Tag: nevin manimala

Int J Cardiol Heart Vasc. 2025 Sep 13;61:101794. doi: 10.1016/j.ijcha.2025.101794. eCollection 2025 Dec.

ABSTRACT

BACKGROUND: Severe tricuspid regurgitation (TR) is strongly associated with high mortality and morbidity. This meta-analysis aims to compare the outcomes of transcatheter tricuspid valve intervention (TTVI) versus optimal medical treatment (OMT) alone among patients with severe TR.

METHODS: Electronic databases were systematically searched to identify randomized controlled trials (RCTs) and propensity score-matched observational studies comparing TTVI with OMT. The primary outcome was all-cause mortality. Summary estimates were calculated using a random-effects model.

RESULTS: Five studies (3 RCTs, 2 observational; n = 1988 patients) were included. TTVI was associated with a nonsignificant trend toward a lower incidence of all-cause mortality (risk ratio [RR]: 0.70, 95 % confidence interval [CI] 0.48-1.03; P = 0.071), primarily driven by observational studies. TTVI demonstrated significant benefits in terms of TR severity reduction (RR: 7.82, 95 % CI 5.60-10.93; P < 0.0001), enhanced health status as measured by the Kansas City Cardiomyopathy Questionnaire (mean difference: +14.46 points, 95 % CI 11.55-17.38; p < 0.0001), and reduced heart failure (HF) hospitalization rates (RR: 0.73, 95 % CI 0.56-0.96; P = 0.025). However, TTVI was associated with an increased risk of major bleeding (RR: 3.21, 95 % CI 1.61-6.39; P = 0.0009).

CONCLUSION: Among patients with severe TR, TTVI was not statistically associated with a lower incidence of all-cause mortality but was associated with a reduced risk of HF hospitalization, significant reduction in TR severity, and improved quality of life. Future large RCTs with extended follow-up are needed to confirm these findings and identify the subset of patients who benefit the most.Systematic review protocol: CRD420251002402 (PROSPERO).

PMID:41467224 | PMC:PMC12744525 | DOI:10.1016/j.ijcha.2025.101794

JGH Open. 2025 Dec 28;9(12):e70333. doi: 10.1002/jgh3.70333. eCollection 2025 Dec.

ABSTRACT

BACKGROUND: Dyspepsia is a prevalent gastrointestinal disorder with complex pathogenesis involving the gut-brain axis. While alterations in gut microbiota have been linked to dyspepsia, the role of central nervous system metabolites, particularly those in cerebrospinal fluid (CSF), remains unexplored.

OBJECTIVE: To investigate the potential causal relationship between CSF metabolites and dyspepsia using a two-sample Mendelian randomization (MR) approach.

METHODS: We conducted a two-sample MR analysis using genome-wide association study (GWAS) summary statistics. CSF metabolite data were derived from 532 individuals across two cohorts, and dyspepsia outcome data were obtained from the UK Biobank (7586 cases and 353 608 controls). Instrumental variables (SNPs) were selected based on genome-wide significance (p < 5 × 10^-8), with clumping to eliminate linkage disequilibrium. The inverse-variance weighted (IVW) method was the primary analytical approach, supplemented by MR-Egger, weighted median, and weighted mode methods. Sensitivity analyses, including heterogeneity tests and MR-PRESSO, were used to assess the robustness of the findings.

RESULTS: Among 71 CSF metabolites tested, only butyrate (4:0) showed a significant inverse causal association with dyspepsia (IVW OR = 0.997, 95% CI: 0.996-0.998, p < 0.001; P _FDR = 0.007). Sensitivity analyses indicated no evidence of heterogeneity or pleiotropy. Additional enrichment analysis revealed involvement of genes associated with serine-type peptidase and protein catabolic processes.

CONCLUSIONS: Our study provides the first genetic evidence linking elevated CSF butyrate levels to a reduced risk of dyspepsia, highlighting a potential neuroprotective role within the gut-brain axis.

PMID:41467218 | PMC:PMC12744957 | DOI:10.1002/jgh3.70333

Digit Health. 2025 Dec 23;11:20552076251351374. doi: 10.1177/20552076251351374. eCollection 2025 Jan-Dec.

ABSTRACT

BACKGROUND: The UK healthcare system faces challenges due to an ageing population and chronic bed shortages. An acute hospital-at-home (HaH) model of care can offer an alternative for acutely ill patients requiring hospital admission. However, monitoring thesepatients at home presents its own challenges. We used the National Early Warning Score (NEWS) for patients admitted to a HaH to identify deteriorating patients and ensure safe and timely transfer back to hospital when needed.

DESIGN: Retrospective observational cohort study of patients with selected medical conditions admitted to acute HaH, from an NHS district hospital, between 2014 and 2017.

RESULTS: Of the 502 patients admitted to HaH, 443 (88.2%) were successfully treated and discharged, 1 patient died at HaH (an expected death), and 58 (11.5%) required transfer back to hospital and no fatalities reported after transfer. The AUC for total NEWS was significantly lower for non-transferred patients (14.06) compared to transferred patients (24.71) (p < 0.001). 95% of patients treated at HaH rated their care as excellent or good, and 98% were likely to recommend the service.

CONCLUSION: The study confirms the safe and effective use of the NEWS to identify deteriorating patients in an acute HaH setting, enabling timely transfer back and demonstrating that HaH care can be extended to acutely ill patients. This service could serve as an alternative healthcare system for clinically selected patients. It optimizes resource utilization, reduces the burden on acute medicine departments, and enhances patient experience.

PMID:41467212 | PMC:PMC12743804 | DOI:10.1177/20552076251351374

Asian J Urol. 2025 Oct;12(4):504-511. doi: 10.1016/j.ajur.2024.11.001. Epub 2025 Feb 12.

ABSTRACT

OBJECTIVE: This study attempted to compare the laser energy-based enucleation with the mechanical dissection-based enucleation regarding the enucleation efficiency and the functional outcomes.

METHODS: This was a prospective multicenter study including patients with a prostate exceeding 80 g. Thulium laser enucleation of the prostate was conducted using a high-power thulium laser either through mechanical dissection-based enucleation (Group A) or through laser energy-based enucleation (Group B) according to the preoperative randomization. In Group A, the resectoscope sheath beak was used to liberate the prostate adenoma and laser energy was reserved for adhesions and for hemostasis. In Group B, laser energy was implemented throughout the procedure.

RESULTS: Groups A and B included 68 and 71 patients, respectively, for analysis. The mean (standard deviation [SD]) enucleation time was shorter in Group A than in Group B (55.2 [SD 9.4] min vs. 77.3 [SD 12.5] min, p=0.021). The enucleation efficiency and total operative time were statistically different between the two groups (p=0.032 and 0.039, respectively). Black eschars were observed in 21% of Group A and 100% of Group B. A larger percentage of Group B (35%) expressed more storage symptoms in the first 3 months after surgery than that of Group A (13%). There was no statistically significant difference between the two groups regarding the postoperative transient stress urinary incontinence. Additionally, there was no statistically significant difference between the two techniques regarding the overall bleeding, or the hospital stay in patients on antiplatelet or anticoagulant therapy.

CONCLUSION: Both mechanical dissection-based and laser energy-based thulium laser enucleation of the prostate are safe and feasible for successful reduction of bladder outlet resistance. The mechanical dissection-based enucleation technique provides higher enucleation efficiency with lower postoperative transient storage symptoms.

PMID:41467207 | PMC:PMC12744696 | DOI:10.1016/j.ajur.2024.11.001

Asian J Urol. 2025 Oct;12(4):419-421. doi: 10.1016/j.ajur.2024.04.004. Epub 2024 Jun 4.

NO ABSTRACT

PMID:41467205 | PMC:PMC12744695 | DOI:10.1016/j.ajur.2024.04.004

Asian J Urol. 2025 Oct;12(4):462-470. doi: 10.1016/j.ajur.2025.01.005. Epub 2025 Aug 8.

ABSTRACT

OBJECTIVE: We aimed to perform a systematic review and meta-analysis to assess the efficacy of virtual reality (VR) distraction technologies in managing pain and anxiety in patients undergoing cystoscopy procedures.

METHODS: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to July 2024, for studies comparing the use of VR distraction technologies versus no VR distraction in patients undergoing cystoscopy. The primary endpoints evaluated were patient-reported anxiety and procedural pain scores, and post-procedural heart rate (HR). Standardized mean differences (SMDs) and their 95% confidence intervals (CIs) were computed with the use of a random-effects model. The statistical analysis was conducted using Review Manager 5.4.

RESULTS: A total of 575 patients from four randomized controlled trials were included, of whom 289 (50%) underwent the cystoscopy procedure using VR distraction technologies. The mean age of all patients was 57.25 years old, and 395 (69%) of them were male. In our pooled analysis, we did not observe a statistically significant reduction in patient-reported procedural pain (SMD -0.16; 95% CI -0.32-0.00; p=0.060; I ²=0%), anxiety (SMD -0.37; 95% CI -1.65-0.90; p=0.6; I ²=93%), or post-procedural HR (SMD -0.58; 95% CI -1.62-0.45; p=0.3; I ²=97%).

CONCLUSION: In this comprehensive meta-analysis comprising 575 patients who underwent cystoscopy, the use of VR was not associated with a significant difference in pain, anxiety, or HR levels.

PMID:41467201 | PMC:PMC12744748 | DOI:10.1016/j.ajur.2025.01.005

Asian J Urol. 2025 Oct;12(4):529-533. doi: 10.1016/j.ajur.2025.04.002. Epub 2025 Jun 9.

ABSTRACT

OBJECTIVE: To determine possible factors that may increase the complexity of reconstruction of pelvic fracture urethral injury. Prediction of complex repair helps in adequate patient counseling and preparation, and possible referral to high-volume reconstructive surgeons.

METHODS: A series of 30 adult male patients with pelvic fracture urethral injury underwent delayed posterior urethroplasty between January 2021 and December 2023 at the Assiut University Hospital and data were collected from medical records. Retrograde urethrography with voiding cystourethrogram was done 3 months after trauma. Defect length was measured and bladder neck position was verified. Urethroplasty was done using an elaborate perineal approach with inferior wedge pubectomy done in select cases.

RESULTS: Patients’ ages ranged from 19 years to 53 years (median 34 years). The overall success rate of urethroplasty was 80%. Displacement of the bladder neck from the midline was significantly associated with prolonged operative time (p=0.004) and increased blood loss (p=0.002). There were strong positive correlations between preoperative defect length and operative time (r_s =0.84) as well as blood loss (r_s =0.78), which were statistically significant (p=0.001).

CONCLUSION: Lateral bladder neck displacement and longer defect length in preoperative retrograde urethrogram were significantly associated with difficult urethroplasty for pelvic fracture urethral injury.

PMID:41467198 | PMC:PMC12744763 | DOI:10.1016/j.ajur.2025.04.002

iScience. 2025 Nov 19;28(12):114129. doi: 10.1016/j.isci.2025.114129. eCollection 2025 Dec 19.

ABSTRACT

Lung cancer (LC) frequently coexists with cardiometabolic diseases (CMDs), complicating clinical management, but their shared genetic architecture remains largely unknown. Here, we analyzed genome-wide association study (GWAS) statistics for LC and 36 cardiometabolic traits and diseases (CMTs) to determine genetic correlations and shared biological pathways. We further explored underlying mechanisms through the analysis of bulk and single-cell RNA sequencing data and identified potential therapeutic candidates using drug-gene interaction databases. Significant genetic associations were revealed between LC and 16 CMTs, including subarachnoid hemorrhage, peripheral arterial disease, heart failure, and physiological traits (Padj <0.05). The shared genes were identified as enriched in lipid and cholesterol metabolism. Notably, monocyte-derived macrophages (mo-Macs) in lung adenocarcinoma exhibited M2-like polarization under high cholesterol metabolism and rosuvastatin and lovastatin were identified as potential drugs for LC-CMD comorbidities. Our findings demonstrate a role for cholesterol metabolism in LC-CMD comorbidities, offering insights into the underlying mechanisms and potential therapeutic strategies.

PMID:41467185 | PMC:PMC12744264 | DOI:10.1016/j.isci.2025.114129

N Am Spine Soc J. 2025 Nov 15;25:100819. doi: 10.1016/j.xnsj.2025.100819. eCollection 2026 Mar.

ABSTRACT

BACKGROUND: The sagittal alignment of the cervical spine is pivotal for spinal biomechanics, head positioning, and overall spinal balance. This systematic review synthesizes the available evidence on sagittal cervical spine parameters, establishing normative values in asymptomatic populations, evaluating their correlation with health-related quality of life, and exploring biomechanical modeling to understand their functional implications.

METHODS: A systematic literature search was conducted in PubMed/MEDLINE (January 2010-May 2025) following PRISMA guidelines. Key cervical alignment parameters were identified, including C2-C7 Cobb angle, C2-C7 sagittal vertical axis (SVA), T1 slope (T1S), T1 slope minus cervical lordosis (T1S-CL), C2 slope, neck tilt, cranial tilt, and spino-cranial angle (SCA). After screening 500 articles, 20 studies meeting predefined inclusion criteria were analyzed. Data on normative values, correlations with HRQoL scores and findings from biomechanical modeling were extracted. A meta-analysis was performed to establish normative values in the asymptomatic population.

RESULTS: Normative values were derived from meta-analyses, and statistical correlations were used to link the cervical spine parameters under study to HRQoL metrics such as the Neck Disability Index (NDI), EuroQol 5 Dimension (EQ-5D), and Short Form-36 (SF-36). Deviations, particularly C2-C7 SVA > 40 mm and T1S-CL > 15-20°, were significantly associated with reduced HRQoL. Biomechanical modeling techniques, including finite element (FE) and multibody dynamics approaches, provide further insights into spinal loading and stress distribution in the setting of abnormal cervical spinal alignment.

CONCLUSIONS: Quantitative evidence shows that cervical alignment is prognostically decisive rather than merely descriptive. Across several clinical cohorts, a C2-7 sagittal vertical axis > 40 mm or a T1-slope minus cervical-lordosis mismatch > 15-20° consistently predicted clinically meaningful disability as measured by NDI, EQ-5D and SRS-22. These thresholds, supported by biomechanical modelling, define actionable targets for surgical planning, rehabilitation and long-term follow-up. Standardized measurement protocols and patient-specific reference ranges are now the critical next steps to transform these radiographic markers into personalized care pathways and prospective interventional trials.

PMID:41467167 | PMC:PMC12744292 | DOI:10.1016/j.xnsj.2025.100819

Br J Occup Ther. 2025 Jul 28;89(1):54-63. doi: 10.1177/03080226251355461. eCollection 2026 Jan.

ABSTRACT

INTRODUCTION: This study aimed to assess the Turkish version of the Daily Living Self-Efficacy Scale for cultural adaptation, validity, and reliability.

MATERIALS AND METHODS: One hundred and four people with stroke (male 60; female 44) were included in the study. The Turkish Daily Living Self-Efficacy Scale was evaluated for data quality, scaling assumptions, acceptability, test-retest reliability, internal consistency, and divergent validity. The Mini-Mental State Examination, Functional Independence Measure, Epworth Sleepiness Scale, Fatigue Severity Scale, and Frenchay Activities Index tests were administered for divergent validity. Data were analyzed using descriptive statistics, Cronbach’s alpha, intraclass correlation coefficients, and Pearson’s correlation coefficients. The translation and cross-cultural adaptation process followed Beaton’s guidelines.

RESULTS: The response rate was 100% for both test and retest, with no missing data. Following the cross-cultural adaptation, minor modifications were made to enhance cultural relevance. The Cronbach alpha coefficient for internal consistency of the Daily Living Self-Efficacy Scale was 0.979, and the intraclass correlation coefficient for test-retest reliability was 0.990. This indicated high reliability. According to the results of various validity analyses, the Daily Living Self-Efficacy Scale showed a strong correlation with the Functional Independence Measure, Mini-Mental State Examination, Fatigue Severity Scale, and Frenchay Activities Index (r = 0.424-0.617; p < 0.01).

CONCLUSION: This study provides preliminary evidence of the validity and reliability of the Turkish Daily Living Self-Efficacy Scale.

PMID:41467087 | PMC:PMC12743911 | DOI:10.1177/03080226251355461