Nevin Manimala

Br J Clin Pharmacol. 2025 May 7. doi: 10.1002/bcp.70087. Online ahead of print.

ABSTRACT

AIMS: This study aimed to identify patterns of direct oral anticoagulant (DOAC) and vitamin K antagonist (VKA) use in hospitalized patients and to examine their association with in-hospital haemorrhagic complications and mortality.

METHODS: An observational cross-sectional study was conducted among hospitalized patients ≥18 years from 2018 to 2022. Data on hospital discharges were obtained from the minimum data set and were matched with pharmacy records to identify patients treated with DOACs or VKAs. In-hospital haemorrhagic complications and mortality rates were calculated for study groups. Multivariate logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (95%CIs), adjusting for age, sex and comorbidities. Analyses were stratified by medical and surgical profiles. Statistical significance was set at .05.

RESULTS: The study included 74 190 patients, with 4774 receiving DOACs and 1768 VKAs. During the study period, DOAC use increased by 45.11%. DOAC-treated patients had lower complication rates than those treated with VKAs (1.9 vs. 2.8%, respectively; P = .032). DOAC use was linked to a lower risk of haemorrhagic complications in surgical patients (OR = 0.65; 95%CI: 0.35-0.91), while in medical patients, the reduction in risk was not statistically significant (OR = 0.59; 95%CI: 0.33-1.10). No effect on mortality risk was observed among medical and surgical patients.

CONCLUSIONS: The increased use of DOACs among hospitalized patients showed a protective effect against haemorrhagic complications in surgical patients, supporting their increasing use in hospital settings.

PMID:40331313 | DOI:10.1002/bcp.70087

Acta Anaesthesiol Scand. 2025 Jul;69(6):e70047. doi: 10.1111/aas.70047.

ABSTRACT

BACKGROUND: Pain management is an important part of prehospital care. Pain assessment and recognition are inseparable in adequate pain treatment. However, relatively scarce literature is available from Nordic and European countries. We investigated the current practices of pain assessment and management in the Emergency Medical Service (EMS) of one Finnish hospital area.

METHODS: The cohort data were originally collected prospectively to assess various quality processes in EMS. This study was designed as a descriptive, retrospective, register-based cohort study, analysing data from 7245 patients encountered by EMS over a one-month period in the Tampere University Hospital area of Finland in 2021. Pain levels were primarily assessed using the numeric rating scale (NRS). Records were combined with auxiliary data from the National Emergency Response Centre Agency. We grouped patients into six age groups and recorded dispatch categories in seven groups to clarify the impact of age and dispatch category on pain assessment and intensity. We used crosstabulation and Pearson’s chi-square test for statistical analyses; we also applied a linear mixed model to analyse the effect of pain medication on pain intensity.

RESULTS: Pain was assessed once in 2586 (36%) patients and then reassessed a second time for 707 (27%) of those patients. Age and dispatch category affected pain intensity (p < 0.001): Patients under 66 reported higher pain intensity than patients over 66 years. In dispatch categories, “oxygen deficiency” and “non-mechanical accident or exposure,” reported pain intensity was minimal compared to other categories. Of the patients with a pain assessment, 611 (24%) experienced pain equal to or greater than 4 on the NRS scale. We found that assessment with a high NRS level was associated with a higher likelihood of administering potent pain medication.

CONCLUSION: The prevalence of pain assessment is relatively low. The diverse nature of EMS interventions must be considered when improving pain management strategies.

PMID:40331303 | DOI:10.1111/aas.70047

Ecology. 2025 May;106(5):e70086. doi: 10.1002/ecy.70086.

ABSTRACT

Occupancy models estimate a species’ occupancy probability while accounting for imperfect detection, but often overlook the issue of false-positive detections. This problem of false positives has gained attention recently with the rapid advancement of automated species detection tools using artificial intelligence (AI), which generate continuous confidence scores for each species detection. Novel occupancy models have been introduced that integrate these confidence scores to identify false positives, but these models require thorough assessments of diagnosis and validation. Here, we propose a new occupancy model based solely on AI-detected species data. We conducted simulations to examine the inferential and predictive accuracies with known true parameters and analyzed AI-detected species data to test the practical usefulness through goodness-of-fit tests and evaluation with external data. Our proposed model mostly outperformed alternative models that ignore imperfect detection or false-positive error probabilities in terms of accuracy in simulation analyses and goodness-of-fit tests in the case study, but not in terms of discrimination metrics based on external data. The proposed occupancy model aids in understanding species-habitat relationships and developing automated biodiversity monitoring workflows by accounting for both false-negative and false-positive errors.

PMID:40331299 | DOI:10.1002/ecy.70086

Ren Fail. 2025 Dec;47(1):2462443. doi: 10.1080/0886022X.2025.2462443. Epub 2025 Feb 6.

ABSTRACT

BACKGROUND: The correlations between the intra-renal resistive index (RRI) and renal histopathology characteristics, especially in those with infected allografts, have not been sufficiently investigated in renal transplant recipients. We aimed to examine the correlation between RRI and renal allograft infection in these subjects.

METHODS: One hundred nine renal allograft recipients were recruited, and RRI was evaluated for correlation with renal allograft infection. Based on laboratory and histopathological findings, 64 renal-allograft recipients were recruited for the infected group, and 45 were recruited for the non-infected group.

RESULTS: The causes of allograft infection were Cytomegalovirus (CMV) infection (30.3%), urinary tract infections (UTI) (18.3%), and polyomavirus 1 (BK virus) infections (10.1%). There was a statistically significant difference in RRI in those with allograft infections, with the ROC curve for detection of infection utilizing RRI demonstrated an Area Under Curve 0.634 (p-value 0.015; cutoff value: 0.765; CI:0.527-0.742), with a specificity of 64.4% and a sensitivity of 68.8%.

CONCLUSION: Normal renal graft arterial resistivity index values, despite a renal allograft dysfunction, may be indicative of allograft infection, guiding clinicians’ decisions regarding kidney biopsy and facilitating further biopsy interpretations.

PMID:40331298 | DOI:10.1080/0886022X.2025.2462443

HIV Med. 2025 May 7. doi: 10.1111/hiv.70039. Online ahead of print.

ABSTRACT

INTRODUCTION: Stigma and discrimination against people living with human immunodeficiency virus (PLHIV) within healthcare settings remain significant barriers to effective care. Stigmatizing attitudes persist among healthcare professionals, potentially undermining care quality. This study aimed to assess HIV-related knowledge and attitudes among healthcare professionals in Portugal, focusing on identifying factors associated with stigma.

METHODS: This study was part of a European survey by the European Centre for Disease Prevention and Control (ECDC) and the European AIDS Clinical Society (EACS). Data were collected via an online self-administered questionnaire between September and December 2023, targeting healthcare professionals in Portugal. Descriptive statistics, chi-square tests and multivariate logistic regression were used to assess associations between sociodemographic characteristics, HIV knowledge and stigma.

RESULTS: A total of 807 healthcare professionals participated in the study, with a majority being women (78%), and a mean age of 43.5 years. Most respondents were nurses (38%) and doctors (28%), worked in hospitals (54%) or primary healthcare centres (31%). The analysis showed that healthcare professionals working in HIV-dedicated departments, hospitals or community centres exhibited significantly higher levels of HIV-related knowledge. In contrast, female professionals, those over 40 years old and non-doctor professionals were less likely to demonstrate high HIV-related knowledge. Regarding stigma, professionals with limited HIV training and lower HIV knowledge were more likely to display higher levels of stigma.

CONCLUSIONS: These findings highlight the need for targeted educational interventions to reduce stigma. Strengthening HIV-specific training, especially in stigma reduction, is crucial for improving care for PLHIV and fostering an inclusive healthcare environment.

PMID:40331284 | DOI:10.1111/hiv.70039

Colorectal Dis. 2025 May;27(5):e70114. doi: 10.1111/codi.70114.

ABSTRACT

AIM: Rectopexy with concomitant sacrocolpopexy (sacrocolporectopexy) is the favoured technique for treating combined pelvic organ prolapse and internal or external rectal prolapse, despite limited functional improvement. Previous studies have assessed anatomical change after standalone rectopexy or sacrocolpopexy, based on supine MRI defaecography. Since a supine position can underestimate the extent of pelvic organ prolapse, it might also incorrectly assess the anatomical effect of sacrocolporectopexy. The aim of this study was to assess the effect of sacrocolporectopexy on the pelvic anatomy in an upright position.

METHOD: Twenty one female patients undergoing sacrocolporectopexy from December 2022 to June 2024 were included. All patients underwent physical examination and MRI defaecography preoperatively and postoperatively. The descent of the bladder, vaginal vault and anorectal junction and the size of the rectocele and enterocele were assessed on the MRI defaecography images during maximum straining. Significance was tested using a paired t-test and an improvement of ≥10 mm was considered clinically relevant. The results were compared with previous studies, which used supine assessment.

RESULTS: Postoperative improvement was found for the bladder, vaginal vault, anorectal junction, rectocele and enterocele with 14, 44, 5, 16 and 54 mm respectively. The bladder, vaginal vault, rectocele and enterocele showed clinically relevant improvement. Compared with supine results, upright assessments revealed a larger organ lift for the vaginal vault as well as a higher, overall, position of the anorectal junction.

CONCLUSION: Upright assessment of sacrocolporectopexy differs from supine assessment, with statistical and clinically relevant lift for the pelvic organs.

PMID:40331245 | DOI:10.1111/codi.70114

Brain Spine. 2025 Apr 21;5:104259. doi: 10.1016/j.bas.2025.104259. eCollection 2025.

ABSTRACT

INTRODUCTION: Quality education is key in addressing the skilled neurological workforce gap in Africa. However, many medics are scared of the neurological sciences because of the challenges faced in medical schools in studying the neurosciences. Understanding its state and educational challenges is crucial for fostering interest in neurosurgery and related specialities on the continent.

RESEARCH QUESTION: What are the current state, challenges, and solutions to improve neuroanatomy education in Cameroon, Africa in miniature?

MATERIALS AND METHODS: A cross-sectional study using an 11-item electronic survey was conducted among medical students from all nine medical schools in Cameroon. Data were analysed using descriptive statistics and independent t-tests, with significance set at p < 0.05.

RESULTS: Among 220 respondents, 40.1 % and 35.0 % respectively, reported cranial nerves/brainstem and neurovascular anatomy to be the most challenging, with a mean comprehension score of 5.83/10. Faculty predominantly relied on PowerPoint lectures (83.2 %), while most students supplemented learning with YouTube videos (77.7 %). 63.9 % of the respondents perceived classroom teaching alone to limit their understanding of neuroanatomy, and 85.8 % of students reported the time allocated for neuroanatomy teaching to be inadequate. The usage of cadaver dissection (69.5 %), and neurosimulation practicals (66.4 %) were the most recommended tools by students to improve neuroanatomy teaching.

DISCUSSION AND CONCLUSION: Challenges in neuroanatomy education in Cameroon are perceived to arise from insufficient hands-on learning, time constraints, and limited access to specialised faculty. These suggest interactive teaching, increased curriculum time, and diverse resources as potential improvements, though further research is needed to assess their effectiveness and ultimately improve understanding, fostering a stronger neurological workforce.

PMID:40331209 | PMC:PMC12051654 | DOI:10.1016/j.bas.2025.104259

Dela J Public Health. 2025 Apr 30;11(1):10-18. doi: 10.32481/djph.2025.04.04. eCollection 2025 Apr.

ABSTRACT

BACKGROUND: The “Food is Medicine” (FIM) model bridges healthcare and food access to mitigate chronic health conditions and address social determinants of health.

OBJECTIVES: This study assesses the impact of the Feeding Families (FF) program, a FIM initiative by Westside Family Healthcare in Delaware, which was conducted between February 2023 and February 2024 and designed to support individuals with diabetes, hypertension, and obesity.

METHODS: We employed a quasi-experimental design to evaluate the implementation and effectiveness of the program over 12 months. The FF program provided participants with nutrient-dense food, bi-weekly nutrition counseling, and behavioral support. Data on body mass index (BMI), glycated hemoglobin (A1C), and fruit and vegetable intake were collected from 43 participants at baseline, midpoint, and endpoint. Participant knowledge, dietary behaviors and food insecurity, changes in goal setting, consumption of sodium, sugar, and fats were also assessed.

RESULTS: Participants demonstrated significant reductions in BMI and improved dietary behaviors, including decreased consumption of sodium, sugar, and fats. While changes in A1C levels were not statistically significant, the overall trend indicated improvement. The program also led to modest enhancements in food security.

CONCLUSION: The Feeding Families program contributes to improving health outcomes among populations with chronic diseases, particularly in reducing BMI and promoting healthier dietary behaviors around sodium, sugar, and fat consumption.

POLICY IMPLICATIONS: The Feeding Families program demonstrates the potential of integrating tailored nutrition, behavioral support, and healthcare services to manage chronic conditions through ‘Food Is Medicine’ best practices, and its impact on BMI, salt, sugar and fat reduction among other benefits. Delaware should prioritize FIM, including establishing Medicaid waivers for funding.

PMID:40331171 | PMC:PMC12051899 | DOI:10.32481/djph.2025.04.04

J Mass Spectrom Adv Clin Lab. 2025 Apr 17;36:52-62. doi: 10.1016/j.jmsacl.2025.04.004. eCollection 2025 Apr.

ABSTRACT

BACKGROUND: Psoriasis is a chronic inflammatory disease with an unclear etiology that affects skin, nails, and joints and often accompanies comorbidities. Recent studies indicate that alterations in metabolites within psoriatic lesions might be linked to inflammation. Studying bioactive lipid mediators or metabolites in skin inflammation and immunity might provide new potential biomarkers and therapeutic prediction factors.

METHODS: Lipids and peptides in the scale extracts from psoriasis patients and healthy controls were characterized by thermal desorption-electrospray ionizationmass spectrometry and matrix-assisted laser desorption/ionization time-of-flightmass spectrometry, respectively. Principal component analysis (PCA) was then applied to these data to identify potential differences between psoriasis patients and healthy controls.

RESULTS: Psoriatic plaques show reduced wax esters and triglycerides and a predominant increase in human neutrophil defensins (HNPs), compared to non-lesional sites of psoriatic patients and healthy control. Additionally, when medical treatments were administered to psoriasis patients, levels of HNPs were significantly reduced, suggesting that they may serve as potential biomarkers to evaluate therapeutic efficacy for psoriasis.

CONCLUSION: Two mass spectrometric techniques were used to rapidly and non-invasively identify and monitor potential biomarkers between psoriasis patients and healthy controls. However, PCA results only showed slight differences, and we intend to broaden the sample base in the future to increase the statistical power of the investigation.

PMID:40331168 | PMC:PMC12051561 | DOI:10.1016/j.jmsacl.2025.04.004

J Diabetes Metab Disord. 2025 May 3;24(1):112. doi: 10.1007/s40200-025-01627-3. eCollection 2025 Jun.

ABSTRACT

BACKGROUND AND PURPOSE: Undesirable adherence to treatment is one of most important challenges in the control and treatment of type 2 diabetes. Therefore, the present study was conducted with the aim of determining the level of adherence to treatment and factors affecting it among patients with type 2 diabetes in Tehran.

METHODS: This cross-sectional descriptive study was conducted in 2023 on 117 patients with diabetes referred to Imam Khomeini Hospital in Tehran. The data collection tool was the Hill-Bone Medication Adherence Scale (HB-MAS), which was completed by the participants. Version 16 SPSS and descriptive analysis at the statistical level of 0.05 were used to analyze the data.

RESULTS: The mean age of the participants in this research was 45.06 ± 8.48 years. The results showed that 41.03% of the participants had the desirable treatment adherence and 58.97% had the undesirable treatment adherence. A significant relationship was observed between the compliance of patients with the variables of gender, level of education and job status (P < 0.05); But the variables of age, duration of illness and type of treatment had no significant relationship with treatment adherence.

CONCLUSION: The findings showed that the level of adherence to treatment in patients with type 2 diabetes in Tehran is not undesirable. It is better for the treatment team to take more effective measures to improve the awareness of patients in adherence to treatment. Planners and policy makers should also take more effective measures to empower patients to access health services.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40200-025-01627-3.

PMID:40331156 | PMC:PMC12049342 | DOI:10.1007/s40200-025-01627-3