Tag: nevin manimala

Arthritis Res Ther. 2025 Jan 14;27(1):8. doi: 10.1186/s13075-024-03465-9.

ABSTRACT

BACKGROUND: Axial spondyloarthritis (SpA) leads to structural bone lesions in every part of the vertebral column. These lesions are only partially visualized on conventional radiographs, omitting posterior parts of the vertebral column and the thoracic spine, that may nevertheless contribute to impaired spinal mobility and function in patients with axial SpA.

METHODS: In this prospective and blinded investigation, we assessed the distribution of structural spinal lesions using magnetic resonance imaging (MRI) of the whole spine in 55 patients with axial SpA classified according to the Assessment in Spondyloarthritis International Society (ASAS) criteria. After assessment of spinal mobility and function two blinded radiologists independently evaluated MRIs of 23 vertebral units in every patient. Non-parametric statistical methods, Spearman’s correlation and linear regression models were used to analyze structural lesion distribution and the relationship with clinical spinal mobility and function parameters.

RESULTS: In 55 patients with axial SpA (13 females, average disease duration 14.9 years) 657 ventral and 139 dorsal vertebral body structural bone lesions and, notably, 534 facet joint lesions could be visualized. The median number of lesions per patient was higher in the thoracic (8.5, range 1.0-41.0) than in the lumbar (7.5, range 0.0-27.5) and the cervical spine (3.5, range 0.0-24.5). A negative correlation was noted between the number of osteoproliferative structural bone lesions and impairment of spinal mobility and function in univariate, but not in multivariate analyses.

CONCLUSION: MRI of the whole spine revealed a high prevalence of lesions in dorsal parts of the vertebral column and in the thoracic spine in patients with axial SpA that may not be adequately visualized on conventional radiographs. These findings could further contribute to a better understanding of reduced mobility of the spine typically associated with axial SpA and assist diagnostics.

PMID:39810235 | DOI:10.1186/s13075-024-03465-9

Crit Care. 2025 Jan 14;29(1):23. doi: 10.1186/s13054-024-05222-5.

ABSTRACT

BACKGROUND: Both quantitative and qualitative aspects of muscle status significantly impact clinical outcomes in critically ill patients. Comprehensive monitoring of baseline muscle status and its changes is crucial for risk stratification and management optimization. However, repeatable and accessible indicators are lacking. We hypothesized that creatinine production rate (CPR) could serve as an integrative indicator of skeletal muscle status.

METHODS: We conducted a series of animal and clinical studies. First, animal experiments were performed to determine whether CPR reflects not only muscle volume, but also qualitative muscle properties. We also evaluated the effects of acute systemic inflammation, a common feature of critical illness, on CPR, as well as its impact on muscle volume and metabolism. In clinical studies, we analyzed CPR, calculated based on urinary creatinine excretion and changes in serum creatinine, of critically ill patients. We assessed the factors affecting CPR on ICU admission and its temporal changes. Finally, we evaluated the clinical utility of CPR by examining the associations of the CPR index (CPR divided by height squared) on ICU admission and its changes with one-year survival.

RESULTS: Animal studies revealed that CPR is determined by muscle volume, creatine content, and metabolic status. Systemic inflammation accompanied by muscle loss led to reduced CPR. Moreover, even without muscle loss, systemic inflammation decreased CPR, likely due to metabolic derangements. In ICU patients, CPR on admission strongly correlated with muscle cross-sectional area (CSA), with age and sex as additional significant factors. In contrast, the percent change in CPR showed a weak correlation with muscle CSA changes. Additionally, the acute-phase CPR trajectories did not show a consistent decline, suggesting multifactorial influences. In a cohort of 629 ICU patients, lower baseline CPR index (hazard ratio [HR] 1.125 per 0.1 g/day/m² less, P < .001) and a decrease in CPR over the first three days (HR 1.028 per 5%, P = 0.032) were independently associated with higher one-year mortality.

CONCLUSIONS: CPR represents an integrative indicator of skeletal muscle status in critically ill patients, reflecting both quantitative and qualitative aspects. Monitoring CPR in the ICU may facilitate risk stratification and optimization of patient care.

PMID:39810218 | DOI:10.1186/s13054-024-05222-5

Syst Rev. 2025 Jan 14;14(1):13. doi: 10.1186/s13643-024-02743-6.

ABSTRACT

BACKGROUND: A systematic appraisal of the comparative efficacy and safety profiles of naso-intestinal tube versus gastric tube feeding in the context of enteral nutrition for mechanically ventilated (MV) patients is imperative. Such an evaluation is essential to inform clinical practice, ensuring that the chosen method of nutritional support is both optimal and safe for this patient population.

METHODS: We executed an exhaustive search across PubMed et al. databases to identify randomized controlled trials (RCTs) that scrutinize the role of naso-intestinal and gastric tubes for mechanically ventilated (MV) patients up to May 30, 2024. The process of study selection, quality assessment, and data extraction was conducted independently by two researchers. RevMan 5.3 software was used for meta-analysis.

RESULTS: Our meta-analysis included 8 RCTs, published between 1992 and 2018, encompassing a total of 676 MV patients. The results indicated that naso-intestinal tube feeding, compared to gastric tube feeding, was associated with a significant reduction in the incidence of ventilator-associated pneumonia (VAP) [Risk Ratio (RR) = 0.69, 95% confidence interval (CI) (0.52, 0.92)] and gastric retention (RR = 0.11, 95% CI (0.04, 0.28)). No statistically significant differences were observed in the incidence of aspiration (RR = 0.93, 95% CI (0.35, 2.50)) vomiting (RR = 0.70, 95% CI (0.23, 2.08)), abdominal distension (RR = 0.87, 95% CI (0.29, 2.63)), or diarrhea (RR = 1.10, 95% CI (0.77, 1.55)).

CONCLUSIONS: The current evidence indicates that naso-intestinal tube feeding is efficacious in lowering the incidence of VAP and gastric retention among MV patients, without a corresponding escalation in the risk of adverse events, including aspiration, vomiting, abdominal distension, and diarrhea. These insights significantly augment the existing corpus of knowledge pertaining to the optimization of enteral nutrition strategies for patients on mechanical ventilation.

PMID:39810188 | DOI:10.1186/s13643-024-02743-6

BMC Nurs. 2025 Jan 14;24(1):49. doi: 10.1186/s12912-025-02692-y.

ABSTRACT

OBJECTIVE: The objective of this study is to investigate the effect after the application of Failure Model and Effect Analysis (FMEA) in nursing care for patients who have undergone endoscopic submucosal dissection (ESD).

METHODS: A cohort of 40 patients who underwent ESD between July and September 2023 were selected as the control group, while 42 patients who underwent ESD between October 2023 and June 2024 after implementing FMEA were selected as the observation group. A multidisciplinary team was established based on the FMEA model to analyze and create a nursing flowchart. The 3 primary processes and 13 sub-processes were thoroughly analyzed and assessed to identify potential failure models, possible causes of failure, and consequences for each sub-process. Risk Priority Numbers (RPNs) were calculated to determine priority failure models, including medication and item preparation, specimen collection, equipment/instrument/accessory preparation, and nursing coordination. Corresponding improvement measures were formulated and implemented followed by a subsequent analysis of the effects.

RESULTS: After implementing the improvement measures, there was a significant decrease in RPNs in the observation group when compared with the control group. A statistical significance was observed in context of medication and item preparation (P < 0.001), specimen collection (P < 0.001), equipment/instrument/accessory preparation (P < 0.001), and nursing coordination (P < 0.001).

CONCLUSION: The application of the FMEA model can effectively facilitate early nursing interventions for identified risks in patient who have undergone ESD. By instituting suitable corrective measures for aspects deemed high-risk, this approach significantly diminishes surgical nursing hazards, enhances the quality of nursing care, and guarantees patient safety.

PMID:39810186 | DOI:10.1186/s12912-025-02692-y

BMC Endocr Disord. 2025 Jan 14;25(1):11. doi: 10.1186/s12902-024-01819-7.

ABSTRACT

BACKGROUND: Thyroid hormone plays an important role in accumulating bone development and regulating bone metabolism. It is established that hypothyroidism is linked to increased risk of osteoporosis and fracture. However, the effects of levothyroxine (LT4) treatment on bone for hypothyroid patients remain controversial.

METHODS: A systematical search was conducted of several databases, from inception until December 9, 2022, and updated the search using the same search strategy on October 30, 2024, for studies evaluating the effects of LT4 treatment on bone in hypothyroidism including subclinical hypothyroidism (SCH) and overt hypothyroidism (OH). The data were reported using a random-effects model with a standardized mean difference (SMD) and 95% conference interval (CI).

RESULTS: Thirteen of the 5996 published articles were included in this meta-analysis. No significance was found in bone mineral density (BMD) at the lumbar spine between SCH patients treated with LT4 and control group either at baseline or after intervention. For OH, BMD at the lumbar spine was statistically lower in LT4 treatment group compared with healthy controls (HCs) (SMD: -0.28, 95%CI: -0.55, -0.02, P = 0.040, I² = 52%). There were no differences in BMD at the femoral neck, trochanter, and Ward’s triangle between OH patients treated with LT4 and HCs. In addition, BMD at the lumbar spine was significantly lower in males with OH undergoing LT4 treatment for a duration of less than five years compared to those treated over five years. Nevertheless, no significant differences were found in bone metabolism biomarkers between OH patients treated with LT4 and HCs.

CONCLUSION: This systematic review and meta-analysis demonstrated that there is a slight adverse effect of LT4 replacement therapy on bone and mineral metabolism in patients with OH, while no observed effect was found in SCH patients.

PMID:39810175 | DOI:10.1186/s12902-024-01819-7

BMC Public Health. 2025 Jan 14;25(1):155. doi: 10.1186/s12889-025-21367-6.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has had profound psychophysiological and socioeconomic effects worldwide. COVID-19 anxiety syndrome (CAS) is a specific cluster of maladaptive coping strategies, including perseveration and avoidance behaviours, in response to the perceived threat and fear of COVID-19. CAS is distinct from general COVID-19 anxiety. The level of CAS in the postpandemic era remained unknown. Despite extensive research on general COVID-19 anxiety and COVID-19 vaccine hesitancy (CVH), few studies have investigated the association between CAS and CVH. The present study aimed to assess the level of CAS and the prevalence of CVH and explore the association between CAS and CVH in the general population of Hong Kong.

METHODS: This cross-sectional study was conducted in Hong Kong. Participants were recruited using convenience and snowball sampling methods and completed an online or a paper-based questionnaire comprising two well-validated instruments. The COVID-19 Anxiety Syndrome Scale (C-19ASS), which includes the C-19ASS-P and C-19ASS-A subscales, was used to evaluate CAS in terms of perseveration and avoidance behaviours. The COVID-19 Vaccine Hesitancy Scale (CVHS) was used to determine the presence of CVH.

RESULTS: This study included 389 participants. The median C-19ASS-P and C-19ASS-A scores were 8 (Interquartile range (IQR) 5-13) and 3 (IQR 0-6), respectively. The CVHS scores revealed a CVH prevalence of 68.1%. A significantly larger proportion of participants with CVH rated “hesitant” compared with those without CVH across all the CVHS items. Furthermore, the median C-19ASS-P and C-19ASS-A scores were significantly higher for participants without CVH than for those with CVH.

CONCLUSIONS: Our findings revealed that CAS persists and CVH is common in the postpandemic era and that CAS is associated with CVH. Comprehensive interventions addressing both informational and psychological aspects are needed to increase the rate of vaccine acceptance and to mitigate the effect of CAS on public health outcomes.

PMID:39810174 | DOI:10.1186/s12889-025-21367-6

BMC Public Health. 2025 Jan 14;25(1):149. doi: 10.1186/s12889-025-21299-1.

ABSTRACT

BACKGROUND: Prevalence of metabolic disorders has been increased in recent years around the world. The relationship between Mediterranean diet (MD) with metabolic health status and serum adropin levels has been less examined in Iranian adults. We investigated the association between MD compliance with metabolic health status and adropin hormone in Iranian adults.

METHODS: This observational study was conducted on 527 men and women. Food intakes were evaluated by a validated food frequency questionnaire. Blood pressure and anthropometric parameters were measured. Fasting blood samples were drawn to measure serum adropin concentrations, blood glucose, triglycerides, high-density lipoprotein cholesterol, high sensitive C-reactive protein and insulin. Metabolic unhealthy (MU) status was defined as having ≥ 2 cardio-metabolic risk factors.

RESULTS: After adjustments for potential confounders, subjects in highest versus lowest tertile of MD had 52% lower odds of MU status (OR = 0.48, 95%CI: 0.23-0.97). Stratified analysis revealed a significant association in normal-weight participants (OR = 0.12; 95%CI: 0.02-0.64), but not in those with overweight/obesity (OR = 0.66, 95%CI: 0.27-1.57). By excluding each component of MD, the association disappeared, except for three components (vegetables, nuts and grains). MD adherence was not significantly related to serum adropin levels in multivariable-adjusted model (unstandardized B= -0.19, 95%CI: -4.97, 4.59; P = 0.94). Serum adropin hormone levels were also not substantially different among metabolic healthy versus unhealthy subjects (P = 0.66).

CONCLUSIONS: This cross-sectional study showed an inverse association between adherence to MD and odds of MU status, especially in subjects with normal-weight. Serum adropin concentrations were not associated with MD adherence or metabolic health status.

PMID:39810172 | DOI:10.1186/s12889-025-21299-1

BMC Public Health. 2025 Jan 14;25(1):152. doi: 10.1186/s12889-025-21341-2.

ABSTRACT

In recent years, the government has promoted the increased deployment of automated external defibrillators (AEDs) in public places with dense crowds, which is of great significance for ensuring that residents enjoy equal health rights. However, it is still unclear what factors decision-makers take into account when formulating deployment plans and whether these factors are related to local characteristics such as population distribution and socioeconomic conditions. Taking Shanghai, China as the research area, we adopted the kernel density estimation and spatial autocorrelation analysis to explore the spatial distribution characteristics of AEDs. We constructed a geographically weighted regression (GWR) model to identify the key factors influencing AED deployment. The results showed that AEDs in Shanghai presented obvious clustering distribution characteristics. The GWR model found that the factors considered by decision-makers in different regions when deploying AEDs followed the guidance of existing policies. It was also found that decision-makers in Shanghai mainly deployed more devices in areas with a high density of the elderly population, dense transportation networks, cultural and educational places, and transportation hubs with large population flows. However, it was observed that the city center might lack sufficient preparation for the elderly group. In order to allocate emergency medical resources more reasonably, it is very important to determine the practices of decision-makers in deploying AEDs. The GWR has shown the potential to evaluate and guide the local implementation of deployment plans.

PMID:39810171 | DOI:10.1186/s12889-025-21341-2

Eur J Med Res. 2025 Jan 15;30(1):28. doi: 10.1186/s40001-025-02282-3.

ABSTRACT

INTRODUCTION: Stroke-associated pneumonia (SAP) is a major cause of mortality during the acute phase of stroke. The A²DS² score is widely used to predict SAP risk but does not include 24-h non-contrast computed tomography-Alberta Stroke Program Early CT Score (NCCT-ASPECTS) or red cell distribution width (RDW). We aim to evaluate the added prognostic value of incorporating 24-h NCCT-ASPECTS and RDW into the A²DS² score and to develop a novel prediction model for SAP following thrombolysis.

METHODS: This retrospective cohort study included thrombolyzed AIS patients at Saraburi Hospital, Thailand. The combined A²DS²-MFP model incorporated 24-h NCCT-ASPECTS and RDW, along with non-linear continuous predictors, using multivariable fractional polynomial (MFP) regression. Predictive performance was evaluated using the area under the receiver operating characteristic curve (AuROC), calibration plots, and decision curve analysis (DCA), comparing it with the traditional A²DS² model and a model with continuous predictors. The goodness of fit for logistic regression models in relation to the observed data was determined through the Hosmer-Lemeshow method, and the accuracy of the probability predictions was examined using a calibration curve. Internal validation was performed using a bootstrapping approach. The predicted probability equation obtained from the final model after optimism correction was developed into a web-based application for predicting the risk of SAP, using PHP and JavaScript.

RESULTS: Of 345 AIS patients, 20.3% developed SAP. The combined A²DS²-MFP model demonstrated excellent discriminative performance (AuROC: 0.917) compared to the traditional A²DS² model (AuROC: 0.868) and the model with continuous predictors (AuROC: 0.888). Both the calibration curve and the Hosmer-Lemeshow test indicated that the predicted probabilities and observed frequencies were in acceptable agreement. Incorporating 24-h NCCT-ASPECTS and RDW significantly improved risk prediction and clinical utility, as shown by improved reclassification indices and DCA. The model was internally validated with a C-statistic of 0.912, confirming its robustness.

CONCLUSIONS: The combined A²DS²-MFP calculation showed superior performance, enabling early SAP detection and improving survival outcomes. This novel model offers a practical tool for resource-limited settings, supporting better SAP risk stratification and clinical management.

PMID:39810169 | DOI:10.1186/s40001-025-02282-3

BMC Health Serv Res. 2025 Jan 14;25(1):78. doi: 10.1186/s12913-024-12148-9.

ABSTRACT

BACKGROUND: Pay-for-performance system (P4P) has been in operation in the Turkish healthcare sector since 2004. While the government defended that it encouraged healthcare professionals’ job motivation, and improved patient satisfaction by increasing efficiency and service quality, healthcare professionals have emphasized the system’s negative effects on working conditions, physicians’ trustworthiness, and cost-quality outcomes. In this study, we investigated physicians’ accounts of current working conditions, their status as a moral agent, and their professional attitudes in the context of P4P’s perceived effects on their professional, social, private, and future lives.

METHODS: First, we held 3 focus groups with 19 residents and 1 specialist regarding their lived experiences under P4P and thematically analyzed the transcripts. Second, we developed a questionnaire to assess how generalizable the qualitative findings are for a broader group of physicians. The tool has three parts questioning 1) demographic information, 2) working conditions, and 3) perceived consequences and effects of P4P. 2136 physicians responded to the survey. After refining the data, we conducted the statistical analysis over 1378 responses by using Spearman’s correlation coefficient, exploratory factor analysis (EFA) for categorical data, and Kruskal-Wallis variance analysis.

RESULTS: Thematic analysis revealed two dimensions: 1) factors leading to estrangement, and 2) manifestations of estrangement. As for the initial, participants thought that P4P affected relationships at work; family and social relationships; working conditions; quality of the specialty training; quality of healthcare services; and it caused healthcare system-related consequences. Concerning the latter, the following themes emerged: Estrangement of the physician; damaging effects on physician’s psychology; physician’s perception of their future life; and physician as a moral agent. According to EFA, a 5-factor structure was appropriate: F1) Estrangement; F2) adverse effects on the physician’s quality of life; F3) favorable consequences; F4) physicians becoming disreputable; F5) unfavorable consequences.

CONCLUSIONS: The findings suggest that under P4P, physicians have become more estranged towards their profession, their patients, and themselves. They suffer from deteriorating working conditions, lack of motivation, lack of work-related satisfaction, and hopelessness regarding their future. Furthermore, P4P impairs their ability to realize themselves as moral subjects practicing in alignment with professional values and principles.

PMID:39810168 | DOI:10.1186/s12913-024-12148-9