitigate rupture risks by considering the unique hemodynamic environments within different aneurysm regions and locations.

PMID:39854706 | DOI:10.3171/2024.9.JNS241208

JMIR Public Health Surveill. 2025 Jan 24;11:e67078. doi: 10.2196/67078.

ABSTRACT

BACKGROUND: Prevalences of mental disorders are increasing worldwide. However, many people with mental health problems do not receive adequate treatment. An important factor preventing individuals from seeking professional help is negative attitudes toward psychotherapeutic treatment. Although a positive shift in attitudes has been observed in recent years, there is still substantial stigma surrounding psychotherapeutic treatment. First studies have linked higher health literacy with more positive attitudes toward psychotherapy, but more research is needed in this area.

OBJECTIVE: This study aimed to examine how general and mental health literacy are associated with attitudes toward psychotherapeutic treatment in Germany. Additionally, associations between sociodemographic factors, experience with psychotherapy, and attitudes toward psychotherapy were explored.

METHODS: A random sample was drawn from a panel representative of the German-speaking population with internet access in Germany and invited to participate in the study via email. Overall, 2000 individuals aged ≥16 years completed the web-based survey with standardized questionnaires in September and October 2022. Attitudes toward psychotherapy and both general and mental health literacy were assessed using the Questionnaire on Attitudes Towards Psychotherapeutic Treatment (QAPT) with 2 subscales (“positive attitudes” and “non-acceptance of society”), the European Health Literacy Survey instrument (HLS-EU-Q16) and the Mental Health Literacy Tool for the Workplace (MHL-W-G). Associations between the questionnaire scales were assessed with Pearson correlations. Additionally, basic sociodemographic information and information on personal and family experiences with psychotherapy were collected. Pearson correlations (age), ANOVAs (level of education and subjective social status), and t tests (experience with psychotherapy, gender, and migration background) were used to analyze how these relate to attitudes toward psychotherapy.

RESULTS: More favorable attitudes toward psychotherapy and lower perceived societal nonacceptance were found in those with higher general (r=0.14, P<.001; r=-0.32, P<.001, respectively) and mental health literacy (r=0.18, P<.001; r=-0.23, P<.001, respectively). Participants with treatment experience for mental health problems (t_1260.12=-10.40, P<.001, Cohen d=-0.49; t_1050.95=3.06, P=.002, Cohen d=0.16) and who have relatives with treatment experience (t_1912.06=-5.66, P<.001, Cohen d=-0.26; t₁₉₂₆=4.77, P<.001, Cohen d=0.22) reported more positive attitudes and higher perceived societal acceptance than those without treatment experience. In terms of sociodemographic differences, being a woman (t₁₉₉₂=-3.60, P<.001, Cohen d=-0.16), younger age (r=-0.11, P<.001), higher subjective social status (F_2,1991=5.25, P=.005, η²=.005), and higher levels of education (F_2,1983=22.27, P<.001, η²=.021) were associated with more positive attitudes toward psychotherapeutic treatment. Being a man (t₁₉₉₄=5.29, P<.001, Cohen d=0.24), younger age (r=-0.08, P<.001), and lower subjective social status (F_2,1993=7.71, P<.001, η²=.008) were associated with higher perceived nonacceptance of psychotherapy.

CONCLUSIONS: Positive associations between attitudes toward psychotherapy and both general and mental health literacy were delineated. Future studies should investigate whether targeted health literacy interventions directed at individuals with lower general and mental health literacy might also help to improve attitudes toward psychotherapeutic treatment and help-seeking behavior.

PMID:39854696 | DOI:10.2196/67078

J Med Internet Res. 2025 Jan 24;27:e56155. doi: 10.2196/56155.

ABSTRACT

BACKGROUND: Sepsis, a critical global health challenge, accounted for approximately 20% of worldwide deaths in 2017. Although the Sequential Organ Failure Assessment (SOFA) score standardizes the diagnosis of organ dysfunction, early sepsis detection remains challenging due to its insidious symptoms. Current diagnostic methods, including clinical assessments and laboratory tests, frequently lack the speed and specificity needed for timely intervention, particularly in vulnerable populations such as older adults, intensive care unit (ICU) patients, and those with compromised immune systems. While bacterial cultures remain vital, their time-consuming nature and susceptibility to false negatives limit their effectiveness. Even promising existing machine learning approaches are restricted by reliance on complex clinical factors that could delay results, underscoring the need for faster, simpler, and more reliable diagnostic strategies.

OBJECTIVE: This study introduces innovative machine learning models using complete blood count with differential (CBC+DIFF) data-a routine, minimally invasive test that assesses immune response through blood cell measurements, critical for sepsis identification. The primary objective was to implement this model within an artificial intelligence-clinical decision support system (AI-CDSS) to enhance early sepsis detection and management in critical care settings.

METHODS: This retrospective study at Tri-Service General Hospital (September to December 2023) analyzed 746 ICU patients with suspected pneumonia-induced sepsis (supported by radiographic evidence and a SOFA score increase of ≥2 points), alongside 746 stable outpatients as controls. Sepsis infection sources were confirmed through positive sputum, blood cultures, or FilmArray results. The dataset incorporated both basic hematological factors and advanced neutrophil characteristics (side scatter light intensity, cytoplasmic complexity, and neutrophil-to-lymphocyte ratio), with data from September to November used for training and data from December used for validation. Machine learning models, including light gradient boosting machine (LGBM), random forest classifier, and gradient boosting classifier, were developed using CBC+DIFF data and were assessed using metrics such as area under the curve, sensitivity, and specificity. The best-performing model was integrated into the AI-CDSS, with its implementation supported through workshops and training sessions.

RESULTS: Pathogen identification in ICU patients found 243 FilmArray-positive, 411 culture-positive, and 92 undetected cases, yielding a final dataset of 654 (43.8%) sepsis cases out of 1492 total cases. The machine learning models demonstrated high predictive accuracy, with LGBM achieving the highest area under the curve (0.90), followed by the random forest classifier (0.89) and gradient boosting classifier (0.88). The best-performing LGBM model was selected and integrated as the core of our AI-CDSS, which was built on a web interface to facilitate rapid sepsis risk assessment using CBC+DIFF data.

CONCLUSIONS: This study demonstrates that by providing streamlined predictions using CBC+DIFF data without requiring extensive clinical parameters, the AI-CDSS can be seamlessly integrated into clinical workflows, enhancing rapid, accurate identification of sepsis and improving patient care and treatment timeliness.

PMID:39854695 | DOI:10.2196/56155