Nevin Manimala

Medicine (Baltimore). 2025 Feb 14;104(7):e41582. doi: 10.1097/MD.0000000000041582.

ABSTRACT

This study shares our 5-year experience with chorionic villus sampling (CVS) and analyzes the indications, results, and complications of this procedure. We conducted a retrospective analysis of data from singleton pregnancies that underwent CVS between 2015 and 2020 at the Maternal-Fetal Medicine Unit of Health Science University, Izmir Tepecik Research, and Training Hospital. Maternal demographics, indications, karyotype results, and pregnancy outcomes were recorded. We retrospectively analyzed data from 468 CVS procedures, conducted between 2015 and 2020. The most common indications for CVS were positive screening test results in the first trimester, fetal structural abnormalities, and increased nuchal translucency (NT) observed during ultrasound. Fetal structural abnormalities had the highest detection rate, at 34.5% for chromosomal abnormalities, followed by increased NT and first-trimester screen-positive test results (26.9% and 11.3%), respectively. The culture success rate was 96.3% (451 out of 468). The most prevalent chromosomal abnormalities were numerical, including Trisomy 21 (10.9%), Trisomy 18 (4.2%), and Trisomy 13 (1.9%). Results could not be obtained in 17 patients (3.6%); 12 (2.5%) were due to insufficient samples and culture failure, while 5 (1.06%) were due to maternal contamination. Amniocentesis was required as a secondary sampling in 24 cases (5.1%) and performed in 17 cases (3.6%). This study emphasizes the significance of CVS in prenatal diagnosis and the management of high-risk pregnancies. However, we must be aware of the associated risks and limitations, which include culture success rates, inconclusive results, and the occasional need for secondary sampling.

PMID:39960922 | DOI:10.1097/MD.0000000000041582

Medicine (Baltimore). 2025 Feb 14;104(7):e41498. doi: 10.1097/MD.0000000000041498.

ABSTRACT

BACKGROUND: Breast cancer as the malignant tumor with the highest incidence and mortality rate among the global female population. Insomnia is a common complaint in breast cancer patients, more than one-third (38-47%) of breast cancer patients suffer it. Auricular acupressure (AA), a non-pharmacological therapy, has been used in the studies to intervene in insomnia in breast cancer patients. The objective of this systematic review and meta-analysis is to investigate the efficacy and safety of AA therapy in intervening with insomnia in breast cancer.

METHODS: A systematic literature search was performed for 10 databases up to January of 2024 to identify randomized control trials (RCTs). The methodological quality of RCTs was assessed independently using the Cochrane Handbook for Systematic Reviews of Interventions. The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation approach. Data were screened and extracted independently using predesigned forms. The meta-analysis was conducted using RevMan 5.3 software, P-value < .05 means statistically significant.

RESULTS: This review included 15 studies from 3 different countries with a total of 1125 adult participants. The pooled results showed that AA significantly in improving sleep quality (mean difference [MD] = -3.36, 95% confidence interval [CI]: [-4.65, -2.07], P < .001) and life quality (MD = -7.82, 95% CI: [-14.76, -0.88], P = .03). Based on data from sleep monitoring devices, AA was valuable for improving sleep efficiency (MD = -3.63, 95% CI: [-4.19,-3.07], P = .03) in breast cancer patients. Adverse events were reported in 5 RCTs. Common adverse reactions include auricular skin allergic reaction (10/259, 3.9%), bruising (7/259, 2.7%), pain (3/259, 1.2%), and local pressure ulcers on the auricular points (2/259, 0.8%). The evidence grade was moderate because of the substantial heterogeneity among studies. Heart, Shenmen, and Subcortex were the 3 most numerous auricular points, with a total share of up to 71.70%.

CONCLUSION: This systematic review and meta-analysis demonstrates the efficacy and safety of AA in intervening insomnia in breast cancer patients, providing a basis for the selection of clinical auricular points. However, the high-quality RCTs in existence are not enough, and more rigorous trials are needed to identify the efficacy of AA and insomnia.

PMID:39960920 | DOI:10.1097/MD.0000000000041498

Medicine (Baltimore). 2025 Feb 14;104(7):e41439. doi: 10.1097/MD.0000000000041439.

ABSTRACT

So far, there is no clear pathogenesis and no cure for systemic lupus erythematosus (SLE). The therapeutic benefits of existing drug therapies are far from ideal. The proteome is a major source of therapeutic targets. Therefore, new drug targets for SLE need to be discovered. Based on the STROBE-Mendelian randomization (MR) checklist, we performed MR to explore potential drug targets for SLE, using genome-wide association study summary statistics of plasma and cerebrospinal fluid (CSF) and further replicated in the external validation. Bidirectional MR, reverse causality testing by Steiger filtering, Bayesian co-localization were used. In addition, protein-protein interaction networks (PPI) were performed to reveal potential associations between proteins and current SLE drugs. At false discovery rate (FDR) significance (PFDR < .05), MR analysis revealed 8 proteins. Five proteins decreased the SLE risks, whereas the other 3 proteins increased the SLE risks. None of the 8 proteins had reverse causality except sICAM-1. Bayesian co-localization suggested that 5 proteins shared the same variant with SLE. PPI network suggested that intercellular adhesion molecular 1 (ICAM-1), Fc-gamma-RIIb (FCG2B) and N-terminal pro-B-type natriuretic peptide (N-terminal pro-BNP) interacted with targets of current SLE medications. Our integrative analysis revealed that SLE risk is causally associated with ICAM-1, FCG2B, and N-terminal pro-BNP. These 3 proteins have the potential to become drug targets of SLE, especially for ICAM-1 and FCG2B. More further studies are also warranted to support this finding.

PMID:39960916 | DOI:10.1097/MD.0000000000041439

Medicine (Baltimore). 2025 Feb 14;104(7):e41539. doi: 10.1097/MD.0000000000041539.

ABSTRACT

BACKGROUND: Vocal cord leukoplakia is a precancerous lesion for which early surgical intervention following ineffective conservative treatment is the predominant approach. Carbon dioxide (CO2) laser treatment is a novel, minimally invasive therapy. However, there is insufficient evidence to suggest that CO2 laser treatment is superior to conventional surgical methods in terms of efficacy and safety. Therefore, this meta-analysis aimed to evaluate the efficacy and safety of CO2 laser treatment vs conventional surgical treatment for vocal cord leukoplakia.

METHODS: A literature search was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across 8 databases. Studies on the use of carbon dioxide laser therapy for vocal cord leukoplakia were included in the review. Two researchers conducted a systematic search for randomized controlled trials in PubMed, Embase, Cochrane, Web of Science, China National Knowledge Infrastructure, Wanfang, Chinese Science and Technology Periodical Database, and Chinese Biomedical Literature databases. Meta-analysis was performed using Stata 18.0, and RevMan 5.2 software.

RESULTS: The findings indicated that Compared with conventional surgery, CO2 laser surgery significantly reduced the recurrence rate of vocal cord leukoplakia (odds ratio [OR] = 0.25, 95% confidence interval, CI [0.12, 0.51]). CO2 laser surgery significantly improved the cure rate of vocal cord leukoplakia (OR = 3.07, 95% CI [1.17, 8.09]). Voice quality following CO2 laser surgery was significantly superior to that following conventional surgery, particularly in terms of fundamental frequency disturbance (standardized mean difference [SMD] = -0.8, 95% CI [-1.25, -0.34]) and amplitude disturbance (SMD = -0.52, 95% CI [-0.95, -0.09]). The CO2 laser group exhibited a lower incidence of postoperative adverse reactions (OR = 0.32, 95% CI [0.03, 3.19]); however, this difference was not statistically significant.

CONCLUSION: The results of this meta-analysis suggest that CO2 laser surgery can reduce the recurrence rate of vocal cord leukoplakia, improve the cure rate, and enhance voice quality. Therefore, CO2 laser surgery is recommended as a minimally invasive surgical approach for vocal cord leukoplakia.

PMID:39960915 | DOI:10.1097/MD.0000000000041539

Medicine (Baltimore). 2025 Feb 14;104(7):e41388. doi: 10.1097/MD.0000000000041388.

ABSTRACT

Spondyloarthritis (SpA) encompasses a group of inflammatory joint disorders affecting the spine and joints, including ankylosing spondylitis and nonradiographic axial SpA, exhibiting diverse extra-articular manifestations. Genetic factors, beyond human leukocyte antigen B27, play a significant role in SpA development. Leveraging advanced statistical methods, this study explores bidirectional Mendelian randomization (MR) and Bayesian colocalization to unravel the genetic links between SpA and its extra-articular manifestations. Positive MR analysis indicates causal relationships between ankylosing spondylitis and various extra-articular conditions. Leave-one-out analysis suggests that these effects are not driven by individual single-nucleotide polymorphisms. In reverse MR, potential reverse causal relationships are explored, revealing uveitis, inflammatory bowel disease, and ulcerative colitis as candidates. Colocalization analysis, unfortunately, does not identify shared genetic foundations. In conclusion, seronegative spinal arthritis may lead to myocarditis, atrioventricular block, bronchiectasis, Crohn disease, and coccygeal plexus syndrome, while there is a 2-way causal relationship with uveitis, inflammatory bowel disease, and ulcerative colitis.

PMID:39960913 | DOI:10.1097/MD.0000000000041388

Anemia. 2025 Feb 7;2025:5695022. doi: 10.1155/anem/5695022. eCollection 2025.

ABSTRACT

Background and Objective: IDA and chronic headache disorders such as migraines and tension-type headaches are common conditions that significantly affect quality of life. Emerging evidence suggests a bidirectional relationship between these two conditions. This systematic review and meta-analysis aimed to explore and quantify the association between iron deficiency anemia (IDA) and chronic headache disorders, with a focus on understanding the bidirectional nature of this relationship. Methods: A comprehensive literature search was conducted across PubMed, Embase, and Web of Science to identify relevant studies published up until August 10, 2024. Observational studies examining the prevalence, incidence, or association between IDA and chronic headache disorders were included. Data were extracted and assessed for quality using the Newcastle-Ottawa Scale. Meta-analyses were performed using a random-effects model to calculate pooled prevalence rates and risk ratios (RRs), with heterogeneity assessed via the I ² statistic and meta-regression. A sensitivity analysis was conducted using the leave-one-out approach, and publication bias was evaluated through a funnel plot. Results: The meta-analysis included 13 studies: five studies examined chronic headaches among patients with IDA, and eight studies examined IDA among patients with chronic headaches. The pooled prevalence of chronic headaches among patients with IDA was 38% (95% CI: 15%-69%). In addition, 20% (95% CI: 10%-35%) of patients with chronic headaches were found to have IDA. Anemic patients were found to have a 76% higher risk of developing chronic headaches compared to nonanemic individuals (RR: 1.76; 95% CI: 1.22-2.52). Significant heterogeneity was observed across the studies. Conclusion: This meta-analysis demonstrates a significant association between IDA and chronic headache disorders, with a pooled prevalence of 38% for chronic headaches in IDA patients and 20% for IDA in chronic headache patients. IDA was associated with a 76% higher risk of chronic headaches. Routine screening for IDA in high-risk populations may improve headache outcomes, but further longitudinal studies are needed to establish causality and refine management strategies.

PMID:39959849 | PMC:PMC11828653 | DOI:10.1155/anem/5695022

MedEdPORTAL. 2025 Feb 14;21:11499. doi: 10.15766/mep_2374-8265.11499. eCollection 2025.

ABSTRACT

INTRODUCTION: With increasing rates of fatal opioid overdoses and substance use disorders, discussing harm reduction strategies in undergraduate medical education is imperative. Medical students learn opioid pharmacology but often lack adequate training in recognizing and responding to opioid overdoses. Incorporating naloxone training into preclinical undergraduate medical education can be lifesaving.

METHODS: This educational activity trained second-year medical students in opioid overdose recognition and response. The 2-hour interactive session included an informative presentation on opioid use statistics, harm reduction, and opioid overdose; a case-based learning session; and hands-on practice on task trainers using an OSCE-style checklist. Student confidence in four areas was assessed through pre- and posttraining surveys on 5-point Likert scales. Data analysis was conducted using R (programming language), with exploratory analyses for sample size, normality, and variable selection. The Wilcoxon signed rank test evaluated changes in attitudes from pre- to posttest.

RESULTS: Eighty-six students participated, with 60 completing pre- and posttest surveys. Significant improvements were observed in confidence across all areas: assessing an opioid overdose (p < .001), administering naloxone (p < .001), continuing management after naloxone (p < .001), and training others on naloxone administration (p < .001).

DISCUSSION: Early training in opioid overdose management increased second-year medical students’ confidence in key areas, potentially enabling them to better combat the crisis during their clinical years and educate at-risk patients. Future activities should incorporate objective skill assessments to evaluate competency and explore long-term knowledge retention during clinical rotations.

PMID:39959842 | PMC:PMC11825861 | DOI:10.15766/mep_2374-8265.11499

PeerJ. 2025 Feb 11;13:e18873. doi: 10.7717/peerj.18873. eCollection 2025.

ABSTRACT

BACKGROUND: Acute myocardial infarction (AMI) significantly contributes to the progression of heart failure (HF). Standard treatment for HF has long been angiotensin-converting enzyme inhibitors (ACEIs), targeting the renin-angiotensin-aldosterone system (RAAS). Recent developments in HF management introduced sacubitril/valsartan (S/V), a novel angiotensin receptor-neprilysin inhibitor (ARNI), showing promising results in global trials. This study aimed to assess the efficacy of early S/V application compared to angiotensin-converting enzyme inhibitors (ACEIs) in reducing NT-proBNP levels and improving clinical outcomes, specifically focusing on dyspnea symptomatology, in Chinese patients with AMI complicated by HF.

METHODS: This single-center, mixed methods study was conducted at Tangshan Gongren Hospital from January to December 2021, including 88 patients diagnosed with AMI and HF. Patients were divided into two groups: 31 received S/V, while 57 were treated with ACEIs. Data collection encompassed baseline demographic, clinical, and biochemical variables, NT-proBNP levels, blood pressure measurements, and dyspnea symptom severity. Follow-up assessments were conducted 1 year post-discharge to evaluate NT-proBNP levels, and symptom progression. Statistical analyses, including t-tests, Wilcoxon rank-sum tests, and chi-square tests, were performed to compare outcomes between the two groups.

RESULTS: At baseline, no significant differences were observed between the two groups in terms of demographic, lifestyle, and medical history. Although patients in the S/V group presented with more severe baseline renal impairment and cardiac dysfunction, there was no significant difference in NT-proBNP levels from admission to discharge. 1-year follow-up showed a trend towards reduced NT-proBNP levels in the S/V group, though this difference did not reach statistical significance. All patients in both groups reported improvements in dyspnea at discharge and at follow-up, with no significant inter-group difference. Notably, the S/V group demonstrated a more significant reduction in both systolic and diastolic blood pressure from admission to discharge compared to the ACEIs group.

CONCLUSIONS: This study found that S/V had similar effects to ACEIs in reducing NT-proBNP levels among Chinese patients with AMI complicated by HF, though S/V was associated with greater reductions in blood pressure. These findings suggest that while S/V may offer additional benefits in blood pressure management, its impact on cardiac biomarkers in acute settings may not significantly differ from ACEIs. Given the study’s limitations, including its single-center design, small sample size, and baseline differences. Further multi-center, randomized controlled trials are warranted to validate these findings and explore tailored treatment strategies for AMI patients with concurrent HF.

PMID:39959840 | PMC:PMC11827574 | DOI:10.7717/peerj.18873

PeerJ. 2025 Feb 12;13:e18870. doi: 10.7717/peerj.18870. eCollection 2025.

ABSTRACT

BACKGROUND: Bladder cancer is a growing health concern, especially in developing countries like Türkiye. Intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is essential for reducing recurrence and progression in non-muscle invasive bladder cancer (NMIBC). However, it can cause local and systemic adverse effects linked to bacterial virulence, allergic reactions, or nosocomial infections. Data from randomized studies on BCG side effects are limited, with severe cases often reported in case studies. This study investigates the association between intravesical BCG immunotherapy and its adverse effects.

METHODS: A retrospective analysis was conducted on 239 patients who underwent BCG immunotherapy between 2017 and 2024. Detailed demographic, clinical, and laboratory data were collected, and the adverse effects that developed following BCG therapy were evaluated. Descriptive statistics, including medians, counts, and percentage distributions, were calculated, and logistic regression analysis was performed to identify factors influencing the development of adverse effects.

RESULTS: Adverse effects related to BCG immunotherapy were observed in 63.1% of the patients. The most common minor adverse effects were hematuria, dysuria, and cystitis, while major adverse effects included sepsis and lymphadenopathy. The analyses revealed that elevated aspartate aminotransferase (AST) levels and the presence of Escherichia coli and Enterococcus faecalis in urine cultures were significant risk factors for the development of adverse effects. Additionally, patients who underwent the 6th cycle of BCG therapy were found to have a higher risk of developing adverse effects compared to those who received fewer cycles.

CONCLUSION: BCG immunotherapy is an effective treatment method for NMIBC; however, the adverse effects that occur during treatment must be closely monitored. Elevated AST levels, the presence of specific pathogens in urine cultures, and the number of BCG doses administered are significant factors that increase the risk of adverse effects. These findings highlight the necessity for more careful monitoring throughout the treatment process.

PMID:39959825 | PMC:PMC11829628 | DOI:10.7717/peerj.18870

PeerJ. 2025 Feb 13;13:e18957. doi: 10.7717/peerj.18957. eCollection 2025.

ABSTRACT

BACKGROUND: The effects of visceral fat and body fat on osteoporosis (OP) have long been controversial. This study investigated the correlation between visceral fat and bone mineral density (BMD) in perimenopausal women aged 40-60. The goal was to evaluate the current state of BMD and its influencing factors, with the specific objective of establishing a foundation for preventing and treating osteoporosis in this demographic.

METHODS: This case-control study included female participants (n = 330), aged 40-60 years, from the Health Management Center of Guilin Medical College Affiliated Hospital, China, between January 2020 to August 2023. Their BMD was assessed using an ultrasound bone mineral density meter, and the visceral fat area was determined utilizing a body composition analyzer. Furthermore, past medical history, dietary habits, and lifestyle factors were collected through a telephonic questionnaire survey. Additionally, we analyzed the baseline characteristics of the population, bone status and visceral fat status, and the relationship between these variables.

RESULTS: Among perimenopausal women with varying bone mineral density statuses, there was no significant difference regarding body fat percentage (p = 0.359). In contrast, a statistically significant difference was observed regarding visceral fat area (p < 0.001) and vitamin D (p < 0.001). The visceral fat area exhibited an inverse correlation with bone density (r = -0.313, p < 0.001). Additionally, mediation analysis outcomes did not support the hypothesis that visceral fat affects bone density through its influence on vitamin D levels (p = 0.92).

CONCLUSIONS: Among perimenopausal women, visceral fat is negatively associated with bone density, suggesting that the distribution of body fat rather than the total amount plays a pivotal role in the development of osteoporosis. These findings suggest the significance of regular physical exercise and the abdominal fat distribution for perimenopausal women.

PMID:39959823 | PMC:PMC11830370 | DOI:10.7717/peerj.18957