Nevin Manimala

Pain Physician. 2025 Jul;28(4):307-320.

ABSTRACT

BACKGROUND: Allergic rhinitis (AR) is a common chronic condition that significantly affects quality of life. Ultrasound-guided sphenopalatine ganglion block (SPGB) is a minimally invasive, safe, and effective treatment gaining clinical attention for symptom relief. Dexamethasone is often used in an SPGB, but its effect on autonomic nerve modulation remains unclear.

OBJECTIVES: This study aimed to assess the therapeutic effect of ultrasound-guided SPGB for treating AR and to compare the clinical efficacy and adverse reactions of dexamethasone used in conjunction with an SPGB.

STUDY DESIGN: A prospective, randomized, single-blind controlled trial.

SETTING: Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, People’s Republic of China.

METHODS: This randomized clinical trial, involving 84 patients with AR, was conducted at Nanjing Drum Tower Hospital from February 2024 through May 2024. Patients were randomly assigned to either the experimental group (42 patients) or the control group (42 patients), with blinding applied. A total of 78 patients completed the study (40 in the experimental group, 38 in the control group). Both groups received an ultrasound-guided SPGB once a week for 4 weeks, alternating sides. The experimental group was treated with a combination of bupivacaine and dexamethasone, while the control group received only bupivacaine. Changes in efficacies, Total Nasal Symptom Score (TNSS), nasal symptom Visual Analog Scale (VAS), Rhino-conjunctivitis Quality of Life Questionnaire (RQLQ) scores, Total Nasal Respiratory Volume (TNRV), Total Nasal Volume (TNV), and Total Nasal Resistance (TNR) were measured at pretreatment and at one week, one month, 3 months, and 6 months posttreatment. Additionally, effective rate was calculated as the percentage of patients achieving a clinically meaningful response, defined as a reduction in TNSS of 30% or greater from baseline.

RESULTS: Both groups had significant reductions in TNSS, nasal symptom VAS, and RQLQ scores compared to pretreatment levels at all follow-up points (P < 0.001). At one week, one month, and 3 months posttreatment, the experimental group had higher efficacies, lower TNSS, lower VAS, and lower RQLQ scores than the control group (P < 0.05). At 6 months posttreatment, there were no significant differences between the groups for efficacy rates, VAS, or RQLQ scores (P > 0.05) while the experimental group had lower TNSS scores (P < 0.05). Both groups had significant improvement in nasal ventilation, with increases in TNRV and TNV and reductions in TNR (P < 0.001). At each follow-up, the experimental group had higher TNRV and TNV and lower TNR compared to the control group, with statistical significance observed at most time points (P < 0.05), except for TNRV at 6 months and TNV at 3 and 6 months posttreatment. Safety indicators showed no significant differences between groups (P > 0.05).

LIMITATIONS: We did not assess patient depression and anxiety; how dexamethasone over triamcinolone potentially affected efficacy; and how the absence of 3D navigation would have resulted in a safer, more precise block.

CONCLUSIONS: Ultrasound-guided SPGB is a safe and effective treatment for AR, improving symptoms, quality of life, and nasal airflow. The addition of corticosteroids may enhance short-term efficacy.

PMID:40773638

Pain Physician. 2025 Jul;28(4):E337-E346.

ABSTRACT

BACKGROUND: Percutaneous kyphoplasty (PKP) can restore spinal stability and relieve pain in patients with osteoporotic vertebral compression fractures (OVCF). However, in some cases, distal lumbosacral pain (DLP) persists postoperatively, affecting patients’ expectations of the surgery and their recovery to activities of daily life.

OBJECTIVE: To use artificial intelligence to predict DLP post-PKP for OVCF, thereby providing personalized treatment plans for patients with OVCF.

STUDY DESIGN: Retrospective study.

SETTING: The study was carried out at a university hospital.

METHODS: A univariate analysis was performed to identify the risk factors for DLP post-PKP. A heatmap analysis was conducted to examine the relationships between variables in the dataset. A random forest model was established, and its performance was evaluated using a confusion matrix. After validating and tuning the model, features were ranked based on their contribution to prediction accuracy.

RESULTS: A total of 179 patients completed this study. Patients were divided into 2 groups (Group 0 without DLP; Group 1 with DLP). The univariate analysis indicated statistically significant differences in terms of bone density, intravertebral vacuum cleft, sarcopenia, bone cement distribution, interspinous ligament degeneration, and Hounsfield unit (P < 0.05). The heatmap analysis revealed a moderate correlation between DLP and both sarcopenia and interspinous ligament degeneration. A random forest model was built. The confusion matrix showed that the model exhibited strong performance across all metrics. The random forest model showed that the preoperative Cobb angle and sarcopenia were the most critical features.

LIMITATIONS: This was a retrospective study, which may be prone to selection and recall bias. Single-center noncontrolled studies may also introduce bias.

CONCLUSION: Our random forest model can effectively predict DLP post-PKP for OVCF, assisting in the selection of treatment plans.

PMID:40773631

Braz J Cardiovasc Surg. 2025 Aug 7;40(5):e20240248. doi: 10.21470/1678-9741-2024-0248.

ABSTRACT

INTRODUCTION: Coronary artery disease (CAD) is the main cause of death among cardiovascular diseases. Current guidelines aim to guide clinical practice in choosing the best treatment, based on the best scientific evidence. The SYnergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) score uses anatomical and clinical factors, helping to assess the complexity of coronary lesions.

OBJECTIVE: To verify whether the treatment used in CAD complied with the recommendations set out in the guidelines and in the SYNTAX study.

METHODS: Single-center, cross-sectional, observational, descriptive, and retrospective study, which analyzed medical records over a three-year period. Patients diagnosed with CAD who had obstructive disease in at least two vessels were selected. The exams were evaluated by a specialist who was unaware of the report and the treatment used for each patient. SYNTAX 1 and 2 scores were calculated, and the recommended treatment was compared to the established treatment.

RESULTS: Two hundred and ten patients were distributed, according to SYNTAX Score 1, into the groups low (Group A), intermediate (Group B), and high risk (Group C). Of 155 patients in Groups B and C, 105 (67.7%) were treated with percutaneous coronary intervention (PCI), vs. 24 (15.5%) with CABG. When calculating the SYNTAX Score 2 of the 101 patients with recommended treatment for CABG, 71 (70.3%) received PCI, compared to 18 (17.8%) treated with CABG. All patients recommended for preferential treatment for PCI had the recommendation respected.

CONCLUSION: The treatment offered was not supported by current guidelines and recommendations. Expanding the sample size may determine the current situation of the treatment of CAD in Brazil.

PMID:40773620 | DOI:10.21470/1678-9741-2024-0248

J Drugs Dermatol. 2025 Aug 1;24(8):782-786. doi: 10.36849/JDD.9238.

ABSTRACT

BACKGROUND: Psoriasis is a common skin condition that affects the physical and emotional well-being of patients. Moisturizers have been shown to significantly improve skin condition and quality of life in this patient population. Skin afflictions such as atopic dermatitis and pruritis share etiological similarities with psoriasis, and oatmeal (Avena sativa)-containing lotion has proven effective in treating the symptoms of those conditions. However, data on the use of an over-the-counter oatmeal-containing lotion alone to treat the symptoms of psoriasis are limited.

METHODS: An open-label clinical study of 60 adult subjects with sensitive skin and mild to moderate psoriasis was completed. Subjects applied a topical lotion containing oat flour, oat oil, and oat extract with avenanthramides (the oatmeal-containing lotion) on the entire body, with a focus on dry patches, at least once daily for 4 weeks as the sole intervention to manage their symptoms. The primary objective of the study was to assess the efficacy and tolerability of the oatmeal-containing lotion in patients with psoriasis. Product satisfaction was also measured after 4 weeks of use.

RESULTS: After 4 weeks of treatment, subjects reported statistically significant improvements in all self-assessment parameters of skin condition, with no adverse effects reported. Overall, subjects expressed high satisfaction with the product.

CONCLUSIONS: This study provides evidence supporting the efficacy and tolerability of a topical, over-the-counter lotion containing oat flour, oat oil and oat extract with avenanthramides as the sole intervention for managing the symptoms of sensitive skin and mild to moderate psoriasis.

PMID:40773617 | DOI:10.36849/JDD.9238

J Drugs Dermatol. 2025 Aug 1;24(8):739-743. doi: 10.36849/JDD.9163.

ABSTRACT

BACKGROUND: Epidermal barrier dysfunction is a key feature of plaque psoriasis. Skincare improves epidermal barrier function and is an increasingly recommended part of psoriasis management.

METHODS: This multicenter, blinded study of adults (N=46) with psoriasis evaluated the use of a gentle skincare regimen (cleanser, moisturizer, and optional moisturizer with SPF 35) as an adjunct to medical therapy during an 8-week period. Efficacy was assessed via clinical grading of body surface area (BSA), target lesion severity score (TLSS), physician global assessment (PGA), and bioinstrumentation for skin hydration and texture. Standard safety and tolerability assessments were performed, and subjects completed satisfaction and the Dermatology Life Quality Index (DLQI) questionnaires.

RESULTS: There was a statistically significant decrease in BSA by week 8 from 9.3 to 5.1 (P&lt;0.05). Significant improvements in TLSS (10.9 to 3.5, P&lt;0.05) and PGA (2.7 to 1.4, P&lt;0.05) occurred by week 8, with improvements noted at each study time point (P&lt;0.05 vs baseline). Bioinstrumentation showed reduced scaling and improved skin smoothness (P&lt;0.05 at all timepoints vs baseline). DLQI results improved from 9.2 at baseline (a moderate effect of disease) to 2.9 at week 8 (small effect, P&lt;0.05). There was a significant reduction in dryness, itching, and burning/stinging throughout the study (P&lt;0.05 at all timepoints). Four adverse events occurred in 4 subjects (itching and burning/stinging) and resolved by the end of the study.

CONCLUSIONS: This study highlighted the benefit of skincare in conjunction with prescription products for plaque psoriasis. The skincare regimen supported the skin barrier and improved patient outcomes.

PMID:40773615 | DOI:10.36849/JDD.9163

J Drugs Dermatol. 2025 Aug 1;24(8):762-768.

ABSTRACT

OBJECTIVE: The study objective was to compare long-term treatment persistence between patients initiating guselkumab vs 3 commonly prescribed biologics in the United States.

METHODS: Adult plaque psoriasis patients enrolled in the CorEvitas Psoriasis Registry initiating guselkumab, adalimumab, secukinumab, or ixekizumab (July 2017 – January 2022) were divided into biologic-na&iuml;ve and biologic-experienced cohorts. The primary outcome measure was average 2-year treatment persistence, estimated as restricted mean survival time (RMST), comparing guselkumab with adalimumab, secukinumab, and ixekizumab. Standardized mortality ratio weighting was used to adjust for confounding.

RESULTS: 1,007 biologic-na&iuml;ve and 1,584 biologic-experienced treatment initiations were included. For biologic-na&iuml;ve initiators, the weighted-average treatment persistence for guselkumab was 20.3 months (95% CI: 19.4, 21.3), 14.6 months (13.5, 15.7) for adalimumab; 17.5 months (16.5, 18.6) for secukinumab, and 18.9 months (17.8, 20.1) for ixekizumab. The RMST difference for guselkumab was 24.9 weeks (95% CI: 18.4, 31.3) vs adalimumab, 12.1 weeks (5.9, 18.2) vs secukinumab and 6.0 weeks (0.4, 12.4) vs ixekizumab. For biologic-experienced initiators, the weighted-average treatment persistence for guselkumab was 17.6 months (95% CI: 16.9, 18.4), 13.5 months (11.6, 15.5) for adalimumab, 16.5 months (15.7, 17.3) for secukinumab, and 16.9 months (16.1, 17.8) for ixekizumab. The RMST difference for guselkumab was 17.7 weeks (95% CI: 8.7, 26.7) vs adalimumab, 5.0 weeks (0.2, 9.1) vs secukinumab and 2.9 weeks (-1.9, 7.7) vs ixekizumab.

CONCLUSIONS: In both biologic-na&iuml;ve and biologic-experienced cohorts in this real-world study, average treatment persistence was significantly longer for guselkumab compared to adalimumab and secukinumab and numerically longer compared to ixekizumab.

PMID:40773600

J Drugs Dermatol. 2025 Aug 1;24(8):777-781. doi: 10.36849/JDD.9210.

ABSTRACT

BACKGROUND: Psoriatic arthritis (PsA) is undiagnosed in up to 41% of cases, risking irreversible joint damage if untreated. This quality improvement initiative facilitates PsA screening, assessment, and rheumatology referral to improve patient outcomes.

METHODS: Our clinical framework integrated the Psoriasis Epidemiology Screening Tool (PEST) and the 12-item Psoriatic Arthritis Impact of Disease questionnaire (PsAID-12) into the electronic medical record system in 26 dermatology clinics. Psoriasis (PsO) patients underwent PsA screening via the PEST. Those scoring &ge;3 or already diagnosed with PsA1 completed the PsAID-12, which guides management. PsAID-12 score &gt;4 indicates an unacceptable symptom state, prompting treatment changes or rheumatology referral.2 Providers received results in real-time for review.

RESULTS: Over 27 months, 7,692 PsO patients were seen by dermatology providers. Of the 6,473 PsO patients without a PsA diagnosis, 37.2% completed the PEST; 12.5% scored &ge;3 and completed the PsAID-12. 75.7% of patients who took the PsAID-12 scored &le;4, indicating effective management. Of the 24.3% of patients scoring &gt;4, 24.7% were referred to rheumatology, and 44.4% subsequently received a diagnosis of PsA. When comparing the 493 patients who took the PsAID-12 at least twice, an average baseline PsAID-12 score of 2.80 was seen compared to an average most recent score of 2.53, indicating a significant reduction (P&lt;0.0001).

CONCLUSION: Our study demonstrates the feasibility of IDEOM’s clinical framework in optimizing PsA screening, assessment, and quality of care.

PMID:40773599 | DOI:10.36849/JDD.9210

J Am Coll Health. 2025 Aug 7:1-8. doi: 10.1080/07448481.2025.2542413. Online ahead of print.

ABSTRACT

OBJECTIVE: This study describes the prevalence of and relationships between suicide risk, substance use, and help-seeking intentions among college students, as well as knowledge and utilization of the 988 Suicide and Crisis Lifeline.

PARTICIPANTS: The sample included 1,345 racially diverse college students from a large, urban university in the Southeastern United States.

METHODS: SPSS was used to test correlational relationships between help-seeking intentions and suicide or substance use. Descriptive statistics revealed current rates of suicide risk, substance use, and help-seeking intentions.

RESULTS: Help-seeking intentions was negatively correlated with suicide risk, suicide behavior, and substance use frequency. Only 20 participants reported using the 988 Lifeline, while 56.6% of participants were unaware of the service. During a crisis, 21.9% of participants reported they would not contact any services.

CONCLUSIONS: These findings suggest the need for crisis training across services and social supports, and greater public awareness of mental health and crisis services.

PMID:40773536 | DOI:10.1080/07448481.2025.2542413

JMIR Cardio. 2025 Aug 7;9:e76850. doi: 10.2196/76850.

ABSTRACT

BACKGROUND: Apolipoprotein B (APOB) rs676210 polymorphism has been associated with altered lipid metabolism and cardiovascular risk in various populations; however, data from Vietnamese populations remain limited.

OBJECTIVE: This study aimed to investigate the association of the APOB rs676210 variant with lipid profiles among Vietnamese individuals newly diagnosed with elevated low-density lipoprotein cholesterol (LDL-C).

METHODS: A cross-sectional study was conducted among 69 Vietnamese adults newly diagnosed with elevated LDL-C (≥130 mg/dL) at a tertiary hospital in Southern Vietnam. Participants were genotyped for APOB rs676210 using real-time polymerase chain reaction (PCR) with allele-specific probes. Lipid profile components, including LDL-C, high-density lipoprotein cholesterol (HDL-C), non-HDL-C, and ApoB, were compared across genotype groups (AA vs GA/GG) and alleles (A vs G). Statistical analyses involved t tests, chi-square tests, and multivariable linear regression adjusted for age, sex, the BMI, and diabetes. P<.05 was considered statistically significant.

RESULTS: Of the 69 participants, 32 (46.4%) carried the AA genotype, while 37 (53.6%) carried the GA or the GG genotype. The AA genotype was associated with significantly higher LDL-C (mean 5.19, SD 0.95, vs mean 4.37, SD 0.97, mmol/L; P<.001), non-HDL-C (mean 5.94, SD 1.08, vs mean 5.31, SD 1.22 mmol/L; P=.03), and ApoB (mean 149.5, SD 26.3, vs mean 136.9, SD 15.2, mg/dL; P=.02) and lower HDL-C (mean 1.26, SD 0.31, vs mean 1.44, SD 0.39, mmol/L; P=.03) compared to the GA/GG genotype. Allele-based analysis showed that carriers of the A allele (98/138, 71%) also had higher LDL-C (mean 4.91, SD 1.02, vs mean 4.36, SD 0.97, mmol/L; P=.004) and ApoB (mean 145.6, SD 23.2, vs mean 135.9, SD 16.0, mg/dL; P=.02) than G allele carriers (40/138, 29%). These associations remained significant after multivariate adjustment.

CONCLUSIONS: APOB rs676210 polymorphism is associated with significant differences in lipid profiles among Vietnamese adults with elevated LDL-C. Specifically, the A allele and the AA genotype confer a more atherogenic profile, suggesting potential utility as a genetic marker in lipid screening and personalized cardiovascular risk management in this population.

PMID:40773287 | DOI:10.2196/76850

Optom Vis Sci. 2025 Aug 8. doi: 10.1097/OPX.0000000000002284. Online ahead of print.

ABSTRACT

SIGNIFICANCE: This study adds to the understanding of how different factors affect quality of life in people with keratoconus.

PURPOSE: To evaluate how various demographic factors, clinical characteristics, and treatment modalities influence quality of life in people with keratoconus.

METHODS: This prospective survey study recruited adult participants (18 years and older) with a history of keratoconus. Demographic information, clinical characteristics, visual and surgical treatment history, and responses to the National Eye Institute 25-Item Visual Functioning Questionnaire (NEI-VFQ-25) were collected.

RESULTS: Between June 2022 and June 2023, 40 participants completed the study. The mean age was 40.9 ± 15.1 years, and 70.0% were male. All participants wore contact lenses (52.5% scleral lenses, 45.0% corneal lenses, and 2.5% soft lenses), and 17.5% had a history of corneal crosslinking. Compared to scleral lens wear, corneal lens wear was associated with worse quality of life on the NEI-VFQ-25 overall composite (p=0.015), general vision (p=0.02), and mental health (p=0.052) domains. History of corneal crosslinking was associated with worse quality of life in the NEI-VFQ-25 overall composite (p=0.002), mental health (p=0.010), role difficulty (p=0.045), and dependency (p=0.021) domains. The five lowest-scoring NEI-VFQ-25 domains in this sample were general health, general vision, ocular pain, mental health, and role difficulties.

CONCLUSIONS: Factors such as the type of contact lens wear may influence an individual’s quality of life. In categories like mental health, general vision, and the overall composite score, scleral lens wearers reported better quality of life. Similarly, surgical treatment history may influence quality of life. Specifically, those with a history of corneal crosslinking reported worse quality of life scores in the categories of mental health, role difficulty, dependency, and the overall composite score. Although these factors were found to be statistically significant, not all reached clinical significance. To determine whether the relationships found in this study are repeatable across different populations, additional studies must be performed. Additionally, eye care providers must consider how different treatment options impact not only a patient’s vision and ocular health but also their quality of life.

PMID:40773279 | DOI:10.1097/OPX.0000000000002284