Tag: nevin manimala

BJOG. 2025 Dec 22. doi: 10.1111/1471-0528.70108. Online ahead of print.

ABSTRACT

BACKGROUND: The levonorgestrel-releasing intrauterine system (LNG-IUS) is a widely used long-term contraceptive with high continuation rates, but acne may lead to discontinuation.

OBJECTIVES: To evaluate the incidence of acne among LNG-IUS users.

SEARCH STRATEGY: A systematic search was conducted in PubMed, Embase, and Cochrane Central from inception to September 2024.

SELECTION CRITERIA: Randomised clinical trials (RCTs) analysing patients of any age using LNG-IUS at 52 mg, 19.5 mg, or 13.5 mg, with acne reported as an outcome, were included.

DATA COLLECTION AND ANALYSIS: Statistical analyses were conducted using OpenMeta. Chi-square and Z-tests assessed differences between groups, and study quality was appraised using the ROB-2 tool.

MAIN RESULTS: Of 587 studies identified, nine RCTs met inclusion criteria, comprising 6305 LNG-IUS users. The overall acne incidence was 15.0% (95% CI 9.8%-20.3%). Among 2295 users of LNG-IUS 52 mg, incidence reached 19.5% (95% CI 5.2%-33.7%), whereas in 2322 users of LNG-IUS 13.5 mg it was 13.1% (95% CI 8.3%-17.9%) (p < 0.001). Two trials evaluated the 19.5 mg device but data were insufficient for pooling. Studies enrolling younger women (mean age ~24 years) reported an incidence of 19.3% (95% CI 11.0%-27.5%). Excluding Suhonen et al. yielded pooled proportions of 11.9% (95% CI 1.1%-22.7%) for LNG-IUS 52 mg users, 10.8% (95% CI 6.1%-15.5%) when all dosages were combined, and 9.9% (95% CI 9.0%-10.9%) among young women. Heterogeneity remained substantial in the overall and dosage-specific analyses (I²≈95%-97%); it was eliminated in the young women subgroup (I² = 0%).

CONCLUSIONS: LNG-IUS 52 mg users showed a higher incidence of acne compared with those using LNG-IUS 13.5 mg. Studies enrolling younger women also showed a higher incidence. These findings suggest that device dosage and age influence acne occurrence among LNG-IUS users.

TRIAL REGISTRATION: PROSPERO registration number: CRD42024588771.

PMID:41424156 | DOI:10.1111/1471-0528.70108

Health Technol Assess. 2025 Dec;29(69):1-113. doi: 10.3310/QNDF3325.

ABSTRACT

BACKGROUND: Community-based optometrists, a major provider of primary eye care in the United Kingdom, are the main source of referrals to hospital eye services. The widespread introduction of optical coherence tomography devices in community practices provides community-based optometrists with an opportunity to identify a broader range of treatable diseases. Standard referral pathways do not effectively filter unnecessary referrals, with misclassification of urgency, and erroneous diagnoses.

OBJECTIVES: To assess the effectiveness of a teleophthalmology referral pathway between community-based optometrists and hospital eye services for retinal diseases. To measure the accuracy of an artificial intelligence decision support system for diagnosis and referral management of retinal disease.

DESIGN: A multicentre, superiority cluster randomised controlled trial to assess the effectiveness of a teleophthalmology referral pathway. A prospective, observational diagnostic accuracy study to measure the performance of artificial intelligence decision support system. A comprehensive economic evaluation was conducted.

SETTINGS: United Kingdom-based community optometry practices with an optical coherence tomography device and hospital eye services.

PARTICIPANTS: Adults requiring referral for retinal disease at the opinion of the community-based optometrists.

INTERVENTIONS: Community optometry practices were randomised 1 : 1 to standard care or teleophthalmology. Referrals sent via the teleophthalmology platform were remotely reviewed by human experts based at the corresponding hospital eye services. A referral decision was provided within 48 hours. Suitable optical coherence tomography scans were solely processed by artificial intelligence decision support system (the ‘Octane’ model).

MAIN OUTCOME MEASURES: Cluster randomised controlled trial’s primary outcome was the proportion of false-positive referrals (not required or not urgent) per arm in overall participants and in referred-only participants against an independent reference standard. Secondary outcomes included the proportion of wrong diagnosis, wrong referral urgency, false-negative referrals, safely triaged referrals for rare diseases, time from referral to consultation and treatment and cost-effectiveness of teleophthalmology. Primary outcome for the artificial intelligence study was the sensitivity and specificity of artificial intelligence referral decisions against the reference standard.

RESULTS: Teleophthalmology significantly reduces the proportion of false-positive urgent referrals by 59% compared to standard care in referred participants. Due to the observed low event rate for false positive referrals, teleophthalmology’s role for reducing false positives overall was inconclusive. No significant difference between arms for safety of referral decisions (false negatives) was found. After accounting for external factors, the time to consultation demonstrated both clinically and statistically significant benefits for the teleophthalmology arm. The time to treatment showed a clinically significant benefit. Of 396 recruited participants, the Octane artificial intelligence model processed images contributed by 204 participants (51.5%). For referral decisions, the model showed comparable sensitivity and specificity against its own preset referral rules (rule-based reference standard) (post hoc analysis), but it showed inferior sensitivity and specificity when compared to human expert assessors making these referral decisions (clinical reference standard) (primary AI analysis). The artificial intelligence model presented challenges relating to its generalisability in a real-world evaluation context.

LIMITATIONS: Technical limitations in optometry practices, lack of ethnicity data.

CONCLUSIONS: Asynchronous teleophthalmology reduces the number of unnecessary urgent referrals, the main drivers of increasing hospital capacity pressures, provides more appropriate referral-to-treatment times and is more cost-effective compared to standard care. The Octane artificial intelligence model could not process images from 48.5% of study participants. Compared to hospital-based experts for referral decisions, Octane was less accurate at making routine and urgent referral decisions and of similar accuracy to community optometrists.

FUTURE WORK: Applied health research, human-artificial intelligence interaction and artificial intelligence clinical trial design.

TRIAL REGISTRATION: This trial is registered as ISRCTN18106677.

FUNDING: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR127773) and is published in full in Health Technology Assessment; Vol. 29, No. 69. See the NIHR Funding and Awards website for further award information.

PMID:41424155 | DOI:10.3310/QNDF3325

Ann Med. 2026 Dec;58(1):2604391. doi: 10.1080/07853890.2025.2604391. Epub 2025 Dec 22.

ABSTRACT

BACKGROUND: Recent reports suggest that the COVID-19 pandemic and associated lockdowns may have influenced the epidemiology of osteoporotic fractures, but results vary across regions and fracture types. The aim of this study was to provide evidence-based insights into the impact of the pandemic on osteoporotic fracture incidence.

METHODS: We searched four databases (PubMed, Embase, Cochrane Library, and Web of Science) up to August 2025 for observational or retrospective studies comparing osteoporotic fracture incidence during the COVID-19 pandemic (2020) with the pre-pandemic period (2019). The primary outcome of interest was the change in fracture incidence, analysed using risk ratios (RR) with 95% confidence intervals (CI) in Review Manager 5.4. Subgroup analyses were performed by sex, geographic region, and fracture type.

RESULTS: Nine studies meeting the inclusion criteria were analysed. Overall, “all types” of osteoporotic fractures showed a significant decrease during the pandemic (RR = 0.85, 95% CI 0.80-0.91, p < 0.0001). Specifically, forearm fractures decreased significantly (RR = 0.87, 95% CI 0.79-0.96, p = 0.002). However, for the most clinically significant fractures, no statistically significant global change was found for hip fractures (RR = 0.93, 95% CI 0.76-1.15, p = 0.14) or vertebral fractures (RR = 1.35, 95% CI 0.85-2.15, p = 0.20). In regional subgroup analysis, hip fracture incidence decreased significantly in South America (RR = 0.79, p = 0.0004) and in both males and females, but no significant change was observed in Europe (RR = 0.92, 95% CI 0.81-1.04, p = 0.17).

CONCLUSION: During the COVID-19 pandemic, there was a decrease in the incidence of minor fractures, such as those of the forearm, likely due to reduced outdoor activity. However, the incidence of major osteoporotic fractures (hip and vertebral) remained stable globally, with significant reductions observed only in specific regions like South America.

PMID:41424145 | DOI:10.1080/07853890.2025.2604391

Contact Dermatitis. 2025 Dec 21. doi: 10.1111/cod.70074. Online ahead of print.

ABSTRACT

Whether atopic dermatitis (AD) is associated with an altered susceptibility to contact sensitization (CS) remains debated. The aim of this systematic review and meta-analysis was to provide updated estimates of the association between AD and CS overall, by population type (general or referred), various demographics and selected allergens. PubMed, Embase and Web of Science were systematically searched for studies published between 2016 and 2025 reporting CS prevalence in individuals with and without AD. Data were combined with a previous systematic review covering studies published between 1982 and 2016. Meta-analyses were performed to calculate pooled odds ratios (ORs). The pooled analyses showed no overall association between AD and CS (OR 1.08, 95% CI: 0.82-1.42), including in referred populations (OR 1.03, 95% CI: 0.76-1.38). In general population studies, CS prevalence was higher among individuals with AD. The association was statistically significant in children and adolescents (OR 1.34, 95% CI: 1.0-1.80) but not in adults. Positive associations were found between AD and CS to Compositae mix and sesquiterpene lactone mix, but not to nickel, cobalt, or chromium. In conclusion, our findings suggest no general association between AD and contact CS, but multiple factors may modify this relationship, underlining the value of patch testing in AD.

PMID:41423749 | DOI:10.1111/cod.70074

Neuro Oncol. 2025 Dec 19:noaf285. doi: 10.1093/neuonc/noaf285. Online ahead of print.

ABSTRACT

BACKGROUND: The utility of chemotherapy for childhood ependymoma is uncertain without a prior randomized trial.

METHODS: ACNS0831, a multi-center phase 3 randomized study conducted through the Children’s Oncology Group (COG), included patients 1-21 years with newly diagnosed intracranial ependymoma. Patients with complete/near total resections (GTR/NTR) or complete response (CR) to induction therapy were randomized to radiation (RT) alone or RT followed by chemotherapy (RT-CHEMO). Primary outcomes were event free survival (EFS) and overall survival (OS). Due to anticipated non-compliance with chemotherapy, an ‘as treated’ analysis was planned. Patients with sub-total resection (STR) were non-randomly assigned to RT-CHEMO. Grade 2 supratentorial tumors, GTR or CR to induction therapy were observed.

RESULTS: Of 449 eligible patients, 325 with GTR/NTR or CR were randomized. Five-year EFS was 63.7% (95% CI 55.1-71.1%) for RT only (n = 161) versus 69.2% (60.8-76.3%) for RT-CHEMO (n = 164) (one-sided log-rank p = 0.299, HR = 0.866). Five-year OS was 86.9% (79.8-91.6%) for RT only versus 88.3% (81.8-92.6%) for RT-CHEMO (one-sided log-rank p-value = 0.172, HR = 0.757). The ‘as treated’ and ‘as randomized’ analysis results were similar. Sixty-three subjects with STR were assigned to RT-CHEMO; 5-year EFS was 33.6% (22·1-45·5%) and OS 74.0% (60.5-83.5%). Supratentorial grade 2 tumors with GTR or CR were observed with a 5-year EFS of 66.9% (49.0-79.7%) and OS of 100%. Molecular classification was provided for 94% (n = 422) of all subjects.

CONCLUSIONS: Primary analysis showed no benefit for maintenance chemotherapy. Further follow-up is important to assess its effect on late relapses. This is the largest cohort of molecularly classified ependymomas treated on a Phase 3 randomized trial.

PMID:41423745 | DOI:10.1093/neuonc/noaf285

Postgrad Med. 2025 Dec 21:1-15. doi: 10.1080/00325481.2025.2603034. Online ahead of print.

ABSTRACT

OBJECTIVES: For many decades, guaifenesin and dextromethorphan have been two of the most well-established and commonly used nonprescription medications to manage cough and cold symptoms. A single source that summarizes the clinical data supporting the use of guaifenesin and dextromethorphan as self-care treatment options in cough and cold could assist healthcare professionals (HCPs) in making informed recommendations to patients. The objective of this narrative review is to discuss the benefits of guaifenesin and dextromethorphan for the management of cough and mucus-related cold symptoms in adults by examining published data on the effectiveness and safety of the products containing these ingredients.

METHODS: Literature searches were performed on PubMed, Embase, and MEDLINE to identify randomized, controlled studies comparing guaifenesin or dextromethorphan treatment with placebo control in adults with cough and cold (mucus) symptoms. Of 36 guaifenesin and 53 dextromethorphan clinical studies initially identified by the literature search, 13 guaifenesin and 19 dextromethorphan publications met the predefined inclusion criteria. Additional studies were identified during manuscript development by reviewing the citations of included articles, for a total of 17 guaifenesin and 21 dextromethorphan publications.

RESULTS: Data from studies of guaifenesin and dextromethorphan either used alone or combined with other active ingredients showed statistically significant improvements compared with placebo control in sputum looseness/adhesiveness and reductions in cough frequency/severity, respectively. A small number of studies did not show significant improvements with study drug compared with placebo control. Conflicting data may originate from differences in study design, patient enrollment, and a relatively high placebo control effect across studies.

CONCLUSION: The data reviewed in this article support the importance of guaifenesin and dextromethorphan in the armamentarium of effective nonprescription treatment options for cough and mucus-related cold symptoms.

PMID:41423743 | DOI:10.1080/00325481.2025.2603034

ACR Open Rheumatol. 2025 Dec;7(12):e70152. doi: 10.1002/acr2.70152.

ABSTRACT

OBJECTIVE: The epidemiology of urinary incontinence (UI) in systemic lupus erythematosus (SLE) remains understudied. We estimated the prevalence and life burden of UI and examined associations of UI with SLE activity and disease damage in a population-based US SLE cohort.

METHODS: Participants (N = 425; mean age, 46.3 years; 82.8% Black; 92.0% women) were recruited from an ongoing adult SLE cohort (October 2019 to May 2022) for a single study visit. UI was assessed via questionnaire and defined as any urinary leakage occurring at least monthly. SLE activity and cumulative organ damage were measured using the Systemic Lupus Activity Questionnaire and Brief Index of Lupus Damage and dichotomized (higher vs lower) at the median score. Logistic regression models adjusted for age, sex, education, and body mass index were used to evaluate associations of SLE activity and cumulative disease damage with UI.

RESULTS: Overall, 36.2% reported UI at least monthly. Of those with UI, 57.7%, 18.8%, and 19.6% reported mixed-type, stress, and urge UI; 39.0% reported that UI was a substantial bother, and 16.2% reported that UI had a substantial impact on daily activities. UI prevalence was higher in women and in participants who were older and who had obesity. Higher disease activity was independently associated with 3-fold higher prevalence odds of UI (odds ratio = 3.02, 95% confidence interval: 1.91-4.76). Higher cumulative disease damage was associated with 36% higher odds of UI, but the association was not statistically significant.

CONCLUSION: UI is common in those with SLE and associated with higher disease activity, highlighting the need for updated clinical UI screening and management strategies in this unique population.

PMID:41423728 | DOI:10.1002/acr2.70152

Zygote. 2025 Dec 22:1-10. doi: 10.1017/S0967199425100245. Online ahead of print.

ABSTRACT

This study aimed to evaluate the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and inactivated virus vaccination on intracytoplasmic sperm injection (ICSI) outcomes in infertile couples. A retrospective case-control study was conducted at the Royan Institute from August 2020 to March 2022. The study included 90 couples in the COVID-19 infection phase and 31 in the vaccination phase. A total of 30 infected but unvaccinated couples were compared to a control group of 60 couples with no COVID-19 infection or vaccination history. Additionally, 31 couples underwent treatment before and after receiving the Sinopharm inactivated vaccine. Key variables analysed included sperm parameters (concentration, motility, progressive motility and morphology), ovarian parameters (antral follicle count, oocyte retrieval), embryological outcomes and pregnancy outcomes. SARS-CoV-2 infection significantly reduced sperm motility (P = 0.02) and progressive motility (P = 0.01) compared to controls. Sperm concentration and morphology showed non-significant declines. Post-vaccination analysis revealed similar but statistically insignificant changes in sperm parameters. Ovarian stimulation parameters and embryological outcomes remained unaffected by both infection and vaccination. Although biochemical, clinical pregnancy and live birth rates were lower among the infected group, these differences did not reach statistical significance (p = 0.16, 0.08 and 0.09). SARS-CoV-2 infection has been associated with impaired sperm progressive motility, which may negatively influence ICSI outcomes. In contrast, vaccination with an inactivated virus does not appear to impact fertility outcomes. These findings provide crucial guidance for physicians and infertile couples managing treatments during and after the pandemic, suggesting the need for extended recovery periods before ART procedures following COVID-19 infection.

PMID:41423724 | DOI:10.1017/S0967199425100245

Contact Dermatitis. 2025 Dec 21. doi: 10.1111/cod.70073. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic actinic dermatitis (CAD) is a photodermatosis associated with contact allergy. Changes in the contact allergen profile in patch-tested CAD patients from our department have been reported over several decades.

OBJECTIVES: To determine the frequency of positive patch tests and allergen profiles in recently investigated CAD patients and compare this to profiles in earlier decades.

METHODS: A retrospective cohort study was undertaken at a tertiary Cutaneous Allergy department between 2011 and 2021. Demographics and 10 allergens with highest positivity in CAD and non-CAD patients were compared.

RESULTS: Patch testing was performed in 309 (88.3%) of 349 CAD patients, with 186 (60.2%) testing positive to any allergen and 8 (2.6%) positive on photo-patch testing. Patients aged > 40 and with Fitzpatrick skin type V-VI were statistically more likely to be patch test positive (age > 40: p = 0.0082; Fitzpatrick skin type: p = 0.0361). Sesquiterpene lactones (SQL) (6.8%) and formaldehyde (4.8%) were amongst the top 10 most frequently positive allergens in CAD but not in non-CAD patients.

CONCLUSION: Allergic contact dermatitis remains prevalent amongst CAD patients, although sensitisation to allergens historically linked to CAD is decreasing. The cause of this is unclear but potentially due to changes in environmental exposures, particularly in younger CAD patients.

PMID:41423722 | DOI:10.1111/cod.70073

Med Phys. 2026 Jan;53(1):e70235. doi: 10.1002/mp.70235.

ABSTRACT

BACKGROUND: Accurate cardiac structure segmentation from echocardiography is essential for quantitative cardiac function assessment in clinical cardiology. However, traditional manual annotation is time-consuming and subjective, and existing automated methods often overlook inter-patient anatomical differences, particularly sex-related variability, limiting their generalizability.

PURPOSE: We propose BTY-Net (Bidirectional Encoder Representations from Transformers (BERT) Text-based Y-shaped Network), a novel automatic segmentation framework designed to incorporate patient-specific attributes, enabling personalized and anatomically adaptive segmentation of echocardiograms.

METHODS: BTY-Net is built upon a Unet3+ backbone combined with a Transformer encoder, incorporates a multi-layer denoising filter to enhance image quality, and employs a pre-trained BERT model to encode patient demographic and acquisition context as natural language embeddings. Experiments were conducted on the Cardiac Acquisitions for Multi-structure Ultrasound segmentation dataset (500 biplane cases, 400/50/50 train/validation/test split). We benchmarked eight state-of-the-art models (e.g., variants of Unet and generative adversarial networks). Dice similarity (Dice) and Hausdorff Distance (HD) served as the primary metrics. Statistical significance was assessed via the Wilcoxon signed-rank test with p < 0.05 as the threshold, and Holm-Bonferroni correction (α = 0.05) was applied for multiple comparisons. The Hedges’ g effect was calculated to quantify the difference.

RESULTS: BTY-Net achieved the highest Dice coefficients across the three cardiac structures (LV endocardium: 0.9316 ± 0.027; LV myocardium: 0.8617 ± 0.050; left atrium: 0.8703 ± 0.086) and the lowest HD values (8.14 ± 3.44, 10.97 ± 7.41, and 11.13 ± 8.16, respectively). Compared with the strongest baseline, BTY-Net improved Dice by up to 0.02-0.03 and reduced HD by approximately 1.1-1.5 mm, with Holm-adjusted p < 0.05 and small-to-medium Hedges’g effect sizes. Across all test cases, BTY-Net yielded the highest agreement with reference ejection fraction (correlation = 0.9119, MAE = 3.40%). Sex-stratified analyses further confirmed stable performance in both male and female subgroups, indicating robust adaptation to anatomical diversity.

CONCLUSIONS: BTY-Net offers an effective and interpretable solution for personalized echocardiographic analysis. By leveraging multimodal fusion of patient information and image data, it enhances segmentation accuracy, and embeds clinically meaningful attention maps, thereby delivering a multimodal, sex-robust and clinically interpretable solution for routine echocardiographic analysis.

PMID:41423714 | DOI:10.1002/mp.70235