Nevin Manimala

Medicine (Baltimore). 2025 Mar 21;104(12):e41722. doi: 10.1097/MD.0000000000041722.

ABSTRACT

BACKGROUND: C-reactive rotein (CRP) has been extensively studied as a biomarker that can predict mortality in patients with acute lung disease and our study aimed to elucidate the prognostic value of CRP levels for mortality in patients with various airway diseases, accounting for these differences and potential confounding factors accounts.

METHODS: An extensive literature search was conducted in several databases including PubMed, Embase, Web of Science, Scopus, and ProQuest to ensure the inclusion of up-to-date evidence from studies published between January 2019 and December 2024. Both fixed-effects and random-effects models were used to calculate pooled mean hazard ratios (HR) and odds ratios (OR) for mortality.

RESULTS: For mortality, the fixed effects model revealed a HR of 1.0065 (95% CI: 1.0054-1.0075, P < .0001), indicating a slightly increased risk of death associated with higher CRP levels. However, the random effects model, considering study heterogeneity, suggested an HR of 1.0488 (95% CI: 0.9978-1.1024, P = .0608), with significant heterogeneity (Q = 135.31, P < .0001). The OR analysis under the random effects model showed a more substantial increase in mortality risk with an OR of 1.2033 (95% CI: 1.0635-1.3614, P = .0033). Regarding ICU admissions and ventilation needs, substantial heterogeneity was also observed. The analysis did not find a statistically significant association between elevated CRP levels and ICU admission (OR = 1.1108, 95% CI: 0.9604-1.2847, P = .1568) or the necessity for ventilation (OR = 1.8981, 95% CI: 0.9651-3.7331, P = .0633), although both indicated trends towards increased risk.

CONCLUSION: CRP levels show a potential yet inconsistent association with mortality risk in patients with pulmonary infections. While elevated CRP levels suggest an increased risk of mortality, the results should be interpreted cautiously due to potential overestimation of the effect and the presence of publication bias.

PMID:40128046 | DOI:10.1097/MD.0000000000041722

Medicine (Baltimore). 2025 Mar 21;104(12):e41927. doi: 10.1097/MD.0000000000041927.

ABSTRACT

Brain ultrasonography has emerged as a key tool in neurocritical care. This study aimed to investigate the global research trends and future research directions in the application of brain ultrasonography for craniocerebral diseases using quantification and visualization approaches. Publications on brain ultrasonography published between 2004 and 2024 retrieved from the Web of Science Core Collection database were screened against predetermined inclusion and exclusion criteria and analyzed. The data were processed using VOSviewer and CiteSpace to identify core countries/regions, institutions, authors, journals, collaborations, and research trends. Over the past 2 decades, 1251 articles focusing on brain ultrasonography as the primary subject were published across 455 journals by 5655 authors from 1619 institutions in 84 countries/regions. Publications exhibited a fluctuating and gradually progressive trend, with the number of publications per year peaking between 2019 and 2021. The USA, the United Kingdom, and Germany emerged as leading countries in this field, demonstrating robust cooperation with other countries/regions. Additionally, the University of Leicester and Panerai RB was the most prolific institution and author, respectively. The clinical applications of brain ultrasonography have progressively broadened from neurocritical care to encompass the general intensive care unit and emergency department. Finally, recent scholarly attention has primarily been directed toward the “deep learning framework” and “hypoxic-ischemic brain injury.” Globally, publications focusing on brain ultrasonography displayed a fluctuating and gradually progressive trend over the past 2 decades. Moreover, primary clinical applications and techniques have been constantly expanding. Overall, the findings of our study expanded our understanding of the current status of brain ultrasonography, potentially guiding future development directions in this field.

PMID:40128044 | DOI:10.1097/MD.0000000000041927

Medicine (Baltimore). 2025 Mar 21;104(12):e41910. doi: 10.1097/MD.0000000000041910.

ABSTRACT

Carry out a cross-sectional survey of medical and health services for the elderly in Sichuan province, understand the medical and health needs of the elderly in Sichuan province, analyze the existing problems and reasons, and then put forward feasible suggestions and opinions. Based on the top 10 single diseases in Sichuan province in 2021, hospitalized elderly patients suffering from the top 10 single diseases from January 2023 to April 2023 were selected as survey subjects, and the health status and medical and health service needs of the elderly population in Sichuan province were investigated using a questionnaire survey and statistical analysis. The sleep quality of the elderly in our province was generally not high, their basic health condition was poor, and the demand for basic medical services was high. There is a great need for medical care, especially for nutrition, medication, rehabilitation, and pain guidance. There is great demand for health education and management, especially for health examinations, health education, and health service systems. There is great demand for daily care, medical care services, mental health consultation, spiritual comfort, etc, and the referral demand is guaranteed to a certain extent, but it is still slightly insufficient in general. Allocating resources properly. The scientific cultivation of talent improves the healthcare system for the elderly and strengthens supervision. Active supply and innovative service methods. Focus on disabled and semi-disabled groups to reduce the burden.

PMID:40128043 | DOI:10.1097/MD.0000000000041910

Medicine (Baltimore). 2025 Mar 21;104(12):e41860. doi: 10.1097/MD.0000000000041860.

ABSTRACT

The significance of adropin levels in chronic renal failure patients has not yet been established. This study’s objectives were to compare serum adropin levels in hemodialysis patients with chronic renal failure and healthy patients as well as the clinical parameters corresponding with the levels. The total sample comprised of 49 hemodialysis individuals and 36 controls. We measured serum adropin concentrations using enzyme-linked immunosorbent assay method and analyzed various biochemical parameters including creatinine, uric acid, C-reactive protein, albumin, parathyroid hormone, and hemoglobin levels. In the patients there were statistically significant lower levels of serum adropin determined at 522.7 ± 169.4 versus 789.6 ± 259.3 ng/L, P < .01. Strong negative correlations were observed between adropin levels and both creatinine (r = -0.613, P < .001) and parathyroid hormone (r = -0.621, P < .001). Additionally, moderate positive correlations were found with albumin (r = 0.534, P < .001) and hemoglobin (r = 0.445, P < .001). There were also statistically significant differences in hemoglobin A1c of the patients and control populations with levels of 5.7 ± 1.8 versus 5.2 ± 0.5, P = .04 and C-reactive protein levels of 21.8 ± 28.9 versus 1.4 ± 2.6 mg/L, P < .01 respectively. These findings suggest that reduced adropin levels in hemodialysis patients are significantly associated with markers of renal dysfunction, inflammation, and nutritional status, indicating its potential role in the pathophysiology of chronic renal failure.

PMID:40128042 | DOI:10.1097/MD.0000000000041860

JMIR Mhealth Uhealth. 2025 Mar 24;13:e56296. doi: 10.2196/56296.

ABSTRACT

BACKGROUND: Smoking cessation apps are increasingly being used to help smokers quit smoking. In China, whether behavioral science-based techniques are being incorporated into smoking cessation apps remains unknown.

OBJECTIVES: This study aims to describe the usage of behavior change techniques (BCTs) among smoking cessation apps available in China and to evaluate the relationship between BCT utilization and the quality of available smoking cessation apps.

METHODS: We searched eligible smoking cessation apps twice on September 12 and October 4, 2022. We coded them with BCTs and assessed their quality by the Mobile App Rating Scale (MARS) and rating score in the App Store. We described the quality of each app (ie, engagement, function, esthetic, and information) and the BCTs used within it, as well as the amount and proportion of all BCTs used. Correlation analysis and linear regression analysis were used to assess the association between the number of BCTs used and the quality of apps.

RESULTS: Nine apps were included in the final analyses. The average number of BCTs being used was 11.44 (SD 2.57), ranging from 5 to 29. Only 1 app used more than 20 BCTs. The most frequently used BCTs were providing feedback on current smoking behavior (9/9, 100%), prompting review of goals (8/9, 88.89%), prompting self-monitoring of one’s smoking behavior (7/9, 77.78%), and assessing current and past smoking behavior (7/9, 77.78%). The most commonly used BCTS specifically focus on behavior, including BM (B refers to behavior change, M focuses on addressing motivation; 4.44/11, 40.36%) and BS (B refers to behavior change, S refers to maximizing self-regulatory capacity or skills; 3.78/11, 34.36%). The average score of MARS for the apps was 3.88 (SD 0.38), ranging from 3.29 to 4.46, which was positively correlated with the number of BCTs used (r=0.79; P=.01). Specifically, more usage of BCTs was associated with higher engagement score (β=.74; P=.02; R2=0.52) and higher information score (β=.76; P=.02; R2=0.52).

CONCLUSIONS: The quality of smoking cessation apps assessed by MARS was correlated with the number of BCTs used. However, overall, the usage of BCTs was insufficient and imbalanced, and the apps demonstrated low quality of engagement and information dimensions. Coordinated efforts from policy makers, technology companies, health behavior professionals, and health care providers should be made to reduce tobacco consumption and to develop high-quality, widely accessible, and effective smoking cessation apps to help smokers quit smoking.

PMID:40127456 | DOI:10.2196/56296

Ann Intern Med. 2025 Mar 25. doi: 10.7326/ANNALS-24-01770. Online ahead of print.

NO ABSTRACT

PMID:40127446 | DOI:10.7326/ANNALS-24-01770

JMIR Res Protoc. 2025 Mar 24;14:e63584. doi: 10.2196/63584.

ABSTRACT

BACKGROUND: The tobacco industry has a history of targeting minority communities, including Hispanic individuals, by promoting vaping through social media. This marketing increases the risk of vaping among Hispanic young adults, including college students. In Texas, college enrollment among Mexican Americans has significantly increased over recent years. However, little research exists on the link between social media and vaping and the underlying mechanisms (ie, outcome expectations, attitudes, and beliefs) explaining how vaping-related social media impacts vaping among Mexican American college students. Moreover, there is limited knowledge about how acculturation moderates the association between social media and vaping. Hispanic individuals, particularly Mexican Americans, are the largest ethnic group in Texas colleges; thus, it is crucial to understand the impact of social media and acculturation on their vaping behaviors.

OBJECTIVE: We outline the mixed methods used in Project Vaping, Acculturation, and Media Study (VAMoS). We present descriptive analyses of the participants enrolled in the study, highlight methodological strengths, and discuss lessons learned during the implementation of the study protocol related to recruitment and data collection and management.

METHODS: Project VAMoS is being conducted with Mexican American students attending 1 of 6 Texas-based colleges: University of Texas (UT) Arlington, UT Dallas, UT El Paso, UT Rio Grande Valley, UT San Antonio, and the University of Houston System. This project has 2 phases. Phase 1 included an ecological momentary assessment (EMA) study and qualitative one-on-one interviews (years 1-2), and phase 2 includes cognitive interviews and a 4-wave web-based survey study (years 2-4) with objective assessments of vaping-related social media content to which participants are exposed. Descriptive statistics summarized participants’ characteristics in the EMA and web-based survey.

RESULTS: The EMA analytic sample comprised 51 participants who were primarily female (n=37, 73%), born in the United States (n=48, 94%), of middle socioeconomic status (n=38, 75%), and aged 21 years on average (SD 1.7 years). The web-based survey cohort comprised 1492 participants self-identifying as Mexican American; Tejano, Tejana, or Tejanx; or Chicano, Chicana, or Chicanx heritage who were primarily female (n=1042, 69.8%), born in the United States (n=1366, 91.6%), of middle socioeconomic status (n=1174, 78.7%), and aged 20.1 years on average at baseline (SD 2.2 years). Of the baseline cohort, the retention rate in wave 2 was 74.7% (1114/1492).

CONCLUSIONS: Project VAMoS is one of the first longitudinal mixed methods studies exploring the impact of social media and acculturation on vaping behaviors specifically targeting Mexican American college students. Its innovative approach to objectively measuring social media exposure and engagement related to vaping enhances the validity of self-reported data beyond what national surveys can achieve. The results can be used to develop evidence-based, culturally relevant interventions to prevent vaping among this rapidly growing minority population.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63584.

PMID:40127433 | DOI:10.2196/63584

J Vet Emerg Crit Care (San Antonio). 2025 Mar 24:e13453. doi: 10.1111/vec.13453. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the variables associated with unsuccessful tracheal decannulation in brachycephalic breeds after upper airway surgery.

DESIGN: Retrospective study from 2010 to 2022.

SETTING: University teaching hospital.

ANIMALS: Fifty-one client-owned dogs requiring a temporary tracheostomy after upper airway surgery for brachycephalic obstructive airway syndrome (BOAS).

PROCEDURES: Medical records of dogs receiving a temporary tracheostomy after upper airway surgery for BOAS were reviewed. Dogs that underwent a tracheostomy decannulation attempt were included. Data were extracted from the medical record, including signalment, patient size, type of airway surgery, presence of hypoplastic trachea, presence of laryngeal collapse, prophylactic versus emergency tracheostomy, frequency of cannula suctioning, and time from tracheostomy to decannulation attempt. The association of these factors with successful decannulation and the number of decannulation attempts were evaluated.

RESULTS: Of 699 dogs with BOAS that had upper airway surgery, 54 (7.7%) had a temporary tracheostomy performed. Dogs with an increased frequency of tracheostomy tube suctioning in the 24-h period before the first decannulation attempt were less likely to have a successful decannulation (P = 0.03). Dogs with laryngeal collapse were less likely to have a successful decannulation at first attempt (P = 0.04). The overall probability of successful decannulation was 88.2% at a median of 50 postoperative hours. Forty-five percent of patients had a successful first decannulation.

CONCLUSIONS: Results indicated that an increased frequency of tracheostomy tube suctioning or a diagnosis of laryngeal collapse was negatively associated with successful decannulation. The use of alternative methods to reduce respiratory secretions and the development of specific suctioning protocols may be warranted. Patients with laryngeal collapse requiring temporary tracheostomy may have a poorer prognosis. Multiple statistical comparisons were made without correction, so these data should be considered preliminary, and future studies are required to confirm these risk factors.

PMID:40127420 | DOI:10.1111/vec.13453

J Clin Hypertens (Greenwich). 2025 Mar;27(3):e70038. doi: 10.1111/jch.70038.

ABSTRACT

We analyzed the usefulness of the carotid-femoral pulse wave velocity (cfPWV) as an integrated marker for hypertension (HTN)-mediated organ damage (HMOD) and cardiovascular (CV) risk in a cohort with repeated measurements. A total of 1031 patients, 80% of whom had HTN, underwent cfPWV determinations by SphygmoCor. An HMOD score was developed, including microalbuminuria, left ventricular hypertrophy (LVH), intima-media thickness (IMT), and carotid plaques. CV complications included atrial fibrillation (AF), heart failure (HF), stroke, ischemic heart disease (IHD), peripheral artery disease (PAD), or CV death. Survival curves based on Cox regression adjusted for age and systolic blood pressure (SBP), along with Harrell’s C statistic, were assessed. There was a trend toward higher cfPWV across categories of the HMOD score. Significant correlations were found among different AS parameters and blood pressure (BP) levels. Age and SBP were highly correlated with cfPWV. Among the 174 patients with at least two cfPWV measurements, there were 12 CV complications over a follow-up period of 2.4 years. The first and second cfPWV measurements, as well as the delta values, were significantly higher in those with CV complications, with most patients experiencing an increase in PWV during follow-up of ≥ 1 m/s. Survival curves significantly differed among tertiles of PWV and the delta, particularly for the second PWV determination, which also showed the highest predictive value (Harrell’s C = 0.86). The optimal threshold to predict complications was 9.10 m/s. Our findings suggest that cfPWV represents a promising integrated marker of HMOD, potentially serving as a surrogate endpoint for CV risk.

PMID:40127411 | DOI:10.1111/jch.70038

Blood Adv. 2025 Mar 24:bloodadvances.2024015594. doi: 10.1182/bloodadvances.2024015594. Online ahead of print.

ABSTRACT

Disease shift of chronic lymphocytic leukemia (CLL) to diffuse large B-cell lymphoma (DLBCL), so-called Richter transformation (RT), is a catastrophic clinical event. Rarely survival can outperform expectations and accurate prognostication for patients may affect therapeutic choices. To date, prognosis has relied on readily available factors such as TP53 disruption, prior CLL treatment status and performance score. Recently, shared clonality assessment by immunoglobulin heavy-chain variable (IgHV) region sequencing of the CLL and RT has been considered therapeutically relevant, but this is infrequently performed. We performed a systematic review of peer-reviewed manuscripts where outcomes in relation to clonal relatedness and lack thereof (clonally-related and -unrelated RT-DLBCL) were examined. Fifteen manuscripts which included 336 patients were found, of which six compared survival outcomes between the two groups in a statistically meaningful way. Two analyses showed no difference in survival outcomes with four studies reporting a significantly poorer prognosis with clonally-related RT-DLBCL. In two of these studies the baseline characteristics of clonally-related and -unrelated groups were compared and the clonally-related cases were enriched for underlying CLL which was TP53 disrupted, IgHV unmutated, more heavily pretreated and exhibiting stereotyped B-cell receptor VH CDR3, as well as RT-DLBCL which was MYD88wt. We demonstrate that although clonal relatedness of the underlying CLL confers a poorer survival, this is not demonstrated in any study to be independent of other well-described clinical and genomic variables known to influence outcome in RT-DLBCL. Further independent validation of this prognostic factor is required to help guide universal adoption into clinical practice.

PMID:40127387 | DOI:10.1182/bloodadvances.2024015594