Nevin Manimala

Open Vet J. 2024 Dec;14(12):3649-3655. doi: 10.5455/OVJ.2024.v14.i12.46. Epub 2024 Dec 31.

ABSTRACT

BACKGROUND: Fibropapillomatosis (FP) is a tumor disease primarily affecting juvenile sea turtles, often characterized by external growths that can regress spontaneously. This study reports the first documented case of total tumor regression in a free-living green turtle (Chelonia mydas) with FP in southern Brazil.

CASE DESCRIPTION: A juvenile green sea turtle (Chelonia mydas) was captured and recaptured on Itapirubá Beach, Santa Catarina, Brazil, showing signs of tumor regression with a period of 302 days between captures. At the first capture, photographs of the head and other regions were taken for photoidentification, along with documentation of fibropapilloma sites and tumor scoring. Tumor samples from the initial capture were histopathologically confirmed as fibropapillomas. At the recapture, the turtle showed a slight increase in carapace length, remaining classified as a juvenile. Tumors observed during the first capture were absent at recapture, with only scars remaining in the affected areas. Photoidentification confirmed the recapture, facilitating case monitoring. Tumor regression in this turtle is likely linked to various environmental and ecological factors.

CONCLUSION: Spontaneous regression of FP tumors remains a crucial indicator in the health monitoring of sea turtle populations. This is the first documented case of FP regression in this region of Brazil, suggesting that the turtle’s increasing age and reduced exposure to anthropogenic pressure may have contributed to the tumor’s regression. Although clinical follow-up of free-living sea turtles is challenging, reports of FP tumor regression are vital for understanding the health dynamics of sea turtle populations.

PMID:39927341 | PMC:PMC11799617 | DOI:10.5455/OVJ.2024.v14.i12.46

Acta Ortop Bras. 2025 Feb 3;33(1):e276452. doi: 10.1590/1413-785220253301e276452. eCollection 2025.

ABSTRACT

OBJECTIVE: Evaluate the impact of COVID-19 on elective and emergency hand and wrist surgeries operated in a private orthopedic center.

METHODS: A retrospective study included hand and wrist surgeries in a private orthopedic center. The total surgeries were computed and separated into elective or emergency surgeries. The numbers were analyzed by month, quarter, and year before and after the pandemic (March 2020).

RESULTS: Eight hundred and forty-three surgeries from March 2018 to February 2022 were included. The mean monthly cases of the initial 12 months of the pandemic (15.3) were statistically equal to previous periods (17.3 and 17.2), but the period from March 2021 to February 2022 showed an increase (20.5; p = 0.037). The first four months of the pandemic had a mean (8.3) lower than the previous period (14.0; p = 0.002), but soon there was a significant increase in the following four months (19.3; p = 0.002). As a historical standard, elective surgeries were greater than an emergency in this institution. Still, in the first two quarters of the pandemic, there was a reduction in elective cases, equaling the emergency.

CONCLUSION: An important but relatively brief impact on surgical volume was observed in hand and wrist surgeries during COVID-19. A significant reduction in elective cases happened at the pandemic’s beginning followed by a fast recovery after four months. Nível de Evidência II; Estudo Retrospectivo.

PMID:39927323 | PMC:PMC11801214 | DOI:10.1590/1413-785220253301e276452

Acta Ortop Bras. 2025 Feb 3;33(1):e282483. doi: 10.1590/1413-785220253301e282483. eCollection 2025.

ABSTRACT

Understanding the nature of musculoskeletal tumors is crucial for appropriate management and to secure a favorable prognosis. Orthopedists’ ability to identify these pathologies early and accurately is paramount. There is a requirement to raise awareness within the orthopedic community regarding the necessity of referrals to orthopedic oncology specialists, as delays in initiating proper treatment can compromise patient prognosis.

OBJECTIVE: The objective was to assess the capability of non-specialist orthopedists in identifying bone lesions suggestive of tumors and thus classify them by employing a questionnaire with radiographs and comparison with specialists. We aim to gain an in-depth understanding of their diagnostic competence and provide insights into teaching the subject in orthopedic residency programs.

METHODS: The sample consisted of 90 participants who answered the questionnaire: 18 orthopedic oncology specialists, 58 non-specialist orthopedists, and 14 orthopedic residents.

RESULTS: Specialists achieved an average accuracy of 12.50 ± 1.07, while non-specialists scored 10.00 ± 0.60 (p<0.001). Among non-specialists, there was no statistical significance when comparing whether they underwent specialization internship during residency nor the duration of the year of such training. The period since graduation also indicated no differences.

CONCLUSION: This study highlights the importance of referring patients with suspected tumors to specialized orthopedists. Level of Evidence V; Expert Opinion.

PMID:39927315 | PMC:PMC11801212 | DOI:10.1590/1413-785220253301e282483

Acta Ortop Bras. 2025 Feb 3;33(1):e280703. doi: 10.1590/1413-785220253301e280703. eCollection 2025.

ABSTRACT

BACKGROUND: Regular physical exercise promotes pain relief, reducing the central facilitation of pain mechanisms.

OBJECTIVE: Evaluate the effect of different frequencies of physical exercise (once, twice, or three times a week) on different modalities (aerobic training, stretching training, and strength training), on the pain in the knee joint, and on the level of independence on people with knee osteoarthritis.

METHODS: Is cross-sectional and used the STROBE-Checklist: cross-sectional studies. A total of 193 elderly people were evaluated, pain and functional independence were analyzed.

RESULTS: For the pain variable, there was a statistical difference in favor of the intervention in the comparisons control versus strength 1 and 2 times a week and stretching 3 times a week already in the Lawton variable, only the comparison control versus aerobic 1 time a week did not prove to be statistically dignified.

CONCLUSION: The exercise modality and the weekly frequency seem to affect the perception of pain, stretching exercises performed three times a week, as well as muscle strengthening exercises, regardless of weekly frequency are efficient in joint pain analgesia. Practicing muscle strength exercises, regardless of weekly frequency and aerobic and stretching exercises at least twice a week, increases and/or maintains IADL. Level of Evidence II; Cross-sectional Study.

PMID:39927314 | PMC:PMC11801204 | DOI:10.1590/1413-785220253301e280703

JAC Antimicrob Resist. 2025 Feb 8;7(1):dlaf008. doi: 10.1093/jacamr/dlaf008. eCollection 2025 Feb.

ABSTRACT

OBJECTIVE: To monitor the gut colonization by multidrug resistant (MDR) bacteria in residents of a single long-term care facility (LTCF) in relation to their clinical evolution, antibiotic consumption and mortality risk.

METHODS: In a total of 187 voluntarily enrolled residents, five rectal swabs samples were recovered over 1 year. Selective media were used to isolate MDR bacteria. Clinical data related to infections, antibiotic consumption and mortality were recovered. Mortality risk among residents who were MDR colonized and non-colonized was compared by Kaplan-Meier curves.

RESULTS: Globally, 25% of residents have gut colonization by ESBL-producing Escherichia coli with a lack of other pathogens such as Acinetobacter baumannii or Clostridioides difficile. Monitoring of ESBL-producing E. coli colonization for 1 year allowed to us to establish three categories among residents: 48.6% never colonized, 15.5% had a persistent colonization, and the remaining 35.8% presented intermittent colonization. The rates of mortality, infections and antibiotic exposure were comparable among ESBL-producing E. coli colonized and non-colonized residents, except for the intermittent colonization group in which a higher and statistically significant mortality rate was observed. As expected, urinary and respiratory tract infections were the most prevalent infectious pathologies in the LTCF, with amoxicillin/clavulanate and fluoroquinolones being the most prescribed antibiotics. A high percentage of ESBL-producing E. coli (28%), and fluoroquinolone resistance were detected in clinical samples.

CONCLUSIONS: The monitoring of gut colonization by MDR microorganisms in a single LTCF for 1 year demonstrated the predominance of ESBL-producing E. coli. Almost half of the residents were resistant to its colonization, whereas in 15.5% of them gut colonization was stable. Incidence of infectious episodes and antibiotic exposure were comparable between colonized and non-colonized subjects, but the group with the highest risk of mortality was that with intermittent colonization by ESBL-producing E. coli.

PMID:39927311 | PMC:PMC11806259 | DOI:10.1093/jacamr/dlaf008

JAC Antimicrob Resist. 2025 Feb 8;7(1):dlae219. doi: 10.1093/jacamr/dlae219. eCollection 2025 Feb.

ABSTRACT

OBJECTIVE: To audit the prescribing of antibiotics at a tertiary-level public hospital, in preparation for the implementation of an antimicrobial stewardship programme.

METHODS: A retrospective audit of antibiotic prescriptions for the period April 2020 to June 2020 was conducted to ascertain appropriate antibiotic prescribing based on a set of process measures, which included whether cultures were taken before the initiation of empirical antibiotics, the duration of antibiotic therapy, de-escalation to a narrower spectrum antibiotic, the concurrent use of four or more antibiotics, documented indication for antibiotic use, and parenteral to oral conversion. Statistics were calculated using Stata (Version 17).

RESULTS: A total of 380 patient medical charts were reviewed. It was noted that there were no standalone antibiotic charts, and antibiotics were prescribed alongside other medication in one prescription record. There was non-compliance to one or more of the process measures in two-thirds of antibiotic prescriptions audited. Excessive duration of therapy was evident in 3.16% (12) prescriptions. There were 18 (4.74%) instances in which de-escalation to a narrower spectrum antibiotic based on susceptibility results did not occur. Only a small proportion of patients were switched from parenteral to oral antibiotics (n = 12, 3.16%). Some of the additional findings included redundant antibiotic coverage (n = 137, 36.05%) and prescription of an antibiotic that did not align with the susceptibility results (n = 98, 25.79%).

CONCLUSIONS: Inappropriate antibiotic prescribing did occur in some cases. The results from this pre-implementation study highlight the importance of introducing antimicrobial stewardship interventions with process and outcome measures.

PMID:39927310 | PMC:PMC11806261 | DOI:10.1093/jacamr/dlae219

Open Access Emerg Med. 2025 Feb 4;17:67-83. doi: 10.2147/OAEM.S493878. eCollection 2025.

ABSTRACT

PURPOSE: This study investigates the predictive value of incorporating anemia, hyperglycemia, and left ventricular ejection fraction (LVEF) into the Global Registry of Acute Coronary Events (GRACE) score for in-hospital mortality in Acute Coronary Syndrome (ACS).

PATIENTS AND METHODS: We conducted a single-center, cross-sectional study involving 634 ACS patients admitted to Dr. Hasan Sadikin General Hospital between 2021 and 2023. Anemia was defined as hemoglobin <13 g/dL in men and <12 g/dL in women, while hyperglycemia was indicated with random blood glucose (RBG) ≥200 mg/dL at admission. Patients with LVEF <50% were classified as having reduced LVEF. The primary outcome was in-hospital mortality. Model goodness-of-fit was assessed using R² and the Hosmer-Lemeshow’s test. The predictive accuracy of the GRACE score alone and combined with these parameters were evaluated through receiver operating characteristic curve analysis, an area under the curve (AUC), and concordance (C)-statistics. Reclassification improvement was quantified using continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI).

RESULTS: Among 634 patients (mean age 58.10±11.08 years old; 80.3% male), anemia, hyperglycemia, and reduced LVEF were observed in 197 (31.1%), 123 (19.4%), and 364 (57.4%) patients, respectively. The in-hospital mortality rate was 6.6%. Regression analysis identified nine predictors of mortality, with anemia, hyperglycemia, and reduced LVEF confirmed as independent predictors. The GRACE score showed an AUC of 0.839 (95% confidence interval/CI 0.77-0.0.90). Incorporating anemia, hyperglycemia, and reduced LVEF increased the AUC to 0.862 (95% CI 0.81-0.91), enhancing predictive accuracy (p = 0.590). Combining these variables yielded an NRI of 0.075 (p = 0.070) and an IDI of 0.035 (p = 0.029).

CONCLUSION: Incorporating anemia, hyperglycemia, and reduced LVEF into the GRACE score improves its predictive capacity for in-hospital mortality in ACS patients. The modified GRACE score offers a more robust risk stratification tool for clinical practice and decision-making.

PMID:39927301 | PMC:PMC11806914 | DOI:10.2147/OAEM.S493878

Breast Cancer (Auckl). 2025 Feb 7;19:11782234251317070. doi: 10.1177/11782234251317070. eCollection 2025.

ABSTRACT

BACKGROUND: Breast cancer is the most common malignancy in women and the leading cause of cancer-related death. Although most early-stage patients are cured, 20% to 30% develop metastases, significantly reducing survival rates. Recent research highlights the role of iron in cancer progression, although its full impact on breast cancer metastasis is not yet fully understood.

OBJECTIVES: The aim of this study is to investigate the association between plasma iron levels at diagnosis of early-stage breast cancer and the risk of developing metastatic disease.

DESIGN: Retrospective single-center study.

METHODS: Patients with stage I to III breast cancer, diagnosed between 2007 and 2017, and with serum iron, transferrin saturation, and ferritin values available within 1.5 months before or after diagnosis were included. Cox proportional hazard models were applied to determine the association between iron levels and risk of metastasis.

RESULTS: In total, 1113 patients were included, 10% of them developed distant metastasis over a median follow-up period of 7 years. In multivariable analysis adjusting for age, stage, and subtype, transferrin saturation and serum iron were significantly associated with an increased risk of breast cancer metastasis. For each 10% increment of transferrin saturation at baseline, there was a 19% increase in metastatic risk (hazard ratio [HR] = 1.19; 95% confidence interval [CI] = [1.02-1.38]). Similarly, a serum iron increment of 10 µg/dL led to a 6% increase in risk (HR = 1.06; 95% CI = [1.01-1.12]). Ferritin was found not to be associated with metastatic risk (HR = 0.99; 95% CI = [0.98, 1.01]). There was no significant association with metastatic site or breast cancer subtype when adjusting for age and stage.

CONCLUSION: Elevated transferrin saturation and serum iron at early breast cancer diagnosis are associated with increased risk for metastatic disease but not with location of metastases or breast cancer subtype. Further research is needed to understand the underlying mechanisms and to explore the potential of iron-targeted therapies.

PMID:39927294 | PMC:PMC11806469 | DOI:10.1177/11782234251317070

Front Nutr. 2025 Jan 24;12:1451193. doi: 10.3389/fnut.2025.1451193. eCollection 2025.

ABSTRACT

BACKGROUND: Infant and Young Child Feeding significantly affect the health, development, and nutritional status of children under 2 years old, ultimately affecting their survival. The aim of this study is to determine the time to improvement in dietary diversity and associated factors in infants aged 6 to 12 months.

METHODS: The study used secondary data from the PMA Ethiopia longitudinal panel survey, involving pregnant women from January to March 2024. The data management and analysis were performed using Stata version 17. The Kaplan-Meier survival curve (KM) and the log-rank test method were implemented. A Cox proportional-hazard regression model was used to explore the association between independent variables and the outcome variable. The strength of the association was indicated by the adjusted hazard ratio (AHR) with a 95% confidence interval. The threshold of p < 0.05 was applied to determine the significance of an association.

RESULTS: The study found that the proportion of infants with improved dietary diversity aged 6-12 months was 22% (95% CI: 19.5, 25%). Factors associated with improved dietary diversity in infants aged 6 to 12 months were married women (AHR = 9.3, 95% CI = 1.19, 8.30), women with a secondary school (AHR = 1.9, 95% CI = 1.05, 3.51), women with technical and vocational (AHR = 2.0, 95% CI = 1.01, 4.05) and women with a university degree (AHR = 2.9, 95% CI = 1.51, 5.38). Moreover, women in the highest wealth quintile (AHR = 3.5, 95% CI = 1.31, 9.41), women visiting PNC (AHR = 1.7, 95% CI = 1.13, 2.62), women visiting ANC 1-3, and more than four times were (AHR = 2.4, 95% CI = 1.51, 3.74) and (AHR = 3.6, 95% CI = 2.28, 5.67) times higher for improving dietary diversity.

CONCLUSION: The findings of this study showed that the proportion of dietary diversity improvement was 22%. Which is relatively low. Marital status, educational status, wealth index, PNC, and ANC visits were identified as statistically significant factors associated with dietary diversity improvements. It suggests that public health interventions should focus on enhancing maternal knowledge and promoting regular healthcare visits to mitigate malnutrition and improve infant health outcomes in Ethiopia.

PMID:39927284 | PMC:PMC11802367 | DOI:10.3389/fnut.2025.1451193

Front Nutr. 2025 Jan 24;12:1515067. doi: 10.3389/fnut.2025.1515067. eCollection 2025.

ABSTRACT

BACKGROUND: Obesity is a major global health issue, driving high morbidity and mortality rates. The body roundness index (BRI), which includes waist circumference, offers a more accurate measure of visceral and total body fat. However, despite evidence of BRI’s effectiveness in predicting obesity-related diseases, national-level data, especially from non-Western populations like China, remain limited.

METHODS: This study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), a large, nationally representative cohort of Chinese adults, to examine the temporal trends of BRI, identify associated risk factors, and investigate the longitudinal associations between BRI and cardiovascular disease (CVD) outcomes. BRI was calculated using height and waist circumference measurements. Temporal trends and risk factors were analyzed cross-sectionally, while longitudinal associations were examined using Cox proportional hazards models adjusted for confounders. Mediation analyses were conducted to assess the role of intermediate factors such as hypertension and diabetes in the relationship between BRI and CVD.

RESULTS: A total of 12,902 participants were included for risk factor analysis, 10,525 for longitudinal analysis, and 7,310 for cumulative analysis. BRI continued to rise slowly across survey cycles but was higher in women, older adults, and urban residents. Multivariable analysis identified age, alcohol consumption, elevated blood pressure, and diabetes as positive predictors of BRI, while male sex, rural residence, and smoking were negatively associated. Higher baseline BRI was significantly associated with increased CVD risk (HR: 1.44, 95% CI: 1.22-1.69), stroke (HR: 1.49, 95% CI: 1.12-1.98), and heart disease (HR: 1.47, 95% CI: 1.22-1.77). Cumulative BRI similarly predicted increased risks of CVD, stroke, and heart disease. Mediation analysis showed that hypertension accounted for 20.69% of the association between BRI and CVD risk.

CONCLUSIONS: BRI is a robust predictor of CVD risk. Targeting hypertension and other metabolic conditions could mitigate the elevated CVD risk associated with high BRI in Chinese adults. These findings underscore the importance of incorporating BRI into public health strategies to better manage obesity-related health risks in China.

PMID:39927280 | PMC:PMC11804525 | DOI:10.3389/fnut.2025.1515067