Tag: nevin manimala

Eur J Med Res. 2025 Apr 2;30(1):228. doi: 10.1186/s40001-025-02477-8.

ABSTRACT

INTRODUCTION: Numerous studies have investigated variables that predict mortality and complications following severe trauma. These studies, however, mainly focus on admission values or a single variable. The aim of this study was to investigate the predictive quality of multiple routine clinical measurements (at admission and in the ICU).

METHODS: Retrospective cohort study of severely injured patients treated at one Level 1 academic trauma centre.

INCLUSION CRITERIA: severe injury (ISS ≥ 16 points), primary admission and complete data set. Exclusion criteria end-of-life treatment based on advanced directive, secondary transferred patients.

PRIMARY OUTCOME: mortality, pneumonia, sepsis. Routine clinical parameters were stratified based on measurement timepoint into Group TB (Trauma Bay, admission) and into Group intensive care unit (ICU, 72 h after admission). Prediction of complications and mortality were calculated using two prediction methods: adaptive boosting (AdaBoost, artificial intelligence, AI) and LASSO regression analysis.

RESULTS: Inclusion of 3668 cases. Overall mean age 45.5 ± 20 years, mean ISS 28.2 ± 15.1 points, incidence pneumonia 19.0%, sepsis 14.9%, death from haemorrhagic shock 4.1%, death from multiple organ failure 1.9%, overall mortality rate 26.8%. Highest predictive value for complications for Group TB include abbreviated injury scale (AIS), new injury severity score (NISS) and systemic Inflammatory Response Syndrome (SIRS) score. Highest predictive quality for complications for Group ICU include late lactate values, haematocrit, leukocytes, and CRP. Sensitivity and specificity of late prediction models using a 25% cutoff were 73.61% and 76.24%, respectively.

CONCLUSIONS: The predictive quality of routine clinical measurements strongly depends on the timepoint of the measurement. Upon admission, the injury severity and affected anatomical regions are more predictive, while during the ICU stay, laboratory parameters are better predictor of adverse outcomes. Therefore, the dynamics of pathophysiologic responses should be taken into consideration, especially during decision making of secondary definitive surgical interventions.

LEVEL OF EVIDENCE: III (retrospective cohort study).

PMID:40176162 | DOI:10.1186/s40001-025-02477-8

Acta Neuropathol Commun. 2025 Apr 2;13(1):69. doi: 10.1186/s40478-025-01991-4.

ABSTRACT

Pediatric high-grade gliomas (pHGG) and pediatric diffuse midline gliomas (pDMG) are devastating diseases without durable and curative options. Although targeted immunotherapy has shown promise, the field lacks immunocompetent animal models to study these processes in detail. To achieve this, we developed a fully immunocompetent, genetically engineered mouse model (GEMM) for pDMG and pHGG that incorporates the glioma-associated antigen, interleukin 13 receptor alpha 2 (IL13RA2). Utilizing the RCAS-Tva delivery system in Nestin-Tva mice, we induced gliomagenesis by overexpressing PDGFB and deleting p53 (p53^fl/fl) or both p53 and PTEN (p53^fl/fl PTEN^fl/fl), with or without IL13RA2 in neonatal mice. De novo tumors developed in models with and without IL13RA2, showing no statistical difference in onset (n = 33, 38 days, p = 0.62). The p53^fl/fl PTEN^fl/fl tumors displayed more aggressive characteristics (n = 12, 31 days). Tumors exhibited features typical of high-grade glioma, including infiltration, pseudopalisading necrosis, and microvascular proliferation. They also showed a high Ki-67 index, variable IL13RA2 expression, a high frequency of CD11b + macrophages, and a low proportion of CD3 + T cells. The model proved effective for evaluating IL13RA2-targeted immunotherapies, with a significant response to CAR T-cell treatment that extended survival (46 days vs. 28 days control; p < 0.0001) and achieved 25% long-term survival in mice. This model facilitates the preclinical assessment of IL13RA2-directed therapies and holds potential for clinical application.

PMID:40176156 | DOI:10.1186/s40478-025-01991-4

J Health Popul Nutr. 2025 Apr 2;44(1):101. doi: 10.1186/s41043-025-00803-8.

ABSTRACT

BACKGROUND: Obesity and overweight are widespread among individuals in both developed and emerging nations. Obesity is a global health issue, and its prevalence has been increasing in Egypt for several decades. The health belief model (HBM) is a comprehensive framework model that has an important role in preventing disease and promoting health.

OBJECTIVES: This study aims to measure the prevalence of overweight and obesity among medical students in the faculty of medicine at Ain Shams University and to determine the effect of nutritional educational program on body mass index and health belief model scales among them.

METHODS: This study was conducted in the Faculty of Medicine at Ain Shams University among medical students in 2 phases: phase 1, a descriptive cross-sectional study to calculate the prevalence of the disease; and phase 2, an intervention study that included a sample of 100 medical students whose body mass index was greater than or equal to 25. The study tool is a self-administered questionnaire based on the health belief model for weight control behavior that is tested by the participants before and after the intervention program.

RESULTS: Most participants had a normal BMI, while 40% were overweight or obese. There was a statistically significant difference in the HBM scores before and after the intervention sessions. The mean BMI before the intervention was 29 ± 0.25 and had improved after the intervention session to 29, where there was a highly statistically significant difference (p-value < 0. 001).

CONCLUSIONS: Nutritional education sessions based on the health belief model help in improving the knowledge and habits of high-risk medical students for weight gain. There were substantial changes between before and after the nutrition program interventions.

PMID:40176154 | DOI:10.1186/s41043-025-00803-8

Int J Retina Vitreous. 2025 Apr 2;11(1):39. doi: 10.1186/s40942-025-00666-5.

ABSTRACT

BACKGROUND: To evaluate methods of preoperative axial length (AL) estimation for intraocular lens (IOL) power calculation in patients with macula-off rhegmatogenous retinal detachment (RRD). These methods included optical biometry, A-scan biometry, and novel decision algorithms.

METHODS: A retrospective analysis of prospectively collected data was conducted at a tertiary hospital from January 2018 to December 2023. Preoperative and postoperative AL measurements were obtained using optical biometry (IOL Master 700, Zeiss, Germany) and A-scan biometry (VuMAX, Sonomed, USA). The primary outcome was the mean absolute prediction error (MAE) between postoperative AL and preoperative estimates generated by five methods, including two novel algorithms.

RESULTS: The study included 56 patients (56 eyes). The lowest MAE was achieved using the simple algorithm (0.31 ± 0.55 mm), followed by the AL of the fellow eye measured via IOL Master (0.34 ± 0.60 mm), and the advanced algorithm (0.36 ± 0.62 mm). A Kruskal-Wallis H test found no statistically significant difference in MAE across the five methods (P = 0.118). Bland-Altman analysis demonstrated good agreement between preoperative and postoperative AL measurements obtained with the IOL Master.

CONCLUSION: For patients undergoing phacovitrectomy for macula-off RRD, the simple algorithm provides accurate AL estimation for IOL power calculation. In cases where AL measurement of the affected eye is not feasible using the IOL Master, the fellow eye’s AL is a reliable alternative.

PMID:40176153 | DOI:10.1186/s40942-025-00666-5

Int Breastfeed J. 2025 Apr 2;20(1):22. doi: 10.1186/s13006-025-00716-6.

ABSTRACT

BACKGROUND: The prevalence of exclusive breastfeeding (EBF) during the first 6 months and breastfeeding up to 24 months in all mothers, regardless of HIV status, in high HIV prevalence settings of South Africa is not frequently evaluated. This study aimed to describe practices of EBF and breastfeeding beyond 12 months, compare these between HIV exposed (HE(s)) and unexposed infants (HU(s)), and determine associated factors.

METHODS: A secondary objective analysis of data from a cross-sectional study conducted during September-December-2019 in a rural South African district, was performed. Mothers living with HIV (MLHIV) paired with their infants in the following age groups: 0 to 3, > 3 to 6, > 6 to 12, and > 12 to 24 months; and mother-infant pairs without HIV with infants aged > 3 to 6 months and > 12 to 24 months, were enrolled. Descriptive statistics and bivariate and multivariable binomial regression were used for analyses.

RESULTS: A total of 771 mother-infant pairs, 62% being MLHIV, were enrolled. Among HEs (including 10 living with HIV), the prevalence of EBF was 41.0% and 16.7% in 0-3, and, 3-6 months age-groups, respectively, and breastfeeding prevalence was 19% in 12-24 months age-group. Among HUs, the prevalence of EBF was 7.9% among 3-6 months old and breastfeeding prevalence was 38.0% among > 12-24 months old. Overall, 79.8% and 45.5% HUs and HEs aged 3-6 months were still breastfeeding, respectively. HEs were more likely to exclusively breastfeed at 3-6 months age compared to HUs (adjusted prevalence ratio [aPR] 3.84; 95% confidence interval (CI) 1.55, 9.53). Breastfeeding practice at 12-24 months age was significantly less likely among HEs (versus HUs) and in infants with unmarried/non-cohabiting mothers (versus married/co-habiting) (aPR 0.42; 95% CI 0.27, 0.63 and aPR 0.66; 95% CI 0.47, 0.92), respectively). Among HEs, breastfeeding beyond 6 months was more likely among MLHIV with known HIV-negative male partners (versus known HIV concordant relationships).

CONCLUSION: In this study population, EBF was comparably more likely among HEs while breastfeeding beyond 12 months was more likely among HUs. Maternal marital status, frequency of antenatal care attendance and male partner’s HIV status also influenced breastfeeding practice. Overall, there is still room for improvement regardless of infant HIV status, requiring continued client-sensitive strengthening of the implementation of the recommended breastfeeding practices.

PMID:40176139 | DOI:10.1186/s13006-025-00716-6

Trials. 2025 Apr 2;26(1):116. doi: 10.1186/s13063-025-08822-w.

ABSTRACT

BACKGROUND: Degenerative rotator cuff tears are common and are often treated with surgical repair. Randomised trials have not shown a clear advantage to surgery over non-surgical treatment, but there have been no published placebo-controlled trials investigating rotator cuff repair. This study aims to compare arthroscopic shoulder surgery with rotator cuff repair to surgery without rotator cuff repair (placebo) for improving shoulder pain and function in people with shoulder pain and full-thickness degenerative rotator cuff tears.

METHODS: The study is a multicentre two-parallel arm, blinded, individually randomised controlled trial (RCT). Participants will be people aged 40-75 years (inclusive) with more than 6 months of shoulder pain, a degenerative (non-traumatic) full thickness rotator cuff tear 1 to 4 cm in length for whom surgery is recommended and repair of the tear is the main reason for surgery. The intervention is arthroscopic surgery (including-as indicated-bursectomy, debridement, acromioclavicular joint resection, acromioplasty and biceps tenodesis or tenotomy) with rotator cuff repair. The control is the same arthroscopic shoulder surgery without rotator cuff repair. Participants will be randomised to cuff repair or no cuff repair in a 1:1 ratio intra-operatively, after all other surgical procedures have been performed. Participants, follow-up surgeons, physiotherapists, study staff and statisticians will be blinded. Post-surgical rehabilitation will be usual care for rotator cuff repair in both groups. The primary outcome will be shoulder pain and function measured using the Western Ontario Rotator Cuff Index at 6 months post-surgery.

DISCUSSION: The ARC trial will provide low bias evidence on a common surgical procedure: rotator cuff repair for degenerative tears.

TRIAL REGISTRATION: The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000789965) on 5 August 2020 and the WHO International Clinical Trials Registry Platform (universal trial number U1111-1251-6599).

PMID:40176135 | DOI:10.1186/s13063-025-08822-w

Implement Sci Commun. 2025 Apr 2;6(1):33. doi: 10.1186/s43058-025-00720-1.

ABSTRACT

BACKGROUND: Home-based care for patients diagnosed in emergency departments (EDs) with low-risk pulmonary embolism (PE) is an evidence-based, guideline-recommended practice that is not widely adopted in the US. Few studies demonstrate how this care pathway can be implemented effectively or test whether implementation strategies can address known barriers. Further, prior studies have lacked diversity in population and health system type and did not integrate theory-informed implementation frameworks. Although essential for establishing the evidence base for safe home management of low-risk acute PE, these studies have thus fallen short of guiding broad dissemination and equitable implementation. To bridge this gap, we are conducting a pragmatic multi-site implementation trial, guided by implementation science theory and frameworks, across twelve diverse hospital settings to assess the effectiveness of new care pathways for patients with low-risk PE presenting to EDs.

METHODS/DESIGN: The study uses a cluster-randomized stepped wedge trial design to investigate a set of implementation strategies to support establishing low-risk PE pathways in 12 EDs. Clusters of three hospitals were randomly assigned to one of four start dates, staggered over a 12-month period. During an initial three-month pre-implementation period, we will work with site champions to identify key site personnel and understand site barriers and facilitators. We will then tailor the care pathway to local needs and capabilities. During the six-month active implementation period, we will provide coaching to help sites implement a multi-component intervention informed by behavioral economics intended to address multi-level (site, provider, patient) barriers and integrate the new care pathway for discharging low-risk PE patients. Sites are then followed for a minimum of 12 months post-implementation. Our primary aim is to assess the change in discharge rates of patients with acute PE pre- and post-implementation. Secondary and exploratory aims will assess change in patient safety outcomes along with other key implementation outcomes guided by the RE-AIM framework.

DISCUSSION: This study expands upon prior effectiveness research to tailor, implement, and robustly evaluate a multi-component implementation intervention for diverse health systems aiming to increase guideline-based outpatient management of low-risk PE. Broad-scale implementation in the US could avert up to 100,000 hospitalizations annually.

TRIAL REGISTRATION: Clinicaltrials.gov (NCT06312332), registered on March 13, 2024.

PMID:40176133 | DOI:10.1186/s43058-025-00720-1

Eur J Med Res. 2025 Apr 2;30(1):229. doi: 10.1186/s40001-025-02441-6.

ABSTRACT

OBJECTIVES: The albumin-globulin ratio (AGR) is considered an important indicator reflecting an individual’s immune function and nutritional status, and it is closely associated with various health conditions. However, despite its widely studied correlations in numerous health fields, the link between AGR and Overactive Bladder (OAB) is still not completely comprehended.

METHODS: Data were sourced from the National Health and Nutrition Examination Survey (NHANES) database, selecting adult samples spanning from 2007 to 2018. Through comprehensive questionnaires and laboratory tests, we gathered data pertinent to OAB and the AGR. To explore the association between AGR levels and the likelihood of developing OAB, we utilized advanced statistical techniques, such as weighted multivariate logistic regression and restricted cubic spline (RCS) models. Furthermore, we carried out subgroup analyses to assess the uniformity of this association across various demographics.

RESULTS: After adjusting for relevant covariates, we discovered a marked negative correlation between AGR levels and the risk of OAB. As AGR increased, the incidence of OAB showed a declining trend (OR = 0.69; 95% CI 0.56-0.85). Furthermore, significant nonlinear dose-response relationship was observed between AGR levels and the risk of OAB (P < 0.001), and this association remained stable in stratified analyses.

CONCLUSIONS: Our results indicate that elevated AGR levels could be linked to a reduced risk of OAB. This observation highlights the potential role of AGR in assessing and preventing the occurrence of OAB.

PMID:40176132 | DOI:10.1186/s40001-025-02441-6

Acta Vet Scand. 2025 Apr 2;67(1):16. doi: 10.1186/s13028-025-00795-9.

ABSTRACT

BACKGROUND: Antibiotic treatments of diarrhoea in suckling piglets and in pigs after weaning are common worldwide and contribute to antimicrobial resistance (AMR) in Escherichia coli from pigs. In Sweden, during the last decades, resistance to trimethoprim-sulphonamide and ampicillin has increased markedly in E. coli from routine clinical samples from piglets with diarrhoea, hereafter referred to as “clinical submissions”. This has occurred despite a comparatively low use of antibiotics in Swedish pig production. However, clinical submissions might be biased towards farms with treatment failures and therefore overestimate occurrence of AMR. To explore the representativeness of data from such samples we compared occurrence of AMR in E. coli from clinical submissions and from concurrent samples collected from piglets with diarrhoea by convenience, referred to as “study samples”. We also investigated associations between farm-related potential risk factors and AMR using farm data collected through a questionnaire. Data were evaluated using univariable and multivariable statistical models, as well as a multivariate model.

RESULTS: In all, 158 study samples from 97 herds and questionnaires from 83 herds were analysed. Resistance to streptomycin (37%), trimethoprim-sulphonamide (32%), ampicillin (30%), and tetracycline (18%) were the most frequent traits. Occurrence of AMR in 158 E. coli isolates from study samples was not significantly different from occurrence in 57 isolates from concurrent clinical submissions (P > 0.05). In 70% of herds, more than 10% of the sows were treated with antibiotics in the first week after farrowing, and trimethoprim-sulphonamide was the most common first choice antibiotic. Trimethoprim-sulphonamide resistance was associated with the proportion of sows receiving post-farrowing treatment. Resistance to ampicillin, tetracycline, and streptomycin resistances were indirectly associated with sow treatments, likely via co-resistance to trimethoprim-sulphonamide. There was no significant association between high dose zinc oxide supplementation and AMR (P > 0.05).

CONCLUSIONS: Clinical submissions do not overestimate occurrence of AMR in E. coli from Swedish piglets with diarrhoea and are therefore relevant for AMR monitoring. Even at low treatment rates, post-farrowing treatment of sows increases the risk for AMR in piglets. This applies especially for trimethoprim-sulphonamide resistance, but also for resistance to other antibiotics, and indicates that antibiotic use must be reduced substantially to achieve a reduction of AMR.

PMID:40176081 | DOI:10.1186/s13028-025-00795-9

BMC Surg. 2025 Apr 3;25(1):130. doi: 10.1186/s12893-025-02866-0.

ABSTRACT

BACKGROUND: As the population continues to age, the occurrence of intertrochanteric femoral fractures (IFFs) has steadily increased. The main aims of this investigation were to evaluate and compare the clinical outcomes, ambulatory ability, overall survival, and all-cause mortality between two cephalic screws combined with compression proximal-femoral intramedullary nailing internal fixation (IF) and long-stemmed cemented bipolar hemiarthroplasty (LCHA) in patients aged 75 years and older. The secondary objective was to investigate the relative independent risk factors contributing to postoperative all-cause mortality.

METHODS: A retrospective analysis was conducted on 251 elderly patients with IFF who underwent IF or LCHA between January 2018 and October 2022. We employed generalized estimation equations along with univariate and multivariate analyses to examine the impact of various surgical interventions and other pertinent factors on postoperative ambulatory ability and all-cause mortality outcomes. Associations between sex, age, number of comorbidities, aspartate aminotransferase (AST) levels, total blood transfusions, and mortality were analyzed via Cox proportional hazards models.

RESULTS: The analysis included a cohort of 120 patients from the IF group and 121 patients from the LCHA group. Statistically significant differences were not observed in the clinical outcomes, ambulatory ability, overall survival, or all-cause mortality after surgical treatment between the groups receiving IF and LCHA (p > 0.05). Nevertheless, among patients aged ≥ 85 years, the IF group demonstrated a lower rate of all-cause mortality than the LCHA group did (p < 0.05). As age increases and the number of preoperative comorbidities and the amount of perioperative transfusion increase, the preoperative AST level decreases, which is associated with a greater risk of postoperative death. (p < 0.05).

CONCLUSIONS: In elderly patients aged 75-84 years with intertrochanteric femur fractures, both internal fixation (IF) and long-stemmed cemented hemiarthroplasty (LCHA) are viable treatment options. However, for patients aged 85 years and older, IF is associated with a relatively lower postoperative all-cause mortality rate and should be prioritized as a treatment modality. Additionally, preoperative AST levels may serve as a valuable predictor of postoperative all-cause mortality in elderly patients undergoing surgery for intertrochanteric femur fractures.

PMID:40176053 | DOI:10.1186/s12893-025-02866-0