Tag: nevin manimala

Medicine (Baltimore). 2025 Jun 6;104(23):e42745. doi: 10.1097/MD.0000000000042745.

ABSTRACT

This study aimed to describe the incidence of abnormal liver function tests (LFTs) in pregnant women post-2019 coronavirus disease (COVID-19) and investigate the characteristics of pregnant women with abnormal LFTs and its impact on pregnancy outcomes. The data for 168 pregnant women who were infected with COVID-19 in the late stages of pregnancy were collected in Hefei Maternal and Child Health Hospital from December 2022 to January 2023, and 86 pregnant women with abnormal liver function were divided into the research group and 82 pregnant women with normal liver function into the control group for retrospective analysis. Population and laboratory data were collected and statistical analysis was conducted. Among the 168 pregnant women with COVID-19, 86 (51.2%) had elevated liver enzymes. In the control group, 4 (4.5%) had elevated liver enzymes. Differences between the 2 groups were statistically significant (P < .05). Single-factor analysis revealed that age, gestational week, and body mass index (BMI) exhibited statistically significant differences (P < .001) as potential factors influencing abnormal LFTs. Logistic regression analysis demonstrated that age (OR: 1.526), gestational week (OR: 1.321), and BMI (OR: 1.159) remained independent risk factors for liver injury (P < .05). Furthermore, the cesarean section rate, postpartum hemorrhage rate, rupture of membranes rate, and fetal intrauterine distress rate in the observation group were all significantly higher than those in the control group (P < .05). Additionally, the incidence of neonatal asphyxia, preterm birth, and low birth weight in the observation group were all significantly higher than those in the control group (P < .05). Pregnant individuals are at an elevated risk of hepatic injury following severe acute respiratory syndrome coronavirus 2 infection. Furthermore, the likelihood of hepatic injury escalates with advancing maternal age, gestational age, and BMI. Hepatic functional aberrations in the latter stages of pregnancy may precipitate adverse pregnancy outcomes.

PMID:40489829 | DOI:10.1097/MD.0000000000042745

Medicine (Baltimore). 2025 Jun 6;104(23):e42622. doi: 10.1097/MD.0000000000042622.

ABSTRACT

Accurate information on pregnancy outcomes in women with prosthetic heart valves (PHVs) is essential for preconception counseling and prenatal care. This study aims to determine the maternal and fetal outcomes in women with PHVs. A total of 138 pregnant women with PHVs admitted into a tertiary center between November 2007 and February 2020 were included in the study, and the data were analyzed retrospectively. Patients were divided into the mechanical heart valves (MHVs) group, 118 patients with MHVs, and the tissue heart valves (THVs) group, 20 patients with THVs. The 2 groups were compared. There was 1 maternal death in the MHV group patients (0.8%). There was no difference between the 2 groups regarding maternal mortality (P = 1.000), valve thrombosis (P = .376), and hemorrhagic events (P = .692). Only 66.9% of patients in the MHV group had a live birth compared to the live birth rate of 100% in the THV (P = .002). Mechanical valve thrombosis (MVT) occurred in 3.2% of patients who used warfarin only; no MVT occurred in patients using a regimen called “sequential therapy”, which utilizes low-molecular-weight heparin (LMWH) during the 1st trimester and warfarin during the 2nd and 3rd trimesters. MVT occurred in 33.3% of patients using LMWH throughout gestation (P < .001). The difference was statistically significant. Compared to patients using other regimens, the patients using the regimen of “warfarin only ” was correlated with the highest rate of miscarriage (38.1%, 3.4%, and 16.7%, P < .001). Women with MHVs have a lower rate of live birth. The anticoagulation regimen of “sequential therapy” was superior to other regimens in terms of the weighted effects of regimens on maternal MVTs and fetal loss.

PMID:40489827 | DOI:10.1097/MD.0000000000042622

Medicine (Baltimore). 2025 Jun 6;104(23):e42664. doi: 10.1097/MD.0000000000042664.

ABSTRACT

Most previous studies on dislocation after total hip arthroplasty (THA) have focused on patient- and surgery-related factors without detailing the specific circumstances of dislocation events. Therefore, this study aimed to analyze dislocation cases and compare these relevant factors between patients who experienced dislocation and those who did not to inform targeted prevention measures during acute care hospitalization. This retrospective study examined the electronic medical records of 420 patients (445 joints) who underwent THA and rehabilitation at our hospital between April 1, 2018, and August 31, 2023. A total of 9 cases of dislocation in 6 patients were reported. Dislocation occurred most frequently in bed within the patient’s room (5 cases; 55.6%), followed by in the rehabilitation room and the toilet (1 case each; 11.1%), and unknown locations (2 cases; 22.2%). Bed-related dislocations were associated with trunk rotation or external rotation of the hip joint; in 2 cases, the dislocation was already present when the patient awoke. The revision THA and THA indication rates, preoperative Functional Independence Measure scores, and locomotion status differed significantly between the patients who showed dislocation and those who did not. Revision THA, THA indications other than osteoarthritis, low Functional Independence Measure score at admission, and low locomotion status may increase the risk of dislocation. Furthermore, the findings suggest that dislocation prevention strategies during acute hospitalization should prioritize safe bed use and sleep positions.

PMID:40489815 | DOI:10.1097/MD.0000000000042664

Medicine (Baltimore). 2025 Jun 6;104(23):e42504. doi: 10.1097/MD.0000000000042504.

ABSTRACT

This study evaluates the effectiveness of a current training program for new nurses over a period of time, identify any existing issues in the program, and put forward recommendations to alleviate these issues, towards improving the structure and management of the training program. A total of 201 newly recruited nurses and 52 head nurses in a Grade-A tertiary hospital (Wuhan, China) were included in this longitudinal study with a 6-month duration. Using the Kirkpatrick model, we evaluated the effectiveness of the training against 4 levels of criteria: reaction, learning, behavior, and results. Cluster sampling was used to select participants, and data were analyzed using SPSS 19.0, including descriptive statistics, u tests, and 1-way analysis of variance to assess theoretical scores, operational scores, and behavioral evaluations. The reaction level responses were that the new nurses were generally satisfied with the training. The learning level responses showed that there was a significant difference in exam scores between new nurses after 3 months of training and after 6 months of training. The behavioral level responses indicated that the clinical nursing abilities and interpersonal skills of new nurses improved after 6 months of training. In the self-evaluation, new nurses gave themselves higher scores than the scores given by head nurses, and the difference between the 2 scores was statistically significant. According to the quality check data from the nursing department, the results level responses showed that the complaint rate against new nurses was 0, the accident rate was 0, and new nurses accounted for 20% of all the commendation letters. The systematic and comprehensive evaluation of new nurse training programs based on the 4 levels of the Kirkpatrick model provides valuable insights for nursing managers.

PMID:40489814 | DOI:10.1097/MD.0000000000042504

JMIR Res Protoc. 2025 Jun 9;14:e75368. doi: 10.2196/75368.

ABSTRACT

BACKGROUND: Postoperative delirium of cardiovascular surgery (PODOCVS) is an acute brain dysfunction characterized by inattention, impaired consciousness, and cognitive disorders, and the severity and presence of these symptoms fluctuate over time. PODOCVS occurs during the early postoperative period and is associated with adverse outcomes, including prolonged mechanical ventilation, premature mortality, and so on. Advances in its early diagnosis and treatment have mitigated some of the initial adverse effects of PODOCVS, but models for predicting risk in patients who have already developed PODOCVS remain inadequate for effective secondary prevention. Developing multivariable prediction models for stratifying PODOCVS risk would enable early, personalized interventions.

OBJECTIVE: This study aims to systematically review and critically evaluate the development, performance, and applicability of existing prediction models for PODOCVS.

METHODS: An extensive systematic search will be performed across multiple databases, including Embase, PubMed, the Web of Science, and so on, to identify studies related to multivariate predictive models for PODOCVS. A manual search of the included studies’ reference lists will also be conducted to identify any additional relevant publications. This systematic review will include studies that meet the following criteria: (1) studies with subject populations comprising adult cardiovascular surgery patients aged ≥18 years, (2) studies involving the development and internal or external validation of predictive models for PODOCVS via multivariate analysis, and (3) studies with outcome measures focused on postoperative delirium. Two researchers (ZXL and WYK) will independently extract the data and assess the included studies’ model quality using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist and the Predictive Model Bias Risk Assessment Tool (PROBAST). Since this study will not involve patient data, ethics approval is not required. Our findings will be published in a peer-reviewed scientific journal and the dataset will be made freely available.

RESULTS: Literature searches were conducted from the inception of the database to May 20, 2024 (updated up to January 31, 2025), and data extraction and analysis are expected to be complete by the end of May 2025. We currently have a preliminary plan to publish the complete study results by August 2025, subject to any unforeseen delays or changes in the research timeline.

CONCLUSIONS: We present a protocol for the systematic review of prediction models for postoperative delirium in cardiac surgery patients. Aiming to identify, summarize, and critically appraise existing risk models globally, this review seeks to provide an up-to-date reference for stakeholders involved in patients with cardiac surgery care, policy making, and research. In addition, we aim to investigate whether machine learning models for PODOCVS offer more accurate predictions than traditional statistical models.

TRIAL REGISTRATION: PROSPERO CRD42024578957; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024578957.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/75368.

PMID:40489772 | DOI:10.2196/75368

Hepatol Commun. 2025 Jun 9;9(7):e0735. doi: 10.1097/HC9.0000000000000735. eCollection 2025 Jul 1.

ABSTRACT

BACKGROUND: Racial and ethnic minority populations are disproportionately impacted by HCC due to more advanced tumor burden and underuse of treatments. We explored racial and ethnic differences in medical mistrust, barriers to treatment, and health literacy among patients with HCC.

METHODS: We conducted a multicenter survey among patients with newly diagnosed HCC between September 2018 and July 2023 at 4 large U.S. health systems. The survey assessed medical mistrust [Group-Based Medical Mistrust Scale (GBMMS)], health literacy (CHEW Assessment of Health Literacy), and barriers to HCC treatment. We performed multivariable logistic regression to evaluate associations between race and ethnicity and survey measures.

RESULTS: Of 1245 eligible patients, 833 (66.9%) completed the survey (45.9% Hispanic, 35.9% White, and 14.2% Black). A higher proportion of Black and Hispanic patients had high medical mistrust than White patients (14.2% and 3.3% vs. 0.7%, respectively; p<0.001). In multivariable analysis, Black race (OR: 19.2, 95% CI: 4.2-87.7) but not Hispanic ethnicity (OR: 3.72, 95% CI: 0.80-17.2) was significantly associated with high mistrust. Compared to White patients, Black and Hispanic patients both reported greater barriers to HCC treatment, with the most common barriers being concerns about pain (41.6%), financial burden (37.6%), and time commitment (31.1%). Limited health literacy was reported by 38.1% of patients (46.8% Hispanic, 41.0% Black, 26.2% White; p<0.001).

CONCLUSIONS: Medical mistrust, barriers to treatment, and limited health literacy are prevalent among Black and Hispanic patients with HCC. Understanding the interplay between race, ethnicity, and these factors is essential to address HCC disparities.

PMID:40489762 | DOI:10.1097/HC9.0000000000000735

Plast Reconstr Surg. 2025 May 28. doi: 10.1097/PRS.0000000000012226. Online ahead of print.

ABSTRACT

BACKGROUND: Smoking’s impact on tissue perfusion and wound healing is particularly relevant in rhinoplasty, where precise tissue healing is crucial for functional and aesthetic outcomes. While the nasal region’s robust vascular supply mitigates smoking’s detrimental effects, concerns remain about postoperative complications. This study investigates whether smoking should be contraindicated for rhinoplasty by comparing infection and revision rates between smokers and nonsmokers.

METHODS: A retrospective review was conducted on 1884 rhinoplasty cases from 2014 to 2022. Patients were categorized as active smokers, former smokers, or nonsmokers. Only patients with at least 12 months of follow-up were included. All procedures were open rhinoplasties conducted under general anesthesia. Primary outcomes analyzed included infection and revision rates. Between group statistical comparisons were performed.

RESULTS: 1884 patients consisted of 80 active smokers, 39 former smokers, and 1765 nonsmokers. Average follow-up was 23.8 months. The overall revision rate was 3.3%, with 3.8% in smokers and 3.3% in nonsmokers. 3.8% of smokers required additional antibiotics for cellulitis compared to 1.6% of nonsmokers; all cases resolved without long-term complications. There were no significant differences between smoker and nonsmoker rhinoplasty patients in rates of revision, postoperative infection, or wound complications.

CONCLUSIONS: Active smoking does not appear to be a strict contraindication for rhinoplasty. Smoker and nonsmoker primary and revision rhinoplasty patients exhibited similar revision, postoperative infection, and wound complications rates. This suggests that, with proper perioperative optimization, rhinoplasty can be safely performed in smokers. While smoking cessation should still be recommended, it may not be mandatory for satisfactory outcomes.

PMID:40489744 | DOI:10.1097/PRS.0000000000012226

Health Syst Reform. 2025 Dec 31;11(1):2510769. doi: 10.1080/23288604.2025.2510769. Epub 2025 Jun 9.

ABSTRACT

The Venezuelan humanitarian crisis has led to the displacement of over 7.7 million migrants, with Colombia hosting around one-third. Colombia has been praised for its progressive policies for Venezuelan migrant integration, and the government’s Estatuto Temporal de Protección para Migrantes Venezolanos (ETPMV), introduced in February 2021, provides one of the region’s most comprehensive regularization policies, permitting 10 years of residency and access to social protection services, including health insurance. We assessed the impact of the ETPMV on self-reported health insurance enrollment and formal healthcare utilization using two telephone surveys with 4,423 female Venezuelan migrants in 2020 and 2023. We used a difference-in-differences methodological approach, accounting for differences in levels of migrant health system integration across municipalities measured by a municipal enrollment index derived from secondary data. We find that the ETPMV significantly increases health insurance enrollment for female Venezuelan migrants and that while uninsured individuals experience a significant decline in healthcare utilization from 2020 to 2023, insured individuals experience no significant change. Additionally, the effect of insurance varies by municipal enrollment index, with greater impacts of insurance in areas with lower levels of regularization and health insurance enrollment. These results highlight the success of ETPMV in enhancing access to healthcare for Venezuelan migrants, with insurance enrollment providing a protective effect against declines in healthcare utilization compared to uninsured individuals. These findings underscore the importance of comprehensive regularization policies to address migrant health needs, while emphasizing the importance of continued efforts toward integration.

PMID:40489735 | DOI:10.1080/23288604.2025.2510769

Eur J Gastroenterol Hepatol. 2025 Jun 6. doi: 10.1097/MEG.0000000000003012. Online ahead of print.

ABSTRACT

The safety and therapeutic efficiency of tyrosine kinase inhibitors (TKIs) and programmed death-1 (PD-1) inhibitors in combination with hepatic artery infusion chemotherapy (HAIC) for patients with unresectable/advanced hepatocellular carcinoma (HCC) require further investigation. This meta-analysis aimed to thoroughly investigate the safety and efficacy of this triple combination therapy based on currently available research. PubMed, Embase, Cochrane Library, Web of Science, VIP, Wan Fang, and China National Knowledge Infrastructure were searched. Outcomes included complete response (CR), partial response (PR), stable disease, overall survival, progression-free survival, and treatment/laboratory-related adverse events. Stata15.1 software was used for random/fixed-effect model analysis. Ten studies with 1108 patients were incorporated in the analysis. For efficacy, the triple combination therapy achieved an improved CR rate [relative risk (RR): 2.76, 95% confidence interval (CI): 1.43-5.33] and PR rate (RR: 1.70, 95% CI: 1.01-2.86) than the control group. Moreover, the triple combination therapy decreased the 44% risk of death [hazard ratio (HR): 0.56, 95% CI: 0.46-0.67] and 37% risk of disease progression (HR: 0.63, 95% CI: 0.53-0.75) compared with the control group. The triple combination therapy group and the control group did not exhibit a statistical difference in treatment- or laboratory-related adverse events. In the management of unresectable/advanced HCC, HAIC in conjunction with PD-1 inhibitors and TKI exhibits both safety and efficacy, providing a scientific basis for clinical practice.

PMID:40489219 | DOI:10.1097/MEG.0000000000003012

ACS Chem Neurosci. 2025 Jun 9. doi: 10.1021/acschemneuro.5c00254. Online ahead of print.

ABSTRACT

ALS is a severe neurodegenerative disorder characterized by motor neuron degeneration, gut dysbiosis, immune dysregulation, and metabolic disturbances. In this study, shotgun metagenomics and ¹H nuclear magnetic resonance (NMR)-based metabolomics were employed to investigate the altered gut microbiome and metabolite profiles in individuals with ALS, household controls (HCs), and nonhousehold controls (NHCs). The principal component analysis (PCA) explained 33% of the variance, and the partial least-squares discriminant analysis (PLS-DA) model demonstrate R² and Q² values of 0.97 and 0.84, respectively, indicating an adequate model fit. The relative bacterial abundance was 99.34% in the ALS group and 98.94% in the HC group. Among the ten identified genera, Bifidobacterium, Lactobacillus, and Enterococcus were more prevalent in ALS individuals, while Lactiplantibacillus and Klebsiella were more abundant in the HC group. We identified 70 metabolites, including short-chain fatty acids (SCFAs), branched-chain amino acids (BCAAs), carbohydrates, and aromatic compounds, using NMR. Orthogonal partial least-squares discriminant analysis (O-PLS-DA) explained 15.8% of the variance, with a clear separation between the ALS and HC groups. Univariate receiver operating characteristic (ROC) analysis identified three fecal metabolites with AUC values above 0.70, including butyrate (0.798), propionate (0.727), and citrate (0.719). These metabolites may serve as potential biomarkers for ALS. The statistical model for metabolic pathway analysis revealed interconnected pathways, highlighting the complexity of metabolic dysregulation, as well as potential microbial and metabolic biomarkers in ALS. These results highlight the role of gut microbiome alterations in ALS and suggest potential avenues for therapeutic intervention.

PMID:40489211 | DOI:10.1021/acschemneuro.5c00254