Nevin Manimala

Arch Dermatol Res. 2025 Feb 8;317(1):374. doi: 10.1007/s00403-025-03867-y.

ABSTRACT

Skin diseases affect millions of Americans, imposing a large financial burden on the U.S. healthcare system annually. Inpatient dermatology is a subspecialty focused on treating complicated skin diseases in hospitalized patients. Utilization of these services enhances diagnostic accuracy, shorten hospital stays, lower readmission rates, and improve patient outcomes. However, studies have indicated an overall decline in inpatient dermatology consultations and dermatology as primary admitting services. Currently, only two academic hospitals in the United States grant dermatologists admitting privileges, indicating decreased exposure to inpatient dermatology in residency despite the need for more hospital-based dermatologists. Therefore, this narrative review aims to characterize the financial impact and utilization of inpatient dermatology services. Historical and recent data consistently highlight the financial benefit of dermatologic hospitalizations and poor utilization of inpatient dermatology consultations. Teledermatology consultations also improve diagnostic accuracy and expedite interventions to improve patient outcomes. However, challenges like reduced reimbursement, lack of protocols, and limited resident training in inpatient dermatology have discouraged dermatologists from providing inpatient consultations. Policy changes are needed to promote these services that benefit patients as well as health systems.

PMID:39921720 | DOI:10.1007/s00403-025-03867-y

Eur Arch Otorhinolaryngol. 2025 Feb 8. doi: 10.1007/s00405-025-09232-z. Online ahead of print.

ABSTRACT

PURPOSE: Listening effort increases as background noise levels rise, affecting both children and adults. Understanding the impact of increased listening effort and identifying effective methods to estimate it in children is crucial, as higher listening effort can hinder learning. This systematic review and meta-analysis examined the effects of noise on listening effort, as measured using various methods, in children aged 5 to 13 years with normal hearing.

METHODS: Four scientific databases, PubMed, Scopus, Cochrane Library, and Web of Science, were searched to retrieve 23 eligible articles. The methodological quality of the studies was assessed using Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Meta-analysis was performed according to different methods of listening effort [behavioral (single-task paradigm and dual-task paradigm), subjective ratings, and physiological (pupillometry)].

RESULTS: Single-task paradigm and subjective ratings showed a medium effect of noise on listening effort, which was significant. Dual-task paradigm and pupillometry did not show statistically significant effects of noise on listening effort. Further, speech perception tasks show a greater effect of noise on listening effort as compared to listening comprehension.

CONCLUSIONS: Single-task paradigm and subjective rating methods revealed the negative effect of noise on listening effort during spoken language processing in children between 5-13 years of age. Thus, a combination of these two methods might provide useful information regarding the effect of noise on this population. The heterogeneity in the findings could be due to the multidimensional nature of listening effort and lack of construct validity of the methods used to assess listening effort.

PMID:39921717 | DOI:10.1007/s00405-025-09232-z

Eur Radiol. 2025 Feb 8. doi: 10.1007/s00330-025-11398-3. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine whether quantitative parameters derived from dual-energy CT (DECT) could predict prognosis in patients with resectable rectal cancer (RC).

MATERIALS AND METHODS: One hundred and thirty-four patients (recurrence/distant metastasis group, n = 36; non-metastasis/non-recurrence group, n = 98) with RC who underwent radical resection and DECT were retrospectively included. DECT quantitative parameters, including iodine concentration (IC), normalized iodine concentration (NIC), electron density (Rho), effective atomic number (Z_eff), dual-energy index (DEI), the slope of the spectral Hounsfield unit curve (λ_HU) on arterial and venous phase images. Univariate and multivariate Cox proportional hazards models were employed to identify independent risk factors of prognosis. The area under the receiver operating characteristic curve (AUC) was used to assess the performance. Disease-free survival (DFS) curves were constructed using the Kaplan-Meier method.

RESULTS: Patients in the metastasis/recurrence group had higher Rho in arterial phase (A-Rho), NIC in venous phase (V-NIC), Rho in venous phase (V-Rho), Z_eff in venous phase (V-Z_eff), λ_HU in venous phase (V-λ_HU), pT stage, pN stage, serum carcinoembryonic antigen (CEA), carbohydrate antigen-199 levels and more frequent in extramural venous invasion than those in non-metastasis/non-recurrence group (all p < 0.05). V-NIC, V-λ_HU, and CEA were independent risk factors of recurrence/distant metastasis (all p < 0.05). The AUC of combined indicator integrating three independent risk factors achieved the best diagnostic performance (AUC = 0.900). In stratified survival analysis, patients with high V-NIC, V-λ_HU, and CEA had lower 3-year DFS than those with low V-NIC, V-λ_HU, and CEA.

CONCLUSION: Combining V-NIC, V-λ_HU, and CEA could be used to noninvasively predict prognosis in resectable RC.

KEY POINTS: Question TNM staging fails to accurately prognosticate; can quantitative parameters derived from dual-energy CT predict prognosis in patients with resectable rectal cancer? Findings Normalized iodine concentration (V-NIC) and the slope of the spectral Hounsfield unit curve in venous phase (V-λHU), and carcinoembryonic antigen (CEA) are independent risk factors for recurrence/metastasis. Clinical relevance The combined indicator integrating V-NIC, V-λHU, and CEA could predict 3-year disease-free survival in patients with resectable rectal cancer and could aid in postoperative survival risk stratification to guide personalized treatment.

PMID:39921716 | DOI:10.1007/s00330-025-11398-3

Arch Dermatol Res. 2025 Feb 8;317(1):369. doi: 10.1007/s00403-025-03826-7.

ABSTRACT

The diagnostic workup for T3 or greater melanoma includes sentinel lymph node biopsy (SLNB) for staging purposes. However, it is unclear if a negative SLNB in this subset of patients is adequate to rule out distant metastases (DMs) in the absence of imaging. Furthermore, current guidelines for imaging in these cases are ambiguous. Therefore, we aim to report and compare the prevalence of DMs found on imaging in patients with T3 or greater melanoma, stratified by SLNB result. In addition, we aim to qualitatively investigate the effect on time to treatment if imaging is delayed in these patients. This is a retrospective study of 140 patients with T3 or greater melanoma who underwent workup and treatment at our institution from 2009 to 2022. Diagnostic data, primary tumor characteristics, and demographics were collected. Descriptive statistics were applied to describe the cohort with granular detail. An independent Fisher’s exact test was performed to compare the prevalence of DMs detected on imaging stratified by SLNB result. A student’s t test was performed to compare average time to treatment within a subset of patients with negative or non-localizing SLNB to assess for any benefit with staging imaging completed prior to SLNB. The prevalence of DMs detected using advanced imaging in patients with T3 or greater melanoma was similar between groups, where 4 of 33 (12.12%) patients with negative or non-localizing SLNB were found to have DMs compared to 6 of 50 (12%) patients with positive SLNB (two-tailed p = 1). For those who had a negative or non-localizing SLNB and underwent adjuvant therapy, a student’s t-test revealed no significant difference in time to treatment initiation between those who had imaging prior to SLNB (56 days) and those who had imaging after SLNB (86 days) was completed (p = 0.2317). Given the similar prevalence of DMs regardless of SLNB result, patients with T3 or greater melanoma may benefit from more extensive imaging alongside SLNB upon initial diagnosis to prevent potential delays in detection of DMs and prompt initiation of appropriate treatment.

PMID:39921714 | DOI:10.1007/s00403-025-03826-7

Arch Dermatol Res. 2025 Feb 8;317(1):379. doi: 10.1007/s00403-025-03872-1.

ABSTRACT

Hyperpigmentation is a commonly occurring skin problem, it affects people’s quality of life by causing anxiety and depression in them. This systematic review aims to critically evaluate the evidence of the effectiveness of formulations utilized in clinical trials for treating hyperpigmentation (melasma and photoaging). A comprehensive search was conducted using the Scopus, PubMed, Google Scholar, and National Center for Biotechnology Information (NCBI) databases, encompassing literature available up to December 2023. Clinical trials employing various formulations to address skin hyperpigmentation effectively were included and subsequently analysed. Meta-analysis was conducted using IBM SPSS Statistics software (version 29.0.1.0 for window) guidelines. From 102 literatures, 07 clinical studies that follow the inclusion criteria were selected. A total of 337 participants underwent a clinical trial, where 198 participants received the drug and 153 received a placebo. Meta-analysis of 07 clinical studies indicated that employed formulations have a significant effect on treating skin hyperpigmentation {Odds Ratio (OR): 4.260, 95% Confidence Interval (CI) 2.244 to 8.087, Probability value (P) p < 0.001} than placebo. Across 07 clinical trials, heterogeneity was found to be low {Tau-Squared (µ²) = 0.46, Degree of Freedom (df) = 6, p = 0.001, i-Squared (I²) = 0.76}. Formulations assessed in the meta-analysis are Ziziphus jujuba (Z. jujuba) syrup, Amorphophallus konjac (A. konjac) capsules, herbal mixture cream, cysteamine cream, 4-hexyl-1,3-phenylenediol lotion, lignin peroxidase cream, and 0.1% tretinoin cream. 0.1% tretinoin cream shows the lowest effect size while A. konjac capsules show the highest effect size among all the included studies. Formulations used in clinical trials have proven to be effective and safe for controlling skin hyperpigmentation compared to placebo treatments. Among all the formulations, 0.1% tretinoin demonstrates lower efficacy, while A. konjac exhibits the highest efficacy in treating hyperpigmentation. This systematic review will guide researchers and dermatologists in selecting quality products from the available formulations.

PMID:39921709 | DOI:10.1007/s00403-025-03872-1

Scand J Immunol. 2025 Feb;101(2):e13432. doi: 10.1111/sji.13432.

ABSTRACT

Oocyte donation (OD) pregnancies show a higher fetal-maternal incompatibility and a higher risk of developing pre-eclampsia (PE) than autologous pregnancies. As maternal monocytes play a role in the tolerization of the allogeneic fetus, the aim of this study was to analyse monocyte phenotypes in healthy and PE OD pregnancies. We collected maternal peripheral blood at different gestational time points in healthy (n = 10) and PE (n = 5) OD pregnancies. Fetal-maternal human leukocyte antigen (HLA) mismatches were calculated. We used a 35-colour antibody panel for Aurora spectral flow cytometry to analyse the composition and surface marker expression of monocyte subsets. Expression of CD38 on intermediate monocytes significantly increased throughout gestation in healthy OD pregnancies. Compared with the healthy group, the PE group exhibited even higher CD38 expression on monocyte subsets, with statistical significance. Immune inhibiting receptors CD85j (LILRB1) and CD85d (LILRB2), as well as monocyte recruitment regulating molecules CCR2 and CD91, also showed significantly enhanced expression on monocyte subsets during PE. When comparing healthy and PE OD only in pregnancies with high HLA mismatches, the different CD38 and CD85j expression in monocyte subsets was still significant. In conclusion, in healthy OD pregnancies, the upregulated CD38 expression might reflect a proinflammatory condition specifically at the third trimester. In PE OD pregnancies, expression of both inflammatory and immune regulatory markers is increased in maternal peripheral monocyte subsets. The elevated expression of CCR2 and CD91 on these subsets might reflect monocyte chemotaxis and the effect from systemic vascular dysfunction at the late stage of PE.

PMID:39920890 | DOI:10.1111/sji.13432

Eur J Med Res. 2025 Feb 7;30(1):83. doi: 10.1186/s40001-024-02258-9.

ABSTRACT

BACKGROUND: Timing the fixator removal is vital for a successful external fixation treatment. The purpose of this study was to determine the effectiveness of axial load-share ratio in vivo as a supplemental decision support tool for the safe removal of an Ilizarov circular external fixator.

METHODS: This prospective observational study consists of 83 patients undergoing tibial or femoral lengthening with Ilizarov circular external fixation in our institution, from January 2011 to October 2019. In group I (38 patients), the external fixator was removed based on the surgeon’s clinical experience and radiographs from January 2011 to June 2015. In group II (45 patients), from July 2015 to October 2019, the supplemental axial load-share (LS) ratio test was accomplished without the knowledge of the clinical results by another medical team. The test was performed by electronically measuring forces in the fixator rods and in a ground force plate. When the LS ratio < 10% was consistent with the conclusion (dense bone formation was achieved in the distraction zone) drawn from the corresponding routine radiographs by the treating surgeon, the external fixator was removed.

RESULTS: There was no statistical significance in demographic data between the two groups (P > 0.05). In group I, 4 of the 38 patients suffered refracture (the refracture rate was 10.5%) after fixator removal, and bone union was finally achieved with further intervention by intramedullary nail. In group II, 36 patients terminated the external fixation after the first mechanical test, and another 9 patients terminated the external fixation at the subsequent test. None of the 45 patients in group II suffered refracture (the refracture rate was 0%). There was statistical significance in the refracture rate between the two groups (P < 0.05).

CONCLUSIONS: Adequate assessment of bone regenerate is crucial before removing an external fixator to prevent deformation or refracture. The axial load-share ratio in vivo is a practically quantitative method to supplement radiography and clinical experience for the assessment of regenerate healing, and the axial load-share ratio dropped below 10% is a safe limit for the Ilizarov circular external fixator removal.

PMID:39920873 | DOI:10.1186/s40001-024-02258-9

J Health Popul Nutr. 2025 Feb 7;44(1):28. doi: 10.1186/s41043-025-00761-1.

ABSTRACT

BACKGROUND: Cardiovascular diseases are a leading cause of global mortality, with diet playing a key role in their progression. The Atherogenic Index of Plasma (AIP) is a predictive marker for cardiovascular risk, but its association with dietary intake across cardiometabolic phenotypes remains underexplored. This study investigates the relationship between dietary intake and AIP, hypothesizing that energy intake and macronutrients influence AIP and, consequently, cardiovascular risk.

METHODS: This cross-sectional study analyzed data from 9,515 participants aged 35-55 in the Azar cohort study. Based on Body Mass Index (BMI) and metabolic syndrome (MetS), participants were classified into four phenotypes: metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUHNW), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUHO). Dietary intake was evaluated using a semi-quantitative food frequency questionnaire (FFQ), and AIP was calculated. Adjustments were made for age, gender, socioeconomic status, and physical activity.

RESULTS: A notable difference was observed in demographic and clinical status between cardiometabolic groups of males and females. The AIP was highest in the MUHNW (0.42 for males; 0.28 for females) and lowest in the MHNW (0.05 for males; -0.05 for females, P < 0.001). There was a statistically significant difference in the mean energy intake and the percentage of energy intake from protein among the cardiometabolic phenotypes (p < 0.001). After adjusting for confounders, only weak but meaningful correlations remained for energy, carbohydrate, and protein intake in the MUHO (r = 0.048, P = 0.01; r = 0.057, P = 0.003; and r = 0.050, P = 0.01) and for carbohydrate and lipid intake in the MHO (r = 0.034, P < 0.01 and r = -0.055, P < 0.001).

CONCLUSION: The study found weak but meaningful correlations between energy, carbohydrate, and protein intake and AIP in the MUHO phenotype and between carbohydrate and lipid intake and AIP in the MHO phenotype. This highlights the role of energy and carbohydrates in AIP within specific subgroups. Future research should focus on the effects of macronutrient combinations on AIP and long-term dietary impacts on metabolic health instead of BMI.

PMID:39920871 | DOI:10.1186/s41043-025-00761-1

Antimicrob Resist Infect Control. 2025 Feb 7;14(1):8. doi: 10.1186/s13756-025-01516-7.

ABSTRACT

BACKGROUND: Despite the proven effectiveness of infection prevention and control (IPC) practices in reducing healthcare-associated infections and related costs, their implementation poses a challenge in neonatal care settings across high-income (HICs) and low- and middle-income countries (LMICs). While existing research has predominantly focused on assessing the clinical effectiveness of these practices in neonatal care, aspects concerning their implementation remain underexplored. This systematic review therefore aimed to analyze implementation determinants and employed strategies for implementing IPC practices in inpatient neonatal care across country income levels.

METHODS: Following a targeted search in seven databases, titles and abstracts as well as full texts were screened in a dual review process to identify studies focusing on the implementation of IPC practices in inpatient neonatal care and reporting on implementation determinants and/or implementation strategies. Implementation determinants were synthesized using the updated Consolidated Framework for Implementation Research. Implementation strategies were coded according to the Expert Recommendations for Implementing Change taxonomy. A convergent integrated approach was used to narratively summarize results across qualitative and quantitative studies. χ² Tests and Fisher’s Exact Tests were performed to analyze differences in implementation determinants and strategies across IPC practices and country income levels. The quality of included studies was assessed using the Mixed Methods Appraisal Tool.

RESULTS: Out of 6,426 records, a total of 156 studies were included in the systematic review. Neonatal units in LMICs and HICs showed general commonalities in reported implementation determinants, which were mainly reported at the organizational level. While educational as well as evaluative and iterative strategies were most frequently employed to support the implementation of IPC practices in both LMICs and HICs, other strategies employed showed variance across country income levels. Notably, the statistical analyses identified a significant association between country income levels and implementation determinants and strategies respectively ([Formula: see text]<0.05).

CONCLUSION: The results of this systematic review underscore the importance of the organizational level for the implementation of IPC practices in neonatal care irrespective of country income level. However, further research is needed to understand the underlying relationships of factors and dynamics contributing to the observed practice variances in LMICs and HICs.

REGISTRATION: PROSPERO (CRD42022380379).

PMID:39920866 | DOI:10.1186/s13756-025-01516-7

BMC Nutr. 2025 Feb 7;11(1):33. doi: 10.1186/s40795-025-01022-4.

ABSTRACT

BACKGROUND: Since foods are consumed in combinations that also interact with other lifestyle variables such as body mass index(BMI) and physical activity, it is difficult to separate the role of single foods or a lifestyle variable alone in predicting the risk of chronic diseases such as metabolic disorders. Therefore, a suitable way to examine the combined effect of food consumption and its interaction with other lifestyle variables is to derive dietary patterns and lifestyle patterns using appropriate statistical methods. This study aimed to derive two dietary and lifestyle patterns related to hyperinsulinemia and insulin resistance(IR) using reduced rank regression(RRR) analysis.

METHODS: The current study was conducted on 1063 individuals aged ≥ 25 years old of the Tehran Lipid and Glucose Study who have complete data on fasting blood sugar, plasma insulin, anthropometric variables, and nutritional intakes. Dietary intakes were collected using a food frequency questionnaire. Dietary and lifestyle patterns were identified via RRR analysis, using 34 food groups, BMI, smoking, and physical activity as predictor variables, and fasting serum insulin and HOMA-IR as response biomarkers.

RESULTS: RRR derived a dietary pattern with a higher intake of processed meat, doogh, pickles, lemon juices, fish, and a lower intake of starchy vegetables, garlic and onion, dried fruits, nuts, red meat, dairy products, and coffee as predictive variables for IR and hyperinsulinemia. Also, RRR derived a lifestyle pattern based on the above-mentioned dietary pattern and high BMI as response variables. In the final adjusted model of cross-sectional analysis, the odds of hyperinsulinemia(OR:1.23,95%CI:1.08-1.41,P_trend=0.002) and IR(OR:1.52,95%CI:1.25-1.86,P_trend<0.001) were elevated with increasing each quartile of RRR-derived dietary pattern score. Also, a higher adherence to RRR-derived lifestyle pattern was associated with higher odds of hyperinsulinemia(OR:2.49,95%CI:2.14-2.88,P_trend<0.001) and IR(OR:3.20,95%CI:2.50-4.10,P_trend<0.001). Moreover, after three years of follow-up, the risk of hyperinsulinemia(OR:1.30,95%CI:1.08-1.56,P_trend=0.006) and IR(OR:1.26,95%CI:1.01-1.58,P_trend=0.037) incidence were increased per each quartile increase of the RRR-derived lifestyle pattern.

CONCLUSIONS: Our findings suggested that a dietary pattern and lifestyle with elevated BMI level, higher consumption of processed meat, doogh, pickles, lemon juices, and fish, and lower consumption of starchy vegetables, garlic and onion, dried fruits, nuts, red meat, dairy products, coffee may be associated with a higher risk of hyperinsulinemia and IR. It is suggested that further studies with a larger sample size and more extended follow-up duration, especially in other populations with different lifestyles and food habits be performed to confirm the findings of the current study.

PMID:39920862 | DOI:10.1186/s40795-025-01022-4