Nevin Manimala

PLOS Glob Public Health. 2025 Nov 26;5(11):e0004867. doi: 10.1371/journal.pgph.0004867. eCollection 2025.

ABSTRACT

Armed conflicts severely impact healthcare systems leading to medication shortages and restricted access to essential services. The ongoing war in Sudan has disrupted healthcare infrastructure affecting patients particularly those with chronic diseases. This study examines the accessibility of medications and the consequences of limited healthcare access during the conflict. A descriptive cross-sectional study was conducted among individuals affected by the Sudan war. Data were collected through an online questionnaire assessing medication accessibility, healthcare service availability, and socioeconomic factors. Statistical analysis was performed using SPSS to examine correlations between accessibility and health outcomes. Out of 300 participants, 56.7% reported poor medication accessibility while 43.3% had to relocate due to a lack of medical care. 65.7% experienced worsening health condition and 61.3% believed medication shortages contributed to increased mortality. Low-income and unemployed individuals faced the greatest challenges in accessing medications. The Sudan war has significantly disrupted healthcare access with severe consequences for medication availability and patient health. Urgent humanitarian interventions and policy measures are needed to restore medication supply chains and improve healthcare access for conflict-affected populations.

PMID:41296819 | DOI:10.1371/journal.pgph.0004867

Plast Reconstr Surg. 2025 Nov 27. doi: 10.1097/PRS.0000000000012648. Online ahead of print.

ABSTRACT

INTRODUCTION: Injectable lipolytic agents have gained popularity as a non-invasive approach to localized fat reduction. While deoxycholic acid (DCA) remains the only FDA-approved agent for submental fat reduction, its application for non-submental regions is an emerging area of interest. This systematic review evaluates existing literature on injectable lipolytic agents beyond the submental region.

METHODS: A systematic review was conducted using PubMed, MEDLINE, EMBASE, Scopus, and Cochrane Central Register of Controlled Trials. Studies evaluating the use of injectable lipolytic agents for non-submental fat reduction were included. Extracted data included treatment outcomes, patient satisfaction, adverse events, and cost considerations. Bias was assessed using the ROBINS-I and RoB 2 tools.

RESULTS: Twenty-five studies met inclusion criteria, encompassing 3,178 patients treated with various agents, including DCA, phosphatidylcholine (PC), and emerging formulations such as CBL-514 and caffeine-hyaluronic acid. Significant reductions in localized adiposity were reported in 93.75% of studies, with 37.5% achieving statistical significance. Adverse events were generally mild and transient. Patient satisfaction varied from 57.1% to 86%. Cost comparisons indicated injectable treatments require multiple sessions, making them costlier than single-session surgical liposuction but competitive with non-invasive modalities like cryolipolysis.

CONCLUSIONS: Injectable lipolytic agents offer a promising, minimally invasive alternative for fat reduction in non-submental regions. However, further clinical trials are needed to standardize treatment protocols, evaluate long-term efficacy, and assess the cost-effectiveness of combining injectables with other weight management strategies. Expanding FDA approval for additional indications remains a potential future direction.

PMID:41296813 | DOI:10.1097/PRS.0000000000012648

Int J Dermatol. 2025 Nov 26. doi: 10.1111/ijd.70142. Online ahead of print.

ABSTRACT

Erysipeloid cutaneous leishmaniasis (ECL) is a rare presentation of cutaneous leishmaniasis that classically presents as erythematous, infiltrated lesions on the centrofacial region. We conducted a systematic review on the demographic characteristics, clinical presentations, laboratory findings, and treatment of ECL in the Old World. A systematic literature search was performed using the terms (“erysipeloid” OR “erysipelas”) AND “leishmaniasis” across Web of Science, PubMed, Scopus, Embase, and Google Scholar. Only studies reporting cases from the Old World were included. Based on the anatomic location of lesions, we defined three clinical distributions of ECL: (1) centrofacial involvement, (2) non-centrofacial lesions involving the face and/or scalp, and (3) lesions on the neck, trunk, and extremities. Our search yielded 3290 publications, of which 24 met the inclusion criteria. In total, 103 patients with ECL, including 73 females (70.9%) and 30 males (29.1%) with a mean age ± standard deviation of 52.1 ± 12.3 years, were included. Seventy-two patients (57 females, 15 males) had centrofacial lesions. Females comprised 83.8% of this subgroup, a difference that was statistically significant (p < 0.005). ECL was more common in postmenopausal females. ECL lesions on the trunk and extremities were reported in five patients. Sixty-five patients (63.1%) were treated with pentavalent antimonials alone or in combination with other drugs. In conclusion, ECL is a rare presentation of cutaneous leishmaniasis, most often affecting elderly women and primarily localizing to the mid-face. Old age and menopause might predispose to ECL development. Clinical suspicion is necessary for the diagnosis of lesions suggestive of ECL in endemic regions.

PMID:41293903 | DOI:10.1111/ijd.70142

Womens Health (Lond). 2025 Jan-Dec;21:17455057251392349. doi: 10.1177/17455057251392349. Epub 2025 Nov 26.

ABSTRACT

BACKGROUND: Person-centered maternity care (PCMC) is a model that prioritizes respect, dignity, and responsiveness to each woman’s needs, values, and preferences during childbirth. It promotes open communication and personalized care, which is crucial for improving maternal satisfaction and increasing hospital-based deliveries. While recognized as a key element of quality maternal care, the implementation of PCMC varies across different countries. This review aims to assess the pooled mean score and key predictors of PCMC in Ethiopia.

OBJECTIVES: This review aims to assess the pooled mean score and key predictors of PCMC in Ethiopia.

DESIGN: Systematic review and meta-analysis.

DATA SOURCES AND METHODS: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search was performed in international databases, and registers including: PubMed, Cochrane Library, Google Scholar, HINARI, Scopus, Web of Science, and African Journals Online databases. The quality of included studies was evaluated using the Joanna Briggs Institute tool. Heterogeneity was measured with the I² statistic and its p-value, and publication bias was examined through funnel plots and Egger’s test. A random effects model was applied to compute the pooled mean score of PCMC, and adjusted β with results presented as 95% confidence interval (CI).

RESULTS: Seven studies, involving 3383 women, were included in the review. The pooled mean PCMC score was 56.75% (95% CI: 55.08, 58.41). The highest scores were reported in Oromia (60.2) and Addis Ababa (59.2), while the lowest was in South Gondar (52.3). Key factors influencing PCMC included educational status (β: -2.7, 95% CI: -3.98, -1.45), complications during childbirth (β: -5.34, 95% CI: -7.24, -3.44), and time of delivery (β: -3.10, 95% CI: -4.10, -2.11).

CONCLUSION: The pooled mean score of PCMC in Ethiopia is lower than in many other countries. Key determinants include women’s education, complications during childbirth, and the timing of delivery. Addressing these factors is crucial for improving the quality of PCMC in Ethiopia.PROSPERO registration number:CRD42024603854.

PMID:41293902 | DOI:10.1177/17455057251392349

Emerg Microbes Infect. 2025 Nov 26:2595793. doi: 10.1080/22221751.2025.2595793. Online ahead of print.

ABSTRACT

Integrase strand transfer inhibitors (INSTIs) have emerged as cornerstone agents in global antiretroviral therapy, though growing drug resistance presents clinical challenges. Conventional Sanger sequencing may underestimate the burden of low-frequency variants. This global meta-analysis systematically assesses the actual INSTI resistance burden among people living with HIV (PLWH) through deep sequencing technology. Our comprehensive search across Web of Science, PubMed, Cochrane Library, Embase, and Scopus (PROSPERO ID: CRD42023495535) identified studies utilizing deep sequencing for HIV integrase resistance detection. Through meta-analysis and individual participant data (IPD) analysis using HIVdb (v9.8), we differentiated pretreatment (PDR) and acquired (ADR) drug resistance, quantifying mutation rates, resistance rates, and missed detection across thresholds (above-threshold, high-frequency, low-frequency). The analysis incorporated 40 studies with 46 datapoints involving 10,778 patients. Treatment-naïve PLWH demonstrated above-threshold, high-frequency, and low-frequency mutation rates of 9.92%, 7.29%, and 5.88%, respectively, corresponding to resistance rates of 2.60%, 0.09%, and 3.90%. Treated patients showed elevated mutation rates of 19.02%, 16.64%, and 10.23%, with resistance rates reaching 16.10%, 8.67%, and 6.95%. IPD analysis of 394 mutation-positive individuals revealed 8.52% low-frequency resistance to dolutegravir and bictegravir in treatment-naïve populations, while treated patients exhibited significantly increased intermediate/high-level resistance to first-generation INSTIs, including raltegravir and elvitegravir. Conventional sequencing thresholds missed 3.61% pretreatment and 2.46% acquired drug resistance. These findings demonstrate that deep sequencing reveals substantially underestimated INSTI resistance burdens in PLWH. Although second-generation INSTIs maintain lower resistance rates, cross-resistance risks necessitate clinical vigilance. Optimized resistance surveillance strategies incorporating low-frequency mutation detection offer critical evidence for advancing global HIV control efforts.

PMID:41293884 | DOI:10.1080/22221751.2025.2595793

Zhejiang Da Xue Xue Bao Yi Xue Ban. 2025 Nov 22:1-9. doi: 10.3724/zdxbyxb-2025-0146. Online ahead of print.

ABSTRACT

OBJECTIVES: To analyze the distribution of Y chromosome azoospermia factor (AZF) microdeletions and their association with testicular development in male pediatric patients with congenital reproductive system disorders, including hypospadias, cryptorchidism, and disorders of sex development (DSD).

METHODS: A prospective cohort study was conducted on pediatric patients admitted to the Department of Urology of Shanghai Children’s Hospital from November 2021 to December 2023. The observation group included boys with hypospadias, cryptorchidism, or DSD, while the control group comprised boys with phimosis, indirect inguinal hernia, or hydrocele. Blood samples were collected for AZF microdeletion analysis using multiplex PCR to detect 15 sequence-tagged sites. Testicular ultrasound was performed to record testicular position and volume. Propensity score matching (PSM) was used to balance the groups. After matching, testicular volume differences were assessed. Stratified analyses compared testicular volume among children with AZF microdeletions, the control group, and children without micro-deletions in observation group.

RESULTS: A total of 493 children were enrolled (observation group: 463; control group: 30). No Y chromosome microdeletions were detected in the control group. Four boys in the observation group had AZF microdeletions: one with cryptorchidism (AZFc+AZFd), one with isolated hypospadias (AZFc), and two with DSD (one with AZFb+AZFc+AZFd and one with AZFa). Ultrasonography measured 888 testicles. After PSM, testicular volume was significantly smaller in the observation group than in the control group (P<0.01). Stratified analysis revealed that among children under 9 years, those with AZF microdeletions tended to be older but had smaller testicular volumes compared to the control group and those without microdeletions in the observation group, although differences were not statistically significant (all P>0.05). Among children over 9 years, ages were comparable, but children with AZF microdeletions had smaller testicular volumes than the other two groups (statistical analysis was not performed due to small sample size).

CONCLUSIONS: The prevalence of Y chromosome microdeletions is higher in male children with congenital reproductive system disorders compared to the general population, particularly in those with DSD. Hypospadias, cryptorchidism, DSD, and AZF microdeletions may be associated with delayed testicular development in these children.

PMID:41293882 | DOI:10.3724/zdxbyxb-2025-0146

J Bronchology Interv Pulmonol. 2025 Nov 26;33(1):e1046. doi: 10.1097/LBR.0000000000001046. eCollection 2026 Jan 1.

ABSTRACT

BACKGROUND: Malignant pleural effusion (MPE) adversely impacts quality of life (QOL), carrying a significant health care burden and inpatient mortality. We hypothesize that multi-specialty management leads to nonstandardized approaches resulting in fragmented, inefficient and costly care. We aimed to design, implement, and evaluate a system-wide clinical pathway for MPE management to streamline care, reduce emergency visits, hospitalizations, pleural interventions and improve cost efficiency.

METHODS: We conducted a single-center study evaluating outcomes before and after pathway implementation. The pathway was developed through a multidisciplinary team (interventional pulmonology, thoracic surgery, oncology, emergency medicine, hospital medicine, and nurse navigation) using survey-driven gap analysis. Standardized workflows were integrated into the electronic medical record (EMR) system to enable early identification, direct triage, and expedited ambulatory pleural procedures. Pathway variations were tailored for inpatient, outpatient oncology, primary care, and surgical referrals. Patients were divided into 3 groups: a prepathway control cohort, an early postpathway cohort 1, and a late postpathway cohort 2 to assess both immediate and sustained impacts.

RESULTS: Implementation of the MPE pathway significantly reduced ER visits (control vs. cohort 1: 80 vs. 43, P = 0.0051; cohort 1 vs. cohort 2: 43 vs. 25, P = 0.028) and hospitalizations (71 vs. 37, P = 0.0046; 37 vs. 21, P = 0.021). Cost analysis showed average savings of $1145 per patient in direct variable ER and inpatient costs. The pathway also reduced pleural procedures and specialist involvement.

CONCLUSION: Centralized, protocolized care for MPE improves outcomes, reduces health care utilization and generates cost savings. Broader adoption may enhance QOL and efficiency in patients with advanced malignancies.

PMID:41293869 | DOI:10.1097/LBR.0000000000001046

J Endourol. 2025 Nov 24. doi: 10.1177/08927790251400302. Online ahead of print.

ABSTRACT

Background: The flexible and navigable suction sheath (FANS) is designed for the effective treatment of renal stones of various sizes. This study aimed to assess and compare the safety and postoperative outcomes at 30 days following FANS treatment for stones smaller and larger than 20 mm. Materials and Methods: From January to December 2024, patients undergoing retrograde intrarenal surgery performed with FANS were prospectively recruited and divided into two groups based on stone diameter (Group 1: DMAX <20 mm, Group 2: DMAX ≥20 mm). Baseline, perioperative, and follow-up characteristics were analyzed. Stone-free rate (SFR) was evaluated with a non-contrast CT scan at 1-month. Statistical analysis was performed using the unpaired Student’s t-test and chi-squared test with Yates’ correction. Results: A total of 140 patients were enrolled, with 77 having stones <20 mm and 63 having stones ≥20 mm. While a significant difference in stone diameters was observed, no discrepancies were noted regarding the mean stone density between the two groups, thus minimizing the potential for bias. No major Clavien-Dindo complications occurred in either group without differences in hospital length of stay, but Group 1 reported lower visual analogue scale pain. No significant differences in Grade A, B, and C SFR (all p > 0.05) and re-intervention (p = 0.58) were observed, suggesting similar efficacy for both stone sizes. Conclusions: This study demonstrates that the FANS as a valuable tool for enhancing patient safety and outcomes in managing larger stones, achieving adequate SFR, and reducing the need for re-intervention without major complications. In the future, FANS may effectively change the indications for stone’s treatment according to diameter.

PMID:41293857 | DOI:10.1177/08927790251400302

J Mater Chem B. 2025 Nov 26. doi: 10.1039/d5tb01945a. Online ahead of print.

ABSTRACT

In this work, we have developed hierarchically porous phosphate-based glasses (PPGs) as novel materials capable of promoting wound closure and simultaneously delivering antibacterial effects at the glass-biological tissue interface. PPGs are characterised by extended porosity, which enhances the controlled release of therapeutic ions, whilst facilitating cell infiltration and tissue growth. Two series of PPGs in the systems P₂O₅-CaO-Na₂O-CuO and P₂O₅-CaO-Na₂O-Ga₂O₃ with (CuO and Ga₂O₃ 0, 1, 5 and 10 mol%) were manufactured using a supramolecular sol-gel synthesis strategy. Significant wound healing promotion (up to 97%) was demonstrated using a human ex vivo wound model. A statistically significant reduction of the bacterial strains Staphylococcus aureus and Escherichia coli was observed in both series of PPGs, particularly those containing copper. All PPGs exhibited good cytocompatibility on keratinocytes (HaCaTs), and analysis of PPG dissolution products over a 7-day period demonstrated controlled release of phosphate anions and Ca, Na, Cu, and Ga cations. These findings indicate that Cu- and Ga-loaded PPGs are promising materials for applications in soft tissue regeneration given their antibacterial capabilities, in vitro biocompatibility with keratinocytes and ex vivo wound healing properties at the biomaterial-human tissue interface.

PMID:41293853 | DOI:10.1039/d5tb01945a

Respir Care. 2025 Nov 24. doi: 10.1177/19433654251391770. Online ahead of print.

ABSTRACT

Background: Breathing frequency is a sensitive indicator of a neonate patient’s condition and a crucial parameter in the neonatal ICU (NICU). However, conventional methods require sensors to be adhered to the newborn’s sensitive skin. This study assesses a noncontact respiratory monitor, using linear frequency modulation continuous wave radar, to determine the monitor’s accuracy when used in the NICU setting. Methods: An observational study was conducted on the noncontact respiration module produced by Mindray, connected to a BeneVisionN12 patient monitor. This unit collected data on breathing frequency; at the same time, the patient breathing frequency was also being measured using a CO₂ monitor (accepted standard). Statistical analyses were performed to assess the agreement between the 2 measurements and to assess whether this noncontact monitor is sufficiently accurate for clinical use. Results: 20 neonatal patients at 2 NICUs were enrolled in the study. The mean bias between the radar-derived and CO₂-derived breathing frequency was -0.29 bpm (95% CI: -0.53 to -0.04); root-mean-square error was 2.60 bpm; concordance correlation coefficient was 0.98; and Pearson correlation coefficient was 0.98. Subgroup analyses grouped by body weight show that the technology has particularly high accuracy and clinical utility for neonates with low body weight (<1.5 kg). Conclusions: The noncontact respiration monitoring technology and module developed by Mindray showed a high degree of agreement with the CO₂ reference standard and met the standard of accuracy required for clinical use.

PMID:41293852 | DOI:10.1177/19433654251391770