Tag: nevin manimala

J Neurosurg. 2025 Feb 14:1-12. doi: 10.3171/2024.9.JNS241175. Online ahead of print.

ABSTRACT

OBJECTIVE: Patients with autosomal dominant polycystic kidney disease (ADPKD) have been identified to have a significantly increased risk of developing intracranial aneurysms (IAs). These patients are diagnosed at younger ages and are also at increased risk for IA rupture. The objective of this systematic review and meta-analysis was to identify risk factors associated with IA detection during screening of asymptomatic ADPKD patients.

METHODS: The authors searched for studies reporting the prevalence of IA among patients with ADPKD screened using MRA, CTA, or DSA on PubMed, Embase, Google Scholar, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov prior to August 2023 by using individualized standardized search strategies. Eligibility of all retrieved studies was assessed according to the PRISMA guidelines. Risk of bias of the included observational studies was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed using a random-effects model.

RESULTS: Twenty-four observational studies involving 5907 patients with ADPKD were identified for quantitative analysis. The authors observed an overall prevalence of IA of 12.6%. They identified several risk factors for IA with statistically significantly increased odds for unruptured IA (UIA) detection, including female sex (18 studies, OR 1.63, 95% CI 1.37-1.94, I2 = 0%), family history of either IA or subarachnoid hemorrhage (SAH) (12 studies, OR 2.17, 95% CI 1.68-2.81, I2 = 0%), family history of SAH (3 studies, OR 2.67, 95% CI 1.25-5.71, I2 = 66.0%), stage 3 or greater chronic kidney disease (CKD) (4 studies, OR 2.55, 95% CI 1.84-3.54, I2 = 0%), and hypertension (13 studies, OR 1.41, 95% CI 1.04-1.91, I2 = 34%). Age > 45 years, family history of ADPKD, smoking status, and presence of liver cysts did not reach statistical significance as risk factors during this meta-analysis.

CONCLUSIONS: The results of the authors’ meta-analysis suggest increased risk of UIA detection in screening of ADPKD patients who are female, have a family history of IA or SAH, have hypertension, or have moderate or more severe CKD. Given the increased prevalence of IA in ADPKD patients with these risk factors, these patients may stand to benefit from screening for IA early in treatment or at time of diagnosis, even if neurologically asymptomatic.

PMID:39951701 | DOI:10.3171/2024.9.JNS241175

J Med Internet Res. 2025 Feb 14;27:e64017. doi: 10.2196/64017.

ABSTRACT

BACKGROUND: Gender-affirming hormone therapy (GAHT) has shown potential for improving mental health outcomes among transgender and gender-diverse adults. How clinical outcomes change among adults receiving GAHT via telehealth across the United States is not well known.

OBJECTIVE: This study evaluated the relationship between initiating GAHT via a telehealth clinic and changes in depression, anxiety, and suicide ideation over a 3-month period.

METHODS: This cohort study evaluated the relationship between initiating GAHT via a telehealth clinic and changes in mental health over a 3-month period. Data were collected at baseline and 3 months later among adults who had their first GAHT visit between August and November 2023. The study included adults aged 18 years and older initiating GAHT for the first time, with a final sample of 342 adults across 43 states (192 initiated estrogen and 150 initiated testosterone therapy). The primary outcomes were depression symptoms using the Patient Health Questionnaire-9 (PHQ-9), anxiety symptoms using the General Anxiety Disorder-7 (GAD-7), and suicide ideation in the past 2 weeks.

RESULTS: Before GAHT initiation, 40% (136/342) of participants reported depression (PHQ-9 ≥10), 36% (120/342) reported anxiety (GAD-7 ≥8), and 25% (91/342) reported suicidal ideation. By follow-up, significant reductions were observed in PHQ-9 (-2.4, 95% CI -3.0 to -1.8) and GAD-7 scores (-1.5, 95% CI -2.0 to -1.0). Among those with elevated symptoms, 40% (48/120) to 42% (56/133) achieved a clinically meaningful response (≥50% reduction in baseline scores), and 27% (36/133) to 28% (33/120) achieved remission (PHQ-9 or GAD-7 score <5). Of those with suicide ideation at baseline, 60% (50/83) had none at follow-up.

CONCLUSIONS: This study highlights the important relationship between telehealth-delivered GAHT and mental health, emphasizing the importance of accessible and timely care.

PMID:39951700 | DOI:10.2196/64017

Neurology. 2025 Mar 11;104(5):e213401. doi: 10.1212/WNL.0000000000213401. Epub 2025 Feb 14.

ABSTRACT

BACKGROUND AND OBJECTIVES: With upcoming clinical trials targeting preclinical stages of genetic frontotemporal dementia (FTD), early detection through cognitive screening is crucial. The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) have potential as screening instruments for early-stage genetic FTD. However, no comparative evaluation has been performed. We aimed to compare MMSE and MoCA performance among presymptomatic, prodromal, and symptomatic pathogenic variant carriers to analyze which screening test has superior discriminative abilities.

METHODS: We used cross-sectional and longitudinal data from 2 longitudinal genetic FTD cohort studies in the Netherlands and the United Kingdom, collected between 2021 and 2024. Participants were either presymptomatic, prodromal, or symptomatic pathogenic variant carriers or healthy controls (first-degree family members without pathogenic variants for FTD). Grouping was based on the global CDR-plus-NACC-FTLD score. Participants were assessed with both MoCA and MMSE. Statistical analyses compared total and subscores between groups and evaluated predictive and classification accuracy of both tests.

RESULTS: A total of 243 participants (mean age 49.9 ± 13.1 years, mean education 14.5 ± 3.0 years, 56% female), 157 of whom were pathogenic variant carriers (MAPT, GRN, C9orf72, TARDBP, and TBK1) and 86 controls, were included. Carriers were classified as presymptomatic (n = 119), prodromal (n = 18), or symptomatic (n = 20). Both MoCA [F(3,239) = 16.565, p < 0.001] and MMSE [F(3,239) = 13.529, p < 0.001] total scores differed significantly between groups, with controls (median MoCA 28.5, 95% CI 28.0-29.0; median MMSE 30, 95% CI 30.0-30.0) outperforming prodromal (median MoCA 26, 95% CI 23.0-27.0; median MMSE 29, 95% CI 27.5-29.5) and symptomatic (median MoCA 20.5, 95% CI 17.0-24.0; median MMSE 26, 95% CI 23.5-29.0) carriers. MoCA distinguished between presymptomatic carriers and controls (median MoCA 28, 95% CI 27.0-29.0), but MMSE did not. MoCA demonstrated superior discriminative ability compared with MMSE (MoCA area under the curve [AUC] = 0.87, 95% CI 0.81-0.94; MMSE AUC = 0.80, 95% CI 0.72-0.89).

DISCUSSION: Its higher sensitivity and better discriminative power make MoCA a more valuable tool for cognitive screening in upcoming clinical trials targeting preclinical FTD. Future studies should aim for larger sample sizes from additional study centers.

PMID:39951678 | DOI:10.1212/WNL.0000000000213401

Otol Neurotol. 2025 Mar 1;46(3):308-313. doi: 10.1097/MAO.0000000000004408. Epub 2024 Dec 24.

ABSTRACT

OBJECTIVES: To assess a decade of experience of treating patients with high hearing risk cerebellopontine angle (CPA) epidermoid lesions and examine factors influencing postoperative outcomes, particularly hearing preservation.

STUDY DESIGN: Retrospective chart review.

SETTING: Single tertiary-referral center.

PATIENTS: Adults with CPA epidermoid lesions who presented with hearing loss or evidence of lesion involving vestibulocochlear nerve.

INTERVENTIONS: The studied intervention was microsurgical resection.

MAIN OUTCOME MEASURES: Main outcome measures included extent of resection, hearing preservation rate for patients with postoperative audiograms, and disease progression.

RESULTS: Twenty-three adults with an average tumor volume of 15.63 ± 16.2 cm3 were included. Five lesions (22%) involved the full internal auditory canal (IAC), 11 (48%) had partial involvement, and 5 (22%) were IAC sparing. Most patients with IAC involvement (88%) had circumferential invasion of the canal. Patients underwent either a retrosigmoid (18, 79%) or combined retrolabyrinthine transpetrosal approach (5, 22%), and gross total resection was achieved in most cases (13, 57%). Of 12 patients with postoperative audiograms, 10 (83%) had preoperative hearing preserved. There was no statistically significant change in hearing scores with treatment based on preoperative extent of IAC involvement. Ten patients (43%) had residual lesions postoperatively, and 6 exhibited progression. One patient ultimately required reoperation 6 years after initial surgery.

CONCLUSIONS: Preoperative hearing was preserved in the majority of the patients who underwent resection of CPA epidermoids via a retrosigmoid or transpetrosal approach. CPA epidermoids often invaded the IAC; however, degree of invasion was not associated with hearing outcomes.

PMID:39951666 | DOI:10.1097/MAO.0000000000004408

Otol Neurotol. 2025 Mar 1;46(3):e74-e80. doi: 10.1097/MAO.0000000000004424. Epub 2025 Jan 22.

ABSTRACT

OBJECTIVE: Chronic suppurative otitis media (CSOM) is typically classified into two distinct types: CSOM (without cholestetoma) and CSOM with cholesteatoma (CCSOM). The main microbial agents in both types are Pseudomonas aeruginosa, Staphylococcus aureus, and Klebsiella pneumoniae. It is believed that the virulence of the infecting microorganisms and their biofilm production capacity play a role in the chronicity and persistence of the disease. The aim of this study was to investigate the pathogen microorganisms with their biofilm formation in CSOM, CCSOM, and their recidivism.

MATERIALS AND METHODS: A cohort of 57 patients was separated into four subgroups as primary CSOM (CSOM, CCSOM) and postoperatively recurring/residual CSOM [(R)CSOM, (R)CCSOM] groups. A control group was formed of 10 patients who underwent tympanotomy for conductive hearing loss without any known past/present ear inflammation. In all 67 patients, ear swabs for culture and the tissue samples for biofilm studies were obtained pre- or intraoperatively.

RESULTS: The most common bacteria grown in the culture mediums were Pseudomonas spp., S. aureus, coagulase-negative Staphylococcus, and coliform bacteria. In the SEM study, biofilms were detected in 9 of 15 CCSOM and 6 of 14 CSOM, and in 13 of 14 (R)CCSOM and 11 of 14 (R)CSOM ears. Statistical analysis showed significantly higher rates of biofilm formation in both recidivist cholesteatomatous and noncholesteatomatous CSOM groups than their primary counterpart groups.

CONCLUSION: The findings that biofilm is more prevalent in the recidivist cases substantiated that biofilm formation is correlated with the persistence and additionally aggressiveness of the disease in both CSOM types. S. aureus appeared as the leading biofilm-producing bacterium.

PMID:39951665 | DOI:10.1097/MAO.0000000000004424

J Low Genit Tract Dis. 2025 Feb 14. doi: 10.1097/LGT.0000000000000879. Online ahead of print.

ABSTRACT

OBJECTIVE: Lichen planus (LP) is a chronic inflammatory skin disease that may affect the skin, scalp, nails, and mucosa. The aim of this study was to investigate the risk of genital premalignant and malignant conditions in patients with anogenital LP (agLP).

METHODS: We identified 60 male and 56 female patients with agLP by searching the biobank archives for a genital or perianal skin biopsy showing LP between 2004 and 2020. We also included 10 randomly selected age- and sex-matched controls for each patient. The risks of genital cancers and their precursors were evaluated.

RESULTS: The incidence of agLP was 1.54 per 100,000 men and 1.36 per 100,000 women. There was no statistical difference between male and female incidence (p = .5721). The odds ratio (OR) for high-grade squamous intraepithelial lesion (HSIL) of the vulva was 31.2 (95% CI = 2.46-1645.00; p = .01). The OR for penile neoplasias could not be calculated because control patients had no neoplasias, but the difference was suggestive of statistical significance (95% CI = 1.90-infinite; p = .008). The mean age at the time of diagnosis of agLP was 59.9 years (median 62 years) in female patients and 40.8 years (median 33 years) in male patients. The difference in the mean ages of female and male patients was statistically significant (95% CI = 11.92-26.13; p < .001).

CONCLUSIONS: Patients with agLP may have an increased risk for vulvar HSIL and penile neoplasia.

PMID:39951645 | DOI:10.1097/LGT.0000000000000879

Pol Merkur Lekarski. 2024;52(6):744-748. doi: 10.36740/Merkur202406119.

ABSTRACT

OBJECTIVE: Aim: This article aims to raise awareness and stimulate serious discussion of the negative impact of criminal law regulation on the prevention and treatment of infectious diseases, including HIV/AIDS, tuberculosis, and sexually transmitted diseases..

PATIENTS AND METHODS: Materials and Methods: The study was conducted in 2024 and based on the empirical and analytical data of the Joint United Nations Programme on HIV/AIDS, the World Health Organization, the legal positions of the ECHR, legal practice and statistics of Ukraine, legal acts of the Ukraine, Germany, Estonia, Lithuania, and Poland. In total, 21 laws, drafts of laws, other documents, and 26 court decisions were analysed. Analytical, comparative, synthetic, systemic, sociological, induction, and deduction research methods were applied.

CONCLUSION: Conclusions: Criminal law should consider the latest medical research results when determining the boundaries of criminal law regulation. It is necessary to proceed from the principle of necessity in a democratic society when deciding on the criminalization of the transmission of HIV, tuberculosis, sexually transmitted diseases, COVID-19, and other infectious diseases. Based on this principle, decriminalization is necessary: a) infection with a disease that does not pose a serious danger; b) placing a person in danger of being infected with an infectious disease if such consequences did not occur and the person did not intend to become infected with such a disease.

PMID:39951644 | DOI:10.36740/Merkur202406119

Pol Merkur Lekarski. 2024;52(6):711-717. doi: 10.36740/Merkur202406114.

ABSTRACT

OBJECTIVE: Aim: To develop and test a methodology for conducting a meta-analysis of studies on the mental state of Ukrainian students under martial law to determine and summarise their results..

PATIENTS AND METHODS: Materials and Methods: The developed methodology of meta-analysis involves: determining the criteria for inclusion/exclusion of materials published by Ukrainian researchers in February 2022 – April 2024; search, selection, and assessment of content and quality; selection and interpretation of interdisciplinary analytical and operational meta-analysis tools (the concept of Effect Zize and Standardised Index; Fixed- and Random-Effects Models; chi-square and Q homogeneity test; actor-observer asymmetry effect; standard PHQ-9 GAD-7 methods); assessment of statistical heterogeneity of research results; preparation of a meta-analytical report.

RESULTS: Results: The search resulted in 135 articles on the issue. After the initial processing, 43 studies were selected for further analysis. They were structured and characterised according to the following criteria and features: types of research; time it was conducted; its authors; participants in sociological and experimental studies. The reflection of the dominant mental states (stress, anxiety, fear, depression, oppression, pessimism, confusion, apathy) in empirical, empirical-analytical, and experimental studies has been determined. The results of studies of mental states in the fields of medicine, psychology, etc.,have been characterised. A meta-analysis of studies that reflect the impact of mental states on students’ attitudes to the learning process and allow tracking the dynamics of changes in their mental reactions at different stages and phases of martial law in Ukraine and related to evacuation has been carried out.

CONCLUSION: Conclusions: based on the results of the studies that became the subject of the meta-analysis, the general reactions that arose in students as a result of traumatic experience have been identified: stress, anxiety, fear, anger, guilt, shame, helplessness, etc. They had a corresponding impact on the effectiveness of their academic performance.

PMID:39951639 | DOI:10.36740/Merkur202406114

Pol Merkur Lekarski. 2024;52(6):698-705. doi: 10.36740/Merkur202406112.

ABSTRACT

OBJECTIVE: Aim: This study aimed to assess the effects of mindfulness practices conducted in natural settings on the mental health, emotional regulation, and attentional focus of young children (ages 6-15) and their teachers in Greece, Cyprus, and Portugal..

PATIENTS AND METHODS: Materials and Methods: A mixed-methods design was employed, combining quantitative data from the MiNa (Mindfulness in Nature) scale with 673 children and 220 adults as well as qualitative interviews with 20 children and 20 teachers across the three countries. Quantitative data was analyzed using descriptive statistics and paired t-tests to measure pre- and post-intervention changes, while qualitative data was examined through thematic analysis to capture nuanced experiences and perceptions.

RESULTS: Results: Findings revealed significant improvements in emotional awareness, attentional focus, and stress reduction for both children and teachers. Children reported higher levels of emotional regulation and connection to their surroundings, while teachers experienced reduced stress and enhanced classroom dynamics. Cross-cultural comparisons indicated that nature-based mindfulness practices provided universal benefits, though participants from all countries Greece, Portugal and Cyprus.

CONCLUSION: Conclusions: Nature-based mindfulness interventions demonstrate promising outcomes in promoting emotional well-being, cognitive focus, and stress resilience for young children and adults. The findings underscore the potential of integrating mindfulness in nature into early childhood education as a holistic approach adaptable to diverse cultural and environmental contexts.

PMID:39951637 | DOI:10.36740/Merkur202406112

Pol Merkur Lekarski. 2024;52(6):691-697. doi: 10.36740/Merkur202406111.

ABSTRACT

OBJECTIVE: Aim: To identify the opportunities, approaches, challenges, and needs of professionals at disease control and prevention centers in the process of using data for developing public health policy..

PATIENTS AND METHODS: Materials and Methods: The program provides for sociological surveys of professionals from disease control and prevention centers regarding the opportunities, needs, and challenges in using data to develop public health policy. The research materials included scientific publications, national-level regulatory legal acts, WHO program documents and sociological research questionnaires. The study utilized bibliosemantic, sociological, medical-statistical methods, and content analysis.

RESULTS: Results: A range of issues was identified regarding the use of data for substantiating and developing public health policy. A survey of professionals from disease control and prevention centers indicated that they encounter a lack of data on social and mental health ([rate ± standard error] 19,7±3,5 per 100 respondents); work with at-risk populations (15,0±3,2); socioeconomic determinants (14,2±3,1); occupational diseases and labor protection (13,4±3,0); and non-communicable diseases and behavioral risk factors (11,0±2,8). Every sixth to tenth respondent reported challenges in obtaining and analyzing data. A high need (74,8±3,8 per 100 respondents) was identified for professional development in data usage for policy substantiation, along with preferred formats.Priority measures for improving data use in public health policy development were identified.

CONCLUSION: Conclusions: The identified issues in data usage for public health policy development, as well as the needs of professionals at disease control and prevention centers concerning data collection and analysis, and the priority measures for improvement, should be considered.

PMID:39951636 | DOI:10.36740/Merkur202406111