Nevin Manimala

Echocardiography. 2025 Jun;42(6):e70207. doi: 10.1111/echo.70207.

ABSTRACT

BACKGROUND: Keratoconus (KC) is a multifactorial disease characterized by progressive corneal thinning and structural deformation. Despite being an ophthalmological disorder, KC is proposed to have systemic implications. The aim of this study was to evaluate cardiac functions in KC patients by two-dimensional (2D) speckle-tracking echocardiography (STE) and three-dimensional (3D) echocardiography.

METHODS: The study included 45 consecutive patients with KC (mean age: 37.6 ± 12.6 years, 23 male) and 42 healthy controls (mean age: 38.1 ± 8.6 years, 23 male). All participants underwent standard transthoracic echocardiography, 3D echocardiography, and 2D STE to evaluate cardiac functions.

RESULTS: Although there were no significant differences in the conventional echocardiographic markers regarding left ventricular (LV) and right ventricular (RV) functions except tricuspid annular plane systolic excursion; patients with KC had significantly lower LV global longitudinal strain (GLS) compared to controls (-17.75 ± 2.43% vs. -19.71 ± 1.97%, p < 0.001). They also had lower RV GLS, left and right atrial reservoir, and conduit strains, although the differences were not statistically significant. LV GLS negatively correlated with corneal densitometry in KC patients. Linear regression analysis showed that KC was independently associated with LV GLS when adjusted for age and sex.

CONCLUSION: Patients with KC had significantly lower LV GLS, suggesting the presence of a subclinical LV dysfunction in these patients, which supports that KC may be a component of a systemic disease.

PMID:40433730 | DOI:10.1111/echo.70207

Int J Urol. 2025 May 28. doi: 10.1111/iju.70131. Online ahead of print.

ABSTRACT

INTRODUCTION: Hypospadias is a congenital anomaly of male genitalia that requires surgical correction to achieve normal anatomy and function. Tubularized incised plate urethroplasty (TIP) is a common repair method, but prognostic studies of TIP outcomes are limited by their methodological quality. This systematic review evaluates the methodological rigor of prognostic studies on TIP urethroplasty in hypospadias cases, employing the Quality in Prognosis Studies (QUIPS) Cochrane tool.

METHODS: Following PRISMA guidelines, a systematic review of single-arm prognostic studies of TIP was conducted. Inclusion criteria were primary studies (first attempt of surgery), evaluating prognostic factors and outcomes, with the QUIPS tool used for quality assessment. Review studies and reports without full text were excluded. Inter-rater agreement was then evaluated using Cohen’s kappa analysis.

RESULTS: Among 14 included studies, most exhibited low risk of bias (RoB). Inter-rater agreement varied across domains, being strongest for statistical analysis (κ = 0.89) and weakest for prognostic factor measurement (κ = 0.42). Nevertheless, overall assessment showed minimal agreement (κ = 0.49), indicating poor reliability of the included studies. Our findings highlight biases inherent in existing literature, particularly with respect to outcome measurement domains, underscoring the need for standardized methods and validated patient-reported outcomes. Selection bias and lack of standardized outcome measures pose significant challenges in interpreting study findings.

CONCLUSION: Low inter-rater agreement indicates methodological shortcomings in prognostic studies of TIP in the context of hypospadias. Future research should prioritize methodological rigor to enhance the reliability and generalizability of findings, thus improving clinical practice and future patient outcomes.

PMID:40433712 | DOI:10.1111/iju.70131

J Cosmet Dermatol. 2025 Jun;24(6):e70261. doi: 10.1111/jocd.70261.

ABSTRACT

INTRODUCTION: Wound healing is a complex process encompassing four main stages: hemostasis, inflammation, cell proliferation, maturation, and differentiation. Timolol (TM) may influence these stages, particularly re-epithelialization. This study aims to evaluate the 1-month effects of timolol on acute surgical wounds in post-mammoplasty patients.

OBJECTIVES: To investigate the efficacy of topical timolol in improving postoperative breast scars, aiming to guide future treatment protocols and prescriptions.

METHODS: A total of 12 patients who underwent bilateral mammoplasty were enrolled in this double-blind randomized clinical trial. Treatment commenced 48 h post-surgery; one breast was treated with 0.5% timolol eye drops, while the contralateral breast received distilled water (control). Patients were advised to minimize sun exposure and pressure on the treated area, and no additional oral or topical medications were prescribed. Cleansing with a prescribed cleanser occurred every 3 days. Cosmetic assessments were conducted by a specialist at 10 and 30 days post-surgery using a 10-point Likert scale. Data were analyzed using two-way repeated measures ANOVA.

RESULTS: Timolol significantly reduced erythema over time (Interaction, p < 0.0001; Treatment, p = 0.02), with an average decrease of 5.38 points (95% CI: 4.22-6.55) compared to 4.41 points (95% CI: 3.83-5) for placebo. The difference in reduction was 0.972 points (95% CI: 0.18-1.7). A significant improvement in the aesthetic appearance of the breast was also noted (Interaction, p < 0.0001; Treatment, p = 0.015), with timolol enhancing the aesthetic score by approximately 5.5 points (95% CI: 4.9-6.2) versus 4.58 points (95% CI: 3.4-5.7) for the placebo. Overall, timolol improved the aesthetic score by 0.972 points (95% CI: 0.23-1.7) more than the placebo.

CONCLUSION: Topical application of 0.5% timolol significantly improved the aesthetic appearance and reduced erythema of post-mammoplasty breast scars over a 1-month period. The results demonstrate a measurable clinical benefit, with statistically significant differences favoring timolol over placebo. These findings suggest that early intervention with topical timolol may offer a safe, effective, and non-invasive option for optimizing scar outcomes in surgical patients.

PMID:40433711 | DOI:10.1111/jocd.70261

Health Informatics J. 2025 Apr-Jun;31(2):14604582251347120. doi: 10.1177/14604582251347120. Epub 2025 May 28.

ABSTRACT

Objective: This review systematically synthesizes empirical evidence from past NEHR initiatives to identify critical gaps between knowledge and practice and provide actionable insights for policymakers, health IT leaders, and practitioners.Materials and Methods: A rapid review approach was employed, focusing on qualitative content analysis of empirical studies published between 2010 and 2024. The search covered the Scopus, PubMed, Medline, and CINAHL databases. A total of 24 studies met the eligibility criteria and were analyzed across key dimensions.Results: Our analysis reveals that successful NEHR implementation hinges on three interdependent factors: (1) Stakeholder engagement and governance-meaningful clinician involvement and adaptive leadership strategies are crucial for system adoption; (2) Institutional and cultural alignment-the tension between centralized mandates and local adaptation must be carefully managed; and (3) Technological and process standardization-balancing interoperability with customizability remains a persistent challenge. Notably, rigid top-down implementations often face resistance, whereas hybrid “middle-out” approaches tend to facilitate smoother transitions.Conclusions: NEHR deployments require a nuanced approach that integrates strategic decision-making, continuous stakeholder engagement, and flexible governance models. Policymakers and project leaders should prioritize participatory implementation strategies, adaptive standardization, and mechanisms for iterative learning to enhance the sustainability and effectiveness of these systems.

PMID:40433709 | DOI:10.1177/14604582251347120

J Cosmet Dermatol. 2025 Jun;24(6):e70249. doi: 10.1111/jocd.70249.

ABSTRACT

AIM: Demodex spp. are ectoparasites that reside in pilosebaceous units, particularly on the face where sebum secretion is prominent. The sebum-reducing effects of isotretinoin play a crucial role in the management of acne vulgaris and rosacea. This study aims to assess the effect of isotretinoin on Demodex density in patients with acne vulgaris and rosacea accompanied by demodicosis. The evaluation includes Demodex mite density, before, during, and after 6 months of isotretinoin treatment.

MATERIALS METHODS: The study included patients diagnosed with acne vulgaris and rosacea accompanied by demodicosis who were prescribed isotretinoin treatment. Demographic data were collected, and Demodex spp. mites were detected using superficial skin biopsy before treatment initiation. Follow-up samples were obtained at 2 and 6 months. Statistical analysis was performed using SPSS version 23, with a significance level set at p < 0.05.

RESULTS: A total of 36 patients, 25 with acne and 11 with rosacea, were included in our study. Demodex density was assessed before treatment, at 2 months, and at 6 months. Our findings showed a significant decrease in Demodex density with isotretinoin treatment, especially in relation to the decrease in sebum secretion (p < 0.001).

CONCLUSION: This study makes a notable contribution to the existing literature by being the first to assess the impact of isotretinoin treatment on Demodex density. Our results indicate that isotretinoin effectively reduces Demodex density, likely due to a reduction in sebum production. To further explore isotretinoin’s effects, future research should involve larger sample sizes and extended follow-up periods. These findings enhance our understanding of isotretinoin’s role in managing Demodex-related dermatological conditions.

PMID:40433708 | DOI:10.1111/jocd.70249

J Mother Child. 2025 May 24;29(1):20-29. doi: 10.34763/jmotherandchild.20252901.d-24-00046. eCollection 2025 Feb 1.

ABSTRACT

BACKGROUND: This study aimed to calculate a pharmacoeconomic indicator, specifically the cost-effectiveness coefficient, for treating paediatric bronchial asthma with combined regimens of bronchodilators and inhaled corticosteroids.

MATERIAL AND METHODS: This study involves 54 children aged 6 to 12 years, who were divided into 6 groups depending on the age and severity of bronchial asthma. Treatment effectiveness is calculated by subtracting the percentage difference between exacerbation frequency and the number of patients. The calculation of pharmacoeconomic data was conducted using the cost-effectiveness ratio (CER).

RESULTS: For the treatment of mild bronchial asthma, the drug Berodual is used for inhalation through a nebuliser, moderate therapy is conducted using a combination of Flixotide and Salbutamol, and severe is stopped by a combination of Symbicort and Salbutamol. From the results obtained, notably, the CER for mild severity was 0.077 for children aged 6-8 years and 0.171 for the age group 9-12 years; for moderate severity, the CER values were 0.27 for the group 6-8 years and 0.35 for the category 9-12 years; severe asthma had the following indicators: 0.506 and 0.798 for groups aged 6-8 and 9-12, respectively.

CONCLUSION: This study’s results indicate that the most cost-effective treatment regimen is in the age groups of 6-8 years. However, the calculation of drug dosages directly depends on the patient’s age and the severity of the disease. Further actions in scientific works should be directed to conducting empirical, statistical studies in the field of pharmacoeconomics of bronchial asthma among children from the standpoint of the state.

PMID:40433701 | DOI:10.34763/jmotherandchild.20252901.d-24-00046

J Cosmet Dermatol. 2025 Jun;24(6):e70235. doi: 10.1111/jocd.70235.

ABSTRACT

BACKGROUND: The use of laser treatments for cosmetic and medical dermatologic conditions has increased significantly, yet provider training varies widely, raising concerns about patient safety and treatment efficacy. This study examines the availability and practice patterns of fellowship-trained laser dermatologists and compares them to medical spas and plastic surgeons offering laser services.

METHODS: In September 2024, an online search and telephone survey were conducted to identify board-certified dermatologists who completed an American Society for Dermatologic Surgery (ASDS) Cosmetics and Lasers Fellowship. Data on consultation availability, pricing, provider involvement, technology investment, and treatment customization were collected from dermatology, plastic surgery, and medical spa practices.

RESULTS: A total of 124 fellowship-trained dermatologists were identified. Compared to medical spas and plastic surgeons, these dermatologists had longer wait times for consultations (23 vs. 4 and 11 days), higher consultation fees ($153 vs. $30 and $78), and a greater number of laser devices per practice. Physician involvement in laser procedures was significantly higher among dermatologists (60%) compared to plastic surgeons (33%) and medical spas (9%). Medical spas relied heavily on nonphysician providers (26%) and laser technicians (56%), with only 41% providing direct on-site supervision. The majority (98%) of dermatologists and plastic surgeons customized laser treatments, compared to 63% of medical spas. Dermatologists dedicated more clinical time to laser procedures, with 19% spending over 50% of their practice on lasers, compared to none at medical spas and plastic surgery offices.

CONCLUSION: Fellowship-trained laser dermatologists provide more direct physician involvement, greater technological resources, and highly customized treatments compared to medical spas and plastic surgeons. While medical spas offer lower costs and shorter wait times, the lack of physician oversight and limited training among providers may represent substandard care. These findings highlight the importance of provider qualifications in ensuring optimal patient outcomes and underscore the value of specialized laser training in dermatology.

PMID:40433697 | DOI:10.1111/jocd.70235

J Adv Nurs. 2025 May 28. doi: 10.1111/jan.17076. Online ahead of print.

ABSTRACT

AIM: To describe and compare attitudes toward hand hygiene and the perceived effectiveness of prevention methods among nursing students and registered nurses at a university and its affiliated university hospital.

DESIGN: A descriptive cross-sectional comparative survey.

METHODS: A total of 201 first- and final-semester nursing students and registered nurses completed the World Health Organisation’s ‘Perceptions Survey for Health-Care Workers’. The survey examined perceptions on hand hygiene, patient safety and the usefulness of improvement measures. Responses were analysed using descriptive statistics.

RESULTS: Nursing students consistently rated the importance of hand hygiene and related interventions higher than registered nurses. Students particularly emphasised the availability of hand disinfectants, ongoing education and supportive leadership. Both groups acknowledged the role of management support, regular feedback and organisational policies in reinforcing optimal hand hygiene.

CONCLUSION: Differences in attitudes between nursing students and registered nurses underscore the need for ongoing education, strong managerial involvement and supportive policies to sustain adherence. Strengthening these factors can help maintain positive perceptions formed during training and enhance patient safety in clinical practice.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Educational curricula and workplace strategies that prioritise hand hygiene may help lower healthcare-associated infections. Management-led feedback, continuous training and accessible hand hygiene resources offer additional support for safe patient care.

IMPACT: What problem did the study address? Low adherence to hand hygiene is a key driver of preventable infections. What were the main findings? Nursing students rated hand hygiene and improvement measures more highly than registered nurses, highlighting a need for strategies that sustain positive attitudes during the transition from education to clinical practice. Who will benefit? Nurse educators, clinical leaders and healthcare workers can use these findings to improve infection prevention across educational and practice settings.

REPORTING METHOD: We adhered to STROBE guidelines for cross-sectional research.

PATIENT OR PUBLIC CONTRIBUTION: No patients or members of the public were involved in designing or conducting this study, which focused on perceptions of nursing students and registered nurses.

PMID:40433679 | DOI:10.1111/jan.17076

Front Cell Infect Microbiol. 2025 May 13;15:1547601. doi: 10.3389/fcimb.2025.1547601. eCollection 2025.

ABSTRACT

INTRODUCTION: Since the first discovery and reporting of the COVID – 19 pandemic towards the end of 2019, the virus has rapidly propagated across the world. This has led to a remarkable spike in the number of infections. Even now, doubt lingers over whether it has completely disappeared. Moreover, the issue of restoring normal life while ensuring safety continues to be a crucial challenge that public health agencies and people globally are eager to tackle.

METHODS: To thoroughly understand the epidemic’s outbreak and transmission traits and formulate timely prevention measures to fully safeguard human lives and property, this paper presents an agent – based model incorporating individual – level factors.

RESULTS: The model designates Xi’an-where a characteristic disease outbreak occurred-as the research area. The simulation results demonstrate substantial consistency with official records, effectively validating the model’s applicability, adaptability, and generalizability. This validated capacity enables accurate prediction of epidemic trends and comprehensive assessment of disease risks.

DISCUSSION: From late 2021 to early 2022, it employs a one – to – one population simulation approach and simulates epidemic impacts and disease risks. Initially, using building statistical data in the study area, the model reconstructs the local real – world geographical environment. Leveraging data from the seventh national population census, it also replicates the study area’s population characteristics. Next, the model takes into account population mobility, contact tracing, patient treatment, and the diagnostic burden of COVID – 19 – like influenza symptoms. It integrates epidemic transmission impact parameters into the model framework. Eventually, the model’s results are compared with official data for validation, and it’s applied to hypothetical scenarios. It provides scientific theoretical tools to support the implementation of government – driven prevention and control measures. Additionally, it facilitates the adjustment of individual behavioral guidelines, promoting more effective epidemic management.

PMID:40433669 | PMC:PMC12106320 | DOI:10.3389/fcimb.2025.1547601

Front Cell Infect Microbiol. 2025 May 13;15:1455735. doi: 10.3389/fcimb.2025.1455735. eCollection 2025.

ABSTRACT

BACKGROUND: Probiotics are recognized as beneficial foods, but adverse reactions reported by individuals still exist. This study aims to analysis adverse events (AE) related to probiotics from the FAERS database from the first quarter (Q1) of 2005 to the fourth quarter (Q4) of 2023.

METHODS: The AE data related to probiotic from the 2005 Q1 to the 2023 Q4 were collected. R language was applied to analyze the standardized AE data and three algorithms including the reporting odds ratio (ROR), the proportional reporting ratio (PRR) and the empirical Bayes geometric mean (EBGM) were used to identify AE signals.

RESULTS: In this study, 10,698,312 reports were collected from the FAERS database, of which 74 probiotic-related adverse events were reported. About one third of the reported cases were older than 60 years.36.36% of the reported cases required Hospitalization. A total of 285 preference terms (PTS) and 15 system organ classes (SOC) were identified. In the overall analysis, only 9 PTs and 2 SOCs met significant disproportionality for all three algorithms simultaneously. SOCs included Gastrointestinal disorders (N=97, ROR=5.3, PRR=3.84, EBGM=3.84) and Hepatobiliary disorders (N=9, ROR =3.39, PRR=3.32, EBGM=3.32). PTs included Gastrointestinal pain (ROR=77.76, PRR=76.69, EBGM=76.63), Hypophagia (ROR=24.13, PRR=23.88, EBGM=28.88), and Hepatobiliary disorders (N=97, ROR=5.3, PRR=3.84, EBGM=3.84) and Flatulence (ROR=23.75, PRR=23.28, EBGM=23.27) were the top four highest. Meanwhile, s found new unique adverse signals such as Agitation (ROR=12.48, PRR=12.32, EBGM=12.32) and Anxiety (ROR=4.10, PRR=4.04, EBGM=4.04). Additionally, subgroup analyses were performed to identify AE signals based on gender and age. Metabolism and nutrition disorders (N=6, ROR=3.21, PRR=3.04, EBGM=3.04) and Asthenia (N=3, ROR=5.9, PRR=5.71, EBGM=5.71) were unique AE signal for the male group.

CONCLUSION: Although, the risk of adverse reactions arising from the application of probiotics cannot be ignored. However, However, the results of this FAERS-based study continue to support the overall safety of probiotic preparations. It is necessary to pay attention to the potential influence of factors such as gender and age on the effects and adverse reactions of probiotic application in basic research and clinical application.

PMID:40433664 | PMC:PMC12106448 | DOI:10.3389/fcimb.2025.1455735