Tag: nevin manimala

Anatol J Cardiol. 2025 Nov 17. doi: 10.14744/AnatolJCardiol.2025.5649. Online ahead of print.

ABSTRACT

BACKGROUND: Calcific aortic valve stenosis (CAVS), the predominant valvular heart disease in developed countries, arises primarily from metabolic and inflammatory dysregulation. The triglyceride-glucose (TyG) index, a composite biomarker of insulin resistance and systemic inflammation, has been associated with cardiovascular diseases. However, its causal association with CAVS remains unclear. This study employs bidirectional Mendelian randomization (MR) to elucidate the potential causal relationship between the TyG index and CAVS.

METHODS: Genome-wide association study) summary statistics of TyG index and CAVS were obtained from UK-biobank cohort (n = 273 368) and FinnGen database (cases = 12 418 and controls = 487 930). Two-sample MR and multiple MR analyses were conducted to evaluate the association of TyG index with CAVS. The primary method was inverse variance weighted (IVW), complemented by MR-Egger, weighted median, and sensitivity analyses to ensure robustness.

RESULTS: The MR analysis demonstrated a significant causal effect of the higher TyG index (per 1-unit increment of TyG index) on CAVS risk (odds ratio [OR] = 1.50, P = .007, 95% CI: 1.12-2.02). Similar causal relationships were observed for triglyceride and glucose levels with CAVS. Sensitivity analyses confirmed robustness with no evidence of horizontal pleiotropy (P > .05). This association remained statistically significant in multiple MR analyses after adjusting for potential confounders (OR = 1.64, P = .003, 95% CI: 1.18-2.28). No reverse causality from CAVS to the TyG index was detected.

CONCLUSION: This MR study provides evidence supporting the causal effect of higher TyG index on CAVS.

PMID:41243889 | DOI:10.14744/AnatolJCardiol.2025.5649

Nurs Crit Care. 2025 Nov;30(6):e70241. doi: 10.1111/nicc.70241.

ABSTRACT

BACKGROUND: Delirium is a common neuropsychiatric complication in the intensive care unit (ICU), the occurrence of which is closely associated with patient prognoses.

AIM: To examine the associations between sleep quality and circadian rhythm stability measured by actigraphy and changes in delirium state in intensive care unit (ICU) patients, as well as their predictive power for mortality risk.

STUDY DESIGN: ICUs of a medical centre in Taiwan, from September 1, 2024, to January 31, 2025. A prospective observational study was conducted in adult ICU patients. Wrist-worn actigraphy was used to monitor total sleep time (TST, h), wake after sleep onset (WASO, h), and circadian rhythm stability (24-h autocorrelation coefficient, r24) for 72 consecutive hours. Delirium was assessed twice daily for three days using the Confusion Assessment Method for the ICU (CAM-ICU) and categorized as no delirium, prolonged delirium (lasting ≥ 3 days), or new-onset delirium (developed after enrollment).

RESULTS: A total of 74 ICU patients were included. Among them, 30 had no delirium, 20 had prolonged delirium, and 24 developed new-onset delirium. Mortality rates in both the prolonged delirium and new-onset delirium groups were 45%, significantly higher than in the no-delirium group (13.3%, p = 0.015). The prolonged delirium group had higher Sequential Organ Failure Assessment (SOFA) scores, longer WASO and lower r24 than the no-delirium group, with r24 significantly associated with prolonged delirium (OR = 0.001, p = 0.012). The new-onset delirium group showed higher WASO, which was significantly associated with delirium (OR = 1.04, p = 0.046). Multivariate Cox analysis identified prolonged delirium (HR = 3.92, p = 0.049) and SOFA score (HR = 1.32, p = 0.027) as independent predictors of mortality.

CONCLUSIONS: WASO and r24 were closely linked to delirium state changes. Lower r24 was strongly associated with prolonged delirium and higher mortality, while higher WASO was related to new-onset delirium.

RELEVANCE TO CLINICAL PRACTICE: Continuous monitoring of sleep continuity and circadian rhythms in ICU patients is recommended. Incorporating WASO into early delirium risk assessments may facilitate timely interventions, reduce delirium incidence and mortality and improve critical care quality.

PMID:41243871 | DOI:10.1111/nicc.70241

Clin Transplant. 2025 Nov;39(11):e70382. doi: 10.1111/ctr.70382.

ABSTRACT

BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) is a potentially life-saving intervention in refractory out-of-hospital cardiac arrest (OHCA). ECPR enables, in most of the treated cases, ICU admission to patients who otherwise would have died at the emergency department (ED). Still, many of them die, frequently after withdrawal of life-sustaining therapies due to irreversible critical conditions and related complications. The additional time provided by ECPR, however, might allow for the assessment of organ donor suitability. The aim of this study was to evaluate the impact of ECPR on the number of potential organ donors after refractory OHCA.

METHODS: We performed a post-hoc analysis of the multicenter INCEPTION trial, which randomized 134 OHCA patients between conventional CPR (CCPR) and ECPR. Detailed patient reports were presented to transplant physicians to determine the acceptability of the liver and kidneys for organ donation. In addition to the intention to treat analysis, we performed an “as-treated” analysis, limited to patients arriving without return of spontaneous circulation (ROSC) at the ED.

RESULTS: Out of 70 patients randomized to ECPR and 64 to CCPR, potential organ donors were identified in 14 (20%) and 4 (6%) patients, respectively (χ² test, p = 0.038). In the as-treated analysis, 15 out of 55 (27%) treated with ECPR were potential donors, compared to 0 out of 59 treated with CCPR (p < 0.001). This included five (9%) potential kidney donors and 15 (27%) potential liver donors.

CONCLUSION: Although ECPR is currently used with life-saving intentions, it may simultaneously increase the number of potential organ donors following cardiac arrest in selected patients.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03101787.

PMID:41243868 | DOI:10.1111/ctr.70382

J Pediatr Orthop. 2025 Nov 17. doi: 10.1097/BPO.0000000000003162. Online ahead of print.

ABSTRACT

BACKGROUND: Although periacetabular osteotomy (PAO) provides excellent clinical outcomes for patients with hip dysplasia, it still remains uncertain how it affects coronal and sagittal spinopelvic alignment. Therefore, this study aims to evaluate changes of coronal and sagittal spinopelvic parameters on standing AP and Lateral entire spine EOS radiographs following unilateral and bilateral PAO surgery.

METHODS: Skeletally mature patients who underwent unilateral and bilateral PAO surgery for symptomatic hip dysplasia were included in this study. Standing anteroposterior (AP) and lateral EOS spine radiographs (EOS Imaging, Paris, France) obtained preoperatively and at the last follow-up were analyzed to assess changes in coronal and sagittal plane measurements. Preoperative and postoperative radiographic outcomes were assessed using the Paired Sample t test for normally distributed variables and the Wilcoxon Signed-Rank test for non-normally distributed variables.

RESULTS: A total of 31 patients with 44 hips were included in this study following our exclusion criteria. Of those, 18 patients (58%) underwent unilateral PAO (Unilateral group) and 13 patients (42%) underwent bilateral staged PAOs (Bilateral group). The mean age of patients at first surgery was 16±3 years in the Unilateral group and 19±5 years in the Bilateral group (P>0.05). The mean preoperative Lateral Central Edge Angle (LCEA) was 13 degrees in the Unilateral group, which improved to 28 degrees at final follow-up (P<0.001). In the Bilateral group, the mean LCEA was 16 degrees preoperatively, which improved to 32 degrees at last follow-up (P<0.001). While the mean Acetabular Index (AI; Tönnis Angle) improved from 17 to 5 degrees at last follow-up in the Unilateral group (P<0.001), it improved from 9 to -1 degrees at last follow-up in the Bilateral group (P<0.001). There were no statistically significant preoperative and postoperative Pelvic Tilt, Sacral Slope, Pelvic Incidence, Lumbar Lordosis changes in the Unilateral and Bilateral groups.

CONCLUSIONS: Spinopelvic alignment did not significantly change following either unilateral or bilateral PAOs, as assessed on standing spine radiographs. Taken together with findings from previous research, our results suggest that pelvic tilt in skeletally mature patients with acetabular dysplasia is likely a fixed morphologic characteristic rather than a compensatory or reversible mechanism.

LEVEL OF EVIDENCE: Level III.

PMID:41243865 | DOI:10.1097/BPO.0000000000003162

Int J Gynaecol Obstet. 2025 Nov 17. doi: 10.1002/ijgo.70671. Online ahead of print.

ABSTRACT

OBJECTIVE: Fetal size and gestational age are essential factors to consider when determining the timing of delivery between mothers and obstetricians in term pregnancies. Previous studies have shown that both fetal size and gestational age have associations with cognitive or academic outcomes. This study aimed to determine whether the association between gestational age (37-41 weeks) and child intelligence is moderated by fetal size in term-born children.

METHODS: Data were harmonized for four national cohorts in the USA, UK, Ireland, and Australia. Predictors included fetal size and gestational age. Fetal size was calculated using Fenton’s chart and grouped into three categories: Large for gestational age (LGA) (>90th percentile), appropriate for gestational age (AGA) (10th to 90th percentile), and small for gestational age (SGA) (<10th percentile). The outcome was intelligence quotient (IQ) scores at age 5 years. Linear models, contrast analyses, and point plots were employed.

RESULTS: In total, 30 035 term-born participants were included in the analysis. Overall, being born before 41 weeks and being born with SGA (but not LGA) were both negatively associated with IQ. No statistically significant interactions between fetal size category and gestational age at term were found. At each gestation from 37 to 41 weeks, being born SGA (but not LGA) was associated with lower IQ when compared to AGA. A small but clinically significant reduction in IQ (i.e., 0.23 IQ Z-score, equivalent to a 3.45 IQ difference) was found in SGA-born children who were born at 37 weeks compared to 41 weeks.

CONCLUSION: The association between gestation and child IQ at age 5 was not moderated by fetal size in term-born children. Regardless of gestational age at term, SGA (but not LGA) is consistently and unfavorably associated with poorer cognitive outcomes. The IQ at age 5 was only clinically meaningfully decreased in SGA children born at 37 weeks.

PMID:41243845 | DOI:10.1002/ijgo.70671

Int J Gynaecol Obstet. 2025 Nov 17. doi: 10.1002/ijgo.70654. Online ahead of print.

ABSTRACT

OBJECTIVE: To measure the woman-centeredness of family planning (FP) care and determine its correlates in West Cameroon.

METHODS: We conducted a cross-sectional analytical study from August to November 2024 in the Mifi Health District (MHD). We included women receiving FP care in all the public health facilities. We collected data were using the person-centered FP care scale (PCFPS). Descriptive and inferential statistics were computed with R software. Respondents’ characteristics were summarized, and woman-centeredness scores computed using the PCFPS guide. We used the cutoff threshold technique to distinguish high and low scores. Bivariate and multivariate linear regressions were conducted to determine the correlates of woman-centeredness of FP care. Regression coefficients with their 95% confidence intervals (CIs) were computed with a significance threshold of 5%.

RESULTS: The median (range) woman-centeredness score for the 179 respondents was 73.33% (12.22-88.88). Specifically, the median (range) score (76.38% [8.33-91.66]) for woman’s respect and autonomy was higher than that (61.11% [5.55-100]) for health facility environment. The FP care woman-centeredness score at the district hospital was seven-point higher than in first-level primary healthcare facilities (a.Coefficient: 7.33; 95% CI: 1.11-13.56; P = 0.02). Likewise the woman-centeredness score of FP care for women with a monthly income ≤100 USD was significantly lower than for women earning >300 USD monthly (a.Coefficient: -6.98; 95% CI: -12.96 to -1.01; P = 0.02).

CONCLUSION: FP care in the MHD was highly women centered. However, FP care was less likely to be woman-centered for low-income women and for those attending first-level primary health care facilities.

PMID:41243834 | DOI:10.1002/ijgo.70654

Pharmacol Res Perspect. 2025 Dec;13(6):e70194. doi: 10.1002/prp2.70194.

ABSTRACT

Avacopan, an oral C5a receptor antagonist approved for treating anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis, has established efficacy and short-term safety from clinical trials, but its post-marketing adverse events (AEs) in real-world settings require further characterization. We conducted a retrospective analysis of the U.S. FDA Adverse Event Reporting System (FAERS) database from Q1 2022 to Q1 2025. After data cleaning, Avacopan-related AEs were extracted, coded using MedDRA terminology, and analyzed via four signal detection methods; subgroup analyses by age, sex, and reporter type were performed. Among 3529 reports, significant disproportionality signals emerged for known AEs (e.g., hepatobiliary disorders, serious infections) and unexpected signals including venous thromboembolism, cholestatic jaundice, and alopecia. Most AEs occurred within the first 30 days of treatment, with variations observed by age and sex. This study provides the first FAERS-based pharmacovigilance assessment of Avacopan, confirming known risks and identifying novel post-approval safety signals, underscoring the need for close early-treatment monitoring and personalized strategies. Further research is warranted to confirm emerging signals and explore their mechanisms.

PMID:41243819 | DOI:10.1002/prp2.70194

Matern Child Nutr. 2026 Mar;22(1):e70134. doi: 10.1111/mcn.70134.

ABSTRACT

Suaahara was a USAID-funded multi-sectoral integrated nutrition program that aimed to improve the nutritional status of children under the age of five and their mothers in Nepal. The program included multiple interventions targeted to mothers and children, as well as other caregivers. Caregiver knowledge of optimal nutrition and health practices among household members is an important driver of healthy child and maternal nutrition behaviors. This study investigates the associations between exposure to Suaahara interventions and knowledge of maternal and child nutrition and health practices among mothers (n = , grandmothers (n = , and male household heads (n = . Linear and logistic regression models were conducted using data from the endline survey of Suaahara’s impact evaluation conducted in 2022. Exposure to Suaahara was associated with mothers’ and grandmothers’ knowledge of ideal child and maternal health and nutrition practices. Compared to those unexposed to Suuahara, mothers and grandmothers who were exposed to Suaahara interventions had 2.09 and 2.23 times higher odds respectively (p = 0.001; p = < 0.001), respectively, of having correct knowledge of exclusive breastfeeding, and 1.48 and 1.47 times higher odds respectively, of having correct knowledge of age of introduction of all types of complementary foods (p = 0.005; p = 0.070). Furthermore, exposed mothers had 1.49 times higher odds (p = 0.021) and exposed grandmothers had 1.42 times higher odds (p = 0.09) of knowing that young children should be fed more during illness. Male household heads who were exposed had 1.71 times higher odds of knowing that colostrum should be given to children immediately after birth (p = 0.027). Exposure to Suaahara was also associated with mothers’ and grandmothers’ knowledge of ideal maternal health and nutrition practices. Exposed mothers had 1.64 times higher odds (p = 0.011) and grandmothers had 2.92 times higher odds (p < 0.001) of knowing that mothers should take iron and folic acid supplementation for 180 days during pregnancy (p = 0.011; p = < 0.001). Exposed grandmothers had 1.87 times higher odds of having correct knowledge that mothers should have at least 4 antenatal care visits (p = 0.012). Exposed mothers and grandmothers had 1.88 and 1.90 times higher odds of having correct knowledge that mothers need at least 3 postnatal care visits (p = 0.002; p = 0.051). This study highlights multiple positive associations between exposure to Suaahara and knowledge of mothers and grandmothers around maternal and child health and nutrition practices. This effect was less pronounced in male household heads suggesting that tailored interventions are necessary to improve knowledge of appropriate child and maternal nutrition and health practices in this group. Future research should consider collecting data from multiple household members to better understand the paths between their knowledge and impact on maternal and child health and nutrition practices.

PMID:41243799 | DOI:10.1111/mcn.70134

Glob Chang Biol. 2025 Nov;31(11):e70594. doi: 10.1111/gcb.70594.

ABSTRACT

The rising threat of marine heatwaves has led to numerous predictions that coral reefs, especially those near the Equator, will be severely degraded by the end of the current century. Yet, environmental conditions near the Equator may regionally moderate coral bleaching by reducing thermal stress during marine heatwaves. We deployed a Bayesian spatio-temporal model over Earth to examine which environmental conditions may characterize marine-heatwave refugia for coral reefs by testing the relationship between the severity of coral bleaching and a suite of temperature, hydrodynamic, topographic, atmospheric, and biological variables. The model considered the severity of coral bleaching as the proportion of bleached hard corals during 30,266 coral-reef surveys conducted at 8728 sites, at depths of up to 20 m, and located between 35° north and south of the Equator across 81 countries, from 2002 to 2020. Except for the eastern Pacific Ocean, the severity of coral bleaching during marine heatwaves was lower on equatorial reefs than on higher-latitude reefs, suggesting that marine-heatwave refugia for corals have been concentrated in the equatorial Coral Triangle region. Indeed, equatorial reefs in the Coral Triangle were, on average, exposed to the weakest marine heatwaves, potentially because they were shielded from extreme insolation by frequent cloud coverage in the Intertropical Convergence Zone. Coral bleaching may also be moderated during marine heatwaves on reefs that experience high wave energy, high current velocity, high cloud frequency, or turbidity. Coral bleaching was also less severe on reefs that historically endured frequent heatwaves than on reefs that were naïve to thermal stress. Based on modern and historical responses of coral reefs to acute thermal stress, we hypothesize that many equatorial reefs will continue to serve as marine-heatwave refugia for corals.

PMID:41243784 | DOI:10.1111/gcb.70594

Ann Biol Clin (Paris). 2025 Nov 17;83(6):0. doi: 10.1684/abc.2025.2003. Online ahead of print.

ABSTRACT

Current guidelines recommend using at least two different assays for lupus anticoagulant (LA) detection. One such assay is the dilute Russell’s viper venom time (dRVVT). This study aimed to evaluate the analytical performance of the Lupus Screen and Lupus Confirm dRVVT reagents (Roche Diagnostics) on the cobas t 711 analyzer and to compare their diagnostic performance against an established reagent pair (LA1/LA2, Siemens) using the Sysmex CN-6000 analyzer (Sysmex Corporation) for LA detection. Repeatability was assessed by testing lyophilized quality control plasmas 20 times in a single run. Reproducibility was evaluated over at least five days with duplicate testing. A total of 101 anonymized patient samples were analyzed with both Roche and Siemens reagents on their respective platforms. Statistical analysis was performed using GraphPad Prism software version 9.5.0 (GraphPad Software, San Diego, CA, USA). Diagnostic performance was assessed via positive percentage agreement (PPA), negative percentage agreement (NPA), and overall rate of agreement (ORA). The within-run and between-run CVs were < 2%. Results obtained with the Roche and Siemens reagents were strongly correlated (r = 0.950, 0.923, and 0.877 for screen, confirm, and normalized screen/confirm ratios, respectively; all p < 0.001) and bias were acceptable. Assuming Siemens reagents as reference, PPA, NPA, and ORA were 92.42%, 100%, and 95.05%, respectively. The Lupus Screen and Lupus Confirm reagents demonstrated excellent analytical and diagnostic performance and are well-suited for LA detection in non-anticoagulated patient samples.

PMID:41243783 | DOI:10.1684/abc.2025.2003