Nevin Manimala

Dan Med J. 2024 Dec 11;72(1):A06240378. doi: 10.61409/A06240378.

ABSTRACT

INTRODUCTION: Ankyloglossia in breastfeeding infants has been proposed to cause maternal nipple pain. Lingual frenotomy has been cited to reduce maternal nipple pain. The aim of this systematic review was to investigate if frenotomy in infants with ankyloglossia and breastfeeding problems reduces maternal nipple pain.

METHODS: We conducted a systematic literature search for RCTs comparing frenotomy to a sham procedure or usual care in mother-infant dyads with ankyloglossia and maternal nipple pain. Maternal nipple pain was registered as the main outcome. We conducted a meta-analysis and assessed the risk of bias using Rob 2.0 and the quality of evidence, adopting the GRADE approach.

RESULTS: Five RCTs were included in the review. Three RCTs were used for the meta-analysis. The meta-analysis showed a significant pre-post intervention reduction in maternal nipple pain in the frenotomy group compared with the comparison group: mean difference = -1.23; 95% confidence interval: -1.88 to -0.57. The overall bias was assessed to range from “some concerns” to “high”. The quality of evidence for the assessed outcome, maternal nipple pain, was classified as “low” to “very low”.

CONCLUSIONS: We found that frenotomy reduced maternal nipple pain in the short term. Despite being statistically significant, the clinical relevance of a 1.2-point reduction on a ten-point VAS must be questioned. Due to a considerable risk of bias along with a low study quality, the definitive benefit of frenotomy on maternal nipple pain remains unproven. Hence, quality large-scale RCTs are warranted.

PMID:39936271 | DOI:10.61409/A06240378

Dan Med J. 2024 Dec 11;72(1):A06240407. doi: 10.61409/A06240407.

ABSTRACT

INTRODUCTION: Acid-base disturbances are common in the emergency department, with acidosis and alkalosis being associated with an elevated risk of mortality and morbidity. Understanding the relationship between pH and mortality may serve to optimise patient outcomes. The primary objective was to describe the association between arterial blood pH and 0-2-day mortality in adult non-traumatic acute visits. The secondary objective was to describe this association for 3-7-day mortality.

METHODS: This population-based, multicentre cohort study included all adult non-traumatic acute visits in the Region of Southern Denmark between 2016 and 2018 who had an arterial blood gas (ABG) drawn within four hours of arrival. We described 0-2- and 3-7-day mortality stratified by pH level, controlled for confounding factors and reported as hazard ratio (HR) compared to normal pH.

RESULTS: A total of 64,725 acute visits in 31,650 individuals with an ABG were included. The overall mortality rate for index visits was 2.4% on days 0-2 and 2.1% on days 3-7. Patients with severe acidosis (pH less-than 7.20) had 20.8% and 8.9% mortality rates (HR = 9.6 and 5.2), whereas patients with acidosis (pH 7.20-7.34) had mortality rates of 7.4% and 5.2% (HR = 4.1 and 2.7) on day 0-2 and 3-7, respectively. Our secondary analysis found a 0-2-day mortality rate of nearly 60% in patients with a pH less-than 6.90.

CONCLUSION: The short-term mortality rates increased with the severity of acidosis. The highest mortality rate was found in patients with a pH less-than 6.90.

FUNDING: None.

TRIAL REGISTRATION: Not relevant.

PMID:39936269 | DOI:10.61409/A06240407

Dan Med J. 2024 Dec 11;72(1):A05240301. doi: 10.61409/A05240301.

ABSTRACT

INTRODUCTION: This study aimed to report the components of optometrist-facilitated eye health checks in optician chain stores in Denmark.

METHODS: In this survey-based cross-sectional study, we screened the 600 optician stores listed on the website of Fight for Sight Denmark and included optician store chains with more than 50 stores nationwide. The websites of each chain were reviewed to identify current trends in eye health checks, from which an interview guide was developed. Survey data were collected by conducting in-person interviews in three different optician stores from each chain.

RESULTS: Five optician store chains were eligible for inclusion in this study. All but one chain included at least non-contact air-puff tonometry and non-mydriatic colour fundus photography in their eye health check. In two of the chains, telemedical evaluation was mandatory for all abnormal results found by the in-store optometrists, whereas telemedical services were optional in the remaining optician chains.

CONCLUSIONS: This study reported the contents and organisation of optometrist-facilitated eye health checks across the five largest optician store chains in Denmark. We found that the content of eye health checks differs between chains and that their results are evaluated differently. Standardisation of the area and development of guidelines may be necessary if optometrists are to play a role in eye health screening.

FUNDING: None.

TRIAL REGISTRATION: Not relevant.

PMID:39936268 | DOI:10.61409/A05240301

JMIR Med Educ. 2025 Feb 10;11:e57634. doi: 10.2196/57634.

ABSTRACT

BACKGROUND: Forensic medicine requires background medical knowledge and the ability to apply it to legal cases. Medical students have different levels of medical knowledge and are therefore likely to perform differently when learning forensic medicine. However, different medical curricula in Thailand deliver forensic medicine courses at different stages of medical study; most curricula deliver these courses in the clinical years, while others offer them in the preclinical years. This raises questions about the differences in learning effectiveness.

OBJECTIVE: We aimed to compare the learning outcomes of medical students in curricula that either teach forensic medicine at the clinical level or teach it at the preclinical level.

METHODS: This was a 5-year retrospective study that compared multiple-choice question (MCQ) scores in a forensic medicine course for fifth- and third-year medical students. The fifth-year students’ program was different from that of the third-year students, but both programs were offered by Mahidol University. The students were taught forensic medicine by the same instructors, used similar content, and were evaluated via examinations of similar difficulty. Of the 1063 medical students included in this study, 782 were fifth-year clinical students, and 281 were third-year preclinical students.

RESULTS: The average scores of the fifth- and third-year medical students were 76.09% (SD 6.75%) and 62.94% (SD 8.33%), respectively. The difference was statistically significant (Kruskal-Wallis test: P<.001). Additionally, the average score of fifth-year medical students was significantly higher than that of third-year students in every academic year (all P values were <.001).

CONCLUSIONS: Teaching forensic medicine during the preclinical years may be too early, and preclinical students may not understand the clinical content sufficiently. Attention should be paid to ensuring that students have the adequate clinical background before teaching subjects that require clinical applications, especially in forensic medicine.

PMID:39936265 | DOI:10.2196/57634

Alzheimers Dement. 2025 Feb;21(2):e14568. doi: 10.1002/alz.14568.

ABSTRACT

INTRODUCTION: Alzheimer’s disease (AD) diagnosis centers on cognitive impairment despite other early indicators like neuropsychiatric symptoms (NPSs) and amyloid beta (Aβ) accumulation. This study examined how cognition, NPS, and Aβ changes are interrelated over time in individuals without dementia.

METHODS: Participants were 1247 individuals from the Alzheimer’s Disease Neuroimaging Initiative (ADNI)-2 and -3 cohorts with at least 48 months of follow-up. Cognitive domains were assessed via ADNI composite measures, NPS via the neuropsychiatric inventory, and Aβ via standardized uptake value ratio (SUVR) composite scores. Co-occurring changes were evaluated with parallel process models.

RESULTS: NPS was longitudinally associated with performance in each cognitive domain. Negative baseline Aβ-cognition associations were observed in three cognitive domains. No Aβ-NPS associations were observed.

DISCUSSION: This study demonstrated strong longitudinal relationships between NPS and cognition in preclinical and prodromal stages of AD. Future studies should incorporate NPS into models of disease trajectories to improve early detection and prediction of disease progression.

HIGHLIGHTS: Co-occurring changes in Aβ, cognition, and neuropsychiatric symptoms are understudied. We found relationships between neuropsychiatric symptoms and cognition. We found baseline, but not longitudinal, Aβ and cognition associations. Changes in neuropsychiatric symptoms should be included in early detection models of ADRD.

PMID:39936256 | DOI:10.1002/alz.14568

Neurol Res Pract. 2025 Feb 12;7(1):12. doi: 10.1186/s42466-024-00358-9.

ABSTRACT

BACKGROUND: The impact of direct oral anticoagulants (DOAC) on haematoma size after intracerebral haemorrhage (ICH) compared to no-anticoagulation is controversial and prospective data are lacking.

METHODS: The investigator-initiated, multicentre, prospective RASUNOA-prime study enrolled patients with non-traumatic ICH and atrial fibrillation while on a DOAC, vitamin K antagonist (VKA) or no anticoagulation (non-OAC). Neuroimaging was reviewed centrally blinded to group allocation. Primary endpoint was haematoma expansion (≥ 6.5 ml or ≥ 33%, any new intraventricular blood or an increase in modified Graeb score by ≥ 2 points) between baseline and follow-up scan within 72 h after symptom onset.

RESULTS: Of 1,440 patients screened, 951 patients with ICH symptom onset less than 24 h before admission were enrolled. Baseline scans were performed at a median of 2 h (IQR 1-6) after symptom onset. Neurological deficit and median baseline haematoma volumes (11 ml; IQR 4-39) did not differ among 577 DOAC, 251 VKA and 123 non-OAC patients. Haematoma expansion was observed in DOAC patients in 142/356 (39.9, 95%-CI 34.8-45.0%), VKA in 47/155 (30.3, 95-CI 23.1%-37.6%), versus non-OAC in 22/74 (29.7, 19.3-40.1%). Unspecific reversal agents in DOAC-ICH (212/356, 59.6%) did not affect the haematoma expansion rate compared to no-antagonization.

CONCLUSION: Baseline haematoma volume and risk of haematoma expansion did not differ statistically significantly in patients with and without DOAC.

PMID:39934933 | DOI:10.1186/s42466-024-00358-9

J Health Popul Nutr. 2025 Feb 11;44(1):37. doi: 10.1186/s41043-024-00722-0.

ABSTRACT

BACKGROUND: This study aims to determine the factors affecting the poverty rate among the households in question by region, the western, central, and eastern regions underwent research separately.

METHODS: This study uses the ordered discrete choice models: the heteroskedastic ordered logistic regression, generalized ordered probit, and partial proportional odds models.

RESULTS: Based on the findings of the data, statistically significant relationships between the variables; age, gender, levels of education, marital status, the number of equivalent individuals within the household, the existence of individuals under the age of 5 within the household, the presence of individuals over the age of 65 within the household, working status, the number of working individuals within the household, financial difficulty, the presence of income generated through real estate (rent) or securities, residential homeownership, chronic diseases, and the year of data collection were spotted.

CONCLUSIONS: Poverty is a multidimensional concept that can emerge due to several economic and social factors. Therefore, the policies that can be developed to reduce poverty can vary. To solve the problem of poverty, countries identify the factors that cause poverty and develop policies accordingly. Factors influencing household poverty levels across regions in Türkiye were identified, and several policy recommendations aimed to alleviate poverty were offered, considering the results achieved in this study. Given the results, Non-Governmental Organizations (NGOs) must implement practical projects that provide in-kind and cash assistance to those in need, offer employment opportunities, and improve the productivity of the impoverished. Continuous aid to the poor without expecting anything in return encourages them to be lazy, which may have a negative effect by increasing their dependency on getting help. In our country, an institutional monitoring mechanism should be established to measure the effectiveness of the in-kind and cash aids provided by central government institutions, local governments, and various non-governmental organizations in the fight against poverty.

PMID:39934907 | DOI:10.1186/s41043-024-00722-0

Perioper Med (Lond). 2025 Feb 11;14(1):18. doi: 10.1186/s13741-025-00500-4.

ABSTRACT

OBJECTIVE: This study aims to investigate the effects of remimazolam on postoperative melatonin secretion, sleep rhythm, and postoperative delirium (POD) in elderly patients undergoing spinal surgery.

METHODS: We selected 120 elderly patients scheduled for elective spinal surgery (lumbar interbody fusion via a posterior approach) under general anaesthesia from November 2023 to January 2024. They were divided into 2 groups according to medication, the remimazolam group (R group) and the propofol group (P group), with 60 patients in each group. The R group received an induction dose of remimazolam 0.2 ~ 0.3 mg/kg, followed by a continuous infusion of remimazolam at 0.1-0.2 mg/kg/h for maintenance. The P group received an induction dose of propofol 1.5 ~ 2.0 mg/kg, followed by a continuous infusion of propofol at 4-6 mg/kg/h for maintenance. Melatonin and cortisol concentrations were measured at 04:00 on the day of surgery and postoperative days 1, 2, and 3. The Pittsburgh Sleep Quality Index (PSQI) and resting visual analog scale (VAS) pain scores were recorded on the day before surgery, and on postoperative days 1 and 2, as well as prior to discharge. Additionally, we documented extubation time, PACU stay duration, total and effective button presses on the analgesia pump, instances of supplemental analgesia, and occurrence of complications.

RESULTS: Compared to the P group, the R group exhibited significantly shorter extubation time and PACU stay duration (P < 0.05). On postoperative days 1 and 2 at 04:00, melatonin concentrations were significantly higher, cortisol concentrations were significantly lower, and PSQI scores were significantly reduced in the R group (P < 0.05). The incidence of POD and postoperative sleep disturbance (POSD) was also significantly lower in the R group (P < 0.05). Furthermore, on postoperative day 1, the PSQI and resting VAS pain scores in the R group were significantly lower compared to the P group (P < 0.05). There were no statistically significant differences between the two groups in terms of surgery duration, anaesthesia duration, total and effective analgesia pump button presses, supplemental analgesia rates, intraoperative hypotension, or incidences of postoperative nausea, vomiting, dizziness, and respiratory depression (P > 0.05).

CONCLUSION: The use of remimazolam in elderly patients undergoing spinal surgery has a minimal impact on postoperative melatonin and cortisol secretion rhythms and sleep patterns, and may reduce the incidence of POD and alleviate postoperative sleep disturbances.

PMID:39934906 | DOI:10.1186/s13741-025-00500-4

Antimicrob Resist Infect Control. 2025 Feb 11;14(1):10. doi: 10.1186/s13756-025-01518-5.

ABSTRACT

BACKGROUND: The emergence of antimicrobial resistance in Gram-negative bacteria (GNB) is a major global concern. Ceftazidime-avibactam (CAZ-AVI) has been identified as a potential treatment option for complicated infections.

OBJECTIVES: This meta-analysis aimed to evaluate the global resistance proportions of GNB to CAZ-AVI comprehensively.

METHODS: Studies were searched in Scopus, PubMed, and EMBASE (until September 2024), and statistical analyses were conducted using STATA software (version 20.0).

RESULTS: CAZ-AVI resistance proportions were determined in 136 studies, with 25.8% (95% CI 22.2-29.7) for non-fermentative gram-negative bacilli and 6.1% (95% CI 4.9-7.4) for Enterobacterales. The CAZ-AVI resistance proportion significantly increased from 5.6% (95% CI 4.1-7.6) of 221,278 GNB isolates in 2015-2020 to 13.2% (95% CI 11.4-15.2) of 285,978 GNB isolates in 2021-2024. Regionally, CAZ-AVI resistance was highest in Asia 19.3% (95% CI 15.7-24.23.4), followed by Africa 13.6% (95% CI 5.6-29.2), Europe 11% (95% CI 7.8-15.2), South America 6.1% (95% CI 3.2-11.5) and North America 5.3% (95% CI 4.2-6.7). Among GNB resistance profiles, colistin-resistant isolates and XDR isolates exhibited the highest resistance proportions (37.1%, 95% CI 14-68 and 32.1%, 95% CI 18.5-49.6), respectively), followed by carbapenem-resistant isolates and MDR isolates [(25.8%, 95% CI 22.6-29.3) and (13%, 95% CI 9.6, 17.3)].

CONCLUSION: A high proportion of GNB isolates from urinary tract infections remained susceptible to CAZ-AVI, indicating its potential as a suitable treatment option. However, the increasing resistance trends among GNB are concerning and warrant continuous monitoring to maintain CAZ-AVI’s effectiveness against GNB infections.

PMID:39934901 | DOI:10.1186/s13756-025-01518-5

Perioper Med (Lond). 2025 Feb 11;14(1):19. doi: 10.1186/s13741-025-00499-8.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the effect of perioperative real-time information sharing on family members’ anxiety in patients undergoing elective thoracoscopic lobectomy and to explore the potential role of information sharing in reducing anxiety levels among family members.

METHODS: This study was a prospective, single-center, well-designed randomized controlled trial (RCT), ensuring methodological rigor, which included family members of patients undergoing elective thoracoscopic lobectomy. Participants were randomly assigned to either the experimental group (real-time information-sharing group) or the control group (routine information communication group). Anxiety levels were assessed at multiple time points, including preoperative (T-1), intraoperative (T1, T2, T3, T4), and postoperative (T5, T6) stages, using widely used anxiety scales: the Self-Rating Anxiety Scale (SAS), the Hospital Anxiety and Depression Scale (HADS), and the Generalized Anxiety Disorder 7 (GAD-7). Statistical analysis was performed using independent sample t-tests, with statistical significance set at P < 0.05 based on a predefined threshold.

RESULTS: At several key time points (T0, T1, T2, T3, T4, T5), family members in the experimental group showed significantly lower anxiety scores compared to those in the control group (P < 0.05). Notably, at T1 (when the patient entered the operating room) and T2 (30 min after the surgery began), the GAD-7 scores of the experimental group were significantly lower than those in the control group (T = 2.98, P = 0.003; T = 3.45, P = 0.001). The experimental group also had significantly lower SAS and HADS scores at time points T-1, T0, T1, T2, T3, and T4 compared to the control group.

CONCLUSION: Perioperative real-time information sharing has been shown to significantly reduce anxiety levels in family members of patients undergoing elective thoracoscopic lobectomy, particularly during the early stages of surgery, such as when the patient enters the operating room and 30 min after the surgery begins. Real-time information sharing may serve as an effective intervention to improve the psychological well-being of family members and is worth promoting in clinical practice.

PMID:39934883 | DOI:10.1186/s13741-025-00499-8