Nevin Manimala

J Nepal Health Res Counc. 2024 Dec 19;22(3):470-476. doi: 10.33314/jnhrc.v22i03.4616.

ABSTRACT

BACKGROUND: Acute kidney Injury associated with Coronavirus disease COVID-19 appeared to negatively influence clinical outcomes and is found to be associated with significant risk of death. This retrospective study aimed to describe the incidence of Acute Kidney Injury, its associations with clinical characteristics and outcomes among COVID-19 patients in Sukraraj Tropical and Infectious Disease Hospital, a tertiary infectious disease hospital in Nepal.

METHODS: A cross-sectional study was done where. Medical and lab records of reverse transcriptase Polymerase chain reaction positive COVID-19 inpatients, admitted between April 2021 to July 2021 were reviewed. It represented the second wave of wave of coronavirus pandemic caused by the delta strain. Patients aged less than 18 years, pregnant females and patients with known chronic kidney disease were excluded Results: Of 393 admissions, 83 (21.1%) patients developed Acute Kidney Injury. Characteristics found to have significant association with development of AKI was age (p <0.001), multiple co morbidities (2 or more) (p <0.001), use of mechanical ventilation (p <0.001), lymphopenia (p<0.001), Neutrophil to Lymphocyte Ratio (p =0.001) and d-dimer levels (p <0.001). Mortality was found to be significantly higher in COVID-19 patients with AKI compared to COVID-19 patients without AKI ((36.14% vs 15.8%, p value <0.01)). The median duration of hospital stay for patients with AKI was higher than for patients without AKI (10 days vs 6 days,p <0.01).

CONCLUSIONS: AKI develops in a sizeable percentage of patients with COVID-19 and is significantly associated with increasing age, multiple comorbidities, increased biomarkers, use of mechanical ventilation and is associated with poor outcome in terms of mortality and morbidity.

PMID:39923158 | DOI:10.33314/jnhrc.v22i03.4616

J Nepal Health Res Counc. 2024 Dec 19;22(3):464-469. doi: 10.33314/jnhrc.v22i03.4604.

ABSTRACT

BACKGROUND: The fear of childbirth is the feeling of fearfulness, anxiety or worry among women in relation to pregnancy and childbirth process which influence their experience of childbirth which is the subjective feeling of sadness or joyfulness regarding childbirth. The main objective of the study was to identify the relationship between fear and experience of childbirth among primiparous women.

METHODS: A descriptive cross-sectional study was done where non probability, purposive sampling technique was used to select a sample of 133 primiparous women attending Paropakar Maternity and Woman’s Hospital having term pregnancy (37-42 weeks of gestation) without any complications and willing to participate in the study. Data were collected through interview technique. Fear of childbirth was assessed by using standard Wijma Delivery Expectancy/ Experience Questionnaire (WDEQ) and experience of childbirth was assessed by using Childbirth Experiences Questionnaire (CEQ). Data analysis was done by using descriptive statistics like frequency, mean, percentage and standard deviation and inferential statistics i.e. Pearson’s correlation and chi square test in Statistical Package for Social Sciences version 16.

RESULTS: The study revealed that fear and experience of childbirth were negatively correlated (r= -0.254). The majority of the respondents (64.7%) had a moderate level of fear of childbirth. Most of the respondents (80.5%) had a positive experience of childbirth.

CONCLUSIONS: This study concludes that there is negative relationship between the fear of childbirth and its experience. Women having higher fear of childbirth have less positive experience of childbirth.

PMID:39923157 | DOI:10.33314/jnhrc.v22i03.4604

Eur J Pain. 2025 Mar;29(3):e4795. doi: 10.1002/ejp.4795.

ABSTRACT

BACKGROUND: Observer pain scales are commonly used to assess pain in individuals with impaired cognition. However, nursing staff have highlighted that extremely tight time schedules and increasing workload demands prevent regular use. With the development of a short version of the Pain Assessment in Impaired Cognition (PAIC15), we aimed to reduce implementation barriers in everyday clinical practice.

METHODS: We developed a new 6-item short version (PAIC6) in a first sample (N = 59) and validated its psychometric properties in a second sample (N = 250) of older individuals with cognitive impairments. The item reduction and evaluation involved four steps. First, we used Sample 1 to exclude items based on item quality statistics (e.g., difficulty, reliability). Second, the Partial Credit Model (PCM) was utilised for further reduction using again Sample 1. Third, an expert panel evaluated the preceding steps and suggested a draft short version with six items (PAIC6). Fourth, psychometric properties of the short version were evaluated in the independent Sample 2. Thereafter, the final short version was approved.

RESULTS: The new PAIC6 showed a high correlation with the total scale PAIC15 (r = 0.870), good reliability (Cronbach’s α = 0.684), and high convergent construct validity, as observed by a high correlation with the established Pain Assessment in Advanced Dementia (r = 0.602).

CONCLUSIONS: Overall, we developed a valid, reliable, and clinically valuable PAIC6 that allows a more time-efficient pain assessment, by reducing the assessment time from 5 min to approximately 2 min (60% time saving).

SIGNIFICANCE: Observer pain scales are commonly used to assess pain in individuals with impaired cognition. However, nursing staff have highlighted that extremely tight time schedules and increasing workload demands prevent regular use. To address this, we developed PAIC6, a short version of the Pain Assessment in Impaired Cognition 15 (PAIC15). PAIC6 includes six items and takes 2 min for completion after training, realising a 60%-time reduction compared to the original scale while keeping the psychometric quality high.

PMID:39923123 | DOI:10.1002/ejp.4795

J Clin Anesth. 2025 Feb 7;102:111770. doi: 10.1016/j.jclinane.2025.111770. Online ahead of print.

ABSTRACT

BACKGROUND: Electroencephalogram oscillations during general anesthesia may change as a function of cognitive and physical health. This study aimed to characterize associations between anesthesia-induced oscillations and postoperative outcomes in cardiac surgery patients over 60 years.

METHODS: This was a prespecified secondary data analysis from the Minimizing Intensive Care Unit Dysfunction with Dexmedetomidine-induced Sleep (MINDDS) study. Participants were admitted from home for elective cardiac surgery with cardiopulmonary bypass. The primary outcome was postoperative delirium obtained using the Confusion Assessment Method. Secondary outcomes were non-home discharge and 30-day readmission. The exposure of interest was alpha power measured during the maintenance phase of isoflurane-general anesthesia. Confounding cognitive and physical health variables were collected.

RESULTS: Of 394 participants in the MINDDS study, 302 had analyzable electroencephalograms. The incidence of postoperative delirium was 11.1 %. Odds of postoperative delirium decreased by 14 % for every decibel increase in alpha power (OR 0.86, 95 % CI: 0.78 to 0.95; P = 0.004). This finding was not significant in adjusted analysis (OR_adj 0.92, 95 % CI: 0.81 to 1.03; P = 0.154). Non-home discharge setting findings were not associated with alpha power. The odds of 30-day readmission decreased by 20 % for every decibel increase in alpha power (OR_adj 0.80, 95 % CI: 0.71 to 0.91; P < 0.001). Findings were conserved in exploratory and sensitivity analyses.

CONCLUSIONS: In this study anesthesia-induced oscillations were associated with postoperative outcomes; however, these were not independently associated with delirium or discharge disposition after considering preoperative cognitive and physical health. These oscillations were robustly associated with 30-day readmission however, which may help anesthesiologists identify high-risk patients, offering benefits beyond the operating room.

CLINICAL TRIAL REGISTRATION: Registration Number: NCT02856594.

PMID:39921932 | DOI:10.1016/j.jclinane.2025.111770

Comput Med Imaging Graph. 2025 Feb 1;121:102508. doi: 10.1016/j.compmedimag.2025.102508. Online ahead of print.

ABSTRACT

This study proposes a deep learning framework, DLPVI, which integrates projection, view-by-view backprojection (VVBP), and image domains to improve the quality of high-sparse-view and ultra-sparse-view cone-beam computed tomography (CBCT) images. The DLPVI comprises a projection domain sub-framework, a VVBP domain sub-framework, and a Transformer-based image domain model. First, full-view projections were restored from sparse-view projections via the projection domain sub-framework, then filtered and view-by-view backprojected to generate VVBP raw data. Next, the VVBP raw data was processed by the VVBP domain sub-framework to suppress residual noise and artifacts, and produce CBCT axial images. Finally, the axial images were further refined using the image domain model. The DLPVI was trained, validated, and tested on CBCT data from 163, 30, and 30 real patients respectively. Quantitative metrics including root-mean-square error (RMSE), peak signal-to-noise ratio (PSNR), structural similarity (SSIM), and feature similarity (FSIM) were calculated to evaluate the method performance. The DLPVI was compared with 15 state-of-the-art (SOTA) methods, including 2 projection domain models, 10 image domain models, and 3 projection-image dual-domain frameworks, on 1/8 high-sparse-view and 1/16 ultra-sparse-view reconstruction tasks. Statistical analysis was conducted using the Kruskal-Wallis test, followed by the post-hoc Dunn’s test. Experimental results demonstrated that the DLPVI outperformed all 15 SOTA methods for both tasks, with statistically significant improvements (p < 0.05 in Kruskal-Wallis test and p < 0.05/15 in Dunn’s test). The proposed DLPVI effectively improves the quality of high- and ultra-sparse-view CBCT images.

PMID:39921927 | DOI:10.1016/j.compmedimag.2025.102508

Leuk Res. 2025 Feb 4;150:107662. doi: 10.1016/j.leukres.2025.107662. Online ahead of print.

ABSTRACT

CMML is a heterogenous myelodysplastic/myeloproliferative neoplasm (MDS/MPN) sharing both diseases’ molecular and clinical phenotypes. Several models are used to risk-stratify patients diagnosed with CMML. Inflammation plays a pivotal role in developing the disease or its progression and has been linked to worse outcomes. Serum albumin (SA) is an inflammatory marker and/or surrogate for co-morbidities. While the role of SA has been investigated in myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), multiple myeloma, and other cancers, its prognostic value in CMML remains unclear. We identified 919 patients diagnosed with CMML with known SA levels at the time of diagnosis or prior to any therapy. We divided patients into three groups based on SA levels: < 3.5 g/dL, 3.5-4.0 g/dL and > 4.0 g/dL. We then compared the baseline characteristics and outcomes of these three groups. Patients with SA < 3.5 g/dL had higher risk disease according to the CPSS-Molecular model, WHO 2022 classification, and FAB classification. Additionally, patients with SA < 3.5 g/dL had a higher median blast percentage, ferritin levels, WBC, and monocyte count (P < 0.001). These patients were also more likely to be cytopenic and RBC transfusion-dependent (RBC-TD) (P < 0.001). In multivariable Cox regression analysis, SA was independently significant for predicting overall survival (OS) after adjusting for CPSS-Molecular risk, WHO 2022 subtype, proliferative CMML (FAB classification), RBC-TD, and bi/pancytopenia. Therefore, SA is an independent prognostic factor for OS among patients with CMML. Low SA may reflect inflammatory disease status or a surrogate for co-morbidities. Risk stratification models should incorporate serum albumin levels to refine their prognostic value.

PMID:39921921 | DOI:10.1016/j.leukres.2025.107662

J Health Popul Nutr. 2025 Feb 8;44(1):36. doi: 10.1186/s41043-025-00759-9.

ABSTRACT

BACKGROUND: Hemoglobin, albumin, lymphocyte and platelet (HALP) score is derived from the counts of hemoglobin, albumin, lymphocytes, and platelets. It serves as a valuable tool for assessing both inflammation and nutritional status in critically ill patients. However, there hasn’t been a specific study exploring the role of the HALP score in critically ill patients. Additionally, whether the HALP score exhibits an incremental effect on the Sequential Organ Failure Assessment (SOFA) score remains unknown.

METHODS: In this study, we used the Medical Information Mart for Intensive Care (MIMIC-IV) version 2.2 database to evaluate the predictive value of HALP score for critically ill patients. The primary outcome investigated was intensive care unit (ICU) death, and the secondary outcomes included in-hospital mortality, ICU length of stay (LOS), hospital LOS, and 28-day mortality.

RESULTS: We analyzed 20,083 critically ill patients. In logistic regression, a low HALP score (HALP score < 3.56) showed higher risk of ICU death (adjusted odds ratio: 1.41, 95% confidence interval [CI]: 1.25 to 1.59). Additionally, the HALP score improved the predictive ability of the SOFA score (∆Area under curve: 0.009, p < 0.001). In Cox proportional hazards models, a low HALP score (HALP score < 3.2) was also associated with a higher risk of 28-day mortality (adjusted hazard ratio: 1.52, 95% CI: 1.33 to 1.74).

CONCLUSION: HALP score is associated with short-term mortality. Additionally, HALP score showed an incremental effect on SOFA score in predicting short-term mortality.

PMID:39923110 | DOI:10.1186/s41043-025-00759-9

Trials. 2025 Feb 8;26(1):45. doi: 10.1186/s13063-025-08752-7.

ABSTRACT

BACKGROUND: Gestational diabetes is one of the most prevalent diseases in pregnancy, with an incidence of 5 to 18% in Brazil, and is associated with high morbidity rates. The first-line treatment is insulin, although some recent studies have indicated that metformin might also be effective. Metformin is safe in pregnancy and appears to produce better results than insulin, including reduced gestational weight gain (GWG) and smaller gestational-age newborns. Few studies have been conducted on this topic in low- and middle-income countries.

METHODS: We designed an open randomized controlled trial comparing two treatments for pregnant women with type II diabetes mellitus (DM) and gestational diabetes (DMG): the metformin group (intervention) and the insulin group (as a routine service). The primary outcome is glycemic control. The secondary outcomes are GWG, the occurrence of hypertensive syndromes, macrosomia, and neonatal hypoglycemia. The sample will comprise 92 pregnant women, 46 per group. The inclusion criteria will be GDM or type II DM requiring medication for glycemic control, singleton pregnancy, and gestational age under 34 weeks. The exclusion criteria will be current treatment with any medication for glycemic control, type I DM, and intolerance to the study medications (metformin or insulin). Women will be routinely followed during antenatal care, childbirth, and the postpartum period. Statistical analyses will include the intention-to-treat approach and a comparison between the two groups.

DISCUSSION: Considering the Brazilian socioeconomic reality and the safety of metformin demonstrated in previous trials, we expect that the MevIP study will demonstrate that metformin is an adequate and appropriate medication for GDM treatment in the Brazilian population, representing an alternative to insulin for GDM.

TRIAL REGISTRATION: This protocol has been registered prospectively in ReBEC under the ID RBR-3j3cktx in August 11, 2023.

PMID:39923109 | DOI:10.1186/s13063-025-08752-7

Allergy Asthma Clin Immunol. 2025 Feb 8;21(1):7. doi: 10.1186/s13223-024-00919-2.

ABSTRACT

BACKGROUND: Our previous 2007 study reported a 19.4% rate of biphasic anaphylaxis in Kingston, Ontario. Since then, few updates have been published regarding the etiology and risk factors of biphasic anaphylaxis. This study aimed to describe the incidence of and predictors of biphasic anaphylaxis in a single centre through a retrospective evaluation of patients with diagnosed anaphylaxis.

METHODS: From November 2015 to August 2017, all patients who presented to the emergency department at two hospital sites in Kingston given a diagnosis of “allergic reaction,” “anaphylaxis,” “drug allergy,” or “insect sting allergy,” were evaluated. Patients were contacted sometime after ED discharge to obtain consent and confirm symptoms and timing of the reaction. A trained allergist determined if criteria for anaphylaxis were met and categorized the reactions as being uniphasic, biphasic, or non-anaphylactic biphasic. A full medical review of the event ensued, and each type of anaphylactic event was statistically compared.

RESULTS: Of 138 anaphylactic events identified, 15.94% were biphasic reactions, 79.0% were uniphasic, and 5.07% were classified alternatively as a non-anaphylactic biphasic reaction. The average time of a second reaction was 19.0 h in patients experiencing biphasic reactivity. For biphasic anaphylaxis, the symptom profiles of second reactions were significantly less severe (p = 0.0002) compared with the initial reaction but significantly more severe than non-anaphylactic biphasic events (p < 0.0001).No differences of management were identified between events.

CONCLUSION: The incidence of biphasic reactions in this cohort was 15.94% and the average second-phase onset was 19.0 h. In biphasic reactivity, it appears that the symptom profile second reaction is less severe compared to the first reaction.

PMID:39923108 | DOI:10.1186/s13223-024-00919-2

BMC Oral Health. 2025 Feb 8;25(1):196. doi: 10.1186/s12903-025-05537-x.

ABSTRACT

BACKGROUND: Conventional method of using carbide burs for caries removal has long been shown to be quite successful. Nevertheless, it has some disadvantages, including excessive dentin removal, and patient discomfort.

OBJECTIVE: The aim of this study was to compare and assess time consumption and the caries removal effectiveness of Smart prep bur II and Brix 3000 in addition to carbide bur (as a control group).

MATERIALS AND METHODOLOGY: 60 newly extracted carious human permanent premolars were collected from patients between 14 and 24 years old. Teeth were extracted for orthodontic reasons. Caries should be deep but without pulp involvement and all teeth have only one surface caries (mesial or distal class II carious lesions). Samples have been collected, cleaned and stored in distilled water until starting the experiment. Teeth were divided into two groups in addition to third group that represent a control group (n = 20). Infected carious dentin for each group was removed using Smart prep bur II (polymer bur) or Brix 3000 (caries dissolving enzymes). Conventional carbide bur was used to remove carious dentin in the control group. Two parameters were assessed: time consumption and caries removal efficacy. Cavities were inspected by stereomicroscopy and caries removal was categorized after application of caries detector dye.

RESULTS: Regarding the amount of time needed for soft caries removal and the efficacy of total amount removed of infected dentine, there was no statistically significant difference (P ˂ 0.001) found between the two minimally invasive groups. While for carbide bur group, recorded values were considered statistically significant (P > 0.001) when compared to the two minimally invasive groups.

CONCLUSION: within the limitation of this in-vitro study, both Smart Prep bur II and BRIX 3000 are efficient methods for caries removal by minimally invasive approach. However, both are less effective and time-consuming methods when compared to conventional carbide bur.

PMID:39923092 | DOI:10.1186/s12903-025-05537-x