Tag: nevin manimala

Medicine (Baltimore). 2025 Jan 3;104(1):e41119. doi: 10.1097/MD.0000000000041119.

ABSTRACT

Positron emission tomography/computed tomography (PET/CT) is widely used to differentiate benign and malignant lesions. However, increased fluorodeoxyglucose (FDG) uptake may occur under certain benign conditions, leading to potential false positives in malignancy assessments. Tuberculosis and sarcoidosis are 2 conditions that can exhibit FDG uptake, presenting with both lymph node and extrathoracic involvement, alongside pulmonary manifestations. This study aimed to explore the utility of PET/CT in distinguishing between thoracic and extrathoracic involvement in patients with sarcoidosis and tuberculosis. A retrospective analysis was conducted on patients diagnosed with sarcoidosis or tuberculosis, either pathologically or microbiologically, who underwent 18F-FDG-PET/CT as part of their diagnostic process. This study evaluated demographic data, PET/CT findings, involvement sites, and maximum standardized uptake values (SUVmax) in patients with tuberculosis and sarcoidosis. PET/CT images of 62 patients (44 with tuberculosis and 18 with sarcoidosis) were analyzed. The median patient age was 55 years. Lymph node involvement in the cervical, abdominal, retro-pancreatic, inguinal, and extrathoracic regions was significantly more prevalent in patients with sarcoidosis than in those with tuberculosis (50% vs 20.5%, P = .0031; 27.8% vs 4.5%, P = .018; 22.2% vs 0%, P = .005; 27.8% vs 6.8%, P = .039; and 66.7% vs 27.3%, P = .009, respectively). No statistically significant difference was found in SUV values between patients with tuberculosis and those with sarcoidosis with regard to mediastinal lymph node, extrathoracic lymph node, lung, and bone PET/CT involvement. In conclusion, 18F-FDG-PET/CT imaging does not appear to be a reliable method for differentiating sarcoidosis and tuberculosis from malignant lesions, as it is not feasible to distinguish between sarcoidosis and tuberculosis solely based on 18F-FDG-PET/CT SUVmax values. Nevertheless, the increased prevalence of extrathoracic lymph node involvement in sarcoidosis compared to tuberculosis may offer valuable insights for clinicians in differential diagnosis.

PMID:40184115 | DOI:10.1097/MD.0000000000041119

Medicine (Baltimore). 2025 Jan 3;104(1):e41129. doi: 10.1097/MD.0000000000041129.

ABSTRACT

Despite the numerous health benefits of physical activity (PA), sedentary behavior (SB) and physical inactivity remain major public health concerns. A lack of PA increases the chance of developing some noncommunicable diseases that are on the rise worldwide. Therefore, this study aimed to evaluate the level of PA, SB, sleep quality (SQ), and quality of life (QOL) among Saudi female college students. A cross-sectional study was carried out among female students enrolled in various colleges, both medical and nonmedical, at King Saud University in Riyadh during the academic year 2018 to 2019. Participation posters were sent to colleges’ departments, and survey links were shared through university social media channels. The study utilized the International Physical Activity Questionnaire and the Pittsburgh Sleep Quality Index to evaluate PA and SQ and the World Health Organization Quality of Life Assessment Instrument to evaluate QOL. In order to conduct statistical analyses, frequency counts, means, and standard deviations were calculated for PA, SQ, and QOL scores. In this study, 131 Saudi female college students were conveniently recruited from 223 who met the inclusion criteria, with a mean age of 20.4 ± 1.4. Most participants were from medical colleges (n = 86, 6, 5.6%) and the minority were nonmedical (n = 45, 34.4%). We have found that International Physical Activity Questionnaire indicated that most students had low PA (52% of the participants), about 35% had a moderate PA, and only 17% had high PA. SB was present among 22.9% of participants. Nearly 68.7% of the students scored poorly on the Pittsburgh Sleep Quality Index for SQ. The students had high QOL, with a mean WHOQOL-BREF total score of 90.76 ± 12.77. Medical and nonmedical students showed no significant differences in PA, SB, or QOL. No apparent relationship was found between PA and SQ or QOL. This study shows that a significant proportion of female college students maintain an unfavorable lifestyle characterized by insufficient PA and subpar SQ. Implementing programs that encourage students to be more physically active, reduce sedentary time, and integrate sleep education programs to improve their sleep habits are necessary.

PMID:40184114 | DOI:10.1097/MD.0000000000041129

Medicine (Baltimore). 2025 Jan 3;104(1):e41145. doi: 10.1097/MD.0000000000041145.

ABSTRACT

OBJECTIVE: To methodically assess the clinical impact of ulinastatin on patients suffering from pulmonary edema.

METHODS: PubMed, Web of Science, Cochrane Library, Embase, Chinese National Knowledge Infrastructure (CNKI), Wanfang data, Chinese Scientific Journal Database (VIP), and Chinese Biomedical Literature Database (CBM) databases were searched using such keywords as ulinastatin, pulmonary edema, and randomized controlled trial (RCT). The search time was from the establishment of the database to August 2023. Two researchers were responsible for literature screening and data collection respectively. After the risk of bias in the included studies was evaluated, meta-analysis was performed using statistical software RevMan 5.4 and GRADE profiler software was used to evaluate evidence quality.

RESULTS: Nine RCTs were included in the meta-analysis. Meta-analysis results showed that compared with conventional treatment group, the incidence of pulmonary edema of the patients in the ulinastatin group decreased, with odds ratios (OR) of 0.36 (95% CI: 0.20, 0.657), extravascular pulmonary water index (EVLWI) decreased, with mean difference (MD) of -0.75 (95% CI: -1.32, -0.17), ventilator use time decreased, with MD of -2.86 (95% CI: -0.26, 0.23), the intensive care unit (ICU) length of stay decreased, with MD of -1.56 (95% CI: -1.75, -1.38). The pulmonary vascular permeability index (PVPI) decreased in ulinastatin group, with MD of -0.10 (95% CI: -0.24, 0.03), but the difference was not statistically significant.

CONCLUSION: Compared with conventional treatment, ulinastatin may reduce the incidence of pulmonary edema, decrease EVLWI, ventilator use time and the ICU length of stay in patients with pulmonary edema, but it could not reduce PVPI.

PMID:40184111 | DOI:10.1097/MD.0000000000041145

Medicine (Baltimore). 2025 Jan 3;104(1):e41113. doi: 10.1097/MD.0000000000041113.

ABSTRACT

To adapt and evaluate the psychometric properties of the SUSESO/ISTAS21 questionnaire for nurses in Spain. Cross-sectional study for the cross-cultural adjustment and psychometric validation of the COPSOQ-ISTAS21 scale. Descriptive analyses were conducted, and data was correlated. A confirmatory factor analysis was performed, thus assessing the reliability and criterion validity. The sample consisted of 2757 Spanish nurses. The exploratory factor analysis identified a 5-factor structure with 15 items, which explained 63.6% of the variance. The factors were named: Support at work; Job satisfaction; Work-related emotional well-being; Job insecurity; and Double presence. The internal consistency of the questionnaire, measured by Cronbach alpha and McDonald omega coefficient, was adequate, with values of 0.764 and 0.741, respectively. The results of the confirmatory factor analysis indicated a good model fit. Three levels of psychosocial risk (low, intermediate, and high) were identified based on percentiles and quartiles of mean scores. The adapted version of the SUSESO/ISTAS21 questionnaire showed reliable psychometric properties in Spanish nurses, making it a valid and robust tool for assessing psychosocial risks in this group.

PMID:40184105 | DOI:10.1097/MD.0000000000041113

Medicine (Baltimore). 2025 Jan 3;104(1):e41229. doi: 10.1097/MD.0000000000041229.

ABSTRACT

Postnatal period is the crucial period for the survival of mothers and neonates. Utilization of postnatal services has been linked with reduction of maternal and neonatal morbidity and mortality. This study used the Health Belief Model to explain factors that influence postnatal services utilization among post-delivery women in Zanzibar. A community-based cross-sectional study design was employed whereas a total of 395 post-delivery women were randomly selected. The study used the Health Belief components to derive operational variables to explain postnatal services utilization. Structured questionnaires and documentary reviews were used to collect data and analyzed using Statistical Package for Social Sciences Version 20. Binary logistic regression analysis was used to establish factors associated with postnatal utilization. The result revealed that only 115 (29.1%) used postnatal services in Zanzibar. After adjusting the confounders (education level, parity, place of delivery, mode of delivery, and maternal complications), variables of the Health Belief Model which showed a significant relationship were perceived benefit AOR = 10.212 at 95% CI = 2.509-41.567, P = .001 and cues of action AOR = 1.958 at 95% CI = 1.05-3.648, P = .034. Other variables of the Health Belief Model showed increased odds (perceived barriers AOR = 1.748 at 95% CI = 0.81-3.771 and perceived susceptibility AOR = 1.795 CI = 0.561-5.74), but they were not statistically significant. Most of postnatal mothers did not utilize postnatal services during the first month post-delivery. Sensitization campaigns such as educational campaigns are recommended to raise the awareness of postnatal women on the benefits of postnatal checkups within the first month of childbirth and hence improve the utilization.

PMID:40184096 | DOI:10.1097/MD.0000000000041229

Medicine (Baltimore). 2025 Jan 3;104(1):e41183. doi: 10.1097/MD.0000000000041183.

ABSTRACT

This study investigates the clinical effect and safety of periosteal distraction in the treatment of senile diabetic foot. The clinical data of 45 patients with diabetic foot treated with periosteal distraction in the Central Hospital of Dalian University of Technology from January 2020 to May 2024 were retrospectively analyzed. Finally, 42 patients were followed up, and 3 patients were lost to follow-up, including 29 males and 13 females, aged (71.17 ± 6.43), (62-84) years respectively. The Wagner grade of the ulcer surface of the affected foot was grade 2 in 25 cases, grade 3 in 13 cases, and grade 4 in 4 cases; the ulcer sites were toes in 18 cases, soles in 14 cases, dorsum of the foot in 8 cases, heels in 1 case, and ankles in 1 case. The toe oxygen saturation, ankle-brachial index (ABI), skin temperature and visual analogue score (VAS) were recorded before operation and at 1 day, 7 days, 14 days, 1 month, 2 months, and 3 months after operation. The therapeutic effect was observed and evaluated in combination with Michigan neurological sign score and lower limb computed tomography angiography. The wound ulcer healing rate, amputation rate and ulcer recurrence were also counted. The toe oxygen saturation, ABI, skin temperature, VAS score and Michigan neurological sign score of all patients were significantly improved after operation compared with those before operation, and the differences were statistically significant (P < .05); After a 3-month post-surgery period, 37 patients were observed to have microcirculation formation in the affected limb, as well as increased and thickened lower extremity arterioles in comparison to pre-surgery conditions, forming an interwoven network. During the follow-up period, 21 patients exhibited healed foot ulcers at 2 months post-surgery, while by the end of the follow-up period, 38 patients had healed foot ulcers, 5 patients had experienced a significant reduction in wound ulcer area, and the overall ulcer healing rate was 90%. Notably, no instances of amputation or ulcer recurrence were observed during treatment. Periosteal distraction is a new surgical method for the treatment of senile diabetic foot ulcer, which can obtain satisfactory short-term efficacy and is worthy of clinical promotion.

PMID:40184093 | DOI:10.1097/MD.0000000000041183

Medicine (Baltimore). 2025 Jan 3;104(1):e41220. doi: 10.1097/MD.0000000000041220.

ABSTRACT

This study compares the efficacy of the TiRobot with traditional external aiming frames in distal locking of femoral intramedullary nails. A cohort of 44 patients, who underwent intramedullary nailing treatment for femoral fractures between October 2020 and October 2023, was retrospectively analyzed. Participants were allocated into 2 groups. The observation group (n = 22) received TiRobot assistance for distal locking of femoral intramedullary nails, and the control group (n = 22) was managed using conventional external aiming frames. Key variables included the first-attempt success rate of distal locking, number of fluoroscopic exposures, time to achieve locking, and volume of intraoperative blood loss. The observation group, assisted by TiRobot, achieved a significantly higher first-attempt success rate of 90.9%, as compared to 54.5% in the control group. All initial failures were subsequently managed manually, with a statistically significant difference noted between the groups (P < .05). Furthermore, the observation group required fewer fluoroscopic exposures (11.00 ± 2.93) than the control group (19.68 ± 16.28) (P < .05). The time to achieve locking was significantly shorter in the observation group (14.05 ± 3.37 min) compared to the control group (24.41 ± 14.93 min) (P < .05). The volume of intraoperative blood loss was reduced in the observation group (54.55 ± 5.54 mL) versus the control group (60.45 ± 11.01 mL) (P < .05). The incorporation of TiRobot in the distal locking of femoral intramedullary nailing prominently enhances the first-attempt success rate, reduces the procedural time and intraoperative blood loss, and diminishes the radiation exposure for both healthcare providers and patients.

PMID:40184090 | DOI:10.1097/MD.0000000000041220

Medicine (Baltimore). 2025 Jan 3;104(1):e41209. doi: 10.1097/MD.0000000000041209.

ABSTRACT

The causal relationship between childhood obesity and osteoporosis is not yet clear. Two-sample randomized Mendelian analysis was applied to examine the causal relationship between childhood obesity and osteoporosis. This study employs a two-sample Mendelian randomization (MR) approach. The single-nucleotide polymorphisms associated with childhood obesity and summary-level data for osteoporosis were selected from publicly published genome-wide association study. The childhood obesity dataset includes individuals under the age of 18 with a body mass index exceeding the 95th percentile, representing both male and female European children. The osteoporosis dataset includes individuals with osteoporosis from the European population (age 0-70), encompassing both genders. MR analysis was primarily conducted via inverse-variance weighted analysis. Quality of our study was assessed according to STROBE-MR guidelines. MR analysis revealed a statistically significant association between childhood obesity and osteoporosis via the inverse-variance weighted method (odds ratio 0.9985, 95% CI [0.9974, 0.9996], P = .0087). Other MR analysis methods also confirmed this result. The heterogeneity analysis and sensitivity analysis show the accuracy and robustness of our results. Our MR study revealed a significant causal relationship between childhood obesity and osteoporosis, indicating that childhood obesity can reduce the incidence of osteoporosis.

PMID:40184084 | DOI:10.1097/MD.0000000000041209

Medicine (Baltimore). 2025 Jan 3;104(1):e40866. doi: 10.1097/MD.0000000000040866.

ABSTRACT

BACKGROUND: To compare the efficacy and safety of robot-assisted laparoscopic hepatectomy (RALH) with laparoscopic hepatectomy (LH) in the treatment of liver tumors.

METHODS: A comprehensive search of English-language literature was conducted in PubMed, Embase, Web of Science, and the Cochrane Library from January 2000 to June 2024. Studies comparing RALH and LH for liver tumors were identified, and after qualitative evaluation, a meta-analysis was performed using Stata 16.0 software.

RESULTS: After applying inclusion and exclusion criteria, 42 articles were included, including 29,969 patients, with 5673 in the RALH group and 24,296 in the LH group. The meta-analysis showed that compared with the LH group, surgery time was longer in the RALH group (MD = 55.33; 95% CI: 34.84-75.83; P < .001), the conversion to open surgery rate was higher (RR = 1.04; 95% CI: 1.03-1.05; P < .001), the total cost was higher (MD = 0.43; 95% CI: 0.14-0.73; P = .004), and the tumor diameter was larger (MD = 0.37; 95% CI: 0.24-0.49; P < .001). Additionally, the R1 resection rate was higher in the RALH group (RR = 1.04; 95% CI: 1.03-1.06; P < .001). However, there were no significant differences between the groups in terms of intraoperative transfusion rate, hepatic hilar occlusion rate, postoperative complications, postoperative hospital stay, mortality rate, malignancy rate, or R0 resection rate (P > .05).

CONCLUSION: Based on current evidence, RALH is safe and effective, although it is associated with higher total costs, increased blood transfusion rates, and longer operative times. However, there were no significant differences between RALH and LH in terms of other outcome indicators, suggesting that both procedures offer similar surgical efficacy and safety. Further clinical randomized controlled trials are needed to confirm these findings.

PMID:40184083 | DOI:10.1097/MD.0000000000040866

Diabetes Obes Metab. 2025 Apr 4. doi: 10.1111/dom.16345. Online ahead of print.

ABSTRACT

AIMS: Proteinuria is a risk factor for end-stage kidney disease (ESKD) and cardiovascular disease (CVD) in patients with diabetes. However, the clinical implications of fluctuating proteinuria are unclear. We investigated the proteinuria burden and the risks of clinical outcomes in patients with diabetes using the Korean National Health Insurance Service database.

MATERIALS AND METHODS: This retrospective cohort study included patients with diabetes who participated in a national health screening between 2015 and 2016, with records of three previous health screenings. Each end-point was followed until 31 December 2022. The proteinuria burden (range: 0-4) was defined as the cumulative number of positive urine protein dipstick tests at each health screening. The outcomes included ESKD, CVD and all-cause mortality.

RESULTS: Among 1 264 699 patients, 86.3%, 9.4%, 2.5%, 1.2% and 0.6% had proteinuria burdens of 0 to 4, respectively. The proteinuria burden and risks of clinical outcomes had dose-dependent associations; compared to proteinuria burden 0, the adjusted hazard ratio (95% confidence interval) of proteinuria burdens 1, 2, 3 and 4, respectively, were as follows: ESKD, 3.539 (3.326-3.766), 9.373 (8.816-9.965), 14.539 (13.652-15.484) and 19.704 (18.412-21.087); CVD, 1.247 (1.214-1.280), 1.530 (1.465-1.599), 1.815 (1.713-1.923) and 2.032 (1.883-2.192); and all-cause mortality, 1.335 (1.302-1.369), 1.703 (1.635-1.774), 1.959 (1.855-2.068) and 2.092 (1.945-2.250). Within the same proteinuria burdens, late-positive proteinuria was associated with worse outcomes than early-positive proteinuria.

CONCLUSIONS: The proteinuria burden was dose-dependently associated with clinical outcomes in patients with diabetes. Even a single positive dipstick test requires active management.

PMID:40183204 | DOI:10.1111/dom.16345