Nevin Manimala

Medicine (Baltimore). 2025 Jan 3;104(1):e41116. doi: 10.1097/MD.0000000000041116.

ABSTRACT

The study aims to compare the efficacy of flexible ureteroscopy (FURS) with holmium laser lithotripsy (HLL, herein collectively referred to as FURS-HLL) and percutaneous nephrolithotomy (PCNL) in the treatment of complex upper urinary tract calculi in elderly patients, highlighting the advantages of FURS-HLL. A total of 40 elderly patients (aged ≥ 60) with complex upper urinary tract calculi admitted to the Department of Urology, Fuyong People’s Hospital from October 2020 to October 2023 were randomly divided into 2 groups on the basis of the treatment they received: the FURS-HLL group (preset ureteral stent) and the PCNL group. The operation time, intraoperative blood loss, hospital stay, stone-free rate, and postoperative complications (fever, hematuria, infection, and severe urinary tract injury) were compared and analyzed between the 2 groups. There were no statistically significant differences in the average age, sex, stone diameter, stone type, and underlying diseases between the 2 groups (P > .05). The FURS-HLL group had significantly less intraoperative blood loss, shorter hospital stays, and longer operation time than the PCNL group (P < .05). The postoperative infection rate and the 1-week stone-free rate were lower in the FURS-HLL group than in the PCNL group (P < .05). However, there were no statistically significant between-group differences in postoperative fever, hematuria, urinary tract injury, 1-month stone-free rate, and the rate of secondary surgery (P > .05). FURS-HLL can significantly improve the stone-free rate and reduce postoperative complications, making it an ideal surgical approach for elderly patients with complex upper urinary tract calculi.

PMID:40184126 | DOI:10.1097/MD.0000000000041116

Medicine (Baltimore). 2025 Jan 3;104(1):e41204. doi: 10.1097/MD.0000000000041204.

ABSTRACT

RATIONALE: Conservative treatment has shown limited effectiveness in managing thoracolumbar tuberculosis (TB) that extends to the intervertebral space, as antibiotics are unable to penetrate avascular intervertebral discs, while conventional surgery is known for its extensive trauma and slow healing process.

PATIENT CONCERNS: Infection of the thoracic and lumbar vertebrae with tuberculosis can lead to difficulties in treatment due to involvement of the intervertebral space.

DIAGNOSIS: The diagnosis of TB was confirmed through clinical manifestations, impact studies, and T-spot experiments.

INTERVENTIONS: A retrospective analysis was conducted on the clinical data of 8 patients with thoracolumbar spinal TB who underwent postural drainage focusing on the intervertebral space as a treatment from June 2012 to August 2019. The average duration of treatment was 7.75 ± 10.19 months. Among the patients, there were 2 cases of thoracolumbar and 6 cases of lumbar spine involvement, with 6 cases affecting a single segment and 2 cases involving 2 segments. The total number of affected vertebrae included 4 thoracic, 12 lumbar, and 2 sacral vertebrae. All patients received standardized quadruple antituberculosis treatment (HRZE scheme). Specific postural drainage paths and catheter placement locations were determined based on clinical imaging results, and percutaneous catheter placement was performed with the assistance of foraminoscopy. Erythrocyte sedimentation rate, C-reactive protein, Visual Analogue Scale score, American Spinal Cord Injury Association score, and Oswestry function index were statistically analyzed before, after postural drainage, and at the final follow-up.

OUTCOMES: The average operation time was 44.38 ± 10.50 minutes, with a blood loss of 6.88 ± 2.59 mL. The average catheter drainage time was 13.25 ± 4.95 days, and the follow-up period ranged from 36 to 122 months. The average total drainage volume was 281.25 ± 167.69 mL. Significant improvements were observed in erythrocyte sedimentation rate, C-reactive protein, Visual Analogue Scale score, American Spinal Cord Injury Association score, and Oswestry functional index at 7 days after postural drainage and at the last follow-up compared to before postural drainage (P < .05). At the last follow-up, there were 8 cases with no recurrence reported among the patients.

LESSONS: The utilization of positional drainage in the intervertebral space, coupled with chemotherapy, has demonstrated encouraging clinical results and may be deemed appropriate for treatment.

PMID:40184121 | DOI:10.1097/MD.0000000000041204

Medicine (Baltimore). 2025 Jan 3;104(1):e41185. doi: 10.1097/MD.0000000000041185.

ABSTRACT

Medical students represent the future of the healthcare workforce. However, the demanding nature of medical education places them at an increased risk of mental health issues. Ensuring their mental well-being is crucial for maintaining a competent and compassionate healthcare system. This study aims to determine the prevalence of depression, anxiety, and stress, along with barriers to accessing mental health services among medical students. A cross-sectional self-administered online survey conducted among medical students of Jazan University, Saudi Arabia, from September 2023 to March 2024. Descriptive and inferential statistical analyses were conducted using International Business Machines Corporation Statistical Package for the Social Sciences version 27.0.1 (Chicago). The study included 390 participants. Median scores for depression, anxiety, and stress were 14.00, 12.00, and 16.00, respectively, with interquartile ranges of 4.00 to 22.00, 4.00 to 20.00, and 6.00 to 24.00. Depression severity categories showed that 38.2% were normal, while 11.5%, 31.8%, 13.6%, and 4.9% experienced mild, moderate, severe, and extremely severe symptoms, respectively. Anxiety severity classifications revealed 37.4% as normal, with 6.2%, 17.4%, 10.0%, and 29.0% falling into mild, moderate, severe, and extremely severe categories, respectively. For stress, 49.2% were normal, while 11.0%, 16.7%, 14.1%, and 9.0% experienced mild, moderate, severe, and extremely severe levels, respectively. Barriers to accessing mental health care included a preference for self-management, confidentiality concerns, societal judgment, and fears of career-related repercussions. This study highlights a high prevalence of depression, anxiety, and stress among medical students at Jazan University, with notable gender differences and symptom severity. Addressing barriers to mental health care, such as confidentiality concerns and societal stigma, is essential to improving service utilization and student well-being.

PMID:40184119 | DOI:10.1097/MD.0000000000041185

Medicine (Baltimore). 2025 Jan 3;104(1):e41119. doi: 10.1097/MD.0000000000041119.

ABSTRACT

Positron emission tomography/computed tomography (PET/CT) is widely used to differentiate benign and malignant lesions. However, increased fluorodeoxyglucose (FDG) uptake may occur under certain benign conditions, leading to potential false positives in malignancy assessments. Tuberculosis and sarcoidosis are 2 conditions that can exhibit FDG uptake, presenting with both lymph node and extrathoracic involvement, alongside pulmonary manifestations. This study aimed to explore the utility of PET/CT in distinguishing between thoracic and extrathoracic involvement in patients with sarcoidosis and tuberculosis. A retrospective analysis was conducted on patients diagnosed with sarcoidosis or tuberculosis, either pathologically or microbiologically, who underwent 18F-FDG-PET/CT as part of their diagnostic process. This study evaluated demographic data, PET/CT findings, involvement sites, and maximum standardized uptake values (SUVmax) in patients with tuberculosis and sarcoidosis. PET/CT images of 62 patients (44 with tuberculosis and 18 with sarcoidosis) were analyzed. The median patient age was 55 years. Lymph node involvement in the cervical, abdominal, retro-pancreatic, inguinal, and extrathoracic regions was significantly more prevalent in patients with sarcoidosis than in those with tuberculosis (50% vs 20.5%, P = .0031; 27.8% vs 4.5%, P = .018; 22.2% vs 0%, P = .005; 27.8% vs 6.8%, P = .039; and 66.7% vs 27.3%, P = .009, respectively). No statistically significant difference was found in SUV values between patients with tuberculosis and those with sarcoidosis with regard to mediastinal lymph node, extrathoracic lymph node, lung, and bone PET/CT involvement. In conclusion, 18F-FDG-PET/CT imaging does not appear to be a reliable method for differentiating sarcoidosis and tuberculosis from malignant lesions, as it is not feasible to distinguish between sarcoidosis and tuberculosis solely based on 18F-FDG-PET/CT SUVmax values. Nevertheless, the increased prevalence of extrathoracic lymph node involvement in sarcoidosis compared to tuberculosis may offer valuable insights for clinicians in differential diagnosis.

PMID:40184115 | DOI:10.1097/MD.0000000000041119

Medicine (Baltimore). 2025 Jan 3;104(1):e41129. doi: 10.1097/MD.0000000000041129.

ABSTRACT

Despite the numerous health benefits of physical activity (PA), sedentary behavior (SB) and physical inactivity remain major public health concerns. A lack of PA increases the chance of developing some noncommunicable diseases that are on the rise worldwide. Therefore, this study aimed to evaluate the level of PA, SB, sleep quality (SQ), and quality of life (QOL) among Saudi female college students. A cross-sectional study was carried out among female students enrolled in various colleges, both medical and nonmedical, at King Saud University in Riyadh during the academic year 2018 to 2019. Participation posters were sent to colleges’ departments, and survey links were shared through university social media channels. The study utilized the International Physical Activity Questionnaire and the Pittsburgh Sleep Quality Index to evaluate PA and SQ and the World Health Organization Quality of Life Assessment Instrument to evaluate QOL. In order to conduct statistical analyses, frequency counts, means, and standard deviations were calculated for PA, SQ, and QOL scores. In this study, 131 Saudi female college students were conveniently recruited from 223 who met the inclusion criteria, with a mean age of 20.4 ± 1.4. Most participants were from medical colleges (n = 86, 6, 5.6%) and the minority were nonmedical (n = 45, 34.4%). We have found that International Physical Activity Questionnaire indicated that most students had low PA (52% of the participants), about 35% had a moderate PA, and only 17% had high PA. SB was present among 22.9% of participants. Nearly 68.7% of the students scored poorly on the Pittsburgh Sleep Quality Index for SQ. The students had high QOL, with a mean WHOQOL-BREF total score of 90.76 ± 12.77. Medical and nonmedical students showed no significant differences in PA, SB, or QOL. No apparent relationship was found between PA and SQ or QOL. This study shows that a significant proportion of female college students maintain an unfavorable lifestyle characterized by insufficient PA and subpar SQ. Implementing programs that encourage students to be more physically active, reduce sedentary time, and integrate sleep education programs to improve their sleep habits are necessary.

PMID:40184114 | DOI:10.1097/MD.0000000000041129

Medicine (Baltimore). 2025 Jan 3;104(1):e41145. doi: 10.1097/MD.0000000000041145.

ABSTRACT

OBJECTIVE: To methodically assess the clinical impact of ulinastatin on patients suffering from pulmonary edema.

METHODS: PubMed, Web of Science, Cochrane Library, Embase, Chinese National Knowledge Infrastructure (CNKI), Wanfang data, Chinese Scientific Journal Database (VIP), and Chinese Biomedical Literature Database (CBM) databases were searched using such keywords as ulinastatin, pulmonary edema, and randomized controlled trial (RCT). The search time was from the establishment of the database to August 2023. Two researchers were responsible for literature screening and data collection respectively. After the risk of bias in the included studies was evaluated, meta-analysis was performed using statistical software RevMan 5.4 and GRADE profiler software was used to evaluate evidence quality.

RESULTS: Nine RCTs were included in the meta-analysis. Meta-analysis results showed that compared with conventional treatment group, the incidence of pulmonary edema of the patients in the ulinastatin group decreased, with odds ratios (OR) of 0.36 (95% CI: 0.20, 0.657), extravascular pulmonary water index (EVLWI) decreased, with mean difference (MD) of -0.75 (95% CI: -1.32, -0.17), ventilator use time decreased, with MD of -2.86 (95% CI: -0.26, 0.23), the intensive care unit (ICU) length of stay decreased, with MD of -1.56 (95% CI: -1.75, -1.38). The pulmonary vascular permeability index (PVPI) decreased in ulinastatin group, with MD of -0.10 (95% CI: -0.24, 0.03), but the difference was not statistically significant.

CONCLUSION: Compared with conventional treatment, ulinastatin may reduce the incidence of pulmonary edema, decrease EVLWI, ventilator use time and the ICU length of stay in patients with pulmonary edema, but it could not reduce PVPI.

PMID:40184111 | DOI:10.1097/MD.0000000000041145

Medicine (Baltimore). 2025 Jan 3;104(1):e41113. doi: 10.1097/MD.0000000000041113.

ABSTRACT

To adapt and evaluate the psychometric properties of the SUSESO/ISTAS21 questionnaire for nurses in Spain. Cross-sectional study for the cross-cultural adjustment and psychometric validation of the COPSOQ-ISTAS21 scale. Descriptive analyses were conducted, and data was correlated. A confirmatory factor analysis was performed, thus assessing the reliability and criterion validity. The sample consisted of 2757 Spanish nurses. The exploratory factor analysis identified a 5-factor structure with 15 items, which explained 63.6% of the variance. The factors were named: Support at work; Job satisfaction; Work-related emotional well-being; Job insecurity; and Double presence. The internal consistency of the questionnaire, measured by Cronbach alpha and McDonald omega coefficient, was adequate, with values of 0.764 and 0.741, respectively. The results of the confirmatory factor analysis indicated a good model fit. Three levels of psychosocial risk (low, intermediate, and high) were identified based on percentiles and quartiles of mean scores. The adapted version of the SUSESO/ISTAS21 questionnaire showed reliable psychometric properties in Spanish nurses, making it a valid and robust tool for assessing psychosocial risks in this group.

PMID:40184105 | DOI:10.1097/MD.0000000000041113

Medicine (Baltimore). 2025 Jan 3;104(1):e41229. doi: 10.1097/MD.0000000000041229.

ABSTRACT

Postnatal period is the crucial period for the survival of mothers and neonates. Utilization of postnatal services has been linked with reduction of maternal and neonatal morbidity and mortality. This study used the Health Belief Model to explain factors that influence postnatal services utilization among post-delivery women in Zanzibar. A community-based cross-sectional study design was employed whereas a total of 395 post-delivery women were randomly selected. The study used the Health Belief components to derive operational variables to explain postnatal services utilization. Structured questionnaires and documentary reviews were used to collect data and analyzed using Statistical Package for Social Sciences Version 20. Binary logistic regression analysis was used to establish factors associated with postnatal utilization. The result revealed that only 115 (29.1%) used postnatal services in Zanzibar. After adjusting the confounders (education level, parity, place of delivery, mode of delivery, and maternal complications), variables of the Health Belief Model which showed a significant relationship were perceived benefit AOR = 10.212 at 95% CI = 2.509-41.567, P = .001 and cues of action AOR = 1.958 at 95% CI = 1.05-3.648, P = .034. Other variables of the Health Belief Model showed increased odds (perceived barriers AOR = 1.748 at 95% CI = 0.81-3.771 and perceived susceptibility AOR = 1.795 CI = 0.561-5.74), but they were not statistically significant. Most of postnatal mothers did not utilize postnatal services during the first month post-delivery. Sensitization campaigns such as educational campaigns are recommended to raise the awareness of postnatal women on the benefits of postnatal checkups within the first month of childbirth and hence improve the utilization.

PMID:40184096 | DOI:10.1097/MD.0000000000041229

Medicine (Baltimore). 2025 Jan 3;104(1):e41183. doi: 10.1097/MD.0000000000041183.

ABSTRACT

This study investigates the clinical effect and safety of periosteal distraction in the treatment of senile diabetic foot. The clinical data of 45 patients with diabetic foot treated with periosteal distraction in the Central Hospital of Dalian University of Technology from January 2020 to May 2024 were retrospectively analyzed. Finally, 42 patients were followed up, and 3 patients were lost to follow-up, including 29 males and 13 females, aged (71.17 ± 6.43), (62-84) years respectively. The Wagner grade of the ulcer surface of the affected foot was grade 2 in 25 cases, grade 3 in 13 cases, and grade 4 in 4 cases; the ulcer sites were toes in 18 cases, soles in 14 cases, dorsum of the foot in 8 cases, heels in 1 case, and ankles in 1 case. The toe oxygen saturation, ankle-brachial index (ABI), skin temperature and visual analogue score (VAS) were recorded before operation and at 1 day, 7 days, 14 days, 1 month, 2 months, and 3 months after operation. The therapeutic effect was observed and evaluated in combination with Michigan neurological sign score and lower limb computed tomography angiography. The wound ulcer healing rate, amputation rate and ulcer recurrence were also counted. The toe oxygen saturation, ABI, skin temperature, VAS score and Michigan neurological sign score of all patients were significantly improved after operation compared with those before operation, and the differences were statistically significant (P < .05); After a 3-month post-surgery period, 37 patients were observed to have microcirculation formation in the affected limb, as well as increased and thickened lower extremity arterioles in comparison to pre-surgery conditions, forming an interwoven network. During the follow-up period, 21 patients exhibited healed foot ulcers at 2 months post-surgery, while by the end of the follow-up period, 38 patients had healed foot ulcers, 5 patients had experienced a significant reduction in wound ulcer area, and the overall ulcer healing rate was 90%. Notably, no instances of amputation or ulcer recurrence were observed during treatment. Periosteal distraction is a new surgical method for the treatment of senile diabetic foot ulcer, which can obtain satisfactory short-term efficacy and is worthy of clinical promotion.

PMID:40184093 | DOI:10.1097/MD.0000000000041183

Medicine (Baltimore). 2025 Jan 3;104(1):e41220. doi: 10.1097/MD.0000000000041220.

ABSTRACT

This study compares the efficacy of the TiRobot with traditional external aiming frames in distal locking of femoral intramedullary nails. A cohort of 44 patients, who underwent intramedullary nailing treatment for femoral fractures between October 2020 and October 2023, was retrospectively analyzed. Participants were allocated into 2 groups. The observation group (n = 22) received TiRobot assistance for distal locking of femoral intramedullary nails, and the control group (n = 22) was managed using conventional external aiming frames. Key variables included the first-attempt success rate of distal locking, number of fluoroscopic exposures, time to achieve locking, and volume of intraoperative blood loss. The observation group, assisted by TiRobot, achieved a significantly higher first-attempt success rate of 90.9%, as compared to 54.5% in the control group. All initial failures were subsequently managed manually, with a statistically significant difference noted between the groups (P < .05). Furthermore, the observation group required fewer fluoroscopic exposures (11.00 ± 2.93) than the control group (19.68 ± 16.28) (P < .05). The time to achieve locking was significantly shorter in the observation group (14.05 ± 3.37 min) compared to the control group (24.41 ± 14.93 min) (P < .05). The volume of intraoperative blood loss was reduced in the observation group (54.55 ± 5.54 mL) versus the control group (60.45 ± 11.01 mL) (P < .05). The incorporation of TiRobot in the distal locking of femoral intramedullary nailing prominently enhances the first-attempt success rate, reduces the procedural time and intraoperative blood loss, and diminishes the radiation exposure for both healthcare providers and patients.

PMID:40184090 | DOI:10.1097/MD.0000000000041220