Tag: nevin manimala

Lancet Reg Health West Pac. 2025 May 8;58:101571. doi: 10.1016/j.lanwpc.2025.101571. eCollection 2025 May.

ABSTRACT

BACKGROUND: Hong Kong has one of the longest life expectancies in the world but was heavily impacted by COVID-19 in 2022. We aimed to estimate patterns in mortality rates and changes in life expectancy in Hong Kong during the COVID-19 pandemic.

METHODS: We constructed sex-specific life tables from 1998 to 2023 using parametric bootstrapping to account for statistical uncertainty in mortality rates. We used Arriaga’s decomposition method to estimate age- and cause-specific contributions to overall changes in life expectancy for 2020-2023, with 2019 as the reference year. We also estimated cause-specific mortality rates.

FINDINGS: Hong Kong reported 50,666 deaths in 2020, 51,354 in 2021, 63,692 in 2022, and 54,731 in 2023. Estimates of life expectancy in males and females in 2020 and 2021 were similar to the pre-pandemic trend from 1998 to 2019 but declined significantly in 2022. Compared to the pre-pandemic trend, the 2022 values of 80.4 years for males and 86.4 years for females corresponded to reductions by 2.22 (95% CI: 2.08, 2.36) years in males and 2.30 (95% CI: 2.17, 2.43) years in females. The loss in life expectancy in 2022 was mainly attributed to increased respiratory mortality rates, with a negative contribution to life expectancy of 1.47 and 1.26 years for males and females respectively. In 2023 life expectancy increased by 0.60 (95% CI: 0.46, 0.75) years in males and by 1.10 (95% CI: 0.95, 1.26) years in females.

INTERPRETATION: In 2022 a very high respiratory mortality rate in older adults in Hong Kong during the COVID-19 pandemic was associated with a reduction in life expectancy by more than 2 years. In 2023 life expectancy increased towards the pre-pandemic trend.

FUNDING: Health and Medical Research Fund, Hong Kong.

PMID:40470520 | PMC:PMC12134540 | DOI:10.1016/j.lanwpc.2025.101571

Orthop J Sports Med. 2025 Jun 3;13(6):23259671251327684. doi: 10.1177/23259671251327684. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Burnout has been associated with decreased quality of patient care and results in an estimated cost of roughly $5 billion per year. With a growing awareness of burnout prevalence in high-level athletes, the physicians working with the athletic departments of the National Collegiate Athletic Association (NCAA) institutions can be forgotten.

PURPOSE: To assess the prevalence of burnout among physicians of the NCAA teams and assess predictors that may lead to burnout.

STUDY DESIGN: Cross-sectional study.

METHODS: A cross-sectional survey using the Professional Fulfillment Index scale with demographic data was sent to multiple Division I NCAA conferences. Eligible participants included any physicians who care directly for Division I NCAA teams. Each item was assessed on a 5-point Likert scale, and comparisons were made between those who did and did not achieve burnout. Linear and logistic regression models were used to assess predictors of burnout score and achievement of burnout, respectively.

RESULTS: Of the 89 completed responses, 79 (79/89; 89%) participants qualified as having achieved burnout. No significant differences were identified in burnout achievement based on patient demographics. Specifically, there was no difference in burnout achievement based on specialty (P = .16), taking call (P = .05), or years in practice (P = .12). A linear regression model showed that the only significant predictor of burnout score was specialty, with family medicine-sports medicine and Other both associated with greater burnout scores (P < .001 and P = .002, respectively) compared with orthopaedics.

CONCLUSION: The prevalence of burnout in NCAA physicians is extremely high, even compared with the rate of other physicians, and the lack of predictive factors shows this issue to be multifactorial. Further studies need to be conducted with larger sample sizes, as well as isolating historical factors of burnout, to better improve the health of this unique physician population.

PMID:40470518 | PMC:PMC12134507 | DOI:10.1177/23259671251327684

Orthop J Sports Med. 2025 Jun 2;13(6):23259671251327600. doi: 10.1177/23259671251327600. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Anterior cruciate ligament (ACL) injuries are common in sports. These injuries often present with ≥1 meniscal tears, which may affect pre- and postoperative patient outcomes.

PURPOSE: To compare patient-reported outcome measures (PROMs) between isolated ACL reconstruction (ACLR) and ACLR with concomitant meniscal surgery, such as meniscal repair or arthroscopic partial meniscectomy, over 2 years to aid in preoperative counselling and rehabilitation.

STUDY DESIGN: Cohort study; Level of evidence 3.

METHODS: This retrospective study included 415 consecutive patients who underwent ACLR at a tertiary referral hospital between January 2009 and December 2022. PROMs-including the Knee injury and Osteoarthritis Outcomes Score (KOOS) and the Lysholm score-were assessed preoperatively and at the 2-year follow-up between the isolated ACLR group and the ACLR with meniscal surgery group using the Mann-Whitney U test. A Wilcoxon signed-rank test within groups was used to assess preoperative to the 2-year follow-up improvements. Also, 95% CIs were utilized to provide the likely values of the true population mean. Two-tailed significance tests were used, and the statistical significance level was set at P < .05.

RESULTS: The patients in the 2 groups (isolated ACLR group, n = 205 and ACLR with meniscal surgery group, n = 210) had similar baseline characteristics for age, sex, and body mass index (P > .05). The meniscal surgery group showed significantly worse Lysholm scores (71.1 [95% CI, 68.8-73.5] vs 74.9 [95% CI, 72.6-77.1]; P = .017) and KOOS domain scores preoperatively compared with the isolated ACLR group: KOOS Symptoms, 72.4 (95% CI, 69.9-75) versus 77.3 (95% CI, 75-80) (P = .011); KOOS Activities of Daily Living, 81.4 (95% CI, 79-83.7) versus 85.6 (95% CI, 83.6-87.6) (P = .006); KOOS Pain, 76.3 (95% CI, 73.9-78.8) versus 81(95% CI, 78.7-83.2) (P = .006); and KOOS Quality of Life, 39.4 (95% CI, 36.4-42.5) versus 43.9 (95% CI, 41-46.9) (P = .028). However, the KOOS Sport and Recreation domain had a lower and insignificant mean (35.6 [95% CI, 31.7-39.4] vs 39.9 [95% CI, 36.2-43.6]; P = .061). Both groups significantly improved across all PROMs at the 2-year follow-up (P < .001). When compared with the isolated ACLR group, the meniscal surgery group had lower postoperative scores for Lysholm scores (93.8 [95% CI, 92.6-95] vs 95.3 [95% CI, 94.3-96.4]; P = .017), the KOOS Sport and Recreation Function (87.5 [95% CI, 85.1-90] vs 89.6 [95% CI, 87-92.2]; P = .025), and the KOOS Pain (97 [95% CI, 96-98] vs 96.7 [95% CI, 95.9-97.6]; P = .010), with insignificant differences in other KOOS domains (P > .05).

CONCLUSION: The study demonstrated that patients undergoing ACLR with concurrent meniscal surgery initially showed slightly poorer functional scores compared with those who underwent isolated ACLR. Both groups showed significant postoperative improvements. However, patients requiring surgical intervention for concurrent meniscal injuries can expect poorer functional outcomes than those requiring isolated ACLR, even after 2 years. These data may be important when counselling patients presenting with ACL tears who need to receive surgical treatment.

PMID:40470515 | PMC:PMC12130643 | DOI:10.1177/23259671251327600

Biologics. 2025 May 31;19:351-363. doi: 10.2147/BTT.S530354. eCollection 2025.

ABSTRACT

Guselkumab, a selective interleukin-23 (IL-23) inhibitor, has emerged as a promising biologic therapy for the management of patients with moderate-to-severe Crohn’s disease (CD) and has been recently approved for its treatment. Unlike conventional therapies, guselkumab offers a different mechanism of action by selectively inhibiting IL-23, a key cytokine implicated in the pathogenesis of CD. IL-23 drives intestinal inflammation through activation of the Th17 cell pathway and other immune processes, positioning IL-23 inhibition as a critical therapeutic approach. In randomized Phase III clinical trials, guselkumab proved to be effective in inducing clinical and endoscopic remission both in patients naive to biologics and in patients already exposed to advanced therapies. Furthermore, no safety issues were found, supporting the well-characterized safety in other indications and its use in clinical practice also in IBD. Moreover, guselkumab has been approved for other immunomediated inflammatory disease moderate to severe plaque psoriasis, psoriatic arthritis and ulcerative colitis. This review summarizes the available evidence on efficacy and safety of guselkumab in patients with moderate to severe CD, focusing on its positioning in the treatment algorithm.

PMID:40470513 | PMC:PMC12136076 | DOI:10.2147/BTT.S530354

Front Neurol. 2025 May 21;16:1601778. doi: 10.3389/fneur.2025.1601778. eCollection 2025.

ABSTRACT

BACKGROUND: Parkinsonism is a progressive neurodegenerative disorder characterized by motor and non-motor impairments, significantly impacting quality of life (QoL). Transcranial direct current stimulation (tDCS) has shown promise in improving motor and cognitive functions when combined with physical therapy. This study aimed to explore the association between tDCS exposure and disability levels, as well as its impact on self-reported QoL in individuals with Parkinsonism undergoing physical therapy.

METHODS: This cross-sectional study enrolled 51 participants diagnosed with Parkinsonism from a tertiary care hospital’s neurology outpatient clinic. Based on clinical records of tDCS sessions, participants were stratified into tDCS-exposed and non-exposed groups. Disability was assessed using the World Health Organization Disability Assessment Schedule, and QoL was measured using the Parkinson’s Disease Questionnaire (PDQ-39). Statistical analyses included t-tests for comparing means and Pearson correlation coefficients for assessing relationships between tDCS exposure, disability, and QoL.

RESULTS: The tDCS-exposed group demonstrated lower mean disability scores (WHODAS 2.0: 42.50 ± 8.12) and better quality of life scores (PDQ-39: 35.10 ± 6.45) compared to the non-exposed group (WHODAS 2.0: 45.30 ± 9.21; PDQ-39: 40.15 ± 7.32); however, these differences were not statistically significant (disability: p = 0.131; QoL: p = 0.236). Subgroup analyses revealed statistically significant improvements among participants under 65 years of age (disability mean difference = -3.3, 95% CI: -6.17 to -0.43, p = 0.023) and those in Hoehn and Yahr stages 1-2 (QoL mean difference = -3.7, 95% CI: -6.16 to -1.24, p = 0.004). Additionally, a moderate negative correlation was observed between tDCS session frequency and disability scores (r = -0.60, 95% CI: -0.78 to -0.30, p = 0.04), and a weak negative correlation with quality of life scores (r = -0.43, 95% CI: -0.66 to -0.11, p = 0.039).

CONCLUSION: These findings suggest possible associations between tDCS exposure and clinical outcomes in individuals with Parkinsonism; however, due to the cross-sectional design and underpowered subgroup analyses, results should be interpreted with caution and viewed as hypothesis-generating.

PMID:40470495 | PMC:PMC12133549 | DOI:10.3389/fneur.2025.1601778

Front Neurol. 2025 May 21;16:1562079. doi: 10.3389/fneur.2025.1562079. eCollection 2025.

ABSTRACT

BACKGROUND: Epilepsy affects approximately 70 million people globally, with a prevalence in Mexico of 10.8 to 20 cases per thousand. Antiseizure Medications (ASM) are the first line of treatment for people with epilepsy (PWE), aiming to achieve early seizure control while minimizing adverse effects that could impact quality of life.

MATERIALS AND METHODS: This retrospective cohort study analyzed data from 2020 to 2024 collected from medical records, clinical histories, and electronic systems, using REDCAP^® and SPSSV21^®. It included all epilepsy patients treated at the National Institute of Neurology and Neurosurgery “MVS” in Mexico City. Descriptive statistics were reported as means ± standard deviations for quantitative variables and percentages for categorical variables. Bivariate analysis used the Q Cochran test for dichotomous variables and the chi-square or Fisher’s exact test for qualitative variables.

RESULTS: Of 1,192 prescriptions, third-generation ASMs accounted for the majority (53.7%), led by levetiracetam (24.1%), lamotrigine (14%), and lacosamide (6%). Second-generation ASMs comprised 42.4%, including valproate (21.5%), carbamazepine (11.3%), and clonazepam (5.5%). First-generation ASMs were less frequently prescribed (3.9%), primarily phenytoin (2.3%), primidone (1.0%), and phenobarbital (0.3%). Third-generation ASMs were the most prescribed for focal seizures (38.6%), generalized seizures (13.3%), and seizures of unknown (1.9%) or unclassified types (2.1%).

DISCUSSION: Compared to a 2012 study in the same population, which showed second-generation ASM as dominant, this study highlights a significant shift toward third-generation ASM, now representing over half of prescriptions. While valproate and carbamazepine remain versatile second-generation options, newer ASMs, such as levetiracetam, are increasingly favored.

CONCLUSION: These findings demonstrate a preference for second- and third-generation ASMs in tertiary hospitals in Latin America, which is concordant with global trends. First-generation ASMs are still prescribed but at lower rates. These results provide insights into changing prescription practices and access to newer medications, informing future research and hospital policies.

PMID:40470492 | PMC:PMC12135803 | DOI:10.3389/fneur.2025.1562079

Front Neurol. 2025 May 21;16:1499407. doi: 10.3389/fneur.2025.1499407. eCollection 2025.

ABSTRACT

OBJECTIVE: Quantitative evaluation of the effect of exercise intervention in amyotrophic lateral sclerosis (ALS).

METHODS: The CNKI, WOS, PubMed, and Scopus databases were searched by computer, and randomized controlled trials (RCTs) of exercise intervention in ALS were screened out according to the inclusion and exclusion criteria of the PICOS principle. Stata 12.0 software was used for statistical analysis.

RESULTS: A total of 12 RCTs including 430 participants were included. Meta-analysis results show that exercise intervention can significantly improve the overall function, walking test (WT) distance and maximum expiratory pressure (MEP) of ALS patients (p < 0.05). However, exercise interventions did not show significant effects on fatigue, maximum inspiratory pressure (MIP), forced vital capacity (FVC), and peak expiratory flow (PEF) in ALS patients (p > 0.05). Subgroup analysis showed that resistance exercise is the most effective intervention for improving the function of ALS patients, while aerobic exercise is the most effective intervention for improving FVC in ALS patients.

CONCLUSION: Exercise intervention in ALS has a positive effect, but due to the small number of included studies and possible heterogeneity, risk of bias and sensitivity issues, further research is needed.

PMID:40470490 | PMC:PMC12133518 | DOI:10.3389/fneur.2025.1499407

Cureus. 2025 May 4;17(5):e83478. doi: 10.7759/cureus.83478. eCollection 2025 May.

ABSTRACT

Background Research has revealed that numerous adolescent girls start menstruating without adequate information or readiness. Nevertheless, there is a lack of literature regarding the impact of educational interventions on improving the knowledge of adolescent girls in this regard. Thus, this study aimed to evaluate how a nurse-led intervention influences stress levels and menstrual parameters among adolescent girls in a chosen school in Navi Mumbai. Methodology The study employed a quantitative research approach and utilized a simple random sampling technique, specifically the lottery method, to select 80 (sample size calculated on the basis of the prevalence of a previous similar study) adolescent girls, with 40 in each group. Data collection involved the use of a self-structured questionnaire. Pre-hemoglobin levels for both the control and study groups were measured using a digital hemoglobin meter. A pre-test was conducted for both groups, focusing on demographic information, perceived stress, and menstrual health parameters. The study group received instruction in stretching exercises for alleviating dysmenorrhea, delivered by two nurse researchers, along with a booklet on menstrual parameters and daily distribution of two servings (100 g each) of iron-rich supplements in the form of laddoos. Results Analysis of the data utilized both descriptive and inferential statistics. The results indicated that the exercise intervention significantly reduced stress levels among adolescent girls in the study group regarding pain management during menstruation (mean=87.900, SD=8.53), with a high level of significance at p<0.001. Additionally, the changes in hemoglobin levels for both the control and study groups were 9.55 ± 2.1477 (p=0.058) and 10.225 ± 1.0975 (p=0.017), respectively, indicating a notable effectiveness of the nutritional supplement in improving anemia-related parameters in the study group. Furthermore, the distribution of booklets addressing menstrual parameters among adolescent girls in the study group resulted in a mean score of 6.20 ± 0.723, reflecting a positive change in menstrual health awareness and practices. The findings were extremely significant, with a p-value of less than 0.001, leading to the rejection of the null hypothesis H01. Conclusion The study suggests that replicating and implementing similar nurse-led educational interventions across all secondary schools in Navi Mumbai could systematically improve adolescents’ understanding of menstruation and menstrual hygiene.

PMID:40470459 | PMC:PMC12134149 | DOI:10.7759/cureus.83478

Cureus. 2025 May 5;17(5):e83519. doi: 10.7759/cureus.83519. eCollection 2025 May.

ABSTRACT

The transition to residency training in the United States presents distinct challenges for both American Medical Graduates (AMGs) and International Medical Graduates (IMGs), particularly in the context of the rapid response team (RRT) involvement. This study investigates the effect of a structured educational intervention entitled “Enhancing the Rapid Response Team’s Understanding” on the performance of postgraduate year-one (PGY-1) Internal Medicine residents at the Ascension Saint Joseph Hospital, Chicago. The intervention aimed to enhance the theoretical knowledge and practical competencies related to RRT activation, fostering better integration into multidisciplinary teams during acute clinical deteriorations. A total of 29 PGY-1 residents participated. Five pre-intervention and four post-intervention responses were received, with both assessments evaluating knowledge acquisition, task performance, and confidence levels. The intervention involved didactic sessions on RRT protocols, followed by supervised inpatient floor rotations. The pre- and post-intervention results indicated a significant improvement in task performance, with a 45.83% increase in mean scores (from 48 to 70), though this change did not reach statistical significance (p=0.1096). Despite an increase in the number of tasks performed by participants (p=0.0397), no significant differences were observed in overall knowledge, awareness (p=0.119), or confidence (p=0.722) regarding the RRTs. Feedback from the participants highlighted the intervention’s value, with 75% rating the sessions as important and of good quality. While the small sample size limited statistical power, the findings suggest that structured educational interventions for interns may positively impact their ability to perform critical tasks during RRT activations. Further research with larger cohorts is needed to comprehensively assess the long-term effects of such interventions on clinical preparedness and patient care outcomes.

PMID:40470455 | PMC:PMC12136531 | DOI:10.7759/cureus.83519

Cureus. 2025 May 5;17(5):e83486. doi: 10.7759/cureus.83486. eCollection 2025 May.

ABSTRACT

Background Violence and stress significantly contribute to the growing mental health crisis in Pakistan. However, access to appropriate care remains limited for many. This study aimed to evaluate the impact of violence and trauma on mental health, identify the prevalence of trauma-related psychiatric disorders, and assess gaps in mental healthcare integration. Methodology A cross-sectional study was conducted at the Abbas Institute of Medical Sciences, Muzaffarabad, Pakistan, from April 2024 to December 2024. The study included 316 participants who had a history of exposure to violence or trauma and associated mental health issues. Data were collected using a structured questionnaire that assessed demographic characteristics, trauma exposure, and mental health conditions. Standardized diagnostic tools were employed to screen for post-traumatic stress disorder (PTSD), anxiety, and depression. Data analysis was carried out using Statistical Product and Service Solutions (SPSS, version 26.0; IBM SPSS Statistics for Windows, Armonk, NY). Chi-square and t-tests were used to assess associations between trauma exposure and mental health outcomes. A p-value of less than 0.05 was considered statistically significant. Results The most prevalent form of trauma exposure was domestic violence (n=102; 32.28%), followed by terrorism-related trauma (n=68; 21.52%) and natural disasters (n=60; 18.99%). PTSD was the most common mental health condition, affecting 34.81% of participants (n=110). Anxiety disorders were present in 31.01% of participants, while 26.90% (n=85) experienced depression. Statistical analysis revealed a significant association between exposure to trauma and an increased prevalence of mental health disorders (p<0.001). Conclusion The findings underscore the need for improvements in the integration of mental health services into primary healthcare systems in Pakistan. There is a need for the development of community-based programs and the implementation of policy reforms aimed at providing comprehensive support to individuals affected by trauma-related mental health conditions.

PMID:40470449 | PMC:PMC12134703 | DOI:10.7759/cureus.83486