Tag: nevin manimala

J Pain Res. 2025 May 26;18:2689-2698. doi: 10.2147/JPR.S520944. eCollection 2025.

ABSTRACT

OBJECTIVE: Transversus abdominis plane block (TAPB) has been widely used for lower-segment cesarean sections (CS). However, traditional single-level TAPB may not provide sufficient analgesia for parturients. This study aimed to validate whether dual-level TAPB could offer more extensive blocking and better clinical outcomes.

METHODS: A total of 114 full-term parturients undergoing lower-segment CS were included in this prospective, randomized, controlled study. Subjects were randomly assigned to receive either single-level (group SL) or dual-level (group DL) TAPB. Dual-level TAPB was performed at the umbilical level and the level above the anterior superior iliac spine, while single-level was performed only at the umbilical level. The primary outcome was the proportion of the abdomen successfully blocked 20 minutes after TAPB.

RESULTS: Twenty minutes after TAPB, dual-level TAPB resulted in a more extensive cutaneous sensory block compared to single-level TAPB. The difference in the proportion of successfully blocked zones was statistically significant, with 46.9% (43.8%, 53.1%) in group SL versus 71.9% (62.5%, 75.0%) in group DL, p < 0.001. Notably, the proportion of parturients with the “surgical area” completely blocked was significantly higher in group DL (94.7%) than in group SL (82.5%) (p = 0.039). Compared to Group SL, the first request for postoperative analgesia was delayed in Group DL by 2.5 hours.

CONCLUSION: Compared to traditional single-level TAPB, dual-level TAPB produced more extensive cutaneous sensory block and better postoperative analgesia effects.

PMID:40454299 | PMC:PMC12125607 | DOI:10.2147/JPR.S520944

J Soc Cardiovasc Angiogr Interv. 2025 May 1;4(5):102611. doi: 10.1016/j.jscai.2025.102611. eCollection 2025 May.

ABSTRACT

BACKGROUND: Pulmonary embolism (PE) is a leading cause of cardiovascular death; little data exist on whether mechanical thrombectomy confers a mortality benefit. Using a retrospective review, 311 consecutive patients with PE who underwent aspiration thrombectomy were compared to 309 propensity score-matched patients with PE treated with anticoagulation alone.

METHODS: Using a retrospective review, we identified 311 consecutive patients with PE who underwent mechanical thrombectomy along with standard of care; we then identified 1841 patients admitted with a primary diagnosis of PE and used propensity score matching to identify 309 patients with similar pulmonary embolism severity index (PESI) scores and variables. We then evaluated 2-year outcomes between the 2 groups.

RESULTS: Of the 311 patients treated with thrombectomy, 262 were at elevated risk by the European Society of Cardiology (ESC) stratification, 261 had a positive simplified pulmonary embolism severity index (sPESI) and 208 were of PESI class III or higher. Of the 309 patients treated with anticoagulation alone, 261 had elevated risk by ESC stratification, 257 had a positive sPESI, and 201 were PESI class III or higher. When all patients were evaluated, there was a mortality benefit starting at 30 days in patients undergoing thrombectomy; when patients with metastatic cancer were excluded, the mortality benefit was only seen in higher-risk patients. Low-risk patients with or without right ventricular strain had similar mortality whether managed with thrombectomy or anticoagulation alone, with numerically more significant bleeding, stroke, and recurrent pulmonary emboli.

CONCLUSIONS: In this single-center, retrospective review, patients with PE who were of ESC high risk and who underwent aspiration thrombectomy with a FlowTriever System (Inari Medical) had a statistically significant reduction in mortality compared to a propensity score-matched group treated with anticoagulation alone; separation in mortality curves continued at 2 years. Our findings also suggest that low-risk patients perform equally well with or without thrombectomy but incur numerically more bleeding events, stroke, and recurrent pulmonary emboli.

PMID:40454282 | PMC:PMC12126064 | DOI:10.1016/j.jscai.2025.102611

Anesth Pain Med. 2025 Apr 30;15(2):e161467. doi: 10.5812/aapm-161467. eCollection 2025 Apr 30.

ABSTRACT

BACKGROUND: This is a prospective observational study. Dexamethasone is commonly associated with postoperative hyperglycemia. There is limited data on the glycemic effect of dexamethasone among the diabetic population.

OBJECTIVES: In the current investigation, postoperative glucose levels were measured in both diabetic and non-diabetic individuals, and then a single dose of intraoperative dexamethasone was administered.

METHODS: A total of 86 participants, with ASA I/II, were categorized into two groups: Diabetic and non-diabetic. Each group consisted of 43 individuals. The participants’ ages ranged from 18 to 70 years. During the operation, a single dosage of dexamethasone, with a maximum of 8 milligrams, was provided intraoperatively. “Postoperative nausea and vomiting” (PONV), random blood glucose (RBG), and pain ratings were recorded before surgery, immediately after surgery, after 12 hours, and 24 hours following surgery. Preoperative blood glucose levels were also recorded. The “Chi-square test and the unpaired t-test” were used for comparison and to analyze the data. A significance level of P < 0.05 was deemed significant.

RESULTS: There was a statistically significant variance in RBG levels between diabetics and non-diabetics (P = 0.001). At various time periods, there was no correlation between the severity of PONV and diabetes among the participants. At various time intervals, the length of the procedure and the pain levels were equivalent to one another. In each group, there was a significant rise in RBG up to 12 hours, followed by a decline after 24 hours to a level similar to preoperative values.

CONCLUSIONS: A single dose of intraoperative “dexamethasone” was associated with transient hyperglycemia postoperatively up to 12 hours, which was more pronounced among the diabetic population and without major adverse effects like PONV in either group.

PMID:40454258 | PMC:PMC12125660 | DOI:10.5812/aapm-161467

Anesth Pain Med. 2025 Mar 11;15(2):e156544. doi: 10.5812/aapm-156544. eCollection 2025 Apr 30.

ABSTRACT

BACKGROUND: Postoperative delirium is a significant problem that deteriorates the cognitive state of patients after cardiac surgery, which can be a short- or long-term complication.

OBJECTIVES: This study was conducted to evaluate the efficacy of dexmedetomidine, commenced simultaneously with anesthesia induction and continued throughout the surgical operation, on postoperative delirium after cardiac surgery with cardiopulmonary bypass.

METHODS: This randomized, double-blind, case-control trial was conducted on sixty-one patients undergoing cardiac surgery. The patients were randomly divided into dexmedetomidine (case) and normal saline (control) groups. The primary outcome was the incidence of delirium, as screened by the Confusion Assessment Method for the ICU (CAM-ICU).

RESULTS: There was no distinction in CAM-ICU outcomes between the two groups at 6 and 24 hours postoperatively. However, the difference in non-positive CAM-ICU results was statistically significant at 24 hours for +1 and -1 Richmond Agitation-Sedation Scale scores.

CONCLUSIONS: Starting dexmedetomidine before cardiopulmonary bypass did not significantly affect the delirium rate based on CAM-ICU assessments. Further research examining larger groups is necessary to clarify the efficacy of perioperative dexmedetomidine on postoperative delirium.

PMID:40454256 | PMC:PMC12125664 | DOI:10.5812/aapm-156544

Oncol Lett. 2025 May 21;30(1):356. doi: 10.3892/ol.2025.15102. eCollection 2025 Jul.

ABSTRACT

The present study explored the impact of dual-source dual-energy CT (DECT) quantitative parameters combined with ultrasonography (US) imaging features on the diagnostic value of extrathyroidal extension in papillary thyroid carcinoma (PTC). Analysis was conducted on 136 nodules pathologically confirmed as PTCs in 102 patients who presented to the Affiliated People’s Hospital of Jiangsu University (Zhenjiang, China) between January 2018 and August 2023. All patients underwent DECT and US examinations, and the parameters for nodule examination using DECT included iodine concentration, normalized iodine concentration and energy spectrum curve slope. Gemstone spectral imaging (GSI) and US imaging features of extrathyroidal extension (ETE) and non-ETE groups were statistically examined for diagnostic usefulness. A logistic regression model was then constructed and diagnostic performance was assessed using receiver operating characteristics curves. The area under the curve (AUC) for iodine concentration in identifying ETE was 0.722, with the highest accuracy when 2.88 mg/ml was used as the diagnostic threshold. The corresponding sensitivity and specificity were 58.3 and 85.6%, respectively, with a Youden index of 0.44. The AUC for normalized iodine concentration in identifying ETE was 0.713, with the highest accuracy when 0.285 was used as the diagnostic threshold. The corresponding sensitivity and specificity were 65.7 and 78.6%, respectively, with a Youden index of 0.443. The AUC for slope of Hounsfield unit curve in identifying ETE was 0.738, with the highest accuracy when 3.4 was used as the diagnostic threshold. The corresponding sensitivity and specificity were 68.5 and 78.6%, respectively, with a Youden index of 0.471. The AUC of US (maximum longitudinal diameter >5 mm) was 0.712, with the highest accuracy when 3.845 cm was used as the diagnostic threshold. The corresponding sensitivity and specificity were 46.3 and 89.3%, respectively, with a Youden index of 0.356. The AUC for ETE identification using GSI and US morphological parameters was 0.782, with the highest accuracy when 0.762 was used as the diagnostic threshold. The corresponding sensitivity and specificity were 80.6 and 85.7%, respectively, with a Youden index of 0.663. In conclusion, the accuracy of ultrasound combined with GSI parameters in diagnosing ETE of PTC was improved when compared with that of single DECT and ultrasound morphological examinations.

PMID:40454243 | PMC:PMC12123170 | DOI:10.3892/ol.2025.15102

Front Cardiovasc Med. 2025 May 16;12:1549736. doi: 10.3389/fcvm.2025.1549736. eCollection 2025.

ABSTRACT

BACKGROUND: The optimal cannulation strategy for acute type A aortic dissection (ATAAD) surgery via a minimally invasive approach remains a topic of debate. This study aimed to compare the feasibility and safety of different aortic arch branch cannulation techniques using a single upper hemisternotomy.

METHODS: A retrospective analysis was performed on 207 patients with ATAAD who underwent total arch replacement combined with frozen elephant trunk techniques between December 2019 and July 2023. Patients were categorized into four groups based on the cannulation site: IA group (innominate artery, n = 174), LCA group (left carotid artery, n = 21), RSA group (right subclavian artery, n = 5), and RCA group (right carotid artery, n = 7). Perioperative outcomes, including mortality, complications, and operative times, were compared using appropriate statistical methods.

RESULTS: A total of 207 patients were included and categorized into four groups based on the site of arterial cannulation: IA (n = 174), LCA (n = 21), RSA (n = 5), and RCA (n = 7). Baseline characteristics, including age and preoperative comorbidities, were comparable across the groups. Intraoperative metrics, such as cross-clamp time, circulatory arrest time, selective cerebral perfusion time, and cardiopulmonary bypass (CPB) time, showed no statistically significant differences. Although the CPB time was numerically shorter in the IA group, this difference was not significant (p > 0.05). Perioperative mortality occurred in 25 patients (12.1%), with no statistically significant differences among the groups (IA: 12.6%, LCA: 0%, RSA: 20.0%, RCA: 28.6%; p > 0.05). Postoperative clinical outcomes, including ventilator support duration, ICU stay, and hospital length of stay, were also similar across all groups.

CONCLUSION: Aortic arch branch cannulation is a feasible and safe arterial perfusion strategy for ATAAD surgery via a minimally invasive single upper hemisternotomy. Among the options, the innominate artery demonstrated favorable outcomes and was not inferior to other arch vessels, and may be considered a suitable first choice when feasible.

PMID:40454235 | PMC:PMC12122429 | DOI:10.3389/fcvm.2025.1549736

JRSM Cardiovasc Dis. 2025 May 30;14:20480040251344344. doi: 10.1177/20480040251344344. eCollection 2025 Jan-Dec.

ABSTRACT

BACKGROUND: Branch pulmonary artery flow patterns in the Fontan circulation manifest oscillations reflecting venous pressure changes. The clinical importance of variation in branch pulmonary artery flow patterns and the relationship with the single ventricle performance is not understood. We describe insights gained from simultaneous hemodynamic and phase contrast magnetic resonance using interventional CMR (iCMR) in these patients.

METHOD: Twenty-seven patients with Fontan circulation referred for iCMR were studied using phase-contrast velocity mapping. The isovolumetric relaxation period (IVRT) was assessed using standard or velocity-encoded cine imaging of the atrioventricular valve (AVV) and aortic valve. We qualitatively assessed branch pulmonary artery flows considering four patterns: IVRT flow reversal, IVRT flow reaching baseline, and normal – phasic flow or continuous flow. We further collected comprehensive left and right heart iCMR hemodynamic and flow data, including pressures, aortopulmonary collateral (APC) burden, and degree of AVV regurgitation.

RESULTS: Most patients underwent extracardiac Fontan palliation and did not have significant APC burden. Cardiac cycle analysis demonstrated that flow reversal and flow reaching baseline correlated with IVRT (v-wave timing on SVC pressure). Further analysis showed statistically significant difference in pulmonary capillary wedge pressure (PCWp) v-wave (P = .008) among the described groups. Notably, patients with IVRT flow reversal pattern had higher PCWp v-wave and most had severe AVV regurgitation.

CONCLUSION: Branch pulmonary artery IVRT flow reversal and IVRT baseline patterns in patients with Fontan circulation may represent indirect signs of single ventricle poor performance and severe AVV regurgitation.

PMID:40454231 | PMC:PMC12125515 | DOI:10.1177/20480040251344344

J Asthma Allergy. 2025 May 28;18:827-834. doi: 10.2147/JAA.S513358. eCollection 2025.

ABSTRACT

OBJECTIVE: To assess the efficacy and safety of the combination of N-acetylcysteine and acebrophylline (Combination named Abiways), in patients with moderate to severe COPD and Asthma.

MATERIALS AND METHODS: In this non-randomized, interventional, prospective, single-arm, post-marketing surveillance study, participants were administered Abiways as an add-on therapy for 90 days. The primary endpoint was Quality of Life, evaluated using the COPD Assessment Test (CAT) and Asthma Control Test (ACT) questionnaires. Secondary endpoints included mean FEV1 and FVC changes. Adverse events were recorded throughout the study.

RESULTS: 97 (of 102 subjects enrolled) completed the study (76 COPD and 21 Asthma patients, respectively; mean age 57.9 ± 8.1 years; 33 females, 64 males). Overall, FEV1 improved significantly from 1.287L to 1.484L (p < 0.001) with similar statistical improvements in COPD (1.237 L to 1.414 L; p = 001) and asthma (1.477 L to 1.747 L; p = 0.004) subpopulations. COPD patients showed statistically significant improvements in CAT scores (17.2 ± 1.0 to 10.6 ± 0.9, p = 0.0001); however, such significance was not observed in the ACT scores for asthma patients. FVC remained unchanged in all subgroups. No severe adverse events were reported.

CONCLUSION: The combination of N-acetylcysteine and acebrophylline improves QoL in moderate to severe COPD patients and FEV1 in both COPD and asthma patients with a favorable safety and tolerability profile. The combination appears safe and effective for managing obstructive airway disease.

PMID:40454226 | PMC:PMC12126983 | DOI:10.2147/JAA.S513358

Front Aging Neurosci. 2025 May 16;17:1595336. doi: 10.3389/fnagi.2025.1595336. eCollection 2025.

ABSTRACT

BACKGROUND: The patient’s somatic health status plays an important role in the factors predisposing to the development of depression. Any disease, especially a chronic one, often associated with pain, may contribute to the development of depression. The aim of the study was to assess the impact of functional capacity on the occurrence of depression among elderly cancer patients.

METHODS: The work used the diagnostic survey method and survey technique research tool consisted of standardized questionnaires: the Nurses’ Observation Scale for Geriatric Patients (NOSGER), the Barthel scale, and the Geriatric Depression Scale (GDS). The authors conducted the study among 110 older adults patients with hospitalized at the Lublin Region Oncology Center in 2022.

RESULTS: When assessing patients using the NOSGER scale, the average result for the entire group was 45.98 ± 12.58 points. The examined people functioned best in terms of memory – average of 5.99 ± 1.32 points. The worst functioning was in the instrumental activities of everyday life – average 9.16 ± 3.61 points. In the assessment of the functional status using the Barthel scale, 54.54% of the respondents were classified as light. Based on the assessment of patients using the GDS scale, it was found that as many as 66.36% of the respondents did not experience symptoms of depression. The regression model showed that the NOSGER scale was a statistically significant variable explaining the geriatric depression scale score in the study group (p < 0.001).

CONCLUSION: Most respondents were fully functional. The surveyed seniors suffering from cancer had the greatest difficulties in the areas of moods and emotions as well as instrumental activities of everyday life. The occurrence of depression symptoms was found in over 30.00% of respondents. It is advisable to use research tools that take into account a wider range of aspects when assessing the impact of functional capacity on the possibility of depression among geriatric patients with cancer.

PMID:40454204 | PMC:PMC12122436 | DOI:10.3389/fnagi.2025.1595336

J Travel Res. 2025 Jul;64(6):1449-1463. doi: 10.1177/00472875241253009. Epub 2024 May 31.

ABSTRACT

Practical measures to entice tourists to behave in environmentally sustainable ways are urgently needed. The effectiveness of such measures is typically tested in survey experiments. This study demonstrates that this approach can be misleading. We test two messages aimed at reducing buffet food waste. One builds on established theories of human behavior (theory of planned behavior, value-belief-norm theory); it assumes that changing beliefs by providing information triggers behavior change. The second message builds on hedonic psychology; it attempts to change behavior through humor, presenting the pro-environmental behavior as enjoyable. In the survey experiment, the belief-based message significantly increases intentions to reduce plate waste; but both messages fail to change behavior in a real hotel. These insights have methodological and practical implications: the effectiveness of new practical measures developed to trigger specific tourist behaviors must be tested in the field before reliable managerial recommendations can be derived.

PMID:40454195 | PMC:PMC12121902 | DOI:10.1177/00472875241253009