Tag: nevin manimala

Intern Med J. 2025 Mar 6. doi: 10.1111/imj.16657. Online ahead of print.

ABSTRACT

BACKGROUND: Secondary stroke prevention is crucial for reducing recurrent events and associated morbidity. Cilostazol, a phosphodiesterase III inhibitor, is considered an alternative to aspirin for patients with ischaemic stroke due to its potentially lower risk of haemorrhagic complications. This meta-analysis evaluates the efficacy and safety of cilostazol versus aspirin for secondary stroke prevention. It provides a basis for drug selection and observation of secondary stroke prevention strategies.

METHODS: A comprehensive search was conducted in PubMed, Cochrane Library, EMBASE and Web of Science databases for randomised controlled trials comparing cilostazol with aspirin in secondary stroke prevention. Key outcomes included recurrence of ischaemic stroke, intracranial haemorrhage (ICH), death, effective rate and incidence of adverse events. Meta-analysis was performed using a random-effects model, and heterogeneity was assessed using I² statistics and Cochran’s Q test. Publication bias was evaluated using Doi plots and Luis Furuya-Kanamori index.

RESULTS: Thirteen studies involving 8993 participants were included. Cilostazol significantly reduced the recurrence of ischaemic stroke (risk ratio (RR): 0.766, 95% confidence interval (CI): 0.624-0.941) and ICH (RR: 0.392, 95% CI: 0.250-0.616) compared to aspirin. No significant differences were observed in overall mortality or adverse events. Cilostazol increased risks of headache, dizziness, diarrhoea and tachycardia but reduced constipation. Heterogeneity was generally low to moderate.

CONCLUSION: Cilostazol is an effective alternative to aspirin for secondary stroke prevention, reducing the risk of recurrent ischaemic stroke and ICH. However, its use is associated with certain adverse effects. Clinicians should consider individual patient profiles and preferences when selecting anti-platelet therapy for stroke prevention. Further research is warranted to optimise cilostazol use in clinical practice.

PMID:40047064 | DOI:10.1111/imj.16657

Ophthalmic Physiol Opt. 2025 Mar 6. doi: 10.1111/opo.13486. Online ahead of print.

ABSTRACT

PURPOSE: To investigate seasonal variations in changes of axial length (AL) among myopic children wearing orthokeratology (ortho-K) lenses.

METHODS: The data of 600 children receiving ortho-K treatment, aged 7-13 years, were collected retrospectively. Data were classified as ‘summer’ or ‘winter’ based on the midpoint of the 6-month period between visits. For each interval, AL from the right eye was used for statistical analysis. Paired sample t-tests were used to compare the seasonal differences in AL. Furthermore, the relationship between seasonal differences in AL, age and initial AL was analysed using Pearson correlation and multiple regression analysis, respectively.

RESULTS: The AL at 1 year after the initial ortho-K treatment was 24.96 ± 0.85 mm, representing an increase of 0.19 ± 0.15 mm. The semi-annual axial elongation was 0.07 ± 0.09 and 0.12 ± 0.09 mm for the summer and winter, respectively (p < 0.001). Linear regression analysis revealed that the control of axial growth in the summer was better than in the winter (β = -0.05, p < 0.001). A similar seasonal pattern was found among children aged 7-12 years as well as for those with an initial AL < 26 mm (but not in children aged 13 years).

CONCLUSIONS: The inhibition of axial growth by ortho-K treatment in the summer months is superior to that seen in the winter. Seasonal differences decrease with age and the initial AL.

PMID:40047056 | DOI:10.1111/opo.13486

Int J Gynaecol Obstet. 2025 Mar 6. doi: 10.1002/ijgo.70047. Online ahead of print.

ABSTRACT

OBJECTIVE: Hoopicoach is a digital health tool designed to support patients throughout all stages of gynecologic surgery, including pre-, intra-, and postoperative phases. It offers a personalized care pathway based on the type of surgery, providing reliable medical information through easily understandable content, diagrams, a chatbot, and videos produced by medical staff. The present study aimed to evaluate patient and caregiver usage and satisfaction with Hoopicoach, focusing on frequency of use, satisfaction, stress management, and patient understanding of surgery. Additionally, the study assessed the tool’s value for healthcare professionals.

METHODS: A pilot, observational, descriptive, single-center cohort study was conducted in a gynecologic and breast cancer surgery department from September 2020 to May 2022. The referring surgeon offered Hoopicoach to all patients scheduled for applicable surgeries. Self-administered questionnaires were completed by patients and caregivers.

RESULTS: A total of 79 patients participated, primarily aged 40-65 years, with most usage occurring before surgery, particularly among those undergoing partial mastectomies. High satisfaction was reported, with 93.7% willing to recommend Hoopicoach. A total of 89% rated their understanding of surgery as 4 or 5 (on a 5-point scale), and 80% felt all their questions were answered. Frequent use correlated with reduced stress, though was not statistically significant. Among 16 caregivers, 94% found Hoopicoach helpful for informing patients, and 87% believed it enhanced care quality.

CONCLUSION: Hoopicoach effectively supports patients throughout their surgical journey in gynecology, with high satisfaction reported by both patients and caregivers.

PMID:40047044 | DOI:10.1002/ijgo.70047

Ther Apher Dial. 2025 Mar 6. doi: 10.1111/1744-9987.70004. Online ahead of print.

ABSTRACT

BACKGROUND: Phosphate binders (PBs) are commonly prescribed to reduce serum phosphate levels. This study examined the association between the PB pill burden and cardiovascular events in hemodialysis patients.

METHODS: This retrospective cohort study included 395 patients undergoing hemodialysis between August 2018 and November 2023 at a single facility in Japan. Statistical analyses were conducted using baseline, time-averaged, and time-dependent Cox proportional hazard models.

RESULTS: Of the 395 included patients, cardiovascular events occurred in 121 patients (30.6%). The patients were categorized into tertiles based on their daily PB pill intake: T1 (<4 pills/day), T2 (4-8 pills/day), and T3 (≥9 pills/day). T3 was associated with increased cardiovascular risk (vs. T1 hazard ratio [HR] = 1.51, p = 0.064; vs. T2 HR = 2.06, p = 0.005). Similar results were obtained for the time-averaged and time-dependent models.

CONCLUSION: A high PB pill burden (≥9/day) is associated with increased cardiovascular risk in patients undergoing hemodialysis.

PMID:40047034 | DOI:10.1111/1744-9987.70004

Vestn Oftalmol. 2025;141(1):37-44. doi: 10.17116/oftalma202514101137.

ABSTRACT

The rising prevalence of diabetes mellitus increases the need for treatment of diabetic maculopathy (DM). Evaluation of surgical outcomes in DM, including postoperative microstructural changes in the retina and its vascular plexuses, remains a relevant challenge.

PURPOSE: This article assesses changes in angiographic parameters of the retinal capillary plexuses after surgical treatment of DM using various methods of internal limiting membrane (ILM) peeling.

MATERIAL AND METHODS: Vitreoretinal surgery, including vitrectomy with membrane peeling, was performed in comparable groups of patients with proliferative diabetic retinopathy and DM. The surgical methods differed in the approach to retinal ILM peeling: in group 1 the ILM was completely removed; group 2 underwent dosed fovea-sparing peeling (DFSP) of the ILM; in group 3 the ILM was left intact. Postoperative outcomes were compared between groups using optical coherence tomography angiography (OCT-A).

RESULTS: Intergroup comparisons across all time points and parameters did not reveal statistically significant differences. The analysis showed no significant changes in angiographic parameters in groups 1 and 3. In group 2 significant changes were observed in the parameters of deep capillary plexus: increased vessel density, vessel skeleton density and vessel perimeter index, as well as reduced foveal avascular zone (FAZ) area. Correlation analysis revealed that high FAZ area values in the deep capillary plexus were predictors of the development of retinal atrophy in the long-term.

CONCLUSION: The obtained results demonstrate the dynamics of changes following DFSP of the ILM in both the neuronal structures of the retina and its capillary plexuses, with these changes tending toward normalization of retinal structure.

PMID:40047021 | DOI:10.17116/oftalma202514101137

Vestn Oftalmol. 2025;141(1):13-20. doi: 10.17116/oftalma202514101113.

ABSTRACT

Iris melanoma is a rare malignant tumor of melanocytic origin. Oncogenic viruses, whose invasion of the cell alters proliferation regulation mechanisms, play an important role in tumor development and progression.

PURPOSE: To identify clinical, morphometric, and pathomorphological correlations with infectious status in patients with iris melanoma and to determine predictors of unfavorable prognosis.

MATERIAL AND METHODS: Sixteen patients with iris melanoma were examined. Anterior segment optical coherence tomography (AS-OCT) was performed using the RS-3000 Advance system (Nidek, Japan) with OCT-Angiography software. The specific humoral response to herpesviruses was assessed by detecting IgG and IgM antibodies in blood serum via enzyme-linked immunosorbent assay (ELISA) using an automated immunoassay analyzer LAZURITE (Dynex Technologies Inc., USA). Statistical analysis employed Spearman’s rank correlation coefficient (r_s).

RESULTS: Iris melanoma was predominantly observed in female patients (n=11) of advanced age (n=8). Biomicroscopy revealed 10 pigmented, 1 hypopigmented, and 5 non-pigmented tumors. The mean prominence on OCT was 1461.7±740.5 μm, the basal diameter was 3409.6±1822.8 μm, and the volume was 4.7±3.7 mm³. Ciliary body involvement was detected in 10 patients. Iris melanomas were classified as epithelioid-cell (n=1), spindle-cell (n=12), and mixed-cell (n=3) types. Extrabulbar growth was noted in three patients. Serological markers of viral reactivation were identified: herpes simplex virus type 1 (n=11) and type 2 (n=5), and cytomegalovirus (n=3).

Direct correlations (r_s=0.5-0.8) were identified between the presence of serological markers of herpesvirus reactivation and unfavorable prognostic features, including advanced age, maximum tumor basal diameter, ciliary body involvement, dense pigmentation, and extrabulbar growth. The mean follow-up period was 18.5±2.97 months, and all patients were alive, with no evidence of recurrence.

CONCLUSION: The findings of this study demonstrated a correlation between herpesvirus reactivation and unfavorable prognostic features of iris melanoma. Further research is needed to deepen the understanding of the role of herpesviruses in the pathogenesis of iris melanoma and to develop personalized approaches to prevention and treatment.

PMID:40047017 | DOI:10.17116/oftalma202514101113

Front Psychiatry. 2025 Feb 19;16:1525631. doi: 10.3389/fpsyt.2025.1525631. eCollection 2025.

ABSTRACT

BACKGROUND: It is well known that postmenopausal women have an increased risk of depression, and there is a dose correlation between carotenoid intake and depression. However, there is no clear study on the relationship between carotenoids and the risk of depression in postmenopausal women. To evaluate the relationship between the prevalence of depression and carotenoid intake in postmenopausal women.

METHODS: The study was based on the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018 and included 1089 postmenopausal female participants. A logistic regression model was used to verify the relationship between carotenoid intake and the prevalence of depression in postmenopausal women. A restricted cubic spline (RCS) model was used to study the dose-response relationship between carotenoid intake and depression.

RESULTS: After adjusting for confounding variables, Odds Ratios (95% confidence intervals) were found for depression in the highest quartile compared with the lower quartile. Among them, the results of lutein zeaxanthin and β-cryptoxanthin were not statistically significant (P > 0.05). Total lycopene 0.29 (0.10,0.87), β-carotene 0.41 (0.18,0.94), and total carotenoid 0.25 (0.09,0.67) were negatively correlated with the risk of depression in postmenopausal women. When α-carotene intake exceeded 2.90 mg/day, it was negatively and non-linearly associated with the prevalence of depression in postmenopausal women (P-nonlinear < 0.0022). When β-carotene intake exceeded 1.06 mg/day, it was negatively correlated with the prevalence of depression in postmenopausal women. It had an L-type nonlinear relationship with the prevalence of depression (P-nonlinear < 0.0016). Total lycopene was linearly correlated with the prevalence of depression in postmenopausal women (P-nonlinear = 0.3). When the intake exceeded 2.05 mg/day, it was negatively correlated with the prevalence.

CONCLUSION: The study found that dietary intake of sufficient α-carotene, β-carotene, lycopene, total lutein, and zeaxanthin was negatively correlated with the prevalence of depression in postmenopausal women. Still, there was no dose correlation between β-cryptoxanthin.

PMID:40046991 | PMC:PMC11880210 | DOI:10.3389/fpsyt.2025.1525631

Laryngoscope Investig Otolaryngol. 2025 Mar 4;10(2):e70116. doi: 10.1002/lio2.70116. eCollection 2025 Apr.

ABSTRACT

OBJECTIVES: To determine the prevalence of positional obstructive sleep apnea (pOSA) in children undergoing adenotonsillectomy (AT) for OSA and to assess whether pOSA improves following AT.

MATERIALS AND METHODS: Children with OSA diagnosed by polysomnography (PSG) at a tertiary care children’s hospital were included. Data was collected on demographics, PSG parameters, and surgical management. Statistical comparisons between groups for the prevalence of pOSA were performed with the χ2 test or Fisher’s exact test, for PSG parameters prior to AT with Student’s t-test or Mann-Whitney Rank Sum Test, and for PSG parameters before and after AT with paired t-test and Wilcoxon Signed Rank Test. p < 0.05 was considered significant.

RESULTS: Of the 1167 children (682 male, 485 female, median age = 5.7 years), 321 (28%) had pOSA. POSA children (median age = 7.4 years) were older than children with no pOSA (median = 5.2) (p ≤ 0.001). The prevalence of pOSA in the subgroups of gender and weight was not different. The prevalence of pOSA was significantly different amongst the race groups (p = 0.005). Compared with the Black/African American race, the white race had 1.4 times the odds of pOSA (95% CI, 1.07-1.98). The prevalence of pOSA was not significantly different between mild, moderate, and severe OSA groups (p = 0.7). Of the 66 POSA children who had PSG pre- and post-TA, 50 (76%) had resolution of pOSA. Children older than 6 years of age and children with obesity had a higher rate of persistent pOSA (p = 0.02 and p = 0.008, respectively).

CONCLUSION: POSA occurred frequently in OSA children undergoing AT. POSA is resolved in the majority of children after AT. Persistent pOSA was more prevalent in older and obese children. AT is used as the first-line treatment for pOSA in children. Future studies are needed to determine the role of positional therapy and other OSA therapies in the management of persistent pOSA after AT.

LEVEL OF EVIDENCE: 4.

PMID:40046983 | PMC:PMC11877339 | DOI:10.1002/lio2.70116

Laryngoscope Investig Otolaryngol. 2025 Mar 4;10(2):e70111. doi: 10.1002/lio2.70111. eCollection 2025 Apr.

ABSTRACT

OBJECTIVES: Transnasal endoscopic sphenopalatine artery ligation (TESPAL) has been proposed as a first-line therapy for intractable epistaxis before utilizing posterior nasal packing and embolization. A specific procedure code for TESPAL was newly introduced in 2018, adding to two prior codes for procedural control of epistaxis. This study compares all-time utilization of the TESPAL CPT code in Medicare beneficiaries with alternative procedural codes for epistaxis management.

METHODS: The publicly available data from the Centers for Medicare and Medicaid Services in the 2013-2022 period was analyzed for the reporting of TESPAL (31241), transcatheter permanent occlusion or embolization of noncentral nervous system, head, or neck (61626), and endoscopic control of epistaxis (31238) codes. Welch two sample t-test and linear regression were used to characterize CPT code utilization.

RESULTS: From 2018 to 2022, TESPAL CPT code reporting averaged 378 instances annually, with a stable utilization trend (p = 0.432). CPT codes 61626 and 31238 averaged 1429 and 3779 instances annually, respectively. CPT 31238 showed a significant decline (p < 0.001), and CPT 61626 showed a stable trend (p = 0.082). There was a significant decline in CPT code 31238 use after 2018 (p < 0.01). CPT 61626 showed a significant increase in usage post-2018 (t = 2.90, p = 0.044).

CONCLUSION: After an initial increase in 2019, TESPAL reporting flattened, while CPT 61626 (which includes all embolization in head and neck vessels) significantly increased post-2018. As recent studies show significant advantages of TESPAL over embolization, these findings warrant further attention and study.

LEVEL OF EVIDENCE: 3.

PMID:40046982 | PMC:PMC11877342 | DOI:10.1002/lio2.70111

Laryngoscope Investig Otolaryngol. 2025 Mar 4;10(2):e70108. doi: 10.1002/lio2.70108. eCollection 2025 Apr.

ABSTRACT

OBJECTIVES: In ultrasonography, gels are used as conduction media to improve sound transmission and to obtain high-quality images; however, gels are rarely used in hearing devices. The application of gel to couple the transducer to the ear could potentially improve the benefits of hearing aids, particularly cartilage conduction (CC) hearing aids, which deliver sound through vibrating the aural cartilage. This study aimed to investigate the effects of gel application on the performance of CC hearing aids.

METHODS: Twenty-three patients (30 ears) with aural atresia or severe canal stenosis were treated with CC hearing aids. The aided thresholds, maximum speech recognition scores (SRSs), and hearing levels at which the maximum SRS (dB [Max]) was observed were compared before and after gel application to the transducer of the CC hearing aids.

RESULTS: Thresholds > 1 kHz significantly decreased (improved) when the gel was applied to the transducer (p < 0.05). The threshold improvement at 1 kHz was significantly better than that at 0.5 kHz, and that at 4 kHz was significantly better than at 0.25 and 0.5 kHz. No significant differences were observed in the maximum SRS or dB (Max).

CONCLUSIONS: Gel application, which is considered to have minimum risk, showed statistically significant improvements in hearing levels at higher frequencies. Therefore, the application of gel can be considered a beneficial option to enhance the performance of CC hearing aids by improving the coupling conditions.

LEVEL OF EVIDENCE: 4.

PMID:40046981 | PMC:PMC11877327 | DOI:10.1002/lio2.70108