Nevin Manimala

Clin Endocrinol (Oxf). 2025 Nov 24. doi: 10.1111/cen.70062. Online ahead of print.

ABSTRACT

OBJECTIVE: Polycystic ovary syndrome (PCOS) is a common condition, that manifests as menstrual irregularities, subfertility, or symptoms of hyperandrogenism – including hirsutism, adult acne, and alopecia. Current pharmacological treatment of the hyperandrogenic symptoms includes the combined oral contraceptive pill. However, there are multiple contraindications and side-effects, which limit their use. Anti-androgens, such as spironolactone, are commonly prescribed off-label but its efficacy in PCOS is uncertain. This review aims to evaluate the efficacy and safety of spironolactone, when compared to other nonhormonal medications in the management of PCOS hyperandrogenic symptoms.

METHODS: Comprehensive literature searches were conducted across MEDLINE, EMBASES, PUBMED and SCOPUS. RCTs published in English assessing the use of spironolactone for hyperandrogenism in PCOS were included. The quality of papers was assessed using Cochrane RoB 2.0 tool. Meta-analysis was conducted using a random-effects model, reporting as standardised mean differences and 95% confidence intervals.

RESULTS: Of 3378 studies identified, five open-label RCTs met the inclusion criteria, three of which were included in the meta-analysis. Spironolactone, monotherapy or combination with metformin, showed no statistically significant difference in reducing Ferriman-Gallwey scores, total testosterone levels or BMI compared to metformin monotherapy. Side effects of spironolactone included menstrual irregularities, polyuria, and gastrointestinal symptoms.

CONCLUSION: Current evidence does not show any significant difference in the use of spironolactone when compared to metformin. Given its widespread use and limited safety concerns, spironolactone remains an off-label option, especially for those unable to take hormonal contraceptives. However, larger, better quality studies are needed to establish its efficacy in PCOS management.

PMID:41277478 | DOI:10.1111/cen.70062

Nutr Diet. 2025 Nov 24. doi: 10.1111/1747-0080.70058. Online ahead of print.

ABSTRACT

AIM: Caring for people with higher weight and complex health needs is increasingly common in hospitals. This study aimed to explore and compare inpatient and staff perspectives on the care of people with higher weight.

METHODS: Cross-sectional study using purpose-designed surveys within Metropolitan Victoria, Australia. Inpatients (who weighed over 100 kg) and hospital staff who provide care across four hospitals were invited to complete an inpatient-specific or staff-specific survey, respectively. Surveys contained questions related to clinical care, environment and dignity/respect. Data was analysed using descriptive statistics of scale-based items, and textual synthesis of free-text responses.

RESULTS: Thirty inpatients and 59 staff participated. Most inpatients reported their clinical care needs were met (73%-83%) and described appropriate equipment and staff support. However, 25% felt judged or emotionally unsupported, with some experiencing delays in care due to staffing or equipment availability. Staff were less positive, with 73% reporting difficulty accessing equipment, 71% citing inadequate staffing and only 39% agreeing that non-stigmatising care was provided. Differences in weight-related terminology preferences emerged: inpatients favoured the terms ‘higher weight’ (27%) or ‘obese/overweight’ (34%), while staff preferred ‘bariatric’ (71%). Three themes were identified: (1) Inappropriate equipment, delays to equipment-access can negatively impact on inpatient experience of care; (2) Processes of care and communication influence inpatient experience of care; and (3) Weight-related stigma.

CONCLUSIONS: Addressing gaps in care requires improved training, better resource access and alignment of language with consumer preferences to reduce stigma and deliver person-centred care.

PMID:41277470 | DOI:10.1111/1747-0080.70058

J Community Psychol. 2025 Nov;53(8):e70057. doi: 10.1002/jcop.70057.

ABSTRACT

We described the experiences of a sample of rural Latinx young adults to identify relevant adult roles and events from their unique perspectives at ages 21 and 26 focusing on heterogeneity by age, sex, and immigrant generational status. Using survey data collected in 2014 (n = 308) and 2019 (n = 285) from respondents who grew up in two rural US towns, we qualitatively examined responses to an open-ended question; explored thematic patterns across age, sex, and immigration generation; and contextualized with quantitative data. Rural Latinx young adults identified milestones typical of young adults (e.g., work, school, relationships, family, living arrangements) and diverse pathways into adulthood. They expressed positive and challenging sentiments regarding transitions, but mostly optimism about their futures. We observed heterogeneity within and between ages, sexes, and generational statuses. Increasing work and educational opportunities for Latinx young adults in rural communities can help them navigate this transition more successfully.

PMID:41277465 | DOI:10.1002/jcop.70057

J Helminthol. 2025 Nov 24;99:e124. doi: 10.1017/S0022149X25100928.

ABSTRACT

Anurans are bioindicators and key components of ecosystem functions. Although South America harbors more than 4,000 identified anuran species, fewer than 10% have been analyzed regarding their trematode fauna. When tadpoles are considered, the paucity of studies becomes even more evident. Considering the ability of digeneans to serve as indicators of ecosystem health, it is evident that there is a gap in the knowledge of trematodes occurring in anuran biodiversity hotspots. Herein, we provide an ecological and morphological analysis of the trematode component community recovered in tadpoles and adult anurans. During a long-term herpetological and helminthological study conducted in a Cerrado fragment in Brazil, 569 anurans from 17 species were necropsied. Eleven species were common to both adults and tadpoles, and six species occurred only in adults. The total prevalence was 61% (352/569), in separate analyses, 65% (192/296) for adult anurans, and 58% (160/273) for tadpoles. A total of 12,397 trematodes belonging to 16 taxa were recovered. The component community was composed mostly of metacercariae. We provided a brief morphological description for each trematode taxa recovered. Additionally, statistical analysis was performed to elucidate the differences between tadpoles and adult anurans trematode communities. The trematode community analyzed in our study revealed 24 new host records and was the first to include tadpoles in such an analysis, highlighting the importance of faunistic inventories for a better understanding of parasitism in their hosts, as well as providing a foundation for further research.

PMID:41277455 | DOI:10.1017/S0022149X25100928

J Otolaryngol Head Neck Surg. 2025 Jan-Dec;54:19160216251387622. doi: 10.1177/19160216251387622. Epub 2025 Nov 24.

ABSTRACT

ImportanceMost French Olfactory Questionnaires are time consuming, which may affect the patient participation.ObjectiveTo validate a short French version of the Olfactory Disorders Questionnaire (Fr-ODQ).DesignProspective controlled study.SettingMulticenter study.ParticipantsPatients with long-lasting olfactory dysfunction (OD) treated with platelet-rich plasma into the olfactory clefts and asymptomatic subjects.InterventionDevelopment and validation of a short ODQ.Main OutcomesIndividuals completed the full Fr-ODQ. The Threshold, Discrimination, and Identification (TDI) test was performed in OD patients. A combined statistical analysis was performed to determine the most informative items of the Fr-ODQ to develop a shorter version. The internal consistency was determined with Cronbach’s alpha. The reliability and external validity were evaluated through a test-retest approach and by correlating with the Fr-ODQ. Both the minimal clinically important difference (MCID) and the threshold of the short ODQ version were determined.ResultsA total of 263 patients (173 [65.8%] females) and 129 controls (92 [71.3%] females) completed the evaluations. The mean age of patients was 51.2 ± 15.3 years. The mean duration of OD was 42.4 ± 54.3 months. The biostatistical models selected 10 essential items composing the Fr-ODQ-10. The baseline Fr-ODQ-10 was significantly correlated with the TDI (r_s = 0.228; P = .001) and the Fr-ODQ (r_s = 0.875; P = .001), demonstrating high external validity. Fr-ODQ-10 was significantly lower in controls compared to OD patients (P = .001), highlighting high internal validity. The internal consistency was good (α = .796). The external consistency was adequate, with significant correlations between the test-retest Fr-ODQ-10. The Fr-ODQ-10 significantly decreased from baseline to 4 months post-treatment. A Fr-ODQ-10 score >7.5 was considered abnormal (sensitivity: 84.8%, specificity: 84.2%). The MCID of Fr-ODQ-10 was established at >3.Conclusion and RelevanceThe Fr-ODQ-10 is a valid and reliable clinical instrument, demonstrating correlation with the psychophysical olfactory assessment.

PMID:41277449 | DOI:10.1177/19160216251387622

Pulmonology. 2025 Dec 31;31(1):2591498. doi: 10.1080/25310429.2025.2591498. Epub 2025 Nov 24.

ABSTRACT

BACKGROUND: The clinical impact of bronchiectasis (BE) in acute exacerbations of COPD (AECOPD) remains controversial, with unclear phenotypic heterogeneity.

RESEARCH QUESTION: Does BE independently influence clinical outcomes and phenotypic heterogeneity in AECOPD patients?

STUDY DESIGN AND METHODS: This prospective multicenter cohort study analysed 11 759 hospitalised AECOPD patients from 10 Chinese medical centres. Propensity score matching (1:3) balanced baseline characteristics, and unsupervised cluster analysis identified phenotypic subgroups. Primary endpoints included mortality and exacerbation frequency, with secondary endpoints assessing mechanical ventilation, ICU admission, and length of stay (LOS).

RESULTS: AECOPD-BE patients had higher rates of non-invasive ventilation (23.5% vs 20.1%, p = 0.002), ICU admission (9.8% vs 6.5%, p < 0.001), and prolonged LOS (median 10 vs 9 days, p < 0.001). Mortality rates were similar (in-hospital: 1.1% vs 1.3%, p = 0.477; 3-year: 17.8% vs 21.6%, p = 0.652), but BE patients had more exacerbations (2.92 ± 4.30 vs 2.18 ± 2.72 events, p = 0.004). Cluster analysis revealed two phenotypes: a Systemic Inflammatory-High Risk (SI-HR) subgroup with severe inflammation and poorer outcomes, and a Stable Compensated (SC) subgroup with milder manifestations.

CONCLUSION: BE independently predicts increased acute healthcare utilisation and exacerbation risk in AECOPD without affecting mortality. The SI-HR phenotype identification supports targeted management strategies for this heterogeneous population.Clinical Trial Registration: Chinese Clinical Trail Registry NO.: ChiCTR2100044625; URL: http://www.chictr.org.cn/showproj.aspx?proj=121626.

PMID:41277420 | DOI:10.1080/25310429.2025.2591498

Psychol Health Med. 2025 Nov 24:1-18. doi: 10.1080/13548506.2025.2591856. Online ahead of print.

ABSTRACT

This study aimed to assess the long-term risk for depression in individuals with epilepsy, identify time-specific risk patterns, and evaluate high-risk subgroups in a nationwide cohort from South Korea. This nationwide retrospective matched cohort study analyzed data from 2,267 patients with epilepsy and 22 670 age- and sex-matched controls retrieved from the Korean National Health Insurance Service cohort (2002-2013) were analyzed. KCD-8 codes (F32 and F33) were used as depression markers and time-stratified Cox proportional hazards models were employed to calculate the adjusted hazard ratios (aHRs) for depression over 10 years, adjusting for demographic and clinical covariates. The incidence rate (IR) of depression was 43.23 per 1,000 person-years in the epilepsy group compared to 14.30 in the controls (IRR = 3.02). Depression risk was highest in the first 0-2 years post-diagnosis (aHR = 3.32) and increased again at 8-10 years (aHR = 2.82). Men (IRR = 3.52) and individuals aged <60 years (IRR = 3.66) also demonstrated elevated IRRs. Smoking, low BMI, and high income were significant additional risk factors. Epilepsy substantially increases the long-term risk of depression, particularly during the early and late post-diagnosis periods and our findings underscore the need for systematic mental health screenings.

PMID:41277411 | DOI:10.1080/13548506.2025.2591856

Thorac Cancer. 2025 Nov;16(22):e70190. doi: 10.1111/1759-7714.70190.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the short-term clinical outcomes of subxiphoid approach thoracoscopic surgery (SATS) versus lateral intercostal approach thoracoscopic surgery (LIATS) for anterior mediastinal tumors.

METHODS: Clinical data from patients who underwent video-assisted thoracoscopic surgery for anterior mediastinal tumors between April 1, 2020 and December 31, 2023 were analyzed. Patients were stratified into two cohorts according to the surgical approach used: the SATS group (n = 679) and the LIATS group (n = 461). Intraoperative and postoperative outcomes were compared between the two groups.

RESULTS: A total of 1140 patients were included in the statistical analysis after screening and assessment. After propensity score matching, a total of 417 SATS patients were matched with 417 LIATS patients. In the analysis of the outcomes, the LIATS group had a shorter operation time than the SATS group (p < 0.001). There were no statistical differences in Numeric Rating Scale (NRS) pain scores on Postoperative Day 1 (p = 0.113), Day 2 (p = 0.189), or Day 3 (p = 0.462). Postoperative atelectasis was more common in the SATS group than in the LIATS group (p = 0.025). There were no perioperative deaths.

CONCLUSIONS: The SATS did not demonstrate significant improvements in postoperative pain compared with the LIATS. However, the LIATS was associated with shorter operative time in the overall cohort.

PMID:41277410 | DOI:10.1111/1759-7714.70190

Paediatr Perinat Epidemiol. 2025 Nov 24. doi: 10.1111/ppe.70099. Online ahead of print.

ABSTRACT

BACKGROUND: Surveillance of congenital anomaly prevalence over time can identify new teratogens. Anomalies with a genetic cause are excluded from the monitoring.

OBJECTIVES: We examined temporal changes in the proportion of genetic diagnoses among cases with a congenital anomaly.

METHODS: Data was used from twenty EUROCAT congenital anomaly registries over the birth years 2013 and 2022. All pregnancy outcomes were included. Multilevel binomial regression models were fitted to estimate the annual change in the proportion of genetic diagnoses of all anomalies by registry. Results were additionally reported, excluding cases with trisomy 13, 18, or 21.

RESULTS: Overall, 20% of the 100,099 cases in the study had a genetic diagnosis, and this proportion increased annually by 1.4% (95% CI, 0.8%-1.9%); an absolute increase of approximately 3% from 2013 to 2022. After excluding the trisomies, the overall proportion was 10% with an annual increase of 1.2% (95% CI 0.4%-2.0%). There was considerable variation in the proportion of genetic cases per registry. An increasing proportion of genetic diagnoses was found for five congenital anomaly groups, after excluding the trisomies. We hypothesise that the increase in genetic diagnoses is due to increased access to clinical genetic services, more extensive genetic testing, and the identification of new genes as causes of congenital anomalies.

CONCLUSIONS: The modest increase in genetic diagnoses among cases with a congenital anomaly is not expected to have a large impact on the surveillance of the non-genetic anomalies in the EUROCAT network. EUROCAT will continue to monitor the proportion of genetic diagnoses every five years.

PMID:41277385 | DOI:10.1111/ppe.70099

Basic Clin Pharmacol Toxicol. 2025 Dec;137(6):e70145. doi: 10.1111/bcpt.70145.

ABSTRACT

Poisoning from organophosphorus compounds (OPCs) poses a significant health issue, especially in countries without proper testing facilities, including cholinesterase (ChE) levels. This study aimed to evaluate the effectiveness of a three-element score called PGI, incorporating pH, the Glasgow Coma Scale (GCS) and impaired systolic blood pressure, in predicting mortality and the need for mechanical ventilation (MV) in acute OPC poisoning. A retrospective cross-sectional study was conducted using medical records of 202 patients admitted for acute OPC poisoning over 3 years. The findings indicated an 11.4% mortality rate and a 25.7% underwent MV. A strong negative correlation was observed between the PGI score and serum ChE level (r = -0.6430, p < 0.0001). The PGI scores of 2 and above were a strong predictor for mortality and MV need. Among PGI components, blood pH < 7.23 was the best mortality predictor, while a GCS < 12 effectively predicted the need for MV (AUC = 0.920). Although the PGI score outperformed PSS in predicting adverse outcomes, it did not show a statistically significant difference compared to serum ChE. The PGI score is a reliable prognostic tool that could replace PSS and serum ChE in predicting the severity of OPC poisoning, as well as the risk of mortality and MV need.

PMID:41277382 | DOI:10.1111/bcpt.70145