Tag: pubmed

Neurology. 2025 Nov 25;105(10):e214319. doi: 10.1212/WNL.0000000000214319. Epub 2025 Nov 3.

ABSTRACT

BACKGROUND AND OBJECTIVES: Evidence on levetiracetam for poststroke seizures is limited. Understanding whether levetiracetam effectively manages poststroke seizures is important for improving prognosis and preventing further complications in stroke patients. The aim of this study was to assess the risk of seizure rehospitalization between levetiracetam and valproic acid in patients with poststroke seizures.

METHODS: Using data from Taiwan’s National Health Insurance Research Database, this observational retrospective cohort study followed the target trial emulation framework to emulate a hypothetical randomized trial estimating the effect of levetiracetam for poststroke seizure management. Eligible patients were those who were hospitalized for their first seizure event (index seizure) between January 1, 2012, and December 31, 2020, and were newly prescribed levetiracetam or valproic acid monotherapy before discharge. Patients should have had a stroke-related hospitalization within 2 years before the seizure. Patients prescribed levetiracetam were assigned to the exposure group, whereas those prescribed valproic acid were assigned to the reference group, based on their first prescription after the index seizure. Inverse probability-weighted marginal structural models were used to assess outcomes between levetiracetam and valproic acid, including seizure rehospitalization as the primary outcome. Secondary outcomes included all-cause mortality and a composite of seizure rehospitalization and all-cause mortality. Both baseline and time-varying confounders were adjusted in the models.

RESULTS: The final sample included 740 levetiracetam users (48.5%) and 786 valproic acid users, with a mean age of 67.2 years in both groups and a similar proportion of men (59.9% for levetiracetam; 61.3% for valproic acid). In the primary outcome analysis, levetiracetam use was associated with a lower risk of seizure rehospitalization compared with valproic acid (hazard ratio 0.78; 95% CI 0.64-0.95). In secondary outcome analyses, no significant differences were observed in all-cause mortality or the composite of seizure rehospitalization and all-cause mortality.

DISCUSSION: Levetiracetam was associated with a lower risk of seizure rehospitalization, with no significant difference in the risk of all-cause mortality. These findings support levetiracetam as a potentially suitable treatment option for patients with poststroke seizures. As this study focused on monotherapy, future investigations should further explore combination antiseizure medication regimens involving levetiracetam.

CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that levetiracetam is associated with a lower risk of seizure rehospitalization compared with valproic acid in patients with post-stroke seizures.

PMID:41183250 | DOI:10.1212/WNL.0000000000214319

Health Aff (Millwood). 2025 Nov;44(11):1330-1335. doi: 10.1377/hlthaff.2025.01073.

ABSTRACT

In Los Angeles, California, predictive analytics help identify high-risk patients who receive intense care management to avert hospital admissions.

PMID:41183240 | DOI:10.1377/hlthaff.2025.01073

J Agromedicine. 2025 Nov 3:1-12. doi: 10.1080/1059924X.2025.2579637. Online ahead of print.

ABSTRACT

OBJECTIVES: Roughly 70% agricultural nursery workers report musculoskeletal dysfunction and fall-related injuries. Exercise has been shown to improve musculoskeletal health and fall risk, but the literature on the benefits of exercise in nursery workers is rare. This mixed-methods feasibility study aimed to elucidate the benefits of an employee-sponsored exercise class for nursery workers.

METHODS: Twenty-five workers were randomized into either the Stay Strong, Stay Healthy (SSSH) resistance training program (n = 14) or control group (n = 11) for 8 weeks. Those assigned to SSSH performed eight exercises twice weekly at their workplace during business hours, while controls were asked to maintain their habits. Pre/post eight-week measures included health, pain, and sleep surveys and functional performance tests of static and dynamic balance, strength, and flexibility. Finally, interviews were conducted pre/post to gauge participants’ perceptions of barriers and facilitators for health behaviors such as exercise. Statistical analyses included independent t-tests to assess baseline differences and two-way, mixed repeated measures analyses of variance models to observe interactions and main effects of time and group for all measures, α ≤ 0.05. Inductive thematic analysis was conducted on interview data.

RESULTS: There were no baseline differences between SSSH and controls (all p ≥ .061). Participants were on average 39 years old, had a BMI of 25.5 kg/m², reported poor sleep quality (PSQI 6.2), and 220 min/wk of physical activity. Over time, timed-up-and-go, 5 sit-to-stand, hand grip strength, and lower-body flexibility improved (all p ≤ .019). Post-hoc analyses revealed pre/post-performance changes only in the SSSH group (all p ≤ .035). Further, qualitative interviews suggest that employee-sponsored SSSH programming improved many areas of nursery workers’ physical, interpersonal, and psychological health. Specifically, four themes emerged, which included labor-intensive job demands as a barrier to exercise engagement, multidimensional health benefits of SSSH, improved job performance after SSSH, and inspiration and insufficiency of SSSH. For example, those in the SSSH group noted improved personal confidence to complete work-related tasks. Conclusion: Employee-sponsored SSSH improved physical performance associated with falls and injury risk and most participants noted a general enjoyment of and benefits from SSSH pointing to the potential value of it to improve nursery workers’ injury risk and health.

PMID:41178692 | DOI:10.1080/1059924X.2025.2579637

J Vet Diagn Invest. 2025 Nov 3:10406387251387786. doi: 10.1177/10406387251387786. Online ahead of print.

ABSTRACT

Bone marrow (BM) samples in dogs are typically acquired from hematopoietically active trabecular BM at appendicular skeletal sites, such as the proximal humerus and femur, or axial skeletal sites, such as pelvis, sternum, and rib. Suitability for in vivo biopsy varies by site, but equivalency of BM composition at different sites is uncertain. We sought to determine whether the composition of BM is comparable in humerus, ilium, rib, and sternum. Samples from each site were obtained within 24 h after death from 30 dogs with spontaneous disease submitted for postmortem examination. Tissues were fixed in acetic acid-zinc-formalin, demineralized with EDTA, and assessed by 4 independent raters for hematopoietic cellularity, granulocytic:erythrocytic (G:E) cell ratio, megakaryocyte (MKC) number, and presence of hemosiderin. Statistical analysis showed lower cellularity, MKC number, and hemosiderin in ilium than in rib, higher cellularity in rib and sternum than in humerus and ilium, and lower G:E cell ratio in rib than in humerus (p < 0.05). Analysis of covariance indicated that most differences between sites were attributable to individual animal variation rather than site or rater. Differences overall were of small magnitude, and values for each parameter were similar to those reported in healthy younger dogs. We concluded that samples from any of the 4 sites are suitable to approximate composition of BM at the other sites.

PMID:41178663 | DOI:10.1177/10406387251387786

Acta Dermatovenerol Croat. 2025 May;33(1):40-41.

ABSTRACT

Dear Editor, Sentinel lymph node biopsy (SLNB) is crucial for melanoma staging, but the presence of nodal nevi (NN) can complicate diagnosis by mimicking metastatic melanoma. Misclassification occurs in over 10% of cases, potentially leading to overtreatment [1]. We present a case of a 53-year-old woman with superficial spreading melanoma (SSM), where SLNB revealed a capsular NN without metastasis. A 53-year-old female patient was referred to our department with an atypical nevus on her right calf. Following its excision, histological analysis confirmed the diagnosis of SSM with a Breslow thickness of 1.80 mm, classified as stage pT2a. The tumor exhibited three mitoses per mm², no evidence of lymphovascular invasion, and a mild chronic inflammatory infiltrate at its base. According to current recommendations, a re-excision of the postoperative scar with SLNB was performed. Histological analysis found no metastases in the scar tissue or the sentinel lymph node (SLN). However, a small, capsular NN was identified within the SLN (Figure 1). Benign melanocytic nevus cell aggregates, commonly referred to as NN, are typically found within the capsule or trabeculae of lymph nodes, as seen in our patient [2]. The origin of NN cells is debated, with two main theories: embryological migration from the neuroectoderm or lymphatic migration from cutaneous nevi. Recent study findings, particularly the intracapsular location of nevus cells and their higher prevalence in melanoma patients than in breast cancer patients, support the hypothesis that these cells migrate via lymphatic routes rather than being remnants of embryonic development [3]. When NN appear in SLNs, which is estimated to be the case in 1% to 11% of SLNBs, they may present significant diagnostic challenges in melanoma patients [4]. Typically, NN are small, triangular, and lack cytonuclear atypia and mitotic activity, distinguishing them from metastatic melanoma, which is usually found in the parenchyma. However, when nevi extend into the parenchyma or paratrabecular areas, they can mimic metastases, making the differential diagnosis challenging, especially for small melanoma metastases with nevoid morphology [1]. A specialized review of SLNB samples initially classified as melanoma-positive revealed that over 10% were misdiagnosed cases of NN [1]. This diagnostic ambiguity between NN and true SLN metastases carries serious implications, as misclassification can lead to either overtreatment or undertreatment of the patient. On the other hand, the updated EORTC protocol demonstrated a high incidence of NN in SLNBs and identified a strong association between NN and nevus-associated melanoma [4]. Furthermore, Kretschmer et al. demonstrated that SLN-negative melanoma patients with NN exhibited a slightly lower survival rate, while SLN-positive melanoma patients who had both NN and melanoma metastases showed a marginally better prognosis compared to those with metastases alone. However, these differences in survival were not statistically significant [2]. This case highlights the diagnostic challenge of NN in SLNBs for melanoma. While NN can mimic metastases, accurate histopathological evaluation is crucial to prevent overtreatment. Our patient’s case, along with existing research, supports the need for careful differentiation between NN and true metastases to ensure appropriate clinical management.

PMID:41178658

Aust Dent J. 2025 Nov 3. doi: 10.1111/adj.70014. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the prevalence, characteristics, and management of post-operative infections (POI) following dentoalveolar surgery in patients admitted to a tertiary oral and maxillofacial surgery (OMS) unit in South Australia over a five-year period.

MATERIAL AND METHODS: A retrospective cross-sectional audit was conducted at a tertiary hospital OMS Unit from January 2019 to December 2023. A post-operative infection was defined as an infection occurring at the surgical site after an initial surgical procedure. Data were collected from 107 patients admitted with POI following surgery. Data on demographics, clinical management, antibiotic use, and microbiological findings were analyzed using descriptive and quantitative statistical methods.

RESULTS: The mean age of patients was 43.5 years, with a slight female predominance (57.9%). Mandibular molars were the most common source of infection (88.8%), with the submandibular space being the most frequently involved (42.1%). Microbiological analysis revealed a 35% antibiotic resistance rate, with clindamycin resistance being particularly high (22.5%). Patients with resistant infections had significantly longer hospital stays (mean 8.9 vs. 4.9 days, t-test, p = 0.012).

CONCLUSIONS: POI following dentoalveolar surgery represents a significant clinical and economic burden, particularly in cases involving antibiotic-resistant organisms. The findings underscore the need for improved antibiotic stewardship, enhanced preventive strategies and definitive early management to optimize patient outcomes and reduce healthcare costs.

PMID:41178649 | DOI:10.1111/adj.70014

Behav Brain Sci. 2025 Nov 3;48:e84. doi: 10.1017/S0140525X25100629.

ABSTRACT

Social cognition (SC) constitutes a predominant aspect of complex cognition (CC) especially in non-human animals. Apart from bees, ants and birds, fish, particularly the teleost group, are considered as an emerging model organism to study vertebrate SC. The commentary deals with some of the CC traits of SC across different families of teleost fish that have been experimentally reported.

PMID:41178625 | DOI:10.1017/S0140525X25100629

Emerg Med Australas. 2025 Dec;37(6):e70166. doi: 10.1111/1742-6723.70166.

ABSTRACT

OBJECTIVE: Paracetamol is commonly taken in overdose. Australian and New Zealand guidelines include specific recommendations on transferring patients with paracetamol poisoning, supporting local treatment of ingestions < 30 g in rural facilities, limiting need for transfer. We aim to investigate paracetamol overdose presentations attended by aeromedical retrieval services and the appropriateness of transfer.

METHODS: This is a retrospective observational series of paracetamol overdose retrievals in Queensland, performed by LifeFlight Retrieval Medicine, Retrieval Services Queensland, and Royal Flying Doctors Service from January 2017 to December 2023. Cases were identified through each services’ databases. Data extracted included details of ingestion, investigations, management, and the reason for patient transfer.

RESULTS: There were 272 cases retrieved during the study period. Retrieval data were available for 174, for inclusion. Paracetamol was taken in isolation in 65 (37%) cases. The median ingestion was 15.0 g (IQR: 10.0-25.0 g). An overdose of ≤ 30 g of paracetamol was taken in 100 (57%) presentations. The most commonly assigned primary reason for transfer was lack of pathology services (87, 50%); insufficient stocks of acetylcysteine occurred in 13 (8%) cases. Over the seven-year period, there were 60 (35%) potentially avoidable transfers, according to the ANZ guideline. Of these, 52 (30%) were retrieved due to unavailable pathology services and eight (5%) for insufficient acetylcysteine.

CONCLUSION: Increased availability of acetylcysteine in rural facilities paired with better alignment of treatment with ANZ toxicology guidelines may reduce the rate of transfer for paracetamol overdoses in Queensland.

PMID:41178618 | DOI:10.1111/1742-6723.70166

Emerg Med Australas. 2025 Dec;37(6):e70165. doi: 10.1111/1742-6723.70165.

ABSTRACT

OBJECTIVES: To examine variation in practice and adherence to international clinical guidelines for the management of fever among Australian Emergency Department (ED) clinicians.

METHODS: Cross-sectional survey across 22 Australian EDs. Clinical vignettes were used to determine compliance with international best practice guidelines (use of antipyretic monotherapy to alleviate fever-associated child distress) for paediatric fever treatment. Comparisons were made between specialist paediatric EDs and general (non-specialist paediatric) EDs, and between medical and nursing staff.

RESULTS: Of 539 survey respondents (300 doctors, 239 nurses; overall response rate 65.9%), only 9.3% (50/539, 95% confidence interval [CI] 7.1%-12.0%) adhered to evidence-based practice guidelines. Specialist paediatric ED clinicians demonstrated less than half the adherence of those from general EDs (5.4% [11/204] vs. 12.4% [38/307], difference -7.0%, 95% CI -11.7% to -1.9%). In a febrile settled child with normal hydration, the proportion of respondents who opted for antipyretics more than doubled in the context of elevated vital signs (40.4% [218/539] vs. 83.1% [44/539], difference -42.7%, 95% CI -46.8% to -38.2%). Nearly half of respondents (239/539, 46.8%, 95% CI 42.4%-51.2%) endorsed giving combined antipyretic therapy. In a febrile settled child, most participants would give antipyretics for temperature reduction (453/539, 84.0%, 95% CI 80.7%-86.9%) and for decreased fluid intake (468/539, 87.5%, 95% CI 84.4%-90.0%). Over one-third (192/539, 36.0%, 95% CI 32.1%-40.2%) recommended using antipyretics for febrile convulsion prevention during the current illness.

CONCLUSIONS: Fewer than 10% of Australian ED clinicians self-report practice consistent with international consensus recommendations for paediatric fever management.

PMID:41178609 | DOI:10.1111/1742-6723.70165

Aust Endod J. 2025 Nov 3. doi: 10.1111/aej.70028. Online ahead of print.

ABSTRACT

This study evaluated four file systems (WaveOne Gold, Reciproc Blue, ProTaper Next and TruNatomy) for their shaping efficacy in oval-shaped maxillary premolar root canals using micro-CT. Twenty-four extracted premolars, each with two roots, were randomly divided into four groups (n = 6 teeth/group) and instrumented following manufacturer guidelines. Pre- and post-instrumentation micro-CT scans were performed. Key parameters analysed included unprepared canal surface area (% Un-PrepCA), changes in canal area and volume (ΔCA, ΔCV and their percentages), canal transportation and centring ability. Statistical significance was set at p < 0.05. While no significant differences were found in transportation, centring ability or most 3D parameters (ΔCA, ΔCV and ΔSMI), the TRN group exhibited a significantly higher % Un-PrepCA. Conversely, the WOG group achieved a significantly greater % ΔCA compared to TRN and PTN. All systems performed comparably without procedural errors; TRN resulted in the least canal wall contact, while WOG provided the largest prepared canal area.

PMID:41178603 | DOI:10.1111/aej.70028