Tag: nevin manimala

Scand J Trauma Resusc Emerg Med. 2025 Nov 15;33(1):185. doi: 10.1186/s13049-025-01512-1.

ABSTRACT

BACKGROUND: Tranexamic acid is an established drug in the treatment of bleeding trauma patients. Concerns have been raised over possible complications of tranexamic acid regarding thromboembolic events as serious complications during the treatment of severely injured patients.

METHODS: In our study we retrospectively analyzed data from 2015-2019 of multiply injured patients receiving tranexamic acid during distinguished treatment periods from the TraumaRegister DGU®. We statistically analyzed overall thromboembolic complications during hospital stay in the context of number of single-dose tranexamic acid administrations.

RESULTS: We report on 37,342 patients, of whom 1,151 (3.1%) suffered from thromboembolic events. Patients without tranexamic acid treatment suffered from thromboembolic events in 2.3%, prehospital and emergency department administration increased the incidence to 4.8% and 5.2%, respectively. Administering tranexamic acid twice or three times was associated with an increased incidence of 8.5% and 8.2%, respectively. In a multivariate logistic regression, we uniquely show an independently associated risk for thromboembolic complications with every consecutive administration of tranexamic acid (one application: odds ratio (OR) 1.56, p < 0.001; two applications: OR 1.79, p < 0.001; three applications: OR 1.50, p = 0.113).

CONCLUSIONS: In our study we report on an associated risk of thromboembolic events in multiply injured patients with every single time tranexamic acid was administered in our study. Thus, before a repetitive dose of tranexamic acid is administered checking for indication is advised and especially in multiply injured patients receiving repeated administrations of TXA starting a thromboprophylaxis, as soon as possible after the traumatic bleeding disorder is controlled, is important.

PMID:41241739 | DOI:10.1186/s13049-025-01512-1

Scand J Trauma Resusc Emerg Med. 2025 Nov 15;33(1):183. doi: 10.1186/s13049-025-01510-3.

ABSTRACT

BACKGROUND: Severe thoracic trauma in children is rare and often underestimated. While standardized protocols exist, the rarity of polytrauma in children may lead to uncertainties in their application. Thus, we aim to characterize severely injured children with significant thoracic trauma and identify age-dependent differences in prehospital and early clinical management.

METHODS: Patients documented by German hospitals between 2008 and 2023 in the TraumaRegister DGU^®, aged ≤ 20 years and sustaining at least serious chest injury (AIS_Thorax ≥ 3) were analyzed. Patients were grouped by age: 0-5 years, 6-12 years and 13-16 years and statistically compared; additional data from patients aged 17-20 years is provided. Demographic, clinical characteristics and treatment comparing the aforementioned groups were evaluated using descriptive statistics. In the group of 0-16 years old independent risk factors for mortality were scrutinized applying multiple logistic regression analysis.

RESULTS: A total of 5,040 severely injured patients were analyzed (310 patients aged 0-5 years, 475 aged 6-12 years, 984 aged 13-16 years and 3,271 in group 17-20 years). With increasing age, significantly more males were injured and mechanism of injury was significantly different between the age groups. During prehospital management significant age dependent differences were seen regarding helicopter emergency medical service treatment, intubation, chest tube placement, application of catecholamines or tranexamic acid. Significant differences were found in terms of injured body regions, where the youngest suffered most from leading thoracic injury and injury to the head while abdominal injury and injury to extremities happened significantly more often in the 13-16 years old. During treatment the 13-16 years old received more blood products, were more likely to undergo thoracic surgery and stayed longer on the respective wards. Multivariate logistic regression showed an independent association with a significant mortality risk for MAIS ≥ 4 (OR = 2.87; p = 0.03), polytrauma (OR = 3.09; p < 0.001) and the need for blood transfusion before admission to the intensive care unit (OR = 2.46; p < 0.001).

CONCLUSIONS: Treating severely injured children is always challenging, even more so when they have suffered critical trauma to the chest. With our results we offer starting points for age-dependent injury prevention and provide information to analyze and question current (pre-) hospital management protocols.

PMID:41241732 | DOI:10.1186/s13049-025-01510-3

BMC Microbiol. 2025 Nov 15;25(1):751. doi: 10.1186/s12866-025-04521-3.

ABSTRACT

BACKGROUND: Early gastrointestinal microbiota establishment is crucial for host metabolism and immune development, with delivery mode and breastfeeding playing key roles. Vaginal delivery promotes colonization by maternal vaginal and gut microbes, while Caesarean section delivery leads to exposures of environmental and skin-derived microbiota. Although maternal contributions have been studied, the role of paternal exposure in shaping infant microbiota remains underexplored. We hypothesized that both parents influence infant microbiota establishment and therefore investigated the contributions of maternal and paternal microbes, as well as delivery mode, on infant oral and fecal microbiota within 48 h of birth and at 1 month of age.

METHODS: We analysed the gut and oral microbiota of 264 pregnant women, 261 partners, and 266 infants using 16S rRNA gene amplicon sequencing. α-diversity (Shannon Index) was compared using Wilcoxon tests, and β-diversity (Bray-Curtis dissimilarity) was assessed with PERMANOVA and PERMDISP. Principal component analysis (PCA) based on centered log-ratio (CLR)-transformed genus-level data was used for ordination and visualisation of taxonomic structure. Differentially abundant taxa across niches and delivery modes were identified using Kruskal-Wallis and Wilcoxon tests with false discovery rate (FDR) correction, followed by linear discriminant analysis (LDA). Putative amplicon sequence variant (ASV) sharing between infants and family members was explored using tree-based phylogenetic plots showing taxon presence and relative abundance across sample types. All analyses were performed in R using established packages.

RESULTS: Adults showed significantly higher microbial α-diversity than infants in both gut and oral samples. β-diversity analyses revealed distinct microbial community structures influenced by ecological niches and delivery mode. Within the first 48 h after birth, differential abundance analyses identified Lactobacillus crispatus in meconium and Blautia_A in oral swabs enriched in vaginally delivered infants. L. crispatus also emerged as a key marker of the vaginal microbiota in our cohort-wide comparison, while Blautia, typically a gut-associated genus, was also detected in parental rectal and meconium samples. This co-occurrence may reflect transient microbial seeding during vaginal delivery. However, due to the limited resolution of 16S rRNA gene sequencing, these patterns suggest ecological overlap rather than definitive evidence of vertical transmission.

CONCLUSIONS: Our findings demonstrate that delivery mode influences early gut and oral microbiota composition, with vaginal delivery associated with taxa also found in maternal samples. While we observed microbial continuity between infant and parental niches, we could not clearly distinguish partner-specific contributions-likely due to the limited resolution of 16S rRNA gene sequencing. These results highlight the importance of delivery-associated exposures in early microbial development and underscore the need for high-resolution approaches to better resolve microbial acquisition within families.

PMID:41241721 | DOI:10.1186/s12866-025-04521-3

Ann Surg Oncol. 2025 Nov 15. doi: 10.1245/s10434-025-18738-z. Online ahead of print.

ABSTRACT

INTRODUCTION: The application of closed incision negative pressure therapy (ciNPT) systems over closed surgical incisions purportedly lowers postoperative complications; however, there is little evidence to support its use in oncoplastic breast surgery. The primary objective of this study was to compare major and minor wound complication rates in patients with breast cancer undergoing oncoplastic procedures, with and without the use of the ciNPT.

PATIENTS AND METHODS: A prospectively maintained database of patients undergoing breast conserving oncoplastic procedures with placement of ciNPT system at a single institution was queried. This cohort was compared with a retrospective contemporaneous control group receiving primary two-layered suture and skin adhesive closure only. Major complications included abscess/hematoma/seroma needing drainage, and wound breakdown or asymmetry requiring return to the OR. Minor complications included breast lymphedema/erythema, minor nipple necrosis, and wound breakdown or mild asymmetry not requiring return to OR. Analyses were performed using Chi-square test or Fisher’s exact test, where applicable, and univariate logistic regression models, with statistical significance set at p < 0.05.

RESULTS: Of 186 patients, there were 93 in the ciNPT and 93 in the control group. There were significantly fewer major complications in the ciNPT group (1.1% ciNPT versus 10.8% control, p = 0.010). There was no significant difference in the rates of minor complications, and no difference in complication rates based on comorbidities or tumor characteristics.

CONCLUSIONS: ciNPT decreases major postoperative wound complications in patients with breast cancer undergoing oncoplastic procedures. Minimization of major postoperative complications can help ensure the timely initiation of adjuvant therapy following breast conserving oncoplastic procedures.

PMID:41241710 | DOI:10.1245/s10434-025-18738-z

Spinal Cord. 2025 Nov 15. doi: 10.1038/s41393-025-01140-7. Online ahead of print.

ABSTRACT

STUDY DESIGN: Cohort study.

OBJECTIVES: To determine the prevalence and to identify predictors of prescription opioid use among persons with non-traumatic spinal cord dysfunction within one year after discharge from inpatient rehabilitation.

SETTING: Ontario, Canada.

METHODS: We conducted a retrospective cohort study using administrative data to determine predictors of receiving prescription opioids during the one year after discharge from inpatient rehabilitation among persons with non-traumatic spinal cord dysfunction between April 1, 2004 and March 31, 2015. We modelled the outcome using a Poisson multivariable regression and reported relative risks with 95% confidence intervals.

RESULTS: We identified 3468 individuals with non-traumatic spinal cord dysfunction (50.35% male) with 66.58% who were aged ≥66. Over half of the cohort (59.46%) received opioids during the observation period. Being female, previous opioid use before rehabilitation, increasing comorbidity level, low functional status, and having a previous diagnosis of osteoarthritis were significant risk factors for receiving opioids after discharge, as shown in an adjusted multivariable analysis. Increasing length of rehabilitation stay was protective against opioid receipt after discharge. Risk of receiving opioids varied with age. Younger individuals had a significantly higher risk of future opioid use, a risk that peaked around 30-40 years of age (aRR 1.54, 95% CI 1.42-1.67 for age 40, as compared to age 80). Risk of opioid use following discharge decreased as age increased beyond 40 years, as compared to age 80.

CONCLUSIONS: Many individuals with non-traumatic spinal cord dysfunction in Ontario are prescribed opioids after discharge from inpatient rehabilitation. This may be problematic due to the number of severe complications that may arise from opioid use and their use in this population warrants future research.

PMID:41241697 | DOI:10.1038/s41393-025-01140-7

Metabolomics. 2025 Nov 15;21(6):174. doi: 10.1007/s11306-025-02376-3.

ABSTRACT

This study builds on a prior proof-of-concept metabolomic analysis of post-mortem pericardial fluid to assess its reproducibility and validate its utility for estimating the post-mortem interval. Sixty-five pericardial fluid samples were collected during medico-legal autopsies in two different Forensic Medicine Institutes with post-mortem intervals spanning 16 to 199 h. Samples underwent liquid-liquid extraction and ¹H NMR analysis, quantifying 50 metabolites. Multivariate statistical analyses were employed to develop post-mortem interval estimation models, controlling for age to minimize its confounding effects. Reproducibility was confirmed, with 92% of metabolites showing high similarity (cosine similarity ≥ 0.90) in 23 re-analyzed samples, demonstrating robust intra-laboratory consistency. For post-mortem intervals of 16 to 100 h, the regression model achieved presented a prediction error of 16.7 h, identifying nine key predictors, including choline, glycine, citrate, betaine, ethanolamine, glutamate, ornithine, uracil, and β-alanine. For intervals of 16 to 130 h, the prediction error was 23.2 h, and for 16 to 199 h, it was 42.1 h. A classification model distinguishing intervals below 48 h from those above 48 h showed high accuracy for detecting longer intervals, with key predictors including aspartate, histidine, and proline. These findings underscore the stability and reproducibility of pericardial fluid metabolomics, establishing its potential as a reliable forensic tool for post-mortem interval estimation, particularly beyond 48 h, with significant implications for forensic investigations.

PMID:41241694 | DOI:10.1007/s11306-025-02376-3

J Immigr Minor Health. 2025 Nov 16. doi: 10.1007/s10903-025-01822-7. Online ahead of print.

ABSTRACT

Patients with Non-English Language Preference face significant barriers to healthcare, often due to inadequate use of professional medical interpreters. Despite evidence showing that medical interpreters improve patient outcomes, many healthcare providers lack training in effective medical interpreter use. This study evaluates the impact of the Med Interpreter website on first-year medical students’ comfort and proficiency in working with interpreters during clinical encounters. The intervention involved a 30-minute presentation on the Med Interpreter website, which offers guidelines and resources for interpreter use in English and Spanish. Following the presentation, students participated in a simulated patient encounter using standardized patients and interpreters. Pre- and post-intervention surveys assessed changes in students’ comfort, confidence, and understanding of interpreter use. A total of 98 out of 130 participants completed both surveys. Statistically significant improvements were observed in student comfort, confidence, and knowledge of interpreter guidelines and resources, highlighting the intervention’s effectiveness. The results highlight the effectiveness of Med Interpreter in enhancing students’ knowledge and skills related to interpreter use. This intervention demonstrates the importance of structured training in addressing language barriers in healthcare and underscores the potential for scalable tools like Med Interpreter to improve patient-provider communication and reduce health disparities.

PMID:41241691 | DOI:10.1007/s10903-025-01822-7

J Mol Neurosci. 2025 Nov 15;75(4):151. doi: 10.1007/s12031-025-02439-z.

ABSTRACT

Spinal cord injury (SCI), a traumatic type of central nervous system injury, is closely associated with neuronal apoptosis. However, the specific biomarkers and regulatory mechanisms of neuronal apoptosis in SCI patients remain unclear. In this study, we aimed to identify differentially expressed proteins (DEPs) that regulate neuronal apoptosis after SCI and reveal potential diagnostic and therapeutic targets. Spinal cord tissues were collected for LC‒MS/MS analysis at five different time points after injury. Enrichment analysis, WGCNA, random forest, support vector machine recursive feature elimination, and receiver operating characteristic (ROC) curve analysis methods were used to identify proteins and pathways associated with neuronal apoptosis. Validation was performed using a rat model and PC12 cells. A total of 351 DEPs were identified. By integrating DEPs, WGCNA, and machine learning methods, filamin A (FLNA), an apoptosis-related protein, was identified. The reliability of this finding was confirmed in the above three datasets. Spearman correlation analysis was performed to identify the top 100 proteins whose expression correlated with that of FLNA, which were then subjected to enrichment analysis. GO enrichment analysis and KEGG enrichment analysis revealed that expression of these proteins was enriched in mitochondrial oxidative phosphorylation. Western blot and qRT‒PCR analyses confirmed the upregulation of FLNA expression in a rat model of SCI. In vitro experiments revealed that silencing FLNA expression using siRNA reduced H₂O₂-induced apoptosis and ROS production in PC12 cells. Additionally, FLNA expression knockdown inhibited the PI3K/AKT signalling pathway. FLNA is a critical molecular target for neuronal apoptosis following SCI.

PMID:41241686 | DOI:10.1007/s12031-025-02439-z

Intern Emerg Med. 2025 Nov 16. doi: 10.1007/s11739-025-04201-0. Online ahead of print.

ABSTRACT

Sepsis and septic shock represent significant health concerns in emergency departments due to their high mortality rates. This study aimed to evaluate the prognostic predictive ability of the HOTEL score in patients diagnosed with sepsis and septic shock in the emergency department. This single-center, prospective, observational diagnostic evaluation study included a total of 151 patients who presented to the emergency department between August 1, 2023, and March 1, 2024, and were diagnosed with sepsis or septic shock. The demographic, clinical, and laboratory data of the patients were recorded. The HOTEL score was calculated based on parameters including systolic blood pressure, oxygen saturation, body temperature, electrocardiographic changes, and loss of independence. Statistical analyses included receiver operating characteristic curves, logistic regression, and diagnostic test performance metrics. The median age of the included patients was 75 (interquartile range: 66.5-83.5) years. In terms of 30-day mortality, the HOTEL score (area under the curve [AUC]: 0.607) and SOFA score (AUC: 0.612) demonstrated similar predictive ability. Regarding the need for intubation in the emergency department, the HOTEL score (AUC: 0.773) and SOFA score (AUC: 0.835) were statistically significant. Multivariate analysis identified the HOTEL score, C-reactive protein levels, and the presence of active malignancy as independent predictors of 30-day mortality. Among the parameters of the HOTEL score, loss of independence emerged as the most significant predictor. According to the results of our study, the HOTEL score serves as an independent predictor of short-term mortality in patients with sepsis and septic shock. It may be a useful tool in predicting short-term mortality and the need for intubation in the emergency department for patients with sepsis and septic shock. However, it is recommended that the HOTEL score be used in combination with other clinical parameters rather than alone. In particular, clinical parameters such as loss of independence appear to contribute significantly to the predictive power of the score. Future studies should focus on modifying the HOTEL score and evaluating its utility in different patient populations and larger sample sizes.

PMID:41241685 | DOI:10.1007/s11739-025-04201-0

Environ Geochem Health. 2025 Nov 16;47(12):574. doi: 10.1007/s10653-025-02872-4.

ABSTRACT

This study highlights the critical environmental and human health risks posed by heavy metal contamination in oil and gas drilling regions. Heavy metal contamination in surface sediments resulting from oil and gas drilling activities presents a significant environmental and human health concern. This research critically examines the impacts of hydraulic fracturing wastewater on surface sediment quality, focusing on environmental consequences. For the first time in the region, sediment samples were analysed to identify heavy metals associated with oil and gas operations. A combination of pollution indices, positive matrix factorization (PMF), and health risk assessment (HRA) was applied to comprehensively assess sediment quality, contamination sources, and health risks. To evaluate contamination levels, various pollution indices were employed, including Geoaccumulation Index (Igeo), enrichment factor (EF), contamination factor (CF), pollution load index (PLI), potential ecological risk index (PERI), toxic risk index (TRI), and modified hazard quotient (mHQ). Source apportionment was conducted using PMF and multivariate statistical techniques to identify the potential origins of heavy metals in surface sediments. The results of the pollution indices indicate moderate to severe contamination, with As, Cr, and Pb showing elevated levels beyond sediment quality guidelines. The PERI and TRI values confirmed high ecological risk, with arsenic and chromium contributing the most to environmental toxicity. PMF analysis identified five major contamination sources, including geogenic weathering, petroleum drilling waste, industrial effluents, aquaculture inputs, and agricultural runoff. The HRA results demonstrated that children are at greater non-carcinogenic risk (HI > 1), particularly due to As, Cr, and Pb exposure via ingestion. The carcinogenic risks for As and Cr exceeded the USEPA threshold (1 × 10^-4), suggesting long-term health concerns for populations residing near contaminated sites. The integration of pollution indices, PMF source apportionment, and HRA provides a scientific framework for assessing contamination severity and health risks. These findings underscore the urgency of implementing proactive environmental monitoring, stricter regulatory controls, and effective remediation strategies to safeguard ecosystem and human health in hydrocarbon-extraction areas.

PMID:41241673 | DOI:10.1007/s10653-025-02872-4