Tag: nevin manimala

Diabetologia. 2025 Sep 24. doi: 10.1007/s00125-025-06546-9. Online ahead of print.

ABSTRACT

AIMS/HYPOTHESIS: The aim of this work was to investigate tissue-specific insulin resistance in South Asian and Nordic women with previous gestational diabetes mellitus (pGDM) and to evaluate potential ethnic differences contributing to type 2 diabetes risk.

METHODS: A cross-sectional study using a two-step hyperinsulinaemic-euglycaemic clamp with a glucose tracer was conducted to assess insulin sensitivity in muscle, liver and adipose tissue in 19 South Asian and 16 Nordic women with pGDM and prediabetes (impaired glucose tolerance and/or impaired fasting glucose), along with 16 ethnicity-specific control women. We assessed inflammation and mitochondrial genes by mRNA sequencing of adipose tissue.

RESULTS: Both South Asian and Nordic women with pGDM showed reduced total glucose disposal (mainly due to muscle insulin resistance) and hyperinsulinaemia compared with the control group. Endogenous glucose production (mainly due to hepatic insulin resistance) was elevated in Nordics with pGDM, while South Asians with pGDM showed pronounced adipose tissue insulin resistance (reduced suppression of glycerol during clamp). mRNA sequencing of adipose tissue indicated increased tissue inflammation in South Asian women compared with Nordic women with pGDM. Furthermore, we observed a differential response to hyperinsulinaemia in South Asians vs Nordics related to mitochondrial mRNA, such as thymidine kinase 2 (TK2). Correlations between adiposity markers and insulin sensitivity also differed by ethnicity, suggesting that the pathways leading to type 2 diabetes may vary across populations.

CONCLUSIONS/INTERPRETATION: South Asian and Nordic women with pGDM exhibited differences in insulin resistance profiles, with South Asians showing greater adipose tissue insulin resistance and inflammation.

PMID:40987939 | DOI:10.1007/s00125-025-06546-9

J Environ Manage. 2025 Sep 22;394:127411. doi: 10.1016/j.jenvman.2025.127411. Online ahead of print.

ABSTRACT

Sustainable development remains a critical priority under the United Nations 2030 Agenda, and the G7 economies-Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States-play a pivotal role due to their economic influence, technological leadership, and environmental responsibility. This study investigates the long-run determinants of sustainable development in the G7 from 1995 to 2022, using the Sustainable Development Index (SDG) as the dependent variable. Six explanatory factors are considered: artificial intelligence adoption (AI), women’s entrepreneurship (FEM), technological intensity (TEC), global warming (SUR), income inequality (INI), and unemployment (UNM). The empirical strategy employs Fixed Effects estimation with Driscoll-Kraay standard errors, validated through the Hausman test, and complemented with Augmented Mean Group (AMG) and Common Correlated Effects Mean Group (CCEMG) estimators for robustness against cross-sectional dependence and slope heterogeneity. The results reveal that AI exhibits a negative association with the SDG index under the baseline model, underscoring the risks of digital transformation without inclusive policies, though AMG suggests a potential positive effect under heterogeneous country conditions. Women’s entrepreneurship, while positively signed, is statistically insignificant, indicating persistent structural barriers in the G7. Technological intensity consistently demonstrates a positive and significant impact, highlighting the role of advanced industrial innovation in driving sustainability. Rising surface temperatures exert a weakly negative effect, reaffirming climate change as a threat to long-term development. Income inequality remains statistically insignificant but directionally adverse. Unemployment shows a strong and positive association across all estimators, reflecting structural labor market adjustments during the transition toward greener and more sustainable sectors. This study contributes to the literature by integrating digital, social, economic, and environmental dimensions within a robust econometric framework tailored for high-income economies. Policy recommendations emphasize inclusive digital transformation, stronger support for women-led enterprises, investment in clean technologies, proactive climate action, and labor market policies that align green transitions with social equity.

PMID:40986962 | DOI:10.1016/j.jenvman.2025.127411

J Environ Manage. 2025 Sep 22;394:127366. doi: 10.1016/j.jenvman.2025.127366. Online ahead of print.

ABSTRACT

Negative developments such as excessive resource consumption and accelerated environmental degradation in recent years have prompted European countries and institutions to adopt the circular economy model instead of the linear economy model. This study examines the relationship between circular economy indicators and gross domestic product, and by so doing, analyzes the impact of the circular economy on achieving sustainable development. To holistically demonstrate the direct and indirect benefits of “becoming circular,” the statistical indicators used were those established within the framework developed by the European Commission for monitoring the circular economy. Thus, the core elements of the circular economy could be monitored through these indicators. A total of 25 European countries were analyzed over the period from 2005 to 2023. The analysis employs panel data econometrics, and the model was estimated using Driscoll-Kraay estimators. This method provides robust estimators in the presence of heteroskedasticity, autocorrelation, and cross-sectional dependence. The results of the study show that measures related to the circular economy have a direct impact on economic growth.

PMID:40986959 | DOI:10.1016/j.jenvman.2025.127366

Diving Hyperb Med. 2025 Sep 30;55(3):212-219. doi: 10.28920/dhm55.3.212-219.

ABSTRACT

INTRODUCTION: Diving necessitates significant physiological adaptations, particularly within the cardiopulmonary system. Resting electrocardiograms (ECGs) are widely used in fitness to dive assessments, but their effectiveness in healthy young divers remains unclear. This study assessed the impact of applying sports medicine ECG criteria compared to traditional clinical standards, aiming to reduce (unnecessary) referrals to a cardiologist without compromising diver safety.

METHODS: In this retrospective study covering 10 years, ECGs from Royal Netherlands Navy divers were analysed. Abnormal ECGs identified by clinical criteria between 2010 and 2019 were re-evaluated using international sports medicine ECG criteria. A control group of normal ECGs was matched based on demographic factors. Statistical analyses were performed using Pearson’s chi-squared and Fisher’s exact test, with significance set at P < 0.05.

RESULTS: Of a total of 3,020 ECGs, 156 were classified as abnormal by clinical criteria. Reassessment using sports medicine standards reduced the number requiring further investigation by 85.9%. In the control group, 1.0% of previously unremarkable ECGs were identified as requiring further investigation upon reassessment. Conduction disorders and rhythm disturbances were the most common findings.

CONCLUSIONS: The findings of this study suggest that the application of sports medicine ECG interpretation criteria effectively reduces the number of ECGs requiring further investigation, thereby minimising referrals and associated costs. These results advocate for a re-evaluation of routine ECG screening practices in fitness to dive assessments in military divers, promoting a more tailored approach for this specific group.

PMID:40986920 | DOI:10.28920/dhm55.3.212-219

Shock. 2025 Sep 23. doi: 10.1097/SHK.0000000000002710. Online ahead of print.

ABSTRACT

BACKGROUND: Although Sepsis-3.0 defines septic shock as hypotension with serum lactate levels >2.0 mmol/L, this criterion may miss low-lactate shock: a clinically significant phenotype characterized by hypotension but without elevated lactate levels. The epidemiological characteristics and prognostic significance of low-lactate shock remain unclear, highlighting a critical gap in current shock management models.

METHODS: We conducted a retrospective cohort study of 3,134 patients with shock admitted to a tertiary care medical institution from January 2015 to March 2022. We used propensity score matching (1:2 ratio) to control for confounding factors, aiming to determine the prevalence of low-lactate shock (lactate ≤ 2.0 mmol/L), identify risk factors through multivariable logistic regression, and validate the predictive model (NRS-APACHE II-TG-TBIL) using ROC analysis.

RESULTS: The 28-day mortality rate was slightly lower in the low-lactate shock group compared to the high-lactate group (25.4% [94/369] vs. 35.8% [990/2,765], respectively). The age, nutritional risk screening (NRS-2002) score, and venous thromboembolism (VTE) risk score were significantly lower in the low-lactate shock group than in the high-lactate shock group (P < 0.05). No statistically significant differences were observed in gender distribution (P = 0.092). Multivariable analysis identified four independent predictors of low-lactate shock: NRS-2002 (OR=0.570, P<0.001), APACHE II (OR=0.869, P<0.001), TG (OR=0.772, P=0.035), and TBIL (OR=0.993, P=0.002). The composite NRS-APACHE II-TG-TBIL model showed excellent discrimination (AUC=0.800, P<0.001) with balanced sensitivity (72.6%) and specificity (73.5%).

CONCLUSIONS: Low-lactate shock carries substantial mortality risk (25.4%). The validated NRS-APACHE II-TG-TBIL model (AUC=0.800) provides an effective tool for early detection, addressing critical diagnostic gaps in shock management.

PMID:40986916 | DOI:10.1097/SHK.0000000000002710

Pain Physician. 2025 Sep;28(5):E555-E566.

ABSTRACT

BACKGROUND: The sacroiliac joint (SIJ) is a frequently overlooked source of lower back pain (LBP), contributing to 15-30% of cases. Nonoperative treatments such as NSAIDs, physical therapy, and SIJ injections have limited effectiveness on LBP. When conservative measures fail, SIJ fusion is recommended, with minimally invasive techniques showing better outcomes than traditional open surgery. However, there is no clear agreement on the optimal approach for SIJ fusion.

OBJECTIVES: This study aims to evaluate the outcomes of minimally invasive SIJ fusion performed by a single surgeon, comparing the lateral and posterior approaches to another in terms of pain relief, functional improvement, and procedure durability.

STUDY DESIGN: A retrospective comparative study.

SETTING: A single pain management center at the Interventional Pain Institute, where patients underwent SIJ fusion between April 2020 and May 2024.

METHODS: A total of 115 patients who underwent minimally invasive SIJ fusion and met the inclusion criteria were included in the study. Patients were assessed before and after the procedure for pain using the Visual Analog Scale (VAS), functional outcomes using the Oswestry Disability Index (ODI), opioid consumption, sleep quality, and procedure durability. Statistical comparisons between the lateral and posterior approaches were performed using the chi-square (c²), Fisher’s exact test, and t-test as appropriate, while durability was analyzed with the Kaplan-Meier curve and log-rank test.

RESULTS: The average follow-up duration was 11.3 ± 5.8 months. Lateral SIJ fusion demonstrated longer procedural durability compared to the posterior approach, with greater improvements in VAS pain scores (66.3% vs. 53.8%, P = 0.017), ODI functional outcomes (45.0% vs. 30.7%, P = 0.002), higher rates of sleep improvement (83.9% vs. 61.0%, P = 0.006), and lower recurrence rates (12.5% vs. 28.8%, P = 0.031). At the last follow-up, most patients (79.1%) maintained their improvements.

LIMITATIONS: This study is limited by its retrospective design, its single-center setting, and the lack of randomization between the lateral and posterior approaches.

CONCLUSION: Both the lateral and posterior approaches to minimally invasive SIJ fusion were beneficial. However, the lateral approach used in our study demonstrated superior outcomes in the areas of pain relief, functional improvement, and procedure durability. Further multicenter prospective studies with larger patient populations are recommended to confirm these findings.

PMID:40986910

West Afr J Med. 2025 Apr 30;42(4):303-310.

ABSTRACT

BACKGROUND: Multiple injured patients are patients who sustained injury to more than one system in the body, while a polytraumatized patient is the one who sustained injury to two or more regions of a system in the body. Better patient outcomes and effective management depend on an understanding of the patterns and characteristics of limb injuries in the multiply injured individuals. This is especially important in places with little resources, like Southwestern Nigeria, where trauma is common and it’s important to make the best use of the few available medical resources. Therefore, the aim of this research is to determine the common aetiology that led to various limb injuries in the multiple injured patients at UNIOSUN Teaching Hospital, Osogbo, Osun state.

METHODOLOGY: A prospective observational design was employed, involving multiple injured patients admitted to UNIOSUN Teaching Hospital from May 1st, 2022 to April 30th, 2024. Data collection includes demographic information, aetiology of the injury and type of injury sustained. SPSS Version 20 was employed to determine the frequency and distribution of data. Descriptive analysis revealed demographic characteristics, patterns of limb injury, highlighting the common causes, prevalence of different types of limb injuries, distribution of affected limbs and sides in the multiply injured patients.

RESULT: The study found a higher representation of males in road traffic accidents, with a diverse age group. Most participants were passengers or pedestrians, with 71.4% of injuries being closed. Most participants did not use seat belts and were not seated.

CONCLUSION: This study demonstrated that limb injuries from road traffic accidents predominantly affected young adult males, with motorcycle crashes being the leading cause. Fractures, especially of the lower limbs, were the most common injury types, and surgical intervention was frequently required. These findings show the significant burden of limb trauma managed at UNIOSUN Teaching Hospital and emphasize the demographic and clinical patterns associated with such injuries.

PMID:40986889

Health Informatics J. 2025 Jul-Sep;31(3):14604582251381145. doi: 10.1177/14604582251381145. Epub 2025 Sep 23.

ABSTRACT

Background: Nurses’ clinical decision-making skills are vital for ensuring safe care and achieving optimal patient outcomes. Similarly, evidence-based practice improves quality of care and standardizes nursing services. Research is needed to examine factors affecting these skills. Objective: This study examined the relationship between informatics competency, attitudes toward evidence-based practice, and clinical decision-making skills among nurses. Method: This descriptive correlational study was conducted in 2024 with 300 nurses from hospitals affiliated with Birjand University of Medical Sciences, Birjand, Iran. Data were collected using questionnaires on demographic information, informatics competency, attitudes toward evidence-based practice, and clinical decision-making skills. Data were analyzed using SPSS-25 software at a significance level of p < 0.05. Results: A significant positive correlation was found between informatics competency (and its components), clinical decision-making skills, and evidence-based practice in the studied nurses. Informatics competency predicted about 26% of the variance in clinical decision-making skills and 20% of the variance in attitudes toward evidence-based practice. Conclusion: Nurse managers should implement targeted interventions to enhance informatics competency and improve attitudes toward evidence-based practice and decision-making skills.

PMID:40986884 | DOI:10.1177/14604582251381145

Orthop Nurs. 2025 Sep-Oct 01;44(5):286-295. doi: 10.1097/NOR.0000000000001151. Epub 2025 Sep 23.

ABSTRACT

This study was conducted to determine the relationship between older patients’ readiness for discharge after total arthroplasty and fear of falling, kinesiophobia, and other variables. This correlational and cross-sectional study was conducted with 250 older people who had undergone total knee and hip arthroplasty. Data were collected using a Patient Descriptive and Clinical Information Form, the Fear of Falling Scale, the Visual Analog Scale, the Tampa Kinesiophobia Scale, and the Readiness for Hospital Discharge Scale-Short Form. The mean Readiness for Hospital Discharge Scale (RHDS) score was 4.70 ± 1.23, and 84.4% of the participants were found to be not ready for discharge. This is low in comparison to the findings from other studies. The model created for readiness for discharge explained 30% of the total variance (p < .005). The independent variables included in the model, namely fear of falling, pain, age, and number of mobilizations, were determined to be statistically significant predictors of readiness for discharge. It is necessary to support mobilization and manage the fear of falling and pain to increase older patients’ readiness for discharge following surgery.

PMID:40986878 | DOI:10.1097/NOR.0000000000001151

Orthop Nurs. 2025 Sep-Oct 01;44(5):278-285. doi: 10.1097/NOR.0000000000001150. Epub 2025 Sep 23.

ABSTRACT

The article aims to examine the effect of a pre-operative high-carbohydrate drink (HCD) on unilateral, primary total hip arthroplasty and total knee arthroplasty patients by measuring post-operative antiemetic medication use and length of stay in the post-anesthesia care unit (PACU). The study used a quasi-experimental cohort design using a historical control group. We compared the intervention group who consumed the pre-operative HCD, to a historical control group, 1 year prior, who did not. The intervention group had more females (62%), was more likely to have spinal anesthesia, and was less likely to receive preoperative antiemetic medications (odds ratio (OR) = 0.41; confidence interval (95% CI): 0.21, 0.79) and postoperative antiemetics (OR = 0.48; 95% CI: 0.29, 0.81). The intervention group’s PACU stay was 10.1 min shorter (p < .0001) than the control group. Patients who consumed HCDs exhibited decreased PACU stay and decreased antiemetic medication use. These findings were used to change institutional preoperative policies for orthopedic patients to enhance outcomes.

PMID:40986877 | DOI:10.1097/NOR.0000000000001150