Nevin Manimala

Emerg Med Australas. 2025 Oct;37(5):e70130. doi: 10.1111/1742-6723.70130.

ABSTRACT

OBJECTIVES: Acute pyelonephritis (APN) is a common diagnosis among patients presenting to the Emergency Department (ED). It is treated by empiric antibiotics within the ED. With a rise in antimicrobial resistance globally, it is unknown whether patients are being managed with empiric antibiotics that are appropriate for the causative organisms of APN. The aim of this study was to describe the pathogens causing APN and to assess whether the current choice of empirical antibiotics is appropriate.

METHODS: A single-centre retrospective review of patients with a discharge diagnosis of APN at an adult tertiary referral hospital in metropolitan Melbourne over a 5-year period (2018-2022) was conducted. Eligible cases were identified from ICD-10 discharge diagnoses. Demographics, cultured organisms and antibiotic regimens were extracted using explicit chart review.

RESULTS: There were 557 patients included with APN with 569 urine samples cultured after initial assessment. The most common pathogen cultured was E. coli, identified in 232 (40.8%) culture results. There were 26 (4.7%; 95% CI: 3.1-6.6) patients managed in the ED with inappropriate antibiotics. This occurred most frequently when ampicillin or amoxicillin monotherapy was prescribed. Patients were discharged with inappropriate antibiotics in 76 (13.6%) cases. This occurred most commonly when no antibiotic was prescribed on discharge.

CONCLUSION: Most empiric antibiotic prescribing for APN was appropriate and sensitive against the cultured organism. E. Coli in urine samples was commonly resistant to amoxicillin, ampicillin or trimethoprim. Strict adherence to national clinical guidelines can further reduce the rates of inappropriate antibiotic prescriptions.

PMID:40931827 | DOI:10.1111/1742-6723.70130

Emerg Med Australas. 2025 Oct;37(5):e70140. doi: 10.1111/1742-6723.70140.

ABSTRACT

Reliably defining the risk of adverse in-flight events in aeromedical trauma patients could enable more informed pre-departure treatment and guide central asset allocation to achieve better system-level outcomes. Unfortunately, the current literature base specifically examining the in-flight period is sparse. Flight duration is often considered a proxy for the risk of in-flight deterioration; however, there is limited data to support this commonly held assumption. This paper examines the association between flight duration and the risk of in-flight deterioration in aeromedical trauma patients. A total of 2927 cases of aeromedical transport for acute trauma were retrospectively examined, and the time to first hypotension was recorded. Cases were categorised as either primary or inter-hospital transfer retrievals. Cases were also subclassified as being a primary Traumatic Brain Injury or not based on several criteria, including initial GCS. The median time to hypotension was 11.5 min overall, 10 min in primary retrieval cases, and 15 min in inter-hospital transfer cases (p = 0.049). Notably, after approximately 50 min, a significant plateau in cumulative risk was observed. Isolated TBI cases had a significantly higher overall rate of in-flight hypotension, at 39.5% compared to 9.2%. Overall, this paper supports the physiologically plausible assumption that longer aeromedical transfer times are associated with an increased risk of deterioration during flight. It also demonstrates that deterioration tends to occur early in flight, raising questions as to why this might occur.

PMID:40931825 | DOI:10.1111/1742-6723.70140

Hypertension. 2025 Sep 11. doi: 10.1161/HYPERTENSIONAHA.125.25259. Online ahead of print.

ABSTRACT

BACKGROUND: Aortic structural degeneration occurs with aging; however, 3-dimensional geometric remodeling has not been well characterized in large populations.

METHODS: We segmented the thoracic aorta from magnetic resonance images of 56 164 UKB (UK Biobank) participants and computed tomography images of 9417 PMBB (Penn Medicine Biobank) participants. We quantified structural measurements of elongation, dilation, tortuosity, and curvature across the thoracic aorta. Multivariate linear regression models estimated the associations between age and aortic structure in a subset of normative healthy participants from the UKB (n=3532), and in the overall cohorts.

RESULTS: Patterns of aging were highly consistent between the UKB and PMBB. In the UKB normative subset, aging was associated with profound geometric changes, including elongation (β per decade of age, 1.001 cm [95% CI, 0.893-1.110]; P<0.0001), luminal dilation (β per decade of age, 0.870 mm [95% CI, 0.794-0.947]; P<0.0001), and decreased curvature (β per decade of age, -0.060 mm^-1 [95% CI, -0.067 to -0.053]; P<0.0001). The strongest relationship with age was observed for aortic volume (β per decade of age, 17.124 mL [95% CI, 15.124-18.386]; P<0.0001). No age-sex interactions were observed in the healthy normative subset, whereas in the overall UKB and PMBB cohorts, females exhibited less pronounced luminal dilation (particularly after menopause) and more pronounced changes in curvature.

CONCLUSIONS: Aging is associated with profound 3-dimensional geometric changes in the thoracic aorta, including elongation, luminal dilation, and decreased curvature. Females demonstrate less eccentric aortic remodeling and more pronounced changes in curvature, likely contributing to unfavorable pulsatile arterial hemodynamics that are present in older females.

PMID:40931824 | DOI:10.1161/HYPERTENSIONAHA.125.25259

Stroke. 2025 Sep 11. doi: 10.1161/STROKEAHA.125.052056. Online ahead of print.

ABSTRACT

Preclinical stroke research faces a critical translational gap, with animal studies failing to reliably predict clinical efficacy. To address this, the field is moving toward rigorous, multicenter preclinical randomized controlled trials (mpRCTs) that mimic phase 3 clinical trials in several key components. This collective statement, derived from experts involved in mpRCTs, outlines considerations for designing and executing such trials. mpRCTs offer advantages such as increased sample sizes, robust statistical design, incorporation of heterogeneity, and standardized protocols, but they face challenges in finding the right balance between standardization and heterogeneity, appropriate stroke model selection, and outcome measures, as well as the implementation of complex network infrastructure. We discuss the importance of rigorous study design, including appropriate stroke models, representation of biological variables and comorbidities, functional outcome readouts, and handling of attrition and mortality. Statistical considerations such as adaptive sequential designs, covariate adjustments, and appropriate handling of missing data are also addressed. The integration of machine learning, the implementation of common data elements, and the selection of appropriate therapeutic candidates are crucial for maximizing the efficiency and utility of mpRCTs. Furthermore, the transition toward mpRCT platforms, akin to clinical trial platforms, holds promise for facilitating continuous evaluation of therapies. Finally, we discuss data-sharing practices and the collateral benefits of mpRCTs, emphasizing their potential to improve preclinical stroke research and bridge the translational gap. Altogether, we hope that this article will serve as a starting point for a lasting debate on the future of stroke mpRCTs and their evolution toward a universally accepted set of principles.

PMID:40931817 | DOI:10.1161/STROKEAHA.125.052056

Telemed J E Health. 2025 Sep 10. doi: 10.1177/15305627251376953. Online ahead of print.

ABSTRACT

Introduction: The Veterans Health Administration (VHA) Clinical Resource Hubs (CRHs) provide telemental health (TMH) services to improve access for Veterans, but use varies greatly across clinics. Methods: A retrospective FY23 analysis examined all VHA outpatient mental health encounters. Clinics were categorized by CRH-MH use and level of CRH-MH penetration. Descriptive statistics, LASSO regression, and fixed-effects models identified key patient and clinic predictors. Results: Of 920 clinics, 218 used CRH-MH services. Clinics using CRH-MH services were larger, more likely to be VA medical centers, and had higher community care referrals. High-penetration sites were smaller, rural clinics with longer travel distances and lower community care use. Discussions: Large sites appear to use CRH-MH alongside existing resources to manage complex needs, while smaller rural sites rely heavily on CRH-MH to fill service gaps. Targeted strategies can strengthen CRH-MH integration, expand Veteran mental health access, and guide similar MH implementations in other health systems.

PMID:40931792 | DOI:10.1177/15305627251376953

F1000Res. 2025 May 6;14:437. doi: 10.12688/f1000research.162696.2. eCollection 2025.

ABSTRACT

BACKGROUND: At the 2020 UN General Assembly, China pledged to peak carbon emissions before 2030 and achieve carbon neutrality by 2060. However, the traditional social development model has led to increasing carbon emissions annually, highlighting the need to resolve the contradiction between development and carbon reduction. This study examines the relationship between carbon emissions, economy, population, and energy consumption in a specific region to support carbon peak and neutrality goals.

METHODS: A comprehensive indicator system was established, encompassing economic, population, energy consumption, and carbon emissions indicators. The study analyzed these factors during the 12th and 13th Five Year Plans, comparing total carbon emissions in 2010 and across the plans, and assessing trends. It also comprehensively analyzed the relationships and mutual influences among these factors. The study identified the main challenges in achieving carbon peak and neutrality. Using the Kaya model and various factor models, it calculated carbon peak times for three scenarios: baseline (2022), natural (2036), and ambitious (2021). These findings provide a basis for dual carbon path planning.

RESULT: The research results indicate that carbon emissions are closely related to the economy, population, and energy consumption. The prediction shows that the future trend of carbon emissions is controllable. Suggestions for dual carbon path planning are proposed to provide empirical basis for policy formulation. Under the baseline scenario, the peak carbon emissions are expected to occur around 2022; Under natural circumstances, the peak carbon emissions will be postponed to 2036; In the ambitious scenario, the carbon peak time can be advanced to 2021.

CONCLUSION: The research results are crucial for achieving carbon reduction targets and sustainable development and can be used to formulate targeted policies to promote regional development and support China’s carbon neutrality commitments.

PMID:40931747 | PMC:PMC12417981 | DOI:10.12688/f1000research.162696.2

Rev Med Liege. 2025 Sep;80(9):584-591.

ABSTRACT

Patients with complex care needs present numerous challenges: the care they receive is often associated with more hospital admissions. The care provided to this group could benefit from being more goal-oriented and better integrated. However, strengthening a net-work of care for these patients starting from hospitalization remains a challenge. This is particularly due to the fact that available assessment tools poorly reflect patient overall needs, especially psychosocial ones, and do not help identify their priorities.Therefore, we implemented a care strategy that includes the use of the ELADEB tool combined with the intervention of a case manager. We present the results of a retrospective study using administrative data from 109 hospitalized patients. We measured the effect of this intervention by comparing the number and duration of hospitalizations, as well as the number of readmissions within 30 days of discharge, one year before the intervention and one year after. We observed a statistically significant decrease in unplanned hospitalizations, average lengths of stay, and readmissions in the year following the intervention. These exploratory results highlight the potential value of such an intervention, yet a rigorous prospective evaluation in our context remains to be done.

PMID:40931734

Rev Med Liege. 2025 Sep;80(9):567-575.

ABSTRACT

Severe emphysema impairs lung function and quality of life in patients with Chronic Obstructive Pulmonary Disease (COPD). Despite optimized medical treatment and rehabilitation, some patients require lung volume reduction interventions (endoscopic or surgical). This study evaluates one-year outcomes of patients managed at the Emphysema Clinic of CHU Liège. This retrospective observational and longitudinal single-center study included 65 patients discussed in multidisciplinary meetings between 2021 and 2023. Patients were divided into two groups: treated (n = 24) with bronchoscopic lung volume reduction (BLVR) using endobronchial valves (EBV), lung volume reduction surgery (LVRS), or referred for lung transplantation (LTx); and non-treated (n = 41). Clinical and functional parameters were compared at baseline (T0) and after one year (T1). At one year, treated patients showed a significant improvement in forced expiratory volume in 1 second (FEV1 : +8.19 %, p = 0.0051), six-minute walk test distance (+54.6 m, p = 0.018), and COPD Assesment Test (CAT score : -5.3 points, p = 0.0017). Advanced interventions for emphysema improve respiratory function, walking distance and quality of life in selected patients based on strict criteria and multidisciplinary consultation.

PMID:40931732

Periodontol 2000. 2025 Sep 11. doi: 10.1111/prd.70002. Online ahead of print.

ABSTRACT

This systematic review and meta-analysis aimed to evaluate the long-term clinical outcomes of regenerative procedures compared with access flap surgery for the treatment of intrabony defects, with a minimum follow-up period of 5 years. A systematic review protocol following PRISMA guidelines was conducted. Both electronic and manual searches were conducted to identify randomized clinical trials (RCTs) on regenerative treatment of deep intrabony defects (≥3 mm) with a follow-up of at least 5 years. Primary outcome variables were probing depth (PD) reduction, clinical attachment level (CAL) gain, recession depth (REC) and tooth loss. Meta-analyses and meta-regressions were performed using random-effects models. Seventeen RCTs published from 2004 to 2022, accounting for 501 defects, with follow-ups ranging from 5 to 20 years, were included. Thirteen studies with some concerns and four with high risks of bias were identified. Meta-analyses revealed that after ≥5 years of follow-up, guided tissue regeneration (GTR) on the intrabony defect resulted in significant CAL gain (3.27 mm; 95% CI: 2.90-3.65) and PD reduction (4.04 mm; 95% CI: 3.69-4.38) compared with baseline. After ≥5 years, regenerative procedures with biologics, bone grafts, or both showed significant improvements in CAL gain (3.21 mm; 95% CI: 2.72-3.70) and PD reduction (3.92 mm; 95% CI: 3.39-4.44). GTR on the intrabony defects obtained higher long-term CAL gain (1.52 mm; 95% CI: 0.06-3.10) and PD reduction (0.89 mm; 95% CI: 0.22-1.99) than OFD (open flap debridement); however, none of the outcomes reached statistical significance (p = 0.06; p = 0.115). Meta-regression identified significant associations between outcomes and factors, such as follow-up time, surgical technique, membrane type, and baseline measurements. The certainty of evidence was low for CAL and PD outcomes, but high for REC. Long-term studies indicate that regenerative procedures for the intrabony defects, particularly GTR, provide significant improvements in clinical parameters compared with baseline. However, the evidence does not conclusively demonstrate the superiority of regenerative approaches over OFD in the long term.

PMID:40931709 | DOI:10.1111/prd.70002

Turk Arch Otorhinolaryngol. 2025 Sep 11. doi: 10.4274/tao.2025.2025-6-5. Online ahead of print.

ABSTRACT

OBJECTIVE: Nasal mucociliary clearance is the first barrier defense mechanism that protects the respiratory system. This study aimed to assess nasal mucociliary clearance time (NMCT) using saccharine test in patients with symptomatic and asymptomatic deviated nasal septum (DNS).

METHODS: This was a prospective study conducted in a tertiary center from February 2022 to July 2023. A total of 40 patients, including 20 symptomatic and 20 asymptomatic patients with DNS, were included. The Nasal Obstruction Symptom Evaluation scale was used to assess the severity of nasal obstruction in patients with symptomatic DNS. NMCT was measured by saccharine test in both the symptomatic and asymptomatic DNS patients. NMCT between these two groups was compared.

RESULTS: There were 27 males and 13 females with a mean age of 28.53±7.86 years. Overall median NMCT was 7 minutes 30 seconds, with a similar duration (7 minutes 30 seconds) in patients with symptomatic DNS and 7 minutes and 15 seconds in asymptomatic patients. The difference in NMCT between the symptomatic and asymptomatic groups was not statistically significant. Similarly, it did not differ based on age, gender, or severity of the nasal obstruction.

CONCLUSION: Although NMCT was longer in patients with symptomatic DNS compared to those with asymptomatic DNS, no statistical difference was found. Additionally, NMCT remained within normal physiological limits in both. We thus conclude that NMCT remains unaffected regardless of whether the DNS patient is symptomatic or asymptomatic.

PMID:40931700 | DOI:10.4274/tao.2025.2025-6-5