Tag: nevin manimala

BMC Ophthalmol. 2025 Oct 7;25(1):551. doi: 10.1186/s12886-025-04394-0.

ABSTRACT

BACKGROUND: Optical coherence tomography angiography (OCTA) has shown promise in assessing microvascular and structural alterations in the retina and optic nerve. This study primarily aimed to evaluate the utility of OCTA in distinguishing aquaporin-4 antibody-positive (AQP4-Ab+) neuromyelitis optica spectrum disorder (NMOSD) patients from healthy controls (HC). Additionally, exploratory analyses were conducted to examine differences between AQP4-Ab + and AQP4-Ab-, all MOG-Ab-negative(double-seronegative) groups in NMOSD patients.

METHODS: We retrospectively analyzed clinical data from NMOSD patients admitted to the Neurology Department of our First Hospital from January 2018 to December 2020. Patients were categorized into AQP4-Ab-positive (AQP4-Ab+) and double-seronegative groups, with an age-matched normal control group. OCTA examinations were conducted to compare differences in optic nerve fiber layer thickness, macular central thickness, optic disc, macular blood flow, and clinical characteristics among the three groups.

RESULTS: There were statistically significant gender differences among the three groups, with a higher proportion of females in the AQP4-Ab + group compared to the other two groups (P < 0.05). Structurally, significant differences were observed in all parameters between the AQP4-Ab + group and healthy controls (HC), as well as between the double-seronegative group and HC (all P < 0.05). Direct comparison between AQP4-Ab + and double-seronegative NMOSD patients revealed significant differences in specific OCTA parameters, including optic disc central vessel density (P < 0.001), inner optic disc ring vessel density (P = 0.010), inner optic disc ring superior vessel density (P = 0.008), and outer macular ring nasal vessel density (P = 0.042). However, most other OCTA parameters showed no statistically significant differences between the antibody-positive and antibody-negative subgroups (P > 0.05). The optic disc vessel density demonstrated the highest diagnostic efficiency overall, with the nasal side vessel density of the optic disc achieving an AUC of 0.829.

CONCLUSION: OCTA exhibits significant clinical utility in diagnosing AQP4-Ab + NMOSD. Differences between AQP4-Ab + and double-seronegative patients were explored and may provide further insight, although further research is required.

TRIAL REGISTRATION: Not applicable.

PMID:41057808 | DOI:10.1186/s12886-025-04394-0

BMC Psychiatry. 2025 Oct 7;25(1):943. doi: 10.1186/s12888-025-07298-x.

ABSTRACT

BACKGROUND: Both suicidal and non-suicidal self-injuring behaviors (NSSI) are common during adolescence In Slovenia, adolescent suicide rates are high, making suicide the leading cause of death in the year 2022 in this age group. These behaviors are influenced by a complex interplay of environmental, psychological, and genetic factors. Previous research has identified risk and protective factors mainly for suicidal behavior in adults, a notable gap in understanding these factors in adolescents remains, especially for NSSI. Notably there is an important lack of effective clinical tools or psychometric assessment methods to reliably assess the risk for either suicidal or NSSI behaviors in acutely hospitalized adolescents.

METHODS AND ANALYSIS: The proposed study uses a mixed-method observational design consisting of a prospective longitudinal cohort component involving adolescents hospitalized for high risk of DSH, and a cross-sectional comparison with a control group of healthy adolescents recruited from primary care settings. It is aimed at identifying genetic, psychosocial, and clinical factors associated with suicidal behaviors and NSSI in adolescents. The study group is recruited from adolescents aged 12-19, admitted to the Intensive Child and Adolescent Psychiatry Unit in Ljubljana due to severe self-harm risk. Exclusion criteria include involuntary treatment, acute psychotic disorders, intellectual disability, severe physical or central nervous system illnesses and acute intoxication. The control group comprises adolescents of comparable age, recruited through regular scheduled health check-ups in Slovenia. Exclusion criteria include suicidality, severe mental disorder, a history of self-harm behavior in a first-degree relative, intellectual disability, severe physical or central nervous system illnesses and acute intoxication. Enrollment runs from February 1, 2023, to December 31, 2025. Participation is voluntary, requiring parental or guardian consent for those 14 or younger. Data collection involves psycho-diagnostic tools assessing demographic, psychopathology, personality traits, trauma and traumatic events, and attachment patterns. Genetic analysis of blood samples will be performed using long-read sequencing to detect DNA methylation and bioinformatic tools for further analyses. Various statistical methods will be used to identify factors potentially linked to suicidality and NSSI. Additionally, the utility of a newly developed tool for the assessment of inpatient self-harm risk (Adolescent Self-Harm Risk Scale; ASHRS) will be tested. The efficacy of the proposed scale will be assessed using data on inpatient self-harm episodes, as well as subsequent suicidal and NSSI behavior collected during follow-ups at 6 and 18 months after the initial inpatient assessment. The study has been approved by the National Medical Ethics Committee of the Republic of Slovenia (No: 0120-507/2022/3) and financed by Slovenian Research Agency grants J3-4534, J5-50176 and P3-0343.

DISCUSSION: This study represents the first longitudinal examination of psychosocial and genetic factors associated with severest suicidal and NSSI behavior in the Slovenian adolescent population. The development of the ASHRS will add to the gap in the quick assessment of inpatient self-harm risk and better inpatient safety for adolescents.

PMID:41057804 | DOI:10.1186/s12888-025-07298-x

BMC Palliat Care. 2025 Oct 7;24(1):243. doi: 10.1186/s12904-025-01892-2.

ABSTRACT

BACKGROUND: People with life-limiting diseases can benefit from early integration of palliative care, yet early identification of these patients is challenging. Emergency Departments (ED) often serve as the initial contact point for hospital admissions due to acute medical problems, providing an opportunity to recognize palliative care needs. This study aims to determine the prevalence of unmet palliative care needs among patients presenting to the ED of a German university hospital and to assess the proportion of these patients already receiving outpatient palliative care services.

METHODS: We conducted a cross-sectional study at the ED of Hannover Medical School over a 30-day period in April and May 2022. All patients aged 18 years or older who were seen by a specialist in either internal medicine or general medicine in the ED were eligible to participate and screened using the Palliative Care and Rapid Emergency Screening Tool (P-CaRES) to identify those with unmet palliative care needs. Data were collected by on-duty physicians. For analysis, we used standard descriptive statistics.

RESULTS: During the study period, 1,122 patients presented to the ED and were seen by a specialist in either internal medicine or general medicine. 1,090 could be included in the study (inclusion rate: 97.1%). At least one life-limiting disease was identified in 280 of the 1,090 patients (25.7%). Of these, 173 patients had two or more potentially unmet palliative care needs, as determined by the P-CaRES screening tool. At the time of assessment, 11.6% of these patients were already receiving outpatient palliative care.

CONCLUSION: A significant proportion of patients presenting to the ED of a university hospital appear to have unmet palliative care needs according to P-CaRES. However, only a small fraction of these patients were known to have pre-existing outpatient palliative care support which could indicate a considerable gap in palliative care provision. Promoting the integrating of palliative care into emergency medicine could substantially enhance patient care by promoting holistic, patient-centred approaches that extend beyond acute medical treatment and facilitate the early implementation of outpatient palliative care services.

PMID:41057801 | DOI:10.1186/s12904-025-01892-2

BMC Psychiatry. 2025 Oct 7;25(1):937. doi: 10.1186/s12888-025-07288-z.

ABSTRACT

AIMS: To investigate the impact of varying levels of chronic stress on the disease-free survival (DFS) and overall survival (OS) of patients with hepatocellular carcinoma (HCC) following curative treatment and establish a comprehensive evaluation index for chronic stress.

METHODS: Ninety HCC patients who underwent curative treatment were assessed for chronic stress using hair cortisol concentration, Stress Score, and the Perceived Stress Scale (PSS-10). The optimal cut-off values for these markers were statistically determined, and correlations among them were analyzed to create the Chronic Stress Index (CSI), which classified patients into high or low chronic stress groups. DFS and OS were compared between the groups. Additionally, a systematic review of literatures on the effects of chronic stress and cancer recurrence was conducted.

RESULTS: The optimal cut-off values of the Stress Score, PSS-10, and hair cortisol concentration were 15.30, 50.00 and 19.70 pg/mg, respectively. Patients with a CSI score of 3 to 4 were classified into the low chronic stress state (LCSS) group, whereas those scoring 5 to 6 were classified into the high chronic stress state (HCSS) group. Patients in the HCSS group had significantly reduced DFS (P < 0.001) and OS (P = 0.033) compared to the LCSS group. The systematic review identified only three clinical trials on chronic stress and cancer recurrence.

CONCLUSION: High chronic stress levels are associated with shorter DFS and OS in HCC patients. The CSI classification effectively categorized the chronic stress state, providing a novel tool for clinical evaluation.

PMID:41057786 | DOI:10.1186/s12888-025-07288-z

Can J Microbiol. 2025 Oct 7. doi: 10.1139/cjm-2025-0153. Online ahead of print.

ABSTRACT

Coinfection and secondary infection by fungi in patients with viral pulmonary infection, especially SARS-CoV-2, are important factors that worsen the prognosis and are associated to increased death rates. This work aims to report the prevalence of Candida isolates in bronchoalveolar and nasopharyngeal samples from suspected COVID-19 patients in the first-second pandemic waves and their antifungal resistance profile. From 2,321 patients, 29.04 % were diagnosed with SARS-CoV-2 infection. The yeast isolation rate of 6.97 % (47/674) from positive SARS-CoV-2 was statistically higher than 4.43% (73/1647) from negative SARS-CoV-2 patients (p=0.0177). Among yeasts, the most prevalent species was Candida albicans (63/120), with four being azole-resistant isolates (6.35%); however other emerging and less susceptible species were also isolated, such as Candida guilliermondii (11), Candida glabrata (5), Candida lusitaniae (4), Candida krusei (1), and Candida norvegensis (1). Here, we highlighted Candida prevalence in respiratory tract, emphasizing the relevance for surveillance in SARS-CoV-2/COVID patients for improvement of management as well as patient outcomes.

PMID:41056573 | DOI:10.1139/cjm-2025-0153

JMIR Form Res. 2025 Oct 7;9:e68710. doi: 10.2196/68710.

ABSTRACT

BACKGROUND: Heart valve surgery is associated with a high risk of perioperative complications. However, current approaches for predicting perioperative complications are all based on preoperative or intraoperative factors, without taking into account the fact that perioperative complications are multifactorial, dynamic, heterogeneous, and interdependent.

OBJECTIVE: We aimed to construct and quantify the association network among multiple perioperative complications to elucidate the possible evolution trajectories.

METHODS: This study used the data from China Cardiac Surgery Registry (CCSR), in which 37,285 patients were included in the analysis. A Bayesian network was used to analyze the associations among 12 complications. Score-based hill-climbing algorithms were used to build the structure and the association between them was quantified using conditional probabilities.

RESULTS: We obtained the network of valve surgery complications. A total of 13 nodes represented complications or death, and 34 arcs with arrows represented the directly dependent relationship between them. We identified clusters of complications that were logically related and not related and quantified the associations. The correlation coefficient between complications increases with the severity of the complications, ranging from 0.01 to 0.41. Meanwhile, the probability of death when multiple complications occurred was calculated. Even mild complications, when progressing to multiple organ dysfunction syndrome, result in a mortality rate of over 90%.

CONCLUSIONS: Our network facilitates the identification of associations among specific complications, which help to develop targeted measures to halt the cascade of complications in patients undergoing the valve surgery.

PMID:41056564 | DOI:10.2196/68710

Hepatology. 2025 Oct 7. doi: 10.1097/HEP.0000000000001558. Online ahead of print.

NO ABSTRACT

PMID:41056560 | DOI:10.1097/HEP.0000000000001558

Ocul Immunol Inflamm. 2025 Oct 7:1-6. doi: 10.1080/09273948.2025.2563170. Online ahead of print.

ABSTRACT

PURPOSE: To assess the association between retinal vasculitis and cerebral stroke and mortality in patients with systemic lupus erythematosus (SLE).

METHODS: Patients with SLE with and without retinal vasculitis were identified in the TriNetX research network. Initially, there were 337,411 patients with SLE and no retinal vasculitis and 570 patients with SLE and retinal vasculitis. After matching to balance age, sex, race, and cardiac risk factors, 540 patients remained in each group. Outcomes evaluated included stroke risk and mortality over a 20-year follow-up. Statistical analysis included risk ratios (RR), Kaplan-Meieranalysis, and Cox proportional hazards modeling.

RESULTS: The 1-year stroke risk was 1.9% in patients without retinal vasculitis and 4.5% with retinal vasculitis. At 5 years, risks were 4.7% and 9.1%; at 10 years, 5.6% and 13.2%; and at 20 years, 7.5% and 17.1%, respectively (p < 0.001). The average weighted stroke risk in patients with and without retinal vasculitis was 8.3% and 3.8%, respectively (RR: 2.19, 95% CI: 1.31-3.68, p = 0.002). Cox regression analysis of stroke risk showed a hazard ratio for retinal vasculitis of 2.25 (95% CI: 1.72-2.94, p < 0.001). Mortality rates over 20 years were 6.9% without retinal vasculitis and 8.3% with retinal vasculitis (RR: 1.21, 95% CI: 0.8 – 1.84, p = 0.3626).

CONCLUSIONS: The presence of retinal vasculitis in patients with SLE significantly increases the risk of stroke over a 20-year period, highlighting the importance of early identification and timely referral of this group of patients.

PMID:41056537 | DOI:10.1080/09273948.2025.2563170

J Trauma Nurs. 2025 Sep 30. doi: 10.1097/JTN.0000000000000884. Online ahead of print.

ABSTRACT

BACKGROUND: The Glasgow Coma Scale has been a standard tool for assessing consciousness in trauma patients for five decades, but its utility is limited by the omission of brainstem reflexes such as pupillary response.

OBJECTIVE: This study aimed to compare the prognostic accuracy of the Pediatric Glasgow Coma Scale (pGCS) and the Pediatric Glasgow Coma Scale – Pupils Score (pGCS-P) in predicting mortality and functional outcomes among pediatric patients with traumatic brain injury (TBI).

METHODS: This single-center observational cohort study was conducted from May 2022 to May 2023 at Bursa Training and Research Hospital, Health Sciences University, Turkey. Pediatric patients (age <18 years) presenting with TBI were evaluated for level of consciousness and pupillary responses on admission. Both the pGCS and pGCS-P scores were calculated for each patient. For patients with anisocoria but preserved light reflexes in both pupils, scoring adjustments were made.

RESULTS: Of the 134 patients studied, 59.7% were male, and the mean (SD) age was 6.3 (5.4) years. In-hospital mortality was 12.7%, and 5.1% had unfavorable functional outcomes (UFOs) at discharge. Both the pGCS-P and pGCS demonstrated excellent ability to predict mortality (AUC, 0.97, 95% CI: 0.94-0.99 and 0.97, 95% CI: 0.94-0.96, respectively). There was no statistically significant difference in prognostic performance between the two scores using either binomial (p = .165) or nonparametric (p = .445) analyses (p >.05).

CONCLUSIONS: In pediatric patients with TBI, the prognostic accuracy of the pGCS with pupil response (pGCS-P) was comparable to that of the pGCS alone for predicting mortality and UFOs. Incorporation of the pupil score did not significantly improve prognostic discrimination in this cohort.

PMID:41056536 | DOI:10.1097/JTN.0000000000000884

Hum Vaccin Immunother. 2025 Dec;21(1):2569738. doi: 10.1080/21645515.2025.2569738. Epub 2025 Oct 7.

ABSTRACT

Female nursing students show high intention yet low uptake of HPV vaccination, which undermines cervical cancer prevention efforts. To examine the mechanisms influencing their vaccination behavior, this study developed and validated an intention-behavior transition model based on Protection Motivation Theory, thereby providing a theoretical foundation for designing targeted interventions and improving vaccination coverage. A total of 631 female nursing students from universities in Wuhan were selected by the convenience sampling method and were surveyed using a General Information Questionnaire, Protection Motivation Questionnaire, and HPV Vaccination Willingness and Behavior Questionnaire, and a structural equation model was constructed using AMOS 24.0 software. 69.3% of the 631 female nursing students had HPV vaccination intention, and 13.3% had vaccination behavior. The results of structural equation model fitting showed that threat appraisal significantly affected female nursing students’ willingness to receive HPV vaccination (β = 0.209, P < .002) and behavior (β = -0.198, P = .002). Coping appraisal significantly influenced their willingness to vaccinate (β = -0.085, P < .008) and behavior (β = -0.170, P < .001). Willingness to vaccinate significantly influenced vaccination behavior (β = 0.627, P < .001). The Protection Motivation Theory is applicable for explaining the decision-making mechanism regarding HPV vaccination among female nursing students, as both threat appraisal and coping appraisal collectively influence the intention-behavior transition process. This study provides theoretical support for formulating immunization promotion policies targeted at this population; however, future research should expand sample diversity to enhance the generalizability of the findings.

PMID:41056529 | DOI:10.1080/21645515.2025.2569738