Nevin Manimala

Cureus. 2025 Jan 21;17(1):e77757. doi: 10.7759/cureus.77757. eCollection 2025 Jan.

ABSTRACT

This systematic review and meta-analysis aimed to evaluate the effects of digital cardiac rehabilitation (DCR) encompassing application-based telehealth compared to traditional cardiac rehabilitation onmajor adverse cardiovascular events (MACE), rehospitalisation, costs, quality of life (QoL), and physical activity levels in patients with coronary artery disease (CAD). From 2014 to May 2024, a systematic search of the MEDLINE, PubMed, Web of Science, and Scopus databases was conducted using relevant keywords to identify randomised controlled trials (RCTs) or randomised cross-over trials. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database (PEDro) scale and risk of bias tool. The included articles were then subjected to qualitative synthesis and meta-analysis. Thirteen studies involving 1850 participants were included in the study. Meta-analysis revealed statistically significant improvements in QoL (mean deviation (MD) = 0.10, 95% CI: 0.05-0.15, p = 0.0002). DCR compared with centre-based rehabilitation (CBR). These improvements in QoL likely translated to enhanced daily functioning, such as the increased ability to perform activities of daily living. However, no significant differences were found for physical activity levels (MD = 1.69, 95% CI: 1.49-4.87, p = 0.30), rehospitalisation (relative risk (RR) = 0.86, 95% CI: 0.66-1.11, p = 0.25) or MACE (RR = 0.67, 95% CI: 0.42-1.07, p = 0.09). High heterogeneity was observed in QoL, likely due to variations in DCR modalities, study populations, and intervention content. The results of this study, therefore, must be interpreted with caution. DCR may offer significant benefits in terms of improving the QoL in patients with CAD. While promising trends were observed for rehospitalisation and MACE, further research is needed to confirm these findings. Potential reasons for the observed benefits of DCR over centre-based rehabilitation plausibly include improved accessibility, enhanced patient engagement, and greater flexibility. However, it is important to acknowledge the presence of heterogeneity among the included studies and potential gender imbalances within the study populations, which may have influenced the results. Future research should prioritize long-term outcomes, cost-effectiveness, real-world effectiveness in diverse populations, and the development of standardized DCR protocols.

PMID:39981488 | PMC:PMC11840654 | DOI:10.7759/cureus.77757

Cureus. 2025 Jan 21;17(1):e77762. doi: 10.7759/cureus.77762. eCollection 2025 Jan.

ABSTRACT

INTRODUCTION: The standard of care after resection of a single brain metastasis is to treat the cavity with stereotactic radiation therapy (SRT) to minimize the risk of recurrence. However, a prospective randomized trial of SRT demonstrated higher than expected rates of local recurrence, possibly due to geographic miss. Conformal partial brain (CPB) irradiation using conventional fractionation is an alternate technique that allows a larger margin of healthy tissue to be safely irradiated, potentially decreasing the risk of tumor recurrence. We performed a retrospective chart review to compare the results between CPB and SRT treatments.

METHODS AND MATERIALS: Patients receiving postoperative cranial radiotherapy within two months of a brain metastasis resection from 2015 to 2022 were eligible for this retrospective single-institution analysis. Fifty-seven patients met the eligibility criteria (SRT: n=32; CPB: n=25). SRT patients were treated using a robotic linear accelerator with a median dose of 24 Gy in 3 fractions. The median prescribed dose for the CPB group was 33 Gy in 11 fractions.

RESULTS: The mean follow-up was 19.9 months. The crude rate of local recurrence rate was 21.9% (SRT) versus 0% (CPB) (p<0.013). The crude rate of radiation necrosis (RN) was 21.9% (SRT) versus 0% (CPB) (p<0.013). The mean cavity volume was 13 cc (SRT) versus 73 cc (CPB) (p<0.001). Most cases of RN were asymptomatic, although one patient suffered grade 4 status epilepticus.

CONCLUSION: In this single-institution cohort, CPB radiation therapy was statistically associated with a lower risk of both local failure and radiation necrosis as compared to SRT. Despite the cavity being much larger, none of the CPB patients suffered either local failure or radiation necrosis. Postoperative CPB irradiation may be beneficial for large cavity sizes or when it is difficult to delineate the tumor bed.

PMID:39981481 | PMC:PMC11841999 | DOI:10.7759/cureus.77762

Cureus. 2025 Jan 20;17(1):e77749. doi: 10.7759/cureus.77749. eCollection 2025 Jan.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the incidence of new-onset diabetes mellitus (NODM) in statin users versus non-users and identify associated risk factors. Retrospective cohort studies leverage real-world data to address gaps in controlled trials, particularly in regions like Thailand, where local factors may affect this association.

MATERIALS AND METHODS: This study was a retrospective cohort study conducted at Phramongkutklao Hospital in Bangkok, Thailand. Using historical medical records, we identified two distinct cohorts – statin users and non-users – and followed them over time (2013-2022) to evaluate the incidence of NODM. A total of 113,850 patients aged over 20 years were included, with 14,120 (12.4%) statin users and 99,730 (87.6%) non-users. The annual incidence of NODM was calculated for each year of the study period, with statistical analyses (chi-square tests and Poisson regression) performed to identify risk factors.

RESULTS: Statin users had a significantly higher incidence of NODM, with 2,957 cases (20.94%) occurring during the follow-up period, compared to 1,643 cases (1.65%) among non-users. Older age, hypertension, and hypercholesterolemia were significantly associated with an increased risk of NODM in statin users. Multivariable analysis showed that statin use increased the risk of NODM by 3.86 times (95% CI: 3.58-4.17, p < 0.001) compared to non-users. The use of non-statin lipid-lowering drugs, as well as obesity, also contributed to the elevated diabetes risk among statin users.

CONCLUSIONS: Statin use is associated with a significantly higher risk of NODM, particularly in older adults and those with pre-existing cardiovascular risk factors. These findings emphasize the need for careful glucose monitoring in statin users and suggest a potential role for lifestyle interventions in mitigating this risk. Further studies are needed to explore strategies for balancing the cardiovascular benefits of statins with their potential metabolic risks.

PMID:39981479 | PMC:PMC11840273 | DOI:10.7759/cureus.77749

Cureus. 2025 Jan 20;17(1):e77739. doi: 10.7759/cureus.77739. eCollection 2025 Jan.

ABSTRACT

Background Diabetic ketoacidosis (DKA) is a common and serious complication of diabetes, often requiring hospitalization and intensive care. Fluid resuscitation is a cornerstone of DKA management, with traditional guidelines recommending isotonic normal saline (NS) for initial volume replacement. Recent studies, however, suggest that large volumes of NS may lead to undesirable outcomes such as hyperchloremic metabolic acidosis. This study investigates the effects of large-volume NS resuscitation on clinical outcomes in DKA management, comparing it to other fluids, such as lactated Ringers (LR). Objective To evaluate whether large-volume resuscitation with isotonic normal saline (NS) is associated with prolonged ICU length of stay (LOS), increased time on insulin infusion, and higher rates of non-anion gap metabolic acidosis in patients with DKA. Materials and methods This was a single-center, retrospective, observational study conducted at Naples Comprehensive Healthcare System. We reviewed electronic medical records of patients diagnosed with DKA, defined by pH <7.3, bicarbonate <18, and anion gap >12. The primary outcome was ICU LOS, and secondary outcomes included overall length of stay, insulin infusion duration after DKA resolution, and incidence of non-anion gap metabolic acidosis after DKA resolution. Patients were grouped by the amount of NS received during resuscitation: 0L, 1L, 2L, and ≥3L. Statistical analyses included analysis of variance (ANOVA), t-tests, and chi-square tests to compare outcomes between groups. Results A total of 109 patients were included in the study. The mean age was 51.34 years, and the cohort consisted of 43.1% females and 56.9% males. There was no significant difference in ICU LOS between patients who received 0L and 1L of NS. However, patients who received 2L (p=0.0249) and ≥3L (p=0.00065) had significantly longer ICU LOS compared to those who received 0L of NS. No significant difference in overall LOS was also observed across all groups (p=0.894). Patients who received ≥3L of NS had a significantly longer duration of insulin infusion compared to those who received 0L (p=0.0101) after DKA anion gap closure while a significant increase in the incidence of non-anion gap acidosis after DKA resolution was observed in patients receiving ≥2L of NS (p=0.0000). Conclusion This study suggests that large-volume resuscitation with isotonic NS in DKA patients is associated with increased ICU length of stay, prolonged insulin infusion, and a higher incidence of non-anion gap metabolic acidosis. These findings support the use of balanced crystalloids, such as lactated Ringers, for initial resuscitation in DKA patients, as they may reduce the risk of complications related to hyperchloremia and improve clinical outcomes. Further prospective studies are needed to confirm these findings and guide fluid management protocols in DKA.

PMID:39981474 | PMC:PMC11839305 | DOI:10.7759/cureus.77739

Personal Ment Health. 2025 Feb;19(1):e70010. doi: 10.1002/pmh.70010.

ABSTRACT

This paper examines the prevalence and comorbidity of complex post-traumatic stress disorder (CPTSD) and borderline personality disorder (BPD) among individuals with probable personality disorder, using baseline data from the Structured Psychological Support clinical trial. The clinical characteristics and personality functioning of participants are summarised and compared between those meeting criteria for BPD, CPTSD, both or neither condition. Among 292 participants, 97% reported significant trauma exposure, and over half met the criteria for CPTSD. Those with CPTSD exhibited higher levels of social dysfunction and depression compared with those with BPD, despite both groups showing elevated emotion dysregulation and anxiety. Comorbidity of CPTSD and BPD was high, with 50% of the sample meeting criteria for both conditions. Participants with comorbid CPTSD and BPD displayed poorer baseline scores across all measures of mental health and functioning than those who met criteria for BPD alone. No statistically significant differences were found in suicidal behaviour or treatment-seeking between groups. There were no significant differences in International Classification of Diseases-11 personality trait domains between participants with CPTSD and BPD, but people with comorbid CPTSD and BPD displayed higher levels of trait negative affectivity than those with BPD alone. The findings highlight the need for trauma-informed assessments in clinical settings and a better understanding of the impact of CPTSD on treatment outcomes for people with personality disorder, including how existing treatments may need to be modified to better meet the needs of people with these highly comorbid conditions. TRIAL REGISTRATION: Current controlled trials ISRCTN13918289 (registered 11/11/2022).

PMID:39980078 | DOI:10.1002/pmh.70010

Syst Rev. 2025 Feb 20;14(1):45. doi: 10.1186/s13643-025-02755-w.

ABSTRACT

BACKGROUND: Diabetic retinopathy (DR) is a leading cause of vision impairment and blindness among individuals with diabetes. Traditional Chinese medicine (TCM) has been explored as an alternative treatment for DR, but the quality of evidence remains uncertain. A comprehensive evidence mapping study is necessary to synthesize existing SRs, identify gaps in the literature, and highlight areas requiring further research.

OBJECTIVE: This study aims to evaluate the reporting and methodological quality of SRs on TCM for DR and to assess the effectiveness of TCM interventions using an evidence-mapping approach.

METHODS: A comprehensive search of major biomedical databases to identify relevant SRs published up to November 2023. The reporting quality of the included SRs was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, while the methodological quality was evaluated using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool.

RESULTS: A total of 51 SRs involving 131,084 participants were included in the analysis. Evidence mapping indicated that TCM is relatively effective in treating DR. However, the methodological quality and reporting standards of these SRs were generally suboptimal. According to the AMSTAR 2 assessment, only one SR (2%) was rated as high quality, 29 SRs (56.9%) were of moderate quality, 20 SRs (39.2%) were of low quality, and one SR (2%) was of critically low quality. While all studies adequately reported the PICO components, risk of bias assessment, and statistical methods, none provided information on funding sources. Furthermore, only one study (2%) included a list of excluded studies with reasons, and eight SRs (15.7%) documented pre-specified protocols. Common reporting deficiencies included incomplete protocol and registration details, unclear review rationales, and insufficient presentation of relevant outcome data.

CONCLUSION: This evidence mapping study highlights the potential benefits of TCM for treating DR while identifying significant gaps in the existing literature. Although TCM interventions show potential benefits for treating DR, the overall quality of SRs is suboptimal. Future research should focus on addressing these gaps, particularly in areas such as funding disclosure and methodological rigor, to enhance the reliability of evidence on TCM interventions for DR.

PMID:39980075 | DOI:10.1186/s13643-025-02755-w

Breast Cancer Res. 2025 Feb 20;27(1):26. doi: 10.1186/s13058-025-01963-5.

ABSTRACT

PURPOSE: CALGB 40903 (Alliance) was a phase II single arm multicenter trial conducted in postmenopausal patients diagnosed with estrogen-receptor (ER) positive breast ductal carcinoma in situ (DCIS) without invasion. Patients were treated with the aromatase inhibitor (AI) letrozole for 6 months prior to surgery with change in magnetic resonance imaging (MRI) enhancement volume compared to baseline as the primary endpoint. In the current study, we performed sequence analysis of pre- and post-treatment specimens to determine gene expression and DNA copy number parameters associated with treatment and response.

EXPERIMENTAL DESIGN: Paraffin sections from pretreatment biopsies and post-treatment surgical specimens were evaluated for presence of DCIS. Proliferation based on KI67 staining was quantified by a study pathologist. Macrodissection of the DCIS components from thin sections was the source of RNA and DNA. Whole-transcriptome RNA and shallow whole-genome DNA sequencing were performed. PAM50 analysis to assign intrinsic subtypes with associated probability of class membership was performed. Differential gene expression comparing responders versus non-responders and pre- versus post-treatment specimens was performed using a two-tiered approach based on candidate genes and a whole genome survey with appropriate multiple testing corrections.

RESULTS: Based on availability of specimens and presence of DCIS component, 29 patients (from the 70 who completed the treatment trial) were included in the final data set, including five who had a pathologic complete response (pCR). Response to treatment was qualified categorically based on a threshold of 10% KI67 in the post-treatment surgical specimen or pCR. Based on this criterion, six of the 29 DCIS were considered non-responders (> 10% KI67) and five subjects with pCR were assigned to the responder group. No standard clinical variables were associated with response. On the basis of gene expression analysis, 19 of the pre-treatment samples were classified as luminal A, all of which were classified as responders. PAM50 classification of the other ten pre-treatment samples included luminal B, HER2, basal, and normal-like, six of which were non-responders. PAM50 class membership shifted from baseline to post-treatment in eight cases, most often from luminal A to normal-like (five cases). Selected genes associated with estrogen receptor levels in invasive breast cancer were higher in AI responsive tumors. AI treatment resulted in reductions in estrogen and proliferation related genes.

CONCLUSIONS: Letrozole treatment produced an effective growth response, particularly in DCIS initially classified as luminal A. Study inclusion criteria of DCIS with at least 1% ER positive cells resulted in the inclusion of other subtypes that failed to respond. Treatment also induced both minor and major changes in intrinsic subtype based on PAM50 probabilities. Overall, these data indicate that response to AI treatment in ER( +) DCIS is variable and analogous to that observed in invasive breast cancers.

TRANSLATIONAL RELEVANCE: Treatment for breast DCIS ranges from active surveillance to mastectomy, often combined with adjuvant endocrine therapy. The work presented here based on a unique neoadjuvant trial provides direct information on hormone therapy responsiveness of this disease and further couples the biology of invasive breast cancer to its non-obligate precursor.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01439711.

PMID:39980051 | DOI:10.1186/s13058-025-01963-5

BMC Res Notes. 2025 Feb 20;18(1):78. doi: 10.1186/s13104-025-07145-y.

ABSTRACT

OBJECTIVE: COVID-19 data exhibit various biases, not least a significant weekly periodic oscillation observed in case and death data from multiple countries. There has been debate over whether this may be attributed to weekly socialising and working patterns, or is due to underlying biases in the reporting process. We investigate these periodic reporting trends in epidemics of COVID-19 and cholera, and discuss the possible origin of these oscillations.

RESULTS: We present a systematic, global characterisation of these weekly biases and identify an equivalent bias in the current Haitian cholera outbreak. By comparing published COVID-19 time series to retrospective datasets from the United Kingdom (UK), we demonstrate that the weekly trends observed in the UK may be fully explained by biases in the testing and reporting processes. These conclusions play an important role in forecasting healthcare demand and determining suitable interventions for future infectious disease outbreaks.

PMID:39980045 | DOI:10.1186/s13104-025-07145-y

Reprod Biol Endocrinol. 2025 Feb 20;23(1):25. doi: 10.1186/s12958-025-01364-5.

ABSTRACT

BACKGROUND: Follitropin delta (hrFSH) is the first recombinant follicle-stimulating hormone produced in a human cell line and more closely resembles native human FSH than follitropin alfa/beta (rFSH). Its efficacy and safety have been demonstrated in numerous clinical trials. However, to date, no real-world study has evaluated the reproductive outcomes associated with controlled ovarian stimulation (COS) with hrFSH compared to rFSH.

METHODS: This study was a retrospective analysis of real-world data prospectively collected by the German IVF Registry (D-I-R; Deutsches IVF-Register). Data from women undergoing COS in Germany between 2017 and 2022 were included, specifically from centers using both hrFSH and rFSH for COS (N = 74). Propensity score matching (PSM) was used to match groups to minimize potential confounders. Matching criteria included age, year of stimulation, stimulation protocol, reproductive procedure, treatment indication, preconditions, and patient sterility factors. Outcomes were number of oocytes retrieved, pregnancy rate (PR) and cumulative PR (followed up to 12/31/2022 and 12/31/2021, respectively), and LBR and cumulative LBR (followed up to 12/31/2021 and 12/31/2020, respectively).

RESULTS: Before and after matching, the mean number of oocytes retrieved was similar between the two groups. Prior to matching, there was no statistically significant difference in PR or LBR per embryo transfer (ET) between women who received hrFSH or those who received rFSH (PR: 38.0% vs. 36.8%; p = 0.1090; LBR: 29.4% vs. 28.2%; p = 0.1103). When examining the cumulative pregnancy rates (PR) and live birth rates (LBR) for all fresh and frozen/thawed embryo transfers (FET) following the initial oocyte retrieval, notable differences emerged between the groups. The use of hrFSH was linked to higher percentages compared to rFSH, with cumulative PR at 68.0% versus 64.9% (p < 0.05) and cumulative LBR at 57.3% versus 51.9% (p < 0.01). After matching, the cumulative LBR remained significantly higher when hrFSH was used for ovarian stimulation compared to rFSH (57.4% vs. 50.7%; p < 0.05).

CONCLUSION: In this large retrospective analysis of a prospectively collected real-world data set, the higher cumulative LBR with hrFSH compared to rFSH supports the use of an individualized fertility treatment approach based on hrFSH.

PMID:39980039 | DOI:10.1186/s12958-025-01364-5

BMC Public Health. 2025 Feb 20;25(1):704. doi: 10.1186/s12889-025-21917-y.

ABSTRACT

BACKGROUND: The unmet need for family planning (FP) occurs when women want to limit or delay childbearing but lack access to contraception, leading to unintended pregnancies and increased maternal and child mortality, especially in developing countries. This study uses the 2021 PMA-Ethiopia survey to assess unmet need for family planning (FP) among reproductive age women, addressing limitations in previous research that relied on outdated and non-representative data. The findings offer valuable insights to help policymakers address local challenges and improve reproductive health outcomes in Ethiopia.

METHODS: This study utilized secondary data from the Performance Monitoring for Action Ethiopia survey conducted in 2021. A total of 5,203 reproductive-aged women were included in this study. STATA version 16 was used to cross-tabulate and fit the models. To account for the hierarchical structure of the data, we employed multilevel logistic regression. We estimated four statistical models: a null model (Model 0) to assess between-community variations, Model I incorporating individual-level predictors, Model II adding community-level factors, and Model III including both. To select the best-fitting model, we conducted model comparison using BIC, AIC, deviance, and log-likelihood ratio (LLR) to assess model performance. We calculated adjusted odds ratios along with their corresponding 95% confidence intervals (CIs). Furthermore, a significance level of p < 0.05 was considered as strong evidence of statistical significance.

RESULTS: The prevalence of unmet need for family planning among reproductive-age women was 23.60% [95% CI: 22.46%, 24.78%]. Model comparison indicated that Model III exhibited the best fit, with the lowest AIC (5306) and DIC (5300) values, along with an improved log-likelihood (-2650). Factors positively associated with unmet need included women aged 45-49 [AOR = 4.7, 95% CI: (2.97, 7.43)], 40-44 [AOR = 3.21, 95% CI: (2.23, 4.61)], 35-39 [AOR = 2.47, 95% CI: (1.78, 3.44)], and 30-34 years [AOR = 2.42, 95% CI: (1.76, 3.33)] compared to those aged 15-19 years. Conversely, having 1-2 children [AOR = 0.47, 95% CI: 0.39, 0.56], having 3-4 children [AOR = 0.50, 95% CI: 0.39, 0.63], and having five or more children [AOR = 0.51, 95% CI: 0.39, 0.66] were factors negatively associated with unmet need compared to women who are para 0. Furthermore, the spatial pattern of unmet need for family planning exhibited clustering (Moran’s index = 0.25, p-value = 0.0039). The primary cluster is located in the central part of Oromia, northern SNNP, northwest of Sidama, and northeastern part of Southwest Ethiopia.

CONCLUSION: This study affirms the ongoing high prevalence of unmet need for family planning in Ethiopia. It identified women’s age and parity as crucial factors correlated with unmet need for FP. Additionally, there exists an unequal distribution of the burden of unmet need for FP across the country. To address the varying reproductive health needs at different life stages and parity levels, the interventional plan needs to be based on women’s age and the number of children they have. Moreover, location-tailored interventional plans should be employed to optimize family planning related service inequalities.

PMID:39980036 | DOI:10.1186/s12889-025-21917-y