Nevin Manimala

Ecancermedicalscience. 2025 Mar 5;19:1864. doi: 10.3332/ecancer.2025.1864. eCollection 2025.

ABSTRACT

PURPOSE: The purpose of this study was to compare the efficacy of oral morphine (MOR) with oral tramadol (TRM) in control of pain as well as physical well-being in patients (pts) with moderate cancer pain (MCP) using the Edmonton Symptom Assessment Scale (ESAS).

METHODS: An Institutional Review Board (IRB) approved randomised phase II trial was performed in opioid-naive pts with MCP as defined by pain score in numerical rating score (NRS) of 4-6. Patients were randomised to receive MOR syrup 5 mg 4 hourly or TRM 50 mg four times a day. Titration of dose was done in both groups for 3 days in case of inadequate pain control as per standard recommendation for MOR or until the maximum recommended daily dose for TRM. MOR was changed to prolonged release form on Day 4. The primary endpoint was the number of early responders, defined as pts with at least 20% reduction in pain intensity on NRS on Day 3. The secondary outcome was the number of patients with highly meaningful pain reduction, defined as a decrease in pain intensity on NRS by ≥5 and improvement in physical well-being with ESAS at Day 7.

RESULTS: Sixty-eight pts consented and were randomised, 34 in each arm. The primary endpoint occurred in 94.1% pts in MOR and 55.9% in TRM (p < 0.001). The number of patients with highly meaningful pain reduction was significantly higher in MOR than in TRM (76.5% versus 32.35%; p < 0.001). Improvement in general physical well-being as assessed by ESAS was better in the MOR group. No difference in adverse effects was noted between the treatment arms.

CONCLUSION: In this study, MOR was superior to TRM in the control of pain with statistically significant differences in the primary and secondary endpoints. Therefore, early use of MOR skipping the World Health Organization sequential analgesic ladder for MCP may be a higher value option in resource-scarce country with limited access to healthcare.

PMID:40492220 | PMC:PMC12146575 | DOI:10.3332/ecancer.2025.1864

Ecancermedicalscience. 2025 Mar 11;19:1868. doi: 10.3332/ecancer.2025.1868. eCollection 2025.

ABSTRACT

Proton pump inhibitors (PPIs) are widely used over-the-counter drugs. The interaction between capecitabine and PPIs is still ambiguous within the literature, with some discrepancies still being present regarding the risks, or benefits, of their concomitant use. This meta-analysis aims to analyse data from the literature regarding both the risk of PPIs on survival in patients treated with capecitabine, as well as their benefits regarding the incidence of hand-foot syndrome (HFS). A total of 17 studies were included after searching PubMed, Medline and Cochrane until October 2022 for the effect of PPIs on the treatment efficacy and pharmacokinetics, and incidence of HFS. Revman Ver. 5.3 was used for all statistical analyses. Our data showed a significant HFS reduction at a relative risk of 0.77 (95% CI: 0.70-085; p < 0.00001) in the PPI-using groups compared to control. Meta-analysis of studies assessing survival, however, showed a reduction in almost all survival aspects, most notably within the recurrence-free survival, with a hazard ratio of 1.75; 95% CI: 1.21-2.53; p = 0.003. Individual data incriminating the use of PPIs with capecitabine is quite limited; however, our robust survival data on around 30,000 patients gave significantly worse survival outcomes, particularly in the (neo)adjuvant setting.

PMID:40492211 | PMC:PMC12146577 | DOI:10.3332/ecancer.2025.1868

MedEdPORTAL. 2025 Jun 9;21:11526. doi: 10.15766/mep_2374-8265.11526. eCollection 2025.

ABSTRACT

INTRODUCTION: Wilderness medicine is a growing field focused on delivering quality medical care in austere environments. Simulation-based education has proven effective in emergency and wilderness medicine, particularly in graduate medical education. We propose that introducing wilderness medicine concepts earlier in medical education as part of a high-fidelity simulation for medical students could both increase interest in wilderness medicine and have widely applicable educational benefits.

METHODS: We developed a novel 1-day case-based simulation curriculum to be performed in a wilderness environment and invited undergraduate medical students to participate. A 25-question survey was administered before and after the simulation to assess subjective change across various topics.

RESULTS: The 10 of 12 students who responded to the survey indicated that the simulation significantly increased their confidence in managing urgent medical cases and increased their interest in the wilderness medicine field. All students agreed that simulation was an effective way to learn this material.

DISCUSSION: Implementing a wilderness medicine simulation in medical curricula appears feasible and provides a comprehensive model that can be easily adapted to other institutions.

PMID:40492203 | PMC:PMC12146433 | DOI:10.15766/mep_2374-8265.11526

J Lipid Atheroscler. 2025 May;14(2):190-199. doi: 10.12997/jla.2025.14.2.190. Epub 2025 Apr 9.

ABSTRACT

OBJECTIVE: The association of lipid parameters with cardiovascular disease (CVD) and the impact of kidney function on this association have not been thoroughly evaluated in patients with type 2 diabetes mellitus (T2DM).

METHODS: Using the Korean National Health Insurance Service Cohort database, we identified 2,343,882 subjects with T2DM in 2015-2016. Baseline lipid levels and kidney function were evaluated and followed up until December 2020. Subjects were classified into three groups according to their estimated glomerular filtration rate (eGFR): ≥60, 30-59, or <30 mL/min/1.73 m². We analyzed the diabetes group with eGFR ≥60 and low-density lipoprotein cholesterol (LDL-C) <70 mg/dL as a reference group.

RESULTS: The risk of CVD began to increase at LDL-C ≥100 mg/dL in the eGFR ≥60 mL/min/m² group. The risk of CVD in the eGFR 30-59 mL/min/m² group was increased by 43%, even in the LDL-C <70 mg/dL, and the risk increased progressively with LDL-C category. Among subjects with eGFR 30-59 mL/min/m², LDL-C 70-99, 100-129, 130-159, and ≥160 mg/dL were significantly associated with the risk of CVD, with hazard ratio (95% confidence interval) of 1.48 (1.43-1.53), 1.54 (1.49-1.60), 1.55 (1.48-1.63), and 1.88 (1.77-2.00), respectively. In the eGFR <30 mL/min/m² group, a 3.3-fold increased risk of CVD was seen, even at LDL-C <70 mg/dL.

CONCLUSION: The cutoff levels of LDL-C that increase CVD risk in patients with T2DM depend on kidney function, which influences the relationship between LDL-C and CVD risk in patients with T2DM.

PMID:40492185 | PMC:PMC12145966 | DOI:10.12997/jla.2025.14.2.190

J Lipid Atheroscler. 2025 May;14(2):145-158. doi: 10.12997/jla.2025.14.2.145. Epub 2025 Feb 11.

ABSTRACT

Statins represent the first-line therapy for cholesterol management. However, for patients prone to statin side effects, unable to tolerate higher doses, or requiring additional low-density lipoprotein cholesterol (LDL-C) reduction, ezetimibe alone or in combination with statins is recommended. This meta-analysis aimed to evaluate the safety and efficacy of combining low- or moderate-intensity statins with ezetimibe compared to high-intensity statin monotherapy, yielding reliable evidence to guide clinical decision-making and personalize treatment strategies. PubMed, Embase, and Scopus were systematically searched from inception until May 2023. All randomized controlled trials (RCTs) comparing a high-intensity statin with a low/moderate-intensity statin with ezetimibe were included. The outcomes of interest comprised changes in concentrations of lipids-LDL-C, high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglycerides (TGs)-and apolipoprotein (Apo) A1, Apo B, and high-sensitivity C-reactive protein (hs-CRP), along with major adverse cardiovascular events (MACE). All data were analyzed using Review Manager version 5.4. p-values less than 0.05 were considered to indicate statistical significance. Overall, 20 RCTs, with 5,412 participants, were included. A low/moderate-intensity statin combined with ezetimibe yielded a significantly greater reduction in LDL-C levels than high-intensity statin monotherapy (mean difference [MD], -6.59; 95% confidence interval [CI], -10.95, -2.24; p=0.003; I²=84%). No significant differences were observed between combination and high-intensity statin monotherapy regarding TC, TG, or HDL-C levels. However, hs-CRP levels were significantly higher with combination therapy (MD, 0.32; 95% CI, 0.01, 0.64; p=0.04; I²=0%). Combination therapy involving a low/moderate-intensity statin with ezetimibe was significantly associated with lower LDL-C levels than high-intensity statin monotherapy. No significant differences were observed for TC, TGs, HDL-C, alanine transaminase, or MACE. However, creatine phosphokinase levels significantly increased with monotherapy.

PMID:40492183 | PMC:PMC12145961 | DOI:10.12997/jla.2025.14.2.145

Sex Med. 2025 Jun 9;13(3):qfaf043. doi: 10.1093/sexmed/qfaf043. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Lesbian, gay, bisexual, transgender, and other gender and sexual minority (LGBT+) individuals often face healthcare disparities, and physicians’ knowledge, attitudes, and clinical preparedness significantly impact access to competent care.

AIM: This study evaluated Turkish physicians’ perspectives, knowledge, and clinical approaches to LGBT+ sexual health, highlighting educational and clinical gaps.

METHODS: A nationwide cross-sectional survey was conducted among physicians from 10 specialties involved in LGBT+ sexual health. The survey, administered anonymously via Google Forms between June 4, 2024, and February 1, 2025, included sociodemographic questions and items assessing attitudes, clinical experience, and guideline familiarity. Statistical analyses included descriptive statistics, chi-square, Fisher’s exact tests, and binary logistic regression to identify predictors of physician attitudes and perceived competence.

OUTCOMES: The primary outcome was to assess physicians’ perspectives, competency, and willingness to provide LGBT+ healthcare, including gender-affirming procedures.

RESULTS: Among 745 participants, 58.8% considered LGBT+ identities normal, while 22.9% classified them as psychiatric disorders. Perceiving LGBT+ identities as normal was significantly associated with being female (OR = 3.12, 95% CI: 1.96-4.96, P < .001), prior experience treating LGBT+ patients (OR = 2.22, 95% CI: 1.60-3.07, P < .001), and physician specialty. This view was most common among psychiatrists (P = .012) and child and adolescent psychiatrists (P = .015). Physicians’ views were primarily shaped by education (43.2%) and socio-cultural environment (40.9%). Although 63.9% had treated LGBT+ patients, only 28.2% felt competent, and 11.5% were aware of relevant guidelines. Only 18% of surgical specialists supported gender-affirming procedures. The most commonly cited reason for reluctance was lack of surgical experience (44.8%), along with concerns related to religious beliefs, absence of a surgical team, and potential surgical complications. Ethical dilemmas were evident, as 58.3% believed LGBT+ patients face discrimination in healthcare, and 21.9% supported a physician’s right to refuse care based on personal beliefs.

CLINICAL IMPLICATIONS: Enhancing physicians’ education and competency in LGBT+ healthcare through structured training and standardized guidelines is crucial to improving equitable healthcare delivery.

STRENGTHS AND LIMITATIONS: This study provides novel insights into physicians’ attitudes and practices regarding LGBT+ healthcare in Turkey. However, self-reported data may introduce response bias, and findings may not be fully generalizable to other regions.

CONCLUSION: Significant educational and clinical gaps persist in LGBT+ healthcare. Addressing these through structured training programs, standardized protocols, and multidisciplinary collaboration is essential to ensuring competent, inclusive, and ethical medical care.

PMID:40492177 | PMC:PMC12147215 | DOI:10.1093/sexmed/qfaf043

J Intellect Disabil Res. 2025 Jun 9. doi: 10.1111/jir.13259. Online ahead of print.

ABSTRACT

BACKGROUND: People with Down syndrome (DS) may exhibit several musculoskeletal disorders, including alterations in muscle tone and activation. Strength training could mitigate the loss of muscle strength and, therefore, improve strength values in this population. Additionally, it may influence health-related outcomes such as physical function, body composition and biochemical markers.

OBJECTIVE: This systematic review and meta-analysis of randomised controlled trials (RCTs) aimed to analyse the characteristics and effects of strength training in people with DS.

METHODS: A search was conducted from inception to 22 April 2025. The methodological quality of the included RCTs was assessed using the 15-item Tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX). In addition, the risk of bias was assessed using the Cochrane’s risk of bias 2 (RoB2).

RESULTS: A total of 10 RCTs (n = 233 participants) were included in the systematic review, of which three (n = 111 participants) could be meta-analysed. The pooled effect showed statistically significant benefits for upper (mean difference [MD] = 5.66 kg, 95% CI 2.42-8.91) and lower (MD = 20.43 kg, 95% CI 1.76-39.10) body strength. The TESTEX scores for most RCTs ranged from 3 to 12 points. The risk of bias analysis indicated that eight RCTs had a low risk of bias, whereas the remaining studies were classified as high risk.

CONCLUSION: Strength training may significantly improve muscle strength in people with DS. However, further research is needed to assess the long-term effects on physical function, body composition and biochemical markers.

PMID:40490858 | DOI:10.1111/jir.13259

Eur J Med Res. 2025 Jun 9;30(1):466. doi: 10.1186/s40001-025-02748-4.

ABSTRACT

BACKGROUND: It is crucial to identify the risk factors for unplanned extubation (UEX) in thoracoabdominal drainage tubes as early as possible and establish applicable risk prediction model to reduce the incidence of UEX.

METHODS: A retrospective survey of patients who underwent Thoracoabdominal drainage tubes placement at a tertiary hospital was conducted in Zhejiang Province, China, between January 2020 and January 2023. A training set was established to build the predictive model and conduct internal validation, which was assessed for discrimination using ROC curves and for Calibration using the Hosmer-Lemeshow test and Calibration curves. A nomogram was constructed to visually present the results of the logistic regression analysis. An external validation dataset was created for assessing the external validation of the model.

RESULTS: a total of 2220 patients were enrolled. Multiple logistic regression analysis showed that negative pressure ball drainage, adhesive fixation method, self-care ability (self-care vs. complete dependence), self-care ability (partial dependence vs. complete dependence), and Thoracoabdominal drainage tubes were statistically significant factors associated with UEX (P < 0.05).The predictive model equation was as follows: a = 0.95-1.66 × drainage method + 2.45 × fixation method -4.17 × self-care ability (self-care vs. complete dependence) -2.79 × self- care ability (partial dependence vs. complete dependence).In the internal validation, the AUC was 0.897 (95% CI = 0.87-0.92; P < 0.001), with a sensitivity of 0.75 and specificity of 0.93, indicating a high level of discrimination for the model. The Hosmer-Lemeshow test yielded a chi-square (χ²) value of 2.823 with 8 degrees of freedom and a P-value of 0.945, indicating high accuracy of the model. In the external validation, the AUC was 0.839 (95% CI = 0.75-0.93; P < 0.001), with a sensitivity of 0.73 and specificity of 0.96. The Hosmer-Lemeshow test yielded a χ² value of 12.85 with 8 degrees of freedom and a P-value of 0.117. The DCA plot shows that the DCA curve is consistently higher than the two extreme curves, indicating a good fit of the model.

CONCLUSION: The predictive model for the risk of unplanned extubation of thoracoabdominal drainage tubes in postoperative patients demonstrates good discrimination and Calibration. It can provide reference for clinical nursing staff in predicting the risk and early development of personalized preventive strategies for drainage tube UEX.

PMID:40490840 | DOI:10.1186/s40001-025-02748-4

BMC Rheumatol. 2025 Jun 9;9(1):67. doi: 10.1186/s41927-025-00517-8.

ABSTRACT

BACKGROUND: Oxidative stress plays a critical role in the pathogenesis of autoimmune diseases, including rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Assessing total antioxidant capacity (TAC) and total oxidant status (TOS) in saliva offers a non-invasive method to evaluate oxidative stress and its relationship with disease severity. This study aimed to measure salivary TAC and TOS levels in RA and SLE patients and compare them with healthy controls.

METHODS: A cross-sectional study was conducted involving 90 participants: 30 RA patients, 30 SLE patients, and 30 healthy controls. Saliva samples were collected and analyzed using specialized TAC and TOS assay kits. Disease severity was evaluated using the Disease Activity Score-28 (DAS-28) for RA and the SLE Disease Activity Index (SLEDAI-2 K) for SLE. Statistical analyses included ANOVA, post-hoc tests, and Pearson correlation coefficients.

RESULTS: Results showed that RA and SLE patients had significantly higher oxidative stress compared to healthy controls, with lower TAC levels (RA: 298.88 ± 31.21 µM, SLE: 287.98 ± 38.07 µM, Control: 461.22 ± 158.22 µM, P < 0.001) and higher TOS levels (RA: 5.81 ± 1.28 µM, SLE: 5.80 ± 1.36 µM, Control: 3.49 ± 1.56 µM, P < 0.001). The TOS/TAC ratio was also significantly elevated in RA (1.95 ± 0.44) and SLE (2.05 ± 0.64) patients compared to controls (0.84 ± 0.44, P < 0.001). A positive correlation was observed between TOS levels and age (R = 0.256, P = 0.016), while no significant gender-based differences were detected.

CONCLUSIONS: RA and SLE patients exhibit significant oxidative imbalance, as indicated by altered salivary TAC and TOS levels. These findings highlight the potential role of oxidative stress in these autoimmune diseases.

PMID:40490822 | DOI:10.1186/s41927-025-00517-8

Ital J Pediatr. 2025 Jun 9;51(1):184. doi: 10.1186/s13052-025-02034-3.

ABSTRACT

BACKGROUND: Feeding intolerance (FI) is a common feeding problem in preterm infants. The gut microbiota contributes significantly to its onset, progression, and outcome. In this study, we aimed to understand the differences in gut microbiota among preterm infants with FI of different gestational ages. The goal was to provide a basis for early probiotic intervention.

METHODS: We undertook a prospective case-control study in which we enrolled 80 preterm infants at a gestational age < 34 weeks. Participants were divided into four groups of 20 each: early preterm infants with FI (EFI group, gestational age < 32 weeks), early preterm infants with feeding tolerance (FT) (EFT group, gestational age < 32 weeks), moderate preterm infants with FI (MFI group, gestational age ≥ 32 weeks), moderate preterm infants with FT (MFT group, gestational age ≥ 32 weeks). 16 S rDNA high-throughput sequencing was employed to analyze the infants’ fecal microbiota and examine the potential link between gut microbiota and gestational age. Statistical analysis was conducted for the collected data. The Statistical Package for Social Sciences software was used. T-tests or non-parametric tests were performed for comparison between groups of measurement data, and the χ2 test was used to compare between groups of count data. At the genus and species level, the potential association between intestinal microbiota and FI and the relationship with gestational age were explored.

RESULTS: The abundance of Citrobacter in the feces of the EFI group was significantly higher than that in the EFT group. Additionally, the abundance of Acinetobacter in the MFI group was significantly higher than that in the MFT group. The abundance of Clostridium XI was significantly low in the MFT group.

CONCLUSIONS: Citrobacter and Acinetobacter genera are implicated in FI in preterm infants with gestational ages < 32 weeks and ≥ 32 weeks, respectively. However, Clostridium XI may be involved in regulating intestinal homeostasis in those with a gestational age ≥ 32 weeks.

TRIAL REGISTRATION: ChiCTR, ChiCTR2400086000. Registered 24 June 2024, https://www.chictr.org.cn/showprojEN.html?proj=210,126 .

PMID:40490820 | DOI:10.1186/s13052-025-02034-3