Eur Radiol. 2025 Aug 22. doi: 10.1007/s00330-025-11875-9. Online ahead of print.
NO ABSTRACT
PMID:40844750 | DOI:10.1007/s00330-025-11875-9
Cardiovasc Drugs Ther. 2025 Aug 22. doi: 10.1007/s10557-025-07759-1. Online ahead of print.
ABSTRACT
PURPOSE: The optimal dosing strategy for direct oral anticoagulants (DOACs) in extended treatment of venous thromboembolism (VTE) remains debated, particularly in balancing efficacy and bleeding risk.
METHODS: A systematic review and meta-analysis was performed to compare reduced-dose versus full-dose DOACs for extended VTE treatment. Databases including PubMed, Embase, and Cochrane Library were searched from inception to March 2025 for randomized controlled trials (RCTs) involving adult patients treated with different DOAC doses for VTE. Primary outcomes were recurrent VTE, major or clinically relevant non-major bleeding, and all-cause mortality. Subgroup analysis was conducted by DOAC type (apixaban vs. rivaroxaban).
RESULTS: Pooled data from 4 studies involving 8421 patients showed no statistically significant difference in recurrent VTE risk between reduced-dose and full-dose DOACs (RR = 0.94; 95% CI, 0.64-1.37; p = 0.75). Bleeding events were significantly lower in the reduced-dose group compared to the full-dose group (RR = 0.71; 95% CI, 0.61-0.82, p < 0.00001). All-cause mortality did not differ significantly between groups (RR = 0.80; 95% CI, 0.54-1.18; p = 0.25). Subgroup analysis showed consistent findings across DOAC type, with no significant interaction effects.
CONCLUSION: Reduced-dose DOACs appear to be as effective as full-dose DOACs in preventing VTE, with a favorable safety profile due to reduced bleeding risk. These findings support reduced-dose DOACs as a viable option for extended anticoagulation in VTE patients.
PMID:40844745 | DOI:10.1007/s10557-025-07759-1
J Neurol. 2025 Aug 22;272(9):587. doi: 10.1007/s00415-025-13328-1.
ABSTRACT
BACKGROUND: Primary Lateral Sclerosis (PLS) is a rare, adult-onset neurodegenerative disease that predominantly affects upper motor neurons. Despite being considered mostly sporadic, familial cases and rare genetic variants in genes associated with amyotrophic lateral sclerosis, hereditary spastic paraplegia and other neurological disorders have been reported in some PLS cases. Due to its rare prevalence among general population, large genetic studies of PLS are lacking.
METHODS: Fifty patients diagnosed with PLS based on consensus criteria were enrolled between 2013 and 2022 for comprehensive phenotypic and genotypic analysis using whole genome sequencing. We analyzed rare single nucleotide variants (SNVs), deemed pathogenic, likely pathogenic or of uncertain significance (VUS) based on the American College of Medical Genetics and Genomics criteria, and repeat expansions (REs) exceeding the pathogenic threshold, in 290 genes involved in neurological disorders.
RESULTS: We identified mutations in 7 patients (13.7%), specifically SNVs in CAPN1 (Spastic paraplegia 76), TBK1 (amyotrophic lateral sclerosis/frontotemporal dementia, ALS4/FTD), LITAF (Charcot-Marie-Tooth disease 1C), POLG (chronic progressive external ophthalmoplegia), APP (Alzheimer’s disease) and OPTN (ALS12 ± FTD), and one RE in ATXN8OS (spinocerebellar ataxia 8). Additionally, two VUS were found in ANTXR2, a candidate gene for PLS recently identified via truncating variant collapsing analysis, but none of them was loss-of-function (one synonymous and one in-frame insertion).
CONCLUSIONS: Our study demonstrates a notable genetic intersection between PLS and various neurological disorders, including motor neuron diseases, neuropathies, mitochondrial disorders, ataxias, and dementias. These findings underscore the relevance of further investigation in larger cohorts to fully elucidate PLS genetic architecture and highlight the need to reconsider the role of genetic testing in its diagnostic criteria.
PMID:40844737 | DOI:10.1007/s00415-025-13328-1
J Health Popul Nutr. 2025 Aug 21;44(1):304. doi: 10.1186/s41043-025-01041-8.
ABSTRACT
BACKGROUND: Uncontrolled type 2 diabetes mellitus warrant the utilization of different combination antidiabetic therapies, however, the addition of these newer agents as add-on therapy increases the risk of side effects and needs to be further investigated in terms of their risk to benefit to the patient. Therefore, the current study aims to evaluate the clinical and safety outcomes in patients taking empagliflozin and Sitagliptin in addition to metformin.
METHOD: A cross-sectional study was conducted using a non-probability consecutive sampling technique to gather data at the Diabetes and Foot Care Clinic in Abbottabad from July 2023 to December 2023. This is an exploratory observational study in which a total of 155 study participants were selected and divided into two groups: Group A, treated with Sitagliptin add-on Metformin (n = 79), and Group B, treated with Empagliflozin add-on Metformin (n = 76), Biochemical parameters (HbA1c, serum creatinine) were collected and eGFR was calculated at baseline and after a 3-month follow-up. All statistical analyses were performed using IBM SPSS version 23.
RESULTS: Among the participant’s majority (53.5%) were males whereas the mean age of the participants was 51.7 ± 10.5 years. Baseline HbA1c and serum creatinine of all the patients were found to be 9.5 ± 1.8% and 1.02 ± 0.2 mg/dL respectively. There was a statistically significant decrease in mean HbA1c values in both the groups at baseline and follow-up (p < 0.001) whereas both the groups were found to be similar in their ability to reduce HbA1c (p = 0.25). Furthermore, there was a statistically significant decrease in serum creatinine values in both the groups at baseline and follow-up (p = 0.002) whereas Empagliflozin add-on Metformin was found to have more ability to reduce serum creatinine (p = 0.01) as compared to Sitagliptin add-on Metformin (p = 0.06). As a result, Empagliflozin add-on Metformin improved the patients’ eGFR significantly (p = 0.001).
CONCLUSION: Empagliflozin as add on therapy in uncontrolled T2DM provided improvements in patients HbA1c, serum creatinine, and eGFR hence improving overall clinical outcomes and patient safety.
PMID:40842035 | DOI:10.1186/s41043-025-01041-8
Eur J Med Res. 2025 Aug 21;30(1):786. doi: 10.1186/s40001-025-03065-6.
ABSTRACT
BACKGROUND: Epilepsy is a neurological disorder that can affect individuals of all genders and ages. Recent studies have indicated that the Mediterranean diet exerts a neuroprotective effect through its anti-inflammatory and antioxidant properties in non-Mediterranean regions. However, the association between the Mediterranean diet and epilepsy requires further elucidation.
METHODS: A total of 14,259 participants were enrolled in this study from the National Health and Nutrition Examination Survey (NHANES) database, spanning the period from 2013 to 2018. Weighted logistic regression analysis assessed the association between Mediterranean diet adherence and epilepsy. Random forest analysis was conducted to evaluate the relative importance of diet components. Furthermore, mediation analysis with bootstrapping was employed to explore the mediating role of epilepsy.
RESULTS: After adjusting for all potential covariates, higher Mediterranean diet adherence was associated with a lower risk of epilepsy (OR = 0.50, 95% CI 0.27-0.95, P = 0.033). Moreover, whole grain was identified as a pivotal component. Mediation analysis revealed that stroke functioned as a potential mediating factor in the association between Mediterranean diet adherence and epilepsy (mediation proportion = 6.49%, P = 0.034). In addition, interaction analysis suggested an interaction between the Mediterranean diet and diabetes (P = 0.029).
CONCLUSIONS: These novel findings suggested that higher adherence to the Mediterranean diet was linked with a lower risk of epilepsy, with stroke having a potential mediating role in the association. Promoting the Mediterranean diet may be a strategy for epilepsy management, supporting the need for further longitudinal studies.
PMID:40842033 | DOI:10.1186/s40001-025-03065-6
BMC Psychol. 2025 Aug 21;13(1):953. doi: 10.1186/s40359-025-03304-9.
ABSTRACT
BACKGROUND: The Dental Anxiety Scale (DAS) is a well-established instrument for assessing dental anxiety. While numerous cross-sectional studies have examined the DAS, longitudinal research investigating age-related changes, reliability, validity over time, associations with mental and physical health, and demographic determinants remains limited. Furthermore, the possibility of longitudinal changes in its factor structure has received limited attention.
METHODS: In 2013/2014, N = 329 German adults (53.6% female, mean age 40.20 years) and in 2019/2020, N = 323 adults (55.7% female, mean age 47.15 years) completed questionnaires, including the DAS, Oslo Social Support Scale (OSSS-3), Health-Score (G-Score), Patient Health Questionnaire (PHQ-2), Generalized Anxiety Disorder Screener (GAD-2), Short Scale for General Life Satisfaction (L-1), and oral health behavior items. DAS reliability was assessed using Cronbach’s alpha and McDonald’s omega, and factor structure via principal component analyses (PCA). Longitudinal dynamics were analyzed using McNemar’s test. Associations between dental anxiety and independent variables were investigated using correlational analyses and Wilcoxon signed-rank tests.
RESULTS: DAS significantly declined from 2013/2014 (M = 9.47) to 2019/2020 (M = 9.21). Internal consistency was excellent (α/Ω = 0.93), and a correlation of dental anxiety across waves was high (rs = 0.79). PCA revealed a stable one-factor structure (2013/2014: 82.25%, 2019/2020: 82.86% explained variance). McNemar test indicated no significant changes in the proportion of subjects with or without dental anxiety over time. Higher dental anxiety was significantly correlated with lower levels of: life satisfaction, perceived influence over health, condition of health, physical and mental health, and social support in both waves (all rs ≥ 0.14; p ≤ 0.015). A significant decrease in dental anxiety over time was observed in participants with frequent tooth brushing, no indication for depression, and at least moderate social support (all z ≤ -2.07, all p ≤ 0.019).
CONCLUSIONS: This study provides evidence for DAS’s reliability, temporal stability, and construct validity. Although dental anxiety showed a statistically significant decline it remains relatively stable for most participants. Findings indicate meaningful associations with psychosocial, behavioral, and health-related factors, supporting the potential value of interdisciplinary approaches that include psychological support in oral health care.
PMID:40842032 | DOI:10.1186/s40359-025-03304-9
Chiropr Man Therap. 2025 Aug 21;33(1):34. doi: 10.1186/s12998-025-00596-x.
ABSTRACT
BACKGROUND: Continuing education (CE) for chiropractors is mandated by state licensing boards to ensure ongoing learning and to maintain professional excellence. While incorporating research into CE programs is crucial for practitioners to remain dynamic and evidence-based, conducting research and academic pursuits is necessary for further development of the profession. We hypothesized that fewer U.S. states would provide CE credit for the completion of research or higher-education teaching activities within the chiropractic profession compared to other health professions.
METHODS: Internet searches of publicly available state board websites for each profession was undertaken with a cross-sectional study design between 12/19/2024 and 03/01/2025. Data extraction focused on whether CE was granted for research (publication and/or peer review) as well as academic pursuits (higher education and/or CE instruction). Descriptive statistics determined the frequency of states allowing CE while Fisher’s Exact test and one-way ANOVA was performed to compare states granting CE credits for research and teaching as well as comparisons among the professions.
RESULTS: Only 16 US states allow DCs to claim research activities for CE credit while 50% allow teaching for CE credit. This is significantly lower (p < 0.001) than ATs, DOs, and MDs where teaching and research activities are accepted for CE credit in all states.
CONCLUSIONS: Precluding research and higher-education teaching opportunities for CE presents a potential barrier to chiropractic academic and research development at present and in the future.
PMID:40842019 | DOI:10.1186/s12998-025-00596-x
BMC Oral Health. 2025 Aug 21;25(1):1353. doi: 10.1186/s12903-025-06745-1.
ABSTRACT
BACKGROUND: Green dentistry promotes sustainable practices in oral healthcare. As environmental challenges intensify, integrating eco-friendly principles into dental education and practice becomes increasingly important. To advance sustainability in oral health settings, it is crucial to comprehend the knowledge, attitudes, and practices (KAP) of dental professionals and students. Despite growing interest, there is scarcity of research on green dentistry and a lack of standardized, validated tools to measure KAP makes it more difficult to compare studies. The rationale for this study was to conduct a psychometric analysis of a KAP questionnaire designed to assess eco-friendly clinical dental practices among dental school personnel and students in a dental school of Karachi.
METHOD: A 43-item questionnaire on green dentistry, adapted from existing green models and literature, and further validated through expert consultation and psychometric analysis, covers knowledge, attitudes, and practices. This cross-sectional pilot study involved 150 dental school personnel and students from the clinical side of an institution, using a self-administered, web-based questionnaire based on the Green Dental Model (GDM). The construct validity of ‘knowledge’ and ‘practice’ sections of the questionnaire was assessed using Partial Least Squares- Structural Equation Modeling (PLS-SEM) whereas Exploratory Factor Analysis (EFA) to uncover the latent factor structure of the ‘attitude’ section.
RESULTS: Findings indicate that the model was identified as formative, with VIF values (< 5) indicating no multicollinearity. Through careful decision-making, almost all formative indicators were retained based on outer loads > 0.5. In EFA, factor loadings for the three extracted factors exceeded the reliability threshold. Factor 1 dealt with digital radiography and energy and water conservation; factor 2 involved waste management, recycling, and sterilization; and factor 3 represented green practices as a financial burden.
CONCLUSION: The instrument’s construct validity and feasibility makes it a valuable resource for sustainability focused researchers and dental professionals. This study uses advanced statistical techniques intended to address the questionnaire’s formative and reflective elements, improving the validity of assessment, a factor that was frequently overlooked in other studies on green dentistry. The distinctive contribution of this novel approach to the existing body of literature could facilitate potential research on the tool’s responsiveness to interventions on KAP change.
PMID:40842016 | DOI:10.1186/s12903-025-06745-1
BMC Womens Health. 2025 Aug 21;25(Suppl 1):398. doi: 10.1186/s12905-025-03945-3.
ABSTRACT
BACKGROUND: The self-administration of the subcutaneous depot medroxyprogesterone acetate (DMPA-SC) has the potential to empower women and improve contraceptive use. Several studies have demonstrated the acceptability of the provider-administered DMPA-SC, for private, public, or community-based health providers, but less is known about self-injection training from community pharmacists (CPs) and Patent and Proprietary medicine Vendors (PPMVs) (also known as drug shops). The purpose of this study was to examine the factors associated with the acceptance of DMPA-SC self-injection training when provided by trained CPs and PPMVs in Lagos and Kaduna states.
METHODS: A cross-sectional study was conducted among 186 women of reproductive age (18-49 years) who received self-injection training on DMPA-SC from trained CPs and PPMVs between August and September 2019, and between May 2022 and June 2023. Women who selected DMPA-SC, opted for self-injection, and were trained by a CP or a PPMV were invited to participate in the study. Quantitative telephone interviews were conducted with eligible clients within six (6) weeks of obtaining DMPA-SC commodities for self-injection from a trained CP or PPMV. Bivariate chi-square test and multivariate logistic regression were used to examine factors associated with acceptability and continued self-injection of DMPA-SC at home. The results were considered significant at a p value < 0.05.
RESULTS: More than half of the women had used a contraceptive in the past (55%), and 73% received information on DMPA-SC from a CP or PPMV. Using a family planning method prior to visiting the provider (Odds ratio (OR) = 4.31; 95% Confidence Intervals (CIs): 1.05, 17.69; p = 0.04), receiving information on DMPA-SC from friends/relative (OR = 5.08; 95% CI: 1.01, 25.62; p = 0.05), perceived high-quality care (OR = 7.72; 95% CI: 2.52, 23.61; p = 0.00) and middle-quality care (OR = 3.35; 95% CI: 1.16, 9.69; p = 0.03) were significantly associated with the likelihood of continued DMPA-SC self-injection at home. A high level of acceptance of training in DMPA-SC self-injection was significantly associated with service from PPMVs (OR = 4.94; 95% CI = 1.46, 16.75; p = 0.01) and perceived high-quality care (OR = 4.23; 95% CI = 1.62, 11.05; p = 0.00).
CONCLUSIONS: The results are promising for expanding DMPA-SC self-injection service delivery in Nigeria through increased method choice, and empowered users. The provision of counseling and DMPA-SC self-injection training by CPs and PPMVs is acceptable among women in Lagos and Kaduna states.
PMID:40842014 | DOI:10.1186/s12905-025-03945-3
Malar J. 2025 Aug 21;24(1):272. doi: 10.1186/s12936-025-05406-6.
ABSTRACT
BACKGROUND: Long-lasting insecticidal nets (LLINs) have been distributed and installed in the Dominican Republic since 2008, and they remain the main vector control intervention used to pursue malaria elimination in the country. However, LLIN performance remains unclear due to a lack of monitoring over the past decade.
METHODS: A cross-sectional household survey was conducted to monitor LLIN coverage, access, use, physical integrity, washing and drying practices, and the time people go to bed and wake up in the two main malaria foci of the country: Azua (4-6 months post-distribution and installation) and San Juan (one year post-distribution and installation).
RESULTS: The percentage of sleeping spaces that could be covered with a LLIN given the LLINs present in the household was 64% in Azua and 63% in San Juan; with any net, coverage was 75% in Azua and 80% in San Juan. Reported LLIN retention was 88.4% in Azua and 80.9% in San Juan. The percentage of people who had access to sleeping under an LLIN was 58.8% in Azua and 65.4% in San Juan. Among people with LLIN access (people with enough LLINs to cover all sleeping spaces in their household), use was 48.8% in Azua and 75% in San Juan; and overall, LLINs use was 32.3% in Azua and 50.5% in San Juan. Most LLINs remained in serviceable physical condition (Azua: 96.4%, San Juan: 88.9%) but those with holes were not repaired. Most LLINs were washed with aggressive products (Azua: 65%, San Juan: 86%), at a frequency that suggests they will be washed more than twenty times in three years (Azua: 52%, San Juan: 73%), and dried under the sun (Azua: 75%, San Juan: 90%).
CONCLUSION: Poor washing and drying practices are prevalent in both areas, low LLIN use was observed in Azua and some LLIN coverage gaps were measured in both foci. Urgent behavioural change strategies are needed to improve LLIN care in both foci and to increase LLIN use in Azua, alongside revisions to LLIN quantification methods to ensure full coverage of all sleeping spaces in use during installation. Heterogeneities in LLINs use across foci suggest the need for monitoring use in each distribution area to identify individual gaps and promptly address them.
PMID:40842007 | DOI:10.1186/s12936-025-05406-6