Nevin Manimala

Eur J Pediatr. 2025 Feb 11;184(2):187. doi: 10.1007/s00431-025-06029-4.

ABSTRACT

Pediatric drowning incidents, both fatal and non-fatal, represent a significant challenge in emergency medicine, particularly for children under 14 years of age. Drowning is a leading cause of unintentional injury-related deaths, with children aged one to four years being especially vulnerable. Accurate and timely assessment, particularly through chest imaging, such as chest radiography (CXR) and lung point-of-care ultrasound (LUS), is crucial for evaluating pulmonary complications and guiding treatment decisions. This retrospective study analyzed 64 pediatric drowning cases in Istituto Giannina Gaslini, Italy, from 2012 to 2023. For all patients, demographic data, vital parameters, blood tests upon PED admission and at 24 h, need for intensive care unit admission, length of stay, therapies administered, ventilatory support in the PED and in the hospital ward, and mortality were recorded. The patients were subsequently divided into two groups based on the chest X-ray result. The results indicated that pathological CXR findings upon admission were associated with a higher likelihood of hospital admission, prolonged hospital stay, and more severe clinical outcomes, including the need for oxygen supplementation and antibiotic therapy. Patients with abnormal CXR findings also exhibited lower oxygen saturation, Glasgow Coma Scale scores, and body temperature upon admission, reflecting a more significant physiological compromise, and higher RCP values at 24 h.

CONCLUSION: Although the majority of non-fatal drowning patients recovered without lasting neurological deficits, the findings suggest that CXR plays a critical role in early management, assisting in the identification of those at greater risk for complications.

WHAT IS KNOWN: • Fatal and non-fatal pediatric drowning incidents may represent a critical issue in pediatric emergency medicine, requiring prompt assessment and accurate management upon admission, even if standardized protocols are lacking.

WHAT IS NEW: • Chest imaging in the initial assessment of pediatric drowning cases may serve as a fundamental tool to support early clinical decision-making, particularly when integrated with other key parameters such as neurological status, vital signs, and blood exams.

PMID:39932575 | DOI:10.1007/s00431-025-06029-4

Eur J Nutr. 2025 Feb 11;64(2):87. doi: 10.1007/s00394-025-03603-2.

ABSTRACT

PURPOSE: To explore the associations of erythrocyte polyunsaturated fatty acids (PUFAs) with the risk of gestational diabetes mellitus (GDM) in pregnant women.

METHODS: A total of 951 women in mid-pregnancy (20-28 weeks of gestation) were recruited during 2017-2018. Erythrocyte PUFAs were measured by gas chromatography and expressed as a percentage of total fatty acids. A 75 g oral glucose tolerance test was used for GDM diagnosis. Logistic regression and restricted cubic spline models were conducted.

RESULTS: Among the 951 pregnant women, 180 were diagnosed with GDM (18.93%). For n-3 PUFAs, each standard deviation (SD) increase in α-linolenic acid (ALA) and docosapentaenoic acid (DPA) was associated with multivariable-adjusted odds ratios (ORs) of 0.789 (95% CI: 0.649, 0.961; P = 0.018) and 0.782 (95% CI: 0.638, 0.957; P = 0.017), respectively. However, the associations became marginally significant after post hoc false-discovery rate (FDR) correction (both P_FDR=0.065). A significant nonlinear association was observed for ALA and GDM risk (P_{– nonlinearity}=0.001). For n-6 PUFAs, γ-linolenic acid (GLA) was significantly associated with a 46.0% higher risk of GDM [OR (95%CI): 1.460 (1.195, 1.785), P_FDR=0.003) per SD increase], with a significant non-linear relationship (P_{– nonlinearity}=0.031). Arachidonic acid (AA) showed a borderline significant association with lower GDM risk after FDR correction [OR (95%CI): 0.736 (0.568, 0.953), P = 0.020, P_FDR=0.065].

CONCLUSION: Erythrocyte GLA was significantly associated with an increased risk of GDM in pregnant women. Furthermore, we observed for the first time significant non-linear associations of erythrocyte ALA and GLA with GDM risk.

CLINICAL TRIAL REGISTRY NUMBER: NCT03023293, 2019-01-11.

PMID:39932572 | DOI:10.1007/s00394-025-03603-2

J Cancer Res Clin Oncol. 2025 Feb 11;151(2):75. doi: 10.1007/s00432-025-06113-0.

ABSTRACT

BACKGROUND: Breast cancer (BC) poses an increasing threat to women’s health, yet its characteristics in women of childbearing age (WCBA) are infrequently reported. This study aims to investigate the patterns and trends in BC incidence among WCBA over the past decades.

MATERIALS AND METHODS: This study focuses on BC incidence in women aged 15-49 years, consistent with the WHO definition of WCBA. Estimates and 95% uncertainty intervals (UIs) for BC incidence in WCBA were obtained from the Global Burden of Diseases Study 2021. We utilized an age-period-cohort (APC) model to estimate the overall annual percentage change in incidence (net drift, % per year) and the annual percentage change within each age group (local drift, % per year). This model also provided fitted longitudinal age-specific rates adjusted for period deviations (age effects) and period/cohort relative risks (period/cohort effects) from 1992 to 2021.

RESULTS: In 2021, the global incidence of BC among WCBA was 561.44 thousand (95% UI 519.76 to 606.99). Between 1992 and 2021, the estimated annual change in BC incidence among WCBA was 0.47 (95% CI 0.41-0.52) worldwide, ranging from -0.43 (95% CI -0.54–0.31) in High sociodemographic index (SDI) region to 2.03 (95% CI 1.97-2.1) in Low-middle SDI region. Local drift analysis showed that higher SDI regions had higher age-standardized incidence rates among WCBA, with age effects demonstrating similar patterns across different SDI regions and increasing risk with age. Notably, the rising trend in BC incidence among WCBA occurs at progressively younger ages. Globally, unfavorable period and cohort effects were observed. All SDI regions exhibited increased period and cohort risks, except for the High SDI region, which saw a reduction in incidence rates influenced by period and cohort effects, particularly among those born after 1996.

CONCLUSION: The increasing incidence of BC among WCBA highlights the urgent need for effective intervention and preventive policies to alleviate this growing global burden.

PMID:39932566 | DOI:10.1007/s00432-025-06113-0

Am J Mens Health. 2025 Jan-Feb;19(1):15579883241312396. doi: 10.1177/15579883241312396.

ABSTRACT

This before-and-after design study, which was conducted during Ramadan 2023, aimed to compare salivary flow rate (SFR), potential hydrogen (pH), and electrolyte concentrations before Ramadan (BR), at the end of Ramadan (ER), and after Ramadan (AR). Men aged 20 to 30 years who were fasting during Ramadan were recruited from the University of Monastir (Tunisia). Unstimulated saliva was collected over a 5-minute period between 10 and 11 a.m. at BR, ER, and AR. After recording the SFR, the pH was measured immediately using a pH meter. Concentrations of several salivary electrolytes (e.g., calcium, potassium, sodium, chloride, and phosphate) were determined using inductively coupled plasma-optical emission spectroscopy. Twenty-seven participants completed all three sessions. Ramadan intermittent fasting (RIF) caused significant changes only in calcium levels and pH. The mean (M)±standard deviation (SD) salivary calcium concentration decreased during ER compared to BR and AR (0.10 ± 0.08 vs. 0.21 ± 0.18 [p = .041] vs. 0.22 ± 0.20 [p = .026], respectively). The M±SD salivary pH increased during ER compared to BR (6.88 ± 0.23 vs. 6.69 ± 0.35 [p = .049], respectively). To conclude, RIF decreased salivary calcium, increased salivary pH, and did not significantly affect potassium, sodium, chloride, or phosphate. The pH change, although statistically significant, was clinically insignificant, as values remained normal. The lack of reference values for salivary calcium limits assessment of its clinical impact. There is a need for further research on the effects of RIF on saliva secretion.

PMID:39931913 | DOI:10.1177/15579883241312396

Recenti Prog Med. 2025 Feb;116(2):108-117. doi: 10.1701/4450.44442.

ABSTRACT

PURPOSE: Pulmonary embolism (PE) can compromise gases exchanges of patients admitted to respiratory wards. The objectives of this observational study were to identify radiological and arterial blood gases (ABG) differences in PEs documented by computed tomography pulmonary angiogram (CTPA) in Covid-19 pneumonia (C-19) vs cancer patients (CP).

METHODS: Fifty-one patients diagnosed with PE were evaluated, 18 CP and 33 C-19. Clinical, ABG and radiological parameters were evaluated. Jamovi software was used for statistics.

RESULTS: Wells score and D-dimer were both significantly higher in CP compared to C-19 cohort. DVT prevalence was significantly higher in CP patients. Alveolar-arterial O2 gradient (ΔA-aO2) was significantly higher in C-19 compared to CP cohort. PE associated to Covid-19 pneumonia was often bilateral and required a higher need of respiratory supports as High flow nasal cannula (HFNC), Continuous positive airway pressure (CPAP) and Non-invasive ventilation (NIV). In both cohorts, standard PaO2 and standard P/F were significantly lower than PaO2 and P/F. Multivariable linear regression analysis showed that in C-19 cohort PESI score and A-aO2 were independently and positively associated with PE severity.

DISCUSSION: These findings show that Wells score and D-dimer may underestimate PE’s risk in C-19 patients. P/F may underestimate the severity of respiratory failure compared to standard P/F. A-aO2 may be a useful tool for prediction of PE severity.

PMID:39931881 | DOI:10.1701/4450.44442

BJOG. 2025 Feb 11. doi: 10.1111/1471-0528.18092. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the 12-year effectiveness of pelvic floor muscle training versus midurethral sling surgery for moderate to severe female stress urinary incontinence.

DESIGN: Observational follow-up study of a randomised controlled trial.

SETTING: Conducted at the Division of Gynaecology, University Medical Centre Utrecht, The Netherlands.

POPULATION: Women from the PORTRET study experiencing moderate to severe stress urinary incontinence.

METHODS: A validated questionnaire was sent to participants.

MAIN OUTCOME MEASURES: The primary outcome was subjective improvement in urinary incontinence symptoms. Secondary outcomes included subjective cure, severity of incontinence, impact of incontinence as urogenital symptom and cross-over and re-operation rates.

RESULTS: In this long-term study, 184 of 386 (47.7%) women responded to the questionnaire. Cross-over (86.9%) from the initial physiotherapy group to surgery was very high. No statistically significant differences were found in the intention to treat analysis. However, the post hoc analysis showed that women who underwent physiotherapy only reported a statistically significant lower improvement compared to those who underwent initial surgery (50.6% absolute difference; 95% CI 28.2-73.1) or surgery after physiotherapy (49.7% absolute difference; 95% CI 25.8-73.7). Subjective cure, decrease in perceived severity and impact of urinary incontinence also statistically significantly favoured women who underwent (initial) surgery Re-operation was reported by 4.6% of women.

CONCLUSION: This 12-year follow-up study showed a very high cross-over rate to surgical treatment, considering a substantial proportion of non-responders. Midurethral sling surgery, either initial or after physiotherapy, statistically significantly improved subjective outcomes for moderate to severe stress urinary incontinence as compared to pelvic floor muscle physiotherapy only in the long-term.

PMID:39931871 | DOI:10.1111/1471-0528.18092

Curr Cardiol Rev. 2025 Feb 11. doi: 10.2174/011573403X345783250128052038. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric heart failure (HF) poses diagnostic challenges, especially in emergency settings, where misdiagnoses are common.

AIM: This study aimed to investigate the causes of HF in children with congenital heart disease (CHD) and provide insights into age-related disparities and clinical classifications.

METHODS: A prospective observational cohort study was conducted on 402 pediatric patients with CHD during the years 2019-2020. Ultimately, 45 pediatric patients diagnosed with HF by two pediatric cardiologists based on clinical symptoms and radiographic changes were included in the study. Information from the patients’ files, including epidemiological findings, clinical examinations, paraclinical findings, and interventions performed, was recorded. Etiological factors and clinical classifications were analyzed using statistical tests.

RESULTS: Among 402 pediatric patients with CHD, 45 (11.19%) were diagnosed with HF, with a median age of 7.5 months. The predominant etiological factors included ventricular septal defect (VSD), atrial septal defect (ASD), and cardiomyopathy. CHD was prevalent in 86.66% of the cases. Clinical classifications revealed age-related differences, emphasizing the heterogeneity of pediatric HF presentations.

CONCLUSION: Considering that 86.7% of the patients with HF in our study had CHD, more investigations into the causes and mechanisms of this issue are necessary, which will be possible with genetic studies. A significant difference was observed between Class II and Class IV, with Class II patients being older and heavier, and having a lower heart rate compared to those in Class IV. This aligns with the classifications, where Class II indicates mild symptoms during ordinary activity, while Class IV signifies severe symptoms at rest.

PMID:39931850 | DOI:10.2174/011573403X345783250128052038

Chronobiol Int. 2025 Feb 11:1-12. doi: 10.1080/07420528.2025.2460648. Online ahead of print.

ABSTRACT

The aim of the current study was to determine the prevalence of night eating syndrome (NES) among preclinical medical students. All participants were asked to complete a socio-demographic form, Night Eating Questionnaire (NEQ), Morningness-Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI), Barratt Impulsiveness Scale-11 (BIS-11), Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales (PHQ-SADS), and the Adult Attention Deficit Hyperactivity Disorder Self-report Scale (ASRS). The participants were categorised according to their NEQ scores, and statistical analyses were carried out between the groups. The mean NEQ score of the participants was 16.31 ± 5.48, and 8.8% were diagnosed with probable NES. Those with probable NES had higher MEQ, PSQI, BIS-11, PHQ-15, GAD-7, PHQ-9, ASRS-A and ASRS-B scores. A moderate positive association was identified between the NEQ score and PSQI and PHQ-9. ASRS-B and BIS-11 were found to have a mediating role in the relationship between NES and MEQ. The findings of our study suggest that the prevalence of probable NES in preclinical medical students is higher than the general population, and that NES symptomatology is associated with many psychiatric clinical entities in addition to depressive and sleep disorders included in the diagnostic criteria.

PMID:39931845 | DOI:10.1080/07420528.2025.2460648

J Ment Health Policy Econ. 2024 Dec 1;27(4):129-143.

ABSTRACT

BACKGROUND: Persistent depressive disorder (PDD; chronic depression) is associated with high personal, economic, and societal burden. Patients with PDD often fail to respond to treatment, despite long-term, intensive care, suggesting that future treatment should focus more on functional recovery. The “Patient and Partner Education Program for All Chronic Diseases-Persistent Depressive Disorder” (PPEP4All-PDD) is a brief self-management program for patients with PDD with nine weekly sessions, provided in group or individual format. Its focus on functional recovery may increase quality of life and shorten treatment duration, thus reducing healthcare and societal costs. This study examined the cost-effectiveness of PPEP4All-PDD for adults and elderly with PDD and their partners/caregivers compared to care-as-usual (CAU).

AIMS OF THE STUDY: In this economic evaluation, we examined whether a favorable cost-utility of PPEP4All-PDD compared to CAU could be attained.

METHOD: In this multicenter pragmatic randomized controlled trial, 70 patients with PDD and 14 partners/caregivers were included. Data were collected at 0, 3, 6, and 12 months. Health-related quality of life was measured using the EuroQoL 5-Dimensions/Levels (EQ-5D-5L). Cost of healthcare utilization and productivity loss were assessed using the Trimbos questionnaire for Costs associated with Psychiatric illness (TiC-P). We examined incremental costs per quality-adjusted life years (QALYs) after one year.

RESULTS: In relation to PPEP4All-PDD, 62% (n = 23) of patients had no participating PPEP4All-PDD partner/caregiver, and 89% (n = 33) of patients participated in group format. On average, PPEP4All-PDD cost €232 including the PPEP4All-PDD partner/caregiver, or €166 excluding the partner/caregiver. There was no statistical difference in mean costs per patient for (mental) healthcare, non-healthcare, and societal costs nor in QALYs between PPEP4All-PDD and CAU. The probability that PPEP4All-PDD is cost-effective compared to CAU remained below 50% for all acceptable values of willingness-to-pay for a QALY.

DISCUSSION: This was the first economic evaluation of PPEP4All-PDD. Compared to CAU, PPEP4All-PDD did not lead to lower total healthcare costs nor higher quality of life in the one-year follow-up period. PPEP4All-PDD patients continued to receive additional mental healthcare sessions, showing that the process of ending treatment after a self-management intervention is not clear. The COVID-19 situation may have also affected this process after PPEP4All-PDD, due to higher levels of anxiety and loneliness. We could not confirm that involvement of the partner/caregiver was beneficial to patient treatment outcomes and requires further examination.

IMPLICATIONS: This economic evaluation failed to find significant differences in costs between PPEP4All-PDD and CAU over a study period of one year. Non-significant differences were in favor of CAU, leading to a low probability of PPEP4All-PDD being cost- effective. Providing biweekly sessions and extending the follow-up period may be necessary in future studies. Patients with PDD may require more time to learn and integrate self-management practices into their daily life prior to effecting changes in personal quality of life and (mental) healthcare utilization. Digital interventions, such as digital PPEP4All-PDD, with or without the partner/caregiver may be a cost-effective option.

PMID:39931808

J Ment Health Policy Econ. 2024 Dec 1;27(4):115-128.

ABSTRACT

BACKGROUND: With over 40 million food insecure Americans, access to food is a significant policy challenge. Food insecurity is associated with many adverse health conditions, including poorer mental health outcomes. However, previous research generally does not address that poor mental health can both be a cause and a consequence of food insecurity.

AIMS OF THE STUDY: We estimate the directional causal effect of food insecurity on mental health status and mental health treatment using bounding methods to partially identify the causal effects from food insecurity to mental health status and mental health treatment.

METHODS: Data on food security, mental health status, mental health treatment, and individual and family socioeconomic characteristics for adults come from the nationally representative 2016 and 2017 Medical Expenditure Panel Survey. We use both the continuous score (0-10) of a 10-question module on food security as well as classifying adults as living in households that are food secure (0) or having marginal (1-2), low (3-5), or very low food security (6-10). Mental health status is measured using the Kessler-6 (K6) and the PHQ2 depression screening scales. A K6 score of 13 or greater indicates serious psychological distress while a score of 7 to 12 indicates moderate distress. A score of 3 or more on the PHQ-2 indicates probable depression. Mental health treatment is measured by ambulatory mental health visits, prescriptions for psychotropic medications, and total mental health expenditures. Standard parametric regression models are used as a baseline for partial identification models that bound the effects of food security on mental health. In our preferred specification, we impose the following assumptions: monotone treatment selection (MTS), monotone treatment response (MTR), and monotone instrumental variables (MIV) using household income as an instrument.

RESULTS: Those living in food insecure households are more likely to experience psychological distress and depression than those who in food secure households, but do not seek commensurately more mental health treatment. Non-parametric bounds suggest food insecurity increases the probability of moderate psychological distress by no more than 7.2 percentage points, serious psychological distress by no more than 3 percentage points, and probable depression by no more than 4.2 percentage points. The estimated effect sizes of food security on mental health treatment are much smaller, with treatment uptake increasing by no more than 2.4 percentage points.

DISCUSSION: Our parametric results are consistent with prior findings on the relationship between food security and mental health. We provide evidence for a causal effect of food insecurity which may account for about half the observed association of food security on mental health. A new and previously unreported result indicates that, despite poorer mental health, the food insecure do not show similar increases in mental health care. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE / IMPLICATIONS FOR HEALTH POLICIES: Our results provide policy relevant bounds on the causal impact of food insecurity on mental health. These results raise concerns about the mental health treatment gap in the food insecure population. The relative lack of treatment may point towards deeper structural issues in access to mental health treatment.

PMID:39931807