Tag: nevin manimala

Int J Stroke. 2025 Sep 6:17474930251380184. doi: 10.1177/17474930251380184. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence on the role of herpes-zoster (shingles) vaccination in reducing stroke risk is inconsistent and limited, particularly concerning intracerebral hemorrhage (ICH). We aimed to examine the association between zoster live vaccine (ZVL) and overall stroke, as well as its main subtypes.

METHODS: We conducted a population-based nested case-control study using the database of Israel’s largest healthcare provider. The underlying cohort consisted of individuals aged 50 years or older, regardless of prior stroke status, from 2015 to 2022, with follow-up through June 2023. Stroke cases diagnosed during follow-up were matched with controls based on age, sex, population sector, and index date. ZVL exposure was defined as the prior filling of a prescription of the vaccine.

RESULTS: Among 37,027 matched case-control pairs, ZVL was associated with significantly reduced odds of stroke, with an adjusted OR of 0.65 (95% CI, 0.58-0.72) for overall stroke, 0.65 (95% CI, 0.58-0.73) for ischemic stroke, and 0.64 (95% CI, 0.47-0.89) for ICH. The protective association with overall stroke decreased as time since vaccination increased; adjusted OR of 0.56 (0.48-0.65) within the first 2.5 years, 0.71 (95% CI, 0.58-0.87) after 2.5 to 5 years, and 0.81 (95% CI, 0.65-1.01) after 5 years. The association between ZVL and stroke was modified by age and sex, with a stronger association in individuals younger than 65 years (P for interaction = 0.004) and males (P for interaction = 0.031).

CONCLUSIONS: ZVL is associated with a reduced risk of both ischemic stroke and ICH. The protective association appears to decrease over time and to be stronger in males and younger individuals.

PMID:40913529 | DOI:10.1177/17474930251380184

Epileptic Disord. 2025 Sep 6. doi: 10.1002/epd2.70101. Online ahead of print.

ABSTRACT

OBJECTIVE: Despite pharmacological advances in epilepsy treatment, one-third of patients remain pharmacoresistant and may require surgery. Despite extensive literature on epilepsy surgery, studies with follow-ups longer than 5 years are rare. Our goal was to analyze the outcomes of patients undergoing epilepsy surgery at our center, with a minimum follow-up of 15 years.

METHODS: This was a retrospective study of prospectively collected data. We used the Engel classification to assess seizure freedom, performed univariate descriptive analysis of the variables of interest, and applied appropriate correlation tests for nominal and categorical variables, with statistical significance set at 0.05.

RESULTS: We included 160 patients with a minimum follow-up of 15 years. A total of 105 (70%) patients underwent resective surgeries, the most common being lesionectomy (46.7%), followed by anterior temporal lobectomy with amygdalectomy (21.9%). Among resective surgeries, 73.6% used intraoperative ECOG. Most surgeries were in the temporal lobe (68.8%), and mesial sclerosis was the most frequent etiology (33.8%), followed by long-term epilepsy-associated tumors (LEAT) (25.6%). Seizure freedom at 15 years was achieved by 57.5% of patients, and most of the remaining patients (63.2%) had rare disabling seizures. The majority (65%) discontinued at least one ASM. Temporal surgeries (χ²(1) = 8.444, p < 0.05), left-sided surgeries (χ²(1) = 6.436, p = 0.04), mesial sclerosis (χ²(1) = 50.870, p = 0.024), and the use of intraoperative ECOG (χ²(1) = 23.235, p < 0.001) were associated with a better prognosis. No differences in outcome were found between the different temporal lobe surgeries (Fisher’s exact test value = 0.859, p = 0.659).

SIGNIFICANCE: Appropriate referral to a refractory epilepsy center permits a multidisciplinary approach that can result in long-term seizure freedom for most patients undergoing surgery, especially for left-temporal lobe surgeries performed with the aid of intraoperative monitoring techniques.

PMID:40913513 | DOI:10.1002/epd2.70101

Eur J Dent Educ. 2025 Sep 6. doi: 10.1111/eje.70038. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: Working in a dental private practice is an investment that requires many skills in management, including the management of the dental office and staff recruitment. The objective of our study was to identify the need for continuing training in dental practice management among dental students at the end of their training.

METHODS: A descriptive cross-sectional study was conducted among students at the end of their course at the Faculty of Dentistry of Casablanca using an anonymous questionnaire. The questionnaire included 7 general questions, 15 questions on the liberal installation, and 7 questions on the financing of the dental office. Data were entered and statistically analysed using SPSS software at the epidemiology and research laboratory of the faculty.

RESULTS: 3% of students were able to answer correctly to the questions on the types of possible contracts for staff. 88.7% of students do not know dental practice management software, and 93.2% do not know which software to use to communicate with prosthetists. 88% of participants express a need for training in the running of their practice. To complete their knowledge, 70.7% of students expressed their interest in workshops, and 66.2% in guided lessons.

CONCLUSION: To address the identified training needs, the organisation of additional scientific events, such as congresses, seminars, and workshops, is proposed within the faculty, in collaboration with the Order Council and other institutional stakeholders.

PMID:40913502 | DOI:10.1111/eje.70038

Australas Psychiatry. 2025 Sep 6:10398562251375269. doi: 10.1177/10398562251375269. Online ahead of print.

ABSTRACT

ObjectivesThere is limited research on entry to aged residential care (ARC) in people living with young-onset dementia (YOD). Most people with YOD eventually require ARC, often in facilities designed for older adults. This study aimed to investigate the time to ARC admission in a previously identified YOD cohort and their health outcomes before and after ARC admission.Methods60 YOD participants (diagnosed in Waikato, New Zealand between 2014 and 2016) were retrospectively followed over a median of 5.4 years, using routinely collected health data (interRAI and mortality data). Survival analysis assessed the ARC admissions time, considering age, gender, ethnicity, and dementia type. McNemar’s/McNemar-Bowker tests were conducted to compare health outcomes before and after ARC admission.Results32 participants required ARC, with a median admission time of 4.5 years post-diagnosis. No significant effects were detected for age at diagnosis, gender, ethnicity (Māori vs non-Māori), or dementia type (Alzheimer’s vs non-Alzheimer’s disease) on ARC admission time. Significant health improvements were observed post-admission regarding health stability (CHESS), smoking, physical activity, and hospitalisations.ConclusionsWell-being improvements after ARC admission are encouraging and align with the New Zealand Aged Care Association (NZACA) report. However, the small sample size warrants further research to confirm these findings.

PMID:40913498 | DOI:10.1177/10398562251375269

J Prim Care Community Health. 2025 Jan-Dec;16:21501319251366123. doi: 10.1177/21501319251366123. Epub 2025 Sep 6.

ABSTRACT

AIMS: To identify risk factors for hyperglycemia in emergency department visits within 1 year following type 2 diabetes diagnosis.

METHODS: In this retrospective cohort study, electronic medical record data from 3333 adult patients newly diagnosed with type 2 diabetes across 57 primary care clinics in West Michigan between April 2021 and January 2023 were analyzed. The primary outcome was hyperglycemia at ED encounters within 12 months of diagnosis. General linear/Cox regression models were used to identify risk factors, adjusting for demographics, clinical characteristics, and medications.

RESULTS: Of 3333 patients (mean age 61.8 years, 56.9% male), 68 (2.0%) experienced hyperglycemia-related ED visits during follow-up. Key risk factors included history of depression (aOR 3.01, 95% CI 1.64-5.52, P < .001), and higher initial HbA1c values (aOR 1.74 per percentage point increase, 95% CI 1.49-2.02, P < .001). Protective factors included metformin (aOR 0.21, 95% CI 0.11-0.39, P < 0.001) and sulfonylureas (aOR 0.11, 95% CI 0.02-0.53, P = .006) prescriptions. Other clinical and demographic factors showed no statistically significant associations.

CONCLUSIONS: A history of depression emerged as a risk factor for hyperglycemia in emergency department visits following type 2 diabetes diagnosis. These findings emphasize the particular importance of addressing psychological distress in diabetes care during the vulnerable post-diagnosis period.

PMID:40913495 | DOI:10.1177/21501319251366123

Nurs Open. 2025 Sep;12(9):e70299. doi: 10.1002/nop2.70299.

ABSTRACT

AIM: To identify individuals at risk of falls and the factors contributing to their risk, we screened community-dwelling older adults using the Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) Assessments.

DESIGN: A descriptive correlational study design.

METHODS: Fall risk screenings with community-dwelling older adults aged 65 or older were conducted during a virtual interprofessional education event (IPE) for fall risk screening. The screening included demographic questions, perception of fall risks, medication questions and physical assessments (Timed Up and Go test, Single Leg test, 30-Second Sit to Stand) using the STEADI algorithm. Screening data were collected via Qualtrics, and descriptive data analyses were performed using SPSS.

RESULTS: In total, 114 community volunteers aged 65 or older were screened for fall risk. Using the STEADI Fall Risk questionnaire, 84 participants (73.7%) exhibited at least one clinically proven risk factor for falls, with 39 (34.2%) having four or more risk factors. The physical assessments identified 37 participants (32.5%) with functional leg weakness, 47 (41.2%) had poor mobility and 32 (28.1%) had poor balance. As a result, the modified STEADI algorithm identified 68 (59.6%) with fall risk and the most frequently discussed SMART objectives were related to physical assessment data issues (34.5%).

PATIENT OR PUBLIC CONTRIBUTION: Our study confirmed the effectiveness of a multifaceted STEADI assessment in identifying community individuals at risk for falls who may not be detected through the normal standard of care. Educating nurses on performing comprehensive fall risk assessments and creating corresponding action plans with SMART objectives is essential to ensure thorough screening and care of their patients. A collaborative, interprofessional education programme can help train health professional students to gain valuable skills in conducting comprehensive fall risk screenings and developing objectives for future care plans based on those findings.

PMID:40913487 | DOI:10.1002/nop2.70299

Pediatr Dermatol. 2025 Sep 6. doi: 10.1111/pde.70039. Online ahead of print.

ABSTRACT

BACKGROUND: There are no universally established guidelines for when pediatric EH warrants hospitalization or intravenous (IV) acyclovir over oral therapy. To address this lack of consensus, this study aimed to describe outcomes of outpatient oral acyclovir treatment in pediatric EH cases, including rates of disease exacerbation, hospitalizations, and complications.

METHODS: We conducted a retrospective cohort review of pediatric patients under age 7 diagnosed with EH who presented to the pediatric emergency department (ED) between January 1, 2008, and December 31, 2022. Cases were identified via electronic medical record (EMR) query using ICD-9/ICD-10 diagnosis codes for EH, 054.0 and B00.0, respectively. All encounters were manually reviewed to confirm diagnosis, assess disease severity, identify complications, and document treatment. The primary outcome was clinical deterioration (e.g., return visits, hospitalization, or new complications). Secondary outcomes included length of stay and treatment modality. Descriptive statistics and subgroup comparisons were performed to assess associations with disposition.

RESULTS: A total of 97 encounters among 87 unique patients were identified. Mean age was 2.05 years. Of 27 patients discharged from the ED, only one returned for hospitalization due to EH. Among 70 hospitalized patients, no intensive care, resuscitation, or deaths occurred. Hospitalization was more common in patients with more severe skin findings, concurrent cellulitis, and younger age. No systemic complications or keratitis were observed.

CONCLUSION: In this cohort, oral acyclovir outpatient management was not followed by disease progression or serious complications. These findings support that some mild EH cases may be managed without hospitalization, but further prospective studies are needed.

PMID:40913473 | DOI:10.1111/pde.70039

Subst Use Addctn J. 2025 Oct;46(4):880-887. doi: 10.1177/29767342251331712. Epub 2025 Apr 28.

ABSTRACT

OBJECTIVES: To estimate the effect of the passage of state laws targeting patient brokering on opioid-related outcomes.

BACKGROUND: In response to growing awareness of unethical substance use disorder (SUD) treatment practices, several states in the United States have passed laws targeting patient brokering and deceptive marketing. Patient brokering and deceptive marketing laws are intended to reduce the chances individuals with SUD interact with bad actors or suffer from adverse outcomes related to inappropriate SUD treatment, but the effectiveness of these laws is unknown.

METHODS: Matched event study analysis comparing early population-level outcomes in 6 states that passed laws targeting patient brokering between 2018 and 2019 and 24 comparison states with similar census region and presence of recovery residence regulations, anti-kickback laws, state SUD task forces. Outcomes, analyzed through 2019, included monthly rates of opioid-related mortality and quarterly rates of opioid-related emergency department visits and hospitalizations per 100,000 residents, and state-year prevalence of unusual patterns of claims for SUD-related services.

RESULTS: In 2018, there was a mean of 326.9 (SD = 72.0) opioid-related hospitalizations/100k state residents, 234.6 (SD = 37.7) opioid-related ED visits/100k state residents, and 122.9 (SD = 73.6) opioid-related deaths/100k state residents in the states in our treatment group. We did not observe evidence that passage of state laws targeting patient brokering or deceptive marketing was associated with changes in any of our outcomes.

CONCLUSIONS: The passage of state laws targeting patient brokering is not associated with significant changes in opioid-related outcomes. Additional resources may be needed to accompany implementation and enforcement efforts before desired policy effects are realized.

PMID:40913376 | DOI:10.1177/29767342251331712

Subst Use Addctn J. 2025 Oct;46(4):901-912. doi: 10.1177/29767342251336035. Epub 2025 Apr 28.

ABSTRACT

BACKGROUND: To address the opioid use disorder (OUD) public health crisis, the ADvancing Pharmacological Treatments for OUD (ADaPT-OUD) external facilitation randomized trial was conducted in 8 intervention and 27 matched control low-performing Veterans Health Administration (VHA) facilities to increase the prescribing of medications for OUD (MOUD). Facilities were considered low-performers if they were in the bottom quartile of the facility ratio of Veterans with OUD who received MOUD. The objective of this analysis was to evaluate the healthcare expenditures of Veterans with OUD who received care in ADaPT-OUD intervention facilities compared to those receiving care in matched control facilities.

METHODS: Difference-in-differences (DID) design was used to compare the overall, outpatient, and inpatient expenditures (extracted from the VHA data warehouse) of Veterans diagnosed with OUD or receiving MOUD between the 2 groups 12 months before and after the intervention.

RESULTS: A total of 7348 Veterans with a diagnosis of OUD or prescribed MOUD on at least 1 encounter 12 months after ADaPT-OUD intervention at all sites (92.39% male and 83.26% white) were included for analysis. ADaPT-OUD intervention did not have a substantial impact on overall healthcare costs. However, we reported 4% fewer total encounters in the intervention sites (DID, 95% confidence intervals [CI]: 0.96 [0.92-1.00]) compared to the control sites, driven by a decline in non-VA services. Notably, the outpatient psychiatric-related costs were $391 (95% CI: $49-$733) higher per Veteran within the year after the intervention sites received external facilitation compared to control sites.

CONCLUSIONS: Veterans at intervention sites with an OUD history had higher outpatient psychiatric-related costs, which could be explained by increased access to optimal mental health services at VHA. Improving access to OUD treatment at VA may lead to more coordinated and comprehensive treatment of both OUD and other associated mental health and physical comorbidities.

PMID:40913373 | DOI:10.1177/29767342251336035

Eur J Neurol. 2025 Sep;32(9):e70355. doi: 10.1111/ene.70355.

ABSTRACT

BACKGROUND: No standardized strategy for integrating κ-free light chain (κ-FLC) index into routine cerebrospinal fluid (CSF) diagnostics has yet been established.

OBJECTIVE: To determine agreement between κ-FLC index and CSF-restricted oligoclonal bands (OCB), and to identify κ-FLC index range where second-line OCB testing is needed.

METHODS: A retrospective analysis was conducted in patients who had κ-FLC measurement between December 2023 and December 2024 at the Medical University of Innsbruck. κ-FLC in CSF and serum was determined by nephelometry; OCB by isoelectric focusing and immunoblotting. The threshold for positivity was defined as ≥ 3 CSF-restricted bands for OCB and ≥ 6.1 for κ-FLC index.

RESULTS: In 632 included samples, κ-FLC index ranged from 0.5 to 971. Among 213 samples with κ-FLC index ≥ 3.5, 180 (85%) samples had a positive κ-FLC index and 148 (69%) positive OCB. Thirty-four (16%) samples showed discordant results. One sample was OCB positive/κ-FLC index negative, showing markedly elevated serum κ-FLC values. Thirty-three samples were OCB negative/κ-FLC index positive; of those, 4 samples had isolated intrathecal immunoglobulin M or A synthesis, and the remaining 29 discordant samples showed a median κ-FLC index of 8.7 (75th percentile: 10.3). The predictive value for OCB positivity exceeded 95% in the case of κ-FLC index > 20.

CONCLUSION: κ-FLC index shows high agreement with OCB. Discordant results were largely confined to κ-FLC index between 3.5 and 20 (“gray zone”). A reflex approach, that is, initial screening with κ-FLC index and in case of values within the “gray zone” performing OCB, seems reasonable.

PMID:40913362 | DOI:10.1111/ene.70355