Nevin Manimala

J Nephrol. 2025 Aug 19. doi: 10.1007/s40620-025-02387-2. Online ahead of print.

ABSTRACT

BACKGROUND: Person-centered care and trust in physicians influence medication adherence among dialysis patients. However, the mechanisms linking person-centered care to medication adherence, particularly the mediating effect of trust in physicians, remain unclear. This study investigated the interrelationships between person-centered care, trust in physicians, and medication adherence.

METHODS: Using a multicenter cross-sectional study of Japanese adults receiving outpatient hemodialysis at six dialysis centers, person-centered care was assessed using the 13-item Japanese Primary Care Assessment Tool-Short Form (JPCAT-SF), which included longitudinality and care coordination. Trust in physicians was measured using the five-item Wake Forest Physician Trust Scale. Medication adherence was measured using the 12-item Adherence Starts Knowledge (ASK-12) scale. General linear models examined person-centered care, physician trust, and medication adherence relationships. Mediation analysis determined how much trust in physicians mediated the person-centered care-medication adherence relationship.

RESULTS: A total of 483 patients, with median age and dialysis vintage of 71.9 and 5.7 years, respectively, were included in the analysis. High-quality person-centered care was associated with lower barriers to medication adherence in a dose-response manner across JPCAT-SF quartiles compared to no usual source of care. Trust in physicians partially mediated this relationship in a dose-response pattern, with the proportion of the indirect effect increasing from 16.1% (95% CI 4.5-33.8%) in Q2 to 33.3% (95% CI 17.4-65.5%) in Q4. Similar findings were observed for person-centered care subdomains.

CONCLUSIONS: High-quality person-centered care was associated with medication adherence, with trust in physicians playing a key mediating role. Strategies to enhance medication adherence in hemodialysis patients should incorporate multidimensional person-centered care approaches, building trust and strengthening continuity and care coordination.

PMID:40828491 | DOI:10.1007/s40620-025-02387-2

Neurosurg Rev. 2025 Aug 19;48(1):608. doi: 10.1007/s10143-025-03775-9.

ABSTRACT

PURPOSE: Traumatic vertebral artery injury (TVAI) poses a risk for ischemic stroke, often requiring prompt antithrombotic therapy. However, when concomitant neurosurgical intervention is necessary, concerns regarding perioperative bleeding frequently lead to delays in antithrombotic initiation. This study evaluates the impact of delayed antithrombotic therapy on stroke risk in TVAI patients undergoing neurosurgical interventions.

METHODS: A retrospective review was conducted of a TVAI registry over 7 years (2016-2023) at a level 1 trauma center for patients who were treated with antithrombotics for stroke prevention. Baseline demographics, vertebral artery injury characteristics, concomitant injury characteristics, acute management and outcomes were compared between surgical and non-surgical cohorts. Statistical analyses included Student’s t-test, Chi-square tests, relative risk (RR), and attributable risk (AR).

RESULTS: Among the 121 patients, 44 (36.4%) underwent neurosurgical procedures. The surgical cohort experienced an average 2-day delay in antithrombotic initiation (p < 0.001). The incidence of stroke in the neurosurgical intervention group was 20.5%, which was significantly higher than 5.19% in the control group (p = 0.016), with an associated RR of 3.94 and excess AR of 15.3%. No significant differences in baseline antithrombotic use, injury severity, or mortality were observed between cohorts.

CONCLUSION: Delayed antithrombotic initiation in TVAI patients undergoing neurosurgical intervention is associated with a nearly fourfold increased risk of stroke. Future multi-center studies should explore neurosurgical strategies allowing safer early antithrombotic initiation in this patient population.

CLINICAL TRIAL NUMBER: not applicable.

PMID:40828475 | DOI:10.1007/s10143-025-03775-9

Am J Reprod Immunol. 2025 Aug;94(2):e70143. doi: 10.1111/aji.70143.

ABSTRACT

INTRODUCTION: SARS-CoV-2 infection affects various sperm quality parameters. This study examines the impact of COVID-19 infection on sperm DNA fragmentation (SDF).

METHODS: A systematic literature search was performed across four databases for studies published between January 1, 2019, and January 1, 2025. The inclusion criteria focused on studies evaluating sperm DNA fragmentation in healthy men infected with the virus. The risk of bias was assessed using the Newcastle-Ottawa scale (NOS). A meta-analysis was conducted using a random effects model based on the tests employed in the studies to measure SDF. Data were reported as weighted mean differences (WMD) and corresponding 95% confidence intervals (CI). Out of 105 identified citations, seven articles were included in this analysis. The NOS results indicated that all studies were of high quality. Subgroup analysis revealed that all testing methods, including TUNEL, flow cytometry, and the sperm chromatin dispersion (SCD) test, demonstrated high heterogeneity, with the lowest heterogeneity found in the TUNEL test.

RESULTS: The pooled analysis indicated a statistically significant increase in SDF (random effects model, WMD = 12.558, 95% CI: 4.482 to 20.635, I² = 99%, Z = 3.05, p < 0.0001). This meta-analysis suggests a statistically significant reduction in sperm DNA integrity 2-3 months following COVID-19 infection.

CONCLUSION: However, caution is warranted when interpreting these results due to the high heterogeneity, which may affect the outcomes. A thorough analysis considering participant characteristics and infection status is recommended.

PMID:40828459 | DOI:10.1111/aji.70143

J Echocardiogr. 2025 Aug 19. doi: 10.1007/s12574-025-00704-z. Online ahead of print.

ABSTRACT

BACKGROUND: There are few studies reporting the prognostic value of three-dimensional echocardiography (3DE)-derived right ventricular ejection fraction (RVEF) in patients with ischemic cardiomyopathy (ICM) and dilated cardiomyopathy (DCM).

METHODS: 120 ICM and 107 DCM patients who underwent 3DE were retrospectively selected and analyzed using 3DE speckle tracking software. The primary endpoint was a composite of cardiac events, including cardiac death, heart failure hospitalization, myocardial infarction, or ventricular tachyarrhythmia.

RESULTS: During a median follow-up of 24.3 and 53.6 months, 45 patients in ICM and 39 patients in DCM, respectively, reached the primary endpoint. Univariate analysis showed that RVEF was statistically significantly associated with cardiac events in both groups [ICM, hazard ratio (HR): 0.92, 95% confidence interval (CI) 0.89-0.95; DCM, HR: 0.90, 95% CI 0.86-0.93, respectively]. In multivariable analysis, RVEF (HR: 0.89-0.92, p < 0.001) was also statistically significantly associated with cardiac events in both ICM and DCM, even after adjustment for clinical factors, left ventricular (LV) systolic and diastolic parameters, or RV systolic parameters. Kaplan-Meier curves, divided into four groups by RVEF ≥ 45% and < 45% and E/e’ ≥ 14 and < 14, showed significant risk stratification for both ICM (p = 0.0068) and DCM (p < 0.0001). RVEF had incremental prognostic value over age, E/e’, and conventional RV systolic parameters, in both ICM and DCM.

CONCLUSIONS: This study confirms the independent and incremental prognostic value of RVEF over conventional echocardiographic parameters in patients with ICM and DCM and allows detailed risk stratification of cardiac events by RVEF and E/e’.

PMID:40828458 | DOI:10.1007/s12574-025-00704-z

CVIR Endovasc. 2025 Aug 19;8(1):67. doi: 10.1186/s42155-025-00587-2.

ABSTRACT

BACKGROUND: Arteriovenous fistula (AVF) thrombosis remains a critical complication in hemodialysis (HD) patients, often leading to treatment delays and requiring urgent intervention. While endovascular therapy (EVT) is commonly employed, less invasive strategies such as percutaneous thrombolytic therapy are gaining attention due to their potential to restore patency and avoid more complex procedures. This study assessed the effectiveness of percutaneous thrombolytic therapy in acute AVF thrombosis and explored key predictors associated with the need for subsequent endovascular intervention.

METHODS: This retrospective study included 42 patients who underwent ultrasound-guided percutaneous thrombolytic therapy using low-dose alteplase (3-5 mg). Technical and clinical success, complication rates, and the need for additional EVT were assessed. Statistical analyses including logistic regression and ROC analysis were used to determine independent predictors for EVT.

RESULTS: The clinical success rate was 97.6%, with 69% of patients achieving AVF patency without EVT. Symptom duration emerged as the strongest predictor for EVT; patients with symptoms > 2.5 days had significantly higher EVT rates (p = 0.01). Each additional day of symptoms increased the odds of requiring EVT by 88.5% (OR = 1.885, p = 0.012). Female patients were also more likely to require EVT than males (p = 0.005). No significant associations were found for age, BMI, or fistula characteristics.

CONCLUSION: Percutaneous thrombolytic therapy is a highly effective and minimally invasive option for acute AVF thrombosis. Symptom duration > 2.5 days is a key threshold predicting the need for EVT, highlighting the critical importance of early intervention. These findings may inform clinical decision-making and optimize access salvage strategies in dialysis patients.

PMID:40828451 | DOI:10.1186/s42155-025-00587-2

Acta Parasitol. 2025 Aug 19;70(5):186. doi: 10.1007/s11686-025-01122-y.

ABSTRACT

Babesia gibsoni infection in dogs causes hemolytic anemia, thrombocytopenia, and systemic inflammation, with many cases progressing to chronic or relapsing forms due to persistent parasitemia and oxidative stress. This study evaluated the clinical, hematobiochemical, and oxidative changes associated with B. gibsoni infection and assessed the therapeutic benefit of N-acetylcysteine (NAC) as an adjunct to triple therapy. Nineteen dogs confirmed positive for B. gibsoni via blood smear and PCR were identified; however, only twelve Labrador Retrievers of similar age (2-3 years) were enrolled for treatment to minimize variability in breed and age. The remaining dogs were excluded due to different breeds or incomplete treatment. Six healthy controls were also included. Infected animals exhibited significant alterations in leukocyte count, erythrocyte indices, platelet count, and urinary protein-to-creatinine ratio (UPC) compared to healthy controls, indicating systemic inflammation and renal involvement. Twelve infected dogs were randomly assigned to two groups: Group I received the triple therapy (doxycycline, clindamycin, metronidazole), while Group II received the same treatment with oral NAC (70 mg/kg for 5 days). Clinical, hematological, biochemical, and oxidative stress parameters were reassessed on Day 21. Both groups showed improvement post-treatment; however, Group II demonstrated greater recovery, including higher RBC counts, hemoglobin levels, platelet counts, and serum antioxidant capacity, along with reduced bilirubin and UPC levels. Mann-Whitney U test on Day 21 revealed significant improvements in serum antioxidant activity and mean corpuscular hemoglobin concentration (MCHC) in Group II (p < 0.05). Although other parameters did not reach statistical significance, several showed favorable trends toward improvement in the NAC group. These findings suggest that NAC supplementation enhances hematological recovery, reduces oxidative stress, and supports renal function in dogs with babesiosis. Given its favorable impact, NAC may serve as a valuable adjunct in managing canine babesiosis, particularly in cases with suspected or confirmed oxidative injury. Further studies with larger sample sizes are recommended.

PMID:40828450 | DOI:10.1007/s11686-025-01122-y

Infection. 2025 Aug 19. doi: 10.1007/s15010-025-02627-4. Online ahead of print.

ABSTRACT

BACKGROUND: COVID-19 continuously causes severe disease conditions and significant mortality. We evaluate whether easily accessible biomarkers can improve risk prediction of severe disease outcomes.

METHODS: Our study analysed 426 COVID-19 patients collected by German CAPNETZ and PROGRESS study groups between 2020 and 2021. Troponin T high-sensitive (TnT-hs), procalcitonin (PCT), N-terminal pro brain natriuretic peptide, angiopoietin-2, copeptin, endothelin-1 (ET-1) and lipocalin-2 were measured at enrolment and related to 28d mortality/ICU admission endpoint. Logistic and relaxed LASSO regression were used to evaluate the added value of biomarkers compared to the CRB-65 score and to develop a combined risk prediction model for our endpoint.

RESULTS: Of the 426 COVID-19 patients, 64 (15%) reached the endpoint. Among individual biomarkers, ET-1 showed the highest predictive performance (AUC = 0.76, 95% CI: 0.70-0.82). CRB-65 alone had an AUC of 0.63 (95% CI: 0.56-0.70). Our machine learning method identified CRB-65 + ET-1 to be optimal for prediction performance and model sparsity (AUC = 0.77, 95% CI: 0.71-0.83). Decision curve analysis demonstrated its greater net benefit over CRB-65 across large range of risk thresholds. The generalizability of our non-COVID CAP model (CRB-65 + TnT-hs + PCT) to COVID-19 patients was also assessed, yielding an AUC of 0.67 (95% CI: 0.60-0.74) for our primary endpoint. For 28d mortality alone as endpoint, it performed remarkably well (AUC = 0.90, 95% CI: 0.85-0.95).

CONCLUSION: Combining the already established clinical CRB-65 score with ET-1 significantly improves risk prediction of intensive care requirement or death within 28 days in hospitalized COVID-19 patients.

PMID:40828447 | DOI:10.1007/s15010-025-02627-4

Odontology. 2025 Aug 19. doi: 10.1007/s10266-025-01175-5. Online ahead of print.

ABSTRACT

This study aimed to evaluate the influence of rheumatoid arthritis on the inflammatory and resorptive process of periapical lesions in an animal model. Forty Wistar rats were divided into four groups (n = 10): control (C), apical periodontitis (AP), rheumatoid arthritis (RA), and AP + RA. RA was induced by two injections into the caudal subcutaneous tissue containing 50 µL volume of methylated bovine albumin (Met-BSA, 40 mg/mL) and 5% glucose emulsified with CFA/complete Freund’s adjuvant (Mycobacterium sp), and a third intra-articular injection in the right knee with half of the same solution. The right knee width was measured throughout the experimental period. AP was induced by pulp exposure of the right upper and lower first and second molars. After 30 days, the animals were euthanized, and the joints were processed for descriptive analysis using hematoxylin-eosin (H&E) staining. The hemi-mandibles were also removed and the inflammatory infiltrate was analyzed by H&E and immunohistochemistry for IL-6, IL-17, TNF-α, and the resorptive process by RANKL, OPG, TRAP, and micro-CT analysis. Statistical tests were applied (p < 0.05). The periapical lesions of the AP + RA group exhibited a more intense inflammatory infiltrate and a more exacerbated immune profile for IL-17 and TNF-α compared to the AP group (p < 0.05). Micro-CT analysis revealed larger lesions in the AP + RA group and greater immunostaining for RANKL and TRAP compared to the AP group (p < 0.05). It can be concluded that RA exacerbates periapical inflammation and bone resorption of AP, increasing the levels of IL-17, TNF-α, TRAP, and RANKL.

PMID:40828445 | DOI:10.1007/s10266-025-01175-5

Neurosurg Rev. 2025 Aug 19;48(1):609. doi: 10.1007/s10143-025-03777-7.

ABSTRACT

BACKGROUND: The etiology of hemifacial spasm (HFS) remains controversial, with both peripheral and central mechanisms proposed. This study investigates the glabella tap reflex in HFS patients, exploring its relationship with facial nucleus hyperexcitability to assess its potential as a clinical marker of central pathophysiological fluctuations.

METHODS: We prospectively enrolled a consecutive cohort of 69 patients with drug-refractory HFS who underwent microvascular decompression (MVD). Preoperative facial motor responses, including glabella tap-induced lateral spread and blink reflex, were assessed and recorded using standardized high-definition video. The latencies of these responses were compared using the Wilcoxon matched-pairs signed-rank test, and the correlation was assessed using Spearman analysis.

RESULTS: Mechanical tapping of the unilateral glabella elicited simultaneous contraction of the orbicularis oculi and orbicularis oris muscles and simple blink reflex in HFS patients. No statistically significant difference was found between the latencies (p = 0.873). However, Spearman analysis revealed a moderate, statistically significant positive correlation between these two latencies (r = 0.563, p < 0.001).

CONCLUSION: The characteristics of the glabella tap reflex observed in HFS patients, particularly the variability in its manifestation, appear to reflect fluctuations in facial motor nucleus hyperexcitability. This reflex may serve as a readily accessible clinical marker for these dynamic central excitability states and potentially provide insights into pathways reconciling peripheral and central theories of HFS pathogenesis.

PMID:40828430 | DOI:10.1007/s10143-025-03777-7

Acta Parasitol. 2025 Aug 19;70(5):185. doi: 10.1007/s11686-025-01123-x.

ABSTRACT

BACKGROUND: Leishmaniasis is a vector-borne infectious disease caused by intracellular protozoan parasites of the genus Leishmania. MicroRNAs (miRNAs) can influence the progress and outcome of the disease. This study aimed to investigate the expression levels of miR-155, miR-133a, and miR-146b in the serum of acute and chronic forms of cutaneous leishmaniasis (CL) in Iran.

METHODS: Samples were collected from 30 clinical cases of CL in Golestan province, who suffered from either acute or chronic forms of the disease, including 15 for each. Leishmania species were identified using PCR (kDNA gene). Total RNA was extracted from serum samples, complementary DNA (cDNA) was synthesized based on the loop technique, and the expression levels of miRNAs (miR-155, miR-133a, and miR-146b) were determined through quantitative real-time PCR analysis.

RESULTS: Conventional PCR on kDNA confirmed the presence of L. major in 30 patients. Healing after one course of treatment and no response to treatment were considered as acute and chronic forms, respectively. Although there were no statistically significant changes, the expression of miR-133a and miR-155 was upregulated in patients with acute CL compared to those with chronic form, while miR-146b was downregulated in patients with acute CL.

CONCLUSIONS: In the current study, the expression changes of miR-155, miR-146b, and miR-133a in acute patients was compared to those patients with chronic CL. Although it was not significant, alterations in the expression levels of miRNAs were observed between acute and chronic forms of CL suggesting different pathogenesis of clinical forms.

PMID:40828401 | DOI:10.1007/s11686-025-01123-x