Tag: nevin manimala

J Exp Biol. 2025 Nov 4:jeb.251474. doi: 10.1242/jeb.251474. Online ahead of print.

ABSTRACT

Digestion elevates metabolism through the heat increment of feeding (HIF)-the energy expended on mechanical and biochemical processes after eating. Quantifying this cost is essential for bioenergetic models that predict energy flow and prey requirements in populations. Using breath-by-breath respirometry, we measured oxygen consumption (V˙O₂) in eight common bottlenose dolphins (Tursiops truncatus) before and after feeding standardized meals (1,659-2,658 kcal of capelin and herring). Metabolic rate rose by ∼37% above resting levels, peaking 60 minutes after feeding before returning to baseline within two hours. When scaled across the day, digestion increased daily metabolic needs by ∼8.2% of basal metabolism, was similar to values reported for Steller sea lions (Eumetopias jubatus) and harbor seals (Phoca vitulina), where HIF contributes 4-10% of daily energy expenditure. This study provides the first multi-individual estimate of HIF in dolphins and suggests that the energetic cost of digestion is a minor contribution to overall daily metabolism, refining energetic models and improving prey requirement estimates for cetaceans in the wild.

PMID:41185930 | DOI:10.1242/jeb.251474

Int Wound J. 2025 Nov;22(11):e70771. doi: 10.1111/iwj.70771.

ABSTRACT

This study aimed to gain clinician consensus on which signs/symptoms reported to be indicative of biofilm in chronic wounds are likely to be so. An international, two-round eDelphi process including wound care clinicians ran from December 2023 to February 2024. Participants rated 26 items on a 9-point Likert scale. Consensus to include: ≥ 70% of respondents rate an item 7-9, ≤ 15% rate it 1-3. Consensus to exclude: ≥ 70% of respondents rate an item 1-3, ≤ 15% rate it 7-9. Eleven items (visual indicators [a shiny, slimy, persistent layer, easily removed, returns quickly without frequent intervention]; failure to respond to antimicrobials; infection > 30 days duration; poor quality granulation tissue; stalled wound despite optimal management; persistent/prolonged inflammation; wound > 6 weeks duration; soft tissue deterioration despite antimicrobials/debridement; signs of local infection; tunnelling/undermining; presence of slough) achieved consensus to include status. To our knowledge, consensus work on this topic has not previously been performed on such a wide scale. When examined alongside similar work, clinical opinion on the matter lacks coherence. We hope that these findings will help direct us toward greater cohesiveness. The work supports a need for research to quantify the predictive abilities of signs and symptoms reported to be indicative of biofilm in chronic wounds.

PMID:41185925 | DOI:10.1111/iwj.70771

Ann Pharmacother. 2025 Nov 4:10600280251380939. doi: 10.1177/10600280251380939. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the efficacy and safety of ketamine or ketorolac compared to opioids in painful vaso-occlusive crisis (VOC).

DATA RESOURCES: A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) criteria and used Embase, MEDLINE, and Cochrane Central to obtain data that evaluated the efficacy and safety of ketamine or ketorolac compared to opioids in acute painful VOC in July of 2025.

STUDY SELECTION AND DATA EXTRACTION: The primary endpoints were meaningful reduction of pain on pain scales, reduction in opioid requirements, and the incidence of adverse effects reported in the studies. A P-value of <0.05 was considered statistically significant, and heterogeneity among the studies was reported as the I² value.

DATA SYNTHESIS: Eight randomized controlled trials were included. Ketorolac showed a statistically significant pain reduction compared to opioids (standard mean difference [SMD]: 0.58 [95% CI: 0.31-0.85, P < 0.0001]), whereas ketamine showed no statistically significant difference in pain reduction (MD: -0.17 [95% CI: -0.53 to 0.18, P = 0.34]). A statistically significant reduction in opioid requirements was demonstrated in both intervention groups (MD: 3.23 [95% CI: -4.40 to -2.06, P < 0.0001]). Regarding safety, ketorolac showed a lower risk of adverse effects compared to opioids (risk ratio [RR]: 0.54 [95% CI: 0.36-0.79, P = 0.0019]), while ketamine demonstrated a higher risk of adverse effects (RR: 9.90 [95% CI: 4.30-22.82, P < 0.0001]).

RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Ketamine or ketorolac demonstrated effective reduction in pain and opioid requirements, with ketorolac showing a greater pain relief and a favorable safety profile compared to ketamine. These findings demonstrate their use as either nonopioid analgesics or opioid-sparing agents.

CONCLUSION: Ketamine or ketorolac may not only reduce opioid requirements but may also serve as nonopioid treatment options, supporting safer and individualized pain-management strategies in painful VOC.

PMID:41185920 | DOI:10.1177/10600280251380939

S Afr J Commun Disord. 2025 Oct 21;72(1):e1-e8. doi: 10.4102/sajcd.v72i1.1132.

ABSTRACT

Despite advancements in recognising the importance of early child language development and linguistic diversity in South Africa, culturally and linguistically appropriate assessment tools remain unevenly distributed across the official languages, posing considerable challenges for researchers and speech-language therapists. This study critically reviews the psychometric status of child language assessment tools in South Africa’s official languages. The current state of tool development is analysed, evaluating language assessment tools available for clinical and research purposes in each language. Tools that assess speech sounds, phonological processing and (pre)literacy skills were excluded, as were untraceable tools reported in previous publications, and tools that do not assess language only but form part of larger developmental assessments. Considering each language version of a tool, 37 traceable language assessment tools (at least 1 per official language), in various states of readiness, are available for use with South Africans aged 0-12 years. Out of these 37 tools, 5 tools, with collectively 7 language versions, have been validated and the statistical results of the validation study published: 4 for isiZulu, 2 for English and 1 for Siswati. Despite advances in tool development, there is still a severe lack of validated standardised child language measurement tools in all official languages of South Africa.Contribution: This is the most recent critical review of the psychometric properties of tools developed for assessing South African children’s language skills, and it highlights that past and current efforts in tool development are still insufficient.

PMID:41185918 | DOI:10.4102/sajcd.v72i1.1132

Curationis. 2025 Oct 24;48(1):e1-e10. doi: 10.4102/curationis.v48i1.2762.

ABSTRACT

BACKGROUND: The shortage of healthcare workers is a global phenomenon with many regions experiencing difficulties in providing a healthcare workforce to meet their demand for healthcare. This situation has led to developed countries recruiting staff from developing countries, thereby causing a shortage in the source country, referred to as a brain drain. Given the negative impact of the turnover of healthcare staff on patient safety, service delivery, healthcare cost and staff morale within healthcare facilities, this research study investigates the current composition of nurses in South Africa versus the World Health Organization (WHO) standard.

OBJECTIVES: The study aims to enhance the retention of healthcare workers.

METHOD: Secondary data collection was utilised to assess how the composition of nurses in South Africa compares against the WHO standard. Non-probability sampling was adopted to draw the study sample to collect data in the original study from nurses registered with the South African Nursing Council (SANC), employing a mixed-method approach to data collection and analysis.

RESULTS: The results indicate that South Africa’s nurses-to-population ratio exceeds the WHO standard.

CONCLUSION: Although South Africa’s nurse-to-population ratio exceeds the WHO standard, these figures do not accurately reflect the nursing situation in the country.Contribution: Recommendations are presented which, when effectively implemented, have the potential to enhance the retention of professional nurses and improve healthcare service delivery in South Africa.

PMID:41185909 | DOI:10.4102/curationis.v48i1.2762

Urologia. 2025 Nov 4:3915603251388202. doi: 10.1177/03915603251388202. Online ahead of print.

ABSTRACT

PURPOSE: Lower calyceal stones are more challenging to treat due to their anatomical position and consequences. Therapies such as Extracorporeal Shock Wave Lithotripsy and Percutaneous Nephrolithotomy often offer limited efficacy or involve significant complications. This study aimed to assess the safety and effectiveness of advanced Flexible Ureteroscopy using six specific techniques compared to conventional in situ laser lithotripsy for large lower calyceal stones 10-25 mm.

METHODOLOGY: Prospective Randomized Controlled Study Design, in which 104 patients were divided into two groups. Group A underwent FURS with six specific (tips & tricks) including Modified T-tilt position (45° Trendelenburg position, 45° lateral tilt opposit the stone side ), bendable access sheaths with suction, modern laser techniques (combination of dusting & pop-corn) using dormia basket to move the stone to renal pelvis or to align the stone with the laser if it was too large to remain in the calyx plus using thin flexible ureteroscopy 7 FR for easy maneuverability and constant irrigation to maintain visibility. Conventional in situ laser lithotripsy was performed for Group B. The primary measure was the stone-free status with analysis of operative time, complications, hospital stay, and further treatments needed and recovery.

RESULTS: The stone-free rate was found to be better in Group A 90.38% compared to Group B 71.15% with p-value 0.025. The median operative time for Group A was longer than Group B, with a median operative time of 78 min. which statistically significant (p < 0.001). Study reports better overall outcomes for Group A, including higher stone-free rate and lower need for additional interventions.

CONCLUSION: Analysis of the techniques shows that their application significantly improves stone clearance rates increases the efficiency of stone removal without increasing risk of complications. These findings support integrating innovative strategies into routine clinical practice.

PMID:41185904 | DOI:10.1177/03915603251388202

Cureus. 2025 Nov 1;17(11):e95911. doi: 10.7759/cureus.95911. eCollection 2025 Nov.

ABSTRACT

Objectives Medical students are a high-risk group for mental health conditions. There is a paucity of research within Caribbean medical schools on attention-deficit/hyperactivity disorder (ADHD), a condition estimated to affect approximately one in 20 adults. The purpose of this research was to determine the prevalence of ADHD-related symptoms and their associated factors affecting attention span among medical students. Methods A cross-sectional survey was conducted among a conveniently selected group of currently enrolled medical students in the Department of Public Health and Primary Care, Faculty of Medical Sciences (FMS) of The University of the West Indies, St. Augustine Campus, in Trinidad and Tobago, between January and June 2024. Participants completed an online questionnaire. The Adult ADHD Self-Report Scale, Pittsburgh Sleep Quality Index, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-9 were used to assess ADHD, sleep quality, anxiety, and depression, respectively. Attention spans and lifestyle factors influencing attention were also evaluated. Statistical analyses were done for predictors of ADHD and factors affecting attention span using logistic regression-derived odds ratios (ORs) with 95% confidence limits. Results Out of 231 respondents, the mean age was 22.6 years (SD 2.3), with 72.3% identifying as female. The overall prevalence of a positive ADHD screen was 45%, showing no significant association with age (P = 0.148) or gender (P = 0.788). ADHD positivity was highest in Year 3 (67.3%), significantly greater than Year 1 (OR 3.66, 95% CI 1.62-8.29, P = 0.002). High rates of poor sleep quality (82.3%), anxiety (65.4%), and depression (73.2%) were observed, all of which were positively correlated with ADHD (P ≤ 0.001). The top five factors affecting attention span included tiredness/energy level (91.3%), academic load (80.1%), sleep quality (79.2%), interest in the subject (78.4%), and time of day (78.4%). Students with ADHD symptoms reported higher levels of exercise, social media usage, caffeine consumption, breakfast skipping, and fluid intake compared to non-ADHD peers (P < 0.05 for all). Conclusions The study highlights a high prevalence of ADHD-related symptoms and mental health comorbidities among medical students, emphasizing the need for curriculum review and enhanced support services.

PMID:41185875 | PMC:PMC12579744 | DOI:10.7759/cureus.95911

Cureus. 2025 Nov 2;17(11):e95956. doi: 10.7759/cureus.95956. eCollection 2025 Nov.

ABSTRACT

INTRODUCTION: Statin prescribing for primary prevention remains a topic of debate, especially among individuals with low to moderate risk for cardiovascular disease (CVD), partly due to limitations of current cardiovascular risk assessment tools. This study aimed to determine whether differences exist in risk estimation among various cardiovascular risk calculators used in Canadian clinical practice guidelines and to describe the proportion of patients who may fall into a different risk category if an alternative risk calculator were used.

METHODS: This work was approved by the local research ethics board. A retrospective chart review was conducted for adult patients aged 40 and older without a statin-indicated condition or prior cardiovascular event who underwent lipid assessment at a single family medicine center in London, Ontario, between 2010 and 2023. Three online calculators and two risk estimators (Framingham and American Society for Cardiovascular Disease) were used to re-estimate cardiovascular risk and compare the results with the values documented in the patient’s chart.

RESULTS: Of 50 patients, 20% did not have a documented cardiovascular risk value in their chart at the time of lipid assessment. However, the mean difference in Framingham risk values between the electronic medical record and the PEER (patients, experience, evidence, research) lipid online calculator was statistically significant (3.44%, 95% CI 0.11-6.76, p<0.05). Additionally, 23 (46%) patients would have fallen into a lower risk category according to Canadian clinical practice guidelines if the atherosclerotic cardiovascular disease (ASCVD) risk calculator had been used instead of the Framingham estimator for CVD risk assessment.

CONCLUSION: Cardiovascular risk percentages differ between those calculated using an electronic medical record tool and those calculated with online calculators. Depending on the tool used, a proportion of patients may fall into a different cardiovascular risk category, resulting in different management decisions. Specifically, patients who would fall into a lower risk category could be considered for lifestyle management alone rather than statin initiation. Further research is needed to guide consistent use of available point-of-care risk tools by clinicians, and clinical practice guidelines should incorporate these recommendations.

PMID:41185874 | PMC:PMC12579958 | DOI:10.7759/cureus.95956

BMC Pregnancy Childbirth. 2025 Nov 3;25(1):1159. doi: 10.1186/s12884-025-08318-0.

ABSTRACT

BACKGROUND: Low birth weight (LBW), defined as a newborn weighing less than 2500 g, is an increasingly significant public health concern. Exploring the risk and protective factors for LBW is getting more and more important. This study aimed to utilize predictive models to identify the critical factors associated with LBW in singleton pregnancies.

METHODS: A retrospective cohort study was conducted at the Binzhou Medical University Hospital, China, from 2022 to 2023. Singleton pregnancies with gestational age exceeding 27 weeks were included, while multiple pregnancies and fetal anomalies were excluded. Logistic regression (LR) model and four machine learning (ML) algorithms were tested(random forest, light gradient boosting machine, support vector machine, and extreme gradient boosting). The LR model was interpreted through odds ratio analysis and clinical nomogram visualization. Shapley Additive Explanations (SHAP) analysis was used to interpret the importance and impact of individual features on ML model.

RESULTS: In this cohort of 10,227 deliveries, 237 cases were classified as LBW. The XGBoost model exhibited superior performance in predicting LBW, with an AUC of 0.786 (training set) and 0.741 (test set, ) AUPRC of 0.350 and 0.186, respectively. Both LR and XGBoost model identified maternal age, gestational age, BMI, hypertensive disorders of pregnancy (HDP), fetal distress as the critical factor. Additionally, a follow-up study on LBW found that LBW infants prone to significant health challenges, such as a high rate of hospitalization and the complex conditions including congenital anomalies, neonatal respiratory distress syndrome (NRDS) and neonatal hyperbilirubinemia.

CONCLUSION: This study demonstrated that the LR and XGBoost model exhibited clinically meaningful predictive performance in identifying factors associated with LBW in singleton pregnancies. Pregnant women with a gestational age of less than 37 weeks, a gestational BMI below 18 kg/m², maternal age under than 25 years, and maternal comorbidities such as HDP or fetal distress are at higher risk of delivering LBW infants.

PMID:41184849 | DOI:10.1186/s12884-025-08318-0

BMC Psychiatry. 2025 Nov 3;25(1):1050. doi: 10.1186/s12888-025-07504-w.

ABSTRACT

BACKGROUND: No study has simultaneously investigated the associations of anxiety comorbidities, persistent depressive disorder (PDD), depression, anxiety, and somatic symptoms at baseline with the total and longest durations of paid employment (DPE) as well as the total number of reasons for occupational impairment (OI) over a 10-year period among patients with major depressive disorder (MDD). The study aimed to investigate these issues.

METHODS: At baseline, 290 subjects with MDD were enrolled. MDD and anxiety comorbidities were confirmed using the Structured Clinical Interview for DSM-IV-TR. The Depression and Somatic Symptoms Scale and the Hospital Anxiety and Depression Scale were employed. At the 10-year follow-up point, 113 subjects were investigated. The total and longest DPE were clarified and recorded. A 28-item list was used to investigate the subjective reasons for OI. Multiple linear regression models were used for statistical analysis.

RESULTS: For the total and longest DPE, 14.2% and 40.7% of the subjects were less than five years, respectively. An increase of one anxiety comorbidity in subjects was associated with a decrease of 4.6 months in the total DPE compared to those without. Subjects with greater somatic symptoms, PDD, and the female gender at baseline reported more reasons for OI. Fatigue, somatic discomfort, decreased motivation, and sensitivity to comments were common reasons for OI.

CONCLUSIONS: In the treatment of depression, clinicians should pay more attention to the above treatable factors, including anxiety comorbidities, PDD, fatigue, decreased motivation, and somatic symptoms, to improve OI.

PMID:41184839 | DOI:10.1186/s12888-025-07504-w