Tag: nevin manimala

Infection. 2025 Feb 3. doi: 10.1007/s15010-024-02465-w. Online ahead of print.

ABSTRACT

BACKGROUND: Invasive fungal infections (IFI) represent a significant contributor to mortality among sepsis patients in the Intensive Care Unit (ICU). Early diagnosis of IFI is challenging, and currently, there are no predictive tools for identifying sepsis patients who may develop IFI. Our study aims to develop a predictive scoring system to assess the risk of IFI in patients with sepsis admitted to the ICU.

METHODS: A retrospective collection of data from a total of 549 patients was conducted. Data-driven, clinically knowledge-driven, and decision tree models were used to identify predictive variables for risk of IFI in ICU patients with sepsis. Demographic data, vital signs, laboratory values, comorbidities, medication use, and clinical outcomes were all collected. The optimal model was selected based on model performance and clinical utility to establish a risk score.

RESULTS: Among adult patients with sepsis admitted to the ICU, 127 patients (23.1%) developed IFI. The final data-driven model included four predictive factors, the clinically knowledge-driven model included three predictive factors, and the decision tree model included two. Based on the good performance and clinical utility of the clinically knowledge-driven model, it was chosen as the optimal risk scoring model (C-statistics: 0.79 (95% confidence interval (CI): 0.75-0.83); Hosmer-Lemeshow (H-L) test P = 0.884). The ICU sepsis patient invasive fungal infection risk (AMI) score, created based on the clinically knowledge-driven model, includes mechanical ventilation, application of immunosuppressants, and the types of antibiotics used. The C-statistics for this risk score was 0.79 (95% CI:0.75-0.84) with good calibration (H-L test P = 0.992 and see calibration curve: Fig. 2). Moreover, in terms of clinical utility, the decision curve analysis for AMI showed a favorable net benefit.

CONCLUSIONS: The application of the AMI score can effectively distinguish whether ICU sepsis patients will develop IFI, which is beneficial for clinicians to formulate targeted and timely preventive and treatment measures based on the risk of IFI.

PMID:39899210 | DOI:10.1007/s15010-024-02465-w

Indian J Gastroenterol. 2025 Feb 3. doi: 10.1007/s12664-024-01723-x. Online ahead of print.

ABSTRACT

BACKGROUND: Anti-human epidermal growth factor receptor-2 (Her-2/neu) target therapy has substantially improved the disease outcome of patients with breast and gastric/gastroesophageal cancers characterized by Her-2/neu overexpression and/or amplification. Consequently, evaluating Her-2/neu expression in other cancers to predict response to Her-2/neu targeting agents emerges as a crucial approach. We aimed at investigating the positivity rate of this receptor in gallbladder cancer (GBC) and assess the relationship between Her-2/neu status, clinicopathological parameters and survival to identify patients who would benefit most from anti-Her-2/neu-targeted therapy. The Her-2/neu expression was correlated with clinicopathological parameters and survival of GBC cases.

METHODS: Total 235 surgically resected and histopathologically proven primary GBC cases were collected over a five-year period from January 1, 2017, and December 31, 2020. Her-2/neu expression in these cases was analyzed using immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH).

RESULTS: Employing testing algorithms (IHC scoring based on gastric cancer criteria, followed by FISH in equivocal cases), Her-2/neu positivity was identified in 43 (18.29%) GBC cases and was significantly associated with grade I tumors, tumor stage > T2, perineural invasion, surgical margin positivity and advanced TNM stage. The mean survival time for Her-2/neu-positive cases was 14 months (SE, 1.1; 95%CI, 11.7-16.06), while it was 20 months (SE, 0.69; 95%CI, 18.1-20.9) for Her-2-negative cases (p < 0.001).

CONCLUSIONS: Her-2/neu is expressed in about one-fifth of GBC patients and is significantly associated with tumor behavior and patient survival. Utilizing novel targeted agents may hold the key to improving the prognosis of these patients.

PMID:39899204 | DOI:10.1007/s12664-024-01723-x

Egypt Heart J. 2025 Feb 3;77(1):19. doi: 10.1186/s43044-025-00613-7.

ABSTRACT

BACKGROUND: New type of arrhythmia called atrial high-rate episodes (AHREs) has been discovered thanks to the ability of cardiac electronic implantable devices to track, record, and analyze complex arrhythmias. The aim is to determine factors associated with AHRE in HFrEF/CRT patients and the effect of AHRE on functional capacity and quality of life (QoL).

RESULTS: We interrogated 100 patients’ devices to gauge the incidence and burden of AHRE, then assessed their functional capacity using the standard 6-min walk test (6MWT), and evaluated their QoL using the Minnesota Living with HF questionnaire (MLHFQ) score. 34% of patients had AHRE, and 91.2% of them had AF. By multivariate logistic regression analysis, smoking (OR 9.426, 95% CI [1.33, 66.65], P 0.025), higher BMI (OR 1.336, 95% CI [1.09, 1.635], P 0.005), and increased LAVI (OR 1.16, 95% CI [1.063, 1.262], P < 0.001) are independent predictors for AHRE. There was a significant correlation between AHRE and the distance walked during 6MWT when compared to the distance expected for an equivalent healthy individual (82.02 ± 17.22% in the non-AHRE group vs. 75.15 ± 15.78% in the AHRE group, P < 0.001). It was found that AHRE was statistically linked to a higher total MLHFQ score (46.76 ± 9.82 in the AHRE group vs. 36.97 ± 7.76 in the non-AHRE group, P 0.032), with higher physical scores in the AHRE group.

CONCLUSION: AHRE significantly reduces functional status and perceived quality of life in HFrEF patients receiving CRT. Longer than five minutes of AHRE was associated with a higher MLHFQ score and worse performance on the 6MWT. In that patient population, smoking, obesity, and elevated LAVI were independent predictors of AHRE.

PMID:39899192 | DOI:10.1186/s43044-025-00613-7

Int J Comput Assist Radiol Surg. 2025 Feb 3. doi: 10.1007/s11548-025-03327-y. Online ahead of print.

ABSTRACT

Purpose Federated training is often challenging on heterogeneous datasets due to divergent data storage options, inconsistent naming schemes, varied annotation procedures, and disparities in label quality. This is particularly evident in the emerging multi-modal learning paradigms, where dataset harmonization including a uniform data representation and filtering options are of paramount importance.Methods DICOM-structured reports enable the standardized linkage of arbitrary information beyond the imaging domain and can be used within Python deep learning pipelines with highdicom. Building on this, we developed an open platform for data integration with interactive filtering capabilities, thereby simplifying the process of creation of patient cohorts over several sites with consistent multi-modal data.Results In this study, we extend our prior work by showing its applicability to more and divergent data types, as well as streamlining datasets for federated training within an established consortium of eight university hospitals in Germany. We prove its concurrent filtering ability by creating harmonized multi-modal datasets across all locations for predicting the outcome after minimally invasive heart valve replacement. The data include imaging and waveform data (i.e., computed tomography images, electrocardiography scans) as well as annotations (i.e., calcification segmentations, and pointsets), and metadata (i.e., prostheses and pacemaker dependency).Conclusion Structured reports bridge the traditional gap between imaging systems and information systems. Utilizing the inherent DICOM reference system arbitrary data types can be queried concurrently to create meaningful cohorts for multi-centric data analysis. The graphical interface as well as example structured report templates are available at https://github.com/Cardio-AI/fl-multi-modal-dataset-creation .

PMID:39899185 | DOI:10.1007/s11548-025-03327-y

Eat Weight Disord. 2025 Feb 3;30(1):12. doi: 10.1007/s40519-025-01718-3.

ABSTRACT

PURPOSE: Intuitive exercise may foster healthier engagement in physical activity, leading to enhanced well-being and more intuitive eating habits. The Intuitive Exercise Scale (IEXS) was originally developed to assess this construct in English speakers. The IEXS is composed of four scales addressing distinct facets of intuitive exercise: emotional exercise, body trust, exercise rigidity, mindful exercise. The present study aimed to validate an Italian translation of the IEXS, exploring its factorial structure, invariance, internal consistency, and convergent validity.

METHODS: A sample of 1140 women and men (age: M = 45.25, SD = 11.64, range 22-76 years) was recruited from the Italian general population; 61.8% were physically active. Inclusion criteria were being an Italian native speaker and being at least 18 years. The sample was randomly split in two equal halves for the Exploratory Factor Analysis (n = 570; women: 50%; physically active: 61.8%) and the Confirmatory Factor Analysis (n = 570; women: 50%; physically active: 61.8%). Multi-group confirmatory factor analyses were performed to assess invariance among women and men and physically and non-physically active individuals. McDonald’s omega was used to assess internal consistency. Pearson’s correlations were utilized to assess convergent validity.

RESULTS: The Italian IEXS replicated a four-factor structure and showed good invariance among women and men. Invariance among physically and non-physically active individuals was only partially supported. Excellent internal consistency and adequate convergent validity were achieved.

CONCLUSIONS: The IEXS demonstrated to be a valid measure to examine intuitive exercise in the Italian population, replicating and expanding the findings of the English version. Level of evidence Level V, Cross-sectional, Psychometric study.

PMID:39899175 | DOI:10.1007/s40519-025-01718-3

J Am Heart Assoc. 2025 Feb 3:e029950. doi: 10.1161/JAHA.123.029950. Online ahead of print.

ABSTRACT

BACKGROUND: The impact of sex-related differences in coronary atheroma and flow impairment severity on clinical events and costs remains unclear.

METHODS AND RESULTS: This is a secondary analysis of patients with stable coronary artery disease who underwent both coronary computed tomography angiography and fractional flow reserve derived from computed tomography as part of the FORECAST (Fractional Flow Reserve Derived From Computed Tomography Coronary Angiography in the Assessment and Management of Stable Chest Pain) trial, investigating (1) the relationship between coronary stenosis severity on coronary computed tomography angiography and fractional flow reserve derived from computed tomography FFR_CT by sex and (2) the association with revascularization, resource usage, and adverse clinical events. A total of 212 patients (64 female participants [32.1%]) and 1245 vessels were included. There was no significant sex difference in the frequencies of significant coronary artery disease (38.2% of women versus 51.3% of men; P=0.073), but female participants had significantly less coronary flow impairment, according to the presence of at least 1 fractional flow reserve derived from computed tomography≤0.8 (47.0% versus 71.5%; P=0.008). Female subjects underwent fewer revascularization procedures (23.5% versus 42.3%; P=0.014), less coronary artery bypass graft surgery (2.9% versus 13.1%; P=0.025) and were less likely to be on statin treatment (72.0% versus 84.7%; P=0.022) by 9-month follow-up. This resulted in lower overall health care costs for female participants compared with male counterparts (median total cost, £1276 versus £2051; P=0.014). In multivariable Cox analysis the presence of significant coronary artery disease (hazard ratio [HR], 2.91; 95% CI, 1.30-6.51) and having a positive fractional flow reserve derived from computed tomography (HR, 4.11; 95% CI, 1.15-14.69) were independent predictors of major adverse cardiovascular events at 9 months, whereas sex was not statistically significant (p=0.13).

CONCLUSIONS: There are significant sex differences in the anatomico-functional assessment of coronary artery disease leading to differences in clinical management, costs, and adverse events.

PMID:39895531 | DOI:10.1161/JAHA.123.029950

J Am Heart Assoc. 2025 Feb 3:e037567. doi: 10.1161/JAHA.124.037567. Online ahead of print.

ABSTRACT

BACKGROUND: Using machine learning for the phenotyping of patients with heart failure with preserved ejection fraction (HFpEF) has emerged as a novel approach to understanding the pathophysiology and stratifying the patients. Our objective is to perform phenotyping of patients with HFpEF in stable phase and to investigate the phenotypic trajectory from acute worsening phase to stable phase.

METHODS: The present study is a post hoc analysis of the PURSUIT-HFpEF (Prospective Multicenter Observational Study of Patients with Heart Failure with Preserved Ejection Fraction) study. We applied the latent class analysis to the discharge data of patients hospitalized for acute decompensated heart failure.

RESULTS: We finally included patient data of 1100 cases and 63 features in the latent class analysis. All patients were subclassified into 5 phenogroups as follows: Phenotype 1, characterized by better renal function and lower NT-proBNP (N-terminal pro-B-type natriuretic peptide) level [N=325 (29.5%)]; Phenotype 2, higher blood pressure, sinus rhythm, and poor renal function. [N=242 (22.0%)]; Phenotype 3, higher prevalence of atrial fibrillation, higher tricuspid pressure gradient, and lower tricuspid annular plane systolic excursion [N=214 (19.5%)]; Phenotype 4, higher C-reactive protein level and higher tricuspid pressure gradient [N=245 (22.3%)]; and Phenotype 5, poor nutritional status, poor renal function, and higher NT-proBNP level [N=74 (6.7%)]. A particular phenotype observed at the time of discharge was correlated with a distinct phenotype of acute worsening.

CONCLUSIONS: We identified 5 distinct stable phase phenotypes of the patients with HFpEF from the data at discharge. A specific phenotype at discharge was associated with a particular phenotype of acute worsening. This grouping can be a basis for future precision medicine of patients with HFpEF.

REGISTRATION: URL: https://www.umin.ac.jp/ctr/; Unique identifier: UMIN000021831.

PMID:39895530 | DOI:10.1161/JAHA.124.037567

J Am Heart Assoc. 2025 Feb 3:e038484. doi: 10.1161/JAHA.124.038484. Online ahead of print.

ABSTRACT

BACKGROUND: Coronary microvascular dysfunction (CMD), which mimics symptoms of obstructive coronary artery disease, has significant prognostic implications. While epicardial adipose tissue normally has a protective role, increased epicardial adipose tissue is associated with inflammation and may contribute to CMD. However, a direct correlation remains unclear. We aimed to investigate this association.

METHODS AND RESULTS: The CMDR (Coronary Microvascular Disease Registry) is a prospective, 2-center registry that is enrolling patients with angina and nonobstructive coronary artery disease who underwent invasive hemodynamic assessment of the coronary microvasculature. Patients with chest computed tomography within 1 year of CMD evaluation were included. We measured epicardial fat volume (EFV) and calculated the EFV index. Logistic regression analysis was used to investigate the association between EFV and EFV index to CMD. Our study included 130 CMDR patients with associated chest CT; 35 were diagnosed with CMD. The CMD-negative patients were younger than the CMD-positive patients (58.52±11.97 versus 63.37±9.56 years; P=0.033), with numerically fewer women (64.2% versus 74.3%; P=0.279). Univariate regression analysis demonstrated a statistically significant association between EFV index and CMD diagnosis (odds ratio, 1.037 [95% CI, 1.014-1.063]; P=0.003), while no significance was observed for EFV (odds ratio, 1.006 [95% CI, 0.995-1.017]; P=0.292).

CONCLUSIONS: Our results suggest a strong association between EFV index (a significant risk factor) and the presence of CMD. Future studies involving larger cohorts are needed to confirm the association of epicardial adipose tissue with CMD and investigate therapeutic targets to prevent CMD.

REGISTRATION: URL: https://www.clinicaltrials.gov; unique identifier: NCT05960474.

PMID:39895522 | DOI:10.1161/JAHA.124.038484

Clin Exp Optom. 2025 Feb 3:1-8. doi: 10.1080/08164622.2025.2454532. Online ahead of print.

ABSTRACT

CLINICAL RELEVANCE: Resilience is a key enabler for healthcare professionals including optometrists, to cope with adversities and practice self-care. Evaluating the levels of resilience and its associated factors in optometry students can lead to the development of appropriate intervention strategies for academic and professional success.

BACKGROUND: The moderately high prevalence of mental health issues and burnout among optometry students suggests a need to equip the next generation of optometrists with the necessary skills to enhance mental health. Resilience has been shown to mitigate burnout among healthcare professionals and offer personal and professional benefits. Additionally, resilience education during healthcare student training can enhance mental health and wellbeing, leading to better patient care. This study aims to evaluate resilience levels and its associated factors (self-efficacy, mindfulness, positive and negative affect, and coping strategies) in optometry students.

METHODS: Students enrolled in optometry schools across eight institutions in six countries were invited to participate in an online survey within the period of April 2023 – January 2024. The survey comprised of demographic data, existing and validated questionnaires on resilience, self-efficacy, mindfulness, positive and negative affect, and coping strategies. Descriptive statistics and linear regressions were used for analysis.

RESULTS: A total of 294 valid responses were collected. There were no significant differences in resilience scores between countries. Greater resilience (p < 0.05) was associated with older age, higher academic grades and having no financial assistance. Additional predictors of greater resilience included higher self-efficacy, mindfulness, positive affect and acceptance scores, and lower behavioural disengagement scores.

CONCLUSION: Identifying factors that affect resilience in optometry students provides information for targeted strategies that enhance resilience. More work is required to understand the generalisability of these results, impact of culture on resilience, and appropriate intervention methods.

PMID:39895514 | DOI:10.1080/08164622.2025.2454532

Surg Laparosc Endosc Percutan Tech. 2025 Jan 28. doi: 10.1097/SLE.0000000000001200. Online ahead of print.

ABSTRACT

OBJECTIVE: Endoscopic papillary balloon dilation (EPBD), small endoscopic sphincterotomy (EST), and small EST plus EPBD are commonly used as rescue techniques to remove bile duct stones. However, we often encountered challenging cases with non-dilated distal bile ducts, especially in those undergoing EPBD. We aimed to explore the reasons by assessing whether patients without the dilated bile duct had a higher risk of early complications and whether it was impacted by the rescue techniques.

METHODS: We performed a retrospective cohort study by frequency matching design in patients diagnosed with stones in non-dilated distal bile duct who received rescue techniques from July 2016 to June 2022. Besides, patients with stones and without dilatation of the distal bile duct (DDBD) were divided into 3 subgroups according to the rescue technique received. Outcomes were compared between the subgroups.

RESULTS: The non-DDBD group was more likely to develop post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) and hyperamylasemia (HP) than the DDBD group (P < 0.05). Some cases had mild or moderate pancreatitis, but no one in either group developed severe pancreatitis. For subgroup analysis, each technique resulted in complete stone removal; the EPBD group had a higher HP rate than the other subgroups and reached statistical significance: the EPBD group versus the small EST group (P = 0.013) and the EPBD group versus the EPBD plus small EST group (P = 0.008). Although there was no statistical significance, PEP incidence in the EPBD group was 13.7% higher than in other subgroups (P > 0.05/3).

CONCLUSION: Non-DDBD patients have a higher risk for endoscopic retrograde cholangiopancreatography-related pancreatic inflammation. EPBD should be used cautiously due to the significant association with increased rates of PEP and HP. Conversely, small EST and combination therapy are suitable for non-dilated bile duct stones because of their high safety profile and efficacy.

PMID:39895510 | DOI:10.1097/SLE.0000000000001200