Tag: nevin manimala

Probiotics Antimicrob Proteins. 2025 Jun 5. doi: 10.1007/s12602-025-10611-5. Online ahead of print.

ABSTRACT

Necrotizing enterocolitis (NEC) is a commonly encountered disease of the gastrointestinal tract in premature infants. The aim of the study was to evaluate the therapeutic role of probiotics on NEC in a preterm rat model. NEC model was induced in preterm formula-fed rats, exposed daily to hypoxia, hypothermia, and administered pathogenic bacteria. Then rats were randomly divided into four different groups: control group, NEC group, NEC-antibiotic group, and NEC-probiotic group. All rats were sacrificed at the end of the experiment. Histological examination of ileal wall under light and electron microscopes was done, and TNF-α and IL-18 staining was also assessed. Statistical analysis of data was performed. Histological examination of the ileal mucosa of NEC group showed inflammatory infiltration, various degrees of separation of the submucosa, thinning of the wall, sloughing, and loss of the intestinal villi. The villus heights significantly decreased (p ≤ 0.05) in the NEC group. Electron micrographs demonstrated signs of enterocytic death, lost microvilli, abnormal nuclei, vacuolated cytoplasm, swollen mitochondria, and loss of junctional complexes. These findings were almost reversed in the probiotic group that regained the normal villous height, and to a lesser extent in the antibiotic group which was still significant compared to the CG (p ≤ 0.05). Immunohistochemical staining showed significantly increased expression of proinflammatory cytokines TNF-α and IL-18 (p ≤ 0.05) in the intestinal mucosa of the NEC group and NEC-antibiotic group as compared to the control group and the NEC-probiotic group. Probiotics could hold therapeutic potential for NEC in preterm neonatal rats.

PMID:40471534 | DOI:10.1007/s12602-025-10611-5

Int J Implant Dent. 2025 Jun 5;11(1):42. doi: 10.1186/s40729-025-00623-9.

ABSTRACT

PURPOSE: This retrospective study aimed to evaluate the incidence of dehiscence following bone augmentation with patient-specific titanium meshes and to identify factors associated with its occurrence.

MATERIAL AND METHODS: Patients who underwent bone grafting with patient-specific titanium mesh between December 2014 and October 2021 were included. The primary outcome was the occurrence of dehiscence. The occurrence of dehiscences was recorded during the following time phases, enabling the determination of whether dehiscences occur early (< 2 weeks), in the mid-term (2-9 weeks), or later in the healing phase (> 9 weeks).

RESULTS: A total of 78 patients undergoing 85 titanium mesh augmentations were included, with a mean follow-up period of 1.2 years. Dehiscence occurred in 33 meshes (38.8%), with 51.5% of these events arising during the early healing phase. In no case was premature removal of the titanium mesh required due to dehiscence. A statistically significant association was observed between dehiscence and both smoking behavior (p < 0.001) and the anatomical location of the maxillary defect (p = 0.029). No significant associations were found between dehiscence and gender (p = 0.160), periodontitis (p = 0.512), gingival phenotype (p = 0.495), defect type (p = 0.490), augmented bone volume (p = 0.373), or incision type (p = 0.354). Logistic regression analysis further identified smoking (odds ratio: 7.07; 95% CI: 2.19-22.80) and maxillary defect alveolar (odds ratio: 11.86; 95% CI: 0.34-4.60) as significant predictors of dehiscence.

CONCLUSION: Dehiscence following customized titanium mesh augmentation was significantly associated with smoking and the location of the maxillary defect, underscoring the importance of early detection and timely intervention.

PMID:40471513 | DOI:10.1186/s40729-025-00623-9

Emerg Radiol. 2025 Jun 5. doi: 10.1007/s10140-025-02349-y. Online ahead of print.

ABSTRACT

PURPOSE: MRI is the preferred imaging modality for patients with acute dizziness when a central etiology is possible. Abbreviated protocols may improve access in urgent settings. This study assesses the diagnostic yield and utility of an abbreviated MRI protocol for patients presenting with dizziness to the emergency department (ED).

METHOD: This retrospective study included 613 adult patients presenting to the ED with dizziness from August 1, 2019 to August 31, 2023. The protocol included 3 mm coronal and axial DWI, axial FLAIR, and SWI sequences, with a duration of approximately 11 min. MRI findings were categorized as negative or positive for intracranial pathology; etiology and location were recorded. Charts were reviewed for concurrent CTA during the ED visit, and findings were assessed for correlation with MRI results.

RESULTS: Of the 613 patients, clinically significant intracranial pathology was identified in 52 cases (8%), including 42 (7%) acute infarcts. Of these infarcts, 19 (45%) were infratentorial, 16 (38%) supratentorial, and 7 (17%) involved both regions. The cerebellum was the most common infratentorial site (38%), followed by the brainstem (24%). Infarcts ranged from 1-84 mm, with 48% measuring less than 1 cm. TOAST classification revealed strokes as cardioembolic (36%), large vessel (26%), cryptogenic (19%), and lacunar (19%). Statistical analysis showed no significant relationship between vertigo and infarct characteristics (P > 0.05).

CONCLUSION: Abbreviated protocol MRI demonstrated a 8% diagnostic yield for detecting intracranial pathology and more often positive than concurrent CT/CTA in identifying acute findings. Supratentorial pathology can present with symptoms of dizziness as well. The abbreviated protocol offers a rapid, efficient diagnostic tool for urgent care settings and MRI identifies more acute findings than concurrent CT/CTA.

PMID:40471503 | DOI:10.1007/s10140-025-02349-y

Endocrine. 2025 Jun 5. doi: 10.1007/s12020-025-04287-8. Online ahead of print.

ABSTRACT

PURPOSE: Thyroid nodules are commonly evaluated using ultrasound-based risk stratification systems, which rely on subjective descriptors. Artificial intelligence (AI) may improve assessment, but its effectiveness in non-subspecialist settings is unclear. This study evaluated the impact of an AI-based decision support system (AI-DSS) on thyroid nodule ultrasound assessments by general endocrinologists (GE) without subspecialty thyroid imaging training.

METHODS: A prospective cohort study was conducted on 80 patients undergoing thyroid ultrasound in GE outpatient clinics. Thyroid ultrasound was performed based on clinical judgment as part of routine care by GE. Images were retrospectively analyzed using an AI-DSS (Koios DS), independently of clinician assessments. AI-DSS results were compared with initial GE evaluations and, when referred, with expert evaluations at a subspecialized thyroid nodule clinic (TNC). Agreement in ultrasound features, risk classification by the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) and American Thyroid Association guidelines, and referral recommendations was assessed.

RESULTS: AI-DSS differed notably from GE, particularly assessing nodule composition (solid: 80%vs.36%,p < 0.01), echogenicity (hypoechoic:52%vs.16%,p < 0.01), and echogenic foci (microcalcifications:10.7%vs.1.3%,p < 0.05). AI-DSS classification led to a higher referral rate compared to GE (37.3%vs.30.7%, not statistically significant). Agreement between AI-DSS and GE in ACR TI-RADS scoring was moderate (r = 0.337;p < 0.001), but improved when comparing GE to AI-DSS and TNC subspecialist (r = 0.465;p < 0.05 and r = 0.607;p < 0.05, respectively).

CONCLUSION: In a non-subspecialist setting, non-adjunct AI-DSS use did not significantly improve risk stratification or reduce hypothetical referrals. The system tended to overestimate risk, potentially leading to unnecessary procedures. Further optimization is required for AI to function effectively in low-prevalence environment.

PMID:40471487 | DOI:10.1007/s12020-025-04287-8

Ann Intensive Care. 2025 Jun 5;15(1):78. doi: 10.1186/s13613-025-01492-6.

ABSTRACT

BACKGROUND: Ventilator-associated pneumonia (VAP) is a significant complication in mechanically ventilated patients. Paradoxically, it lacks precise diagnostic criteria, making the identification of a reliable diagnostic indicator an unmet medical need. Lipids are critical regulators of innate lung defense. The aim of the study was to identify lipid alterations specific to VAP in tracheal aspirates of patients with ARDS.

METHODS: Tracheal aspirates samples from ventilated patients were collected longitudinally from patients with COVID-19-related ARDS. Tracheal aspirates sampled at the day of VAP diagnosis were used to assess VAP specific lipidome and were compared with matched controls (patients without VAP). Lipid detection was performed using ultra-high-performance liquid chromatography with high resolution mass spectrometry. The statistical analysis included: unsupervised multivariate methods, partial least squares discriminant analysis (PLS-DA), orthogonal partial least squares discriminant analysis (OPLS-DA), and the area under the receiver operating characteristic (AUROC) curve to assess classification performance. The Benjamini-Hochberg adjusted p-value was used to control the false discovery rate.

RESULTS: We studied 39 patients (26 VAP and 13 control patients). The characteristics of VAP and control patients were similar, including biological markers such as neutrophils, CRP, and PCT. The lipid signature, composed of 272 lipids, differed between VAP and control patients (p = 0.003). Phosphatidylcholines were the most represented with 17 significantly upregulated and 6 downregulated lipids. OPLSDA identified 8 best candidates as VAP biomarkers with sphingomyelin (34:1) and phosphatidylcholine (O-34:1) presenting the best scores (AUROC = 0.85 [0.71-0.95] and 0.83 [0.66-0.94], respectively). Combinations of several lipid biomarkers did not improve the prediction accuracy. During ARDS, lung lipidome mostly resulted in breakdown product of host-pathogen interactions (surfactant and pulmonary cells).

CONCLUSION: We investigated VAP-specific lipids in tracheal aspirate and identified significant alterations in lipidomic profiles, likely driven by active infection dynamic and the breakdown of surfactant and pulmonary cells. Among the potential VAP biomarker candidates in COVID-19 ARDS, sphingomyelin (34:1) and phosphatidylcholine (O-34:1) demonstrated predictive performance for VAP that surpassed all previously tested biomarkers.

PMID:40471479 | DOI:10.1186/s13613-025-01492-6

Eur J Health Econ. 2025 Jun 5. doi: 10.1007/s10198-025-01797-0. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the psychometric performance of the Child Health Utility (CHU9D) proxy version compared with the Pediatric Quality of Life Inventory (PedsQL) in Australian children aged 0-7 years with anorectal malformations (ARM) or Hirschsprung disease (HD).

METHODS: Parents of children with ARM or HD were identified from a patient database managed by a tertiary paediatric hospital in Australia over the past 20 years. Since 2020, CHU9D and PedsQL proxy report versions were administered to parents via telephone interview. Using data collected between 2020 and 2022, we assessed the feasibility, ceiling and floor effects, known-group validity and convergent validity for both instruments in the total sample, by conditions and child age.

RESULTS: The study included 145 children with ARM or HD, among which, 13.1% had missing values on the CHU9D schoolwork dimension, and 20.7% had missing values on the PedsQL school functioning domain (2-4 year old version). The CHU9D and PedsQL did not demonstrate ceiling effects. The CHU9D showed stronger effect size (ES) in differentiating children with ARM (ES = 0.32) or HD (ES = 0.90) with healthy children compared to the PedsQL. We did not find statistically significant differences in CHU9D or PedsQL scores between ARM and HD. There were moderate to strong correlations in most theoretically related dimensions of the CHU9D and PedsQL.

CONCLUSION: The CHU9D and PedsQL demonstrated comparable and acceptable psychometric properties in Australian children aged 2 years and above with ARM or HD. However, the validity of the CHU9D in children under 2 years old needs to be further explored and modification may be needed.

PMID:40471476 | DOI:10.1007/s10198-025-01797-0

Health Econ Rev. 2025 Jun 5;15(1):47. doi: 10.1186/s13561-025-00644-5.

ABSTRACT

BACKGROUND: This review examined methodologies used to cost the impact of antimicrobial resistance (AMR) infections in humans from household and health system perspectives. Although extensive research has been conducted on the clinical AMR burden in low- and middle-income countries (LMICs) in terms of prevalence and other drivers of antimicrobial resistance, there is increased misuse and overuse of antibiotics which increases the risk of AMR infections compared to high-income countries. Lack of comprehensive estimates on economic costs of AMR in LMICs due to lack of standard methodologies that incorporate time biases and inference for instance, may negatively affect accuracy and robustness of results needed for reliable and actionable policies.

METHODS: We conducted a systematic review of studies searched in PubMed and other electronic databases. Only studies from LMICs were included. Data were extracted via a modified Covidence template and a Joanna Briggs Institute (JBI) assessment tool for economic evaluations to assess the quality of the papers.

RESULTS: Using PRISMA, 2542 papers were screened at the title and abstract levels, of which 148 were retrieved for full-text review. Of these, 62 articles met the inclusion criteria. The articles had a quality assessment score averaging 85%, ranging from 63 to 100%. Most studies, 13, were from China (21%), followed by 8 from South Africa (13%). Tuberculosis (TB), general bacterial, and nosocomial infection costs are the most studied, accounting for 40%, 39%, and 6%, respectively with TB common in South Africa than the rest of the countries. The majority of the papers used a microcosting approach (71%), followed by gross costing (27%), while the remainder used both. Most studies analyzed costs descriptively (61%), followed by studies using regression-based techniques (17%) and propensity score matching (5%), among others.

CONCLUSION: Overall, the use of descriptive statistics without justification, limited consideration for potential data challenges, including confounders, and short-term horizons suggest that the full AMR cost burden in humans in LMICs has not been well accounted for. Given the limited data available for these studies, the use of a combination of methodologies may help triangulate more accurate and policy-relevant estimates. While the resources to conduct such cost studies are limited, the use of modeling costs via regression techniques while adjusting for cofounding could help maximize robustness and better estimate the vast and varied burden derived directly and indirectly from AMR.

PMID:40471471 | DOI:10.1186/s13561-025-00644-5

Biomech Model Mechanobiol. 2025 Jun 5. doi: 10.1007/s10237-025-01969-0. Online ahead of print.

ABSTRACT

We present a continuum hypothesis-based two-dimensional biomorphoelastic model describing post-burn scar hypertrophy and contraction. The model is based on morphoelasticity for permanent deformations and combined with a chemical-biological model that incorporates cellular densities, collagen density, and the concentration of chemoattractants. We perform a sensitivity analysis for the independent parameters of the model and focus on the effects on the features of the post-burn dermal thickness given a low myofibroblast apoptosis rate. We conclude that the most sensitive parameters are the equilibrium collagen concentration, the signaling molecule secretion rate and the cell force constant, and link these results to stability constraints. Next, we observe a relationship between the simulated contraction and hypertrophy and show the effects for significant variations in the myofibroblast apoptosis rate (high/low). Our ultimate goal is to optimize post-burn treatments, by developing models that predict with a high degree of certainty. We consider the presented model and sensitivity analysis to be a step toward their construction.

PMID:40471469 | DOI:10.1007/s10237-025-01969-0

Ann Noninvasive Electrocardiol. 2025 Jul;30(4):e70096. doi: 10.1111/anec.70096.

ABSTRACT

BACKGROUND: Alcohol intake increases recurrence of atrial fibrillation (AF), but its relationship with cardiovascular outcomes is less well characterized. We aimed to study the association between different levels of alcohol intake and cardiovascular outcomes in a global cohort of patients with AF.

METHODS: This is a cross-sectional analysis of the RE-LY AF registry, including 15,400 patients with AF who visited emergency departments in 47 countries. Patients were categorized into abstainers, light (< 7 standard drinks [SD]/week), moderate (7-13 SD/week), and heavy drinkers (≥ 14 SD/week). Outcomes were stroke/systemic embolism, heart failure (HF) hospitalization, and major bleeding at 1-year follow-up. Logistic mixed-effects regression models were used to calculate multivariable-adjusted odds ratios (aOR) with a 95% confidence interval (CI).

RESULTS: In total,14,058 patients (mean age = 65.9 ± 14.7 years, 48.0% women) with available alcohol intake level data were included. This consisted of 12,091 (86.0%) abstainers, 1150 (8.2%) light, 458 (3.3%) moderate, and 359 (2.6%) heavy drinkers. The odds of stroke/systemic embolism were not significantly different in light (aOR = 0.88, 95% CI: 0.60-1.28), moderate (aOR = 0.91, 95% CI: 0.53-1.57) or heavy drinkers (aOR = 0.79, 95% CI: 0.41-1.54) compared to abstainers. Major bleedings were numerically, but not statistically significantly, higher among heavy drinkers (aOR = 1.52, 95% CI: 0.82-2.80). Compared to abstainers, alcohol intake was associated with fewer HF hospitalizations (light: aOR = 0.73, 95% CI: 0.58-0.92; moderate: aOR = 0.53, 95% CI: 0.35-0.78; heavy: aOR = 0.63, 95% CI: 0.41-0.98). However, this protective association was observed only in upper-middle and high-income countries (p-interaction < 0.001).

CONCLUSION: Alcohol drinking is unlikely to be associated with increased thromboembolic events in patients with AF, but may be associated with a lower risk of HF hospitalizations.

PMID:40470582 | DOI:10.1111/anec.70096

Catheter Cardiovasc Interv. 2025 Jun 5. doi: 10.1002/ccd.31668. Online ahead of print.

ABSTRACT

BACKGROUND: Various drug-eluting stents (DES) are currently used for percutaneous coronary intervention (PCI). However, long-term trials reveal inconsistent results in head-to-head comparisons.

AIMS: To conduct a network meta-analysis of relevant trials to assess the performance of different DES currently used in PCI.

METHODS: We systematically searched major databases for randomized controlled trials (RCTs) reporting 5-year outcomes of currently used DES and conducted a network meta-analysis using a frequentist random-effects model with odds ratios (ORs) as effect measures. DES were ranked by P-scores across several outcomes, with definite/probable stent thrombosis as the primary outcome. Statistical analyses were conducted in R software (v4.4.1), with significance set at p < 0.05.

RESULTS: Twenty-nine RCTs involving 46,502 patients were included in the analysis. Six currently used DES-Orsiro, Xience, Resolute, Nobori/BioMatrix, Synergy, and Promus-were analyzed. All comparisons showed nonsignificant results for outcomes at 5-year follow-up. Synergy ranked highest for definite/probable stent thrombosis (p = 0.85), all-cause mortality (p = 0.76), cardiac death (p = 0.87), and target vessel revascularization (p = 0.91). Promus ranked best for any myocardial infarction (MI) (p = 0.86), target lesion revascularization (p = 0.93), and target vessel-related MI (p = 0.73). Nobori/BioMatrix ranked highest for target lesion failure (p = 0.80). The newer generation Biofreedom stent also showed nonsignificant results but was excluded from the main analysis due to the availability of 5-year outcomes from only one study. Global and local inconsistencies were nonsignificant for all outcomes and comparisons.

CONCLUSION: The analysis revealed no significant differences in 5-year outcomes among the various DES. However, Synergy and Promus performed best for key outcomes such as stent thrombosis, mortality, and MI, suggesting their potential for favorable performance in clinical practice.

PMID:40470578 | DOI:10.1002/ccd.31668