Tag: nevin manimala

J Lipid Atheroscler. 2025 May;14(2):145-158. doi: 10.12997/jla.2025.14.2.145. Epub 2025 Feb 11.

ABSTRACT

Statins represent the first-line therapy for cholesterol management. However, for patients prone to statin side effects, unable to tolerate higher doses, or requiring additional low-density lipoprotein cholesterol (LDL-C) reduction, ezetimibe alone or in combination with statins is recommended. This meta-analysis aimed to evaluate the safety and efficacy of combining low- or moderate-intensity statins with ezetimibe compared to high-intensity statin monotherapy, yielding reliable evidence to guide clinical decision-making and personalize treatment strategies. PubMed, Embase, and Scopus were systematically searched from inception until May 2023. All randomized controlled trials (RCTs) comparing a high-intensity statin with a low/moderate-intensity statin with ezetimibe were included. The outcomes of interest comprised changes in concentrations of lipids-LDL-C, high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglycerides (TGs)-and apolipoprotein (Apo) A1, Apo B, and high-sensitivity C-reactive protein (hs-CRP), along with major adverse cardiovascular events (MACE). All data were analyzed using Review Manager version 5.4. p-values less than 0.05 were considered to indicate statistical significance. Overall, 20 RCTs, with 5,412 participants, were included. A low/moderate-intensity statin combined with ezetimibe yielded a significantly greater reduction in LDL-C levels than high-intensity statin monotherapy (mean difference [MD], -6.59; 95% confidence interval [CI], -10.95, -2.24; p=0.003; I²=84%). No significant differences were observed between combination and high-intensity statin monotherapy regarding TC, TG, or HDL-C levels. However, hs-CRP levels were significantly higher with combination therapy (MD, 0.32; 95% CI, 0.01, 0.64; p=0.04; I²=0%). Combination therapy involving a low/moderate-intensity statin with ezetimibe was significantly associated with lower LDL-C levels than high-intensity statin monotherapy. No significant differences were observed for TC, TGs, HDL-C, alanine transaminase, or MACE. However, creatine phosphokinase levels significantly increased with monotherapy.

PMID:40492183 | PMC:PMC12145961 | DOI:10.12997/jla.2025.14.2.145

Sex Med. 2025 Jun 9;13(3):qfaf043. doi: 10.1093/sexmed/qfaf043. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Lesbian, gay, bisexual, transgender, and other gender and sexual minority (LGBT+) individuals often face healthcare disparities, and physicians’ knowledge, attitudes, and clinical preparedness significantly impact access to competent care.

AIM: This study evaluated Turkish physicians’ perspectives, knowledge, and clinical approaches to LGBT+ sexual health, highlighting educational and clinical gaps.

METHODS: A nationwide cross-sectional survey was conducted among physicians from 10 specialties involved in LGBT+ sexual health. The survey, administered anonymously via Google Forms between June 4, 2024, and February 1, 2025, included sociodemographic questions and items assessing attitudes, clinical experience, and guideline familiarity. Statistical analyses included descriptive statistics, chi-square, Fisher’s exact tests, and binary logistic regression to identify predictors of physician attitudes and perceived competence.

OUTCOMES: The primary outcome was to assess physicians’ perspectives, competency, and willingness to provide LGBT+ healthcare, including gender-affirming procedures.

RESULTS: Among 745 participants, 58.8% considered LGBT+ identities normal, while 22.9% classified them as psychiatric disorders. Perceiving LGBT+ identities as normal was significantly associated with being female (OR = 3.12, 95% CI: 1.96-4.96, P < .001), prior experience treating LGBT+ patients (OR = 2.22, 95% CI: 1.60-3.07, P < .001), and physician specialty. This view was most common among psychiatrists (P = .012) and child and adolescent psychiatrists (P = .015). Physicians’ views were primarily shaped by education (43.2%) and socio-cultural environment (40.9%). Although 63.9% had treated LGBT+ patients, only 28.2% felt competent, and 11.5% were aware of relevant guidelines. Only 18% of surgical specialists supported gender-affirming procedures. The most commonly cited reason for reluctance was lack of surgical experience (44.8%), along with concerns related to religious beliefs, absence of a surgical team, and potential surgical complications. Ethical dilemmas were evident, as 58.3% believed LGBT+ patients face discrimination in healthcare, and 21.9% supported a physician’s right to refuse care based on personal beliefs.

CLINICAL IMPLICATIONS: Enhancing physicians’ education and competency in LGBT+ healthcare through structured training and standardized guidelines is crucial to improving equitable healthcare delivery.

STRENGTHS AND LIMITATIONS: This study provides novel insights into physicians’ attitudes and practices regarding LGBT+ healthcare in Turkey. However, self-reported data may introduce response bias, and findings may not be fully generalizable to other regions.

CONCLUSION: Significant educational and clinical gaps persist in LGBT+ healthcare. Addressing these through structured training programs, standardized protocols, and multidisciplinary collaboration is essential to ensuring competent, inclusive, and ethical medical care.

PMID:40492177 | PMC:PMC12147215 | DOI:10.1093/sexmed/qfaf043

J Intellect Disabil Res. 2025 Jun 9. doi: 10.1111/jir.13259. Online ahead of print.

ABSTRACT

BACKGROUND: People with Down syndrome (DS) may exhibit several musculoskeletal disorders, including alterations in muscle tone and activation. Strength training could mitigate the loss of muscle strength and, therefore, improve strength values in this population. Additionally, it may influence health-related outcomes such as physical function, body composition and biochemical markers.

OBJECTIVE: This systematic review and meta-analysis of randomised controlled trials (RCTs) aimed to analyse the characteristics and effects of strength training in people with DS.

METHODS: A search was conducted from inception to 22 April 2025. The methodological quality of the included RCTs was assessed using the 15-item Tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX). In addition, the risk of bias was assessed using the Cochrane’s risk of bias 2 (RoB2).

RESULTS: A total of 10 RCTs (n = 233 participants) were included in the systematic review, of which three (n = 111 participants) could be meta-analysed. The pooled effect showed statistically significant benefits for upper (mean difference [MD] = 5.66 kg, 95% CI 2.42-8.91) and lower (MD = 20.43 kg, 95% CI 1.76-39.10) body strength. The TESTEX scores for most RCTs ranged from 3 to 12 points. The risk of bias analysis indicated that eight RCTs had a low risk of bias, whereas the remaining studies were classified as high risk.

CONCLUSION: Strength training may significantly improve muscle strength in people with DS. However, further research is needed to assess the long-term effects on physical function, body composition and biochemical markers.

PMID:40490858 | DOI:10.1111/jir.13259

Eur J Med Res. 2025 Jun 9;30(1):466. doi: 10.1186/s40001-025-02748-4.

ABSTRACT

BACKGROUND: It is crucial to identify the risk factors for unplanned extubation (UEX) in thoracoabdominal drainage tubes as early as possible and establish applicable risk prediction model to reduce the incidence of UEX.

METHODS: A retrospective survey of patients who underwent Thoracoabdominal drainage tubes placement at a tertiary hospital was conducted in Zhejiang Province, China, between January 2020 and January 2023. A training set was established to build the predictive model and conduct internal validation, which was assessed for discrimination using ROC curves and for Calibration using the Hosmer-Lemeshow test and Calibration curves. A nomogram was constructed to visually present the results of the logistic regression analysis. An external validation dataset was created for assessing the external validation of the model.

RESULTS: a total of 2220 patients were enrolled. Multiple logistic regression analysis showed that negative pressure ball drainage, adhesive fixation method, self-care ability (self-care vs. complete dependence), self-care ability (partial dependence vs. complete dependence), and Thoracoabdominal drainage tubes were statistically significant factors associated with UEX (P < 0.05).The predictive model equation was as follows: a = 0.95-1.66 × drainage method + 2.45 × fixation method -4.17 × self-care ability (self-care vs. complete dependence) -2.79 × self- care ability (partial dependence vs. complete dependence).In the internal validation, the AUC was 0.897 (95% CI = 0.87-0.92; P < 0.001), with a sensitivity of 0.75 and specificity of 0.93, indicating a high level of discrimination for the model. The Hosmer-Lemeshow test yielded a chi-square (χ²) value of 2.823 with 8 degrees of freedom and a P-value of 0.945, indicating high accuracy of the model. In the external validation, the AUC was 0.839 (95% CI = 0.75-0.93; P < 0.001), with a sensitivity of 0.73 and specificity of 0.96. The Hosmer-Lemeshow test yielded a χ² value of 12.85 with 8 degrees of freedom and a P-value of 0.117. The DCA plot shows that the DCA curve is consistently higher than the two extreme curves, indicating a good fit of the model.

CONCLUSION: The predictive model for the risk of unplanned extubation of thoracoabdominal drainage tubes in postoperative patients demonstrates good discrimination and Calibration. It can provide reference for clinical nursing staff in predicting the risk and early development of personalized preventive strategies for drainage tube UEX.

PMID:40490840 | DOI:10.1186/s40001-025-02748-4

BMC Rheumatol. 2025 Jun 9;9(1):67. doi: 10.1186/s41927-025-00517-8.

ABSTRACT

BACKGROUND: Oxidative stress plays a critical role in the pathogenesis of autoimmune diseases, including rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Assessing total antioxidant capacity (TAC) and total oxidant status (TOS) in saliva offers a non-invasive method to evaluate oxidative stress and its relationship with disease severity. This study aimed to measure salivary TAC and TOS levels in RA and SLE patients and compare them with healthy controls.

METHODS: A cross-sectional study was conducted involving 90 participants: 30 RA patients, 30 SLE patients, and 30 healthy controls. Saliva samples were collected and analyzed using specialized TAC and TOS assay kits. Disease severity was evaluated using the Disease Activity Score-28 (DAS-28) for RA and the SLE Disease Activity Index (SLEDAI-2 K) for SLE. Statistical analyses included ANOVA, post-hoc tests, and Pearson correlation coefficients.

RESULTS: Results showed that RA and SLE patients had significantly higher oxidative stress compared to healthy controls, with lower TAC levels (RA: 298.88 ± 31.21 µM, SLE: 287.98 ± 38.07 µM, Control: 461.22 ± 158.22 µM, P < 0.001) and higher TOS levels (RA: 5.81 ± 1.28 µM, SLE: 5.80 ± 1.36 µM, Control: 3.49 ± 1.56 µM, P < 0.001). The TOS/TAC ratio was also significantly elevated in RA (1.95 ± 0.44) and SLE (2.05 ± 0.64) patients compared to controls (0.84 ± 0.44, P < 0.001). A positive correlation was observed between TOS levels and age (R = 0.256, P = 0.016), while no significant gender-based differences were detected.

CONCLUSIONS: RA and SLE patients exhibit significant oxidative imbalance, as indicated by altered salivary TAC and TOS levels. These findings highlight the potential role of oxidative stress in these autoimmune diseases.

PMID:40490822 | DOI:10.1186/s41927-025-00517-8

Ital J Pediatr. 2025 Jun 9;51(1):184. doi: 10.1186/s13052-025-02034-3.

ABSTRACT

BACKGROUND: Feeding intolerance (FI) is a common feeding problem in preterm infants. The gut microbiota contributes significantly to its onset, progression, and outcome. In this study, we aimed to understand the differences in gut microbiota among preterm infants with FI of different gestational ages. The goal was to provide a basis for early probiotic intervention.

METHODS: We undertook a prospective case-control study in which we enrolled 80 preterm infants at a gestational age < 34 weeks. Participants were divided into four groups of 20 each: early preterm infants with FI (EFI group, gestational age < 32 weeks), early preterm infants with feeding tolerance (FT) (EFT group, gestational age < 32 weeks), moderate preterm infants with FI (MFI group, gestational age ≥ 32 weeks), moderate preterm infants with FT (MFT group, gestational age ≥ 32 weeks). 16 S rDNA high-throughput sequencing was employed to analyze the infants’ fecal microbiota and examine the potential link between gut microbiota and gestational age. Statistical analysis was conducted for the collected data. The Statistical Package for Social Sciences software was used. T-tests or non-parametric tests were performed for comparison between groups of measurement data, and the χ2 test was used to compare between groups of count data. At the genus and species level, the potential association between intestinal microbiota and FI and the relationship with gestational age were explored.

RESULTS: The abundance of Citrobacter in the feces of the EFI group was significantly higher than that in the EFT group. Additionally, the abundance of Acinetobacter in the MFI group was significantly higher than that in the MFT group. The abundance of Clostridium XI was significantly low in the MFT group.

CONCLUSIONS: Citrobacter and Acinetobacter genera are implicated in FI in preterm infants with gestational ages < 32 weeks and ≥ 32 weeks, respectively. However, Clostridium XI may be involved in regulating intestinal homeostasis in those with a gestational age ≥ 32 weeks.

TRIAL REGISTRATION: ChiCTR, ChiCTR2400086000. Registered 24 June 2024, https://www.chictr.org.cn/showprojEN.html?proj=210,126 .

PMID:40490820 | DOI:10.1186/s13052-025-02034-3

Thyroid Res. 2025 Jun 10;18(1):24. doi: 10.1186/s13044-025-00240-z.

ABSTRACT

BACKGROUND: The incidence of thyroid dysfunction is high in HIV patients, contributing to the high mortality and morbidity associated with HIV.

OBJECTIVES: This study focused on evaluating the prevalence of thyroid dysfunction and associated factors among people living with HIV (PLWH) attending Comprehensive care centre at Maua Methodist Hospital, Kenya.

METHODS: Clinical and sociodemographic data of participants were collected including HIV viral loads, CD4 counts, HAART regimen and type, age, gender, marital and education status, and co-infection. Serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) were assessed in all groups. Regression analysis and Pearson correlation were performed to assess thyroid dysfunction and associated factors.

RESULTS: The prevalence of thyroid dysfunction was 51.9% (95% CI: 50.8 ~ 53.2) in this population. 77% (77%) of the HAART group had thyroid dysfunction compared to 47% of the HAART naïve group. Additionally, the prevalence of thyroid dysfunction was high in the HIV-non-suppressed individuals (97%, 95% CI: 97.1 ~ 97.9) compared to suppressed group (83%, 95% CI: 82.7 ~ 84.3). HIV (p < 0.001), HAART exposure (p < 0.001), TB (p < 0.001) and duration of infection (p = 0.002) were significantly associated with thyroid dysfunction. There was a positive correlation between TSH (r = 0.28; p < 0.01) and HIV + individuals under HAART, TSH (r = 0.37; p < 0.001) and TB, and FT3 (r = 0.35; p < 0.001) and duration of infection. Additionally, there was positive corelation between thyroid dysfunction and age (r = 0.13, p = 0.13), and a negative correlation between thyroid dysfunction and CD4 counts (r = -0.39, p < 0.055) though statistically not significant.

CONCLUSIONS: Thyroid dysfunction is more common in HIV patients on HAART, mainly manifested as subclinical hypothyroidism. Routine screening for thyroid dysfunction should be considered for PLWH, especially those on HAART and with viral blips.

PMID:40490810 | DOI:10.1186/s13044-025-00240-z

Parasit Vectors. 2025 Jun 9;18(1):217. doi: 10.1186/s13071-025-06865-1.

ABSTRACT

BACKGROUND: Toxoplasma gondii is a widespread parasite that can infect almost all vertebrate species including humans, causing variable clinical symptoms from asymptomatic infection to serious diseases. Though extensive research has been done in recent decades, the prevention and control of T. gondii continue to present substantial challenges. Herbal medicines have long been a rich source of chemical entities and may provide new avenues for drug discovery against T. gondii. Thus, this study was performed to investigate the anti-T. gondii effect of two monomers, beta, beta-dimethylacrylshikonin (DMAS) and isobutyrylshikonin (IBS), extracted from the roots of a widely distributed and used medical plant.

METHODS: The cytotoxicity of DMAS and IBS on Vero cells was evaluated using the MTT assay, and the toxicity in mice was assessed on the basis of the changes of body weight combined with the histopathologic examinations on spleen, liver, and kidney. The effects of DMAS and IBS on mice against T. gondii acute infection were evaluated by combining survival curves with splenic histopathologic examination. Ultrastructural change in T. gondii tachyzoites post co-incubation in vitro was observed by electron microscopy. ACT1-quantitative polymerase chain reaction (qPCR) was conducted to quantify T. gondii tachyzoites, including proliferation and the inhibitory efficacy of DMAS and IBS. Invasion and attachment, intracellular proliferation, and parasitophorous vacuole viability evaluations were conducted to assess the effects on the asexual life cycle of T. gondii. In addition, untargeted metabolomics analysis was performed to clarify the underlying mechanisms by which DMAS and IBS act against this parasite.

RESULTS: Both DMAS and IBS, with higher half-maximal cytotoxic concentration (CC₅₀) values, exhibited concentration-dependent cytotoxicity in Vero cells and significantly inhibited the intracellular proliferation of T. gondii in vitro, showing lower half-maximal inhibitory concentration (IC₅₀) values and higher selectivity index (SI) values. DMAS showed a statistically more potent effect than IBS, but both were not significantly more potent than that of pyrimethamine (PM). The tachyzoites exhibited severe ultrastructural damage following treatment with DMAS or IBS. Metabolomics analysis indicated that this abnormal biological lesion was caused by the disruptions in purine and pyrimidine metabolism pathways in T. gondii, with mechanisms likely differing from that of PM. In vivo, a dose of 1.5 mg/kg of DMAS showed no significant toxicity in Kunming (KM) mice, with no significant pathological damage or weight loss. At this dosage, both DMAS and IBS significantly alleviated the splenic hyperemia and statistically prolonged the survival times of T. gondii-infected mice.

CONCLUSIONS: This study demonstrated that DMAS and IBS have an inhibitory effect on T. gondii infection in vitro and in vivo, probably associated with the disruption of nucleotide metabolism in the parasite. These results highlight that the two monomers, in particular DMAS, hold promise as a potential therapeutic medicine for toxoplasmosis.

PMID:40490809 | DOI:10.1186/s13071-025-06865-1

Stem Cell Res Ther. 2025 Jun 9;16(1):297. doi: 10.1186/s13287-025-04432-0.

ABSTRACT

BACKGROUNDS: Exosomes is a promising cell-free therapy for Diabetic peripheral neuropathy (DPN) that imposes long-term negative effects on patients’ finances, mental health, and quality of life. We conducted a meta-analysis to assess the therapeutic effects of exosomes (such as SCs-derived, FCs-derived, BMSCs-derived, MSCs-derived, and Plasma-derived) on DPN.

METHODS: We searched nine databases from inception to February 2025, then two researchers independently screened studies, extracted data, and assessed the quality of included studies using SYRCLE’s tool. The outcome indicators consisted of at least one of the three key DPN endpoints (electrophysiology, behavioural assessment, and nerve structure) based on the Neurodiab guidelines. R 4.4.2 software was used to conduct all statistical analyses.

RESULTS: 11 studies were identified, and the risk of bias in most studies was unclear generally. Pooled analyses demonstrated that exosome improved the nerve conduction velocity [MCV (SMD = 4.71 [2.18;7.25], P = 0.0003; I²= 91.8%), SCV (SMD = 1.07 [0.30;1.85], P = 0.0069; I²= 85.3%)], may restore IENFD [SMD = 1.46 [-0.85; 3.77], P = 0.2164; I²=88.7%], alleviated neuropathic pain [mechanical allodynia (SMD= -0.27 [-1.02;0.47], P = 0.4697; I² = 85.0%), thermal hyperalgesia (SMD= -1.48 [-2.45;-0.50], P = 0.003; I² = 88.4%)], ameliorated vascular function [blood flow perfusion in plantar (SMD = 2.84 [0.89; 4.80], P = 0.0043; I² = 74.9%), blood flow perfusion in sciatic nerves (SMD = 2.62 [0.80; 4.43], P = 0.0047; I² = 75.9%), vessel density (SMD = 2.69 [0.90; 4.49], P = 0.0032; I² = 0%)], and restored the peripheral nerve structure [sciatic nerve fiber diameter (SMD = 3.29 [1.61; 4.96], P = 0.0066; I² = 75.5%), axon diameter (SMD = 2.26 [1.64; 2.88], P < 0.0001; I² = 54.3%), myelin sheath thickness (SMD = 2.56 [1.39; 3.72], P < 0.0001; I² = 73.0%), g-ratio (SMD= -1.64 [-3.28; 0.00], P = 0.0502; I² = 34.17)]. Furthermore, after exosome therapy, the expressions of NF-200 (SMD = 2.57 [0.39; 4.75], P = 0.0210; I² = 33.0%), MBP (SMD = 2.27 [-1.49; 6.02], P = 0.1064; I² = 59.0%), and S-100β (SMD = 1.90 [0.09; 3.72], P = 0.0399; I² = 32.5%) evaluating axonal regeneration and remyelination increased significantly. Notably, high-glucose pretreatment of exosomes significantly attenuated these effects, while genetic overexpression modifications or novel dressings-mediated delivery partially counteracted this suppression.

CONCLUSIONS: Exosome therapy provides a novel therapeutic strategy for the benefit of neurovascular remodeling and functional recovery of DPN, especially when used in conjunction with exosome modification and novel dressings. To bridge the translational gap between preclinical and clinical studies, future research should conduct more large-scale, meticulously designed preclinical trials adhering to ARRIVE criteria before proceeding to clinical translation, to enhance translational rigor and mitigate risks associated with variability in study design.

PMID:40490808 | DOI:10.1186/s13287-025-04432-0

Contracept Reprod Med. 2025 Jun 9;10(1):36. doi: 10.1186/s40834-025-00364-5.

ABSTRACT

BACKGROUND: The use of a dual contraception method (DCM) is recommended as an effective method to prevent Human Immunodeficiency Virus (HIV) transmission and the adverse consequences of pregnancy in people living with HIV infection. In developing countries like Ethiopia, contraception use is subjected to sociocultural, knowledge, and accessibility-related factors that influence consumption. Accordingly, this study aims to explore the magnitude of DCM use and factors related to consumption in HIV-positive women of reproductive age.

METHODS: An institutional-based cross-sectional study was conducted at Hawassa University Comprehensive Specialized Hospital. The study used a systematic sampling technique to select 268 consenting participants. Data was collected using a semi-structured questionnaire via face-to-face interview. Descriptive statistics were used to present background information, and a hierarchical binary logistic regression was used to investigate DCM use and associated factors. Results with a p-value less than 0.05 are considered significant. All data analysis was performed using SPSS version 26.

RESULTS: The magnitude of DCM use was 30% (95% CI; 24.0-35.0). After controlling for potential confounding variables women aged 15-36 years, (AOR = 8.65, 95% CI: 2.60, 28.75) and 37-40 years, (AOR = 6.25, 95% CI, 2.08, 18.82), women with no fertility desire (AOR = 8.34, 95% CI: 3.95, 17.61), women who have open discussions with their partners (AOR = 5.71, 95% CI: 2.15, 15.11), and women with knowledge of CD4 count (AOR = 2.94, 95% CI: 1.35, 6.38) were found to have a higher likelihood of DCM use.

CONCLUSIONS: The magnitude of DCM use among reproductive-age HIV-positive women was unsatisfactory. This provided an enormous window for counseling and reproductive health promotion measures. Interventional studies and strengthening of ART and family planning services must be customized to target the major social, cultural, and knowledge barriers identified in this study to enhance the practice of DCM use.

PMID:40490805 | DOI:10.1186/s40834-025-00364-5