Nevin Manimala

J Surg Res. 2025 Feb 24;307:93-99. doi: 10.1016/j.jss.2025.01.008. Online ahead of print.

ABSTRACT

INTRODUCTION: The COVID-19 pandemic limited many patients to an unhealthy, sedentary lifestyle, with literature specifically demonstrating an increasing trend of obesity in pediatric patients. The goal of this study is to assess the relationship between the COVID-19 pandemic and total number of laparoscopic cholecystectomies performed pre-COVID compared to during COVID.

METHODS: Data between 2017 and 2021 were collected from the National Surgical Quality Improvement Program on patients ≤18 ys who underwent elective or urgent cholecystectomies. Data was categorized as pre-COVID (2017-2018) or during COVID (2020-2021). Analysis subcategories included case acuity (elective versus urgent versus emergent), wound classification, race, weight, and complications.

RESULTS: There were 13,579 pediatric laparoscopic cholecystectomies from 2017 to 2021. The COVID group had 7605 (56.0%) cases, and pre-COVID group 5974 (44.0%). The COVID group had significantly greater average weight and body mass index (BMI) than pre-COVID group (P < 0.001). Increased BMI was associated with increased case acuity and complication rates. Minorities including African Americans and Native American/Pacific Islanders had an increase in number of cholecystectomies performed during COVID. Undergoing a cholecystectomy during COVID was more likely to be classified as urgent or emergent than pre-COVID (P < 0.0001). The COVID group overall had less favorable surgical wound classification as more were classified as class III or class IV cases.

CONCLUSIONS: There were increases in weight/BMI, case severity, and total laparoscopic cholecystectomies performed during COVID-19. A statistically significant difference in average weight may suggest a relationship between isolation during the COVID-19 pandemic and rates of cholecystectomy. Future research is encouraged to identify contributing factors in these trends.

PMID:39999510 | DOI:10.1016/j.jss.2025.01.008

Biomed Phys Eng Express. 2025 Feb 25. doi: 10.1088/2057-1976/adb9ed. Online ahead of print.

ABSTRACT

Computed Tomography (CT) is often required in special circumstances during pregnancy to determine internal medicine, specifically when information from other imaging techniques, such as ultrasound and magnetic resonance imaging (MRI), is still inadequate. In CT-Chest, abdomen, and pelvis (CAP) examination, direct irradiation of the fetal is necessary, indicating that the potential for fetal exposure must be considered. Therefore, this study evaluated the effects of current modulation on image quality and fetal absorbed dose in pregnant patients. Calculation using IndoseCT and film dosimeters were used with a 3D-printed anthropomorphic pregnant phantom thorax-abdomen-pelvic during the first and third trimesters of pregnancy. Image quality analysis and image noise were then measured by IndoseCT, while fetal dose analysis was performed using IndoseCT software, as well as through direct measurements with an XR-QA2 film dosimeter. Statistical tests were performed to compare the data obtained using both methods. The results showed that the use of current modulation increased the image noise. The fetal dose can be significantly reduced by adjusting the tube current and patient diameter without affecting image quality in the first and third trimesters. It was also revealed that the smallest diameter received the largest dose in both trimesters for nonmodulation. Although there were differences in the dose values obtained from the IndoseCT and measurements, the data patterns were not significantly different. Furthermore, based on these results, the dosage value was below the tolerance threshold for deterministic effects (i.e., <50 mGy).

PMID:39999476 | DOI:10.1088/2057-1976/adb9ed

J Phys Chem B. 2025 Feb 25. doi: 10.1021/acs.jpcb.4c06069. Online ahead of print.

ABSTRACT

Diffusion at the molecular level involves random collisions between particles, the structure of local microscopic environments, and interactions among the molecules involved. Sampling all of these aspects, along with correcting for finite-size effects, can make the calculation of infinitely dilute diffusion coefficients computationally difficult. We present a new approach for estimating the translational diffusion coefficient of biomolecular structures by encapsulating these driving forces of diffusion through piecewise assembly of the component residues of the protein structure. By linking the local chemistry of a solvent-exposed patch of a molecule to its contribution to the overall hydrodynamic radius, an accurate prediction of the computationally and experimentally comparable diffusion coefficients can be constructed following a solvent-excluded surface area calculation. We demonstrate that the resulting predictions for diffusion coefficients from peptides through to protein structures are comparable to explicit molecular simulations and improve on statistical mass-based predictions, which tend to rely on limited training data. As this approach uses the chemical identity of molecular structures, we find that it is able to predict and identify differences in diffusivity for structures that would be indistinguishable by mass information alone.

PMID:39999471 | DOI:10.1021/acs.jpcb.4c06069

Health Rep. 2025 Feb 19;36(2):15-28. doi: 10.25318/82-003-x202500200002-eng.

ABSTRACT

BACKGROUND: The prevalence of Canadians living with obesity has increased over the past four decades. Disease and mortality risk increase as the number of years lived with obesity increases.

METHODS: This study used self-reported weight history and health data collected from 2007 to 2011 via the Canadian Health Measures Survey (n = 5,761) to examine whether increased exposure to obesity during adulthood increases the odds of having poor health outcomes.

RESULTS: The percentage of respondents with an obesity-related chronic condition was lower among those who did not have obesity at the time of survey or report having obesity in the past (50.6%) compared with those who did not have obesity at the time of the survey but did in the past (65.9%) or who had obesity at the time of the survey and in the past (71.1%). Relative to never having obesity, having obesity in the past but not at present or having obesity in the past and at present were associated with increased odds of having a range of chronic conditions. The highest odds were observed for type 2 diabetes (odd ratio (OR) = 3.26, 95% confidence interval (CI): 2.40 to 4.43 and OR = 5.36, 95% CI: 3.88 to 7.41), hypertension (OR = 2.41, 95% CI: 1.69 to 3.44 and OR = 3.76, 95% CI: 2.84 to 4.97), and poor or fair self-rated general health (OR = 2.04, 95% CI: 1.51 to 2.76 and OR = 2.68, 95% CI: 2.11 to 3.40).

INTERPRETATION: Having had obesity in the past, regardless of current obesity status, was associated with increased odds of poor health outcomes. Obesity history information should be considered when estimating the population burden of obesity.

PMID:39999465 | DOI:10.25318/82-003-x202500200002-eng

Am J Trop Med Hyg. 2025 Feb 25:tpmd240630. doi: 10.4269/ajtmh.24-0630. Online ahead of print.

ABSTRACT

We assessed the effect of active follow-ups on viral load (VL) suppression among people living with HIV (PLWH) who had missed their clinic visit(s) and were receiving intensive adherence counseling (IAC) at a large referral hospital in mid-western Uganda. We designed a quasi-experimental study, using a locator map (a local map showing residence) as an external factor (instrumental variable) that influenced active follow-up. We performed instrumental variable analysis. Of the 165 participants included, 24.8% had a client locator map, and possessing a map was associated with active follow-up (F-statistics 53.1; P <0.0001). Active follow-up did not significantly improve VL suppression at varying cutoffs, namely <1,000 copies/ml (P = 0.607), less than 200 copies/ml (P = 0.684), and less than 50 copies/ml (P = 0.435). Although active follow-up did not significantly improve VL suppression among PLWH on IAC, it showed a modest trend toward improvement. Large, randomized trials are needed.

PMID:39999462 | DOI:10.4269/ajtmh.24-0630

Am J Trop Med Hyg. 2025 Feb 25:tpmd240390. doi: 10.4269/ajtmh.24-0390. Online ahead of print.

ABSTRACT

This prospective study was done to compare the initial presentation and treatment outcomes of tuberculosis among adult patients who have diabetes mellitus with those without diabetes mellitus. In this study, all adult patients (age 18 years old or older) with microbiologically confirmed drug-sensitive pulmonary tuberculosis who were put on treatment in Ballabgarh block in Haryana were enrolled. Information on clinical, radiological, and microbiological parameters at baseline was obtained by interview or record review. Symptom score was calculated by assigning one point for each symptom from zero to seven. Patients were followed for 6 months from the start of treatment to assess treatment outcomes. Data were analyzed using the χ2 or Fisher exact test. Logistic regression was used to assess the factors associated with death or unfavorable outcomes. In total, 412 patients were included in the study, of which 17.5% had diabetes mellitus. The mean symptom scores among those with and without diabetes were 3.7 (SD 1.3) and 3.6 (SD 1.4), respectively. Treatment success was achieved in 83.6% of patients with diabetes and 86.4% of patients without diabetes. Death was observed in 12.3% of patients with diabetes compared with 7.1% of patients without diabetes. There was no significant difference in clinical presentation, radiology, or sputum smear grade at baseline between patients with or without diabetes. Although treatment success rate was less and death rate was higher in patients with tuberculosis who had diabetes compared with those who did not have diabetes, the difference was not statistically significant.

PMID:39999456 | DOI:10.4269/ajtmh.24-0390

Am J Trop Med Hyg. 2025 Feb 25:tpmd240321. doi: 10.4269/ajtmh.24-0321. Online ahead of print.

ABSTRACT

The WHO has a simplified grading system for assessing trachoma. However, even for experts, it can be difficult to classify certain cases as strictly positive or negative for a given grade. Given the absence of a true gold standard, we performed a Latent Class Analysis (LCA) on a set of 200 graded photos of the superior tarsal conjunctiva. Ten trained graders assessed the presence of two trachoma grades: trachomatous inflammation-follicular (TF) and trachomatous inflammation-intense (TI). The LCA was modeled in two different ways: first with two classes (presence/absence), and then with three classes, with the extra class presumed to represent a more discrepant “borderline” case. Cohen’s κ-statistics measuring agreement between graders were calculated for TF and TI grades (separately) before and after removing the third latent class. The κ-statistic increased by 0.10 (95% CI = 0.72-0.85; P <0.001) for TF and 0.13 (95% CI = 0.81-0.90; P <0.001) for TI, indicating that the third latent class represented a discrepant-case borderline class. The identification of borderline grading cases using a three-class LCA may be useful in creating balanced grader certification examinations that represent the full spectrum of disease. Additionally, a multiclass LCA could act as a probabilistic gold standard used to train and analyze future convolutional neural network models.

PMID:39999453 | DOI:10.4269/ajtmh.24-0321

Am J Trop Med Hyg. 2025 Feb 25:tpmd240161. doi: 10.4269/ajtmh.24-0161. Online ahead of print.

ABSTRACT

A critical impediment to efficient outbreak response is the availability of timely and complete data on cases and their linkage to care. To inform solutions to this issue, this study investigated the utility of self-testers reporting their coronavirus disease 2019 results using a mobile health platform. Our study has demonstrated that the mobile health platform is feasible; it achieved a 74.5% reporting rate, indicating a strong likelihood of data entry into the unstructured supplementary service data platform. Support from community health workers (CHWs) and healthcare professionals, particularly nurses, contributed to this success, especially among users with limited digital literacy. Specifically, 44.9% of self-test results were submitted by study participants themselves, 24.7% were submitted with the assistance of healthcare professionals, and 30.4% were submitted with the assistance of CHWs. The platform broadens the population base by increasing access and equity, allowing participation even among users without smartphones. Additionally, it integrates rapid antigen diagnostic tests with digital reporting, simplifying data processing and enabling standardized screening, real-time data capture, and effective patient follow-up. This technology also lays a foundation for pandemic preparedness in low- and middle-income countries by demonstrating the feasibility of fully integrating response loops for disease management and interventions. Future response loops could leverage artificial intelligence, machine learning, and integration with existing health surveillance systems, directly benefiting users through enhanced support.

PMID:39999452 | DOI:10.4269/ajtmh.24-0161

JMIR Mhealth Uhealth. 2025 Feb 25;13:e60115. doi: 10.2196/60115.

ABSTRACT

BACKGROUND: Lung cancer ranks as the leading cause of cancer-related deaths. For lung cancer survivors, cardiopulmonary fitness is a strong independent predictor of survival, while surgical interventions impact both cardiovascular and pulmonary function. Home-based cardiac telerehabilitation through wearable devices and mobile apps is a substitution for traditional, center-based rehabilitation with equal efficacy and a higher completion rate. However, it has not been widely used in clinical practice.

OBJECTIVE: The objective of this study was to broaden the use of digital health care in the cardiopulmonary rehabilitation of lung cancer survivors and to assess its impact on cardiopulmonary fitness and quality of life (QOL).

METHODS: Early-stage nonsmall cell lung cancer survivors aged 18-70 years were included. All the participants received surgery 1-2 months before enrollment and did not require further antitumor therapy. Participants were randomly assigned to receive cardiac telerehabilitation or usual care for 5 months. Artificial intelligence-driven exercise prescription with a video guide and real-time heart rate (HR) monitoring was generated based on cardiopulmonary exercise testing. Aerobic exercise combining elastic band-based resistance exercises were recommended with a frequency of 3-5 d/wk and a duration of 90-150 min/wk. The effective exercise duration was recorded when patients’ HR reached the target zone (HR_resting + [HR_max – HR_resting] × [≈40%-60%]), representing the duration under the target intensity. The prescription used a gradual progression in duration and action intensity based on the exercise data and feedback. Outcome measurements included cardiopulmonary fitness; lung function; cardiac function; tumor marker; safety; compliance; and scales assessing symptoms, psychology, sleep, fatigue, and QOL.

RESULTS: A total of 40 (85%) out of 47 patients finished the trial. The average prescription compliance rate of patients in the telerehabilitation group reached 101.2%, with an average exercise duration of 151.4 min/wk and an average effective exercise duration of 92.3 min/wk. The cardiac telerehabilitation was associated with higher improvement of maximal oxygen uptake peak (3.66, SD 3.23 mL/Kg/min vs 1.09, SD 3.23 mL/Kg/min; P=.02) and global health status or QOL (16.25, SD 23.02 vs 1.04, SD 13.90; P=.03) compared with usual care. Better alleviation of affective interference (-0.88, SD 1.50 vs 0.21, SD 1.22; P=.048), fatigue (-8.89, SD 15.96 vs 1.39, SD 12.09; P=.02), anxiety (-0.31, SD 0.44 vs -0.05, SD 0.29; P=.048), and daytime dysfunction (-0.55, SD 0.69 vs 0.00, SD 0.52; P=.02) was also observed in the telerehabilitation group. No exercise-related adverse events were identified during the intervention period.

CONCLUSIONS: The 5-month, digital therapeutics-based telerehabilitation improved cardiorespiratory fitness in lung cancer survivors with good compliance and safety. Patients receiving telerehabilitation also reported improved QOL with reduced levels of fatigue, anxiety, and daytime dysfunction.

TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2200064000; https://www.chictr.org.cn/showproj.html?proj=180594.

PMID:39999435 | DOI:10.2196/60115

J Med Internet Res. 2025 Feb 25;27:e68462. doi: 10.2196/68462.

ABSTRACT

BACKGROUND: Regular exercise may counteract obesity-related health risks, but adherence is low among individuals with obesity. Personal trainers may positively influence exercise behavior by providing motivational support. Individuals who receive regular exercise coaching are more likely to adhere to their exercise routine, compared with those who exercise individually. However, investing in personalized exercise guidance, such as a personal trainer, can be expensive for the individual. Thus, integrating web-based coaching could be a more economically sustainable option, offering both flexibility and reduced costs compared with in-person coaching only. Yet, research is needed to assess the effect of hybrid models in improving psychosocial factors among women with obesity.

OBJECTIVE: This 20-week, pragmatic randomized controlled trial aimed to investigate the effect of weekly in-person coaching compared with 2 combinations of in-person and web-based coaching on 5 psychosocial factors in women with obesity (BMI ≥30 kg/m²).

METHODS: Participants were invited through Facebook and Instagram advertisements posted by various fitness clubs across rural and urban locations in Norway (7 different counties and 12 different municipalities). Women with low activity (n=188; <150 minutes of moderate-intensity physical activity/week; 42.7, SD 10.5 years; mean BMI of 35.1, SD 6.9 kg/m²) were allocated into 3 groups of in-person coaching-weekly (n=47), twice weekly (n=47), and once monthly (n=47)-and as controls (n=47). Those with twice weekly and once monthly in-person coaching received web-based coaching of 15 minutes during weeks without in-person coaching. Data included background variables, motivation (Behavioral Regulation in Exercise Questionnaire-2), barriers, self-efficacy (The Self-Efficacy Survey), social support (Social Support Questionnaire), and health-related quality of life (36-Item Short Form Health Survey [SF-36]).

RESULTS: A total of 120 (64%) out of 188 participants completed baseline and postintervention assessments. A minor difference was observed in one item of the SF-36, where all intervention groups reported a greater “change in health last year” than the control group (mean difference: 14.2-17.1, 95% CI 2.04-29.5; g=0.79-1.14; P≤.01). No other effects were found on the selected psychosocial factors. It should be noted that controls reported higher intrinsic motivational regulation at baseline than intervention groups (mean difference: 0.43-0.93; P≤.05). All intervention arms exercised more frequently than controls (mean difference: 1.1-1.5; P≤.001), with no differences in weekly exercise frequency between the 3 intervention arms (P=.30).

CONCLUSIONS: We found no effects on motivation, barriers, self-efficacy, perceived social support, or other health domains compared with controls. All intervention groups reported a slight improvement in self-perceived health in 1 of the 8 subscales of the SF-36. Combined in-person and web-based coaching may give a minor improvement in self-perceived health in women with obesity. However, the lack of impact on motivation, barriers, and self-efficacy warrants further research.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05792657; https://clinicaltrials.gov/study/NCT05792657.

PMID:39999434 | DOI:10.2196/68462