Tag: nevin manimala

Eur J Med Res. 2025 Apr 15;30(1):285. doi: 10.1186/s40001-025-02558-8.

ABSTRACT

OBJECTIVES: In endoscopic retrograde cholangiopancreatography anesthesia, both intubation and non-intubation techniques have their own advantages and disadvantages. However, whether either approach is associated with postoperative and anesthesia-related adverse events remains controversial.

METHODS: We searched the literature in PubMed, Web of Science, Cochrane Library, Scopus, Ovid and Embase databases up to October 2024. All studies comparing intubated vs. non-intubation anesthesia for endoscopic retrograde cholangiopancreatography were included. The main outcome measures were sedation-related adverse events and death. Data were combined using risk ratio with 95% confidence intervals. The study protocol was prospectively registered with PROSPERO (CRD42024608807).

RESULTS: We finally included 8 studies with a total of 21,433 patients. Endotracheal intubation was associated with a lower risk of sedation-related adverse events (RR: 2.85, 95% CI 1.33-6.09, p = 0.007). However, the risks of death (RR: 0.59, 95% CI 0.36-0.96, p = 0.03) and intraoperative hypotension (RR: 0.43, 95% CI 0.26-0.69, p = 0.0006) were lower without intubation. In the trial-sequence analysis, the trial-sequence monitoring boundary is crossed, indicating conclusive evidence of a statistically significant effect.

CONCLUSIONS: Our findings suggest that endotracheal intubation during endoscopic retrograde cholangiopancreatography is associated with a lower risk of sedation-related adverse events but a higher risk of mortality and intraoperative hypotension compared to non-intubation. However, these associations do not establish direct causality and should be interpreted with caution. Further high-quality randomized controlled trials are needed to validate these findings. Clinicians should adopt a patient-centered approach, carefully balancing the potential benefits and risks of intubation to optimize airway management strategies in endoscopic retrograde cholangiopancreatography.

PMID:40229855 | DOI:10.1186/s40001-025-02558-8

Eur J Med Res. 2025 Apr 15;30(1):283. doi: 10.1186/s40001-025-02548-w.

ABSTRACT

BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) has long been recognized as a significant contributor to mortality rates, holding a prominent position in the hierarchy of causes of death. Nevertheless, the presence of a causal relationship between serum uric acid (SUA) and the risk of ASCVD, as well as mortality rates, remains unclear.

METHODS: We initially conducted a comprehensive cohort study utilizing data sourced from National Health and Nutrition Examination Survey (NHANES) 1999-2018 to investigate the specific correlation between SUA levels and ASCVD. Then, we subsequently examined the link between SUA levels and all-cause and cardio-cerebrovascular mortality among ASCVD individuals.

RESULTS: We identified a U-shaped relationship between SUA levels and the risk of ASCVD in all participants (inflection point at 5.399, p value = 0.014). Similarly, SUA levels showed U-shaped trends with all-cause mortality (inflection point at 5.748, p value < 0.0001) and cardio-cerebrovascular mortality (inflection point at 5.936, p value < 0.0001), respectively.

CONCLUSIONS: Our findings demonstrate a U-shaped association between SUA levels and the risks of ASCVD, all-cause mortality, and cardio-cerebrovascular mortality. However, further research is needed to better understand how SUA affects ASCVD and its underlying mechanisms.

PMID:40229850 | DOI:10.1186/s40001-025-02548-w

Eur J Med Res. 2025 Apr 15;30(1):273. doi: 10.1186/s40001-025-02404-x.

ABSTRACT

BACKGROUND: Macular edema (ME) is a prevalent complication of diabetic retinopathy (DR) and retinal vein occlusion (RVO) that contributes significantly to vision impairment worldwide. This condition is primarily driven by elevated vascular endothelial growth factor (VEGF) and pro-inflammatory cytokines, resulting in the use of anti-VEGF agents such as aflibercept and corticosteroids such as dexamethasone implants. However, evidence comparing the clinical efficacy and safety of these two modalities remains limited.

OBJECTIVES: This systematic review and meta-analysis aimed to compare the safety and efficacy of intravitreal aflibercept injections and dexamethasone implants in ME associated with DR and RVO.

METHOD: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with PROSPERO (CRD42024577212). A comprehensive search of the PubMed, Cochrane, Web of Science, and Scopus databases was performed until August 30, 2024. Nine studies, involving 572 eyes, were included in the analysis. Key outcomes assessed included Best-Corrected Visual Acuity (BCVA), Central Retinal Thickness (CRT), and Intraocular Pressure (IOP). A random-effects model was applied to the pooled effect size calculations, and heterogeneity was addressed using sensitivity analyses.

RESULTS: Both treatments showed comparable efficacy in improving BCVA and reducing CRT across follow-up intervals. At 3 months, dexamethasone implants demonstrated statistically significant superiority in BCVA improvement (MD = 1.18, 95% CI [0.89, 1.47], P < 0.001) and CRT reduction (MD = – 62.45 µm, 95% CI [- 85.67, – 39.22], P < 0.001) compared to aflibercept. Similarly, at 12 months, dexamethasone implants maintained greater efficacy in CRT reduction (MD = – 58.73 µm, 95% CI [- 78.12, – 39.34], P < 0.001). However, dexamethasone implants were associated with an increased IOP at 3 and 6 months (MD = 1.04 mmHg, 95% CI [0.56, 1.52], P < 0.001). No significant differences in IOP were observed between treatments at 12 months.

CONCLUSION: Intravitreal aflibercept injections and dexamethasone implants are effective modalities for the management of ME, with each presenting distinct advantages. Dexamethasone implants minimize the frequency of treatment, while achieving superior outcomes in terms of BCVA and CRT. However, they are also associated with a heightened risk of IOP elevation and cataract formation. Conversely, aflibercept requires more frequent administration, which may result in logistical and financial challenges for patients and health care providers. Therefore, personalized treatment strategies should consider disease severity, comorbidities, and individual preferences. Future research should prioritize patient-centered outcomes, emphasizing quality of life and treatment costs while also investigating condition-specific responses to these therapeutic interventions.

PMID:40229845 | DOI:10.1186/s40001-025-02404-x

Eur J Med Res. 2025 Apr 15;30(1):287. doi: 10.1186/s40001-025-02550-2.

ABSTRACT

OBJECTIVE: To explore the technical innovation and clinical application effect of inflatable mediastinoscopy synchronous laparoscopic radical resection of esophageal cancer.

METHODS: The clinical data of 180 patients with esophageal cancer treated by the same surgical team from January 2018 to December 2019 were retrospectively analyzed. The patients were divided into the inflatable mediastinoscopy synchronous laparoscopic group (n = 93) and the McKeown group (n = 87) according to the surgical approach. Preoperative general baseline data, perioperative indices, postoperative indices, and short- and long-term survival rates were recorded and statistically analyzed for both groups.

RESULTS: Compared to McKeown’s procedure, the inflatable mediastinoscopy synchronized laparoscopic esophagectomy was associated with relatively less operative time, blood loss, and hospital stay, specifically (94.46 ± 20.17) minutes, (36.76 ± 16.63)ml, and (13.63 ± 2.57) days, respectively. At the same time, the postoperative complication rate of the inflatable mediastinoscopy synchronized laparoscopic esophagectomy was low compared to the postoperative complication rate of McKeown’s procedure.

CONCLUSION: Compared with the traditional McKeown procedure, the patients treated with inflatable mediastinoscopy synchronous laparoscopic radical resection of esophageal cancer have a lower incidence of thoracic complications, shorter operation time, less pain, and faster postoperative recovery so that it can be used as a new supplementary method for mainstream McKeown radical resection of esophageal cancer.

PMID:40229843 | DOI:10.1186/s40001-025-02550-2

J Intensive Care. 2025 Apr 14;13(1):21. doi: 10.1186/s40560-025-00790-2.

ABSTRACT

BACKGROUND: Treatment effect of high-dose intravenous selenium remains controversial in patients with sepsis or septic shock. Here, we reanalyzed data from the randomized placebo-controlled trial of Sodium Selenite and Procalcitonin Guided Antimicrobial Therapy in Severe Sepsis (SISPCT) to reveal possible treatment differences according to established sepsis phenotypes.

METHODS: In this secondary data analysis of the SISPCT trial all 1089 patients of the original study were included. Patients were assigned to one of the four phenotypes by comparing patient variables with the Sepsis Endotyping in Emergency Care (SENECA) validation cohort. Survival analyses were performed using Kaplan-Meier and log-rank tests.

RESULTS: No robust effect of selenium on mortality and other outcome parameters could be determined in any sepsis phenotype. Phenotype frequencies were markedly different in our study cohort compared to previous reports (α: 2.2%, β: 6.3%, γ: 68.0%, δ: 23.4%). Differences in mortality between the respective phenotypes were not significant overall; however, 28-day mortality showed a lower mortality for the α- (20.8%) and β-phenotype (20.3%), followed by the γ- (27.1%), and δ-phenotype (28.5%).

CONCLUSIONS: Application of the four sepsis phenotypes to the SISPCT study cohort showed discrete but non-significant mortality differences within 28 days. However, beneficial treatment effects of high-dose intravenous selenium were still not detectable after categorizing the SISPCT study cohort according to four phenotype criteria.

PMID:40229841 | DOI:10.1186/s40560-025-00790-2

Respir Res. 2025 Apr 14;26(1):146. doi: 10.1186/s12931-025-03214-9.

ABSTRACT

BACKGROUND: Idiopathic pulmonary arterial hypertension (IPAH) is a rare and severe form of pulmonary hypertension, with a genetic basis most commonly associated with mutations in the BMPR2 gene. However, no genetic testing has been reported for IPAH patients in the Russian population, nor have systematic studies been conducted to assess the frequency of pathogenic variants in this group.

METHODS: The study cohort included 105 IPAH patients, consisting of 23 males and 82 females, who were managed at the PH care center in Moscow, Russia, from 2014 to 2024. Genetic testing was performed using whole-genome sequencing. Variant identification and annotation were conducted using GATK, DeepVariant, VEP, sv-callers and AnnotSV. A meta-analysis, performed with MOOSE, included 24 studies involving 3124 IPAH patients and 470 P/LP variants. Pathogenicity reassessment was carried out using InterVar, which incorporates ACMG criteria.

RESULTS: Analysis of 105 adult IPAH patients in Russia revealed 11 patients (10.48%) as carriers of pathogenic or likely pathogenetic (P/LP) BMPR2 variants. As the result of reassessment, the number of P/LP BMPR2 variants raised from 394 (59%) to 445 (67%) with 80 pathogenic variants became of uncertain significance, and 152 unclassified variants became P/LP. The meta-analysis of these reevaluated pathogenic variants showed that while the frequency of P/LP variants in our cohort (10.48%) is lower than the overall average of 17.75% from the meta-analysis, the difference is not statistically significant (p = 0.062). Additionally, we report three P/LP BMPR2 variants, not reported in literature, with one being structural, and four P/LP variants in TBX4, ATP13A3 and AQP1 genes from 27 IPAH genes in 3 patients.

CONCLUSIONS: For the first time, we present the results of genetic testing in IPAH patients from the Russian population. Despite the considerable heterogeneity in the world-wide data, the prevalence of pathogenic BMPR2 mutations in IPAH patients from the Russian population does not significantly differ from the overall average in the meta-analysis. It is crucial to periodically reassess the pathogenicity of published variants, as half of the pathogenic BMPR2 IPAH variants were reclassified as LP or of uncertain significance.

PMID:40229839 | DOI:10.1186/s12931-025-03214-9

BMC Pregnancy Childbirth. 2025 Apr 14;25(1):442. doi: 10.1186/s12884-025-07574-4.

ABSTRACT

INTRODUCTION: Globally adverse birth outcome is being a series public health problem. As studies showed, even though the etiologies are multifactorial, extreme age pregnancies have more risk for adverse birth outcome. This study determines the estimated effect of teenage pregnancy on adverse birth outcome.

METHOD: The study analyzed data from the most recent Demographic and Health Surveys (DHS) data. Propensity score matching (PSM) analysis was employed by using age as treatment variable, teenager as treated and non-teenagers as control group and weighted sample of 45,790 (non-teenagers = 41,769 and teenagers = 4,021). The outcome variable; adverse birth outcome was categorized as “Yes” if a woman had either preterm birth, still birth, low birth weight or macrosomia in her recent birth and “No” otherwise. Covariates that had significant association with the treatment and outcome variables were considered for PSM analysis. After testing of each matching techniques (nearest neighbor, kernel and radius), the nearest neighbor (10) approach produced better covariate balance and selected as the best matching algorism for our analysis. Finally, the effect of teenage pregnancy on adverse birth outcome was measured and reported as average treatment effect on the treated (ATT) and the quality of matching and sensitivity to hidden bias was assed by t-statistics significance level and Mantel-Haenszel statistic respectively.

RESULTS: This study found that around one in ten (8.7%) of the women had pregnancy between the age of 15 and 19 years. The magnitude of adverse birth outcome among teenagers and non-teenagers was also 45.4% and 39.9% respectively. Teenage pregnancy contributed to a 4.7% increasing adverse birth outcome (ATT = 4.7%). Similarly, the Average Treatment Effect on Untreated (ATU) was 4.8%.

CONCLUSION: This study revealed that around one in teen women had pregnancy between the age of 15 and 19 years and teenage pregnancy had more risk of having adverse birth outcomes as compared to non-teenagers. Thus, we recommend to policy makers and implementers to design policies and strategies to improve teenagers’ access to prenatal care, family planning, and sexual education, awareness of creation on teenage pregnancy risks.

PMID:40229821 | DOI:10.1186/s12884-025-07574-4

BMC Med Inform Decis Mak. 2025 Apr 14;25(1):163. doi: 10.1186/s12911-025-02996-8.

ABSTRACT

BACKGROUND: The integration of artificial intelligence (AI) in healthcare has rapidly expanded, particularly in clinical decision-making. Large language models (LLMs) such as GPT-4 and GPT-3.5 have shown potential in various medical applications, including diagnostics and treatment planning. However, their efficacy in specialized fields like sports surgery and physiotherapy remains underexplored. This study aims to compare the performance of GPT-4 and GPT-3.5 in clinical decision-making within these domains using a structured assessment approach.

METHODS: This cross-sectional study included 56 professionals specializing in sports surgery and physiotherapy. Participants evaluated 10 standardized clinical scenarios generated by GPT-4 and GPT-3.5 using a 5-point Likert scale. The scenarios encompassed common musculoskeletal conditions, and assessments focused on diagnostic accuracy, treatment appropriateness, surgical technique detailing, and rehabilitation plan suitability. Data were collected anonymously via Google Forms. Statistical analysis included paired t-tests for direct model comparisons, one-way ANOVA to assess performance across multiple criteria, and Cronbach’s alpha to evaluate inter-rater reliability.

RESULTS: GPT-4 significantly outperformed GPT-3.5 across all evaluated criteria. Paired t-test results (t(55) = 10.45, p < 0.001) demonstrated that GPT-4 provided more accurate diagnoses, superior treatment plans, and more detailed surgical recommendations. ANOVA results confirmed the higher suitability of GPT-4 in treatment planning (F(1, 55) = 35.22, p < 0.001) and rehabilitation protocols (F(1, 55) = 32.10, p < 0.001). Cronbach’s alpha values indicated higher internal consistency for GPT-4 (α = 0.478) compared to GPT-3.5 (α = 0.234), reflecting more reliable performance.

CONCLUSIONS: GPT-4 demonstrates superior performance compared to GPT-3.5 in clinical decision-making for sports surgery and physiotherapy. These findings suggest that advanced AI models can aid in diagnostic accuracy, treatment planning, and rehabilitation strategies. However, AI should function as a decision-support tool rather than a substitute for expert clinical judgment. Future studies should explore the integration of AI into real-world clinical workflows, validate findings using larger datasets, and compare additional AI models beyond the GPT series.

PMID:40229819 | DOI:10.1186/s12911-025-02996-8

BMC Pulm Med. 2025 Apr 14;25(1):182. doi: 10.1186/s12890-025-03654-5.

ABSTRACT

BACKGROUND: Surfactant decreases surface tension in the peripheral airways and plays a role in regulating the lung’s immune responses. Several reports have documented changes in surfactant proteins levels, especially surfactant protein D (SP-D) and surfactant protein A (SP-A), suggesting their potential as biomarkers for asthma. However, the results of these studies are controversial. This systematic review was done to assess the levels of surfactant proteins in asthmatic patients compared to healthy individuals.

METHODS: A systematic review was conducted according to PRISMA guidelines. Searches were performed in the Medline/PubMed, Web of Science, Embase, and ScienceDirect databases to identify studies that assessed surfactants proteins levels in asthmatic patients. Pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using R version 4.4.3 meta package.

RESULTS: A total of 16 studies met the inclusion criteria and were thus considered for this systematic review. Among these, SP-D was the most frequently studied protein in relation to asthma, asthma severity, and lung function parameters in asthmatic patients. Serum and sputum levels of SP-D in asthmatic patients were slightly elevated compared to non-asthmatic individuals. However, these differences were not statistically significant; the pooled SMDs were 0.27 (95% CI: -0.034 to 0.574, P = 0.082) for serum levels and 1.47 (95% CI, -0.197 to 3.103, P = 0.084) for sputum levels. Similarly, no significant difference was detected for the analysis of serum SP-A levels, with SMD = 0.18 (95% CI, -0.505 to 0.866, P = 0.606). Though, some of the reviewed studies showed an association between SP-D levels and disease severity in asthmatic patients.

CONCLUSION: Although alterations have been observed in asthma and proposed as biomarkers, this systematic review did not find significant differences in the levels between asthmatics and healthy individuals. However, some studies have suggested an association between SP-D levels and asthma severity. Given the limited number of studies investigating this association, further research is needed to validate the clinical relevance of correlation between SP-D levels and asthma severity.

PMID:40229817 | DOI:10.1186/s12890-025-03654-5

Radiography (Lond). 2025 Apr 13;31(3):102948. doi: 10.1016/j.radi.2025.102948. Online ahead of print.

ABSTRACT

INTRODUCTION: Integrating decision support mechanisms utilising artificial intelligence (AI) into medical radiation practice introduces unique challenges to accountability for patient care outcomes. AI systems, often seen as “black boxes,” can obscure decision-making processes, raising concerns about practitioner responsibility, especially in adverse outcomes. This study examines how medical radiation practitioners perceive and attribute moral responsibility when interacting with AI-assisted decision-making tools.

METHODS: A cross-sectional online survey was conducted from September to December 2024, targeting international medical radiation practitioners. Participants were randomly assigned one of four profession-specific scenarios involving AI recommendations and patient outcomes. A 5-point Likert scale assessed the practitioner’s perceptions of moral responsibility, and the responses were analysed using descriptive statistics, Kruskal-Wallis tests, and ordinal regression. Demographic and contextual factors were also evaluated.

RESULTS: 649 radiographers, radiation therapists, nuclear medicine scientists, and sonographers provided complete responses. Most participants (49.8 %) had experience using AI in their current roles. Practitioners assigned higher moral responsibility to themselves in positive patient outcomes compared to negative ones (χ²(1) = 18.98, p < 0.001). Prior knowledge of AI ethics and professional discipline significantly influenced responsibility ratings. While practitioners generally accepted responsibility, 33 % also attributed shared responsibility to AI developers and institutions.

CONCLUSION: Patient outcomes significantly influence perceptions of moral responsibility, with a shift toward shared accountability in adverse scenarios. Prior knowledge of AI ethics is crucial in shaping these perceptions, highlighting the need for targeted education.

IMPLICATIONS FOR PRACTICE: Understanding practitioner perceptions of accountability is critical for developing ethical frameworks, training programs, and shared responsibility models that ensure the safe integration of AI into clinical practice. Robust regulatory structures are necessary to address the unique challenges of AI-assisted decision-making.

PMID:40228324 | DOI:10.1016/j.radi.2025.102948