Nevin Manimala

BMC Infect Dis. 2025 Dec 6. doi: 10.1186/s12879-025-11747-z. Online ahead of print.

ABSTRACT

BACKGROUND: Aminoglycoside pharmacokinetics is expected to change in premature infant. However, the PK profile of amikacin in Chinese premature infants has not been characterized. The aim of this study was to assess the safety and describe the pharmacokinetics properties of amikacin in Chinese premature infants.

METHODS: This was a two-center, retrospective, pharmacokinetic study. Phoenix NLME was used to construct a pharmacokinetics model. Monte Carlo simulations were performed to screen the optimal dosage regimen.

RESULTS: A total of 54 amikacin concentrations from 23 patients were available for population pharmacokinetic analysis. The patients received an amikacin total daily dose (median(range)) of 14.32 (10.34-19.70) mg/kg. The distribution of C_min (median(range)) was 4.07 (1.01-30.99)µg/mL, and C_max (median(range)) was 17.45 (4.56-164.72) µg/mL. There were 14 patients achieved target C_min, and 6 infants achieved C_max. There were 3 cases occurred acute kidney injury, with C_max and C_min all exceeded the recommended range. A one-compartment model with first-order elimination best described the amikacin concentration-time data. The estimated typical values of clearance and volume of distribution for amikacin were 1.43 L/h/70kg and 30.97 L/70kg, respectively. Covariate analyses revealed that statistically significant relationships between amikacin clearance and weight, postmenstrual age and renal function, while there was a statistically significant relationship between volume of distribution and weight. Based on the model-based simulations, the initial recommend dosage regimens prior to therapeutic drug monitoring were suggested as 13 mg/kg q24h, 12 mg/kg q36h and q48h for serum creatinine between 15-22µmol/L; 23-36 and 37-60µmol/L, respectively.

CONCLUSION: Weight, postmenstrual age and renal function have significant influence on the PK of amikacin in Chinese premature infants. The optimal dosage regimens might provide an alternative choice for premature infants in China in the therapy of amikacin.

PMID:41350991 | DOI:10.1186/s12879-025-11747-z

BMC Geriatr. 2025 Dec 5;25(1):999. doi: 10.1186/s12877-025-06685-z.

ABSTRACT

BACKGROUND: As the number of older people living at home increases, the role of home care services (HCS) becomes more important. Diabetes is associated with premature mortality and is common among older people in HCS, yet mortality patterns among HCS recipients are not well known. This study aimed to estimate all-cause and cause-specific mortality risk in persons with pharmacologically treated diabetes receiving HCS compared to other HCS recipients and explore whether mortality risk differed between diabetes treatment subgroups.

METHODS: This nationwide registry study merged data from the Norwegian Information System for the Nursing and Care Sector with data from the Norwegian Prescription Database, the Norwegian Patient Registry, and the Cause of Death Registry (CDR). The study population included recipients of HCS (aged 65-90 years at baseline) in Norway between 2009 and 2014. Individuals were classified as having pharmacologically treated diabetes (hereafter referred to as diabetes) (≥ 1 prescription of glucose-lowering drugs (GLD) in the current half year or the year before), or not having diabetes. Those with diabetes were further sub-classified into “non-insulin GLD only”, “insulin and non-insulin GLD”, or “insulin only”. Time of death and the underlying cause of death were retrieved from CDR. The study population, diabetes status, covariates, and all-cause mortality were updated each half-year. Mortality risk was compared between groups using Cox proportional hazards regression, with age as time scale, and reported as hazard ratio (HR) with 95% CIs.

RESULTS: Women in the “insulin only” group had a higher risk of all-cause mortality (HR 1.18 (CI 1.11-1.25)) than women without diabetes, while in the “non-insulin GLD only” and “insulin and non-insulin GLD” subgroups, both women and men with diabetes had lower mortality risks than those without diabetes. Overall, persons with diabetes had a higher risk of cardiovascular mortality (HR 1.23 (CI 1.19-1.28)) compared to persons without diabetes, and a lower risk of dying from cancer (HR 0.68 (CI 0.66-0.70)) and respiratory disease (HR 0.67 (CI 0.62-0.72)).

CONCLUSION: Mortality risk varied by diabetes status and treatment subgroups. Most diabetes subgroups had lower all-cause mortality risk than those without diabetes, except for women using “insulin only”, underscoring the need for individualized HCS.

PMID:41350985 | DOI:10.1186/s12877-025-06685-z

BMC Geriatr. 2025 Dec 5;25(1):1000. doi: 10.1186/s12877-025-06620-2.

ABSTRACT

BACKGROUND/OBJECTIVE: The relationship between frailty and sarcopenia is well-known in older adults, but the factors associated with frailty were not adequately investigated. This study aimed to investigate the relationship between frailty levels and balance, fall risk, and kinesiophobia in older adults with primary sarcopenia and to compare them by sex.

METHODS: This cross-sectional study included 68 (32 female, mean age 71.56 ± 5.04 years; 36 male, mean age 71.97 ± 4.86 years) older adults with primary sarcopenia. Sarcopenia was assessed based on grip strength, skeletal muscle mass, and physical performance. Frailty levels (Edmonton Frailty Scale (EFS)), dynamic and static balance (Force plate), fall risk (Denn Fall Risk Assessment Scale), and kinesiophobia (Tampa Kinesiophobia Scale (TSK)) of the individuals were assessed.

RESULTS: Sarcopenic females had statistically significantly higher levels of frailty, fall risk, kinesiophobia, and decreased balance stability areas than males (p < 0.05). The prevalence of frailty among older adults with sarcopenia was 51.5%, with a mean EFS score of 6.54 ± 2.51. Females had significantly higher frailty levels than males (7.53 ± 2.81 vs. 5.67 ± 1.83, p = 0.002). Fall risk was also higher in females (10.66 ± 5.83 vs. 7.17 ± 4.29, p = 0.007), as was kinesiophobia (47.59 ± 6.37 vs. 41.81 ± 5.09, p < 0.001). Frailty showed a moderate positive correlation with fall risk (r = 0.603, p < 0.001) and kinesiophobia (r = 0.510, p < 0.001), and a weak negative correlation with balance stability in the anterior direction (r=-0.249, p = 0.040) and to the right (r=-0.265, p = 0.030).

CONCLUSION: Sarcopenic females have higher levels of frailty and have a higher risk of falling and kinesiophobia than males. Sarcopenic females also have more impaired balance. Increased frailty levels in older sarcopenic adults are associated with increased fear of falling and kinesiophobia, and impaired balance. Therefore, assessment of frailty and associated factors in older adults with sarcopenia is essential in planning rehabilitation.

PMID:41350982 | DOI:10.1186/s12877-025-06620-2

BMC Anesthesiol. 2025 Dec 5. doi: 10.1186/s12871-025-03532-x. Online ahead of print.

ABSTRACT

BACKGROUND: The objective of this study is to compare the effects of remimazolam and dexmedetomidine on the incidence of hypotension in middle-aged and elderly patients undergoing general anesthesia, and to evaluate the safety profiles of both medications.

METHODS: We systematically searched PubMed, Cochrane Library, EMBASE, and Web of Science from inception to July 2024 for randomized controlled trials comparing remimazolam versus dexmedetomidine in patients aged ≥ 45 years undergoing general anesthesia. Two investigators independently screened studies, extracted data, and assessed risk of bias using the Cochrane RoB 2 tool. Meta-analyses employed random-effects models to calculate risk ratios (RR) with 95% confidence intervals. The primary outcome was intraoperative hypotension incidence; secondary outcomes included bradycardia, tachycardia, hypertension, and postoperative nausea and vomiting.

RESULTS: This meta-analysis included 8 randomized controlled trials with 741 patients (384 remimazolam; 357 dexmedetomidine). There was no statistically significant difference in intraoperative hypotension between groups (RR 0.78, 95% CI 0.36-1.68, P = 0.53, I²=71%). Remimazolam showed a significant reduction in bradycardia risk compared to dexmedetomidine (RR 0.41, 95% CI 0.23-0.73, P = 0.002, I²=0%). However, remimazolam had a higher risk of tachycardia (RR 3.41, 95% CI 1.47-7.90, P = 0.004, I²=0%). There was no significant difference in intraoperative hypertension (RR 0.85, 95% CI 0.38-1.90, P = 0.69, I²=0%) or postoperative nausea and vomiting(RR 0.98, 95% CI 0.30-3.23, P = 0.97, I²=0%).

CONCLUSIONS: Remimazolam and dexmedetomidine did not differ significantly in intraoperative hypotension, intraoperative hypertension, or postoperative nausea and vomiting in middle-aged and elderly patients. Remimazolam reduced the incidence of bradycardia. In contrast, dexmedetomidine had an advantage in reducing intraoperative tachycardia. These findings support individualized anesthetic selection based on patients’ specific cardiovascular risk profiles.

PMID:41350976 | DOI:10.1186/s12871-025-03532-x

Appl Health Econ Health Policy. 2025 Dec 5. doi: 10.1007/s40258-025-01019-x. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to update EQ-5D-5L data on health-related quality of life (HRQoL) in the Vietnamese population using the EQ-5D-5L instrument and examine associated sociodemographic and health-related factors.

METHOD: A cross-sectional online survey was conducted between April and May 2025 among 3550 Vietnamese adults aged 18 years and older across three geographic regions. Participants were recruited through convenience and snowball sampling using online platforms. HRQoL was assessed using the EQ-5D-5L index (derived from the Vietnamese value set) and the EQ-VAS. Descriptive statistics, t-tests, ANOVA, and multivariable Tobit regressions were used.

RESULTS: The mean EQ-5D-5L index score was 0.896 (SD 0.14) and the mean EQ-VAS score was 86.7 (SD 11.8). Significant differences were observed across age groups, employment status, education levels, and chronic disease presence (p < 0.001). Older age, unemployment, low education, and multiple morbidities were independently associated with lower HRQoL scores.

CONCLUSION: The findings provide updated data for HRQoL in Vietnam, confirming the impact of age, socioeconomic status, and health conditions. These results are useful for healthcare planning, health economic evaluations, and prioritizing public health interventions in Vietnam.

PMID:41350957 | DOI:10.1007/s40258-025-01019-x

J Math Biol. 2025 Dec 6;92(1):8. doi: 10.1007/s00285-025-02324-8.

ABSTRACT

For two resource-sharing species we explore the interplay of harvesting and dispersal strategies, as well as their influence on competition outcomes. Although the extinction of either species can be achieved by excessive culling, choosing a harvesting strategy such that the biodiversity of the populations is preserved is much more complicated. We propose a type of heterogeneous harvesting policy, dependent on dispersal strategy, where the two managed populations become an ideal free pair, and show that this strategy guarantees the coexistence of the species. We also show that if the harvesting of one of the populations is perturbed in some way, then it is possible for the coexistence to be preserved. Further, we show that if the dispersal of two species formed an ideal free pair, then a slight change in the dispersal strategy for one of them does not affect their ability to coexist. Finally, in the model, directed movement is represented by the term $\Delta (u/P)$ , where P is the dispersal strategy and target distribution. We justify that once an invading species, which has an advantage in carrying capacity, chooses a dispersal strategy that mimics the resident species distribution, then successful invasion is guaranteed. However, numerical simulations show that invasion may be successful even without an advantage in carrying capacity. More work is needed to understand the conditions, in addition to targeted culling, under which the host species would be able to persist through an invasion.

PMID:41350947 | DOI:10.1007/s00285-025-02324-8

Commun Psychol. 2025 Dec 5. doi: 10.1038/s44271-025-00362-y. Online ahead of print.

ABSTRACT

Children incorporate items found in their environment into their play, transforming everyday objects and materials into an opportunity for exploration. Termed loose parts, these versatile, natural, or manufactured materials (e.g., cardboard, pipes, buttons, sticks) are widely recommended for supporting children’s early STEM learning. Limited empirical work has documented children’s indoor STEM behaviours with loose parts. Using a within-subjects experimental design, we examined children’s early STEM behaviours and engagement (N = 60; 32 females, 28 males; Mage = 58.6 months, SD = 10.9) during unstructured solitary play with loose parts and toys that have limited function and affordance (e.g., toy percussion instruments; control). We conducted observations of children’s STEM behaviours. Children’s cognitive functioning, executive function, and home learning environment were also assessed via standardized measures and parent reports. Children demonstrated significantly more STEM behaviours with loose parts than in the control condition. There was no credible evidence that these behaviours differed by sex. Cognitive functioning predicted STEM Engagement Score with loose parts, with children’s verbal comprehension being the strongest predictor in the control condition. Children’s executive function and parents’ attitudes regarding play and engagement in play activities at home predicted constructing structures, which were the most common STEM behaviours. This study thus demonstrates that loose parts may offer a powerful opportunity for STEM-related early learning; however, children’s cognitive capacities and home experiences should be considered, rather than assuming uniform benefits.

PMID:41350933 | DOI:10.1038/s44271-025-00362-y

Eur J Med Res. 2025 Dec 6. doi: 10.1186/s40001-025-03634-9. Online ahead of print.

ABSTRACT

BACKGROUND: Metabolic syndrome (MetS) populations are at increased risk of stroke, and oxidative stress is an important pathogenesis of stroke. The oxidative balance score (OBS) is an emerging tool for the assessment of an individual’s overall oxidative balance. We aimed to investigate the association of OBS with stroke in the MetS population through NHANES 1999-2018.

METHODS: OBS consisted of dietary OBS and lifestyle OBS and were assessed by validated methods. MetS was assessed by NCEP-ATP III criteria, whereas stroke was assessed according to self-report. Multivariable logistic regression analyses were used to explore these associations and to calculate odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS: A total of 6125 MetS participants were included. After adjusting for all confounders, OBS was negatively associated with the odds of stroke (OR 0.937, 95% CI 0.916-0.959, p < 0.0001). Compared to Q1, OBS at Q3 and Q4 was associated with significantly lower stroke prevalence (OR 0.580 and 0.370, respectively; p for trend < 0.0001). Similar findings were found for dietary and lifestyle OBS. OBS and dietary OBS were nonlinearly associated with stroke, whereas lifestyle OSB was linearly associated. High-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol ratio significantly mediated the association between OBS and stroke in MetS, with mediation percentages of 16.51% and 13.67%, respectively. Education level and coronary heart disease influenced the association.

CONCLUSIONS: OBS was negatively associated with stroke prevalence in the MetS, and certain serum lipid profiles mediated this association. Adherence to an antioxidant diet and lifestyle can help reduce stroke in MetS.

PMID:41350917 | DOI:10.1186/s40001-025-03634-9

Syst Rev. 2025 Dec 5. doi: 10.1186/s13643-025-03009-5. Online ahead of print.

ABSTRACT

BACKGROUND: Invasive intra-arterial blood pressure (IABP) monitoring using an arterial catheter carries both risks and practical limitations. Noninvasive blood pressure (NIBP) monitoring using the widely adopted oscillometric automated brachial cuff is performed in nearly all patients in acute care settings at some point, yet its reliability remains in question. Conventional statistical approaches to assessing the global trueness (bias) and precision (standard deviation, SD) of NIBP compared to IABP may not fully capture the risk of harm posed by NIBP’s measurement errors to patients, nor its ability to detect blood pressure (BP) values above or below critical thresholds. Moreover, risk factors for poor performance of NIBP warrant further investigation. We will perform a meta-analysis using individual participant data (IPD) to evaluate the clinical suitability of NIBP in acute care settings.

METHODS: We will search the Cochrane Library, MEDLINE, and Scopus^™ databases to identify relevant peer-reviewed studies published in full-text English or French from 2000 to June 20, 2024. Studies will be included if they compare brachial cuff NIBP measurements with simultaneous radial, femoral, brachial, or pedal intra-arterial IABP measurements in adult patients in acute care settings. Retrospective studies will be excluded. Authors will be contacted to request IPD. For mean and systolic BP, we will assess the risk of harm associated with measurement error (via a dedicated error grid). As secondary objectives, we will evaluate (i) the bias between NIBP and IABP measurements (pooled estimate, SD, and limits of agreement), (ii) the precision (via within-patient SD, calculated for patients who had multiple paired measurements taken closely in time during stable periods), (iii) the ability of NIBP to detect IABP above or below critical thresholds and to identify response to therapy (via the area under the receiver operating characteristic curve), and (iv) the covariates associated with each of the abovementioned outcomes and with poor performance of NIBP. One-stage generalized linear mixed-effects models will be applied for the analyses. A meta-analysis combining IPD and aggregated data will also be conducted using a two-stage approach. Risk-of-bias assessment will follow the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) guidelines. For each outcome, a subgroup of particular interest will consist of studies with a low risk of bias. No funding is required.

DISCUSSION: This meta-analysis will provide actionable insights to optimize BP monitoring strategies.

TRIAL REGISTRATION: PROSPERO CRD42021233707.

PMID:41350911 | DOI:10.1186/s13643-025-03009-5

Virol J. 2025 Dec 5. doi: 10.1186/s12985-025-03027-8. Online ahead of print.

ABSTRACT

BACKGROUND: Hepatitis E virus (HEV) is a major cause of viral hepatitis in low- and middle-income countries, particularly in South Asia, where poor sanitation facilitates its fecal-oral transmission. Nepal, Bangladesh, and Pakistan experience a significant HEV burden, with severe outcomes in high-risk groups like pregnant women and hepatic patients, who face elevated mortality rates. This systematic review and meta-analysis aimed to estimate HEV seroprevalence in these countries, focusing on the general population, pregnant women, and hepatic patients, to inform public health strategies.

METHODS: We searched PubMed, Embase, Cochrane Library, and ProMED-mail for studies published between 2000 and 2017, following PRISMA guidelines and a registered protocol [PROSPERO: CRD42018099558]. Studies reporting HEV seroprevalence in Nepal, Bangladesh, or Pakistan using serological or molecular methods were included. The original search period was retained as data extraction was completed in 2018, and including newer studies was not feasible. A random-effects meta-analysis was conducted using the ‘metaprop’ function in R, with heterogeneity assessed via I² and τ² statistics. Publication bias was evaluated using Egger’s test and funnel plots.

RESULTS: The meta-analysis included 64 studies, totaling 25,301 participants. Pooled HEV seroprevalence was 23.8% (95% CI: 13.7%-35.5%) in the general population (n = 9,935), 41.2% (95% CI: 27.6%-55.6%) in pregnant women (n = 4,345), and 41.8% (95% CI: 30.7%-53.4%) in hepatic patients (n = 11,021). High heterogeneity was observed (I²=98.3-99.4%), with significant country-level variation in hepatic patients (p = 0.0002). Subgroup analyses revealed country-specific variations, particularly for hepatic patients where Bangladesh and Nepal showed higher prevalence than Pakistan. Publication bias was evident in pregnant women (p = 0.0002) and hepatic patients (p = 0.0066), but not in the general population (p = 0.6235).

CONCLUSIONS: These findings highlight the substantial burden of HEV in South Asia, with notable differences across population groups and countries. The high seroprevalence in hepatic patients and pregnant women underscores the need for targeted surveillance and intervention strategies like improved sanitation and vaccination. High heterogeneity and publication bias suggest cautious interpretation, and future research should focus on standardizing diagnostics and conducting longitudinal studies to assess temporal trends in HEV prevalence.

PMID:41350906 | DOI:10.1186/s12985-025-03027-8