Tag: nevin manimala

Western Pac Surveill Response J. 2025 Sep 1;16(3):1-7. doi: 10.5365/wpsar.2025.16.3.1176. eCollection 2025 Jul-Sep.

ABSTRACT

OBJECTIVE: To outline the management of an outbreak of invasive group A Streptococcus (iGAS) in a residential aged-care facility in rural Queensland, Australia, comparing outbreak management with the newly released Australian Series of National Guidelines (SoNG) for this disease and exploring unique aspects of rural iGAS outbreak management.

METHODS: An outbreak of iGAS was identified in a rural Queensland residential facility, where two cases occurred within 24 hours. A confirmed case was defined as any individual linked to the facility who had laboratory evidence of group A Streptococcus (GAS) in a sterile site. Whole genome sequencing was performed on all confirmed cases. The public health management of this outbreak was conducted according to the Queensland Communicable Disease Control guidelines and was compared with the new SoNG.

RESULTS: A phylogenetic tree confirmed that the two samples clustered closely together with a single allele difference. Chemoprophylaxis was offered to all residents and staff in the affected part of the facility; 95% (42/44) of residents consented to chemoprophylaxis. Increased surveillance for GAS and increased facility cleaning were recommended by the public health unit. No additional cases were identified after 30 days of surveillance. Management of the outbreak largely aligned with the SoNG except for post-outbreak surveillance, which would have been extended under the new guidelines.Discussion: This paper highlights factors unique to managing iGAS outbreaks in rural areas. Rural workforce factors and access to pathology services impact rural outbreak management, and thus involving local services and considering the local context are vital. The use of chemoprophylaxis continues to be recommended by the SoNG, and in this case was considered to be an important adjunct to other management strategies.

PMID:40970256 | PMC:PMC12441184 | DOI:10.5365/wpsar.2025.16.3.1176

Cureus. 2025 Sep 6;17(9):e91713. doi: 10.7759/cureus.91713. eCollection 2025 Sep.

ABSTRACT

Introduction Successful laryngeal mask airway (LMA) insertion requires suppression of airway reflexes and adequate jaw relaxation. Although propofol is the preferred induction agent, higher doses may cause adverse hemodynamic and respiratory effects. Adjuvants such as opioids or dexmedetomidine can enhance insertion conditions while minimizing propofol requirements. This pilot study compared dexmedetomidine-propofol and fentanyl-propofol combinations in terms of LMA insertion conditions and hemodynamic responses. Materials and methods In this prospective, randomized, double-blind pilot study, 40 American Society of Anesthesiologists (ASA) I and II patients were randomized to receive either an intravenous infusion of 1 microgram per kilogram of dexmedetomidine (Group D, n=20) diluted to 20 ml, or normal saline 20 ml (Group F, n=20) administered over 10 minutes. Following this, Group F received 1 microgram per kilogram of fentanyl over two minutes, while Group D received an equivalent volume of normal saline. All patients were induced with 1.5 mg/kg of propofol. The primary outcome was the ease of LMA insertion, assessed by jaw mobility and the presence of adverse airway reflexes (coughing, gagging, or movement during insertion), which was noted and scored. Secondary outcomes included heart rate (HR), systolic and mean arterial pressure, respiratory rate, and oxygen saturation, measured at baseline, pre-insertion, and at one, three, five, 10, 15, and 20 minutes post-insertion. Both the anesthesiologist administering the drugs and the investigator performing the insertion were blinded to group allocation. Results All patients in Group D had favorable LMA insertion scores (<2), while 30% in Group F had unfavorable scores (>2) (p=0.020). Apnea occurred in two patients in Group D and six patients in Group F. A statistically significant reduction in HR was observed in group D compared to group F; however, the values remained within the clinically acceptable range, without evidence of hemodynamic instability (HR before insertion (p<0.001), HR at one minute (p<0.001), HR at three minutes (p=0.026), HR at five minutes (p=0.022), and HR at 10 minutes (p=0.038)). Respiratory rate was significantly higher in Group D at the time points of one minute (p=0.003), three minutes (p=0.002), five minutes (p=0.011), 10 minutes (p=0.024), 15 minutes (p=0.007), and 20 minutes (p =0.002) post insertion. Conclusion When compared to fentanyl with propofol, dexmedetomidine with propofol provided effective conditions for LMA insertion with preserved respiratory function and comparable hemodynamic stability. Larger randomized studies are needed to confirm these findings and optimize dosing.

PMID:40970230 | PMC:PMC12441473 | DOI:10.7759/cureus.91713

Cureus. 2025 Sep 14;17(9):e92331. doi: 10.7759/cureus.92331. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: Lipedema is a chronic disorder characterized by symmetrical and disproportionate fat accumulation, pain, and easy bruising, often resistant to conventional treatments. Functional dysmetria (FD), a maladaptive neuromotor response linked to epigenetic stress, has been proposed as a relevant contributor to pain in lipedema.

OBJECTIVE: This retrospective observational study aimed to evaluate whether correcting FD through the radioelectric asymmetric conveyer (REAC) technology Neuropostural Optimization (NPO) protocol can reduce pain in patients with lipedema, using a sham-controlled design.

METHODS: In this retrospective observational study, 83 consecutive women with stage 2-5 lipedema underwent both sham and real NPO procedures during a single session. Pain intensity was measured using the visual analog scale (VAS) immediately after each procedure. Statistical analyses were performed using paired t-tests with effect sizes (Cohen’s dz) and 95% confidence intervals.

RESULTS: Baseline pain was uniformly high (mean 7.41 ± 0.53), with some pre-sham values reaching 10/10. Pain reduction was observed exclusively after real NPO and not after sham. Sham NPO induced no significant changes, whereas real NPO yielded a mean pain reduction exceeding 3.5 VAS points across all stages (mean change -3.65 ± 0.62; 95% CI: -3.79 to -3.51; Cohen’s dz = 5.88, 95% CI: 4.85-6.92; p < 0.0001).

CONCLUSIONS: These findings suggest that correction of FD by REAC NPO provides rapid and clinically meaningful analgesic effects in lipedema patients, addressing an upstream neuropsychomotor dysfunction that may contribute to disease progression. However, given the retrospective single-center design and absence of long-term follow-up, these conclusions are limited to the short-term effects observed. Further multicenter and longitudinal studies are warranted to confirm these results and evaluate long-term outcomes.

PMID:40970229 | PMC:PMC12441218 | DOI:10.7759/cureus.92331

Bayesian Anal. 2022 Dec;17(4):1043-1071. doi: 10.1214/21-ba1287. Epub 2021 Sep 27.

ABSTRACT

Stacking is a widely used model averaging technique that asymptotically yields optimal predictions among linear averages. We show that stacking is most effective when model predictive performance is heterogeneous in inputs, and we can further improve the stacked mixture with a hierarchical model. We generalize stacking to Bayesian hierarchical stacking. The model weights are varying as a function of data, partially-pooled, and inferred using Bayesian inference. We further incorporate discrete and continuous inputs, other structured priors, and time series and longitudinal data. To verify the performance gain of the proposed method, we derive theory bounds, and demonstrate on several applied problems.

PMID:40970226 | PMC:PMC12442486 | DOI:10.1214/21-ba1287

F1000Res. 2025 Sep 1;13:417. doi: 10.12688/f1000research.149264.4. eCollection 2024.

ABSTRACT

BACKGROUND: Urinary tract infection (UTI) is a frequent bacterial infection among women of reproductive age. Inappropriate and irrational prescribing of antibiotics -such as the use of unapproved fixed-dose combinations or empirical broad-spectrum therapy-has contributed to growing antimicrobial resistance. Adverse drug reactions (ADRs) further complicate treatment outcomes, yet remain underreported, especially in routine outpatient practice. Therefore, an assessment of current prescribing patterns and ADRs is essential to promote rational drug use.

OBJECTIVES: •To describe the prescribing patterns of drugs used for urinary tract infections (UTIs) among women of reproductive age (15-44 years).•To evaluate the incidence, type, and severity of adverse drug reactions (ADRs) associated with these prescriptions, as documented in hospital records.•To assess the prescription of fixed-dose combinations (FDCs) and combination antimicrobial therapy in relation to standard treatment guidelines (WHO, NLEM 2022).

METHODS: This is a retrospective observational study based on outpatient department (OPD) prescriptions for women aged 15-44 years diagnosed with community-acquired, uncomplicated UTIs at a tertiary care hospital in Central India. Data from 139 prescription records will be retrieved from the medical record section and analyzed. Prescribing indicators, documented ADRs, and use of FDCs will be assessed against national guidelines using descriptive statistics, chi-square tests, and logistic regression analysis.

PMID:40970219 | PMC:PMC12441663 | DOI:10.12688/f1000research.149264.4

iScience. 2025 Aug 8;28(9):113306. doi: 10.1016/j.isci.2025.113306. eCollection 2025 Sep 19.

ABSTRACT

This study leverages utility smart-meter data in a differences-in-difference framework to quantify the effect of low-income home energy assistance program (LIHEAP) funding on energy consumption behavior for 1,351 households in the Mid-Atlantic region of the U.S. Results reveal that LIHEAP funding leads to outcomes statistically indistinguishable from zero, although on average, we observe increases in energy consumption for homes that are electrically heated (37 kWh/month) and natural gas heated (0.30 MMBtu/month). Additionally, wide confidence intervals in most of our findings signal substantial variability in household responses to LIHEAP. Lastly, under more granular analytic conditions, outcomes show that the effect of LIHEAP funding may result in a restriction of energy consumption. Based on results, we offer two policy recommendations: (1) enhance data sharing among utilities, researchers, and LIHEAP program administrators to facilitate mechanism-specific quantitative analyses and enable cross-regional comparisons of program impact; and (2) expand LIHEAP’s performance measures to include measures of energy consumption behavior.

PMID:40970207 | PMC:PMC12441724 | DOI:10.1016/j.isci.2025.113306

Front Cardiovasc Med. 2025 Sep 3;12:1612060. doi: 10.3389/fcvm.2025.1612060. eCollection 2025.

ABSTRACT

BACKGROUND: This study evaluates the efficacy of various pharmacological therapies in mitigating the cardiotoxicity associated with anthracycline chemotherapy and furnishes contemporary, evidence-based guidelines and recommendations for clinical practice.

METHODS: We searched the EMBASE, Cochrane Library, PubMed, Web of Science, and Scopus databases from the beginning of each database to April 2024 and were limited to English-language documents. The primary objective of this study is to assess the efficacy of cardioprotective drugs in preventing the reduction of left ventricular ejection fraction (LVEF) and the incidence of cardiac events. The secondary objective is to evaluate the impact of these drugs on reducing left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic diameter (LVEDD), as well as on maintaining the ratio of peak mitral annular diastolic velocity to atrial contraction velocity (E/A ratio).

RESULTS: 54,852 studies were retrieved from five databases, and 28 randomized controlled trials involving 2,858 patients were finally included. Network Meta-analysis results showed that, compared to the control group, Spironolactone demonstrated the most significant improvement in (LVEF [MD = 12.10, 95% CI (7.50, 16.70)] and LVESD [MD = -5.00, 95% CI (-7.68, -2.32)]. For reducing cardiac events, Dexrazoxane [OR = 0.28, 95% CI (0.16, 0.50)] and Vitamin E combined with Levocarnitine [OR = 0.27, 95% CI (0.08, 0.90)] were the most effective interventions. In terms of diastolic function (E/A ratio), Nebivolol outperformed other β-blockers [MD = 0.23, 95% CI (0.09, 0.37)]. However, no intervention demonstrated a statistically significant effect on LVEDD.

CONCLUSION: According to the research findings, Spironolactone and Dexrazoxane significantly prevent the decline in LVEF and the occurrence of cardiac events compared to placebo or conventional chemotherapy, with statistical significance. This discovery provides valuable reference for the clinical prevention of anthracycline chemotherapy-induced cardiotoxicity, contributing to the optimization of treatment regimens, reduction of cardiac toxicity risks in patients, and improvement of prognosis.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42024567684).

PMID:40970189 | PMC:PMC12442320 | DOI:10.3389/fcvm.2025.1612060

Front Mol Biosci. 2025 Sep 3;12:1648421. doi: 10.3389/fmolb.2025.1648421. eCollection 2025.

ABSTRACT

INTRODUCTION: Automated dilution has improved the efficiency of human chorionic gonadotropin (hCG) testing, however, challenges persist regarding the cost implications of repeated testing. This study proposes the concept of cost-effective optimization, which aims to further optimize testing efficiency while maintaining controllable costs, and establishes an automated process with preset dilution factors for the hCG testing.

MATERIALS AND METHODS: The hCG testing process at Suining Central Hospital was optimized using the Aptio™ Automation Solution (Siemens Healthineers, Erlangen, Germany) integrated with Siemens Atellica® IM1600 analyzer. A novel middleware program was developed within the DataLink V2.0 (Siemens Healthineers, Erlangen, Germany) to automate dilution factor assignment. Relevant data such as dilution factors, sample reception time and review time were captured for statistical purposes to analyze the accuracy, ability to shorten TAT, and economic benefits of hCG testing.

RESULTS: After 8 months of continuous improvement, implementation of automated hCG dilution attained 91.19% compliance rate with 19.7% reduction in in-laboratory TAT. The process achieved 75.60% compliance against the 90 min benchmark, while the preset dilution process generated 15.03% mean cost savings per test.

CONCLUSION: In this study, a preset dilution factor program was utilized to establish an automated dilution process, achieving accurate and rapid prediction of hCG. These strategies not only improve efficiency, but also effectively reduce costs, enabling the expansion of testing items and facilitating the implementation in laboratories. Furthermore, they also help to shorten the in-hospital TAT for patients, and improve the hospital’s service quality.

PMID:40970183 | PMC:PMC12440790 | DOI:10.3389/fmolb.2025.1648421

J Multidiscip Healthc. 2025 Sep 13;18:5801-5815. doi: 10.2147/JMDH.S528778. eCollection 2025.

ABSTRACT

BACKGROUND: The demand for anterior cruciate ligament (ACL) reconstruction is steadily rising, necessitating a comprehensive post-ACL rehabilitation plan to accelerate recovery. This study explores the comparative effects of Open Kinetic Chain (OKC), Closed Kinetic Chain (CKC), and their combined effect at a specific knee angle (60° to 90°) in post-ACL reconstruction patients.

METHODOLOGY: This clinical trial was registered in the Iranian Registry of Clinical Trials (IRCT) on 21-04-2020 (Ref# IRCT20200331046903N1) and conducted on 54 post-ACL reconstruction patients, randomly allocated to three groups (OKC, CKC, and Combined KC) using the lottery method. All groups underwent 16-week rehabilitation programs. Outcomes assessed were pain, range of motion (ROM), and knee function using the visual analog scale, goniometer, and Lysholm score, respectively. Statistical analysis was conducted using one-way and repeated measures ANOVA in SPSS-25.

RESULTS: The mean age was 27.25±4.16 years and BMI 25.12±4.03 kg/m². All groups showed statistically significant improvement over 16 weeks (p<0.0001). At week 16, mean pain scores were 10.56±4.38 (Group A), 9.78±3.81 (Group B), and 3.28±3.12 (Group C) (p<0.001); ROM improved to 131.83±7.35, 129.22±7.57, and 140.61±6.13, respectively (p=0.001); knee function scores reached 90.78±4.83, 91.67±4.49, and 97.50±2.15, respectively (p=0.001). All outcome measures showed significant main effects of Group and Visit, with large effect sizes and significant Group×Visit interactions. From baseline to week 16, pain decreased by 85% (Group A), 86% (Group B), and 95% (Group C); ROM increased by 73%, 72%, and 90%; knee function improved by 58%, 63%, and 72%, respectively.

CONCLUSION: These findings indicate that the combined kinetic chain approach is most effective in improving ROM, knee function, and pain reduction following ACL reconstruction.

TRIAL REGISTRATION: https://irct.behdasht.gov.ir/.

PMID:40970149 | PMC:PMC12442813 | DOI:10.2147/JMDH.S528778

Front Digit Health. 2025 Sep 3;7:1590150. doi: 10.3389/fdgth.2025.1590150. eCollection 2025.

ABSTRACT

BACKGROUND: Recent findings suggest that a single gait assessment in a clinic may not reflect everyday mobility.

OBJECTIVE: We compared gait measures that best differentiated individuals with spinocerebellar ataxia (SCA) from age-matched healthy controls (HC) during a supervised gait test in the clinic vs. a week of unsupervised gait during daily life.

METHODS: Twenty-six individuals with SCA types 1, 2, 3, and 6, and 13 (HC) wore three Opal inertial sensors (on both feet and lower back) during a 2-minute walk in the clinic and for seven days in daily life. Seventeen gait measures were analyzed to investigate the group differences using Mann-Whitney U-tests and area under the curve (AUC).

RESULTS: Ten gait measures were significantly worse in SCA than HC for the clinic test (p < 0.003), but only 3 were worse in daily life (p < 0.003). Only a few gait measures consistently discriminated groups in both environments. Specifically, variability in Swing Time and Double Support Time had AUCs of 0.99 (p < 0.0001) and 0.96 (p < 0.0001) in the clinic, and 0.84 (p < 0.0003) and 0.80 (p < 0.002) in daily life, respectively. Clinical gait measures showed stronger correlations with clinical outcomes (ie, SARA and FARS-ADL; r = 0.50-0.77) than between daily life gait measures (r = 0.31-0.49). Gait activity in daily life was not statistically significant between the SCA and HC groups (p > 0.06).

CONCLUSIONS: Digital gait measures discriminate SCA in both environments. In-clinic measures are more sensitive, while daily life measures provide ecological validity, highlighting a trade-off and offering complementary insights.

PMID:40970140 | PMC:PMC12440962 | DOI:10.3389/fdgth.2025.1590150