Nevin Manimala

Scand J Gastroenterol. 2025 Jan 7:1-6. doi: 10.1080/00365521.2025.2450042. Online ahead of print.

ABSTRACT

BACKGROUND: Evaluate the clinical significance of esophagogastric junction (EGJ) morphology and esophagogastric junction contractile integral (EGJ-CI) in refractory gastroesophageal reflux disease (RGERD) patients.

METHODS: From June 2021 to June 2023, 144 RGERD patients underwent comprehensive evaluation, recording symptom scores, demographic data. GERD classification (NERD or RE, A-D) was based on endoscopic findings. Reflux was assessed through 24-hour pH-impedance monitoring, and high-resolution esophageal manometry(HREM) measured parameters including EGJ-CI.

RESULTS: HREM revealed EGJ morphologies (type I, II, III) in 80.6%, 13.9%, and 5.6% of subjects, respectively. As the separation between the lower esophageal sphincter(LES) and crural diaphragm(CD) increased, EGJ-CI decreased (p < 0.005). Subjects with EGJ morphology types II and III had significantly higher acid exposure times(AET), DeMeester scores, and impedance reflux times than type I (p < 0.05). There was no statistical difference between types II and III. Impedance reflux times in subjects with type III morphology were significantly higher than those with types I and II (p < 0.05). The optimal EGJ-CI cutoff for distinguishing pathological reflux was 24.8 mmHg·cm, with 68% sensitivity, 72.3% specificity, and an AUC of 0.693 (95% CI 0.609-0.768). Logistic regression analysis identified EGJ-CI <24.8 mmHg·cm (OR = 2.5, 95% CI 1.1-5.5, p = 0.022) and ineffective esophageal motility(IEM) (OR = 2.4, 95% CI 1.2-5.2, p = 0.027) as independent risk factors.

CONCLUSION: EGJ-CI is crucial for clinically assessing EGJ barrier function, predicting pathological reflux and selecting patients with persistent reflux symptoms for surgery.

PMID:39764668 | DOI:10.1080/00365521.2025.2450042

Hum Brain Mapp. 2025 Jan;46(1):e70130. doi: 10.1002/hbm.70130.

ABSTRACT

The brain develops most rapidly during pregnancy and early neonatal months. While prior electrophysiological studies have shown that aperiodic brain activity undergoes changes across infancy to adulthood, the role of gestational duration in aperiodic and periodic activity remains unknown. In this study, we aimed to bridge this gap by examining the associations between gestational duration and aperiodic and periodic activity in the EEG power spectrum in both neonates and toddlers. This cross-sectional study involved EEG data from 73 neonates (postnatal age 1-5 days, 40 females) and 56 toddlers (postnatal age of 2.9-3.2 years, 28 females) from the FinnBrain Birth Cohort Study. EEG power spectra were parameterized to aperiodic and periodic components using the SpecParam tool. We tested the associations between gestational duration as well as postnatal age and SpecParam parameters in neonates and toddlers while including birth weight and child sex as covariates. For neonates, multilevel models were employed, considering different data acquisitions (sleep and auditory paradigm + sleep), while in toddlers, regression models were used as only data from the auditory paradigm was available. We found that longer gestational duration was associated with a steeper power spectrum across EEG frequencies both in neonates and toddlers. Effect was especially strong in toddlers (β = 0.45, p = 0.004), while in neonates, it remained nearly statistically significant (p = 0.061). In neonates, a quadratic association between gestational duration and beta center frequency (12.5-30 Hz) was found. In toddlers, beta center frequencies were overall higher in females compared to males. Offset (calculated as the power of the aperiodic curve at 2.5 Hz) and theta center frequency had negative associations with postnatal age in neonates, but not in toddlers. Our results suggest that gestational duration may have significant and relatively long-lasting effects on brain physiology. The possible behavioral and cognitive consequences of these changes are enticing topics for future research.

PMID:39764646 | DOI:10.1002/hbm.70130

Public Health Nutr. 2025 Jan 7:1-16. doi: 10.1017/S1368980024002611. Online ahead of print.

ABSTRACT

OBJECTIVE: The public health nutrition workforce is well-placed to contribute to bold climate action, however tertiary educators are seeking practical examples of how to adequately prepare our future workforce. This study examines the responses of university students engaged in a co-designed planetary health education workshop as part of their public health nutrition training.

DESIGN: A mixed-methods approach was used to collect and interpret student responses to four interactive tasks facilitated during an in-person workshop. Data were analysed using statistical tests, frequency counting and content analysis.

SETTING: The intervention was co-designed by students (n = 5) and an educator over a 4-week period as part of a larger multi-disciplinary study at an Australian university.

PARTICIPANTS: The workshop engaged nutrition and dietetics students (n = 44) enrolled in public health nutrition coursework.

RESULTS: Students’ reported an increase in self-perceived knowledge about planetary health as a concept and how they can promote it within their future professional roles. Students’ descriptions of what planetary health means to them were focused on humans’ role in protecting and preserving the ecosystem, the responsible and sustainable use of natural resources and a need to sustain a healthy life for future generations. Students prioritised the values of ‘collaboration’ and ‘respect’ as being critical to guide personal and professional practice to promote planetary health.

CONCLUSIONS: This study demonstrated that incorporating planetary health curricula designed by, and for, university students could be a feasible and effective way to prepare the future public health nutrition workforce to address planetary health challenges.

PMID:39764641 | DOI:10.1017/S1368980024002611

Int J Surg. 2025 Jan 7. doi: 10.1097/JS9.0000000000002144. Online ahead of print.

ABSTRACT

BACKGROUND: The inclusion of clinical frailty in the assessment of patients planned for major surgery has proven to be an independent predictor of outcome. Since approximately half of all patients in the UK diagnosed with oesophagogastric (OG) cancer are over 75 years of age, assessment of frailty may be important in selection for surgery.

MATERIALS AND METHODS: This retrospective cohort study applied the Hospital Frailty Risk Score to data obtained from the NHS Secondary Uses Service electronic database for patients aged 75 years or older undergoing oesophagectomy and gastrectomy between April 2017 and March 2020. Descriptive statistics were performed to assess the effect of patient frailty on length of stay, 30-day readmission, and 30-day mortality rates. These outcomes were compared with those published by the National Oesophago-Gastric Cancer Audit.

RESULTS: Over 90% of the 1775 patients identified according to the age and resection criteria exhibited some degree of frailty. The median length of stay and 30-day readmission rate increased as patient frailty increased following both oesophagectomy and gastrectomy, as did the 30-day mortality rate following gastrectomy.

CONCLUSION: Frailty is a dynamic state and increasing age alone should not be a barrier to receiving the most appropriate treatment. Introducing standardized assessment of clinical frailty for patients with OG cancer to identify this cohort of patients earlier might enable targeted screening for frailty syndromes. This could facilitate the enhanced delivery of more holistic, frailty-attuned, approaches to person-centred care, and evidence-based treatment pathways for improved patient outcomes.

PMID:39764586 | DOI:10.1097/JS9.0000000000002144

Front Med (Lausanne). 2024 Dec 23;11:1506340. doi: 10.3389/fmed.2024.1506340. eCollection 2024.

ABSTRACT

PURPOSE: Acute fatty liver of pregnancy (AFLP) is a severe complication that can occur in the third trimester or immediately postpartum, characterized by rapid hepatic failure. This study aims to explore the changes in portal vein blood flow velocity and liver function during pregnancy, which may assist in the early diagnosis and management of AFLP.

METHODS: This longitudinal study was conducted at a tertiary healthcare center with participants recruited from routine antenatal check-ups. The study included healthy women aged 20-40 years with singleton pregnancies. Doppler ultrasonography was used to assess portal vein flow and velocity, complemented by standard laboratory tests to monitor liver function. A nomogram model integrating the clinical features and Doppler ultrasonography parameters was constructed using logistic regression analysis for differentiating AFLP from normal controls.

RESULTS: A total of 135 women were enrolled, divided into control and AFLP groups. The AFLP group demonstrated a significant reduction in portal vein flow velocity and alterations in liver dimensions. Laboratory tests indicated elevated liver enzymes and altered lipid profiles in the AFLP group. Statistical analysis showed that portal vein flow velocity could be a sensitive marker for predicting liver dysfunction in AFLP. The area under the receiver operating characteristic (ROC) curves (AUC) of the nomogram model were 0.88 (95% confidence interval [CI]: 0.82-0.95) with specificity, sensitivity, negative predictive value, and positive predictive value of 67.8, 95.0, 95.0, and 67.8, respectively, in the training cohort and 0.86 (95% CI: 0.72-0.98) and 86.9, 75.0, 83.3, and 80.0 in the test cohort, respectively. The calibration curves demonstrated good agreement between the predicted and observed probability for predicting AFLP.

CONCLUSION: The study underscores the potential of using portal vein flow velocity as an early diagnostic marker for AFLP in pregnant women. Further research is required to establish standardized diagnostic thresholds for portal vein flow measurements.

PMID:39764553 | PMC:PMC11701050 | DOI:10.3389/fmed.2024.1506340

Front Med (Lausanne). 2024 Dec 20;11:1459802. doi: 10.3389/fmed.2024.1459802. eCollection 2024.

ABSTRACT

OBJECTIVE: The study aimed to explore the utility of contrast-enhanced ultrasound (CEUS) as a tool for detecting minimal inflammation in rheumatoid arthritis (RA) patients in sustained remission (SR) and to correlate the findings with Disease Activity Score 28 (DAS28) status scores and various ultrasound (US) scores.

PATIENTS AND METHODS: Thirty RA patients in SR (minimum 6 months), 12 with active disease, and 10 healthy controls were included. Clinical evaluations and US assessments were performed, including grayscale US (GSUS), power Doppler US (PDUS), and Global OMERACT-EULAR Synovitis Score (GLOESS). The CEUS was performed in the two most active joints and was scored semi-quantitatively (SQ) and quantitatively.

RESULTS: Healthy controls and remission RA patients had similar total US scores. Active RA patients had higher US scores than the healthy and remission groups, with statistically significant differences in all the groups compared to the healthy group. However, significant differences were only observed in the GSUS and GLOESS when comparing active RA patients with the remission group. Ninety-five joints were selected for the CEUS, and we detected more microvascularization with the SQ CEUS score than with the PDUS in all groups (18 vs. 58% in the remission group; p-value 0.006). The weighted Cohen’s kappa for the intra-rater and inter-rater IACUS CEUS score was 0.714 (confidence interval 0.610-0.819, p-value < 0.001) and 0.540 (confidence interval: 0.419-0.662, p-value < 0.001), respectively. Spearman’s correlation between the SQ CEUS and quantitative scores was 0.655.

CONCLUSION: For the majority of RA patients in SR, conventional US may fail to detect microvascularization potentially related to the subclinical disease. The CEUS may be helpful for this purpose.

PMID:39764550 | PMC:PMC11701587 | DOI:10.3389/fmed.2024.1459802

EClinicalMedicine. 2024 Nov 25;78:102952. doi: 10.1016/j.eclinm.2024.102952. eCollection 2024 Dec.

ABSTRACT

BACKGROUND: Therapeutic advancements for the polyglutamine diseases, particularly spinocerebellar degeneration, are eagerly awaited. We evaluated the safety, tolerability, and therapeutic effects of L-arginine, which inhibits the conformational change and aggregation of polyglutamine proteins, in patients with spinocerebellar ataxia type 6 (SCA6).

METHODS: A multicenter, randomized, double-blind, placebo-controlled phase 2 trial (clinical trial ID: AJA030-002, registration number: jRCT2031200135) was performed on 40 genetically confirmed SCA6 patients enrolled between September 1, 2020, and September 30, 2021. The main inclusion criteria were as follows: SCA6 diagnosed by genetic testing, 20 years of age or older, Scale for the Assessment and Rating of Ataxia (SARA) “walking” score of at least one point, and SARA “total” score of at least 10 points, and ability to walk 10 m or more with or without an assistive device. The investigational drug was administered orally at 0.50 g/kg/day (L-arginine group: L-arginine 0.38 g/kg/day; placebo group: L-arginine 0.0 g/kg/day) for 48 weeks. Subjects who consented to participate were assigned a subject identification code, and were allocated 1:1 to the L-arginine or the placebo group, according to a predetermined allocation chart. The primary efficacy endpoint was change in total Scale for the Assessment and Rating of Ataxia (SARA) score from baseline to 48 weeks. The secondary endpoints were 1) SARA walking + standing score, 2) each of the eight SARA scales at 0, 4, 8, 16, 24, 32, 40, and 48 weeks, and 3) TUGT, BDI-II, CGI, PGI-I, and SF-8.

FINDINGS: Forty patients received the investigational drug, and 37 completed the study (L-arginine group: 18; placebo group: 19). The mean medication adherence rate was 97.2% in the l-arginine group. Regarding the primary endpoint, the difference between the L-arginine group and the placebo group was -1.52 (95% CI: -3.10 to 0.06, P = 0.0582). As the secondary endpoints, the change of SARA total score from baseline was greater in the L-arginine group than in the placebo group at all assessment time points, but the differences were not significant. Two serious (required hospitalization) adverse reactions occurred in the L-arginine group, including one case of pneumonia (severe, death) and one case of abnormal liver function (moderate, recovery).

INTERPRETATION: L-arginine treatment resulted in an improvement tendency in SARA total score of SCA6 patients. Our results suggest that a phase 3 study of L-arginine for SCA6, with a 48-week observation period and change in total SARA score as the primary endpoint, may be feasible for further analyzing the therapeutic effect of L-arginine. However, careful consideration of statistical power and sample size is necessary.

FUNDING: Japan Agency for Medical Research and Development and Health Labour Sciences Research Grant, Japan.

PMID:39764542 | PMC:PMC11701440 | DOI:10.1016/j.eclinm.2024.102952

World J Clin Cases. 2025 Jan 6;13(1):99884. doi: 10.12998/wjcc.v13.i1.99884.

ABSTRACT

BACKGROUND: Monkeypox (Mpox), is a disease of global public health concern, as it does not affect only countries in western and central Africa.

AIM: To assess Burundi healthcare workers (HCWs)s’ level of knowledge and confidence in the diagnosis and management of Mpox.

METHODS: We conducted a cross-sectional study via an online survey designed mainly from the World Health Organization course distributed among Burundi HCWs from June-July 2023. The questionnaire comprises 8 socioprofessional-related questions, 22 questions about Mpox disease knowledge, and 3 questions to assess confidence in Mpox diagnosis and management. The data were analyzed via SPSS software version 25.0. A P value < 0.05 was considered to indicate statistical significance.

RESULTS: The study sample comprised 471 HCWs who were mainly medical doctors (63.9%) and nurses (30.1%). None of the 22 questions concerning Mpox knowledge had at least 50% correct responses. A very low number of HCWs (17.4%) knew that Mpox has a vaccine. The confidence level to diagnose (21.20%), treat (18.00%) or prevent (23.30%) Mpox was low among HCWs. The confidence level in the diagnosis of Mpox was associated with the HCWs’ age (P value = 0.009), sex (P value < 0.001), work experience (P value = 0.002), and residence (P value < 0.001). The confidence level to treat Mpox was significantly associated with the HCWs’ age (P value = 0.050), sex (P value < 0.001), education (P value = 0.033) and occupation (P value = 0.005). The confidence level to prevent Mpox was associated with the HCWs’ education (P value < 0.001), work experience (P value = 0.002), residence (P value < 0.001) and type of work institution (P value = 0.003).

CONCLUSION: This study revealed that HCWs have the lowest level of knowledge regarding Mpox and a lack of confidence in the ability to diagnose, treat or prevent it. There is an urgent need to organize continuing medical education programs on Mpox epidemiology and preparedness for Burundi HCWs. We encourage future researchers to assess potential hesitancy toward Mpox vaccination and its associated factors.

PMID:39764536 | PMC:PMC11577511 | DOI:10.12998/wjcc.v13.i1.99884

World J Clin Cases. 2025 Jan 6;13(1):99744. doi: 10.12998/wjcc.v13.i1.99744.

ABSTRACT

Machine learning (ML) is a type of artificial intelligence that assists computers in the acquisition of knowledge through data analysis, thus creating machines that can complete tasks otherwise requiring human intelligence. Among its various applications, it has proven groundbreaking in healthcare as well, both in clinical practice and research. In this editorial, we succinctly introduce ML applications and present a study, featured in the latest issue of the World Journal of Clinical Cases. The authors of this study conducted an analysis using both multiple linear regression (MLR) and ML methods to investigate the significant factors that may impact the estimated glomerular filtration rate in healthy women with and without non-alcoholic fatty liver disease (NAFLD). Their results implicated age as the most important determining factor in both groups, followed by lactic dehydrogenase, uric acid, forced expiratory volume in one second, and albumin. In addition, for the NAFLD- group, the 5^th and 6^th most important impact factors were thyroid-stimulating hormone and systolic blood pressure, as compared to plasma calcium and body fat for the NAFLD+ group. However, the study’s distinctive contribution lies in its adoption of ML methodologies, showcasing their superiority over traditional statistical approaches (herein MLR), thereby highlighting the potential of ML to represent an invaluable advanced adjunct tool in clinical practice and research.

PMID:39764535 | PMC:PMC11577516 | DOI:10.12998/wjcc.v13.i1.99744

World J Clin Cases. 2025 Jan 6;13(1):94284. doi: 10.12998/wjcc.v13.i1.94284.

ABSTRACT

BACKGROUND: Addressing oculoplastic conditions in the preoperative period ensures both the safety and functional success of any ophthalmic procedure. Some oculoplastic conditions, like nasolacrimal duct obstruction, have been extensively studied, whereas others, like eyelid malposition and thyroid eye disease, have received minimal or no research.

AIM: To investigate the current practice patterns among ophthalmologists while treating concomitant oculoplastic conditions before any subspecialty ophthalmic intervention.

METHODS: A cross-sectional survey was disseminated among ophthalmologists all over India. The survey included questions related to pre-operative evaluation, anaesthetic and surgical techniques preferred, post-operative care, the use of adjunctive therapies, and patient follow-up patterns.

RESULTS: A total of 180 ophthalmologists responded to the survey. Most practitioners (89%) felt that the ROPLAS test was sufficient during pre-operative evaluation before any subspecialty surgery was advised. The most common surgical techniques employed were lacrimal drainage procedures (Dacryocystorhinostomy) (63.3%), eyelid malposition repair (36.9%), and ptosis repair (58.7%). Post-operatively, 47.7 % of respondents emphasized that at least a 4-week gap should be maintained after lacrimal drainage procedures and eyelid surgeries. Sixty-seven percent of ophthalmologists felt that topical anaesthetic procedures should be preferred while performing ocular surgeries in thyroid eye disease patients.

CONCLUSION: Approximately 50% of ophthalmologists handle prevalent oculoplastic issues themselves, seeking the expertise of an oculoplastic surgeon under particular conditions. Many ophthalmologists still favor using ROPLAS as a preliminary screening method before proceeding with cataract surgery. Eyelid conditions and thyroid eye disease are not as commonly addressed before subspecialty procedures compared to issues like nasolacrimal duct obstruction and periocular infections.

PMID:39764534 | PMC:PMC11577510 | DOI:10.12998/wjcc.v13.i1.94284