Tag: nevin manimala

Biomed Phys Eng Express. 2025 Dec 18. doi: 10.1088/2057-1976/ae2ebb. Online ahead of print.

ABSTRACT

Respiratory phase mismatch between single-photon emission computed tomography (SPECT) and computed tomography (CT) acquisition phases presents a challenge in lung perfusion scintigraphy using SPECT/CT. This study simulated lung volume and SPECT counts changes under free-breathing and breath-hold CT conditions compared to respiratory-synchronized acquisition. Chest 4D-CT images, divided into 10 respiratory phases, were used to generate lung, soft tissue, liver, and bone regions for each phase. A digital phantom was constructed via image processing using ImageJ. SPECT images were generated from these phantoms by employing the Prominence Processor to simulate projection data and reconstruct images. Simulations included a “synchronized image,” where both SPECT and μMAP for attenuation correction were created in the same phase; a “free-breathing image,” combining a free-breathing SPECT and μMAP; and a “CT breath-hold image,” using phase-specific μMAPs with the free-breathing SPECT image for attenuation correction. Lung volumes and SPECT counts in the free-breathing and CT breath-hold images were compared with those in the synchronized image. By analyzing the relative errors caused by differences in the μMAPs, the study evaluated the impact of mismatch between SPECT and CT phases. Results indicated that lung volumes appeared reduced during inspiration and increased during expiration compared with synchronized images. No significant difference in the relative error was observed between the free-breathing and CT breath-hold images. Our findings revealed that in the quantitative evaluation of lung perfusion SPECT, varying the μ-map phase during free-breathing acquisition did not result in a significant improvement, suggesting that the mismatch between SPECT and CT had no statistically significant effect on quantitative accuracy. Compared with respiratory-gated SPECT, free-breathing acquisitions introduced potential errors of approximately 2.5% in lung volume measurement and 1.2% in SPECT counts. However, these errors were within acceptable tolerance limits for clinical diagnosis, indicating that free-breathing acquisition had minimal effects on diagnostic capability.

PMID:41410023 | DOI:10.1088/2057-1976/ae2ebb

Pharm Stat. 2026 Jan-Feb;25(1):e70066. doi: 10.1002/pst.70066.

ABSTRACT

The introduction of checkpoint inhibitors in immuno-oncology has raised questions about the suitability of the log-rank test as the default primary analysis method in confirmatory studies, particularly when survival curves exhibit non-proportional hazards. The log-rank test, while effective in controlling false positive rates, may lose power in scenarios where survival curves remain similar for extended periods before diverging. To address this, various weighted versions of the log-rank test have been proposed, including the “MaxCombo” test, which combines multiple weighted log-rank statistics to enhance power across a range of alternative hypotheses. Despite its potential, the MaxCombo test has seen limited adoption, possibly owing to its proneness to produce counterintuitive results in situations where the hazard functions on the two arms cross. In response, the modestly weighted log-rank test was developed to provide a balanced approach, giving greater weight to later event times while avoiding undue influence from early detrimental effects. However, this test also faces limitations, particularly if the possibility of early separation of survival curves cannot be ruled out a priori. We propose a novel test statistic that integrates the strengths of the standard log-rank test, the modestly weighted log-rank test, and the MaxCombo test. By considering the maximum of the standard log-rank statistic and a modestly weighted log-rank statistic, the new test aims to maintain power under delayed effect scenarios while minimizing power loss relative to the log-rank test in worst-case scenarios. Simulation studies and a case study demonstrate the efficiency and robustness of this approach, highlighting its potential as a robust alternative for primary analysis in immuno-oncology trials.

PMID:41410010 | DOI:10.1002/pst.70066

Glob Health Action. 2025 Dec;18(1):2602116. doi: 10.1080/16549716.2025.2602116. Epub 2025 Dec 18.

ABSTRACT

BACKGROUND: Since the establishment of national health insurance in Ghana, the government’s health policy has focused on reducing out-of-pocket expenditure (OOP) to ensure that people do not become poorer while accessing healthcare services. However, studies show that OOP expenditure remains high, and a substantial portion of the population experiences catastrophic health expenditure (CHE).

OBJECTIVE(S): We estimated the level and determinants of catastrophic health expenditures for hypertension management among adults in the Greater Accra Region of Ghana.

METHODS: We conducted a cross-sectional CHE survey at two randomly selected district primary health facilities in the Greater Accra Region. Data collection took place between December 2023 and February 2024. A questionnaire was used to collect data on direct and indirect medical expenditures related to hypertension care from 382 participants. CHE was defined at thresholds of 10% and 40% of the household’s capacity for direct and indirect medical expenditures, respectively. Multivariate logistic regression was used to assess the determinants of CHE.

RESULTS: A total of 382 patients were included in the analysis; the majority were females (76%), and Christians (95%). Based on the 10% and 40% thresholds of household income capacity to pay, 65% and 58% of the total sample experienced CHE, respectively. The regression model revealed that being widowed (OR = 0.32, 95% CI: 0.09-1.10, p = 0.07), unemployed (OR = 0.26, 95% CI: 0.08-0.09, p = 0.03), and having a large household size (OR = 1.32, 95% CI: 0.95-1.84, p = 0.09) correlate with CHE for hypertension management and care.

CONCLUSION: The study demonstrates that hypertension care imposes a considerable financial burden on households.

PMID:41410004 | DOI:10.1080/16549716.2025.2602116

J Arrhythm. 2025 Dec 15;41(6):e70247. doi: 10.1002/joa3.70247. eCollection 2025 Dec.

ABSTRACT

INTRODUCTION: Antiarrhythmic effects of sacubitril/valsartan in heart failure (HF) have been previously reported; however, its impact among individuals with ventricular arrhythmias with cardiac defibrillators remains unclear. Therefore, we performed this systematic review and meta-analysis to address this lack of evidence.

METHOD: A systematic search of PubMed, Embase, and Cochrane Library was conducted from inception until February 26, 2025. Binary and continuous variables were analyzed by odds ratio (OR) and mean differences, respectively. All analyses were performed using a random-effects model by RevMan.

RESULTS: Four paired observational cohort studies, including 397 patients with HF and implanted cardiac defibrillators (ICDs) were enrolled. This study showed that sacubitril/valsartan could significantly reduce the incidence of ICD shocks (OR, 0.33; 95% CI, 0.19 to 0.60; p = 0.0003; I ² = 13%), appropriate ICD shocks (OR, 0.21; 95% CI, 0.10 to 0.47; p = 0.0001; I ² = 0%), NSVT duration (OR, -1.86; 95% CI, -3.43 to -0.30; p = 0.02; I² = 86%), and biventricular (Biv) pacing < 90% (OR, 0.15; 95% CI, 0.03 to 0.83; p = 0.03; I ² = 0%). However, the mata-analysis didn’t reveal a significant association between sacubitril/valsartan and a lower rate of ventricular arrhythmia, sustained ventricular tachycardia (SVT), non-sustained ventricular tachycardia (NSVT), inappropriate ICD shocks, premature ventricular contractions per hour (PVC/h), and left ventricular ejection fraction (LVEF).

CONCLUSION: Sacubitril/valsartan may have a potential benefit among HF patients with cardiac defibrillators; future investigations are warranted to confirm the antiarrhythmic effects of sacubitril/valsartan in this setting.

PMID:41409992 | PMC:PMC12705482 | DOI:10.1002/joa3.70247

JAC Antimicrob Resist. 2025 Dec 16;7(6):dlaf246. doi: 10.1093/jacamr/dlaf246. eCollection 2025 Dec.

ABSTRACT

BACKGROUND: Although adjunctive rifampicin and/or gentamicin have been recommended for Staphylococcus aureus prosthetic valve endocarditis, evidence regarding the evaluation of their clinical effectiveness is limited.

OBJECTIVES: To compare the clinical impact of adjunctive rifampicin without gentamicin, and adjunctive gentamicin without rifampicin therapies for S. aureus prosthetic valve endocarditis.

METHODS: This retrospective study used TriNetX to evaluate multicentre electronic medical records of patients aged 18 years or older in the USA between 2016 and 2024. After propensity score matching, HRs were estimated with 95% CIs. Covariates included age, sex, ethnicity and medical comorbidities.

RESULTS: A total of 353 and 369 patients were identified in the rifampicin and gentamicin groups, respectively. One-year all-cause mortality was observed in 87 (31.3%) and 111 (39.9%) patients in the rifampicin and gentamicin groups after propensity score matching, respectively, leading to an HR of 0.71 (95% CI, 0.54-0.94; P = 0.016). The HRs were not statistically significant for ICU admission (HR 0.93; 95% CI, 0.74-1.18; P = 0.540), recurrent endocarditis (HR 0.76; 95% CI, 0.42-1.40; P = 0.381), kidney failure (HR 0.93; 95% CI, 0.74-1.18; P = 0.540) or hepatic failure (HR 0.96; 95% CI, 0.66-1.39; P = 0.822).

CONCLUSIONS: The rifampicin-containing regimen without gentamicin was associated with reduced 1 year mortality compared with the gentamicin-containing regimen without rifampicin. Although the results should be interpreted with caution because of potential residual unmeasured confounders, including duration of antimicrobial treatment and biases, our findings provide further evidence that adjunctive gentamicin may not be routinely needed for S. aureus prosthetic valve endocarditis.

PMID:41409990 | PMC:PMC12706467 | DOI:10.1093/jacamr/dlaf246

Cureus. 2025 Nov 16;17(11):e96939. doi: 10.7759/cureus.96939. eCollection 2025 Nov.

ABSTRACT

Background Leaving against medical advice (LAMA) in pediatric intensive care units (PICUs) carries substantial risks, yet limited data exist from Indian settings. This study aimed to determine the incidence, demographic and clinical characteristics, and contributory factors for LAMA in a tertiary care PICU. Methods A prospective observational study was conducted at the PICU of King George’s Medical University, Lucknow, India, over 12 months. All children aged between one month and 12 years discharged against medical advice (DAMA) were included. Data on demographics, socioeconomic status, diagnosis, reasons for LAMA, and outcomes at 15 days were analyzed using IBM SPSS Statistics, version 23.0 (IBM Corp., Armonk, NY). Results Of 932 admissions, 135 (14.5%) left against medical advice. Among these patients, the mean age was 62.8 months; most were male, 76 (56.3%), and from rural areas, 78 (57.8%), and a total of 31 (23.0%) belonged to the lower socioeconomic class. The main reasons cited for LAMA were perceived poor survival, 85 (63.0%), and financial burden, 58 (43.0%). Parental illiteracy was reported in 27 (29.7%), and low income also showed significant associations for mortality among patients who left against medical advice. Conclusion LAMA rates in this PICU were high, predominantly driven by socioeconomic hardship and pessimism regarding prognosis. Interventions combining financial assistance, strengthened caregiver communication, and structured support services may help reduce LAMA and improve outcomes in critically ill children.

PMID:41409962 | PMC:PMC12706387 | DOI:10.7759/cureus.96939

Cureus. 2025 Nov 16;17(11):e96955. doi: 10.7759/cureus.96955. eCollection 2025 Nov.

ABSTRACT

BACKGROUND: Intrauterine growth restriction (IUGR) has been linked to disturbances in growth after birth and various developmental anomalies. However, its impact on the shape of the face and dental health is still a question. Exploring these links can be helpful for the early prevention and orthodontic treatment of a pediatric population.

OBJECTIVE: Comparison of differences in craniofacial morphometric parameters and dental abnormalities of children with IUGR and healthy children.

METHODS: A cross-sectional case-control study was performed in 60 children aged between 3 and 7 years (30 IUGR; 30 controls matched for age and sex). Lateral cephalometric radiograph standardization was done for assessment of craniofacial parameters, and dental anomalies were confirmed by clinical examinations. The statistical analysis consisted of Student’s t-test, chi-square test, and logistic regression with significance set at p <0.05.

RESULTS: Children with IUGR had a markedly reduced cranial base length (91.3 ± 4.9 mm vs. 99.6 ± 5.4 mm, p < 0.001) and mandibular length (65.2 ± 4.0 mm vs. 73.9 ± 4.5 mm, p < 0.001) and an increased lower facial height (54.6 ± 3.1 mm vs. 51.0 ± 3.2 mm, p < 0.001). Enamel defects in the IUGR group (33.3%) were twice as many as in the control group (10.0%), and the adjusted odds were almost five times higher (OR = 4.83, 95% CI 1.04 – 22.36, p = 0.044). The occurrences of caries, hypodontia, and microdontia in the IUGR group have increased, but their differences are not statistically significant.

CONCLUSION: IUGR is related to changed patterns of craniofacial development that feature shortening of the cranial base and mandibular lengths and lengthening of the lower facial height. It is also associated with a greater number of cases of enamel defects. Screening of children with IUGR and their cephalometric evaluation at an early stage will provide better preventive and orthodontic interceptive treatment guidance.

PMID:41409956 | PMC:PMC12706629 | DOI:10.7759/cureus.96955

Cureus. 2025 Nov 16;17(11):e96960. doi: 10.7759/cureus.96960. eCollection 2025 Nov.

ABSTRACT

Objectives The main objective of this study is to examine how environmental and demographic factors shape regional prescription patterns of circadian-related hypnotics, and to develop a pharmacoepidemiological indicator for detecting potential regional overuse. Methods A nationwide ecological cross-sectional study was conducted using 2022 data from all 47 prefectures of Japan. Population-adjusted prescription volumes of ramelteon, suvorexant, and lemborexant were obtained from the National Database of Health Insurance Claims. Environmental (annual sunlight duration and ultraviolet index) and demographic (aging rate and outpatient clinic density) variables were extracted from governmental statistics. Pearson correlation and multivariable linear regression analyses were conducted, and residuals were geographically visualized to identify regional deviations from model expectations. Results Ramelteon and suvorexant prescriptions were significantly associated with shorter sunlight duration and higher aging rates (r = -0.64 and -0.61, both p < 0.001). In multivariable analysis, sunlight duration and aging rate independently predicted prescription volumes (adjusted R² = 0.46), with improved performance (adjusted R² = 0.51) after exclusion of high-influence outliers. Residual analysis revealed that unexplained positive deviations were concentrated in urban prefectures, suggesting locally elevated prescribing tendencies. Conclusions Regional prescription volumes of circadian-related hypnotics can, to some extent, be anticipated from environmental determinants such as sunlight duration. The proposed indicator-based pharmacoepidemiological framework may help identify regions at risk of potential overuse and guide climate-sensitive strategies for optimizing hypnotic use in older adults.

PMID:41409951 | PMC:PMC12706815 | DOI:10.7759/cureus.96960

Cureus. 2025 Nov 13;17(11):e96807. doi: 10.7759/cureus.96807. eCollection 2025 Nov.

ABSTRACT

BACKGROUND: Glaucoma is a leading cause of irreversible blindness, yet awareness and early detection remain poor in rural India. Data from North-Eastern India, particularly Tripura, is scarce.

OBJECTIVE: This study aims to assess awareness, knowledge, and practices (AKP) regarding glaucoma and identify predictors of awareness among adults in rural North Tripura.

METHODS: A community-based cross-sectional survey (April-June 2025) was conducted in four randomly selected villages under the District Residency Programme. Multistage cluster random sampling targeted adults aged ≥30 years. A pretested questionnaire (Bengali/Kokborok) captured demographics, awareness, knowledge, practices, and information sources. Descriptive statistics and binary logistic regression identified determinants of awareness.

RESULTS: Of the 420 eligible adults, 368 completed the survey (response rate: 87.6%). A total of 72/368 (19.6%) had ever heard of glaucoma. Among the aware, 25/72 (34.7%) achieved a good awareness score, and 9/72 (12.5%) had good knowledge. Across the full sample, 39/368 (10.6%) reported an eye examination in the past year; among the aware, 17/72 (23.6%) had an exam. Information sources among the aware included health workers, 29/72 (40.3%); eye camps, 20/72 (27.8%); mass media, 13/72 (18.1%); and family/friends, 10/72 (13.8%). Higher education (adjusted odds ratio (AOR): 3.05; 95% CI: 1.87-4.98; p < 0.001) and prior ophthalmic consultation (AOR: 4.92; 95% CI: 2.68-9.02; p < 0.001) independently predicted awareness.

CONCLUSIONS: Less than one-fifth of rural adults in North Tripura were aware of glaucoma, and misconceptions were common. Educational status and prior eye-care contact strongly influenced awareness. Community-based education led by trained health workers and integration of glaucoma messaging into routine eye camps may enhance early detection and reduce avoidable blindness.

PMID:41409948 | PMC:PMC12708009 | DOI:10.7759/cureus.96807

Cureus. 2025 Nov 15;17(11):e96879. doi: 10.7759/cureus.96879. eCollection 2025 Nov.

ABSTRACT

The optimal management of localized diverticular perforation remains uncertain, with ongoing debate between surgical intervention and conservative antibiotic therapy. While randomized trials have addressed uncomplicated diverticulitis, evidence specific to perforated disease is limited and heterogeneous. This study aimed to evaluate the effectiveness of surgical intervention compared to antibiotic therapy in managing localized diverticular perforation in adults, focusing on key clinical outcomes including adverse events, stoma creation, mortality, and intra-abdominal abscess formation. We conducted a systematic review and meta-analysis of studies comparing surgical versus antibiotic therapy in adults with localized diverticular perforation. Major outcomes included composite adverse events, stoma creation, all-cause mortality, and intra-abdominal abscess. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed using the I² statistic. Four comparative studies (n = 12,922 patients) were included. For composite adverse outcomes, no significant pooled difference was observed (Pooled OR 3.79, 95% CI 0.36-39.56, p = 0.266; I² = 97.4%), though individual studies showed conflicting results. Surgical intervention was associated with a significantly higher risk of stoma creation compared to antibiotics (Pooled OR 16.16, 95% CI 4.11-63.63, p < 0.001; I² = 43.3%). Mortality did not differ significantly between groups (Pooled OR 3.68, 95% CI 0.28-47.99, p = 0.320; I² = 88.8%). Intra-abdominal abscess rates were also comparable (Pooled OR 3.01, 95% CI 0.53-17.07, p = 0.212; I² = 87.8%). Surgical management of localized diverticular perforation provides definitive treatment but significantly increases the risk of stoma creation. Antibiotic therapy may be effective in carefully selected patients, particularly when initiated promptly, although study findings remain inconsistent. Given the high heterogeneity across available studies, further randomized trials are needed to establish evidence-based guidance for treatment selection in this patient population.

PMID:41409946 | PMC:PMC12706538 | DOI:10.7759/cureus.96879