Nevin Manimala

Saudi Pharm J. 2025 Dec 23;33(6):53. doi: 10.1007/s44446-025-00053-z.

ABSTRACT

Sterile Injectable Products (SIPs) represent a critical class of pharmaceuticals that frequently face shortages and ultimately compromise patient care. Disruptions within the pharmaceutical supply chain are significant factors contributing to these shortages. This study aimed to investigate the causes and impacts of SIPs shortages in Saudi Arabia, with the central hypothesis that pharmaceutical supply chain disruptions are the primary drivers of these shortages and that they negatively affect patient outcomes. A cross-sectional questionnaire was administered to two key stakeholder groups: supply chain management (SCM) personnel and healthcare professionals (HCPs). A total of 350 responses were collected and statistically analyzed. Our findings demonstrate a strong consensus among SCM respondents, with 73% agreeing that supply chain disruptions significantly affect SIPs availability. Poor demand forecasting and limited sourcing capabilities were identified as the primary contributing factors. From the perspective of HCPs, over 65% indicated that SIP shortages adversely impacted patient care, resulting in treatment delays, extended hospital stays, and increased healthcare costs. Additionally, many respondents reported that staff time is often wasted in the search for alternative therapies, which may also be of short supply. Interestingly, more than 70% of respondents from both groups expressed robust support for the adoption of advanced technologies such as artificial intelligence (AI) and machine learning (ML) to enhance forecasting and inventory management. Taken together, these findings underscore the urgent need for integrated strategies including proactive forecasting, sustainable inventory management, expanded local manufacturing, and AI-driven tools to strengthen the resilience of the SIP supply chain in Saudi Arabia and beyond.

PMID:41432861 | DOI:10.1007/s44446-025-00053-z

Aging Clin Exp Res. 2025 Dec 23. doi: 10.1007/s40520-025-03293-0. Online ahead of print.

ABSTRACT

BACKGROUND: Frailty is a critical geriatric syndrome associated with adverse health outcomes and exhibits a complex relationship with obesity. Traditional anthropometrics, such as body mass index (BMI), inadequately assess obesity-related risks in the aging population. Emerging indices better capture visceral adiposity, potentially enhancing frailty prediction. This study evaluates these indices’ associations with frailty in older adults.

METHODS: This study analyzed existing data collected between 2002 and 2007 as part of the National Health and Nutrition Examination Survey (NHANES). BMI, body roundness index (BRI), a body shape index (ABSI), waist-to-height ratio (WHtR), and waist/height0.5 (WHT·5R) were calculated using waist circumference, weight, and height. We used a modified frailty index (FI) with 36 standardized parameters to quantify the severity of frailty by the cumulative proportion of deficits.

RESULTS: In the adjusted model, increases in all indices except ABSI were statistically significantly associated with increases in FI (BRI: β(95%CI) = 0.004(0.003, 0.005); BMI: β(95%CI) = 0.001(0.0001, 0.001); ABSI: β(95%CI) = 2.034(1.627, 2.440); WHtR: β(95%CI) = 0.093(0.067, 0.119); WHT·5R: β(95%CI) = 0.007(0.005,0.009)). Bootstrap analysis showed that BRI had a greater impact on FI than BMI (difference = 0.0019), while WHtR and WHT·5R had a stronger impact on FI than BRI (difference = -0.0746 and -0.0027, respectively). The effect of WHtR on FI was significantly higher than that of WHT·5R (difference = 0.0719).

CONCLUSION: This study highlighted that WHtR was more strongly associated with FI than BMI, BRI, and WHT·5R, and highlighted the priority of waist-centered obesity measures in frailty risk assessment and clinical intervention in the elderly.

PMID:41432859 | DOI:10.1007/s40520-025-03293-0

Environ Monit Assess. 2025 Dec 23;198(1):64. doi: 10.1007/s10661-025-14930-6.

ABSTRACT

Microsampling is a technique involving the collection of a small amount of biological material in a volume of several to dozens of microliters. The most common material collected is blood from a fingertip. Following a finger prick, dry blood spots are formed after being transferred to a carrier. The method is microinvasive and causes little discomfort during the collection. The preservation of blood in the form of dry spots seems to be an ideal tool for pesticide exposure assessment in the general population and occupationally exposed groups. Populations in agricultural areas are constantly exposed to environmental xenobiotics, including a wide range of pesticides and other pollutants. This technique can be a practical way to assess pesticide exposure, particularly in rural areas or places where whole blood collection is difficult. The issue has generated considerable scientific debate, primarily due to challenges associated with the analysis of small blood spots of unknown volume and the influence of the haematocrit (HCT) effect. The use of dry blood spots can significantly contribute to the expansion of the scale of pesticide biomonitoring, which will allow for the quick and effective identification of individuals exposed to their effects. The technique of microsampling and analysis of DBS indicate great potential in the assessment of pesticide exposure due to its simplicity of specimen collection, minimal invasiveness, and the possibility of storing and transporting the material without the use of specialized conditions. Clinical trial number: not applicable.

PMID:41432856 | DOI:10.1007/s10661-025-14930-6

Int Urol Nephrol. 2025 Dec 23. doi: 10.1007/s11255-025-04913-4. Online ahead of print.

ABSTRACT

PURPOSE: We examined the relationship between psychiatric comorbidities-namely depression, anxiety, and combined depression-anxiety-and hospitalization outcomes among patients diagnosed with neurogenic bladder. Using a large, nationally representative database, the study sought to generate evidence for refining clinical guidelines and improving patient management.

METHODS: A retrospective study was performed using National Inpatient Sample (NIS) records from 2010-2019, identifying 676,826 adults with neurogenic bladder. Mental health comorbidities were classified through ICD-9/ICD-10 coding for depression (n = 125,654), anxiety (n = 77,730), and depression with anxiety (n = 34,330). Outcomes assessed included hospital length of stay, total charges, in-hospital mortality, and specific urological complications. Descriptive statistics and logistic regression analyses were applied, with adjustments for demographic and hospital-related variables.

RESULTS: Depression, anxiety, and depression-anxiety were found in 13.5%, 6.4%, and 5.1% of cases, respectively, with higher rates among older adults and women. Anxiety was associated with elevated risks of hydronephrosis (OR 1.420), urinary tract infections (OR 1.050), urinary stones (OR 1.511), and acute renal failure (OR 1.246), whereas the odds of cystitis were reduced (OR 0.636). Patients with both depression and anxiety exhibited comparable complication patterns, while depression alone showed no significant associations. Surprisingly, individuals with any of these psychiatric conditions had shorter median hospital stays (5 vs 6 days) and lower mortality (1.8-2.4% vs 3.7%).

CONCLUSION: Mental health comorbidities in patients with neurogenic bladder are linked to a nuanced spectrum of outcomes. Anxiety increases the risk of several urological complications yet may confer protective effects regarding mortality. These results underscore the importance of systematic psychological assessment and integrated multidisciplinary management in neurogenic bladder care.

PMID:41430520 | DOI:10.1007/s11255-025-04913-4

Int Ophthalmol. 2025 Dec 23;46(1):46. doi: 10.1007/s10792-025-03927-2.

ABSTRACT

PURPOSE: To evaluate the effects of upper eyelid blepharoplasty on corneal topography and higher-order optical aberrations (HOAs).

METHODS: Seventy-seven patients (154 eyes) who underwent upper eyelid blepharoplasty for dermatochalasis and had complete preoperative and 3-month postoperative corneal topography and aberrometry data were included. All measurements were obtained using the Sirius topography system. Aberrometric parameters-including total RMS, HOA RMS, coma, trefoil, and spherical aberration-as well as advanced topographic indices such as EIf, EIb, TSI, and TImax were analyzed. As this was a retrospective observational study, trial registration was not applicable.

RESULTS: No statistically significant change was observed in total RMS values. At a 6 mm pupil diameter, HOA RMS decreased from 0.53 ± 0.25 to 0.49 ± 0.17 (p = 0.014), and coma decreased from 0.31 ± 0.20 to 0.27 ± 0.14 (p = 0.002). Spherical aberration also showed a postoperative reduction (0.23 ± 0.10 to 0.21 ± 0.10; p = 0.008). Significant improvements were detected in trefoil (p < 0.001), TImax (p < 0.001), EIf (p < 0.001), EIb (p = 0.008), and TSI (p = 0.005). No significant postoperative differences were observed in keratometric values or secondary astigmatism (p > 0.05).

CONCLUSION: Upper eyelid blepharoplasty appears to produce beneficial changes in corneal surface morphology and optical aberrations. Given its potential to enhance visual quality and patient satisfaction, the functional implications of blepharoplasty should be considered alongside its aesthetic goals during surgical planning.

PMID:41430516 | DOI:10.1007/s10792-025-03927-2

J Math Biol. 2025 Dec 22;92(1):16. doi: 10.1007/s00285-025-02331-9.

ABSTRACT

Starvation driven diffusion (SDD) describes a cognitive strategy that starvation of a species leads to its stronger movement. In this paper, to better understand the effects of SDD, we propose and analyze a type of predator-prey systems with predator and prey both obeying SDD. By analyzing the linearized eigenvalue problem, we investigate the stability and instability of a semi-trivial steady state, which depends on the conversion efficiency of prey to predator as well as on the predator’s minimum motility rate when conversion efficiency is properly large. Predator and prey coexist if the unique semi-trivial steady state is unstable. Utilizing Crandall-Rabinowitz bifurcation theorem, we investigate the local existence, stability, and structure of a bifurcating nontrivial steady state. There exists only one critical conversion efficiency guaranteeing the occurrence of steady-state bifurcation at the unique semi-trivial steady state. The global existence and structure of a bifurcating nontrivial steady state are proven by the global bifurcation theorem. One nontrivial steady state always exists for sufficiently large conversion efficiency. As examples, we apply theoretical results to predator-prey models with Holling type II/IV functional response involving SDD, and verify them via numerical simulations. We numerically observe spatially inhomogeneous periodic solutions, which should arise from nontrivial steady states via Hopf bifurcation, or even via homoclinic bifurcation in the case of Holling type IV functional response. Notably, these solutions consistently mirror resource distribution patterns, aligning conceptually with the ideal free distribution.

PMID:41430494 | DOI:10.1007/s00285-025-02331-9

World J Mens Health. 2026 Jan;44(1):194-202. doi: 10.5534/wjmh.250093.

ABSTRACT

PURPOSE: While the association between defect of DNA damage repair (DDR) genes and prostate cancer (PCa) risk is well-established, there has been a lack of data in East Asian population. This study reports contemporary prevalence of DDR genes mutations in Korean PCa patients.

MATERIALS AND METHODS: We analysed samples from 1,316 patients with PCa in Korea. Whole genome sequencing and targeted cancer panel sequencing were employed for genetic analysis. A total of 26 DDR genes were analysed based on the previous literature.

RESULTS: Germline mutation profiling was conducted in 1,026 patients, identifying 66 mutations (6.4%) at 14 genes. Somatic mutation profiling in 550 patients revealed 105 mutations (19.1%) at 15 genes. While BRCA2 was most frequent (3.4%) among germline mutations, CDK12 was most frequent (6.5%) among somatic mutations in our study. Patients with metastatic disease showed significantly higher mutation frequency than patient with localized disease in both germline and somatic mutation (both p-value<0.05). There were statistically positive correlation between increase of grade group and higher frequency in both germline and somatic DDR gene mutations (p<0.001). The patients with higher stage showed significantly higher rate of DDR gene mutation in germline analysis (p<0.001) but not in somatic analysis (p=0.888).

CONCLUSIONS: BRCA2 was the most prevalent in germline mutations but CDK12 was out-numbered BRCA2 in somatic mutations in the present study. The higher frequency of DDR gene mutation was associated with advanced cancer stage and higher cellular grade group.

PMID:41430472 | DOI:10.5534/wjmh.250093

Surg Endosc. 2025 Dec 22. doi: 10.1007/s00464-025-12496-5. Online ahead of print.

ABSTRACT

INTRODUCTION: Liver resection is technically challenging due to the liver’s anatomical complexity. Augmented reality (AR), especially when combined with indocyanine green (ICG) fluorescence, has been adopted to enhance resection precision, reduce intraoperative complications, and improve outcomes. This systematic review and meta-analysis aimed to evaluate whether AR-guided liver surgery is associated with reduced intraoperative bleeding and improved clinical outcomes compared to conventional techniques.

METHODS: A comprehensive search was conducted in Embase, PubMed, and the Cochrane Library, following PRISMA 2020 guidelines. Studies comparing AR-guided liver resections were included. Outcomes analyzed included blood loss, transfusion rates, Clavien-Dindo classification, operative time, liver failure, surgical site infection (SSI), resection-related complications, hospital stay length, and tumor recurrence. Statistical analysis was performed using Review Manager 5.4 and R Studio 4.5, applying a random-effects model when heterogeneity was high.

RESULTS: Of 284 identified studies, 5 met inclusion criteria, totaling 410 patients (AR group n = 141), with 56% male and a mean age of 57 years. AR use was significantly associated with reduced blood loss (MD: -75.9 mL; 95% CI -103.4 to -48.3; p < 0.001), lower transfusion rates (RR: 0.47; 95% CI 0.26 to 0.85; p = 0.01), and fewer resection-related complications (RR: 0.64; 95% CI 0.46 to 0.90; p = 0.009). Subgroup analysis in patients with liver tumors confirmed these benefits, including a lower recurrence rate (RR: 0.52; 95% CI 0.34 to 0.79; p = 0.002). No significant differences were found for Clavien-Dindo classification, operative time, liver failure, SSI, or hospital stay duration.

CONCLUSION: AR-guided liver surgery demonstrated significant clinical benefits, notably reducing intraoperative bleeding, transfusion needs, resection-related complications, and tumor recurrence. Despite limitations in study number and methodological variability, this meta-analysis supports AR as a safe and effective tool in liver surgery, warranting further research to standardize its application.

PMID:41430466 | DOI:10.1007/s00464-025-12496-5

Surg Endosc. 2025 Dec 22. doi: 10.1007/s00464-025-12479-6. Online ahead of print.

ABSTRACT

BACKGROUND: Laparoscopic common bile duct exploration (LCBDE) is an important surgical treatment for choledocholithiasis; however, the choice between indwelling T-tube placement and primary suture remains controversial. This study aimed to evaluate the safety and feasibility of LCBDE coupled with primary suture using a prospective cohort design, as well as to summarize the key techniques of primary suturing.

METHODS: Patients with choledocholithiasis who met the inclusion criteria between January 2019 and March 2023 were enrolled. The primary suture group comprised patients who underwent LCBDE with primary closure, while the T-tube drainage group consisted of those who received LCBDE with T-tube drainage. Perioperative data and follow-up outcomes were collected and statistically analyzed for both groups.

RESULTS: Operative time (120.00 [100.00-139.50] vs. 99.00 [85.00-118.50] min; P = 0.000) and postoperative hospital stay (7.00 [5.00-9.00] vs. 5.00 [4.00-6.00] days; P = 0.000) differed significantly between groups. No significant differences were observed in estimated blood loss (40.7 ± 24.1 vs. 41.4 ± 23.7 mL; P = 0.537), conversion rate to laparotomy (2.38% vs. 2.27%; P = 0.918), time to gastrointestinal function recovery (2.1 ± 0.7 vs. 2.0 ± 0.6 days; P = 0.317), or postoperative complication rate (2.92% vs. 3.18%; P = 0.959). During follow-up, one case of common bile duct (CBD) stenosis and one case of extrahepatic cholangiocarcinoma occurred in the T-tube group; no such complications were observed in the primary suture group. The rates of residual stones (1.75% vs. 0.45%; P = 0.225) and recurrent stones (1.75% vs. 1.81%; P = 0.980) were without statistical significance.

CONCLUSION: In our grouping situation, LCBDE and primary suture is safer and more feasible than T-tube drainage in operative time and postoperative hospital stay. This conclusion has certain reference value for clinicians to choose the surgical method in laparoscopic surgery for choledocholithiasis.

PMID:41430465 | DOI:10.1007/s00464-025-12479-6

Eur Arch Otorhinolaryngol. 2025 Dec 22. doi: 10.1007/s00405-025-09932-6. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to evaluate and compare the diagnostic accuracy of two multimodal large language models-ChatGPT-5.0 Plus and Gemini 2.5-in interpreting pure tone audiograms. The primary hypothesis was that ChatGPT-5.0 Plus would outperform Gemini 2.5 in identifying auditory thresholds, determining type and degree of hearing loss, detecting masking, and providing treatment recommendations based on standardized visual inputs.

DESIGN: A diagnostic simulation study was conducted using 80 software-generated audiograms representing common hearing loss profiles, including normal, conductive, sensorineural, and mixed types. Each audiogram was interpreted by both models using a structured seven-question diagnostic prompt aligned with professional audiological guidelines. Two independent evaluators-an audiologist and an otolaryngologist with audiology expertise-rated each model’s response using a five-point Likert scale. Inter-rater agreement and comparative analyses were performed using non-parametric statistical tests.

RESULTS: ChatGPT-5.0 Plus outperformed Gemini on six of seven diagnostic items and in the overall score. Inter-rater agreement for ChatGPT was almost perfect overall (κ = 0.951), with moderate concordance on Q1 (κ = 0.490) and very high agreement across the remaining items (κ = 0.912-0.981). Gemini also showed strong but lower consistency (overall κ = 0.823; item-level 0.833-0.949), with the weakest agreement on treatment recommendation (Q7). Comparative analyses revealed statistically significant advantages for ChatGPT in air and bone conduction threshold identification, classification of hearing loss type and degree, and diagnostic accuracy. Differences in masking evaluation (Q5) were not significant. Median score differences of 1-2 points on the 5-point scale underscored the clinical relevance of ChatGPT’s superior performance.

CONCLUSIONS: ChatGPT-5.0 Plus demonstrated superior accuracy and consistency in interpreting pure tone audiograms compared to Gemini 2.5. While not suitable as standalone diagnostic tools, large language models may serve as useful adjuncts in primary care and telehealth environments for preliminary audiological assessment. Further validation in real-world clinical settings is necessary before broader implementation.

PMID:41430450 | DOI:10.1007/s00405-025-09932-6