Tag: nevin manimala

JAMA Surg. 2025 Sep 17. doi: 10.1001/jamasurg.2025.3581. Online ahead of print.

ABSTRACT

IMPORTANCE: Robot-assisted surgery (RAS) is increasingly used for abdominal procedures; however, postoperative pulmonary complications (PPCs) are more frequent in patients undergoing RAS compared with patients undergoing conventional laparoscopic surgery (CLS).

OBJECTIVE: To compare the incidence of PPCs after CLS and RAS and to determine which patient-, surgery-, and anesthesia-related factors are associated with PPCs.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used the Laparoscopic and Robot-Assisted Surgery (LapRAS) database, a pooled dataset containing individual patient data of 2 worldwide prospective cohort studies: the Local Assessment of Ventilatory Management During General Anaesthesia for Surgery (LAS VEGAS) study and the Assessment of Ventilatory Management During General Anesthesia for Robotic Surgery and Its Effects on Postoperative Pulmonary Complications (AVATaR) study. Data were collected from adult patients requiring intraoperative ventilation during general anesthesia for CLS or RAS surgical procedures from 163 centers and 31 countries in the Americas, Europe, the Middle East, and North Africa from January 2013 to March 2019. Data were analyzed from December 2023 to October 2024.

EXPOSURES: Type of surgical approach (CLS vs RAS), duration of intraoperative ventilation, and intensity of mechanical ventilation, assessed using the 4 times the driving pressure (DP) plus respiratory rate (RR) estimator (4DP + RR).

MAIN OUTCOME AND MEASURES: The primary outcome was occurrence of 1 or more PPCs in the first 5 postoperative days. Mixed-effects logistic regression assessed associations with PPCs; mediation and matched cohort analyses served as sensitivity analyses.

RESULTS: A total of 2738 patients (median [IQR] age, 56 [41-66] years; 1456 female [53.1%]) were included. PPCs occurred in 172 of 903 patients (19.0%) in the RAS group and 174 of 1835 patients (9.5%) in the CLS group (P < .001). Duration of intraoperative ventilation was longer in RAS compared with CLS (median [IQR] duration, 219 [180-270] vs 95 [68-145] minutes; P < .001) and the intensity of mechanical ventilation was higher (median [IQR] intensity, 84 [69-100] vs 72 [60-87] 4DP + RR; P < .001). PPCs were independently associated only with duration of ventilation (adjusted odds ratio [aOR], 1.49; 95% CI, 1.33-1.66; P < .001), not with the surgical approach (ie, RAS vs CLS; aOR, 1.35; 95% CI, 0.72-2.54; P = .35) nor the intensity of ventilation as measured by 4DP + RR (aOR, 1.01; 95% CI, 1.01-1.01; P = .21). A post hoc analysis showed a more pronounced association of intensity of ventilation in surgical procedures of shorter duration.

CONCLUSIONS AND RELEVANCE: In this cohort study, patients who received RAS vs CLS had a higher incidence of PPCs and received longer and more intense mechanical ventilation; however, only the duration of ventilation rather than intensity of ventilation or type of surgical approach (ie, RAS vs CLS) was independently associated with the occurrence of PPCs, indicating that the longer duration of ventilation in RAS underlies the higher incidence of PPCs observed in those who undergo this type of surgery.

PMID:40960804 | DOI:10.1001/jamasurg.2025.3581

Br Poult Sci. 2025 Sep 17:1-7. doi: 10.1080/00071668.2025.2559391. Online ahead of print.

ABSTRACT

1. The following reports an in-vivo study to investigate the toxicity profile of the azithromycin drug in broilers.2. Ninety, 1-d-old Hubbard chicks were purchased from Dakahliah Poultry Company, Egypt and, on d 25 of age, were subdivided into three groups. Group 1 (G1, control) received only drinking water, Group 2 (G2, treatment 1) received 50 mg azithromycin/kg body weight (BW) and Group 3 (G3, treatment 2) received 300 mg azithromycin/kg BW. All treatments were administered orally. Immunological, histopathological, and immunohistochemical assays were performed to evaluate the effect of azithromycin on broiler health.3. The weights of bursa of Fabricius and spleen in azithromycin-treated broilers decreased, particularly in G3. A decrease in both the phagocytic activity and index was evident in the treated groups (G2 and G3). Prominent degenerative changes and necrosis of immune organs were observed in treated chicks. Furthermore, strong immunoreactivity to caspase-3 was observed in the G3 group, which indicated elevated apoptosis in immune organs following exposure to a high-dose of azithromycin.4. It was concluded that administering azithromycin in broilers at a dose of 300 mg/kg impaired the immune function, promoted apoptosis and induced many microscopical alterations in different organs.

PMID:40960799 | DOI:10.1080/00071668.2025.2559391

JAMA Cardiol. 2025 Sep 17. doi: 10.1001/jamacardio.2025.3043. Online ahead of print.

ABSTRACT

IMPORTANCE: Animal studies and meta-analysis of human observational data suggest that pneumococcal polysaccharide vaccination (PPV) could be protective against atherosclerosis; however, to the authors’ knowledge, no randomized clinical trial has been conducted.

OBJECTIVE: To determine whether pneumococcal vaccination (Pneumovax [Merck Sharp & Dohme Corp]) decreases the composite primary outcome of fatal and nonfatal acute coronary syndrome and ischemic stroke in people at increased risk, with an average follow-up of 7 years after immunization.

DESIGN, SETTING, AND PARTICIPANTS: This was a double-blind, placebo-controlled, parallel-arm randomized clinical trial conducted at 6 centers across Australia. Participants were community-dwelling adults 55 to 60 years of age at baseline in 2016 to 2017, with at least 2 risk factors (obesity, hypertension, or hypercholesterolemia) for cardiovascular disease (CVD) but no prior CVD event or indication for early pneumococcal vaccination. Data were analyzed from February 2023 to December 2024 using competing risk proportional hazards regression models, stratified by sex and center.

INTERVENTIONS: Participants received either 23-valent PPV (PPV23) or placebo (saline).

MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of fatal and nonfatal myocardial infarction or ischemic stroke, ascertained via electronic medical records from emergency department, admitted patient, and mortality data collections using International Statistical Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) codes.

RESULTS: A total of 4725 participants (mean [SD] age, 58.0 [1.7] years; 2433 male [52%]) were included in this study. There was no significant difference in the primary outcome (58 of 2366 events in the active PPV23 group compared with 64 of 2357 events in the control group, hazard ratio, 0.90; 95% CI, 0.63-1.28; P = .57). Similarly, no significant differences occurred in the exploratory outcomes of all-cause mortality, all-cause hospital presentations, and CVD-related hospital procedures. These results are tempered by the lower than expected event rate leading to low power.

CONCLUSIONS AND RELEVANCE: Results of this randomized clinical trial found that PPV23 did not reduce the rates of fatal and nonfatal acute coronary syndrome and ischemic stroke, although the study was underpowered.

TRIAL REGISTRATION: ANZCTR Identifier: ACTRN12615000536561.

PMID:40960793 | DOI:10.1001/jamacardio.2025.3043

Einstein (Sao Paulo). 2025 Sep 15;23:eAO1525. doi: 10.31744/einstein_journal/2025AO1525. eCollection 2025.

ABSTRACT

OBJECTIVE: To analyze the overall and disease-free survival of patients with oropharyngeal squamous cell carcinoma.

METHODS: Sociodemographic and clinical data, HPV status, and alcohol/tobacco consumption were assessed among patients treated at AC Camargo Cancer Center, São Paulo, Brazil. Absolute and relative frequencies, overall survival, and disease-free survival at 5 and 7 years were calculated using Kaplan-Meier analysis, and Cox regression was used to estimate the risk of death.

RESULTS: The 7-year overall survival rate was 61.6% for patients with oropharyngeal squamous cell carcinoma (67.5% for HPV-positive cases and 51.1% for HPV-negative cases). Among HPV-positive cases, the risk of death was 5.29-fold higher for smokers than that for non-smokers (p<0.001) and 4.42-fold higher for patients with metastasis than that for those without (p=0.108). Among HPV-cases, those with clinical stage T3/T4 disease had a 1.8-fold higher risk of death than those with T1/T2 disease (p=0.039), and those with metastasis exhibited a 4.62-fold higher risk than those without (p<0.001). The 7-year disease-free survival rate for oropharyngeal squamous cell carcinoma was 88.6% (90.1% for HPV-positive cases and 85.9% for HPV-negative cases). Among HPV-positive cases, patients with metastasis had an 11.75-fold higher risk of recurrence than those without (p<0.001); among HPV-negative cases, patients with metastasis had a 4.62-fold higher risk than those without (p=0.004).

CONCLUSION: Patients with HPV-positive oropharyngeal squamous cell carcinoma had higher overall survival and increased recurrence rates within the first 3 years but lower recurrence rates beyond 5 years than patients with HPV-negative disease. More frequent follow-ups after 5 years are recommended for patients with HPV-positive disease. Tobacco and alcohol consumption negatively affect the overall survival of patients with HPV-positive oropharyngeal squamous cell carcinoma.

PMID:40960779 | DOI:10.31744/einstein_journal/2025AO1525

Einstein (Sao Paulo). 2025 Sep 15;23:eAO1399. doi: 10.31744/einstein_journal/2025AO1399. eCollection 2025.

ABSTRACT

OBJECTIVE: To analyze changes in surgical volume across different specialties in Brazil before, during, and after the COVID-19 pandemic.

METHODS: This descriptive observational study compared surgical volumes for the specialties with the highest number of procedures each year from 2019 to 2023. Data were sourced from the Department of Informatics of the Unified Health System (DATASUS – TabNet).

RESULTS: A total of 2,117,383 surgical procedures across 13 operation types were analyzed. Between 2019 and 2020, surgical volume declined by 35%, with reductions ranging from -1% to -54% depending on the procedure. Although volumes increased by 2023, this was insufficient to address the backlog of delayed surgeries. Otorhinolaryngology and urology were the most affected specialties, while cholecystectomy saw a net post-pandemic increase.

CONCLUSION: The COVID-19 pandemic significantly disrupted all analyzed surgical procedures in Brazilian Public Health System, resulting in a 35% overall decline. Despite partial recovery, the persistent surgical deficit remains a major challenge, reflecting patterns observed internationally.

PMID:40960778 | DOI:10.31744/einstein_journal/2025AO1399

Braz J Med Biol Res. 2025 Sep 12;58:e14749. doi: 10.1590/1414-431X2025e14749. eCollection 2025.

ABSTRACT

Breast cancer is the most frequent neoplasm and has the highest mortality rate among women. In the Afro-descendant population, these tumors may appear earlier and assume a more aggressive behavior. This study aimed to assess the epidemiological and clinical behavior of breast cancer in a predominantly Afro-descendant population, identify risk and prognostic factors, and compare them with already available data. Clinical and sociodemographic data were obtained from medical records and interviews with the patients involved. The variables ethnicity, age, number of children, monthly income, and education were used to describe the epidemiological profile and the results of clinical evaluation and pathological anatomy study. The immunohistochemical analysis was used to correlate the clinical characteristics of the tumors and prognosis. Afro-descendant women represented 77% of the population and the mean age at diagnosis was 54.4 years. Approximately 75% had up to 2 children, 20.5% had low income, and 37.3% had a low level of education. Infiltrating ductal carcinoma was diagnosed in 91% of patients, 70.2% had a moderate degree of differentiation, luminal subtype A was the most prevalent (39%), and a higher than global average percentage had a triple negative profile (22.9%). Early stages were identified in 53.4% of patients and only 4.8% were diagnosed with metastatic disease. The recurrence rate was 11.6%, and the mortality rate was 6.8%. The present study showed that unfavorable sociodemographic and clinical aspects, such as the high prevalence of triple-negative tumors, were not associated with a worse prognosis.

PMID:40960774 | DOI:10.1590/1414-431X2025e14749

An Acad Bras Cienc. 2025 Sep 15;97(3):e20241516. doi: 10.1590/0001-3765202520241516. eCollection 2025.

ABSTRACT

Length-weight relationships (LWR) were calculated for five freshwater ornamental fish species from the middle Negro River basin in the Brazilian Amazon. Samplings were carried out from October 2011 to February 2012, and the specimens were found close to stream margins and submersed tree trunks and captured with hand nets. This study provides the LWR and condition factor (Kn) parameters for <italic>Carnegiella strigata </italic>butterfly fish, <italic>Dekeyseria brachyura </italic>jaguar fish, <italic>Dicrossus maculatus </italic>chess fish, <italic>Paracheirodon axelrodi</italic> cardinal and <italic>Petitella georgiae </italic>drunk’s nose. Descriptive statistics and estimated LWR parameters, including coefficient of determination (r2) and 95% confidence limits for a and b. Values of a ranged from 0.005 to 0.014, b ranged from 2.555 to 3.418, and r2 ranged from 0.931 to 0.996. Every species of fish displayed allometric growth (b ≠ 3). No difference was observed between the Kn of the five fish species, indicating good body condition. The information gathered here could be helpful for population dynamics research as well as for developing conservation and sustainable management plans for ornamental fish populations in the middle Negro River basin, Amazonas, Brazil.

PMID:40960769 | DOI:10.1590/0001-3765202520241516

An Acad Bras Cienc. 2025 Sep 15;97(3):e20240726. doi: 10.1590/0001-3765202520240726. eCollection 2025.

ABSTRACT

This study aims to assess the scientific knowledge regarding the impact of pesticides and non-essential metals on freshwater aquatic organisms within the Amazon basin. The investigation encompasses a comprehensive analysis, including: i) temporal patterns; ii) methodological approaches; iii) keywords; iv) geographical distribution; v) academic institutions; vi) studied groups of aquatic organisms; and vii) specific environmental contexts investigated. It was used 203 publications in Web of Science and Scopus databases. A discernible ascending trajectory in publication frequency was observed over time, exhibiting a robust and statistically significant correlation with citation counts. The predominant disciplinary focus was discerned to be Environmental Science. Prevalent keywords encapsulated “Mercury,” “Fish,” “Amazon”, “methylmercury” and “bioaccumulation”. Noteworthy scholarly contributions emanated primarily from Brazil, with substantive collaboration of the United States, France, Canada and Bolivia. Among the foremost research entities were Brazilian institutions. Bioindicator selection exhibited a distinct predilection for fishes. The diverse spectrum of aquatic environments scrutinized included rivers, lakes, laboratory settings, and reservoirs. This scientometric analysis not only furnishes insights into the global trajectory of research on pesticides and non-essential metals within Amazonian aquatic ecosystems but also identifies prevailing methodologies, research lacunae, and prospects for future investigations within the Amazon basin.

PMID:40960765 | DOI:10.1590/0001-3765202520240726

Epidemiol Serv Saude. 2025 Sep 15;34:e20240519. doi: 10.1590/S2237-96222025v34e20240519.en. eCollection 2025.

ABSTRACT

OBJECTIVE: To investigate the prevalence and mortality of respiratory diseases between 2008 and 2019 in municipalities with gypsum industry activity in the Sertão do Araripe region, Pernambuco, Brazil.

METHODS: This was a population-based ecological study using data extracted from hospital and mortality information systems. Ten municipalities from the gypsum production hub were compared to other municipalities in Pernambuco that do not have gypsum industry activity. Prevalence and mortality rates were calculated per 100,000 and 1,000 inhabitants and presented by mean values (standard deviation) for chronic obstructive pulmonary disease, asthma, acute bronchitis, and pneumonia. Pearson’s correlation tests, Mann-Whitney U tests, and multiple linear regression were performed to assess the relationship between gypsum industry activity and respiratory diseases.

RESULTS: During the study period, 17,630 cases of respiratory diseases were recorded, with a mean prevalence of 454.74 (147.16) per 100,000 inhabitants and a mortality rate of 0.34 (0.08) per 1,000 inhabitants. Pneumonia accounted for 12,680 hospitalizations, with a prevalence of 431.20 (173.04) per 100,000 inhabitants, being most frequent in Ouricuri (543.08), Ipubi (409.93), and Moreilândia (404.80). A higher prevalence of pneumonia was observed in municipalities within the gypsum production hub (p-value 0.007). A positive correlation was found between respiratory diseases and the hospital bed occupancy rate (r 0.24; p-value<0.050), and a negative correlation with per capita public health expenditures. There was a significant association between the presence of the gypsum industry and pneumonia (p-value<0.001).

CONCLUSION: The gypsum industry’s activity is associated with the prevalence of respiratory diseases in the region, with a particular emphasis on the high rates of pneumonia.

PMID:40960761 | DOI:10.1590/S2237-96222025v34e20240519.en

Epidemiol Serv Saude. 2025 Sep 15;34:e20240092. doi: 10.1590/S2237-96222025v34e20240092.en. eCollection 2025.

ABSTRACT

OBJECTIVE: To analyze the mortality of users attended by a Mobile Emergency Care Service located in Paraná.

METHODS: This is a cross-sectional analytical study based on service reports from 2019 and 2020. The Mobile Emergency Care Service covered 21 municipalities, divided into hubs A and B. The dependent variables defined were death and time of care. Survival functions were calculated using the Kaplan-Meier estimator and the log-rank test; hazard ratio (HR) for death, by Cox regression with 95% confidence interval (95%CI).

RESULTS: The study evaluated 13,326 instances of care provided. Of these, 246 resulted in death. The risk of death was higher in time-sensitive calls (HR 0.17; 95%CI 0.008; 0.37), in 2020 (HR 2.09; 95%CI 1.39; 3.16), attended by advanced support (HR 21.51; 95%CI 12.61; 36.70) and in Hub B (HR 4.26; 95%CI 2.53; 7.17).

CONCLUSION: Mortality was higher in cases that had a long wait for time-sensitive calls, occurred in less populated regions, and were dealt with by advanced support in 2020.

PMID:40960760 | DOI:10.1590/S2237-96222025v34e20240092.en