Category: Nevin Manimala

Patient Prefer Adherence. 2025 Aug 15;19:2493-2504. doi: 10.2147/PPA.S529666. eCollection 2025.

ABSTRACT

PURPOSE: To address limited population-level data on prescription medication taking during COVID-19, we assessed the impact of the pandemic on adherence to the costliest drug classes prescribed for chronic diseases in British Columbia (BC).

PATIENTS AND METHODS: Of the 100 top drug classes contributing to total drug spending in 2020, we categorized those prescribed for chronic diseases into 26 drug groups; specifically, drugs for psychiatric and neurologic, cardiac and respiratory, hormone-related, and immune and musculoskeletal conditions. Using administrative health data on all dispensed medications, we quantified adherence by monthly proportion of days covered (PDC) and performed interrupted time-series analysis (ITS) to estimate changes in PDC trends 1-year before and after the implementation of pandemic mitigation measures.

RESULTS: We included 3,906,377 adults with ≥1 prescription to ≥1 included drug groups. The most common prescriptions among our study population were for antidepressants (45.0%), drugs for obstructive airway diseases (41.6%), renin-angiotensin system agents (30.5%), diuretics (28.2%), and lipid modifying agents (24.8%). ITS models for 22 of 26 drug groups showed statistically significant changes in monthly PDC trends, with the greatest change occurring among parenteral immunosuppressants, injectable insulins and analogues, and renin-angiotensin system agents.

CONCLUSION: Findings suggest that the pandemic did not substantially impact adherence to commonly used medications; however, adherence was found to be suboptimal across all drug groups regardless of the impact of COVID-19. Medication adherence remains a critical therapeutic challenge requiring our attention irrespective of major healthcare system stressors such as COVID-19.

PMID:40838205 | PMC:PMC12363557 | DOI:10.2147/PPA.S529666

Acta Neurochir (Wien). 2025 Aug 21;167(1):225. doi: 10.1007/s00701-025-06651-z.

ABSTRACT

BACKGROUND: Trigeminal neuralgia secondary to vertebrobasilar dolichoectasia (VBD-TN) poses a significant challenge in the surgical management of trigeminal neuralgia. This study aimed to evaluate and compare the therapeutic efficacy of microvascular decompression (MVD) and percutaneous balloon compression (PBC) in patients with VBD-TN.

METHODS: We conducted a retrospective cohort analysis of consecutive VBD-TN patients treated at a tertiary hospital in China between September 2013 and August 2022. Participants were stratified by the intervention (MVD vs PBC), with systematic evaluation of postoperative pain control efficacy and complication rates.

RESULTS: This study enrolled 107 patients with VBD-TN, with a mean age of 64.8 ± 10.0 years and a mean follow-up duration of 3.9 ± 1.9 years. The cohort comprised 64 patients undergoing MVD and 43 receiving PBC. Both groups achieved excellent initial pain control (The Barrow Neurological Institute scoring system (BNI) pain score I or II). The recurrence (BNI Ⅲ, Ⅳ, Ⅴ) rates were 12.5% (8/64) in the MVD group versus 20.9% (9/43) in the PBC group (p = 0.242) at the last follow-up, showing no statistically significant difference. Early postoperative assessment revealed significantly higher incidences of trigeminal dysfunction including facial numbness, dry eye symptoms, and masticatory muscle weakness in the PBC group compared to the MVD group (p < 0.05 for all). Conversely, the MVD group demonstrated more diverse complications, with craniotomy-related adverse events including intracranial infection (4.7%), cerebrospinal fluid leakage (3.1%), and incision infection (3.1%), while cranial nerve complications comprised diplopia (3.1%), facial palsy (1.6%), hearing loss (7.8%), and tinnitus (9.4%). At the final follow-up, the PBC group exhibited significantly higher BNI numbness scores than the MVD group (p = 0.001). The PBC group showed advantages in healthcare utilization metrics, with significantly shorter postoperative hospital stays and lower hospitalization costs compared to the MVD group (p < 0.001).

CONCLUSIONS: Both MVD and PBC are safe and effective therapeutic options for VBD-TN. MVD is associated with higher hospitalization costs, prolonged hospital stays, and a greater incidence of cranial nerve complications, though most of these complications are treatable. The main disadvantage of PBC lies in the long-term facial numbness.

PMID:40836140 | DOI:10.1007/s00701-025-06651-z

Eur J Orthop Surg Traumatol. 2025 Aug 20;35(1):354. doi: 10.1007/s00590-025-04488-x.

ABSTRACT

PURPOSE: Several surgical techniques are used to treat large to massive reparable rotator cuff tears, including arthroscopic rotator cuff repair (ARCR), graft augmentation (GA), and superior capsular reconstruction (SCR). However, direct comparisons among these three approaches remain limited in the current literature.

METHODS: PubMed, Embase, Cochrane, and Web of Science databases were searched for randomized clinical trials (RCTs) and comparative studies focusing on large to massive rotator cuff tears. Outcomes included American Shoulder and Elbow Surgeons (ASES) scores, Constant-Murley scores, and retear rates. Data analyses were performed using Cochrane Review Manager, with statistical significance set at p ≤ 0.05.

RESULTS: A total of 10 studies (606 patients) were included in this analysis. The comparison between ARCR and GA comprised 7 RCTs and 1 comparative study. Although no significant difference was observed in Constant-Murley scores (mean difference 3.24, 95% Confidence Interval [CI] -1.36, 7.83), the ARCR group exhibited a higher retear rate than the GA group (Risk Ratio [RR] 0.53, 95% CI 0.28, 0.98, p < 0.05). One RCT comparing GA to SCR demonstrated similar ASES scores (GA 77.9 ± 19.9; SCR 74.8 ± 23.9), with SCR having slightly lower retear rates (GA 36%, SCR 25%). Only one cohort study compared SCR to ARCR, which reported similar ASES scores (SCR 85.4 ± 15; ARCR 85.4 ± 16.5) and retear rates (SCR 7%, ARCR 3.5%).

CONCLUSIONS: All three surgical interventions were effective in repairing large to massive rotator cuff tears. However, this analysis found no significant evidence favoring one surgical method, aside from a lower risk of retear in patients with GA compared to ARCR.

PMID:40836122 | DOI:10.1007/s00590-025-04488-x

Acta Neurochir (Wien). 2025 Aug 21;167(1):224. doi: 10.1007/s00701-025-06649-7.

NO ABSTRACT

PMID:40836120 | DOI:10.1007/s00701-025-06649-7

J Perinatol. 2025 Aug 20. doi: 10.1038/s41372-025-02390-2. Online ahead of print.

ABSTRACT

OBJECTIVES: To identify clinical variables and indicators associated with pulmonary hemorrhage in preterm infants.

METHODS: This case-control study included inborn infants <32 weeks. Data were collected in 12-h epochs from birth until hemorrhage onset or up to 72 h for controls. Machine learning used the Random Forest algorithm. Statistical analysis included T test and Mann-Whitney U test.

RESULTS: Among 1133 screened infants, 35 had hemorrhage. Mean gestational age was 25.6 ± 1.6 weeks, birth weight 753 ± 224 g, and median onset of hemorrhage was 44.5 h. Affected infants more often required chest compressions and invasive ventilation. Machine learning (accuracy = 83%, AUC = 90%) identified repeated surfactant dosing and postnatal hypotension in the first 12 h of life as top predictors, along with maternal and gestational age. Mortality was higher in cases than controls (19% vs. 3%, p = 0.005).

CONCLUSION: Repeated surfactant dosing and early postnatal hypotension are key predictors for pulmonary hemorrhage in preterm infants.

PMID:40836119 | DOI:10.1038/s41372-025-02390-2

J Perinatol. 2025 Aug 20. doi: 10.1038/s41372-025-02387-x. Online ahead of print.

ABSTRACT

Neonatal hypoglycemia is the most common metabolic disorder in newborns and can lead to neurological damage if untreated. While intravenous dextrose is the standard treatment, it is invasive. Oral 40% dextrose gel (0.5 ml/kg) offers a non-invasive alternative. A systematic review of five randomized controlled trials (RCTs), involving 2,742 neonates (1,326 received dextrose gel; 1,416 received placebo), assessed its effectiveness in reducing NICU admissions in neonates with blood glucose < 2.6 mmol/L. Although the overall meta-analysis showed a non-significant reduction in NICU admissions (risk ratio 0.68; 95% CI: 0.33-1.38; p = 0.28), a sensitivity analysis excluding one outlier study improved consistency (I² = 19%) and revealed a statistically significant reduction (risk ratio 0.52; 95% CI: 0.31-0.90; p = 0.02). These findings suggest that oral dextrose gel may reduce NICU admissions in neonates with hypoglycemia, but further large-scale studies are required to confirm its clinical effectiveness.

PMID:40836118 | DOI:10.1038/s41372-025-02387-x

Int J Obes (Lond). 2025 Aug 20. doi: 10.1038/s41366-025-01857-8. Online ahead of print.

ABSTRACT

OBJECTIVE AND METHODS: We have developed a novel Bayesian Linear Structural Equations Model (BLSEM) with variable selection priors (available as an R package) to build directed acyclic graphs to delineate complex variable associations and pathways to BMI development. Conditional on standard assumptions used in causal inference, the model provides interpretable estimates with uncertainty for natural direct, indirect (mediated) and total effects.

RESULTS: We showcase our method using data on 4119 offspring followed from the pre-pregnancy period to age 46 years (y) in a Finnish population-based birth cohort. The BLSEM enabled efficiently to analyse all available data over the long-time span, identifying factors to distil potential causal pathways contributing to adult BMI development. All of the associations between early childhood and adolescence variables with adult BMI at 46 y (BMI46) were indirect via multiple paths. For example, maternal prepregnancy BMI, smoking and socioeconomic position are associated with BMI46 through 35, 31 and 26 paths. Another notable feature was that the contribution of very early life factors, particularly prenatal, was captured by growth patterns along childhood, which were the strongest early predictors of middle age BMI46 (the age at adiposity rebound (AgeAR), early growth parameters between the AgeAR to 11 y). BMI and blood pressure measured 15 y earlier also predicted BMI46, all other factors held constant. Genetic predisposition by the polygenic risk score for BMI showed an indirect effect that became apparent at AgeAR and thereafter.

CONCLUSIONS: The Bayesian approach we present and the BLSEM software developed advances methodologies for the analysis of complex, multifaceted life-course data prior to the estimation of potential causal pathways. Our results, although exploratory in nature, suggest that the effective interventions to tackle adverse BMI development could be designed throughout childhood, though the period by AgeAR may be paramount. We feature the importance of integrated life-course analyses that help to understand the contribution of life-stage factors of development.

PMID:40836111 | DOI:10.1038/s41366-025-01857-8

Pediatr Res. 2025 Aug 20. doi: 10.1038/s41390-025-04320-6. Online ahead of print.

ABSTRACT

BACKGROUND: Current diagnostic and monitoring of pediatric brain tumors rely on invasive tissue biopsies and imaging, highlighting the need for non-invasive alternatives. For that matter, liquid biopsy is a promising method. This pilot study investigated the potential of circulating miRNAs to serve as non-invasive biomarkers of pediatric glioma tumors.

METHODS: The levels of mir-182-5p, mir-10b-5p, mir-106b-3p, mir-25-3p, and mir-21-5p were quantified in plasma samples from 68 pediatric gliomas patients and 12 Healthy controls using Real-time PCR. The results were assessed by differential and ROC curve analysis. Additionally, the involvement of mir-182-5p in pediatric high-grade gliomas aggressiveness was examined by functional studies using two cellular models.

RESULTS: All five circulating miRNAs demonstrated increased levels in pediatric glioma patients compared to HCs, significant correlation with Gliomas, and differential expression between various glioma subtypes. These miRNAs presented potential diagnostic discrimination between HCs and pediatric gliomas, as well as between different glioma subgroups. mir-182-5p showed the highest correlation to glioma and induction of migration as well as invasion ability of pediatric diffuse high-grade glioma 4 (pHGG-4) cells in vitro.

CONCLUSIONS: Our findings present circulating miRNAs as promising biomarkers and treatment targets that, with further research, may be clinically utilized for monitoring pediatric glioma tumors.

IMPACT: This study demonstrates the potential of circulating miRNAs as valuable biomarkers for pediatric glioma detection and monitoring. Five examined circulating miRNAs were differentially expressed in pediatric glioma patients compared to controls. These miRNAs were correlated with glioma and could distinguish healthy from gliomas patients. Statistical analysis suggested these miRNAs may also distinguish between various glioma subtypes. Inhibition of the most promising circulating miRNA, miR-182-5p, decreased migration ability and invasiveness of pediatric high-grade glioma IV cells. In the future, the miRNAs studied could have applications as biomarkers for clinical management and treatment targets.

PMID:40836108 | DOI:10.1038/s41390-025-04320-6

Sci Rep. 2025 Aug 20;15(1):30527. doi: 10.1038/s41598-025-16017-1.

ABSTRACT

In recent years, there has been a significant increase in academic interest regarding the sleep quality of university students. Physical exercise has been extensively studied for its association with sleep quality in this population. However, the roles of anxiety and subjective well-being in mediating the relationship between physical exercise and sleep quality require further investigation. This study examines the interplay between physical exercise (independent variable), sleep quality (dependent variable), and the chain mediating effects of anxiety (mediator 1) and subjective well-being (mediator 2). A sample of 4,142 university students (1,525 males and 2,617 females; mean age = 19.05 ± 1.16 years) participated in this study. Cross-sectional self-report measures were used to assess physical exercise, anxiety levels, subjective well-being, and sleep quality. SPSS software facilitated descriptive statistics and correlation analyses. Subsequently, the SPSS PROCESS macro was employed to test and construct the chain mediation model described in the background and objective. The findings revealed a significant positive relationship between physical exercise and both sleep quality and subjective well-being, whereas a significant negative correlation was observed between physical exercise and anxiety. Furthermore, anxiety exhibited a negative association with sleep quality and subjective well-being. Importantly, anxiety and subjective well-being were found to sequentially mediate the link between physical exercise and sleep quality. By integrating clinical psychological (anxiety) and positive psychological (subjective well-being) factors, this study provides deeper insights into the mechanisms through which physical exercise influences sleep quality in college students. Encourage college students to engage in regular physical exercise, as this is often linked to anxiety, subjective well-being, and sleep quality, thereby leading to a higher quality of life.

PMID:40836074 | DOI:10.1038/s41598-025-16017-1

Sci Rep. 2025 Aug 20;15(1):30576. doi: 10.1038/s41598-025-16251-7.

ABSTRACT

Unio pictorum (L. 1758) and Unio tumidus (Philipsson, 1788) are common bivalve molluscs from the Unionidae family, with significant ecological importance in aquatic ecosystems. Their shells are essential for species identification and can also be used to assess changes in population structure, individual growth, and body form under varying environmental conditions. The aim of this study was to: (i) compare the individual size and shape of shells, (ii) assess length growth, and (iii) analyse population structures (based on length and age) of the bivalve molluscs Unio pictorum and Unio tumidus between specimens from the early medieval period (EMS) and those currently found (MS) in the Oder River near Szczecin, Poland. EMS shells were collected from archaeological excavations in cultural layers dated to the 10th and 11th centuries. They were located at three sites in Szczecin, approximately 500-700 m from the Oder River. MS specimens were collected using a bottom dredge between 12 and 21 May 2024 from sites within 1,000 m of the excavation area. For both groups, measurements included size, age, growth (using the von Bertalanffy model), and morphometric characteristics (length [L], height [H], width [W]), as well as the Elongation Index and Convexity Index. The shells of Unio pictorum and U. tumidus from the modern sample (MS) exhibited statistically significantly greater length, width, and height compared to those from the early medieval sample (EMS). At the same time, lower values of the Convexity Index and, in U. pictorum, the Elongation Index were recorded in the MS group. The length and age structure of both species in the MS group was dominated by larger and older individuals relative to the EMS group. The growth of contemporary Unio pictorum and U. tumidus can be considered moderate compared to other present-day populations, with maximum predicted ages of eight and nine years, respectively, and asymptotic lengths (L_∞) of 93.85 mm and 87.03 mm. In contrast, in the EMS group, the maximum predicted age and asymptotic length were 10 years and 70.12 mm for U. pictorum, and 6 years and 96.25 mm for U. tumidus, respectively. Higher values of the φ’ and P growth indices in the MS group indicate that both species are currently growing at a faster rate than their early medieval counterparts (EMS). The observed differences in individual and population characteristics of Unio pictorum and U. tumidus between present-day specimens (MS) and those from the early Middle Ages (EMS) are attributed to long-term changes in temperature, nutrient availability, and water regime over the past 1,000 years.

PMID:40836071 | DOI:10.1038/s41598-025-16251-7