Nevin Manimala

Medicine (Baltimore). 2025 Apr 11;104(15):e42105. doi: 10.1097/MD.0000000000042105.

ABSTRACT

In our study, we aimed to investigate the relationship between anti-müllerian hormone (AMH) and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) score, which are known to be increased in patients with polycystic ovary syndrome (PCOS), and morning blood pressure surge (MBPS), and whether these measurements are a marker for early cardiovascular disease risk in patients with PCOS. Forty patients aged between 18 and 65 years with hypertension (HT) and PCOS, 40 patients with HT but without PCOS, and 40 people representing the healthy control group were included in our prospective, cross-sectional study. All patients underwent ambulatory blood pressure measurement for 24 hours and MBPS was calculated. The study groups were divided into 3 groups as healthy control group (group 1), patient group with HT without PCOS (group 2), and patient group with HT and PCOS (group 3). MBPS was found to be statistically significantly higher in group 3. In linear regression analysis, AMH and HOMA-IR levels were found to be independently associated with MBPS. In patients with PCOS, AMH, and HOMA-IR levels were significantly higher in the group with MBPS > 25 mm Hg. Early diagnosis and treatment of PCOS and accompanying comorbidities can halt the progression of cardiac disorders and reduce cardiovascular mortality and morbidity. AMH level, HOMA-IR score, and MBPS measurement can be used in early detection and prediction of cardiovascular disease in PCOS patients.

PMID:40228266 | DOI:10.1097/MD.0000000000042105

Medicine (Baltimore). 2025 Apr 11;104(15):e41692. doi: 10.1097/MD.0000000000041692.

ABSTRACT

BACKGROUND: To evaluate the effect of laparoscopic procedures integrated with traditional Chinese medicine (TCM), specifically aimed at enhancing blood flow and alleviating blood stasis, on oxidative stress levels in individuals with endometriosis-induced infertility.

METHODS: We performed a systematic quantitative review to evaluate the effects of laparoscopic surgery combined with TCM on oxidative stress in endometriosis-related infertility by enhancing blood circulation and resolving stasis. A literature search of 9 major databases was performed. Meta-analysis was performed using Review Manager version 5.4 (R Foundation for Statistical Computing, Vienna, Austria) and Stata Release 16.0 (StataCorp LLC, College Station, TX). This systematic review was registered with the International Prospective Register of Systematic Reviews (i.e., “PROSPERO”) (registration number: CRD42024526800).

RESULTS: Thirteen trials comprising 1084 participants were included. Laparoscopy combined with TCM for promoting blood circulation and removing blood stasis significantly reduced the levels of 8-isoprostane prostaglandin F2α (mean difference [MD] -29.57 [95% confidence interval (CI) -32.65 to -26.49]; P < .001), regulated on activation, normal T cell expressed and secreted (MD -231.83 [95% CI -341.33 to -122.32]; P < .001), reactive oxygen species (MD -0.92; [95% CI -1.12 to -0.73]; P < .001), monocyte chemoattractant protein-1 (MD -31.23 [95% CI -42.70 to -19.77]; P < .001), and increased glutathione peroxidase (MD 31.45 [95% CI 26.04 to 36.87]; P < .001), vitamin E (MD 4.86 [95% CI 3.77 to 5.94]; P < .001), superoxide dismutase (standardized MD 0.92 [95% CI 0.41 to 1.42]; P < .001).

CONCLUSION: Compared with laparoscopic surgery alone, the combination of TCM for promoting blood circulation and removing blood stasis demonstrated the potential to ameliorate oxidative stress in patients with endometriosis-induced infertility. However, further large-scale clinical trials are required to confirm these findings.

PMID:40228263 | DOI:10.1097/MD.0000000000041692

Medicine (Baltimore). 2025 Apr 11;104(15):e42073. doi: 10.1097/MD.0000000000042073.

ABSTRACT

Anxiety is common in emergency department (ED) patients, affecting physiological stability, treatment adherence, and clinical outcomes. Standardized quality care models may alleviate these effects, but further validation is needed. This study evaluates the impact of a standardized quality care model on anxiety, physiological parameters, and quality of life in ED patients. This retrospective cohort study included 205 ED patients treated between January 2021 and December 2023, selected using consecutive sampling. Patients were categorized into the standardized quality care group (n = 95) or the routine care group (n = 110) based on prior nursing care. Anxiety and depression were assessed using SAS, HAMA, GAD-7, and self-depression scale (SDS), and psychological distress with SCL-90. Quality of life was measured using social functioning (SF)-36v2, while physiological indicators (heart rate, blood pressure, oxygen saturation), patient satisfaction, and medical compliance were recorded. Statistical analyses were conducted using SPSS 26.0, with independent sample t-tests or Mann-Whitney U tests for continuous variables and chi-square (χ²) tests for categorical variables (P < .05 considered significant). The standardized care group had significantly lower anxiety (SAS, HAMA, GAD-7) and depression (SDS) scores than the routine care group (P < .05). Moderate to severe psychological distress (SCL-90) was also lower (P = .015). Physiological indicators, including heart rate (P = .012), systolic blood pressure (P = .03), diastolic blood pressure (P = .03), and oxygen saturation (P = .03), improved significantly. At the 1-month follow-up, SF-36v2 scores, including physical component summary and mental component summary, were significantly higher in the standardized care group (P < .05). Patient satisfaction (χ² = 13.28, P = .004) and medical compliance (χ² = 6.01, P = .049) were also improved. The standardized quality care model effectively reduces anxiety and depression, enhances physiological stability, and improves quality of life, patient satisfaction, and treatment adherence in ED patients. These findings support integrating structured nursing interventions into ED care. Larger prospective studies are needed to validate long-term benefits and explore technology-driven enhancements.

PMID:40228261 | DOI:10.1097/MD.0000000000042073

Medicine (Baltimore). 2025 Apr 11;104(15):e42163. doi: 10.1097/MD.0000000000042163.

ABSTRACT

Pneumonia and other lower respiratory tract diseases rank as the fourth leading cause of death worldwide. The objective of this study was to examine pneumonia hospitalization patterns, and trends in total pneumonia hospitalization stratified by age group, by type of hospitalization, and by age group in Australia, England, Wales. This study utilized 3 databases to obtain hospital admissions data: the National Hospital Morbidity Database for Australian hospital admissions data, the Hospital Episode Statistics database (HES) for England hospital admissions data, and the Patient Episode Database for Wales. Pneumonia hospitalization data were extracted utilizing J12 to J18 codes. From 2013 to 2020, there were 4,514,444 cases of pneumonia hospitalizations reported in Australia (646,515 [14.32%]), England (3,668,106 [81.25%]), and Wales (199,823 [4.43%]). The most common type of pneumonia hospitalization in Australia, England, and Wales was “pneumonia, organism unspecified,” accounting for 77.12%, 95.49%, and 95.75% of the total number of pneumonia hospitalizations in each country, respectively. The most common subtype of pneumonia hospitalization in Australia was “pneumonia, unspecified,” accounting for 72.98% of the total number of pneumonia hospitalizations in the country. The most common type of pneumonia hospitalization in England and Wales was “lobar pneumonia, unspecified,” accounting for 59.00% and 56.73% of the total number of pneumonia hospitalizations in each country, respectively. Most pneumonia hospitalizations in Australia, England, and Wales were non-same-day hospitalizations, accounting for 90.78%, 99.91%, and 99.95%, respectively. Pneumonia hospitalizations in Australia, England, and Wales were directly related to age. Males accounted for most pneumonia hospitalizations in Australia, England, and Wales. This study highlighted that hospitalization rate for pneumonia increased during the past decade in Australia, England, and Wales. The age and male gender were clearly contributing factors that affected pneumonia hospitalizations rate. Educational campaign aiming to increase public knowledge of pneumonia, its risk factors, and lifestyle modification should be prioritized to decrease pneumonia episodes.

PMID:40228257 | DOI:10.1097/MD.0000000000042163

Medicine (Baltimore). 2025 Apr 11;104(15):e41961. doi: 10.1097/MD.0000000000041961.

ABSTRACT

This research seeks to thoroughly examine the present state and research hotspots in Mendelian randomization (MR) in osteoporosis (OP)-related fields, providing a reference for future research directions in this area. Following an exhaustive search of the Web of Science Core Collection database, our analysis utilized citation statistics for osteoporosis studies conducted from January 1, 2007, through March 15, 2024. Bibliometric and visual analyses were conducted using two online analysis systems, CiteSpace and VOSviewer. The analysis included a variety of dimensions, including the distribution of citations, authorship, published journals, year of publication, countries, co-occurrence keywords and keyword clustering. From 2007 to 2024, the number of publications in MR in OP-related fields showed an overall increased. High-impact publications and leading contributors were primarily from China, followed by the USA and England. The journal with the largest number of publications in MR in OP-related fields is the Journal of Bone and Mineral Research. Risk factor research, genome-wide associations, meta-analysis, fractures, and gene loci were the main research hotspots. Interdisciplinary integration, MR research combined with data from clinical trials and observational studies, represents the future development trend. Research on MR in OP-related fields has mainly been conducted in China, the USA, and England. The research hotspots were aimed at exploring the causative between risk factors and OP. Future studies are likely to center on multidisciplinary integration.

PMID:40228251 | DOI:10.1097/MD.0000000000041961

Medicine (Baltimore). 2025 Apr 11;104(15):e42119. doi: 10.1097/MD.0000000000042119.

ABSTRACT

Autism Spectrum Disorder (ASD), characterized mainly by stereotyped behaviors and social impairments, affects about one in 100 children worldwide. Schizophrenia (SCZ), a chronic mental illness, affects 1% of the global population. The pathogenesis and specific treatment strategies for ASD and SCZ remain unclear. Previous research has suggested similarities in SCZ and ASD etiology and symptoms. However, no definitive correlation has been confirmed. Therefore, we conducted a Mendelian randomization study to assess the relationship between SCZ and ASD, providing new insights into their etiology and treatment. We used the two-sample Mendelian randomization (TSMR) approach to investigate the bidirectional causal association between SCZ and ASD, employing summary-level genome-wide association studies (GWAS) data. ASD summary data from the IEU GWAS database and SCZ summary data from the Psychiatric Genomics Consortium (PGC) were used as exposure and outcome variables, respectively. Statistical analysis was performed using the TwoSampleMR package in R version 4.3.2, with sensitivity analysis conducted to verify the result’s reliability. Based on the results of the MR analysis, we retrieved and analyzed the relevant genetic information from the GWAS Catalog. TSMR analysis revealed higher ASD risk in SCZ (IVW: OR: 1.19, 95% CI: 1.12-1.26, P < .001). Bidirectional MR analysis confirmed a causal relationship between ASD and SCZ (IVW: scz2018clozuk (Clozapine UK), OR: 1.12, 95% CI: 1.04-1.21, P = .003; scz2019asi, OR: 1.14, 95% CI: 1.05-1.23, P = .002). Our study demonstrated a bidirectional relationship between SCZ and ASD in the European population, suggesting that each may induce the onset of the other.

PMID:40228250 | DOI:10.1097/MD.0000000000042119

J Med Internet Res. 2025 Apr 14;27:e67772. doi: 10.2196/67772.

ABSTRACT

BACKGROUND: Crisis hotlines serve as a crucial avenue for the early identification of suicide risk, which is of paramount importance for suicide prevention and intervention. However, assessing the risk of callers in the crisis hotline context is constrained by factors such as lack of nonverbal communication cues, anonymity, time limits, and single-occasion intervention. Therefore, it is necessary to develop approaches, including acoustic features, for identifying the suicide risk among hotline callers early and quickly. Given the complicated features of sound, adopting artificial intelligence models to analyze callers’ acoustic features is promising.

OBJECTIVE: In this study, we investigated the feasibility of using acoustic features to predict suicide risk in crisis hotline callers. We also adopted a machine learning approach to analyze the complex acoustic features of hotline callers, with the aim of developing suicide risk prediction models.

METHODS: We collected 525 suicide-related calls from the records of a psychological assistance hotline in a province in northwest China. Callers were categorized as low or high risk based on suicidal ideation, suicidal plans, and history of suicide attempts, with risk assessments verified by a team of 18 clinical psychology raters. A total of 164 clearly categorized risk recordings were analyzed, including 102 low-risk and 62 high-risk calls. We extracted 273 audio segments, each exceeding 2 seconds in duration, which were labeled by raters as containing suicide-related expressions for subsequent model training and evaluation. Basic acoustic features (eg, Mel Frequency Cepstral Coefficients, formant frequencies, jitter, shimmer) and high-level statistical function (HSF) features (using OpenSMILE [Open-Source Speech and Music Interpretation by Large-Space Extraction] with the ComParE 2016 configuration) were extracted. Four supervised machine learning algorithms (logistic regression, support vector machine, random forest, and extreme gradient boosting) were trained and evaluated using grouped 5-fold cross-validation and a test set, with performance metrics, including accuracy, F₁-score, recall, and false negative rate.

RESULTS: The development of machine learning models utilizing HSF acoustic features has been demonstrated to enhance recognition performance compared to models based solely on basic acoustic features. The random forest classifier, developed with HSFs, achieved the best performance in detecting the suicide risk among the models evaluated (accuracy=0.75, F₁-score=0.70, recall=0.76, false negative rate=0.24).

CONCLUSIONS: The results of our study demonstrate the potential of developing artificial intelligence-based early warning systems using acoustic features for identifying the suicide risk among crisis hotline callers. Our work also has implications for employing acoustic features to identify suicide risk in salient voice contexts.

PMID:40228243 | DOI:10.2196/67772

JMIR Mhealth Uhealth. 2025 Apr 14;13:e55433. doi: 10.2196/55433.

ABSTRACT

BACKGROUND: Despite the effects of poor relationship quality on individuals’, couples’, and families’ well-being, help seeking often does not occur until problems arise. Digital interventions may lower barriers to engagement with preventive relationship care. The Paired app, launched in October 2020, aims to strengthen and enhance couple relationships. It provides daily questions, quizzes, tips, and detailed content and facilitates in-app sharing of question and quiz responses and tagged content between partners.

OBJECTIVE: To explore the potential of mobile health to benefit couple relationships and how it may do this, we examined (1) Paired’s impact on relationship quality and (2) its mechanisms of action.

METHODS: This mixed methods evaluation invited Paired subscribers to complete (1) brief longitudinal surveys over 3 months (n=440), (2) a 30-item web-based survey (n=745), and (3) in-depth interviews (n=20). For objective 1, survey results were triangulated to determine associations between relationship quality measures and the duration and frequency of Paired use, and qualitative data were integrated to provide explanatory depth. For objective 2, mechanisms of action were explored using a dominant qualitative approach.

RESULTS: Relationship quality improved with increasing duration and frequency of Paired use. Web-based survey data indicate that the Multidimensional Quality of Relationship Scale score (representing relationship quality on a 0-10 scale) was 35.5% higher (95% CI 31.1%-43.7%; P=.002), at 7.03, among people who had used Paired for >3 months compared to 5.19 among new users (≤1 wk use of Paired), a trend supported by the longitudinal data. Of those who had used Paired for >1 month, 64.3% (330/513) agreed that their relationship felt stronger since using the app (95% CI 60.2%-68.4%), with no or minimal demographic differences. Regarding the app’s mechanisms of action, interview accounts demonstrated how it prompted and habituated meaningful communication between partners, both within and outside the app. Couples made regular times in their day to discuss the topics Paired raised. Daily questions were sometimes lighthearted and sometimes concerned topics that couples might find challenging to discuss (eg, money management). Interviewees valued the combination of fun and seriousness. It was easier to discuss challenging topics when they were raised by the “neutral” app, rather than during stressful circumstances or when broached by 1 partner. Engagement seemed to be enhanced by users’ experience of relationship benefits and by the app’s design.

CONCLUSIONS: This study demonstrates proof of concept, showing that Paired may have the potential to improve relationship quality over a relatively short time frame. Positive relationship practices became embedded within couples’ daily routines, suggesting that relationship quality improvements might be sustained. Digital interventions can play an important role in the relationship care ecosystem. The mixed methods design enabled triangulation and integration, strengthening our findings. However, app users were self-selecting, and methodological choices impact our findings’ generalizability.

PMID:40228241 | DOI:10.2196/55433

J Med Internet Res. 2025 Apr 14;27:e55621. doi: 10.2196/55621.

ABSTRACT

BACKGROUND: Concerned significant others (CSOs) play a significant role in supporting individuals with substance use disorders. There is a lack of tailored support services for these CSOs, despite their substantial contributions to the well-being of their loved ones (LOs). The emergence of helplines as a potential avenue for CSO support is outlined, culminating in the focus on the Partnership to End Addiction’s helpline service, an innovative public health intervention aimed at aiding CSOs concerned about an LO’s substance use.

OBJECTIVE: The article analyzes the demographics and use patterns of the Partnership to End Addiction’s helpline service, highlighting the critical role of such services, and advocating for expanded, tailored support models.

METHODS: This observational study draws data from 8 data platforms spanning April 2011 to December 2021, encompassing 24,096 client records. Surveys were completed by helpline specialists during synchronous telephone calls or self-reported by CSOs before helpline engagement. Collected information encompasses demographics, interaction language, substance of concern, CSO-LO relationship, and the LO’s “use state,” that is, their location on the continuum of substance use.

RESULTS: CSOs primarily comprised women (13,980/18,373, 76.1%) seeking support for their children (1062/1542, 68.9%). LOs were mostly male (1090/1738, 62.7%), aged 18-25 years (2380/7208, 33%), with primary substance concerns being cannabis (5266/12,817, 40.9%), opioids (2445/12,817, 19%), and stimulants (1563/12,817, 12.1%). CSOs primarily sought aid for LOs struggling with substances who were not in treatment (1102/1753, 62.9%). The majority of CSOs were looking for support in English (14,738/17,920, 82.2%), while the rest (3182/17,920, 17.8%) preferred to communicate in Spanish. Spanish-speaking CSOs were significantly more likely to call about cannabis (n=963, 53.7% vs n=4026, 38.6%) and stimulants (n=304, 16.9% vs n=1185, 11.3%) than English-speaking CSOs (P<.001). On the other hand, English-speaking CSOs were more likely to be concerned about opioids than Spanish-speaking CSOs (n=2215, 21.3% vs n=94, 5.2%; P<.001).

CONCLUSIONS: The study illuminates the helpline’s pioneering role in aiding CSOs grappling with an LO’s substance use. It highlights helplines as crucial resources for CSOs, revealing key demographic, substance-related, and use-state trends. The dominant presence of women among users aligns with other helpline patterns and reflects traditional caregiving roles. While parents form a significant percentage of those reaching out, support is also sought by siblings, friends, and other family members, emphasizing the need for assistance for other members of an LO’s social network. Spanish-speaking individuals’ significant outreach underscores the necessity for bilingual support services. Substance concerns revolve around cannabis, opioids, and stimulants, influenced by age and language preferences. The helpline serves as an essential intermediary for CSOs, filling a gap between acute crisis intervention services and formalized health care and treatment services. Overall, the study highlights this helpline’s crucial role in aiding CSOs with tailored, accessible support services.

PMID:40228240 | DOI:10.2196/55621

Cancers (Basel). 2025 Apr 2;17(7):1209. doi: 10.3390/cancers17071209.

ABSTRACT

OBJECTIVES: Inflammatory fibroid polyps, also known as Vanek’s tumors, are rare benign lesions of the gastrointestinal tract. Although the exact cause remains unclear, several theories suggest an association with inflammatory processes and genetic factors. This study aims to present the largest cohort of inflammatory fibroid polyp cases to date, analyzing their clinical presentation, diagnostic methods, and treatment approaches.

MATERIALS AND METHODS: A retrospective multicentric analysis was conducted on 67 patients diagnosed with inflammatory fibroid polyps between 2013 and 2023 across four hospitals. Clinical data regarding tumor location, size, symptoms, and treatment were collected. Non-parametric statistical tests, including the chi-square test, Cramér’s V coefficient, and the Mann-Whitney U test, were used to identify association between tumor characteristics, location, and treatment outcomes.

RESULTS: The cohort included 67 patients (58.2% female, median age 60 years). The stomach was the most common tumor site (47.8%), followed by the colon (32.8%), and small intestine (10.4%). The majority of patients (73.1%) were asymptomatic, while 9% experienced intestinal obstruction, all of which were located in the small intestine. Endoscopic resection was successful in 77.6% of cases, but surgical intervention was more frequently required for tumors in the small intestine. A significant association was found between larger tumor size, emergency presentation, intestinal location, and the need for surgery.

CONCLUSIONS: Inflammatory fibroid polyps are commonly managed with endoscopic resection, particularly in gastric and colonic locations. However, small intestinal tumors more often need surgical treatment, especially when presenting with complications like intestinal obstruction.

PMID:40227778 | DOI:10.3390/cancers17071209