Tag: nevin manimala

Neurocrit Care. 2025 Jul 2. doi: 10.1007/s12028-025-02312-2. Online ahead of print.

ABSTRACT

BACKGROUND: Hemorrhagic transformation (HT) remains a common and serious complication after endovascular treatment (EVT) for acute ischemic stroke (AIS). Limited data exist on how dynamic status of leptomeningeal collaterals influence HT in AIS. This study aims to investigate the impact of dynamic status of leptomeningeal collaterals on postoperative HT in patients with AIS undergoing EVT.

METHODS: A prospective cohort study was performed between January 2019 and June 2023. Only patients with middle cerebral artery occlusion who received EVT were included. Preoperative leptomeningeal collaterals were evaluated using the regional leptomeningeal collateral (rLMC) score, and postoperative collaterals were assessed using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology score.

RESULTS: A total of 342 patients with middle cerebral artery occlusion were included in this study. Multivariate analysis demonstrated that patients with good rLMC scores (˃ 10) experienced fewer HT events compared with those with poor rLMC scores (≤ 10) (adjusted odds ratio [aOR] 0.46, 95% confidence interval [CI] 0.28-0.76, P = 0.002). Further subgroup analysis based on intravenous thrombolysis showed that good leptomeningeal collaterals were significantly associated with reduced risk of HT in patients receiving bridging therapy (aOR 0.12, 95% CI 0.03-0.38, p < 0.001). Among 75 patients with incomplete recanalization, analysis of collateral changes indicated that patients with consistently good preoperative and postoperative collateral had the lowest risk of HT (aOR 0.19, 95% CI 0.04-0.95, P = 0.043). However, no significant correlation was detected between symptomatic intracranial hemorrhage and preoperative and postoperative collateral or its dynamic evolution.

CONCLUSIONS: Good preoperative leptomeningeal collateral status is associated with reduced risk of HT and better 90-day functional outcomes after EVT, possibly due to its role in maintaining cerebral perfusion and slowing infarct growth. Although our findings suggest that collateral-dependent infarct growth may be a potential mechanism for HT and unfavorable outcomes, this hypothesis requires further investigation.

PMID:40603823 | DOI:10.1007/s12028-025-02312-2

Aesthetic Plast Surg. 2025 Jul 2. doi: 10.1007/s00266-025-05015-3. Online ahead of print.

ABSTRACT

BACKGROUND: The increasing use of glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, for weight management has raised new considerations in aesthetic surgery. While these drugs offer significant preoperative weight loss benefits, their impact on surgical outcomes, tissue healing, and perioperative complications remains unclear.

OBJECTIVE: This study aims to evaluate the effects of GLP-1 receptor agonists on postoperative complications in patients undergoing 360° lipoabdominoplasty.

METHODS: A prospective cohort of 21 patients treated with semaglutide (Group G1) was compared with a retrospectively selected control group (Group G2). Outcomes including wound healing, seroma, hematoma, bruising, hyperpigmentation, and thromboembolic events were analyzed. Statistical comparisons were performed using an independent samples t-test and Welch’s t-test for unequal variances.

RESULTS: No statistically significant differences were observed in major postoperative complications between the two groups. However, hyperpigmentation and bruising were more frequent in the GLP-1 treated group (p = 0.10 and p = 0.09, respectively), suggesting a potential metabolic or vascular effect of the drug.

CONCLUSIONS: While GLP-1 receptor agonists do not appear to significantly increase overall surgical risks, their effects on tissue healing and bruising warrant further investigation. The role of rapid weight loss and potential micronutrient deficiencies in perioperative outcomes should be explored in larger, long-term studies to optimize surgical safety and patient selection criteria.

LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:40603775 | DOI:10.1007/s00266-025-05015-3

Eur Radiol. 2025 Jul 2. doi: 10.1007/s00330-025-11788-7. Online ahead of print.

ABSTRACT

OBJECTIVES: Evaluation of extranodal extension (ENE) after neoadjuvant chemoradiotherapy (nCRT) might improve the currently suboptimal prognostic implication of preoperative nodal evaluation in rectal cancer, but evidence is lacking. The aim of this study was to evaluate diagnostic accuracy and prognostic value of MRI-determined ENE after nCRT in rectal cancer.

MATERIALS AND METHODS: This single-center study included a prospective developing dataset and a retrospective validation cohort, which enrolled patients who underwent nCRT and surgery from 2021 to 2023 and 2018 to 2019, respectively. In the developing dataset, participants were chronologically divided into training and test sets in 3:1 ratio and multiparametric features were analyzed on MRI before and after nCRT (hereafter, post-nCRT) in nodes that achieved per-node matching with pathology. The diagnostic process was established with logistic analyses and evaluated with areas under the receiver operating characteristic curve (AUCs). In the validation cohort, potential risk factors were evaluated, and Cox analysis was used to explore their association with disease-free survival (DFS).

RESULTS: 208 participants were included in the developing dataset. The post-nCRT process, which incorporated the tail sign and vessel interruption on post-nCRT MRI, yielded AUCs of 0.86 (95% CI: 0.82, 0.89) and 0.83 (95% CI: 0.76, 0.89) in the training and test sets, respectively. In the validation cohort of 123 patients, the presence of ENE on post-nCRT MRI was demonstrated to be an independent risk factor for DFS (p = 0.02).

CONCLUSION: The evaluation of ENE after nCRT better predicts prognosis, whose presence may serve as an indicator of intensified therapy in rectal cancer patients.

KEY POINTS: Question Evidence of evaluating the extranodal extension (ENE), a pathological prognostic indicator, on MRI after neoadjuvant chemoradiotherapy (nCRT) is lacking in rectal cancer. Findings ENE could be detected by only two features on post-nCRT MRI, and its presence was associated with poorer disease-free survival. Clinical relevance The preoperative evaluation of ENE after nCRT improved the currently suboptimal contribution of nodal evaluation to prognostication in rectal cancer patients.

PMID:40603772 | DOI:10.1007/s00330-025-11788-7

Eur Radiol. 2025 Jul 2. doi: 10.1007/s00330-025-11764-1. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to assess the feasibility of “double-low,” low radiation dosage and low contrast media dosage, CT pulmonary angiography (CTPA) based on deep-learning image reconstruction (DLIR) algorithms.

MATERIALS AND METHODS: One hundred consecutive patients (41 females; average age 60.9 years, range 18-90) were prospectively scanned on multi-detector CT systems. Fifty patients in the conventional-dose group (CD group) underwent CTPA with 100 kV protocol using the traditional iterative reconstruction algorithm, and 50 patients in the low-dose group (LD group) underwent CTPA with a 70 kVp DLIR protocol. Radiation and contrast agent doses were recorded and compared between groups. Objective parameters were measured and compared. Two radiologists evaluated images for overall image quality, artifacts, and image contrast separately on a 5-point scale. The furthest visible branches were compared between groups.

RESULTS: Compared to the control group, the study group reduced the dose-length product by 80.3% (p < 0.01) and the contrast media dose by 33.3%. CT values, SD values, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) showed no statistically significant differences (all p > 0.05) between the LD and CD groups. The overall image quality scores were comparable between the LD and CD groups (p > 0.05), with good in-reader agreement (k = 0.75). More peripheral pulmonary vessels could be assessed in the LD group compared with the CD group.

CONCLUSION: 70 kVp combined with DLIR reconstruction for CTPA can further reduce radiation and contrast agent dose while maintaining image quality and increasing the visibility on the pulmonary artery distal branches.

KEY POINTS: Question Elevated radiation exposure and substantial doses of contrast media during CT pulmonary angiography (CTPA) augment patient risks. Findings The “double-low” CT pulmonary angiography protocol can diminish radiation doses by 80.3% and minimize contrast doses by one-third while maintaining image quality. Clinical relevance With deep learning algorithms, we confirmed that CTPA images maintained excellent quality despite reduced radiation and contrast dosages, helping to reduce radiation exposure and kidney burden on patients. The “double-low” CTPA protocol, complemented by deep learning image reconstruction, prioritizes patient safety.

PMID:40603771 | DOI:10.1007/s00330-025-11764-1

Am J Surg. 2025 Jun 6;247:116455. doi: 10.1016/j.amjsurg.2025.116455. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Inguinal hernioplasty is a common surgical procedure, often associated with complications such as post-operative urinary retention (POUR). POUR, characterized by an inability to urinate despite a full bladder following a surgery that may need foley catheterization that on its own can lead to urinary tract infection, stricture, prolonged hospitalization, and increases cost of hospital care. Tamsulosin is a selective alpha-1 adrenergic blocker that can increase urine flow by relaxing the smooth muscle of urethra and prostate, thereby as a less invasive method may be effective in prevention of POUR.

MATERIALS AND METHODS: This randomized clinical trial involved 179 male participants over 50 undergoing unilateral hernioplasty under spinal anesthesia. Group A (87 subjects) received 0.4 ​mg Tamsulosin 8 ​h before surgery, then 6-12 ​h post-operatively. Group B (92 subjects) received a placebo on the same schedule. Both were monitored for POUR incidence within 24 ​h post-surgery. Data were analyzed using SPSS software version 18 and the P ​< ​0.05 was considered statistically significant.

RESULTS: The mean age of participants was 63.37 ​± ​10.62 years. POUR requiring catheterization occurred in 10.3 ​% of Group A and 16.3 ​% of Group B. However, the difference was not statistically significant (p ​= ​0.242). Logistic regression showed no significant prophylactic effect of Tamsulosin (p ​= ​0.171), hypertension (p ​= ​0.166), diabetes mellitus (p ​= ​0.196), or benign prostatic hyperplasia (p ​= ​0.273) on POUR incidence.

CONCLUSION: Prophylactic Tamsulosin did not significantly reduce the incidence of POUR following inguinal hernioplasty under spinal anesthesia.

PMID:40602006 | DOI:10.1016/j.amjsurg.2025.116455

Am J Emerg Med. 2025 Jun 27;96:201-207. doi: 10.1016/j.ajem.2025.06.067. Online ahead of print.

ABSTRACT

INTRODUCTION: Gastroparesis (GP), cyclic vomiting syndrome (CVS), and cannabinoid hyperemesis syndrome (CHS) are chronic disorders of gut-brain motility. Though GP, CVS, and CHS are relatively common, recent, large scale data on their incidence and acute management are lacking. Thus, we sought to assess the incidence, rates of admission, medication administrations, and demographic data among emergency department (ED) visits for GP, CVS, and CHS in the United States.

METHODS: This was a retrospective cohort study of all ED presentations for GP, CVS, and CHS from 1/1/2016 to 12/31/2024 in the Epic Cosmos database. Emergency department visits for adults with GP, CVS, and CHS were identified by ICD-10 codes. Outcomes included incidence, admission rates, medications administered, and hospital length of stay (LOS). Data were analyzed using descriptive statistics and compared using multilevel chi-squared tests.

RESULTS: Out of 248,293,507 ED encounters over a nine-year period from 2016 to 2024, there were 165,857 (0.07 %), 204,636 (0.08 %), and 134,059 (0.05 %) encounters with an ICD-10 code corresponding to GP, CVS, and CHS, respectively. Gastroparesis and CVS were most prevalent in the southern United States; CVS was equally prevalent in the South and the Midwest. All three conditions primarily affected females. The mean age of patients with GP, CVS, and CHS is 44.7 years, 36.5 years, and 32 years, respectively. Mean admission rates for patients with GP and CHS remained steady over the nine-year period at approximately 25.4 % and 13.5 %, respectively. Admission rates for patients with CVS dropped from 20.3 % in 2016 to 11.5 % in 2024. The mean LOS for GP, CVS, and CHS were 5.8, 4.7, and 3.8 days, respectively. For all conditions, ondansetron was the most commonly administered medication (61.3 % for GP, 63 % for CVS, and 58.7 % for CHS). For GP and CVS, the second most commonly administered medication was metoclopramide (48.2 % and 27.4 %, respectively). For CHS, the second most commonly administered medication was haloperidol (32.6 %).

CONCLUSION: Gastroparesis, CVS, and CHS are common reasons for presentation to the ED. Ondansetron remains the most common treatment for acute exacerbations of GP, CVS, and CHS. Rates of admission and hospital LOS for all three conditions demonstrate that GP, CVS, and CHS continue to pose a significant burden on healthcare systems.

PMID:40602005 | DOI:10.1016/j.ajem.2025.06.067

Geriatr Nurs. 2025 Jul 1;64:103414. doi: 10.1016/j.gerinurse.2025.103414. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to test the psychometric properties of the Papadum/Pizza Test.

DESIGN: This was a descriptive study.

SAMPLE: Participants included 80 individuals living in low-income senior housing. The majority were female (70 %) and Black (70 %) older adults.

MEASURES: Demographics, the Patient Health Questionnaire-2, the Papadum/Pizza test, and the Clock test were obtained.

DATA ANALYSIS: Descriptive statistics were done. A Cohen’s Kappa was calculated to evaluate inter-rater reliability. Rasch analysis using Winsteps was done to test internal consistency, Differential Item Functioning (DIF), and model testing for construct validity. Hypothesis testing was done using Pearson correlations.

RESULTS: There was a Cohen’s kappa of .98, an alpha coefficient of .95, no DIF between groups, and all items fitting the model, and all hypotheses tested were supported.

CONCLUSION: The study provided support for reliability and validity of the Pizza Test when used with older adults in senior housing.

PMID:40602003 | DOI:10.1016/j.gerinurse.2025.103414

Aust J Gen Pract. 2025 Jul;54(7):477-483. doi: 10.31128/AJGP-04-24-7229.

ABSTRACT

BACKGROUND AND OBJECTIVES: In July 2022, a policy change was enacted in the National Cervical Screening Program (NCSP) to allow all women and people with a cervix (hereafter people) the choice of a self-collected sample. This study aimed to understand healthcare practitioners’ decisions, and factors related to, the provision (or not) of this change.

METHOD: Semi-structured interviews (n=28) were conducted between February and July 2023 with general practitioners, nurses and practice managers. The COM-B model of behaviour change framework informed the analysis.

RESULTS: Although most (n=22) interviewees reported that they, or healthcare practitioners at their practice, were providing a choice of self-collection to all, a minority (n=6) reported that either they (n=4) or their practice (n=2) were not. Factors that informed the selective provision of self-collection are reported.

DISCUSSION: For self-collection to facilitate improved equity in the NCSP, strategies are needed to reassure healthcare practitioners that self-collection is an appropriate screening modality, and ensure people are aware of their screening choices.

PMID:40601982 | DOI:10.31128/AJGP-04-24-7229

Aust J Gen Pract. 2025 Jul;54(7):471-476. doi: 10.31128/AJGP-04-24-7242.

ABSTRACT

BACKGROUND AND OBJECTIVES: Relatively little is known about public understanding of the secondary use of general practice data. We investigated what the Australian public knows about the secondary use of information in their general practice records.

METHOD: The investigation used a mixed methods approach with four focus groups (n=22) and a cross-sectional survey that was weighted to be nationally representative (n=2604).

RESULTS: Participants broadly understood what was in their general practice record. Most believed it was shared with hospital health professionals and other medical staff to support their care. Fewer than 30% thought their health information was shared with health administrators, planners and researchers, and fewer than half believed it was used for planning, to improve health services generally or for research.

DISCUSSION: The secondary use of general practice data outside the clinical encounter is poorly understood by the public. More and better information about how, where and with whom general practice data are shared is needed.

PMID:40601981 | DOI:10.31128/AJGP-04-24-7242

Aust J Gen Pract. 2025 Jul;54(7):459-464. doi: 10.31128/AJGP-04-24-7247.

ABSTRACT

BACKGROUND AND OBJECTIVES: Comprehensive nicotine and smoking cessation interventions can be crucial for successful and sustained cessation, but require adequate time, training and experience. This study aimed to quantify uptake of the temporary Medicare Benefits Schedule (MBS) smoking cessation services from July 2021 to December 2023.

METHOD: MBS nicotine and smoking cessation claims processed for face-to-face and telehealth services from July 2021 to December 2023 were examined. Quarterly rates of claims and 95% confidence intervals per 1000 people who smoke were calculated.

RESULTS: Overall, 188,904 claims were processed during this period. The national trends in the rate of face-to-face (P<0.001) and telephone (P<0.001) services increased significantly. The quarterly rate of claims processed for face-to-face services increased by 16-fold, from a rate of 1 to 16 per 1000 people who smoke.

DISCUSSION: This study highlights that the temporary MBS smoking cessation services were increasingly used, but that changes to this service might deter smoking cessation efforts.

PMID:40601979 | DOI:10.31128/AJGP-04-24-7247