Tag: nevin manimala

Front Med (Lausanne). 2024 Dec 20;11:1459802. doi: 10.3389/fmed.2024.1459802. eCollection 2024.

ABSTRACT

OBJECTIVE: The study aimed to explore the utility of contrast-enhanced ultrasound (CEUS) as a tool for detecting minimal inflammation in rheumatoid arthritis (RA) patients in sustained remission (SR) and to correlate the findings with Disease Activity Score 28 (DAS28) status scores and various ultrasound (US) scores.

PATIENTS AND METHODS: Thirty RA patients in SR (minimum 6 months), 12 with active disease, and 10 healthy controls were included. Clinical evaluations and US assessments were performed, including grayscale US (GSUS), power Doppler US (PDUS), and Global OMERACT-EULAR Synovitis Score (GLOESS). The CEUS was performed in the two most active joints and was scored semi-quantitatively (SQ) and quantitatively.

RESULTS: Healthy controls and remission RA patients had similar total US scores. Active RA patients had higher US scores than the healthy and remission groups, with statistically significant differences in all the groups compared to the healthy group. However, significant differences were only observed in the GSUS and GLOESS when comparing active RA patients with the remission group. Ninety-five joints were selected for the CEUS, and we detected more microvascularization with the SQ CEUS score than with the PDUS in all groups (18 vs. 58% in the remission group; p-value 0.006). The weighted Cohen’s kappa for the intra-rater and inter-rater IACUS CEUS score was 0.714 (confidence interval 0.610-0.819, p-value < 0.001) and 0.540 (confidence interval: 0.419-0.662, p-value < 0.001), respectively. Spearman’s correlation between the SQ CEUS and quantitative scores was 0.655.

CONCLUSION: For the majority of RA patients in SR, conventional US may fail to detect microvascularization potentially related to the subclinical disease. The CEUS may be helpful for this purpose.

PMID:39764550 | PMC:PMC11701587 | DOI:10.3389/fmed.2024.1459802

EClinicalMedicine. 2024 Nov 25;78:102952. doi: 10.1016/j.eclinm.2024.102952. eCollection 2024 Dec.

ABSTRACT

BACKGROUND: Therapeutic advancements for the polyglutamine diseases, particularly spinocerebellar degeneration, are eagerly awaited. We evaluated the safety, tolerability, and therapeutic effects of L-arginine, which inhibits the conformational change and aggregation of polyglutamine proteins, in patients with spinocerebellar ataxia type 6 (SCA6).

METHODS: A multicenter, randomized, double-blind, placebo-controlled phase 2 trial (clinical trial ID: AJA030-002, registration number: jRCT2031200135) was performed on 40 genetically confirmed SCA6 patients enrolled between September 1, 2020, and September 30, 2021. The main inclusion criteria were as follows: SCA6 diagnosed by genetic testing, 20 years of age or older, Scale for the Assessment and Rating of Ataxia (SARA) “walking” score of at least one point, and SARA “total” score of at least 10 points, and ability to walk 10 m or more with or without an assistive device. The investigational drug was administered orally at 0.50 g/kg/day (L-arginine group: L-arginine 0.38 g/kg/day; placebo group: L-arginine 0.0 g/kg/day) for 48 weeks. Subjects who consented to participate were assigned a subject identification code, and were allocated 1:1 to the L-arginine or the placebo group, according to a predetermined allocation chart. The primary efficacy endpoint was change in total Scale for the Assessment and Rating of Ataxia (SARA) score from baseline to 48 weeks. The secondary endpoints were 1) SARA walking + standing score, 2) each of the eight SARA scales at 0, 4, 8, 16, 24, 32, 40, and 48 weeks, and 3) TUGT, BDI-II, CGI, PGI-I, and SF-8.

FINDINGS: Forty patients received the investigational drug, and 37 completed the study (L-arginine group: 18; placebo group: 19). The mean medication adherence rate was 97.2% in the l-arginine group. Regarding the primary endpoint, the difference between the L-arginine group and the placebo group was -1.52 (95% CI: -3.10 to 0.06, P = 0.0582). As the secondary endpoints, the change of SARA total score from baseline was greater in the L-arginine group than in the placebo group at all assessment time points, but the differences were not significant. Two serious (required hospitalization) adverse reactions occurred in the L-arginine group, including one case of pneumonia (severe, death) and one case of abnormal liver function (moderate, recovery).

INTERPRETATION: L-arginine treatment resulted in an improvement tendency in SARA total score of SCA6 patients. Our results suggest that a phase 3 study of L-arginine for SCA6, with a 48-week observation period and change in total SARA score as the primary endpoint, may be feasible for further analyzing the therapeutic effect of L-arginine. However, careful consideration of statistical power and sample size is necessary.

FUNDING: Japan Agency for Medical Research and Development and Health Labour Sciences Research Grant, Japan.

PMID:39764542 | PMC:PMC11701440 | DOI:10.1016/j.eclinm.2024.102952

World J Clin Cases. 2025 Jan 6;13(1):99884. doi: 10.12998/wjcc.v13.i1.99884.

ABSTRACT

BACKGROUND: Monkeypox (Mpox), is a disease of global public health concern, as it does not affect only countries in western and central Africa.

AIM: To assess Burundi healthcare workers (HCWs)s’ level of knowledge and confidence in the diagnosis and management of Mpox.

METHODS: We conducted a cross-sectional study via an online survey designed mainly from the World Health Organization course distributed among Burundi HCWs from June-July 2023. The questionnaire comprises 8 socioprofessional-related questions, 22 questions about Mpox disease knowledge, and 3 questions to assess confidence in Mpox diagnosis and management. The data were analyzed via SPSS software version 25.0. A P value < 0.05 was considered to indicate statistical significance.

RESULTS: The study sample comprised 471 HCWs who were mainly medical doctors (63.9%) and nurses (30.1%). None of the 22 questions concerning Mpox knowledge had at least 50% correct responses. A very low number of HCWs (17.4%) knew that Mpox has a vaccine. The confidence level to diagnose (21.20%), treat (18.00%) or prevent (23.30%) Mpox was low among HCWs. The confidence level in the diagnosis of Mpox was associated with the HCWs’ age (P value = 0.009), sex (P value < 0.001), work experience (P value = 0.002), and residence (P value < 0.001). The confidence level to treat Mpox was significantly associated with the HCWs’ age (P value = 0.050), sex (P value < 0.001), education (P value = 0.033) and occupation (P value = 0.005). The confidence level to prevent Mpox was associated with the HCWs’ education (P value < 0.001), work experience (P value = 0.002), residence (P value < 0.001) and type of work institution (P value = 0.003).

CONCLUSION: This study revealed that HCWs have the lowest level of knowledge regarding Mpox and a lack of confidence in the ability to diagnose, treat or prevent it. There is an urgent need to organize continuing medical education programs on Mpox epidemiology and preparedness for Burundi HCWs. We encourage future researchers to assess potential hesitancy toward Mpox vaccination and its associated factors.

PMID:39764536 | PMC:PMC11577511 | DOI:10.12998/wjcc.v13.i1.99884

World J Clin Cases. 2025 Jan 6;13(1):99744. doi: 10.12998/wjcc.v13.i1.99744.

ABSTRACT

Machine learning (ML) is a type of artificial intelligence that assists computers in the acquisition of knowledge through data analysis, thus creating machines that can complete tasks otherwise requiring human intelligence. Among its various applications, it has proven groundbreaking in healthcare as well, both in clinical practice and research. In this editorial, we succinctly introduce ML applications and present a study, featured in the latest issue of the World Journal of Clinical Cases. The authors of this study conducted an analysis using both multiple linear regression (MLR) and ML methods to investigate the significant factors that may impact the estimated glomerular filtration rate in healthy women with and without non-alcoholic fatty liver disease (NAFLD). Their results implicated age as the most important determining factor in both groups, followed by lactic dehydrogenase, uric acid, forced expiratory volume in one second, and albumin. In addition, for the NAFLD- group, the 5^th and 6^th most important impact factors were thyroid-stimulating hormone and systolic blood pressure, as compared to plasma calcium and body fat for the NAFLD+ group. However, the study’s distinctive contribution lies in its adoption of ML methodologies, showcasing their superiority over traditional statistical approaches (herein MLR), thereby highlighting the potential of ML to represent an invaluable advanced adjunct tool in clinical practice and research.

PMID:39764535 | PMC:PMC11577516 | DOI:10.12998/wjcc.v13.i1.99744

World J Clin Cases. 2025 Jan 6;13(1):94284. doi: 10.12998/wjcc.v13.i1.94284.

ABSTRACT

BACKGROUND: Addressing oculoplastic conditions in the preoperative period ensures both the safety and functional success of any ophthalmic procedure. Some oculoplastic conditions, like nasolacrimal duct obstruction, have been extensively studied, whereas others, like eyelid malposition and thyroid eye disease, have received minimal or no research.

AIM: To investigate the current practice patterns among ophthalmologists while treating concomitant oculoplastic conditions before any subspecialty ophthalmic intervention.

METHODS: A cross-sectional survey was disseminated among ophthalmologists all over India. The survey included questions related to pre-operative evaluation, anaesthetic and surgical techniques preferred, post-operative care, the use of adjunctive therapies, and patient follow-up patterns.

RESULTS: A total of 180 ophthalmologists responded to the survey. Most practitioners (89%) felt that the ROPLAS test was sufficient during pre-operative evaluation before any subspecialty surgery was advised. The most common surgical techniques employed were lacrimal drainage procedures (Dacryocystorhinostomy) (63.3%), eyelid malposition repair (36.9%), and ptosis repair (58.7%). Post-operatively, 47.7 % of respondents emphasized that at least a 4-week gap should be maintained after lacrimal drainage procedures and eyelid surgeries. Sixty-seven percent of ophthalmologists felt that topical anaesthetic procedures should be preferred while performing ocular surgeries in thyroid eye disease patients.

CONCLUSION: Approximately 50% of ophthalmologists handle prevalent oculoplastic issues themselves, seeking the expertise of an oculoplastic surgeon under particular conditions. Many ophthalmologists still favor using ROPLAS as a preliminary screening method before proceeding with cataract surgery. Eyelid conditions and thyroid eye disease are not as commonly addressed before subspecialty procedures compared to issues like nasolacrimal duct obstruction and periocular infections.

PMID:39764534 | PMC:PMC11577510 | DOI:10.12998/wjcc.v13.i1.94284

World J Clin Cases. 2025 Jan 6;13(1):96578. doi: 10.12998/wjcc.v13.i1.96578.

ABSTRACT

Historically, psychiatric diagnoses have been made based on patient’s reported symptoms applying the criteria from diagnostic and statistical manual of mental disorders. The utilization of neuroimaging or biomarkers to make the diagnosis and manage psychiatric disorders remains a distant goal. There have been several studies that examine brain imaging in psychiatric disorders, but more work is needed to elucidate the complexities of the human brain. In this editorial, we examine two articles by Xu et al and Stoyanov et al, that show developments in the direction of using neuroimaging to examine the brains of people with schizophrenia and depression. Xu et al used magnetic resonance imaging to examine the brain structure of patients with schizophrenia, in addition to examining neurotransmitter levels as biomarkers. Stoyanov et al used functional magnetic resonance imaging to look at modulation of different neural circuits by diagnostic-specific scales in patients with schizophrenia and depression. These two studies provide crucial evidence in advancing our understanding of the brain in prevalent psychiatric disorders.

PMID:39764531 | PMC:PMC11577517 | DOI:10.12998/wjcc.v13.i1.96578

J Clin Tuberc Other Mycobact Dis. 2024 Nov 7;37:100495. doi: 10.1016/j.jctube.2024.100495. eCollection 2024 Dec.

ABSTRACT

BACKGROUND: Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae) However, the emergence of drug-resistant strains of this bacterium, especially multidrug-resistant (MDR) strains, is a serious concern. This study aimed to evaluate the global prevalence of MDR M. leprae and its implications.

METHODS: Using PRISMA guidelines, we systematically reviewed ISI Web of Science, MEDLINE, and EMBASE up to August 2023 to assess the prevalence of MDR M. leprae. We included human clinical trials on MDR M. leprae, as well as excluded reviews, animal studies, and unavailable full texts. Data was analyzed using Comprehensive Meta-Analysis software, and publication bias was addressed using Egger’s, Begg’s tests, and the trim-fill method.

RESULTS: Overall, 861 articles were initially identified, of which 28 met the methodological criteria for inclusion in the quantitative synthesis. Statistically, the combined prevalence of drug resistant M. leprae was approximated at 11.7 % (95 % CI: 7.7-17.3; I² : 90.79; p value = 0.01). Specific drug resistance rates included 7.4 % to dapsone and 5.1 % to rifampin, among others. The global rate for MDR M. leprae was measured at 2.2 % (95 % CI: 1.2-3.9; I² : 82.68; p value = 0.01). Factors such as bacterial density and the lepromatous phase were associated with elevated DR M. leprae risk (OR: 2.69; 95 % CI: 1.35-2.48). A systematic assessment of publication bias indicated a minimal impact on the general results.

CONCLUSIONS: The increasing prevalence of MDR M. leprae globally requires urgent and strategic interventions to prevent further spread, which in turn is effective in treating leprosy patients.

PMID:39764485 | PMC:PMC11701851 | DOI:10.1016/j.jctube.2024.100495

Cureus. 2025 Jan 4;17(1):e76928. doi: 10.7759/cureus.76928. eCollection 2025 Jan.

ABSTRACT

BACKGROUND: Erectile dysfunction (ED) in men is overlooked and is often linked with psychogenic causes. Due to cultural barriers, this area of research remains neglected.

OBJECTIVE: The study was conducted to determine the factors that can be associated with ED in otherwise apparently healthy men.

METHODS: We conducted our cross-sectional case-control study at the teaching hospital (Mekran Medical College) Turbat for six months from March 2023 to September 2023. After obtaining informed consent, 119 subjects aged less than 48 years were included using a convenient purposive sampling technique. Subjects suffering from any chronic disease like diabetes, hypertension, or chronic renal disease were excluded. The sociodemographic data of the participants were recorded. Patient’s blood samples were taken to analyze serum testosterone levels. IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States) was used for the analysis of data. The chi-square test and an independent sample t-test were applied to analyze the data.

RESULTS: Among 119 study participants, 65 participants had ED. A significant association of ED was found with the area of residence (OR: 1.60, 95% CI: 1.04-2.48, p-value: 0.031) and smoking status (OR: 3.68, 95% CI: 1.66 – 8.12, p-value: 0.001). A significant difference in the mean age, duration of marriage, and testosterone level was found between subjects with and without ED (p < 0.05).

CONCLUSION: Men do suffer from ED. Smoking and low levels of testosterone increase ED in men. Effective healthcare strategies should be implemented to address the issue of ED in men.

PMID:39764481 | PMC:PMC11702912 | DOI:10.7759/cureus.76928

Cureus. 2025 Jan 6;17(1):e77021. doi: 10.7759/cureus.77021. eCollection 2025 Jan.

ABSTRACT

BACKGROUND: Soft tissue specifications and facial values ​​vary depending on the underlying skeletal structures. To achieve the ideal treatment result and patient satisfaction, one must know the attractive soft tissue specifications compatible with each type of malocclusion. This study aims to analyze the facial measurements that contribute to perceived facial attractiveness in patients with vertical growth patterns and skeletal class I malocclusion, focusing on gender-specific differences.

METHODOLOGY: A panel of 30 laypersons, including raters from both genders equally, aged 19-24 years, evaluated extraoral photographs taken before the treatment of 60 patients (evenly divided between males and females employing a disproportionate stratified sampling method through a computer-generated list) with skeletal class I malocclusion, vertical growth pattern based on the Bjork sum, aged 18-25 years (with an average age of 22 ± 1.53 years), with the photographs taken in three positions (frontal relaxed, frontal during a smile, and relaxed profile). The raters utilized the visual analog scale (VAS) to assign an esthetic quality score to each photograph. Based on the average esthetic scores of each photo, two groups were created: the most attractive group, which received the highest esthetic score, and the least attractive group, which received the lowest esthetic score. After selecting 12 patients for each group, the angles and proportions of the frontal and lateral photos were calculated, and the results were compared between the two groups using an independent-sample t-test to see any significant differences.

RESULTS: The most attractive females had a significantly lower value of mouth width to lower facial height than the least attractive females (P = 0.039). In addition, the most attractive males had a substantially greater value of facial convexity angle than the least attractive males (P = 0.041). Regarding other profile and frontal variables, no statistically significant differences existed between the most and least attractive males and females.

CONCLUSIONS: In patients with vertical growth pattern malocclusion, it is important to consider the chin protrusion of male patients during treatment planning and diagnosis because it enhances masculine features in these patients, as well as the lower facial height of female patients.

PMID:39764478 | PMC:PMC11703561 | DOI:10.7759/cureus.77021

J Gastroenterol Hepatol. 2025 Jan 6. doi: 10.1111/jgh.16875. Online ahead of print.

ABSTRACT

BACKGROUND: Guidelines recommend endoscopic surveillance for gastric cancer without therapeutic intervention every 3 years in patients with high-risk gastric intestinal metaplasia (GIM). This study aimed to evaluate the efficacy of radiofrequency ablation (RFA) in eradicating high-risk GIM.

METHODS: This randomized self-control trial was conducted between June 2020 and February 2023. Patients with histology-verified high-risk GIM were enrolled. The endoscopist performed a biopsy on both the left and right sides of the stomach (five each) by targeting the suspected GIM area where available; otherwise, a random biopsy was taken. Patients were randomized to receive a unilateral RFA on either the left or right side. A repeated RFA on the assigned side was performed every 2-3 months for a total of two to three times. The primary outcome was complete resolution of GIM at 1 year after RFA.

RESULTS: Forty-six patients with a mean age of 66 ± 8 years were analyzed. The complete resolution rate of overall GIM lesions after RFA was significantly higher (49/142; 34/5%) than that in the observation group (29/127; 22.8%, RR = 0.84, 0.73-0.98, p = 0.03). For the subgroup analysis, the complete resolution rate after RFA revealed a significantly higher value than observation only in the incomplete GIM group (24/87; 27.6% vs. 11/82; 13.4%, RR = 0.83, 0.71-0.97, p = 0.02). The percentage of patients with extensive GIM regression after RFA (15/25; 60%) was higher than in the observation group (9/25; 36%) but did not meet statistical significance (RR = 0.62, 0.35-1.09, p = 0.09).

CONCLUSION: In high-risk GIM, RFA can significantly eradicate incomplete GIM when compared with observation alone.

PMID:39762988 | DOI:10.1111/jgh.16875