Tag: nevin manimala

Therap Adv Gastroenterol. 2025 Sep 20;18:17562848251378066. doi: 10.1177/17562848251378066. eCollection 2025.

ABSTRACT

BACKGROUND: Effective Helicobacter pylori (H. pylori) eradication depends on maintaining intragastric pH >6 and overcoming antibiotic resistance. High-dose dual therapy (HDDT) with a proton pump inhibitor (PPI) and amoxicillin has shown promising results.

OBJECTIVES: To compare the efficacy of 14-day vonoprazan-based (VA) and esomeprazole-based (EA) HDDT for H. pylori eradication and evaluate the impact of antibiotic resistance.

DESIGN: Randomized controlled trial (RCT).

METHODS: A total of 121 patients with confirmed H. pylori infection were randomized to receive either VA therapy (vonoprazan 20 mg twice daily plus amoxicillin 750 mg four times daily (QID)) or EA therapy (esomeprazole 40 mg three times daily plus amoxicillin 750 mg QID) for 14 days. Eradication was assessed by the ¹³C-urea breath test at week 8. Antibiotic susceptibility testing was performed on cultured isolates.

RESULTS: Baseline demographic and clinical characteristics were comparable between the VA and EA groups. In the intention-to-treat analysis, eradication rates were 86.9% (95% confidence interval (CI): 78.4%-95.4%) in the VA group and 81.7% (95% CI: 71.3%-89.4%) in the EA group (p = 0.430). Per-protocol (PP) analysis showed eradication rates of 93.0% (95% CI: 86.4%-99.6%) for VA and 84.5% (95% CI: 73.8%-92.1%) for EA (p = 0.150), indicating no statistically significant difference. Adverse events (AEs) were mild and similar between groups (5.3% in VA vs 5.2% in EA, p = 0.983), with constipation and diarrhea being the most reported. Both groups achieved 100% compliance. Antibiotic resistance patterns did not significantly affect outcomes.

CONCLUSION: Both VA and EA-HDDT regimens demonstrated comparable efficacy, excellent compliance, and minimal AEs. Although VA therapy achieved a >90% eradication rate in the PP analysis, our study was underpowered to confirm superiority. Therefore, larger, adequately powered RCTs are warranted to validate the potential superiority of VA.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT06811207.

PMID:40984972 | PMC:PMC12450270 | DOI:10.1177/17562848251378066

Cureus. 2025 Aug 22;17(8):e90717. doi: 10.7759/cureus.90717. eCollection 2025 Aug.

ABSTRACT

INTRODUCTION AND AIM: Diabetes mellitus is a metabolic disease characterized by hyperglycemia, leading to long-term organ damage and complications like foot ulcers. Aggressive management of diabetic foot ulcers can prevent complications and lower extremity amputations. This study aimed to assess the barriers faced by physicians in managing diabetic feet in primary care settings.

METHODS: This is a descriptive cross-sectional study conducted in primary healthcare settings in Al-Ahsa, Saudi Arabia, between 2024 and 2025, involving 220 participants through simple random sampling. The study used a structured, valid, pretested, and self-administered questionnaire to collect data. The Statistical Package for the Social Sciences (SPSS) version 27 (Armonk, NY: IBM Corp.) was used to analyze the data. Both descriptive and inferential statistics were used, with a p≤0.05 considered statistically significant.

RESULTS: This study included 220 physicians (mean age: 32.14±6.05 years, 53.6% male), 130 (59.0%) had practiced for less than five years, 97 (44.1%) reported less than five continuing medical education (CME) hours related to diabetes, and 132 (60.0%) reported no special training in diabetes mellitus (DM). A majority of them, 160 (72.7%), rated their knowledge as average; 197 (89.5%) reported educating patients on preventive foot care, and 189 (85.9%) reported recommending therapeutic footwear. Only 102 (46.4%) probe for bone exposure in open diabetic foot (DF) infections, and 93 (42.3%) request serial radiographs. More than half identified a lack of continuing education and knowledge as the main barriers to the effective diagnosis and management of diabetic foot infections. Further barriers reported by participants were the absence of a vascular medicine specialty and a lack of diabetic foot management guidelines. Furthermore, 140 (63.6%) reported a lack of access to foot examination tools, and 152 (69.1%) reported insufficient time for comprehensive foot examinations.

CONCLUSION: This study highlights significant gaps in knowledge, practice, and resources among healthcare professionals involved in diabetic foot management. The findings demonstrate the need for targeted interventions in Al-Ahsa to improve clinician competency, enhance resource availability, and address systemic challenges.

PMID:40984968 | PMC:PMC12450305 | DOI:10.7759/cureus.90717

Clinics (Sao Paulo). 2025 Sep 21;80:100795. doi: 10.1016/j.clinsp.2025.100795. Online ahead of print.

ABSTRACT

BACKGROUND: Myofascial Pain Syndrome (MPS) is regarded as an extremely common clinical disorder, but is not fully understood. Shoulder pain has a lifetime prevalence of up to 66.7% in the general population, and pain due to Myofascial Trigger Points (MTPs) located in the deltoid muscle is fairly common. Analyses of the correlations between innervation patterns and trigger point locations have been successful in other muscular groups.

OBJECTIVE: The objective of this study was to provide a mathematical analysis of the entry points of the axillary nerve into the deltoid muscle and correlate them with the described areas of myofascial pain.

METHOD: Ten cadavers were carefully dissected to measure a series of parameters in each deltoid muscle. The entry points of the axillary nerve into the deltoid muscle were placed in a cartesian graph created by dividing the deltoid muscle into 4-quadrants. Statistical analysis was carried out on the number of points in each quadrant.

RESULTS: Quadrant 1 had the largest number of axillary nerve entry sites, with a mean of 6.85 sites (63%), followed by quadrant 3 with 2.75 sites (25%), quadrant 2 with 1.15 sites (10%), and quadrant 4 with 0.25 sites (2%).

CONCLUSION: In accordance with the clinical literature, the branches of the axillary nerve in the deltoid muscle corresponded to the described areas of the MTPs. Anatomical correlations between MTPs may be useful tools for gaining a better understanding of the physiopathology of these disorders and providing a basis for their treatment.

PMID:40983051 | DOI:10.1016/j.clinsp.2025.100795

Clinics (Sao Paulo). 2025 Sep 21;80:100795. doi: 10.1016/j.clinsp.2025.100795. Online ahead of print.

ABSTRACT

BACKGROUND: Myofascial Pain Syndrome (MPS) is regarded as an extremely common clinical disorder, but is not fully understood. Shoulder pain has a lifetime prevalence of up to 66.7% in the general population, and pain due to Myofascial Trigger Points (MTPs) located in the deltoid muscle is fairly common. Analyses of the correlations between innervation patterns and trigger point locations have been successful in other muscular groups.

OBJECTIVE: The objective of this study was to provide a mathematical analysis of the entry points of the axillary nerve into the deltoid muscle and correlate them with the described areas of myofascial pain.

METHOD: Ten cadavers were carefully dissected to measure a series of parameters in each deltoid muscle. The entry points of the axillary nerve into the deltoid muscle were placed in a cartesian graph created by dividing the deltoid muscle into 4-quadrants. Statistical analysis was carried out on the number of points in each quadrant.

RESULTS: Quadrant 1 had the largest number of axillary nerve entry sites, with a mean of 6.85 sites (63%), followed by quadrant 3 with 2.75 sites (25%), quadrant 2 with 1.15 sites (10%), and quadrant 4 with 0.25 sites (2%).

CONCLUSION: In accordance with the clinical literature, the branches of the axillary nerve in the deltoid muscle corresponded to the described areas of the MTPs. Anatomical correlations between MTPs may be useful tools for gaining a better understanding of the physiopathology of these disorders and providing a basis for their treatment.

PMID:40983051 | DOI:10.1016/j.clinsp.2025.100795

Med Image Anal. 2025 Sep 20;107(Pt A):103814. doi: 10.1016/j.media.2025.103814. Online ahead of print.

ABSTRACT

Acquiring high-resolution Magnetic resonance (MR) images is challenging due to constraints such as hardware limitations and acquisition times. Super-resolution (SR) techniques offer a potential solution to enhance MR image quality without changing the magnetic resonance imaging (MRI) hardware. However, typical SR methods are designed for fixed upsampling scales and often produce over-smoothed images that lack fine textures and edge details. To address these issues, we propose a unified diffusion-based framework for arbitrary-scale in-plane MR image SR, dubbed Progressive Reconstruction and Denoising Diffusion Model (PRDDiff). Specifically, the forward diffusion process of PRDDiff gradually masks out high-frequency components and adds Gaussian noise to simulate the downsampling process in MRI. To reverse this process, we propose an Adaptive Resolution Restoration Network (ARRNet), which introduces a current step corresponding to the resolution of input MR image and an ending step corresponding to the target resolution. This design guide the ARRNet to recovering the clean MR image at the target resolution from input MR image. The SR process starts from an MR image at the initial resolution and gradually enhances them to higher resolution by progressively reconstructing high-frequency components and removing the noise based on the recovered MR image from ARRNet. Furthermore, we design a multi-stage SR strategy that incrementally enhances resolution through multiple sequential stages to further improve recovery accuracy. Each stage utilizes a set number of sampling steps from PRDDiff, guided by a specific ending step, to recover details pertinent to the predefined intermediate resolution. We conduct extensive experiments on fastMRI knee dataset, fastMRI brain dataset, our real-collected LR-HR brain dataset, and clinical pediatric cerebral palsy (CP) dataset, including T1-weighted and T2-weighted images for the brain and proton density-weighted images for the knee. The results demonstrate that PRDDiff outperforms previous MR image super-resolution methods in term of reconstruction accuracy, generalization, and downstream lesion segmentation accuracy and CP classification performance. The code is publicly available at https://github.com/Jiazhen-Wang/PRDDiff-main.

PMID:40983006 | DOI:10.1016/j.media.2025.103814

Comput Methods Programs Biomed. 2025 Sep 9;272:109072. doi: 10.1016/j.cmpb.2025.109072. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Coronary Artery Disease (CAD) diagnosis relies heavily on coronary angiography, yet interpretation suffers from variability. Deep learning (DL) offers potential for improvement, particularly in vessel segmentation, a critical step for analysis. This study aims to enhance vessel segmentation accuracy in angiography using a DL framework incorporating advanced preprocessing and texture features.

METHODS: We developed a U-Net architecture integrating Texture Representation of Image (TRI) features (Haralick and Law features) to capture subtle vascular details. Advanced preprocessing (Laplacian Pyramid Restoration, Gaussian Differential Scale-Invariance) was applied to improve image quality. The model was pre-trained on the DRIVE dataset and fine-tuned using 7600 clinical angiography images. Performance was evaluated on a held-out test set (19 patients, ∼1700 images) from the same institution and benchmarked against the public ARCADE dataset. Statistical tests assessed performance improvements. Post-segmentation analysis included branching point detection and vessel diameter visualization using heatmaps.

RESULTS: The proposed method achieved high segmentation performance on the clinical test set (Accuracy: 0.98, Precision: 0.87, Sensitivity: 0.91, F1-score: 0.89, IoU: 0.801, with CIs provided). Ablation studies confirmed statistically significant contributions from both preprocessing and TRI features (p < 0.01 for all metrics). Performance on the ARCADE benchmark was also strong (F1-score: 0.78), considering annotation differences.

CONCLUSIONS: Integrating TRI features and advanced preprocessing with a U-Net architecture significantly improves coronary angiography vessel segmentation. This provides a robust foundation for subsequent quantitative analysis potentially supporting CAD assessment. While limitations exist regarding external validation and direct clinical impact assessment, the enhanced segmentation capability represents a valuable advancement for angiographic image analysis tools.

PMID:40983000 | DOI:10.1016/j.cmpb.2025.109072

J Craniofac Surg. 2025 Sep 22. doi: 10.1097/SCS.0000000000011958. Online ahead of print.

ABSTRACT

BACKGROUND: Rhinoplasty is a frequently performed plastic surgery, but it carries potential short- and long-term complications. Surgeons continuously seek ways to reduce these risks and enhance patient outcomes. Nasal packing is often used postoperatively, but its efficacy in improving recovery remains debated. This study aims to assess the impact of bilateral anterior nasal packing on early postoperative outcomes.

METHODS: In this prospective study, conducted from January to December 2023, 64 rhinoplasty patients were evaluated at Hôtel Dieu de France University Hospital. Twenty patients received short-term nasal packing with paraffin-soaked gauze, while 44 did not. Outcomes were assessed based on periorbital ecchymosis, edema, nasal obstruction, and the occurrence of septal hematomas and epistaxis.

RESULTS: At postoperative day 7, the packing group exhibited significantly more ecchymosis (mean score 3.65 versus 2.47; P = 0.017). However, no significant differences were noted for periorbital edema (P = 0.471) or nasal obstruction (P = 0.172). Postoperative epistaxis and septal hematomas occurred in 10% of patients in the packing group, compared with none in the nonpacking group, though these differences were not statistically significant (P = 0.175).

CONCLUSION: Bilateral anterior nasal packing significantly increases ecchymosis after rhinoplasty without reducing other complications such as edema, nasal obstruction, epistaxis, or septal hematomas. These findings suggest that nasal packing may not be beneficial and should be avoided.

PMID:40982970 | DOI:10.1097/SCS.0000000000011958

Psychiatr Danub. 2025 Sep;37(Suppl 1):99-103.

ABSTRACT

BACKGROUND: This study explores the relationship between cognitive deficits, cognitive reserve (CR), and rehabilitation outcomes in psychiatric offenders and non-offenders. The objective is to analyze how neurocognitive functioning, impulsivity, and CR influence the duration and effectiveness of psychiatric rehabilitation.

METHODS: Fifty-five patients from rehabilitation centers in Southern Italy were assessed using standardized psychiatric and neuropsychological scales. Participants were divided into offenders (n=19) and non-offenders (n=36). Assessments included BPRS, BIS-11, CRIq, T.I.B., and TMT A/B. Statistical analyses involved Pearson’s correlation and t-tests using JASP.

RESULTS: Significant correlations were observed between months of rehabilitation (MoR) and TIQ in non-offenders and CRIq in offenders. A significant correlation between MoR and TMT was observed only in offenders. Offenders with more than 24 months of rehabilitation showed lower impulsivity scores (BIS-11). These findings indicate distinct rehabilitative trajectories and neurocognitive responses in the two groups.

CONCLUSION: Cognitive reserve and neurocognitive assessment can inform individualized rehabilitation strategies in forensic psychiatric populations. Offenders may particularly benefit from longer and more targeted interventions to mitigate impulsivity and enhance cognitive functioning.

PMID:40982968

Psychiatr Danub. 2025 Sep;37(Suppl 1):409-412.

ABSTRACT

BACKGROUND: It is known that youth aged 16 to 23 are more vulnerable to mental distress than other age groups. This vulnerability can be explained by several factors such as the high prevalence of mental illnesses, the changes in the environment, the social expectations and so on. Moreover, in this age group the transition between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) impacts the continuity of care, leading to a negative impact on the prognosis. This article aims to characterize this population based on risk factors, history of care and care plan.

SUBJECTS AND METHOD: We conducted a retrospective study including patients who attended transition psychiatry consultations between October 2020 and December 2023. Data were collected at a secondary care outpatient service.

RESULTS: The sample (n=122) was predominantly female (70.5%, n=86). Referrals were mostly made by psychologists (35.2%, n=43), although many individuals were self-referred (32%, n=39). In most cases, the consultation request came directly from the young person (60.7%, n=74). Regarding previous mental health support, 79.5% (n=97) had already received psychological care at the time of their transition consultation. In terms of risk factors, many participants had been exposed to adverse childhood experiences (ACE): 60% (n=69) reported a first-degree family history of psychiatric disorders, 28% (n=33) had experienced sexual abuse, and 37.3% (n=44) had been exposed to domestic violence. Among those who received follow-up care, 19.7% (n=24) were scheduled for planned inpatient care. Psychotherapeutic follow-up was offered to 79.6% of patients, and psychotropic medication was recommended for 68.9%.

CONCLUSION: This research highlights the major vulnerability of transition-aged youth (TAY) and reinforces the need for specialized care and continuity between CAMHS and AMHS.

PMID:40982949

Psychiatr Danub. 2025 Sep;37(Suppl 1):391-397.

ABSTRACT

BACKGROUND: Food-related problems in Feeding and Eating Disorders (hereafter referred to as eating disorders – EDs) might be considered as the expression of dysfunctional individual and relational patterns based on emotional and behavioral dysregulation. Dysphoria is a transnosographic syndrome found in a multitude of psychiatric disorders including EDs, our cross-sectional study aims to analyze its presence in Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorder (BED) to define its socio-demographic, clinical correlates and phenomenological expression in the three types of EDs.

SUBJECTS AND METHODS: A total of 165 patients were recruited from March 2019 to November 2024. Anamnestic history was collected through a specific form. The Italian version of the Nepean Dysphoria Scale (NDS-I) was used to evaluate Dysphoria. After performing descriptive analyses, one-way ANOVA and Pearson’s r test were performed to respectively assess between-group differences and correlations. Significance was defined as p<0.05.

RESULTS: AN presented the highest degree of Dysphoria than the three, BED the lowest. Older age, physical illnesses and ongoing medical therapy correlated with lower levels of Dysphoria. A Statistically significant positive correlation was found in smoking habits, association with another psychiatric disorder, especially with anxiety disorder, use of benzodiazepines (BDZ) and use of antipsychotics (AP).

CONCLUSIONS: Dysphoria acquires fundamental importance within EDs, possibly having a specific role in the etiology and maintenance of eating behaviors, it might play a core role in this type of mental disorder, with the behavioral aspect aimed at reducing dysphoric anxiety. Understanding these connections could represent a useful tool for the comprehension of EDs, which are increasing and have always represented a great diagnostic and therapeutic challenge.

PMID:40982945