Nevin Manimala

Air Med J. 2025 Nov-Dec;44(6):478-484. doi: 10.1016/j.amj.2025.06.023. Epub 2025 Jul 23.

ABSTRACT

OBJECTIVE: Air medical evacuation (AE) plays a vital role in emergency medical services by facilitating swift transfer of critically ill or injured patients to advance health care facilities. Despite its increasing importance, standardized protocols and comprehensive research on AE outcomes remain scarce, particularly in Nepal. This study evaluates clinical characteristics, interventions, and prognostic determinants of AE cases managed by anesthesiologists at a military tertiary care hospital.

METHODS: This retrospective observational study analyzed AE cases handled by anesthesiologists in an 11-year period (July 2013-July 2024). Data were retrieved from hospital records, encompassing patient demographics, clinical characteristics, air medical factors, and outcomes. The primary outcomes assessed were in-hospital mortality and recovery. Chi-square tests and logistic regression analyses were used to evaluate associations between key clinical variables and patient outcomes.

RESULTS: The study included 83 patients, with a median age of 30 years (interquartile range: 23-36) and a male-to-female ratio of 16:1. Road traffic accidents were leading cause of AE (39.8%), followed by high-altitude illness and heat-related conditions (9.6% each). Mortality was significantly associated with hemodynamic instability (odds ratio: 96.67, 95% confidence interval: 11.34-823.77, P < .001) and intubation status (odds ratio: 12.75, 95% confidence interval: 3.236-50.191, P < .001), whereas no significant correlation was observed between the reason for AE and mortality.

CONCLUSIONS: Our study represents first in-depth analysis of AEs involving anesthesiologists in Nepal, identifying illness severity, hemodynamic instability, and intubation status as significant predictors of mortality. The findings underscore urgent need for improved AE infrastructure, implementation of standardized protocols, and specialized training to enhance patient outcomes.

PMID:41161876 | DOI:10.1016/j.amj.2025.06.023

Air Med J. 2025 Nov-Dec;44(6):473-477. doi: 10.1016/j.amj.2025.06.022. Epub 2025 Jul 21.

ABSTRACT

OBJECTIVE: This study aimed to determine the impact of having 2 physicians versus 1 physician in a helicopter emergency medical team on OST.

METHODS: This retrospective observational study analyzed 828 patients who underwent helicopter emergency medical services in 2 years (2020-2021). We used chi-square and t tests to analyze the difference in OST between patients attended by 1 versus 2 physicians. We then used general linear model analysis to evaluate the impact of the number of physicians on OST.

RESULTS: Of the 828 patients, we observed 1 physician group (n = 356) and 2 physician groups (n = 472). Analysis revealed significant main effects of diagnosis type (F = 10.78, P < .001) and the number of physicians (F = 18.60, P < .001) on OST, whereas the interaction was not significant (F = 0.30, P = .911). In another analysis, the interaction between the transport facility and the number of physicians was significant (F = 7.00, P = .008), including their main effects.

CONCLUSIONS: Having 2 physicians on board the helicopter emergency medical services seems to reduce OST compared with having 1, particularly in trauma and neurology cases.

PMID:41161875 | DOI:10.1016/j.amj.2025.06.022

Liver Transpl. 2025 Oct 29. doi: 10.1097/LVT.0000000000000765. Online ahead of print.

ABSTRACT

Geographic variation in liver transplant access in the United States have spurred interest in spatial accessibility to care. There is currently no consensus about which measure should be used for spatial accessibility. We used 2015-2022 data from the Scientific Registry of Transplant Recipients and the National Center for Health Statistics to calculate county listing-to-death ratios (LDR) for liver transplant. We used a two-step floating catchment area approach to define a novel measure of spatial accessibility (Spatial Accessibility Ratio, SPAR). We compared this measure to other accessibility measures using generalized linear models and Vuong’s non-nested hypothesis test. Across 3,108 included counties, SPAR ranged from 0.56 to 9.98; 29% of counties and 65% of the population had a SPAR≥1 (mean or better accessibility to liver transplant). SPAR outperformed distance (p<0.001), rurality (p<0.001), and health care resource-based measures (p<0.001) in predicting population-based transplant access; SPAR remained significantly associated with LDR after adjustment for other county-level factors. Sensitivity analyses revealed that the association between SPAR and LDR was modified by socioeconomic characteristics and geographic region. This measure may be used in future research on spatial accessibility, including developing interventions to improve access to liver transplant for patients in low-accessibility areas.

PMID:41160883 | DOI:10.1097/LVT.0000000000000765

Traffic Inj Prev. 2025 Oct 29:1-11. doi: 10.1080/15389588.2025.2570829. Online ahead of print.

ABSTRACT

OBJECTIVE: As of 2022, motorcyclist fatalities in the United States had risen 38% since 2010, representing 15% of all U.S. traffic fatalities. Recently developed injury risk models have sought to better predict injury potential for certain collision configurations involving motorcycles using relative speed as a primary predictor variable. Advancing the state-of-the-art, this study developed injury risk models for motorcyclist collisions with passenger vehicles across all planar configurations and incorporated biomechanically-relevant predictor variables including a novel speed parameter.

METHODS: We analyzed real-world crash data from the German In-Depth Accident Study (GIDAS) (1999-2023) to examine motorcyclist injury patterns and create injury risk functions at the MAIS2 + F, 3 + F, 4 + F, and 5 + F levels. Biomechanically relevant variables, including age (via a spline function), sex, and a geometric-based assessment of motorcyclist post-impact response (i.e., potential for a normal projection), were considered. Effective Collision Speed, combining passenger vehicle and motorcycle speeds while accounting for reduced engagement associated with frictional effects in side impacts, was employed as an important predictor. We analyzed the impact of reweighting the dataset to German national statistics, addressing GIDAS’ bias toward severe and fatal collisions.

RESULTS: The dataset comprised 2,499 passenger-vehicle to motorcycle collisions, of which 59% involved contact with the front of the passenger vehicle, 25% the side, and 16% the rear. 37% of motorcyclists sustained AIS2 + F injuries and 11% sustained AIS3 + F injuries. At the MAIS3 + F level, the lower extremities were the most commonly injured body region, followed by the thorax and head. Age significantly influenced injury risk at MAIS2 + F and MAIS3 + F levels. A potential normal projection was associated with higher injury risk, significant only for MAIS2 + F. Effective Collision Speed emerged as the sole significant predictor for higher severity levels.

CONCLUSIONS: These findings highlight the importance of incorporating biomechanical factors and refined speed metrics into motorcyclist injury risk models. The proposed Effective Collision Speed demonstrated strong predictive capability, offering a more comprehensive approach for assessing injury potential across varied crash configurations.

PMID:41160882 | DOI:10.1080/15389588.2025.2570829

Nucleic Acids Res. 2025 Oct 29:gkaf1058. doi: 10.1093/nar/gkaf1058. Online ahead of print.

ABSTRACT

Proteins are biological effectors that mediate the effects of exposures on diseases and serve as predictors for constructing high-performance disease prediction models. However, an integrative, sex-specific proteomic resource using a biobank-scale dataset remains unavailable. Here, we introduce ProteoNexus, a database featuring a standardized best-practice pipeline integrating protein pQTLs mapping, mediation analysis, and risk prediction. Following stringent quality control, ProteoNexus comprises three categories of exposures: 129 measurement-based variables, 54 environmental variables, 1 251 123 single-nucleotide polymorphisms (SNPs), and 57 incident diseases among 33 325 European participants. ProteoNexus identifies 16 998 putative causal pQTLs, of which 5 979 are cis-pQTLs and 11 019 are trans-pQTLs in the combined-sex dataset, while 9 464 and 7 832 pQTLs were identified in the female and male datasets, respectively. Using a two-step screening strategy, ProteoNexus identifies 308 325, 144 975, and 1 336 significant pathways caused by measurement-based variables, environmental variables, and SNPs, respectively, followed by enrichment analysis of proteins associated with these exposures. With 21 optimized parameters for four machine learning algorithms, ProteoNexus provides an online analysis module that enables users to analyze their own proteomic data. Users can search for results by protein, reported disease, ICD-10 code, or exposure, with accompanying summary statistics for each query. ProteoNexus is freely accessible at https://www.proteonexus.com/.

PMID:41160873 | DOI:10.1093/nar/gkaf1058

Wiad Lek. 2025;78(9):1899-1908. doi: 10.36740/WLek/212533.

ABSTRACT

OBJECTIVE: Aim: The objective of the study is to analyze the economic determinants that contribute to enhancing the quality of medical care in the context of metropolitan zoning.

PATIENTS AND METHODS: Materials and Methods: The study draws on statistical data from the Center for Medical Statistics of the Ministry of Health of Ukraine, the State Statistics Service of Ukraine, and the Health Departments of the metropolitan cities of Dnipro and Kharkiv for the years 2010, 2013-2014, and 2018-2020. The research employed methods of statistical analysis and synthesis, logical analysis, generalization, and systems approaches.

CONCLUSION: Conclusions: An analysis was conducted of morbidity trends in the Dnipro metropolis during 2010, 2013-2014, and 2018-2020 with respect to socially significant diseases – hypertension, myocardial infarction, stroke, HIV/AIDS, as well as AIDS-related mortality, all of which pose risks of premature death (18 years and older). Consideration was also given to the human resources available in primary health care and prevailing demographic trends. A comparative analysis of the effectiveness of health care systems in the metropolises of Dnipro and Kharkiv was undertaken by assessing the number of emergency medical service calls per 100,000 average annual population. The study proposes approaches to assessing the influence of metropolitan health care infrastructure on medical institutions within the metropolitan region and substantiates the prospects for establishing a unified metropolitan health care system. In the context of the ongoing war in Ukraine, there is an urgent need to create a competitive health care environment in metropolitan areas, prioritizing economic determinants of quality optimization. This will require the joint efforts of government, business, academia, and the media in developing modern competitivestrategies for metropolitan development, supported by the adoption and implementation of legislation on the status and functions of metropolises. Such measures are expected to reduce irrational and unjustified financial expenditures in the health care sector.

PMID:41160871 | DOI:10.36740/WLek/212533

Wiad Lek. 2025;78(9):1837-1842. doi: 10.36740/WLek/212523.

ABSTRACT

OBJECTIVE: Aim: The aim of our research was to investigate the regional features of the prevalence of risk factors for the occurrence of orthodontic pathology among the children’s population of Poltava.

PATIENTS AND METHODS: Materials and Methods: sociological, forecasting, bibliosemantic, analytical, medical-statistical. Materials: results of examination by a pediatric dentist of schoolchildren of different age groups (406 children), results of a questionnaire of parents of examined schoolchildren of different age groups (406 respondents).

RESULTS: Results: In our study, using the method of simple logistic regression, regional features of the prevalence of risk factors associated with the occurrence of orthodontic pathology were identified: the chances of detecting orthodontic pathology increase with the use of a pacifier, somatic morbidity in the first year of life (dysbacteriosis, rickets), the presence of caries in the child (complicated caries), the removal of permanent teeth due to caries, concomitant diseases (otorhinolaryngological pathology) in the child, the presence of heredity (orthodontic pathology in the family), and occupational hazards during the mother’s pregnancy.

CONCLUSION: Conclusions: The identified risk factors for orthodontic pathology are mostly modifiable, that is, they are amenable to correction. Therefore, it is extremely necessary for pediatricians, family doctors and pediatric dentists to carry out both preventive measures to prevent the negative impact of these factors, and explanatory work with parents of children, who must be aware of the importance and necessity of prevention.

PMID:41160863 | DOI:10.36740/WLek/212523

Wiad Lek. 2025;78(9):1813-1820. doi: 10.36740/WLek/206076.

ABSTRACT

OBJECTIVE: Aim: The aim of the study was to investigate changes in the structure of musculoskeletal injuries in patients during the war in Ukraine and to determine the organizational and methodological features of the rehabilitation of patients with these injuries according to the conclusions of rehabilitation specialists.

PATIENTS AND METHODS: Materials and Methods: The study was conducted in 2022-2024, 102 rehabilitation specialists participated in it. Scientific methods: analysis of sources of scientific information, questionnaires, statistical methods. The survey of rehabilitation specialists was conducted using the author’s questionnaire, which contains 27 questions divided into 3 blocks.

RESULTS: Results: It was established that during the war years, significant changes occurred in the structure of appeals from patients with musculoskeletal diseases. The share of appeals for help for limb amputations increased to 23.6%, for injuries to joints, muscles and tendons – to 37.3%, for habitual dislocation of the patella – to 6.8%. Physiotherapists are convinced that the quality of rehabilitation services can be improved by using the latest equipment (35.3%), systematic advanced training of specialists (26.5%), expanding access to equipment (21.6%), and introducing the latest physiotherapy methods (13.7%).

CONCLUSION: Conclusions: Based on the conducted research, a system of exercise therapy tools for certain diseases of the musculoskeletal system and the sequence of their application were determined, and practical recommendations were developed for the rehabilitation of the population with musculoskeletal disorders, taking into account changes in their structure and the opinions of rehabilitation specialists who have experience working during the war in Ukraine.

PMID:41160860 | DOI:10.36740/WLek/206076

Wiad Lek. 2025;78(9):1805-1812. doi: 10.36740/WLek/204031.

ABSTRACT

OBJECTIVE: Aim: The study aimed to assess the association between rs1333049 polymorphic variants of the ANRIL gene and the development of clear cell renal cel carcinoma in the Ukrainian population.

PATIENTS AND METHODS: Materials and Methods: Venous blood from 201 individuals was analyzed, including 101 ccRCC patients (42 women, 59 men) and 100 cancer-free controls (34 women, 66 men). ANRIL rs1333049 genotyping was performed using real-time PCR, with statistical analysis conducted via Prism (v10.4.1) and R (v4.4.2).

RESULTS: Results: The rs1333049 genotype distribution in ccRCC patients was GG – 16 (15.8%), GC – 50 (49.5%), CC – 35 (34.7%); in controls: 28 (28%), 49 (49%), 23 (23%) (P=0.0561). The C allele was more frequent in ccRCC patients (P=0.0167). In the dominant model, GC+CC carriers had a 2.066-fold higher risk than GG homozygotes (P=0.0392). No genotype differences were found between sexes in controls (P=0.39), but allele distribution differed in male and female ccRCC patients (P=0.0105). In the recessive model, males with CC had a 2.5-fold higher ccRCC risk (P=0.02). Kaplan-Meier analysis found no effect of rs1333049 on overall survival.

CONCLUSION: Conclusions: The rs1333049 polymorphism of the ANRIL gene increases ccRCC risk. GC and CC genotypes raise risk 2.07-fold (P=0.0392), up to 3.1-fold (P=0.040) after adjustments. In males, CC genotype increases risk 2.5-fold (P=0.02) and 3.12-fold (P=0.05) after adjustments. No link to overall survival was found (P=0.4321).

PMID:41160859 | DOI:10.36740/WLek/204031

Wiad Lek. 2025;78(9):1798-1804. doi: 10.36740/WLek/212517.

ABSTRACT

OBJECTIVE: Aim: To study the quality of life in Ukraine during martial law and identify priority areas for its improvement.

PATIENTS AND METHODS: Materials and Methods: The research was conducted in 2023-2024. It involved 159 respondents of different genders and age. Research methods: bibliographic, self-assessment of quality of life (survey), medical, and statistical. The author’s questionnaire consists of 6 blocks and contains 77 questions.

RESULTS: Results: It has been established that 51.6 % of the respondents are dissatisfied with their health, 65.4 % – with the health care system in Ukraine, 52.2 % – with the education system; housing conditions during the war deteriorated by 34.6 %; the number of those satisfied with their financial situation decreased from 52.8 % to 37.7 %, with their place of work – from 83.0 % to 67.3 %; the level of satisfaction with the quality of life decreased from 76.1 % to 31.5 %. Priority areas for improving the quality of life of Ukrainians in the postwar period have been identified: maintaining public health, improving the quality of medical services, providing housing and employment, increasing access to and quality of education, improving the environmental situation, increasing incomes, social assistance, modernizing infrastructure, stabilizing the socio-political situation, etc.

CONCLUSION: Conclusions: It has been found that during the war, there were significant negative changes in the quality of life of the Ukrainian population. The findings should be considered when public health experts develop practical recommendations for improving the quality of life of the Ukrainian population during and after the war.

PMID:41160858 | DOI:10.36740/WLek/212517