Nevin Manimala

Clin Nurse Spec. 2025 Mar-Apr 01;39(2):82-90. doi: 10.1097/NUR.0000000000000879.

ABSTRACT

PURPOSE: Central line-associated bloodstream infection (CLABSI) rates have been consistently high at an academic comprehensive cancer hospital. CLABSI prevention bundles can mitigate central line infections, and many components focus on nursing practice. Identification of barriers to maintaining adherence to these elements is not always assessed or addressed. The purpose of this project was to increase adherence to CLABSI prevention nursing practices and to implement a sustainable program to elevate nurses’ skills and documentation of CLABSI prevention bundle components.

DESCRIPTION: Pre-implementation/post-implementation chart reviews, post-implementation visual audits, and a survey for nurses post project were completed over a 9-week period. This project identified and addressed barriers to CLABSI prevention bundle compliance. Audits assessed nursing practice elements of the CLABSI prevention bundle. Evidence-based Kamishibai cards (K-cards) were used as a visual audit tool to display compliance of CLABSI bundle elements.

OUTCOMES: Compliant documentation of daily chlorhexidine gluconate (CHG) bathing increased to 75%. Inconsistent communication practices and knowledge gaps were frequent barriers to compliance. Seventy-five percent of nurses reported the K-card display changed their own CLABSI prevention practices.

CONCLUSION: This project increased knowledge, adherence to CLABSI prevention practices, and awareness of components most often missed.

PMID:39969809 | DOI:10.1097/NUR.0000000000000879

J Cosmet Dermatol. 2025 Feb;24(2):e70068. doi: 10.1111/jocd.70068.

ABSTRACT

OBJECTIVE: The current study aimed to assess the prevalence of cosmetics utilization and perceived adverse effects among female final-year undergraduate students at the University of Gondar, northwest Ethiopia.

METHODS: An institutional-based cross-sectional study was carried out from October 2023 to May 2024. We used stratified, simple random sampling techniques to select study participants. Data were collected by using a self-administered questionnaire administered to trained graduate pharmacist students. EPI Info 7.1 was used for data entry, and SPSS version 26 was used for the data analysis. Descriptive statistics have been done for percentages and frequencies. We used bivariate and multiple logistic regressions to identify factors. Those variables with p < 0.05 were declared to be associated factors for the prevalence of cosmetics utilization and perceived adverse effects.

RESULTS: A total of 403 study participants were included, with a response rate of (96%). In the current study, 81% of the students were using cosmetics, and 55.6% were exposed to cosmetics-related adverse reactions, primarily skin rash (41%) and itching (38.3%). The most frequently used cosmetic products were toothpaste, lipstick, deodorant, and perfume, which accounted for 83.7%, 56.8%, and 24.7%, respectively. Lower age (20-25 years) AOR = 5.62, urban residence AOR = 1.97, health-related department AOR = 2.46, economic income 501-1000 Ethiopian birr AOR = 4.05, not love engaged AOR = 3.65, and 3 and 4 years of study AOR = 2.96, with a 95% CI, were significantly associated with cosmetic usage for the students. Shampoos and conditioners AOR = 3.42; hair dye use AOR = 3.40; read information from the container AOR = 2.11; add water or other agents to cosmetics AOR = 2.26; and test Cosmetic adverse reactions AOR = 4.10, with a 95% CI, were significantly associated with cosmetics-related adverse effects.

CONCLUSION: A significant proportion of the users suffered from cosmetic-related adverse reactions. The health care system should be restructured to consider rational cosmetic utilization practices and prevent adverse health effects.

PMID:39968726 | DOI:10.1111/jocd.70068

Am J Epidemiol. 2025 Feb 17:kwaf030. doi: 10.1093/aje/kwaf030. Online ahead of print.

ABSTRACT

Traumatic brain injury (TBI) is a major public health concern affecting millions of people yearly. Disparities in TBI outcomes based on social determinants of health (SDoH), such as race and socioeconomic position, highlight the need to explore the causative structural inequities. We employed a socio-epidemiological approach, with particular focus on the putative role of structural racism, to investigate the prevalence, sociodemographic patterns, and neuropsychiatric outcomes of TBI in the All of Us database. This study included 11,286 individuals with a documented TBI diagnosis, determined based on a curated phenotype definition using the International Statistical Classification of Diseases Clinical Modification criteria. Outcome measures included TBI prevalence and sociodemographic distribution; TBI severity; and neuropsychiatric diagnoses related to TBI. Nearly equivalent TBI prevalences were observed across racial categories. Black participants with TBI had higher socioeconomic deprivation indices and higher prevalence of certain neuropsychiatric conditions, such as substance use disorders and headache disorders, compared to White participants. This study underscores the importance of considering SDoH, particularly race and socioeconomic position, in TBI research. These findings highlight the need for efforts to address structural inequities that impact disparities in TBI and call for future research investigating how healthcare practices relate to disparities in TBI outcomes.

PMID:39968724 | DOI:10.1093/aje/kwaf030

Int J Gynaecol Obstet. 2025 Feb 19. doi: 10.1002/ijgo.70009. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore the relevant factors associated with successful labor in twin pregnancies and investigate maternal and fetal outcomes in the group with failed labor.

METHODS: A retrospective analysis was conducted on twin pregnancies that underwent labor in our hospital from July 2016 to June 2023. A total of 519 cases were divided into two groups: the successful labor group (450 cases with vaginal delivery of both fetuses) and the failed labor group (69 cases with cesarean delivery of one or two fetuses). The relevant factors of the labor, as well as the maternal and fetal outcomes, were analyzed between these two groups.

RESULTS: Multivariate analysis indicated that advanced maternal age (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.05-1.22), high pre-delivery body mass index (OR 1.11, 95% CI 1.04-1.19), and vertex/transverse twins (OR 3.75, 95% CI 1.35-10.40) were risk factors for the failure of vaginal labor. Multiparity (OR 0.15, 95% CI 0.08-0.29), premature birth (OR 0.43, 95% CI 0.24-0.78), and neuraxial analgesia (OR 0.37, 95% CI 0.20-0.72) were protective factors for the failure of delivery. There were no statistically significant differences (P > 0.05) in decreased hemoglobin and neonatal outcomes between the two groups. The postpartum hospitalization time in the successful labor group was shorter than that in the failed labor group (P < 0.05).

CONCLUSIONS: Labor in twin pregnancies is generally safe. Factors such as multiparity, previous premature birth, and neuraxial analgesia can significantly enhance the likelihood of a successful vaginal delivery.

PMID:39968720 | DOI:10.1002/ijgo.70009

J Cosmet Dermatol. 2025 Feb;24(2):e70046. doi: 10.1111/jocd.70046.

ABSTRACT

BACKGROUND: Rosacea is a chronic skin condition that affects millions of people worldwide, and its management continues to pose a significant challenge in dermatology.

AIM: In this study, we investigated the efficacy and safety of 30% supramolecular salicylic acid (SSA) as a treatment for papulopustular rosacea, with a particular focus on improving skin lesions, reducing persistent erythema, and enhancing skin barrier function.

METHODS: Thirty-four patients diagnosed with papulopustular rosacea were randomly divided into an experimental group treated with 30% SSA and a control group receiving a placebo. Clinical outcomes were evaluated based on lesion reduction rates, investigator severity assessment (ISA) scores, VISIA red area scores, and skin barrier, including trans-epidermal water loss (TEWL), sebum levels, stratum corneum hydration, and pH values.

RESULTS: A total of 34 patients were collected for both the experimental and control groups, with no statistical differences in age or disease severity between the groups (p > 0.05). The effective rate was 68.75% in the experimental group (p < 0.01). After treatment, the ISA score was 1.75 ± 0.68 in the experimental group and 2.40 ± 0.83 in the control group, indicating significant improvement (p < 0.05). The improvement rate of the VISIA redness score was 25.1% in the experimental group (p < 0.01). Among the 17 patients who underwent skin barrier function testing. Skin hydration significantly improved on left cheek (p < 0.05), right cheek (p < 0.01), and nose (p < 0.05) after 30% SSA treatment in experimental group. Sebum levels were significantly reduced on both cheeks and forehead (p < 0.05). No statistical differences were observed in other locations. Skin TEWL and pH value showed no changes.

CONCLUSION: 30% SSA reduced papules and pustules in rosacea, improved persistent erythema, and enhanced stratum corneum hydration in the 30% SSA-treated group compared to the placebo group. No significant differences were observed in TEWL and skin pH values between the two groups. Our findings suggest that 30% SSA is an effective and safe option for managing papulopustular rosacea, offering a well-tolerated alternative to traditional treatments.

PMID:39968706 | DOI:10.1111/jocd.70046

J Diabetes. 2025 Feb;17(2):e70058. doi: 10.1111/1753-0407.70058.

ABSTRACT

AIM: This study aimed to examine microvascular lesions and neurodegenerative changes in diabetic retinopathy (DR) compared to type 2 diabetes mellitus (T2DM) without DR (NDR) using structural MRI and to explore their associations with DR.

METHODS: 243 patients with NDR and 122 patients with DR were included. Participants underwent conventional brain MRI scans, clinical measurements, and fundus examinations. Cerebral small vessel disease (CSVD) imaging parameters were obtained using AI-based software, manually verified, and corrected for accuracy. Volumes of major cortical and subcortical regions representing neurodegeneration were assessed using automated brain segmentation and quantitative techniques. Statistical analysis included T-test, chi-square test, Mann-Whitney U test, multivariate analysis of variance (MANCOVA), multivariate logistic regression, area under the receiver operating characteristic curve (AUC), and Delong test.

RESULTS: DR group exhibited significant differences in 11 CSVD features. Meanwhile, DR showed an atrophy trend in the frontal cortex, occipital cortex, and subcortical gray matter (GM) compared to NDR. After adjustment, DR patients exhibited greater perivascular spaces (PVS) numbers in the parietal lobe (OR = 1.394) and deep brain regions (OR = 1.066), greater dilated perivascular spaces (DPVS) numbers in the left basal ganglia (OR = 2.006), greater small subcortical infarcts (SSI) numbers in the right hemisphere (OR = 3.104), and decreased left frontal PVS (OR = 0.824), total left DPVS (OR = 0.714), and frontal cortex volume (OR = 0.959) compared to NDR. Further, the CSVD model showed a larger AUC (0.823, 95% CI: 0.781-0.866) than the brain atrophy model (AUC = 0.757, 95% CI: 0.706-0.808).

CONCLUSION: Microvascular and neurodegeneration are significantly associated with DR. CSVD is a better imaging biomarker for DR than brain atrophy.

PMID:39968694 | DOI:10.1111/1753-0407.70058

Alzheimers Dement. 2025 Feb 19:e14489. doi: 10.1002/alz.14489. Online ahead of print.

ABSTRACT

INTRODUCTION: Early-onset and late-onset Alzheimer’s disease (EOAD and LOAD, respectively) have distinct clinical manifestations, with prior work based on small samples suggesting unique patterns of neurodegeneration. The current study performed a head-to-head comparison of cortical atrophy in EOAD and LOAD, using two large and well-characterized cohorts (LEADS and ADNI).

METHODS: We analyzed brain structural magnetic resonance imaging (MRI) data acquired from 377 sporadic EOAD patients and 317 sporadicLOAD patients who were amyloid positive and had mild cognitive impairment (MCI) or mild dementia (i.e., early-stage AD), along with cognitively unimpaired participants.

RESULTS: After controlling for the level of cognitive impairment, we found a double dissociation between AD clinical phenotype and localization/magnitude of atrophy, characterized by predominant neocortical involvement in EOAD and more focal anterior medial temporal involvement in LOAD.

DISCUSSION: Our findings point to the clinical utility of MRI-based biomarkers of atrophy in differentiating between EOAD and LOAD, which may be useful for diagnosis, prognostication, and treatment.

HIGHLIGHTS: Early-onset Alzheimer’s disease (EOAD) and late-onset AD (LOAD) patients showed distinct and overlapping cortical atrophy patterns. EOAD patients showed prominent atrophy in widespread neocortical regions. LOAD patients showed prominent atrophy in the anterior medial temporal lobe. Regional atrophy was correlated with the severity of global cognitive impairment. Results were comparable when the sample was stratified for mild cognitive impairment (MCI) and dementia.

PMID:39968692 | DOI:10.1002/alz.14489

Monaldi Arch Chest Dis. 2025 Feb 18. doi: 10.4081/monaldi.2025.3246. Online ahead of print.

ABSTRACT

Patients undergoing endobronchial ultrasound-guided fine needle aspiration may have multiple comorbidities, contributing to higher risks of hypoxia and adverse events, such as arrhythmias. The current study compared the efficacy of two oxygenation modalities: the high-flow nasal cannula (HFNC) vs. conventional oxygen therapy (CNC). Patients were randomized to either the HFNC or the CNC arm. HFNC and CNC were initiated and escalated as per predefined protocols. The number of desaturation events [fall in saturation of peripheral oxygen (SpO2) by 3% from the baseline] and change in levels of transcutaneous CO2 (tcCO2) from baseline were noted. Subgroup analysis was done in patients with cardiopulmonary comorbidities and in patients with SpO2<97%. A total of 122 patients were randomized. Overall, there was no significant difference in the number of desaturation events and change in tcCO2 levels; however, in patients with cardiopulmonary comorbidities (obstructive sleep apnea, heart diseases, and stable chronic obstructive airway disease), 50% in the HFNC arm had no desaturation compared to 11.7% in the CNC arm (p=0.007). 41.17% of patients in the HFNC arm had a rise in tcCO2 levels, compared to 36.11% of patients in the CNC arm (p>0.5). In patients with SpO2<97%, 48.88% in the HFNC arm had no desaturations compared to 14.70% in the CNC arm (p=0.001); there was no statistical difference in rise in tcCO2. Hence, HFNC would be a better modality for oxygenation in patients with a high risk of hypoxia without increasing the risk of hypercapnia.

PMID:39968686 | DOI:10.4081/monaldi.2025.3246

J Sep Sci. 2025 Feb;48(2):e70097. doi: 10.1002/jssc.70097.

ABSTRACT

The aim of this research was the therapeutic drug monitoring for valproic acid in epilepsy patient’s serum samples by the common, sensitive, and accessible HPLC-UV method. Because of the absence of a suitable chromophore in the valproic acid structure, a facile, selective, and cost-effective pre-column derivatization was designed. This catalyst-free ultrasound-assisted derivatization assay can accomplish the derivatization very quickly only in 5.0 min and at a mild temperature of 60°C. 2,4′-Dibromoacetophenone and nonanoic acid was used as derivatizing agent and internal standard, respectively. The effect of sample pH, buffer concentration, ultrasound exposure time, reaction temperature, and derivatizing agent amount were optimized. The proposed method exhibited a good linear range of 5.0-300.0 µg/mL with acceptable correlation coefficients of 0.9981. The limit of detection was as low as 0.4 µg/mL. Also, the limit of quantification was reported as 1.3 µg/mL. Interday and intraday relative standard deviations (n = 10) were 1.1% and 0.3%-7.0%, respectively. In addition, the relative recovery ranged from 100.3% to 107.7%. The measurement of valproic acid was performed in the presence of several epilepsy and non-epilepsy drugs by the developed protocol. This confirmed the specific and accurate determination of valproic acid in the patient’s serum. A comparative evaluation was employed against the precise chemiluminescence immunoassay approach. The correlation coefficient between the two methods was 0.9992, which demonstrated the results were statistically the same.

PMID:39968684 | DOI:10.1002/jssc.70097

Ann Surg. 2025 Feb 19. doi: 10.1097/SLA.0000000000006675. Online ahead of print.

ABSTRACT

OBJECTIVE: To estimate the risk of insurance instability following firearm injury.

BACKGROUND: Health insurance instability is associated with negative clinical outcomes. After nonfatal firearm injury, continuity of health care is particularly important given substantially increased physical, mental, and rehabilitative needs and related healthcare spending.

METHODS: Using 2007-2022 commercial insurance claims data, we studied 3,653 survivors and 17,422 matched controls to investigate the risk of health insurance instability associated with firearm injury. Participants were matched on age, Diagnostic Cost Group risk score, year, month, plan type, drug coverage, sex, metropolitan statistical area, state, and enrollee category.

RESULTS: The mean age of survivors was 30.5 years, 83.7% were male, 39.2% were primary enrollees, with observable characteristics closely balanced between exposed and control groups after matching. Within 1 year of injury, 36.1% of survivors experienced insurance instability compared with 28.1% of matched controls-an attributable risk of 8.0 (95% CI: 5.8, 10.1) and adjusted hazard ratio of 1.34 (95% CI: 1.26, 1.42). For survivors with more severe injuries, 37.3% experienced insurance instability compared with 27.6% of matched controls-an attributable risk of 9.8 (95% CI: 6.7, 12.9) and adjusted hazard ratio of 1.43 (95% CI: 1.31, 1.56). On average, firearm-injured primary enrollees experiencing insurance instability provided coverage for 0.84 dependents (spouses and children) at the time of their insurance status change.

CONCLUSIONS: Firearm injury was followed by increased insurance instability among survivors, with increased risk following more severe injuries. Insurance instability may disrupt care and shift costs to the public through public insurance enrollment and uncompensated care for the uninsured.

PMID:39968652 | DOI:10.1097/SLA.0000000000006675