Tag: nevin manimala

Eur Radiol. 2025 Jul 25. doi: 10.1007/s00330-025-11860-2. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the efficacy, safety, and factors influencing the response to radiofrequency ablation (RFA) in patients with primary hyperparathyroidism (PHPT) in a prospective multicenter trial.

MATERIALS AND METHODS: Between September 2022 and June 2024, 34 patients with 35 parathyroid lesions who either refused surgery or were ineligible for it underwent RFA for treatment of PHPT across three hospitals. Nodule size, volume, and biochemical data were compared before and after treatment (at 2 h, 1 week, and 1, 3, 6, and 12 months). Complications were assessed during and after treatment. Factors influencing the treatment response to RFA for PHPT were analyzed.

RESULTS: Significant reductions in nodule size and volume, as well as improvements in serum parathyroid hormone (PTH) and total calcium levels, were noted at the 3-, 6-, and 12-month follow-ups after RFA (all p < 0.05). Out of the 34 patients, 17 experienced a complete response with normalized serum PTH and calcium levels (50.0%), whereas 17 showed a partial response (50.0%) (median number of sessions 1). The initial serum PTH level was a key factor associated with the treatment response to RFA, with an area under the receiver operating characteristic curve of 0.853 using a PTH cutoff value of ≥ 118 pg/mL. Transient voice change (n = 1) and hypocalcemia (n = 1) were reported after the procedure.

CONCLUSION: In selected cases, RFA is a safe and effective treatment option for patients with PHPT. The initial PTH level of < 118 pg/mL is associated with achieving a biochemical cure after a single treatment.

KEY POINTS: Question The efficacy of radiofrequency ablation in treating primary hyperparathyroidism remains unclear due to limited evidence, highlighting the need for further study. Findings In this prospective multicenter study, the complete response rate was 50.0%, with 79.4% achieving normocalcemia. Baseline serum parathyroid hormone levels significantly influenced treatment response. Clinical relevance Radiofrequency ablation is a safe and effective treatment for selected patients with primary hyperparathyroidism, especially those who are ineligible for surgery. Initial serum parathyroid hormone levels predict the likelihood of achieving a biochemical cure after a single treatment.

PMID:40715823 | DOI:10.1007/s00330-025-11860-2

Eur Radiol. 2025 Jul 25. doi: 10.1007/s00330-025-11845-1. Online ahead of print.

ABSTRACT

OBJECTIVES: Lung cancer is the leading cause of cancer-related mortality. While early detection improves survival, distinguishing malignant from benign pulmonary nodules remains challenging. Artificial intelligence (AI) has been proposed to enhance diagnostic accuracy, but its clinical reliability is still under investigation. Here, we aimed to evaluate the diagnostic performance of AI models in classifying pulmonary nodules.

MATERIALS AND METHODS: This single-center retrospective study analyzed pulmonary nodules (4-30 mm) detected on CT scans, using three AI software models. Sensitivity, specificity, false-positive and false-negative rates were calculated. The diagnostic accuracy was assessed using the area under the receiver operating characteristic (ROC) curve (AUC), with histopathology serving as the gold standard. Subgroup analyses were based on nodule size and histopathological classification. The impact of imaging parameters was evaluated using regression analysis.

RESULTS: A total of 158 nodules (n = 30 benign, n = 128 malignant) were analyzed. One AI model classified most nodules as intermediate risk, preventing further accuracy assessment. The other models demonstrated moderate sensitivity (53.1-70.3%) but low specificity (46.7-66.7%), leading to a high false-positive rate (45.5-52.4%). AUC values were between 0.5 and 0.6 (95% CI). Subgroup analyses revealed decreased sensitivity (47.8-61.5%) but increased specificity (100%), highlighting inconsistencies. In total, up to 49.0% of the pulmonary nodules were classified as intermediate risk. CT scan type influenced performance (p = 0.03), with better classification accuracy on breath-held CT scans.

CONCLUSION: AI-based software models are not ready for standalone clinical use in pulmonary nodule classification due to low specificity, a high false-negative rate and a high proportion of intermediate-risk classifications.

KEY POINTS: Question How accurate are commercially available AI models for the classification of pulmonary nodules compared to the gold standard of histopathology? Findings The evaluated AI models demonstrated moderate sensitivity, low specificity and high false-negative rates. Up to 49% of pulmonary nodules were classified as intermediate risk. Clinical relevance The high false-negative rates could influence radiologists’ decision-making, leading to an increased number of interventions or unnecessary surgical procedures.

PMID:40715822 | DOI:10.1007/s00330-025-11845-1

Int J Impot Res. 2025 Jul 25. doi: 10.1038/s41443-025-01131-5. Online ahead of print.

ABSTRACT

Delayed ejaculation (DE) is among the most challenging male sexual dysfunctions. We aim to explore and compare socio-demographic and clinical characteristics of men with self-reported DE and primary premature ejaculation (PE). Data from 555 consecutive men seeking first medical help for DE or primary PE were retrospectively analyzed. Socio-demographic, clinical, laboratory data, and self-reported symptoms of anxiety and depression were collected. Patients completed International Index of Erectile Function (IIEF) and Beck Depression Inventory (BDI). We excluded men who had undergone pelvic surgery. Descriptive statistics compared clinical and socio-demographic characteristics. Linear regression models tested the association between depressive symptoms and baseline IIEF domain scores among men with DE. Of 555 patients, 479(86.3%) and 76(13.7%) had PE and DE, respectively. Men with DE were significantly older than those with PE [47(34-63.5) vs. 44(33-53), P = 0.01]. Conversely, men with PE depicted a CCI ≥ 1 more frequently compared to those with DE [17(22.4%) vs. 53(11.1%); P = 0.01]. The two groups did not differ regarding relational status, BMI, waist circumference, and hormonal milieu. Men with DE reported more frequently symptoms referable to anxiety and depression (P = 0.001) along with higher median (IQR) baseline BDI scores [8(4.8-14.3) vs. 6(2-10); P = 0.01], lower median IIEF-orgasmic function (OF) [6(5-9) vs. 9(6-10); P = 0.003] and IIEF-sexual desire (SD) [7(5.8-8) vs. 8(6-9); P = 0.001] domain scores compared to men with PE. At linear regression analysis, in men with DE, the higher the BDI score the lower the IIEF-overall satisfaction [β = -1.57, CI(-2.60, -0.53), P = 0.004], and the lower the IIEF-intercourse satisfaction [β = -0.76, CI(-1.29, -0.16), P = 0.01] domain scores. Conversely, no association between BDI and IIEF-OF, -SD, and -erectile function domain scores were found. Of men complaining of ejaculatory disorders, one out of ten reports DE. Patients with DE have higher chances to report clinically significant depression which can significantly impact their overall sexual satisfaction.

PMID:40715810 | DOI:10.1038/s41443-025-01131-5

Pediatr Cardiol. 2025 Jul 25. doi: 10.1007/s00246-025-03970-x. Online ahead of print.

ABSTRACT

The pulmonary artery pulsatility index (PAPi), calculated as (systolic pulmonary artery pressure – diastolic pulmonary artery pressure)/mean right atrial pressure). This study aimed to assess the clinical utility of PAPi in risk stratification for pediatric idiopathic pulmonary arterial hypertension (IPAH) and its performance in predicting the need for invasive intervention due to severe right heart failure. We analyzed clinical, echocardiographic, and right heart catheterization findings of 24 IPAH patients between April 2019 and November 2024. Statistical analyses included ROC curve analysis for PAPi’s diagnostic performance, Kaplan-Meier survival analysis, and Cox regression for identifying independent predictors of intervention. The study included 24 patients (mean age 8.2 ± 4.7 years, 66.7% female). Based on pediatric risk classification, 45.8% were lower-risk, and 54.2% were high-risk, with PAPi significantly lower in high-risk patients (p < 0.001). ROC analysis identified PAPi < 3.24 as a strong predictor of high-risk status (sensitivity = 92%, specificity = 82%). PAPi correlated positively with 6MWT (r = 0.802) and TAPSE (r = 0.812) and negatively with WHO-FC (r = – 0.692) and NT-proBNP (r = – 0.713) (p < 0.001). Over 22 ± 15.9 months, 37.5% (n = 9) required invasive interventions for syncope, WHO-FC III/IV symptoms, or right ventricular failure, including atrial septostomy (77.8%), partial ASD closure (11.1%), and reverse Potts shunt (11.1%). Post-intervention, all but one patient improved. Patients requiring intervention had lower PAPi (1.88 ± 0.71 vs. 3.95 ± 1.27, p < 0.001). Kaplan-Meier analysis confirmed PAPi > 3.24 was associated with longer event-free survival (p = 0.002). Cox regression showed higher PAPi independently predicted lower intervention risk (HR 0.36, p = 0.042). In conclusion, this study suggests that PAPi is a reliable prognostic marker for risk stratification and predicting the need for invasive intervention in pediatric IPAH.

PMID:40715799 | DOI:10.1007/s00246-025-03970-x

Braz J Microbiol. 2025 Jul 27. doi: 10.1007/s42770-025-01730-w. Online ahead of print.

ABSTRACT

Glanders, caused by Burkholderia mallei, is a zoonotic disease with profound socioeconomic and public health implications, affecting equines and humans. This study investigated glanders cases in Brazil from 2006 to 2023 to identify persistent clusters and analyze temporal trends, providing a foundation for the formulation of effective control policies. Official data were obtained from the National Animal Health Information System (SIZ) and Brazilian Institute of Geography and Statistics (IBGE), encompassing case notifications and equine population statistics by state and year. The incidence risk (IR) was calculated, and prospective spatiotemporal analyses were performed using the discrete Poisson model in SatScan software. Temporal trends were assessed through segmented regression in Joinpoint software. A total of 2,654 glanders cases were reported, with the Northeast region accounting for 52.19% of cases and Pernambuco presenting the highest IR (342.58/100,000). Primary clusters were detected in the Northeast (RR = 5.16), while secondary clusters were identified in the North, South, Central-West, and Southeast regions, with the most notable cluster in Amazonas (RR = 60.32). Temporal trend analysis revealed overall stability in Brazil but demonstrated increasing trends in the North, South, and Central-West regions. These results underscore the critical need for integrated epidemiological surveillance, stricter health regulations, and improved control of equine movement, particularly in regions at higher risk. Strengthening early diagnostic capabilities and implementing targeted educational initiatives are essential to curbing the spread of B. mallei and mitigating the socioeconomic and public health impacts of glanders in Brazil.

PMID:40715785 | DOI:10.1007/s42770-025-01730-w

Int J Gynaecol Obstet. 2025 Jul 26. doi: 10.1002/ijgo.70415. Online ahead of print.

ABSTRACT

Obstetric anal sphincter injuries (OASIs) constitute a significant complication in vaginal childbirth, affecting up to 26% of deliveries and representing the leading cause of anal incontinence among women. Despite their prevalence and serious long-term consequences, OASIs remain widely underreported, partly because of clinicians’ hesitancy linked to fear of litigation, peer criticism, and a pervasive culture that discourages disclosure of adverse events. Recent evidence emphasizes that underreporting exacerbates rather than mitigates legal risks and patient harm, underscoring the urgent need for systemic changes. This article reviews critical factors contributing to OASI underreporting, including inadequate clinical training, inconsistent national guidelines, variable litigation landscapes, and differing diagnostic practices across European healthcare systems. Examples from the UK, Poland, Sweden, Norway, France, Italy, the Czech Republic, and Belgium demonstrate significant variations in prevention strategies, diagnostic accuracy, and management protocols, reflecting uneven progress and highlighting opportunities for standardized care improvements. These national discrepancies in OASI definitions, classification, and reporting thresholds may lead to significant inconsistencies in both clinical outcomes and statistical comparisons across healthcare systems. Implementing structured training, standardized protocols, multidisciplinary collaboration, and transparent reporting systems are essential for improving maternal outcomes and reducing litigation risks. Encouraging an institutional culture of accountability and openness will support continuous improvement, ensuring enhanced patient safety and quality care across global healthcare systems.

PMID:40715780 | DOI:10.1002/ijgo.70415

Arch Gynecol Obstet. 2025 Jul 26. doi: 10.1007/s00404-025-08131-2. Online ahead of print.

ABSTRACT

PURPOSE: To compare and analyze surgical outcomes and postoperative pregnancy outcomes between electrotomy and cold instruments for hysteroscopic myomectomy.

METHODS: This study included patients who were diagnosed with submucosal fibroids (FIGO 0-2) in our center and underwent hysteroscopic myomectomy from January 2022 to November 2024. Hysteroscopic myomectomy was performed by either bipolar system or cold instruments. Surgical and postoperative pregnancy outcomes were recorded and analyzed.

RESULTS: A total of 36 patients underwent hysteroscopic myomectomy at our center during the 3-year period, 21 in the cold instruments group and 15 in the electrotomy group. The mean age of the patients in the cold instruments group was significantly higher than that of the electrotomy group (39.00 ± 5.18 vs 35.20 ± 3.45, P = 0.019). In the electrotomy group, four patients found residual fibroids and required a second surgery. The incidence of residual fibroids and a second procedure were significantly higher than those in the cold instruments group (4/15(26.67%) vs 0, P = 0.023). The postoperative biochemical pregnancy rate and clinical pregnancy rate were higher in patients in the cold instruments group, but the difference was not statistically significant (14/21 (66.67%) vs 8/15 (53.33%), P = 0.644; 10/21(47.62%) vs 5/15(33.33%), P = 0.607).

CONCLUSION: Cold instruments for hysteroscopic myomectomy seem to be a safe and feasible surgical procedure. It has an advantage over electrotomy in terms of complete removal of submucosal fibroids. Moreover, cold instruments for hysteroscopic myomectomy have no electrothermal damage to normal endometrium, which is favorable for pregnancy as soon as possible after surgery.

PMID:40715777 | DOI:10.1007/s00404-025-08131-2

Am J Cardiovasc Drugs. 2025 Jul 27. doi: 10.1007/s40256-025-00744-x. Online ahead of print.

ABSTRACT

BACKGROUND: Higher quality scaled-up evidence on pulmonary arterial hypertension (PAH), a rare and life-threatening disease, is needed to support informed decision-making. We aimed to map the current knowledge of PAH treatments and evaluate the methodological quality of published systematic reviews.

METHODS: An overview with literature searches in PubMed and Embase (May 2025) was performed (CRD42023414469). The methodological and reporting quality of the eligible records was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist, respectively. Association analyses between tools’ scores with key variables (article publication date, journal impact factor, country/region) were performed (SPSS v.28). An evidence map summarizing the most reported treatments and outcomes was also built.

RESULTS: Overall, 57 systematic reviews (n = 52; 91.2% with meta-analysis) published between 1997 and 2025 (median year 2017), authored mostly by countries from Asia (n = 35; 61.4%) and North America (n = 12; 21.1%), were included. The classes of phosphodiesterase type-5 inhibitors, endothelin receptor antagonists, and prostanoids and combination therapies were each assessed in one-third of the studies each. Over 20 different outcomes were reported, with the most common surrogate endpoints being 6-min walking distance (n = 42; 73.7%) and mean pulmonary arterial pressure (n = 33; 57.9%). Most studies were classified as having critically low methodological quality (n = 48; 84.2%), with only three presenting high-quality methodology according to AMSTAR 2. The mean PRISMA score was 21.3 ± 2.9, indicating an adherence rate of 78.9% to the checklist among authors. Although there was an improvement over time in the quality of the reviews (p = 0.016 for AMSTAR; p = 0.002 for PRISMA), no correlations were found based on country nor journal impact factor.

CONCLUSIONS: Methodological weaknesses remain common in systematic reviews of PAH; therefore, enforcing compliance with guidelines and standardizing outcome measurements through a core outcome set is crucial for improving data comparability and clinical application.

REGISTRATION: PROSPERO identifier no. CRD42023414469.

PMID:40715772 | DOI:10.1007/s40256-025-00744-x

Arch Gynecol Obstet. 2025 Jul 26. doi: 10.1007/s00404-025-08136-x. Online ahead of print.

ABSTRACT

PURPOSE: In vitro fertilization and embryo transfer (IVF-ET) has become crucial for infertile couples. Previous studies have suggested that multiple ETs are associated with increased risks of preterm birth and low birth weight. The current study aims to investigate this association.

METHODS: PubMed, Cochrane Library, EMBASE, ScienceDirect, and China National Knowledge Infrastructure databases were systematically searched. Network meta-analysis was performed to compare the associations between different numbers of embryo transfers (≥ 2) and the incidence rates of preterm birth and low birth weight. Consistency and inconsistency models were applied to ensure reliability. Frequentist statistical methods used data integration. The surface under the cumulative ranking curve (SUCRA) value was used to rank the risks of preterm birth and low birth weight associated with varying numbers of ETs.

RESULTS: There was a significant difference in the incidence of low birth weight between the 2-ET and 4-ET groups. The 4-ET group had the highest risks for preterm birth and low birth weight.

CONCLUSION: Multiple ETs are associated with increased risks of preterm birth and low birth weight. This study highlights the need for tailored clinical strategies to optimize pregnancy outcomes and mitigate complications.

PMID:40715771 | DOI:10.1007/s00404-025-08136-x

Drugs Real World Outcomes. 2025 Jul 26. doi: 10.1007/s40801-025-00509-7. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Anticholinergic medications are known to affect the prognosis of older nursing home residents. Various anticholinergic scales were developed to measure the cumulative anticholinergic burden; among them, the CRIDECO Anticholinergic Load Scale (CALS) has recently emerged as a new tool to identify patients with cognitive impairment due to anticholinergic burden. This study aimed to externally validate the CALS and to evaluate the association of CALS and the anticholinergic cognitive burden (ACB) scales with baseline cognitive and functional impairment, as well as with 3-year mortality rates.

METHODS: A prospective cohort of 600 nursing home residents (mean age 80.4 ± 8.0 years; 69.8% women) underwent a comprehensive geriatric assessment. Anticholinergic burden was assessed at baseline using both CALS and ACB scales. Cognitive impairment (Mini-Mental State Examination < 24) and physical disability (one or more impaired activities of daily living) were evaluated cross-sectionally using a logistic regression model. Cox proportional hazards models were used to estimate the association between anticholinergic burden and 3-year mortality, adjusting for age, sex, multimorbidity, nutritional status, and cognitive and functional status.

RESULTS: Among 600 nursing home residents included in the study, 72.0% had cognitive impairment and 56.3% had at least one activity of daily living limitation. The CALS and ACB scores were significantly correlated ( $\rho$ = 0.76), but CALS identified a higher number of residents with moderate-to-high anticholinergic burden. Multivariate logistic regression showed that CALS ≥ 2 was independently associated with cognitive impairment (odds ratio 1.84, 95% confidence interval 1.02-3.34), whereas ACB ≥ 2 was not. Both scales were associated with activities of daily living disability, with a stronger gradient and better goodness of fit for CALS than ACB. During the 3-year follow-up, 25.3% of residents died. Cox regression analyses showed that residents with CALS or ACB ≥ 2 had significantly lower survival over 3 years. In fully adjusted Cox models, both CALS ≥ 2 (hazard ratio 1.93, 95% confidence interval 1.07-3.46) and ACB ≥ 2 (hazard ratio 1.69, 95% confidence interval 1.02-2.83) remained associated with increased mortality. Prognostic performance was similar (CALS C-index: 0.783; ACB: 0.781), but the model fit favored CALS.

CONCLUSIONS: In this cohort of nursing home residents, anticholinergic burden as measured by both CALS and ACB was associated with baseline physical impairment and 3-year mortality, but CALS showed a better goodness of fit. Between the two scales, CALS only was independently associated with baseline cognitive impairment. These findings support the clinical utility of CALS in assessing anticholinergic-related risk among frail older adults in institutional settings.

PMID:40715770 | DOI:10.1007/s40801-025-00509-7