Tag: pubmed

Ann Saudi Med. 2025 Nov-Dec;45(6):421-434. doi: 10.5144/0256-4947.2025.421. Epub 2025 Nov 20.

ABSTRACT

BACKGROUND: Anthracyclines are widely used in cancer treatment and cause dose-dependent cardiotoxicity 2 different by increasing oxidative stress and RAS activation. Angiotensin converting enzyme inhibitors (ACEIs) show promise in reducing this damage.

OBJECTIVES AND DESIGN: This systematic review and meta-analysis evaluated the efficacy and safety of ACEIs in preserving left ventricular function and reducing cardiotoxicity associated with anthracycline therapy.

METHODS: A comprehensive search of databases up to May 2024 included randomized controlled trials (RCTs) that assessed ACEIs to prevent cardiotoxicity. Random-effects meta-analysis was applied.

MAIN OUTCOME MEASURES: The primary outcome was changes in left ventricular ejection fraction (LVEF). Secondary outcomes included cardiac event incidence and adverse events.

SAMPLE SIZE: Nine RCTs were included, encompassing 869 patients (440 ACEI group, 429 control group).

RESULTS: ACEIs significantly improved LVEF at six months (mean difference of 7.93%; 95% CI 3.18-12.67%; P=.001) but not at 12 months. Moreover, ACEIs were associated with non-statistically significant lower rates of heart failure and arrhythmia development compared to the control, with no significant differences noted in adverse events.

QUALITY OF EVIDENCE: Evidence quality was high for short-term LVEF improvement and moderate-to-low for other outcomes. Egger’s regression test indicated a low risk of publication bias for LVEF.

HETEROGENEITY: High (I²=97%) for LVEF at 6 months.

CONCLUSION: ACEIs prevent cardiotoxicity in the short term without increasing adverse events. More extensive trials are needed to confirm long-term benefits.

LIMITATIONS: The small number of RCTs and high heterogeneity limit the study. Inconsistent reporting of baseline cardiovascular factors and confounders also hindered accurate assessment of treatment effects.

REGISTRATION: PROSPERO CRD42024555546.

PMID:41275346 | DOI:10.5144/0256-4947.2025.421

Ann Saudi Med. 2025 Nov-Dec;45(6):395-405. doi: 10.5144/0256-4947.2025.395. Epub 2025 Nov 20.

ABSTRACT

BACKGROUND: Obstetric anal sphincter injuries (OASIS) are severe complications of vaginal deliveries with long-term physical and psychological sequelae. Data on the prevalence and risk factors of OASIS are limited in Saudi Arabia. This study aimed to assess the incidence of OASIS annually from 2017 to 2020, identify associated maternal and delivery factors, and investigate patients’ characteristics related to OASIS Grades.

OBJECTIVE: To evaluate the annual incidence of OASIS from 2017 to 2020, identify maternal and delivery-related risk factors, and assess characteristics associated with different OASIS grades.

DESIGN: Single-center, retrospective observational study.

SETTING: King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

METHODS: Medical records of all vaginal deliveries from 2017 to 2020 were reviewed. The study included 112 patients with singleton vaginal deliveries complicated by OASIS, out of a total of 12 081 deliveries. Exclusion criteria included preterm births and incomplete records. Data on maternal demographics, obstetric history, labor type, mode of delivery, episiotomy use, and neonatal outcomes were collected. The Royal College of Obstetricians and Gynaecologists (RCOG) classification was used to grade OASIS severity. Chi-square and t-tests were used for analysis.

MAIN OUTCOME MEASURES: Annual incidence of OASIS, distribution of OASIS grades, and associations between clinical variables and injury severity.

SAMPLE SIZE: 112 cases of OASIS among 12081 vaginal deliveries.

RESULTS: The incidence of OASIS was 0.93%, showing a decreasing trend from 2017 to 2020. Most patients were Saudis (78.6%), primigravidae (58%), and nulliparous (67%). Spontaneous vaginal delivery occurred in 73.2% of cases, with episiotomies performed in 62%. Grade III tears were observed in 79.5% of cases, whereas 8.0% were classified as Grade IV. No significant differences were observed between Grades III and IV in terms of maternal and delivery characteristics, except for higher estimated blood loss in Grade IV cases. Incomplete documentation was noted in repair techniques and episiotomy details.

CONCLUSION: Incidence of OASIS shows a decreasing trend in both the number of cases and the incidence rate over the four years between 2017 and 2020. Further research is necessary to address documentation gaps and refine regional prevention and management practices.

LIMITATION: Retrospective design and missing values limited the ability to analyze some variables thoroughly.

PMID:41275344 | DOI:10.5144/0256-4947.2025.395

Med Sci Monit. 2025 Nov 23;31:e950460. doi: 10.12659/MSM.950460.

ABSTRACT

BACKGROUND Intrauterine devices (IUDs) are widely used for contraception and are generally well tolerated. A rare complication is spontaneous fracture of the IUD while in situ. This study aimed to evaluate the prevalence of spontaneous IUD fractures and compare occurrence between 2 IUD types. MATERIAL AND METHODS This retrospective study included 463 women who underwent IUD insertion and follow-up between January 1, 2011, and December 31, 2021. Two IUDs were evaluated: Type 1, a copper IUD with a gold core (375 mm²), and Type 2, a copper IUD (300 mm²) without a gold core. Spontaneous fractures were identified based on symptoms or routine annual ultrasonography. Statistical analyses included descriptive statistics, normality testing, and comparisons using chi-square, t-tests, or Mann-Whitney U tests. A p value <0.05 was considered significant. RESULTS Among 463 patients, 183 used a Type 1 IUD and 280 used Type 2. Spontaneous fractures were observed in 12 of 183 Type 1 users (6.56%, 95% CI: 2.97-10.15%), while no fractures occurred among Type 2 users. Overall fracture prevalence was 2.59% (95% CI: 1.49-4.48%). Fractured arms were often located in the uterine cornua (n=9) and cervical canal (n=3). Fragments in the canal were removed using Novak extraction, while those in the cornua required hysteroscopy. CONCLUSIONS Spontaneous IUD fractures can occur without symptoms and must be considered during follow-up. Prompt recognition is essential to avoid complications. Hysteroscopy and Novak extraction are effective for fragment removal. Clinicians should consider routine ultrasonographic evaluation to detect asymptomatic IUD fractures, especially in users of Type 1 devices.

PMID:41275328 | DOI:10.12659/MSM.950460

J Psychosom Obstet Gynaecol. 2025 Dec 31;46(1):2584909. doi: 10.1080/0167482X.2025.2584909. Epub 2025 Nov 22.

ABSTRACT

OBJECTIVE: This study aims to systematically analyze the disease burden and epidemiological characteristics of depression among women of childbearing age (WCBA) globally and across regions from 1990 to 2021, as well as explore the current research status and hotspots.

METHODS: Data from the 2021 Global Burden of Disease, Injuries, and Risk Factors Study (GBD 2021) were used to examine age-standardized incidence rates (ASIR) and disability-adjusted life years (DALYs) of depression among WCBA by region, age, and socio-demographic index (SDI) level. Relevant literature was retrieved from the Web of Science Core Collection, with bibliometric analyses (temporal-spatial distribution, themes, keywords) performed via VOSviewer and CiteSpace.

RESULTS: In 2021, there were ~133 million new global cases of depression among WCBA, with an ASIR of 6,808.01 per 100,000 population. Incidence rose significantly since 1990, accelerating from 2019 to 2021. High SDI regions had higher ASIR, age-standardized DALY rates (ASDR), and average annual percentage change (AAPC). Globally, incidence peaked at 45-49 years with age growth, but younger WCBA (15-29 years) in high SDI regions had higher ASIR. Bibliometric analysis showed rapid research expansion in recent years, covering pregnancy, risk factors, and obesity, with “polycystic ovary syndrome” and “oxidative stress” as emerging hotspots.

CONCLUSION: The study highlights the rising global burden of depression among WCBA and disparities across regions, socioeconomic backgrounds, and age groups, providing scientific evidence for targeted public health interventions.

PMID:41275327 | DOI:10.1080/0167482X.2025.2584909

BMC Pregnancy Childbirth. 2025 Nov 22. doi: 10.1186/s12884-025-08523-x. Online ahead of print.

ABSTRACT

BACKGROUND: The postpartum period is a critical phase that can impact maternal mental health and functional adaptation. This study evaluated the effect of midwife-led psychosocial counseling with family support on postpartum depression and maternal functioning among primiparous women.

METHOD: This randomized controlled trial enrolled 56 primiparous women aged 15-45 years who were recruited from healthcare centers in Tehran, Iran. Participants were selected through convenience sampling and randomly assigned to intervention and control groups using a four- block randomization protocol. The intervention group received three individualized 120-minute sessions of midwife-led psychosocial counseling, with a family member support person present; these sessions were administered at 3-5, 15-30, and 42 days postpartum. The control group received routine postpartum care. The Edinburgh Postnatal Depression Scale and the Barkin Index of Maternal Functioning were administered before, immediately after, and one month post-intervention.

RESULTS: Repeated measures analysis revealed that depression scores declined over time in both groups; however, between-group differences were not statistically significant (P = 0.07, CI [-1.45-2.94]. Furthermore, repeated measures analysis indicated that maternal functioning improved significantly in the intervention group compared to the control group (p = 0.02, CI [0.58-7.03], η² = 0.075).

DISCUSSION: Midwife-led psychosocial counseling with family participation significantly enhances maternal functioning in the early postpartum period. However, no statistically significant between-group effect was observed for postpartum depression, indicating that improvements in depressive symptoms may require longer follow-up or more intensive approaches.

TRIAL REGISTRATION: The study was registered in the Iranian Clinical Trials Registry with NO (IRCT20231209060304N1) on 2024/2/20.

PMID:41275322 | DOI:10.1186/s12884-025-08523-x

BMC Oral Health. 2025 Nov 22. doi: 10.1186/s12903-025-07299-y. Online ahead of print.

ABSTRACT

BACKGROUND: Dental caries ranks among the most frequent childhood diseases worldwide, significantly impacting oral health and overall well-being. The objective of this systematic review and meta-analysis was to evaluate the efficacy of school-based supervised toothbrushing (STB) intervention in the prevention of dental caries by enhancing oral hygiene.

METHODS: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) sourced from PubMed, Scopus, Web of Science, and other databases up to February 2025. Eligible studies were those that contrasted school-based STB intervention with no-intervention controls, documenting results in DMFT/dmft or DMFS/dmfs indices. Two reviewers independently screened studies, extracted data, and assessed risk of bias using Risk of Bias 2 (RoB2) tool. A random-effects model was used to pool the results, and standardized mean differences (SMDs) were calculated to account for differences in dentition types. Heterogeneity was assessed using the I² statistic and Cochran’s Q test.

RESULTS: Five of the eight RCTs that satisfied the inclusion requirements were included in the meta-analysis. A statistically significant reduction was shown in DMFS/dmfs that resulted from STB intervention (SMD = -0.22; 95% CI: -0.42 to -0.01; p = 0.037; I² = 64.6%), indicating a modest preventive effect with moderate heterogeneity. However, there was no significant effect on DMFT/dmft (SMD = 0.05; 95% CI: -0.27 to 0.37; p = 0.754; I² = 86.8%), reflecting high between-study variability.

CONCLUSION: School-based supervised toothbrushing intervention appear to effectively reduce dental caries at tooth surface level, as reflected in the significant reduction in DMFS/dmfs scores. However, their effect on whole-tooth caries, as measured by DMFT/dmft, remains less evident in the short term. These findings support using STB as a practical community-level intervention to promote oral health in children.

TRIAL REGISTRATION: We have registered the protocol on the Open Science Framework (OSF) (Registration DOI: https://doi.org/10.17605/OSF.IO/2JWR9).

PMID:41275321 | DOI:10.1186/s12903-025-07299-y

BMC Nurs. 2025 Nov 22. doi: 10.1186/s12912-025-04090-w. Online ahead of print.

ABSTRACT

BACKGROUND: Cancer and its treatments accelerate frailty in older adults with cancer (OACA). Exercise is safe and beneficial during and after treatment, yet many, including older adults, do not meet current exercise guidelines. The primary objective of this study was to understand oncology clinic nurses’ knowledge and current practices regarding exercise discussion and promotion in patients with cancer, including in older patients. The secondary objectives were to: (1) explore barriers to initiating exercise discussion and promotion; and (2) explore the relationship between oncology nurses’ exercise behavior, and their knowledge about existing guidelines and exercise promotion practices.

METHODS: A cross-sectional online survey was conducted via REDCap between February and May 2023 involving nurses who practice in outpatient oncology clinics. The survey was developed based on the expert consensus of the study team and was distributed through professional networks. Descriptive statistics and chi-square were used to analyze the collected data.

RESULTS: Ninety-seven nurses participated. The majority were aged 41-50 years (38.1%) and 31-40 years (27.8%). Mean years of practice was 13.5 (0.5-45). Many nurses lacked formal training on exercise discussion with patients (57.8%), yet expressed interest in learning (91%). Most nurses (90%) agreed exercise benefits patients during treatment. The majority (75%) reported discussing or recommending exercise to patients with cancer, especially advising patients to stay active during and after treatment. Barriers to promoting exercise included limited clinic time (77.7%) and concerns about safety especially for OACA (72.2%). 37.6% of nurses reported engaging in moderate-intensity aerobic activity. 26.6% endorsed both being quite/very knowledgeable in discussing exercise guidelines with patients with cancer in general and 74.7% reported typically discussing exercise with patients with cancer in general. A statistically significant association was found between nurses’ exercise promotion behaviour and perceived knowledge about exercise promotion (p = .01).

CONCLUSION: Many nurses agree that exercise promotion is important and consider it part of their scope of practice to discuss exercise with patients with cancer. Although perceived knowledge regarding specific recommendations is generally low, nurses express interest in enhancing their knowledge and participating in diverse educational opportunities. Institutions should prioritize nurse education to support efforts in exercise promotion.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41275319 | DOI:10.1186/s12912-025-04090-w

Antimicrob Resist Infect Control. 2025 Nov 22. doi: 10.1186/s13756-025-01653-z. Online ahead of print.

ABSTRACT

BACKGROUND: The spread of antibiotic resistance makes it necessary to implement Antimicrobial Stewardship (AMS) Programs; the aim of this study is to evaluate the impact of an AMS program in the management of urinary tract infection (UTI) in emergency setting.

METHODS: A prospective multicentre study was conducted enrolling all adult patients admitted to one of the 8 emergency departments participating in the study with a diagnosis of UTI from February 2023 to July 2024. Only one of the eight centers received a persuasive AMS program. The primary outcome evaluated was the prevalence of empirical antimicrobial prescription belonging to Access class according to WHO classification in AMS and non-AMS ED; secondary outcomes included the prevalence of etiologial diagnosis, the clinical response and seven-day and 30-day mortality rates.

RESULTS: During the study period, 657 patients were enrolled, 135 in the AMS and 522 in the non-AMS group, with a median age of 71 years (IQR 58-79). Patients in the AMS group had a more severe disease with a higher rate of sepsis or septic shock at admission (p < 0.001). In the AMS group, the percentage of patients with a microbiological diagnosis was higher (67% vs 43.1% p < 0.001); regarding empirical antibiotic therapy, drugs of the Access class were more frequently prescribed as empirical treatment in the AMS group (48.3 vs 37%, p = 0.04). No statistically significant differences were observed in terms of 7- and 30-day mortality and 7-day clinical response between the 2 groups, despite the higher severity of patients in the AMS group.

CONCLUSIONS: In the centre where an AMS program was conducted, an increase in the number of positive urine cultures (67% vs 43.1%) has been observed, and a higher rate of prescriptions for Access class antibiotics. Further prospective data are needed to evaluate the impact of AMS intervention on antimicrobial prescribing in emergency setting.

PMID:41275300 | DOI:10.1186/s13756-025-01653-z

BMC Sports Sci Med Rehabil. 2025 Nov 22. doi: 10.1186/s13102-025-01418-6. Online ahead of print.

ABSTRACT

Despite significant debate over UEFA’s decision to abolish the away goals rule in 2021 and introduce the use of Video Assistant Refereeing (VAR), little research has considered its potential effects on team performance. Hence, this study investigates how the change in the goals rule and use of (VAR) during the knock phase of UEFA Women’s Champions League affected selected game-related statistics. Data were sourced via the Wyscout platform. The sample consists of 78 UEFA Women’s Champions League knockout round matches; 30 of the matches took place in seasons with the away goals rule (AGR) and no VAR (2016 to 2019) and 48 in seasons without AGR and VAR included (2021 to 2025). Data analysis was performed using a combination of T-Tests; Mann-Whitney-U Tests and Generalised Linear Models. The findings demonstrate that the change in rules resulted in a reductions in the numbers of balls lost (p < 0.01), ball recoveries (p < 0.01), long passes (p < 0.01), forward passes (p < 0.05), passes to the final third (p < 0.01), fouls (p < 0.05), aerial duels (p < 0.01), aerial duels won (p < 0.01), and free kicks (p < 0.01). In contrast, elimination of the away goals rule and inclusion of VAR led to a significant increase in the number of goals (p < 0.05), percentage of accurate passes and counter attacks with shots (p < 0.05). Football governing bodies could consider these findings when deciding whether the rule changes has impacted on the women’s game as expected.

PMID:41275298 | DOI:10.1186/s13102-025-01418-6

Int J Health Geogr. 2025 Nov 22;24(1):35. doi: 10.1186/s12942-025-00423-9.

ABSTRACT

BACKGROUND: Mental-health geomatics require reliable ways to convert high-frequency GPS trajectories into meaningful place types that support indicators such as homestay, location entropy, and spatial extent of daily activities. Raw coordinates are typically noisy and carry little semantic information. We introduce H3-MOSAIC(H3-based Multimodal OSM-and-Satellite AI for Classification), a multimodal generative framework that fuses OpenStreetMap (OSM) building text and satellite imagery on H3 grids to infer place semantics from high-frequency GPS.

METHODS: Raw GPS was smoothed by minute-level speed filtering, then assigned to Level 10 H3 hexagons. Cells were retained if the mean speed was ≤ 1.2 m/s and the cumulative duration was ≥ 15 min, contiguous cells were merged, and home was defined as the cell with the longest dwell from 23:45 to 06:00. We compared text-only OSM classification with image-based and fused approaches across open-source models (DeepSeek, CLIP, LLaVA, Qwen-VL) and proprietary models (GPT-4o-mini, Gemini-2.5-flash-lite). Performance was assessed by accuracy, Cohen’s kappa, precision, recall, F-measure, and confusion matrices. Day level associations between H3 semantic exposures and stress were examined by a random forest model and explainable methods.

RESULTS: Multimodal methods outperformed single-modality baselines. In the 11-class task, accuracies were: CLIP 0.179, LLaVA 0.269, Qwen-VL 0.565, GPT-4o-mini 0.779, and Gemini-2.5-flash-lite 0.790. In the 5-class consolidation, accuracies rose to 0.702 (Qwen-VL), 0.849 (GPT-4o-mini), and 0.858 (Gemini-2.5-flash-lite). Text-only OSM baselines were lower (≈ 0.60-0.68). Across 3,845 hexagons with OSM text, closed-source models agreed on 79% of labels; disagreements concentrated in mixed-use, office, and green classes. Error modes reflected area-dominant versus keyword-triggered reasoning, hybrid-parcel ambiguity, tag sparsity, and symbolic artifacts. Stabilized semantics support more robust computation of homestay, entropy, and activity space and are suitable for privacy-aware, cross-city reuse. In a day-level case study, minutes at Home related to lower stress; Green showed a U-shaped pattern.

CONCLUSIONS: H3-MOSAIC provides a scalable, auditable pipeline for semantic place detection from high-frequency GPS. Multimodal fusion markedly improves accuracy and consistency. Proprietary models are most robust on hard classes and open-source models are practical for coarse taxonomies. H3 day level exposures show stress patterns consistent with established mental health pathways, supporting face validity. The framework enables downstream exposure analyses with reduced misclassification and improved interpretability.

PMID:41275284 | DOI:10.1186/s12942-025-00423-9