Nevin Manimala

J Nephrol. 2025 Mar 5. doi: 10.1007/s40620-024-02180-7. Online ahead of print.

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) is a frequent and severe complication in COVID-19 patients, associated with poor outcomes. This study evaluates the characteristics and outcomes of AKI in COVID-19-positive versus negative patients during the pandemic in an emerging country, emphasizing differences in incidence, recovery, and healthcare resource utilization.

METHODS: We conducted a retrospective cohort study including 9112 intensive care unit (ICU) patients from two major hospitals in Brazil, hospitalized between March 2020 and April 2022. Statistical analyses included logistic regression, Kaplan-Meier survival analysis, and time series analysis of AKI trends across COVID-19 waves.

RESULTS: 2333 patients (25.6%) tested positive for COVID-19. AKI incidence (79.7% vs. 52.6%, p < 0.001) and severity (Stage 3: 48.6% vs. 26.6%, p < 0.001) were significantly higher in the COVID-19-positive group. COVID-19 patients with AKI had longer ICU stays (median 11 vs. four days, p < 0.001) and higher mechanical ventilation needs (57.9% vs. 31.1%, p < 0.001). COVID-19 independently increased the risk of AKI (OR 2.03, CI 1.77-2.32); the coexistence of COVID-19 and AKI conferred significantly higher odds for mortality (OR 8.53, CI 6.67-11.02). Kidney recovery was less frequent in COVID-19 patients, with a higher incidence of acute kidney disease in survivors (OR 1.99, CI 1.74-2.28). Sensitivity analysis of septic patients confirmed higher AKI incidence and mortality in COVID-19 patients.

CONCLUSION: COVID-19 significantly affects AKI incidence, severity, and recovery, particularly in resource-limited settings. These findings emphasize the need for targeted strategies to manage kidney complications during pandemics and stress the importance of healthcare system preparedness in emerging countries.

PMID:40042786 | DOI:10.1007/s40620-024-02180-7

Indian J Pediatr. 2025 Mar 5. doi: 10.1007/s12098-025-05447-4. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the proportion of children with withdrawal syndrome in sedoanalgesic drug rotation protocol vs. sedoanalgesia with no rotation using Withdrawal Assessment Tool Version-1 (WAT-1).

METHODS: Sixty children one mo to 18 y admitted to the Pediatric Intensive Care Unit (PICU) for mechanical ventilation were randomized into two groups in a 1:1 ratio. The intervention group received a protocolized rotation of sedative and analgesic drugs combination. In contrast, the control group received sedative and analgesic drugs without any rotation for the entire duration of ventilation. In both groups, adequate depth of sedation was achieved by titrating the sedatives using COMFORT-Behavioural (COMFORT-B) scores. The primary outcome assessed was the incidence of withdrawal syndrome as defined by a WAT-1 score ≥ 3. Secondary outcomes included cumulative doses of midazolam needed as rescue therapy, mechanical ventilation (MV) duration, need for inotropic support, and the length of stay (LOS) in the PICU.

RESULTS: In the present study, median (IQR) age of patients was 24 (7, 93) mo. There was a reduced incidence (20% vs. 53.3%; P = 0.004) and median duration of withdrawal syndrome (WAT-1 score ≥ 3) [1 (IQR 0, 2) vs. 0 (IQR 0, 0); P = 0.012] in the intervention group compared to the control group. The need for inotropic support was higher in the intervention group (62.5% vs. 37.5%; P = 0.038). No other statistically significant outcomes were seen.

CONCLUSIONS: The present study showed that protocolised rotation of sedoanalgesic drugs in mechanically ventilated children can result in lower incidence as well as the duration of withdrawal syndrome.

PMID:40042783 | DOI:10.1007/s12098-025-05447-4

Ann Nucl Med. 2025 Mar 5. doi: 10.1007/s12149-025-02034-7. Online ahead of print.

ABSTRACT

OBJECTIVE: Using fluorine-18-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT), a multiparametric analysis will be performed in the differential diagnosis of patients with single solitary pulmonary lesion and extrapulmonary malignant tumor to discriminate between a second primary lung cancer (SPLC) and pulmonary metastasis (PM).

METHODS: This study retrospectively studied 84 patients with preoperative exams utilizing ¹⁸F-FDG PET/CT. Using complementing PET/CT parameters, a composite model was developed. A receiver operating characteristic (ROC) analysis assessed the combined model and each independent parameter’s differential diagnostic efficacies. Furthermore, this study investigated the improvement in diagnostic efficacy using other metrics, such as integrated discriminatory improvement (IDI) and net reclassification improvement (NRI).

RESULTS: The highest discriminative diagnostic value was obtained by the independent parameters energy (1,039,358.1 [95126.2-1,965,032.2] vs. 92,011.0 [45916.3-365,322.9], P = 0.001). In comparison to peak standardized uptake value (SUVpeak), total lesion glycolysis (TLG), energy, lobulation, and spiculation alone, the combined model (addition of these factors) significantly improved the differential diagnostic efficacy of SPLCs and PMs (sensitivity = 76.2%, specificity = 83.8%, area under the curve [AUC] = 0.826) and permitted reclassification using IDI = 0.176 (P < 0.001), 0.169 (P < 0.001), 0.127 (P < 0.001), and categorical NRI = 0.678 (P < 0.001), 0.637 (P < 0.001), and 0.592 (P < 0.001) compared to SUVpeak, TLG and energy separately. DeLong’s test revealed a statistically significant enhancement in ROC when compared to SUVpeak (Z = 2.372, P = 0.018), TLG (Z = 2.095, P = 0.036), and energy (Z = 2.318, P = 0.020).

CONCLUSION: Combining multiple parameters using ¹⁸F-FDG PET/CT may further improve distinguishing between SPLCs and PMs in patients with single solitary pulmonary lesion and extrapulmonary malignant tumor.

PMID:40042775 | DOI:10.1007/s12149-025-02034-7

Vet Res Commun. 2025 Mar 5;49(3):129. doi: 10.1007/s11259-025-10695-y.

ABSTRACT

A cross-sectional study was conducted to estimate the prevalence of chorioptic mange affecting the distal legs of horses in Belgium, focusing on the association between mange and chronic progressive lymphedema (CPL) in Belgian draft horses. Clinical examinations and skin scrapings were performed on the distal legs of 156 Belgian draft horses and 142 Belgian warmblood horses. In the Belgian draft horse breed, 144 (92.31%) horses were infested with Chorioptes bovis mites, and 126 (80.77%) displayed clinical signs of CPL. CPL prevalence in draft horses aged < 1 year was 17.86%, while mites were detected in 85.71% of this age group, with infestations observed as early as 6 days of age. In a subset of horses aged ≥ 1 year, CPL and mange prevalence amounted to 94.53% and 93.75%, respectively. In contrast, no mites or CPL were detected in the Belgian warmblood horses examined. Statistical analysis revealed a strong association between C. bovis and CPL (prevalence odds ratio: 7.37; p = 0.002). The prevalence of CPL was approximately twice as high in horses with mites compared to non-infested horses (prevalence ratio: 2.02). Furthermore, the prevalence risk difference of 42.36%, indicates a substantial absolute increase in CPL prevalence among infested horses. This study demonstrates the high prevalence of C. bovis and its breed-specific predilection in Belgian draft horses. The strong association between mange and CPL highlights the potential role of C. bovis as a contributing factor in CPL pathogenesis.

PMID:40042772 | DOI:10.1007/s11259-025-10695-y

MAGMA. 2025 Mar 5. doi: 10.1007/s10334-025-01233-7. Online ahead of print.

ABSTRACT

OBJECTIVE: This study presents a novel deep learning-based framework for precise brain MR region segmentation, aiming to identify the location and the shape details of different anatomical structures within the brain.

MATERIALS AND METHODS: The approach uses a two-stage 3D segmentation technique on a dataset of adult subjects, including cognitively normal participants and individuals with cognitive decline. Stage 1 employs a 3D U-Net to segment 13 brain regions, achieving a mean DSC of 0.904 ± 0.060 and a mean HD95 of 1.52 ± 1.53 mm (a mean DSC of 0.885 ± 0.065 and a mean HD95 of 1.57 ± 1.35 mm for smaller parts). For challenging regions like hippocampus, thalamus, cerebrospinal fluid, amygdala, basal ganglia, and corpus callosum, Stage 2 with SegResNet refines segmentation, improving mean DSC to 0.921 ± 0.048 and HD95 to 1.17 ± 0.69 mm.

RESULTS: Statistical analysis reveals significant improvements (p-value < 0.001) for these regions, with DSC increases ranging from 1.3 to 3.2% and HD95 reductions of 0.06-0.33 mm. Comparisons with recent studies highlight the superior performance of the performed method.

DISCUSSION: The inclusion of a second stage for refining the segmentation of smaller regions demonstrates substantial improvements, establishing the framework’s potential for precise and reliable brain region segmentation across diverse cognitive groups.

PMID:40042762 | DOI:10.1007/s10334-025-01233-7

Obes Surg. 2025 Mar 5. doi: 10.1007/s11695-025-07769-w. Online ahead of print.

ABSTRACT

BACKGROUND: Mental disorders are relatively common in individuals who undergo metabolic bariatric surgery (MBS). Prior research suggests that mental disorders may relate to increased healthcare use after MBS. We retrospectively explored the association between preoperative mental health disorders and healthcare use in the first postoperative year.

METHODS: Patients who underwent primary MBS and had a structured preoperative psychological assessment report were included. Data on healthcare use was collected as the total number of non-routine healthcare appointments including inpatient, outpatient, and emergency department visits. Additionally, gastrointestinal (GI) healthcare use at the radiology, gastroenterology, and emergency departments was analyzed separately.

RESULTS: Of the 944 included patients, 261 (28%) had a preoperatively diagnosed mental disorder. Most prevalent were depressive disorders, anxiety disorders, and eating disorders. Patients with a preoperative mental disorder had a 15% (adjusted, CI 1.04-1.27, p = 0.005) higher rate of total healthcare use compared to those without. Among patients who had any GI-related healthcare, those with a mental disorder had a 61% higher rate of GI-related healthcare use (CI 1.02-2.55, p = 0.041). Patients with a mental disorder tended to have 20% lower odds of having no GI-related healthcare appointments (unadjusted, not statistically significant, CI 0.37-1.74, p = 0.568).

CONCLUSION: The presence of preoperative mental disorders was weakly related to higher total non-routine hospital healthcare use in the first year after MBS. Models explained only 5-13% of the variation in appointment frequency, meaning unmeasured and/or unknown factors play a role in healthcare use.

PMID:40042759 | DOI:10.1007/s11695-025-07769-w

Obes Surg. 2025 Mar 5. doi: 10.1007/s11695-025-07766-z. Online ahead of print.

ABSTRACT

BACKGROUND: Eating disorders and disordered eating habits are frequently identified among metabolic and bariatric surgery (MBS) patients. However, how these factors may affect postsurgical outcomes has not been adequately addressed. The aim of this study was to investigate the associations between patients’ eating habits and optimal clinical response after MBS.

METHODS: The study analyzed data from patients who underwent MBS at Marmara University Hospital between 2015 and 2023. Patient demographics, body mass index, obesity-associated medical problems, follow-up periods, surgical procedures (laparoscopic sleeve gastrectomy-SG, laparoscopic Roux-en-Y gastric bypass-RYGB), and eating habits (binge eating, carbohydrate craving, night eating, and sweet eating) were analyzed. Patients were divided into two groups: the optimal clinical response group (%TWL ≥ 20) and the suboptimal clinical response group (%TWL < 20) after surgery, and the groups were compared.

RESULTS: A total of 426 patients, including 197 patients who underwent SG and 229 patients who underwent RYGB, were included. The mean age of all patients was 40.9 ± 10.7 years. During the preoperative period, binge eating, carbohydrate craving, night eating, and sweet eating habits were detected in 55.9%, 67.6%, 47.7%, and 60.6% of the patients, respectively. The mean follow-up period was 24 months (1-60 months). Eighty percent of the patients achieved an optimal clinical response. The preoperative eating habits and %TWL values of the patients were analyzed. There was no statistically significant effect of eating habits on the optimal clinical response in all patients or in the SG vs RYGB groups.

CONCLUSIONS: This study investigated the effect of preoperative disordered eating habits on weight loss after MBS and revealed no significant difference between those with these habits and those without these habits. It is difficult to predict weight loss after MBS on the basis of preoperative eating behavior. However, further studies are needed to evaluate this factor in combination with other factors before or after surgery.

PMID:40042758 | DOI:10.1007/s11695-025-07766-z

Ann Afr Med. 2025 Mar 4. doi: 10.4103/aam.aam_254_24. Online ahead of print.

ABSTRACT

INTRODUCTION: Insufficient recognition of ominous headache red flags delays specialized care for potentially life-threatening secondary pathologies. Population-level awareness in Saudi Arabia warrants assessment to guide public health planning. The aim of the study was to evaluate headache red flag knowledge and associated care-seeking attitudes among Saudi adults through a cross-sectional survey.

METHODS: A multistage random sample of 643 Saudis aged 15-85 years was recruited proportionally across 13 regions from November 23, 2023 to February 14, 2024. A self-administered questionnaire assessed knowledge of 12 common red flags through closed responses. Total scores were calculated, and associations with demographic/clinical predictors were examined using statistics including Chi-square, ANOVA, and Bayesian correlations.

RESULTS: Mean knowledge score was 11.73/24 indicating partial overall understanding. Higher scores correlated with male gender, ages 36-55 years, tertiary education, and prior headache histories. Knowledge of key red flags like “thunderclap headache” was incomplete. Timely specialist evaluation for concerning symptoms received limited endorsement over analgesic use. Vulnerable subgroups demonstrating low awareness included females, youth, and those reliant on unreliable hazard information sources.

CONCLUSION: Saudi adults demonstrated modest yet uneven headache red flag knowledge influenced by sociodemographic attributes. Specific deficits warrant targeted educational campaigns addressing individual and systemic barriers to prompt neurological evaluations for alarm symptoms. Public health efforts involving experts, community leaders, and technological innovations hold promise enhancing timely diagnosis of secondary pathologies nationwide if periodically monitored.

PMID:40041935 | DOI:10.4103/aam.aam_254_24

Am J Hum Biol. 2025 Mar;37(3):e70016. doi: 10.1002/ajhb.70016.

ABSTRACT

OBJECTIVES: Despite growing evidence linking adverse childhood experiences (ACEs) with physical health conditions such as obesity and hypertension, research in low- and middle-income countries (LMICs), including India, remains limited. This study aims to examine the relationship between ACE exposure and the risk of overweight/obesity and hypertension among young adults in Delhi-NCR, India.

METHODS: The present cross-sectional study involved 1702 young adults of both sexes. Participants were recruited from two universities in Delhi-NCR, India. ACEs were measured using the ACE-International questionnaire (ACE-IQ), while anthropometric (weight, height, waist circumference, and hip circumference) and blood pressure parameters were assessed using standard protocols.

RESULTS: The prevalence of overweight/obesity increased with higher ACE categories, from 38% among participants with no ACEs to 49.7% among those with ≥ 4 ACEs (p = 0.006). Linear regression showed a significant positive association between ACE scores and BMI (β = 0.182, p = 0.004), waist circumference (WC; β = 0.351, p = 0.022), and waist-to-height ratio (WHtR; β = 0.002, p = 0.026). Odds ratio analysis revealed that participants with 3 or more ACEs had increased odds of being overweight/obese compared to unexposed individuals. No consistent associations were found between ACE exposure and blood pressure parameters. Among specific ACE domains, household mental illness was associated with higher odds of both general and central obesity, and bullying showed the highest odds for overweight/obesity.

CONCLUSIONS: ACE-exposed young adults may be at a higher risk of overweight/obesity; however, the risk of hypertension may not be immediate. Early intervention may help offset the risk of obesity and related disorders among ACE-exposed youth.

PMID:40041929 | DOI:10.1002/ajhb.70016

Front Glob Womens Health. 2025 Feb 18;6:1481164. doi: 10.3389/fgwh.2025.1481164. eCollection 2025.

ABSTRACT

BACKGROUND: Involvement of male partners in postnatal care (PNC) is an effective approach to improving maternal and child health outcomes. Despite this, it has been perceived as a woman’s responsibility and continues to be a significant problem in developing countries, including Ethiopia. Furthermore, there is a paucity of evidence regarding male involvement during postnatal care in Ethiopia, particularly in the study area. Therefore, the purpose of this study was to assess the current status of male partners’ involvement in postnatal care and associated factors in the study area, Wolaita Sodo, in southern Ethiopia in 2023.

METHODS: A community-based cross-sectional study design was conducted on 629 participants from 1 April to 1 May 2023 using a multistage sampling technique. A pre-tested and structured questionnaire was used to collect data. Data were entered into EpiData version 4.6 and exported to Statistical Package for Social Science (SPSS) version 25 for analysis. Bivariable and multivariable logistic regression analyses were employed to identify factors associated with male partner involvement during postnatal care. The level of significant association in the multivariable analysis was determined based on a P-value of <0.05.

RESULTS: This study found that 32.95% [95% confidence interval (CI): 29.2-36.8] of male partners are involved in postnatal care service utilization. A higher maternal educational level [adjusted odds ratio (AOR): 2.95, 95% CI: 1.76-4.94], good knowledge of postnatal care services (AOR: 3.2, 95% CI: 1.93-5.3), good knowledge of danger signs and complications (AOR: 4.5, 95% CI: 2.39-8.48), a favorable attitude (AOR: 4.02, 95% CI: 2.50-6.45), distance (AOR: 1.91, 95% CI: 1.15-3.17), and cesarean delivery (AOR: 2.5, 95% CI: 1.39-4.60) were significantly associated with male partner involvement in postnatal care services.

CONCLUSION: In this study, a male partner’s involvement in their spouse’s PNC service utilization was found to be low. Maternal educational status, good knowledge of PNC services, good knowledge of danger signs and complications, a favorable attitude, distance, and cesarean delivery were associated with male partner’s involvement in PNC. Therefore, strengthening awareness about postnatal care services and danger signs through health education and promoting a positive attitude toward postnatal services are essential.

PMID:40041927 | PMC:PMC11876152 | DOI:10.3389/fgwh.2025.1481164