Tag: nevin manimala

J Ophthalmic Inflamm Infect. 2025 Jan 14;15(1):6. doi: 10.1186/s12348-025-00453-1.

ABSTRACT

PURPOSE: To identify the macular retinal layer thickness changes in polyarteritis nodosa (PAN) patients without pathological findings appearing in color fundus photography (CFP), and to investigate the correlations with disease durations.

METHODS: A total of 24 PAN patients who had been for 3 years or more and underwent SD-OCT were recruited from the UK Biobank, with exclusions for diabetes, eye disease, or abnormal CFP findings. Only the right eyes were included, with each PAN patient paired one-to-one with a control matched for age, sex, and ethnicity. Paired t-tests or Wilcoxon Signed-Rank tests were used to assess the differences in thickness of different retinal layers between groups, followed by linear regression analysis to evaluate the correlations with disease durations.

RESULTS: PAN patients had significantly thinner retinal nerve fiber layer (RNFL) by 12.27% (mean ± standard deviation = 27.39 ± 8.94 μm for PAN patients and 31.22 ± 5.57 μm for controls, p = 0.048) and thinner outer plexiform and outer nuclear layers (OPL-ONL complex) by 10.67% (44.93 ± 6.59 μm for PAN patients and 50.31 ± 7.60 μm for controls, p = 0.032). Visual acuity and the whole macular thickness showed no statistical difference. The RNFL was thinned by 1.22 μm per year of disease progression (95% confidence interval: 0.12, 2.32, p = 0.042).

CONCLUSIONS: PAN patients without visual impairments or abnormal CFP findings may exhibit significant thinning in RNFL and OPL-ONL complex. SD-OCT may serve as a useful tool for early screening of ophthalmic changes in PAN.

PMID:39808358 | DOI:10.1186/s12348-025-00453-1

Neurosurg Rev. 2025 Jan 14;48(1):46. doi: 10.1007/s10143-025-03198-6.

ABSTRACT

Public and private medical institutes must adhere to the same standards of quality set by the Pakistan Medical & Dental Council (PMDC). However, studies have noted varied learning environments. The current study aims to assess opportunities and compare the differences in perceptions between the two sectors. An online survey was conducted among medical students, interns, and medical officers across Pakistan. Respondents were divided into two groups: private and public sector and the survey responses of the two groups were compared. Descriptive statistical analyses of responses were performed, and a chi-square test was used to obtain the p-values. 2,481 responses were collected (48.6% public vs 51.3% private sector). A higher proportion of public sector respondents reported neurosurgery within their curriculum (71.2% public, 58.9% private) ( p < 0.001), while a greater proportion of private sector respondents had less exposure to neurosurgery clerkships (58.5% public, 71.9% private). A higher proportion from the private sector reported that sufficient mentorship opportunities (38.3% private, 29.5% public) (p < 0.001) were provided by their medical college. More private sector respondents reported lack of work-life balance (39.5% public, 42.4% private), competitive work environment (55.9% public, 61.3% private) (p < 0.001) and financial burden (67.3% private, 60.8% public) (p < 0.001) as major barriers towards pursuing neurosurgery. Our study outlines key areas for improvement from the perspective of the learners themselves. These include increasing exposure to neurosurgery in medical colleges and affiliated hospitals and improving post-graduate training among all sectors. Addressing these concerns of the medical students, interns, recent graduates and medical officers can foster the pursuit of neurosurgery as a career in Pakistan. It is crucial to further investigate medical education in Pakistan and study differences in the public and private education sector globally.

PMID:39808338 | DOI:10.1007/s10143-025-03198-6

Eur Arch Otorhinolaryngol. 2025 Jan 14. doi: 10.1007/s00405-024-09172-0. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to identify factors predicting postoperative ICU admission, the need for orotracheal intubation (OTI), and the occurrence of supraglottic stenosis in children undergoing supraglottoplasty for laryngomalacia.

METHODS: A retrospective analysis was conducted on 31 children (Dear Reviewer, we would have greatly preferred to include a larger sample size. However, as you know, this type of management is rare, and we deliberately selected a 7-year period to ensure a minimum of 30 children while avoiding significant differences in management guidelines over time. Thank you for your understanding.) who underwent supraglottoplasty at Robert Debre University Hospital from February 2016 to June 2023. Patient demographics, medical history, pre- and postoperative findings, and outcomes were evaluated. Statistical analyses were performed using R software.

RESULTS: A total of 60% of patients required ICU admission postoperatively. Factors predictive of ICU admission included a history of genetic anomalies, younger age at surgery, poor weight gain, and preoperative enteral feeding. Among those requiring OTI, significant predictors included a history of neurological disease, abnormal vocal cord mobility, and intraoperative arterial oxygen saturation dropping below 90%. Two patients developed supraglottic stenosis, with a noted correlation to surgical technique and preoperative respiratory severity.

CONCLUSION: While supraglottoplasty is generally safe and effective, specific factors can predict the need for postoperative ICU care and intubation. The findings highlight the importance of thorough preoperative assessments and optimization of gastroesophageal reflux management to mitigate complications.

PMID:39808334 | DOI:10.1007/s00405-024-09172-0

Eur J Trauma Emerg Surg. 2025 Jan 14;51(1):14. doi: 10.1007/s00068-024-02750-1.

ABSTRACT

PURPOSE: This study aims to identify predictors of discharge to post-acute care in geriatric emergency general surgery (EGS) patients.

METHODS: This is a retrospective study of geriatric emergency general surgery (EGS) patients at a tertiary care facility between 2017 and 2018. Inclusion criteria were ≥ 65 years old and presented directly from home. Non-survivors or those admitted from a healthcare facility were excluded. The primary outcome was discharge to home versus post-acute care.

RESULTS: Out of 577 patients, the median age was 74, and 36.9% were discharged to a post-acute care facility. Factors predicting discharge to post-acute care were: mobility aid use (1.92, [1.19-3.11], p = 0.008), cerebrovascular accident (4.67, [1.99-10.94], p < 0.001), delirium (11.06, [2.29-53.43], p = 0.003), pre-operative transfusion (2.39, [1.13-5.08], p = 0.023), fall history (3.74, [1.90-7.36], p < 0.001), AKI (5.42, [2.61-11.25], p < 0.001), and lack of capacity to consent (4.11, [2.10-8.02], p < 0.001). Non-operative management was protective against discharge to post-acute care (0.38, [0.24-0.60], p < 0.001).

CONCLUSION: Early recognition of the role of these factors in influencing discharge disposition may help with clinical decision-making and discharge planning.

PMID:39808317 | DOI:10.1007/s00068-024-02750-1

Eur J Pediatr. 2025 Jan 14;184(2):134. doi: 10.1007/s00431-025-05980-6.

ABSTRACT

We aimed to determine the prevalence of gastroesophageal reflux disease (GERD) and oropharyngeal dysphagia as explanatory diagnoses, risk factors for acid suppression treatment, and risk factors for repeat hospital visit in infants hospitalized after brief resolved unexplained event (BRUE) using a multicenter pediatric database. We performed a multicenter retrospective database study of infants admitted with BRUE in the Pediatric Health Information System between 2016 and 2021. Data included diagnostic testing, explanatory diagnoses, treatment with acid suppression, and related repeat hospital visits within 6 months. Multivariable logistic regression models were used to determine risk factors for treatment with acid suppression and repeat hospital visit. Of 17,558 subjects admitted to 47 hospitals, 34% were given an explanatory diagnosis of GERD and 1.4% oropharyngeal dysphagia. Twelve percent were treated with acid suppression, with some centers having rates as high as 26%. Multiple factors, including most notably the GERD diagnosis, were associated with increased prescribing risk. Ten percent of subjects had repeat hospital visits. Subjects given an explanatory diagnosis of GERD (OR 1.66, 95% CI 1.48-1.86, p < 0.001) or oropharyngeal dysphagia (OR 2.13, 95% CI 1.55-2.91, p < 0.001) had increased risk for repeat hospital visit as did those treated with acid suppression. CONCLUSION: GERD as an explanatory diagnosis was associated with increased risk of repeat hospital visit, despite its conception as a benign, treatable condition. Treatment with acid suppression was common but did not prevent repeat hospitalization. Oropharyngeal dysphagia as an explanatory diagnosis was also associated with increased risk of repeat hospital visit.

PMID:39808308 | DOI:10.1007/s00431-025-05980-6

Diabetologia. 2025 Jan 14. doi: 10.1007/s00125-024-06353-8. Online ahead of print.

ABSTRACT

AIMS/HYPOTHESIS: Existing evidence on the relationship between intake of monounsaturated fatty acids (MUFAs) and type 2 diabetes is conflicting. Few studies have examined whether MUFAs from plant or animal sources (MUFA-Ps and MUFA-As, respectively) exhibit differential associations with type 2 diabetes. We examined associations of intakes of total MUFAs, MUFA-Ps and MUFA-As with type 2 diabetes risk.

METHODS: We used data from 51,290 women in the Nurses’ Health Study (1990-2016), 61,703 women in the Nurses’ Health Study II (1991-2017) and 29,497 men in the Health Professionals Follow-up Study (1990-2016). Using food frequency questionnaires and food composition tables, we calculated MUFA-P and MUFA-A intakes every 4 years and modelled their associations with type 2 diabetes using Cox regression models.

RESULTS: During 3,268,512 person-years of follow-up, we documented 13,211 incident type 2 diabetes cases. After multivariate adjustment, total MUFA intake was associated with higher type 2 diabetes risk, with HR for Q5 vs Q1 of 1.10 (95% CI 1.01, 1.22). MUFA-Ps and MUFA-As demonstrated divergent associations, with HRs of 0.87 (95% CI 0.81, 0.94) and 1.34 (1.23, 1.45), respectively. In substitution analyses, HRs were 0.92 (95% CI 0.86, 0.99) for replacing 2% of energy from trans fatty acids or 0.72 (0.66, 0.78) and 0.82 (0.77, 0.88) for replacing 5% from MUFA-As and 5% from the sum of saturated fatty acids and MUFA-As with MUFA-Ps, respectively. Substituting MUFA-As for saturated fatty acids and refined carbohydrates was associated with a 43% and 33% higher risk, respectively.

CONCLUSIONS/INTERPRETATION: Higher intake of MUFA-Ps was associated with lower type 2 diabetes risk, whereas increased intake of MUFA-As was associated with higher risk. Replacing saturated fatty acids, trans fatty acids and MUFA-As with MUFA-Ps may be beneficial for type 2 diabetes prevention.

PMID:39808307 | DOI:10.1007/s00125-024-06353-8

Protoplasma. 2025 Jan 14. doi: 10.1007/s00709-025-02031-7. Online ahead of print.

ABSTRACT

Stay-green (SG) and stem reserve mobilization (SRM) are two significant mutually exclusive traits, which contributes to grain-filling during drought and heat stress in wheat. The current research was conducted in a genome-wide association study (GWAS) panel consisting of 278 wheat genotypes of advanced breeding lines to find the markers linked with SG and SRM traits and also to screen the superior genotypes. SG and SRM traits, viz. soil plant analysis development (SPAD) value, canopy temperature (CT), normalized difference vegetation index (NDVI), leaf senescence rate (LSR) and stem reserve mobilization efficiency (SRE) were recorded. The trial was conducted in α-lattice design, under control and combined heat and drought stress (HD). Analysis of variance and descriptive statistics showed a significant difference across the evaluated traits. The highest mean of SRE (31.7%) and SRM (0.42 g/stem) was reported in HD, while highest SRE in HD and lowest in control was 52.56% and 15.7%, respectively. Genotyping was carried out using the 35 K Axiom R Wheat Breeder’s Array, 14,625 SNPs were kept after filtering. Through GWAS, 36 significant marker trait associations (MTAs) were identified on 16 distinct chromosomes; out of this, 22 MTAs were found under control and 14 MTAs under HD. Candidate genes that code for UDP-glycosyltransferase 73C4-like and protein detoxification 40-like was linked to SPAD and CT respectively. One MTAs was detected for SRM on chromosome 6B that code for wall associated receptor kinase 4 like. These SNPs can be utilized to generate cultivars that adapt to climate change by a marker-assisted gene transfer.

PMID:39808290 | DOI:10.1007/s00709-025-02031-7

Clin Exp Rheumatol. 2025 Jan 13. doi: 10.55563/clinexprheumatol/gskbin. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess the efficacy and safety of an intra-articular (IA) CLK/DYRK inhibitor, lorecivivint (LOR), for the treatment of moderate to severe symptomatic knee osteoarthritis (OA).

METHODS: This was a Phase 3, 28-week, multicentre, double-blind, placebo-controlled study evaluating the efficacy and safety of a single IA injection of LOR. Patients with ACR-defined knee OA, Kellgren-Lawrence (KL) grades 2-3, and pain Numeric Rating Scale (NRS) ≥4 and ≤8 in the target knee were randomised (1:1) to receive LOR 0.07 mg or vehicle placebo (PBO) on Day 1. The primary endpoint was the change from baseline in Pain NRS at Week 12 between LOR and PBO. Additional outcomes included the change from baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Function, WOMAC Pain, Patient Global Assessment and safety.

RESULTS: 498 patients were randomised, and 51.9% had KL Grade 3 severity. In the full analysis set (FAS), LOR failed to meet the primary endpoint when compared to PBO. No significant treatment differences were noted in other efficacy endpoints. A post-hoc analysis demonstrated a positive treatment effect of LOR relative to PBO in the KL Grade 2 subgroup; the difference in weekly Pain NRS between LOR and PBO groups showed nominal statistical significance at Week 4 (p<0.05). Incidences, seriousness, and severity of adverse events were similar across the treatment groups.

CONCLUSIONS: LOR was well tolerated despite not meeting the primary endpoint. Efficacy signals were identified in patients with less severe structural knee OA disease, suggesting earlier intervention may be more effective.

PMID:39808288 | DOI:10.55563/clinexprheumatol/gskbin

Environ Manage. 2025 Jan 14. doi: 10.1007/s00267-025-02112-6. Online ahead of print.

ABSTRACT

This research assesses heavy metal contamination within the riparian zone of the Danro River, a tributary of the Ganges River basin in India, particularly impacted by sand mining activities. The study conducted analyses on major and trace elements in soil samples, focusing on those identified as ecologically hazardous by the Water Framework Directive of India. Utilizing a combination of indices (Enrichment Factor, Pollution Load Index, and Index of geo-accumulation) and statistical techniques such as Principal Component Analysis (PCA), the investigation aimed to evaluate contamination severity, ecological risks, and pollution sources. Results revealed arsenic concentrations ranging from 0.00-0.54 mg/kg to 117-136 mg/kg, and ecological risks for cadmium exceeding 30. PCA identified three dominant factors explaining over 95% of variance. This study also employed the Analytic Hierarchy Process (AHP) method to assess land use suitability. Results unveiled that chromium and nickel predominantly stemmed from natural origins, while arsenic, cadmium, lead, and zinc exhibited a mixed origin. While most sites displayed low to moderate contamination, south-western portion of the basin demonstrated significantly elevated copper concentrations. Cadmium emerged as a particular concern, posing downstream ecological risks alongside chromium, nickel, and zinc, surpassing established thresholds. Further examination using PCA analysis pinpointed three primary pollution sources: traffic emissions, industrial activities, and natural processes. The research concludes by proposing a novel approach for remediation, including the Miyawaki technique alongside traditional methods like electrokinetic remediation and soil leaching. Policy suggestions advocate for collaborative efforts between economic entities and governments to promote sustainable practices that minimize heavy metal pollution.

PMID:39808281 | DOI:10.1007/s00267-025-02112-6

Pediatr Radiol. 2025 Jan 14. doi: 10.1007/s00247-024-06142-w. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric ultrasound (US)-guided percutaneous liver biopsy is a commonly performed procedure in children, and may be performed in a variety of clinical settings. However, there is little research on the relative costs associated with different sedation methods and locations.

OBJECTIVE: This study uses time-driven activity-based costing (TDABC) to identify relevant costs associated with different biopsy sedation techniques and locations to help inform providers and patients as well as guide value-conscious care. This study analyzes the direct costs associated with pediatric liver biopsy performed in an OR versus a dedicated pediatric sedation clinic.

MATERIALS AND METHODS: A single-center retrospective review including data from consecutive procedures all completed by one board-certified interventional radiology physician between June 2021 and April 2024 was performed. Exclusion criteria included procedures with lack of timestamps (N = 3), and multiple procedures being completed causing a deviation from the standard pathway process (N = 19). Direct costs were calculated using cost capacity rates (CCR) and TDABC methodology. Propensity score matching between procedures performed in a sedation clinic versus an operating room (OR) was performed adjusting for age, gender, American Society of Anesthesiologists (ASA) status, and inpatient status, and subsequent matches were analyzed via paired t-test in SPSS.

RESULTS: A total of 111 procedures performed in the OR (N = 71) or sedation clinic (N = 40) were found and considered for analysis (N = 55 male, N = 56 female; mean age = 9.13, SD = 6.69 years). A technical success rate of 100% and a complication frequency of 5% (N = 3, mean = 13.67, SD = 2.05, all grade 1) were observed. Complication frequency was not statistically significant between the sedation clinic (N = 1) and OR (N = 2) groups (P = 0.28). After propensity matching, N = 58 matched procedures (OR, N = 29; sedation clinic, N = 29) were included. Pre-procedure times in the sedation clinic were shorter in duration (62.11 ± 42.25) than in the OR (111.96 ± 62.11, P < 0.001). Total procedure times were also shorter in duration in the sedation clinic (14.07 ± 4.99) than in the OR (21.76 ± 18.22, P = 0.03). In addition, procedures completed in the OR utilized additional anesthesia staff for an average of 72 min, contributing to overall cost. The average total included costs for matched liver biopsy procedures were $1,089.51 ± 384.34 in the sedation clinic and $2,801.36 ± 1,201.52 in the OR (P < 0.001).

CONCLUSIONS: Liver biopsies completed in the sedation clinic were associated with significantly lower direct costs and were not associated with higher complication rates. These findings provide evidence for promoting pediatric sedation clinics as a safe and cost-effective location to perform liver biopsies in appropriate patients.

PMID:39808273 | DOI:10.1007/s00247-024-06142-w